[Considerations of the placebo problem in acupuncture. Reflections on usefulness, ethical justification,...

28 different acupuncture placebos were found in 28 controlled studies, making a comparison of the results impossible. The following differentiation of acupuncture placebos is proposed: 1.a) Real placebos without intrinsic effect, 1.b) Pseudoplacebos with intrinsic effect, 2.a) Placebos without damage of physical integrity (not incisive), 2.b) Placebos with damage of physical integrity (incisive), for example the usual method of placebo-acupuncture-needling outside the known acupuncture points with or without additional stimulation. Painful pseudoplacebos with damage of the physical integrity should only be used in short-term trials on experimentally induced pain in healthy volunteers. For therapeutic studies with really sick persons, only real placebos, painless and without damage of the physical integrity, should be used, e.g. mock-TENS or laser. In order to prevent the patient from knowing the group determination, a third group with another correct treatment is essential, e.g. correct acupuncture, mock-TENS and real TENS or laser. A genuine acupuncture placebo is as unthinkable as placebo-surgery. Since single- or double-blind trials cannot be correctly carried out in acupuncture therapy it appears desirable to replace them by follow-up studies.