Research: DINCER and LINDE,

Listed in Issue 104

Abstract

DINCER and LINDE, Department of Clinical Medicine II, Centre for Complementary Medicine Research, Technische Universitaet Muenchen, Munich, Germany, have reviewed (67 references) sham interventions in randomized clinical trial of acupuncture.

Background

It is notoriously difficult to find placebo or sham interventions for acupuncture that are both inert (i.e. not a treatment in themselves) and indistinguishable for the recipient. The authors have reviewed placebo-controlled trials of acupuncture in order to establish which types of sham acupuncture have been used in the past, in what respects true and sham acupuncture differed, and whether trials using different types of sham acupuncture yielded different results.

Methodology

47 randomized controlled trials comparing true and sham acupuncture for pain and a variety of other conditions were identified from systematic reviews and a search of PubMed. Details of patients, interventions, and outcomes were extracted.

Results

Sham techniques used in the literature include superficial needling of true acupuncture points (2 trials), needling of acupuncture points not indicated for the condition (4 trials), needling outside acupuncture points (27 trials), use of placebo needles (5 trials), and pseudo-interventions such as switched-off laser acupuncture devices (9 trials). True and sham acupuncture often differed in a variety of other ways such as depth of insertion, manipulation of needles, achievement of an irritating needle sensation (de-chi), etc. No clear association was found between the type of sham acupuncture used and the results of trials.

Conclusion

A great many different control treatments have been used as sham acupuncture in randomized controlled trials. It seems misleading and scientifically unacceptable to describe them all as placebo controls.

References

Dincer F, Linde K. Sham interventions in randomized clinical trials of acupuncture – a review. Complementary Therapies in Medicine 11 (4): 235-242, Dec 2003.

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