Are acupoints specific for diseases? A systematic review of the randomized controlled trials with sham acupuncture controls

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Abstract

Background

The results of many clinical trials and experimental studies regarding acupoint specificity are contradictory. This review aims to investigate whether a difference in efficacy exists between ordinary acupuncture on specific acupoints and sham acupuncture controls on non-acupoints or on irrelevant acupoints.

Methods

Databases including Medline, Embase, AMED and Chinese Biomedical Database were searched to identify randomized controlled trials published between 1998 and 2009 that compared traditional body acupuncture on acupoints with sham acupuncture controls on irrelevant acupoints or non-acupoints with the same needling depth. The Cochrane Collaboration's tool for assessing risk of bias was employed to address the quality of the included trials.

Results

Twelve acupuncture clinical trials with sham acupuncture controls were identified and included in the review. The conditions treated varied. Half of the included trials had positive results on the primary outcomes and demonstrated acupoint specificity. However, among those six trials (total sample size: 985) with low risk of bias, five trials (sample size: 940) showed no statistically significant difference between proper and sham acupuncture treatments.

Conclusion

This review did not demonstrate the existence of acupoint specificity. Further clinical trials with larger sample sizes, optimal acupuncture treatment protocols and appropriate sham acupuncture controls are required to resolve this important issue.

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Most cited references 31

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Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.

K Schulz, I. Chalmers, R Hayes … (1995)

To determine if inadequate approaches to randomized controlled trial design and execution are associated with evidence of bias in estimating treatment effects. An observational study in which we assessed the methodological quality of 250 controlled trials from 33 meta-analyses and then analyzed, using multiple logistic regression models, the associations between those assessments and estimated treatment effects. Meta-analyses from the Cochrane Pregnancy and Childbirth Database. The associations between estimates of treatment effects and inadequate allocation concealment, exclusions after randomization, and lack of double-blinding. Compared with trials in which authors reported adequately concealed treatment allocation, trials in which concealment was either inadequate or unclear (did not report or incompletely reported a concealment approach) yielded larger estimates of treatment effects (P < .001). Odds ratios were exaggerated by 41% for inadequately concealed trials and by 30% for unclearly concealed trials (adjusted for other aspects of quality). Trials in which participants had been excluded after randomization did not yield larger estimates of effects, but that lack of association may be due to incomplete reporting. Trials that were not double-blind also yielded larger estimates of effects (P = .01), with odds ratios being exaggerated by 17%. This study provides empirical evidence that inadequate methodological approaches in controlled trials, particularly those representing poor allocation concealment, are associated with bias. Readers of trial reports should be wary of these pitfalls, and investigators must improve their design, execution, and reporting of trials.

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Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials.

Howard H Moffet (2009)

This study sought to determine whether sham acupuncture is as efficacious as true acupuncture, as defined by traditional acupuncture theories. A systematic review was conducted of clinical trials that used sham acupuncture controls with needle insertion at wrong points (points not indicated for the condition) or non-points (locations that are not known acupuncture points). This study used a convenience sample of 229 articles resulting from a PubMed search using the keyword "acupuncture" and limited to "clinical trials" published in English in 2005 or 2006. Studies were categorized by use of wrong points versus non-points and the use of normal insertion and stimulation versus superficial insertion or minimal stimulation. Thirty-eight acupuncture trials were identified. Most studies (22/38 = 58%) found no statistically significant difference in outcomes, and most of these (13/22 = 59%) found that sham acupuncture may be as efficacious as true acupuncture, especially when superficial needling was applied to non-points. The findings cast doubt on the validity of traditional acupuncture theories about point locations and indications. Scientific rationales for acupuncture trials are needed to define valid controls, and the theoretical basis for traditional acupuncture practice needs to be re-evaluated.

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Is Open Access

Minimal acupuncture is not a valid placebo control in randomised controlled trials of acupuncture: a physiologist's perspective

Irene Lund, Jan Näslund, Thomas Lundeberg (2009)

Placebo-control of acupuncture is used to evaluate and distinguish between the specific effects and the non-specific ones. During 'true' acupuncture treatment in general, the needles are inserted into acupoints and stimulated until deqi is evoked. In contrast, during placebo acupuncture, the needles are inserted into non-acupoints and/or superficially (so-called minimal acupuncture). A sham acupuncture needle with a blunt tip may be used in placebo acupuncture. Both minimal acupuncture and the placebo acupuncture with the sham acupuncture needle touching the skin would evoke activity in cutaneous afferent nerves. This afferent nerve activity has pronounced effects on the functional connectivity in the brain resulting in a 'limbic touch response'. Clinical studies showed that both acupuncture and minimal acupuncture procedures induced significant alleviation of migraine and that both procedures were equally effective. In other conditions such as low back pain and knee osteoarthritis, acupuncture was found to be more potent than minimal acupuncture and conventional non-acupuncture treatment. It is probable that the responses to 'true' acupuncture and minimal acupuncture are dependent on the aetiology of the pain. Furthermore, patients and healthy individuals may have different responses. In this paper, we argue that minimal acupuncture is not valid as an inert placebo-control despite its conceptual brilliance.

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Author and article information

Journal

Journal ID (nlm-ta): Chin Med

Title: Chinese Medicine

Publisher: BioMed Central

ISSN (Electronic): 1749-8546

Publication date Collection: 2010

Publication date (Electronic): 12 January 2010

Volume: 5

Page: 1

Affiliations

[1 ]School of Chinese Medicine, Faculty of Science, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

[2 ]School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China

Article

Publisher ID: 1749-8546-5-1

DOI: 10.1186/1749-8546-5-1

PMC ID: 2818640

PubMed ID: 20145733

SO-VID: 04c56b8c-6bf0-448e-95e9-82915a414e98

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Are acupoints specific for diseases? A systematic review of the randomized controlled trials with sham acupuncture controls

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Abstract

Background

Methods

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Conclusion

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Most cited references 31

Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.

Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials.

Minimal acupuncture is not a valid placebo control in randomised controlled trials of acupuncture: a physiologist's perspective

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