How large are the non-specific effects of acupuncture?

Acupuncture is a common therapeutic intervention for a range of illnesses from migraines to infertility. However, while it is a popular form of therapy, it has been difficult to know whether or not acupuncture actually works, due to the variety of indications it is used for, but also the nature of research trials thus far. This is because separating the effects of ‘true’ acupuncture versus the effects of ‘sham’ acupuncture used in control experiments is complicated. True acupuncture involves needles being inserted into the skin and then manipulated at defined parts of the body. Sham acupuncture differs because either the needle is not inserted into the skin, or the needle is inserted but not at a defined place. In all cases, there is a mild, painful stimulus. Past studies have indicated that there are moderate effects of sham acupuncture, although the causes of which is controversial.

In a meta-analysis published in BMC Medicine this week, Linde and colleagues attempt to uncover the significance of sham acupuncture. To do this, they used data for over 5000 patients from previous trials that compared patients who had undergone true acupuncture, sham acupuncture and no acupuncture. Their findings have important implications for design of future clinical trials and for the interpretation of results.

Currently, the National Institute for Health and Clinical Excellence (NICE) recommends acupuncture as a treatment option limited to lower back pain. If clinical studies can be standardised to make the benefits, if any, of acupuncture clearer, then acupuncture may become available as an NHS complementary treatment for a wider range of illnesses.

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