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Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture
Peter White1, Felicity L Bishop, Phil Prescott
1Faculty of Health Sciences, University of Southampton, Highfield, Southampton, UK School of Medicine, Primary Medical Care, Aldermoor Health Centre, University of Southampton, Southampton, UK School of Mathematics, University of Southampton, Highfield, Southampton, UK.
Acupuncture showed no specific pain relief for osteoarthritis compared to placebo. Patient beliefs and practitioner characteristics significantly influenced outcomes, suggesting nonspecific effects are key in pain management.
Area of Science:
- Pain Management
- Osteoarthritis Research
- Complementary and Alternative Medicine
Background:
- Nonspecific effects of acupuncture are recognized but not fully quantified in osteoarthritic (OA) pain.
- Understanding factors like needling, consultation, and practitioner influence is crucial for OA pain management.
Purpose of the Study:
- To quantify nonspecific factors (needling, consultation, practitioner) in osteoarthritic pain relief.
- To compare the efficacy of real acupuncture against placebo acupuncture and mock electrical stimulation.
- To explore the impact of empathic versus nonempathic consultations on pain outcomes.
Main Methods:
- Prospective, randomized, single-blind, placebo-controlled, multifactorial, mixed-methods trial.
- 221 patients with OA awaiting joint replacement received eight 30-minute treatments over 4 weeks.
- Interventions included acupuncture, Streitberger placebo acupuncture, mock electrical stimulation, with empathic/nonempathic consultations. Pain (VAS) was the primary outcome.
Main Results:
- All interventions showed improvement from baseline, with no significant differences between real acupuncture and placebos (P=.40) or mock stimulation (P=.25).
- Empathic consultations did not significantly affect pain relief (P=.26).
- Practitioner 3 achieved greater analgesia than practitioner 2 (P=.002), and patient beliefs influenced outcomes.
Conclusions:
- Acupuncture demonstrated no specific efficacy over placebo for osteoarthritic pain.
- Individual practitioner characteristics and patient beliefs significantly impacted treatment outcomes.
- Placebo interventions were as effective and credible as acupuncture, highlighting the role of nonspecific effects.
