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Needling Point Location Used in Sham Acupuncture for Chronic Nonspecific Low Back Pain: A Systematic Review and
Boram Lee1, Chan-Young Kwon2, Hye Won Lee3
1KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.
JAMA Network Open
|September 6, 2023
Summary
Sham acupuncture using the same points as actual acupuncture (SATV) is not a true placebo for chronic low back pain (CLBP) and may underestimate treatment effects. Different point sham acupuncture (SATS) showed acupuncture was more effective.
Area of Science:
- Integrative medicine
- Clinical trial methodology
- Pain management
Background:
- Sham acupuncture controls are used to evaluate acupuncture efficacy, but sham needling techniques often differ from true acupuncture.
- The placement of sham acupuncture points (same vs. different from verum acupuncture) may influence study outcomes.
Approach:
- A systematic literature search identified randomized clinical trials (RCTs) comparing acupuncture to sham acupuncture or waiting lists for chronic nonspecific low back pain (CLBP).
- Network meta-analysis (NMA) compared outcomes between acupuncture, sham acupuncture therapy (verum) (SATV), and sham acupuncture therapy (sham) (SATS).
- Pain and back-specific function were assessed using standardized mean differences (SMD) with 95% confidence intervals (CIs).
Key Points:
- Acupuncture showed significant improvements in pain and function compared to SATS, but not SATV.
- SATV was associated with better pain and function outcomes than SATS.
- The risk of bias was generally low, with moderate to low certainty of evidence.
Conclusions:
- Sham acupuncture at the same points (SATV) is not an appropriate placebo control for evaluating acupuncture efficacy in CLBP.
- Using SATV may lead to an underestimation of acupuncture's true clinical benefits.
- Methodological considerations in sham control selection are crucial for accurate acupuncture research.
