German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. A controlled trial on acupuncture for chronic neck pain. A pilot study of acupuncture as adjunctive treatment of rheumatoid arthritis A Blinded Randomised Trial of Acupuncture (Manual and Electroacupuncture) Compared with a Non-Penetrating Sham for the Symptoms of Osteoarthritis of the Knee Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee Myofascial trigger point needling for whiplash associated pain--a feasibility study. Acupuncture in patients with osteoarthritis of the knee: a randomised trial Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) – A pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment The prevalence and characteristics of fibromyalgia in the general population. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle. The efficacy of dry needling and procaine in the treatment of myofascial pain in the jaw muscles. Acupuncture treatment of chronic low-back pain – a randomized, blinded, placebo-controlled trial with 9-month follow-up A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Acupuncture in the treatment of rheumatoid arthritis: a double-blind controlled pilot study Acupuncturists' perspectives on outcome measures to evaluate acupuncture care for chronic low back pain. Survey of Adverse Events following Acupuncture (Safa): A Prospective Study of 32,000 Consultations Acupuncture for chronic shoulder pain in persons with spinal cord injury: a small-scale clinical trial. Preference, expectation, and satisfaction in a clinical trial of behavioral interventions for acute and sub-acute low back pain. Functional MRI in healthy subjects during acupuncture: different effects of needle rotation in real and false acupoints Acupuncture for Acute Non-Specific Low Back Pain: A Randomised, Controlled, Double-Blind, Placebo Trial Acupuncture for the treatment of pain of osteoarthritic knees. Efficacy of acupuncture on osteoarthritic pain. A controlled, double-blind study. Acupuncture for acute non-specific low back pain: a pilot randomised non-penetrating sham controlled trial. Efficacy of acupunture in patients with chronic neck pain--a randomised, sham controlled trial. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial Effect of acupuncture treatment on chronic neck and shoulder pain in sedentary female workers: a 6-month and 3-year follow-up study Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: a double-blind, randomized, placebo controlled study. A Randomized Clinical Trial of Acupuncture Compared with Sham Acupuncture in Fibromyalgia Effects of Trigger Point Acupuncture on Chronic Low Back Pain in Elderly Patients – a Sham-Controlled Randomised Trial Non-penetrating sham needle, is it an adequate sham control in acupuncture research? Acupuncture as an adjunctive therapy to pharmacological treatment in patients with chronic pain due to osteoarthritis of the knee: A 3-armed, randomized, placebo-controlled trial Remote Effects of Dry Needling on the Irritability of the Myofascial Trigger Point in the Upper Trapezius Muscle The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain Relief of Low Back Pain Immediately after Acupuncture Treatment – a Randomised, Placebo Controlled Trial Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. Are Sham Acupuncture Interventions More Effective than (Other) Placebos? A Re-Analysis of Data from the Cochrane Review on Placebo Effects Acupuncture in patients with acute low back pain: A multicentre randomised controlled clinical trial The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists Relief of chronic neck and shoulder pain by manual acupuncture to tender points--a sham-controlled randomized trial. Trigger Point Acupuncture for Treatment of Knee Osteoarthritis – a Preliminary Rct for a Pragmatic Trial Applicability of Press Needles to a Double-blind Trial: A Randomized, Double-blind, Placebo-controlled Trial [Transient therapeutic effect and safety of superficial needling therapy for treatment of periarthritis of shoulder]. Efficacy of acupuncture as a treatment for chronic shoulder pain. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Introducing a placebo needle into acupuncture research Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Experiences of acupuncturists in a placebo-controlled, randomized clinical trial. Analysis on the effect of acupuncture in treating cervical spondylosis with different syndrome types A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient‐provider communication Paraspinal Stimulation Combined With Trigger Point Needling and Needle Rotation for the Treatment of Myofascial Pain: A Randomized Sham-controlled Clinical Trial The effects of collateral meridian therapy for knee osteoarthritis pain management: a pilot study. Randomized clinical trial of acupuncture for myofascial pain of the jaw muscles. Acupuncture in chronic epicondylitis: a randomized controlled trial. The analgesic effect of acupuncture in chronic tennis elbow pain. [Treatment of knee joint pain with superficial needling]. The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome: a single-blind randomized controlled trial. Acupuncture treatment of chronic back pain. A double-blind placebo-controlled trial. The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial. Assessment of a traditional acupuncture therapy for chronic neck pain: a pilot randomised controlled study. Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. Acupuncture for Treatment of Persistent Arm Pain Due to Repetitive Use: A Randomized Controlled Clinical Trial Immediate effects of acupuncture on gait patterns in patients with knee osteoarthritis. Non-specific effects of traditional Chinese acupuncture in osteoarthritis of the hip. The short-term effects of acupuncture on myofascial pain patients after clenching. Does acupuncture improve the orthopedic management of chronic low back pain – a randomized, blinded, controlled trial with 3 months follow up
BACKGROUND To our knowledge , verum acupuncture has never been directly compared with sham acupuncture and guideline -based conventional therapy in patients with chronic low back pain . METHODS A patient- and observer-blinded r and omized controlled trial conducted in Germany involving 340 outpatient practice s , including 1162 patients aged 18 to 86 years ( mean + /- SD age , 50 + /- 15 years ) with a history of chronic low back pain for a mean of 8 years . Patients underwent ten 30-minute sessions , generally 2 sessions per week , of verum acupuncture ( n = 387 ) according to principles of traditional Chinese medicine ; sham acupuncture ( n = 387 ) consisting of superficial needling at nonacupuncture points ; or conventional therapy , a combination of drugs , physical therapy , and exercise ( n = 388 ) . Five additional sessions were offered to patients who had a partial response to treatment ( 10%-50 % reduction in pain intensity ) . Primary outcome was response after 6 months , defined as 33 % improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale question naire or 12 % improvement or better on the back-specific Hanover Functional Ability Question naire . Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement . RESULTS At 6 months , response rate was 47.6 % in the verum acupuncture group , 44.2 % in the sham acupuncture group , and 27.4 % in the conventional therapy group . Differences among groups were as follows : verum vs sham , 3.4 % ( 95 % confidence interval , -3.7 % to 10.3 % ; P = .39 ) ; verum vs conventional therapy , 20.2 % ( 95 % confidence interval , 13.4 % to 26.7 % ; P < .001 ) ; and sham vs conventional therapy , 16.8 % ( 95 % confidence interval , 10.1 % to 23.4 % ; P < .001 . CONCLUSIONS Low back pain improved after acupuncture treatment for at least 6 months . Effectiveness of acupuncture , either verum or sham , was almost twice that of conventional therapy To evaluate the efficacy of Chinese medicine ( CM ) acupuncture for  chronic neck pain ( CNP ) , a single blind , controlled , crossover , clinical trial was undertaken . Twenty-nine volunteers with CNP were r and omly recruited into two groups . Both groups received two phases of treatment with a washout period between the two phases . Group A ( 14 volunteers ) received CM acupuncture in the first phase and sham acupuncture in the second , while Group B ( 15 volunteers ) received sham in the first and real in the second . CM acupuncture was individualized and consisted of nine sessions on both local and distal points . Manual twisting of the needle was applied on all points plus strong electrical stimulation of distal points in CM acupuncture . Sham acupoints ( lateral to the real ) and sham ( weak ) electrical stimulation was used in the control group . Comparison of subjective and objective measures between the two groups was made at different periods , including baseline , after each phase of treatment , after washout , and after the 16th week follow-up . The subjective measures included pain intensity , duration per day , analgesic medication count , visual analogue scales ( VAS ) and neck disability index ( NDI ) . The objective measures consisted of neck range of motion ( ROM ) and pain threshold ( PT ) . Both the real and sham treatments significantly reduced subjective pain , without significant differences between groups for most subjective measures . Objective measures showed no significant change for either group before and after each period or by inter-groups analysis . A minimum 16-week effect of both real and sham acupuncture was found for subjective measures in the follow-up periods . Further study is recommended with an increased sample size , a longer washout period , and a longer baseline period We evaluated the efficacy of acupuncture as a useful adjuvant treatment in the management of rheumatoid arthritis ( RA ) . A pilot , r and omized , double-blind , and controlled clinical trial was conducted . Forty RA patients with active disease despite stable therapy for at least the preceding 1 month were r and omized to receive a st and ard protocol of acupuncture ( AC ) or superficial acupuncture at non-acupuncture points ( controlAC ) for 9 weeks . The primary outcome was achievement of 20 % improvement according to the American College of Rheumatology ( ACR ) 20 criteria after five and ten treatment sessions and after 1 month of follow-up . Secondary measures included Disease Assessment Scale ( DAS ) , tender and swollen joint count , morning stiffness , Health Assessment Question naire ( HAQ ) , visual analogue scale ( VAS ) of pain , physician global assessment of activity disease , physician and patient global assessment of treatment , and inflammatory markers ( erythrocyte sedimentation rate and C-reactive protein ) . There was not significant difference between the groups regarding the number of patients that reached ACR20 at the end of the treatment ( p = 0.479 ) . However , after 1 month of follow-up , there was a trend in favor of the AC group , with p = 0,068 . Compared with the controlAC , the AC group also demonstrated significant improvement in the patient and physician global assessment of treatment and physician global assessment of disease activity , but there was no difference on other clinical and laboratorial measures . On the other h and , only the AC patients had within group improvement on the variables DAS , HAQ , morning stiffness , patient and physician global assessment of treatment , and physician global assessment of disease activity in comparison to baseline visit . Despite the improvement of some studied variables , there was no significant difference in the proportion of patients that reached ACR20 between the AC and controlAC groups . This negative result can be related to the small sample size , selection of patients , type of acupuncture protocol applied , and difficulties in establishing an innocuous and trustworthy placebo group to studies involving acupuncture Objectives To compare the effect of acupuncture ( manual and electroacupuncture ) with that of a non-penetrating sham ( ‘ placebo ’ needle ) in patients with osteoarthritic knee pain and disability who are blind to the treatment allocation . Methods Acupuncture naive patients with symptomatic and radiological evidence of osteoarthritis of the knee were r and omly allocated to a course of either acupuncture or non-penetrating sham acupuncture using a sheathed ‘ placebo ’ needle system . Acupuncture points for pain and stiffness were selected according to acupuncture theory for treating Bi syndrome . Both manual and electrical stimulation were used . Response was assessed using the WOMAC index for osteoarthritis of the knee , self reported pain scale , the EuroQol score and plasma β-endorphin . The effectiveness of blinding was assessed . Results There were 34 patients in each group . The primary end point was the change in WOMAC pain score after the course of treatment . Comparison between the two treatment groups found a significantly greater improvement with acupuncture ( mean difference 60 , 95 % CI 5 to 116 , P=0.035 ) than with sham . Within the acupuncture group there was a significant improvement in pain ( baseline 294 , mean change 95 , 95 % CI 60 to 130 , P<0.001 ) which was not seen by those who had sham acupuncture ( baseline 261 , mean change 35 , 95 % CI-10 to 80 , P=0.12 ) . Similar effects within group , but not between groups , were seen with the secondary end points of WOMAC stiffness , WOMAC function , and self reported pain . One month after treatment the between group pain difference had been lost ( mean difference 46 ; 95 % CI −9 to 100 , P=0.10 ) although the acupuncture group was still benefiting compared to baseline ( mean difference 59 ; 95 % CI 16 to 102 , P=0.009 ) . The EuroQol score , a generic measure of health related quality of life , was not altered by the treatments . A minority of patients correctly guessed their treatment group ( 41 % in the acupuncture group and 44 % in the control group ) . Plasma β-endorphin levels were not affected by either treatment . Conclusions Acupuncture gives symptomatic improvement for patients with osteoarthritis of the knee , and is significantly superior to non-penetrating sham acupuncture . The study did not confirm earlier reports of release of plasma β-endorphin during acupuncture ABSTRACT Neurobiological mechanisms invoking the release of endogenous opioids and depression of stress hormone release are believed to be the basis of acupuncture analgesia . This study compared plasma β‐endorphin and cortisol levels with self assessment scores of intensity of pain , before and after 10 days of electro‐acupuncture treatment in patients suffering from chronic pain as a result of osteoarthritis knees . Forty patients of either sex over 40 years with primary osteoarthritis knee were recruited into a single‐blinded , sham‐controlled study . For electro‐acupuncture group the points were selected according to the Traditional Chinese Medicine Meridian Theory . In the sham group needles were inserted at r and om points away from true acupoints and no current was passed . Both groups were treated for 10 days with one session every day lasting for 20–25 min . Pre‐ and post‐treatment Western Ontario and McMaster Universities ( WOMAC ) index of osteoarthritis knee and Visual Analogue Scale ( VAS ) for pain were recorded and blood sample s were taken for the measurement of plasma cortisol and β‐endorphin levels . Following electro‐acupuncture treatment there was a significant improvement in WOMAC index and VAS ( p = 0.001 ) , a significant rise in plasma β‐endorphin ( p = 0.001 ) , and a significant fall in plasma cortisol ( p = 0.016 ) . In conclusion electro‐acupuncture result ed in an improvement in pain , stiffness and disability . Of clinical importance is that an improvement in objective measures of pain and stress/pain associated biomarkers was shown above that of a sham treatment ; hence demonstrating acupuncture associated physiological changes beyond that of the placebo effects Clinicians cl aim that myofascial trigger points ( MTrPs ) are a primary cause of pain in whiplash injured patients . Pain from MTrPs is often treated by needling , with or without injection . We conducted a placebo controlled study to test the feasibility of a phase III r and omised controlled trial investigating the efficacy of MTrP needling in patients with whiplash associated pain . Forty-one patients referred for physiotherapy with a recent whiplash injury , were recruited . Patients were r and omised to receive st and ardised physiotherapy plus either acupuncture or a sham needle control . A trial was judged feasible if : i ) the majority of eligible patients were willing to participate ; ii ) the majority of patients had MTrPs ; iii ) at least 75 % of patients provided completed self- assessment data ; iv ) no serious adverse events were reported and v ) the end of treatment attrition rate was less than 20 % . 70 % of those patients eligible to participate volunteered to do so ; all participants had clinical ly identified MTrPs ; a 100 % completion rate was achieved for recorded self- assessment data ; no serious adverse events were reported as a result of either intervention ; and the end of treatment attrition rate was 17 % . A phase III study is both feasible and clinical ly relevant . This study is currently being planned BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee . METHODS Patients with chronic osteoarthritis of the knee ( Kellgren grade < or = 2 ) were r and omly assigned to acupuncture ( n=150 ) , minimal acupuncture ( superficial needling at non-acupuncture points ; n=76 ) , or a waiting list control ( n=74 ) . Specialised physicians , in 28 outpatient centres , administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks . Patients completed st and ard question naires at baseline and after 8 weeks , 26 weeks , and 52 weeks . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index at the end of week 8 ( adjusted for baseline score ) . All main analyses were by intention to treat . RESULTS 294 patients were enrolled from March 6 , 2002 , to January 17 , 2003 ; eight patients were lost to follow-up after r and omisation , but were included in the final analysis . The mean baseline-adjusted WOMAC index at week 8 was 26.9 ( SE 1.4 ) in the acupuncture group , 35.8 ( 1.9 ) in the minimal acupuncture group , and 49.6 ( 2.0 ) in the waiting list group ( treatment difference acupuncture vs minimal acupuncture -8.8 , [ 95 % CI -13.5 to -4.2 ] , p=0.0002 ; acupuncture vs waiting list -22.7 [ -27.5 to -17.9 ] , p<0.0001 ) . After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant ( p=0.08 ) . INTERPRETATION After 8 weeks of treatment , pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee . However , this benefit decreases over time OBJECTIVE This article examines the specific and nonspecific effects of Japanese  acupuncture on chronic myofascial neck pain in a r and omized single-blind trial . DESIGN Forty-six patients were r and omly assigned to receive relevant acupuncture , irrelevant acupuncture , or no-acupuncture control treatment consisting of nonsteroidal anti-inflammatory medication . The two acupuncture groups underwent comparable light shallow needling . The irrelevant acupuncture group received acupuncture at specific sites not relevant for cervical pain . OUTCOME MEASURES The study measures included the McGill Pain Question naire-Short Form ( SF-MPQ ) , the Short-Form Health Survey ( SF-36 ) , the Symptom Checklist 90-Revised ( SCL-90-R ) , medication diary , and physiologic measures . The factors examined as predictors of outcome pain ratings were experience with , beliefs about , and knowledge of acupuncture before treatment ; perceived efficacy , credibility , and logic of acupuncture ; perceived competence of the acupuncturist ; and painfulness of acupuncture . RESULTS No differences were found among the three groups at baseline , except that the relevant acupuncture group reported having had more previous acupuncture treatments . No significant differences in terms of perceived credibility or perceived effectiveness of treatment were found between the two acupuncture groups . The relevant acupuncture group had significantly greater pre-/posttreatment differences in pain than the irrelevant acupuncture and control groups ( p < .05 ) . The nonspecific effects of confidence in the acupuncturist , willingness to try any treatment , mood , and physiologic effect of needling were not predictive of treatment outcome , whereas confidence in the treatment and past experiences with acupuncture did correlate significantly with a decrease in pain . CONCLUSIONS Relevant acupuncture with heat contributes to modest pain reduction in persons with myofascial neck pain . Previous experience with and confidence in treatment help to predict benefit . Measurement of nonspecific effects of alternative therapy is recommended in future clinical trials & NA ; The German R and omized Acupuncture Trial for chronic shoulder pain ( GRASP ) comprised 424 out patients with chronic shoulder pain ( CSP ) ≥6 weeks and an average pain score of VAS ≥50 mm , who were r and omly assigned to receive Chinese acupuncture ( verum ) , sham acupuncture ( sham ) or conventional conservative orthopaedic treatment ( COT ) . The patients were blinded to the type of acupuncture and treated by 31 office‐based orthopaedists trained in acupuncture ; all received 15 treatments over 6 weeks . The 50 % responder rate for pain was measured on a VAS 3 months after the end of treatment ( primary endpoint ) and directly after the end of the treatment ( secondary endpoint ) . Results : In the ITT ( n = 424 ) analysis , percentages of responders for the primary endpoint were verum 65 % ( 95 % CI 56–74 % ) ( n = 100 ) , sham 24 % ( 95 % CI 9–39 % ) ( n = 32 ) , and COT 37 % ( 95 % CI 24–50 % ) ( n = 50 ) ; secondary endpoint : verum 68 % ( 95 % CI 58–77 % ) ( n = 92 ) , sham 40 % ( 95 % CI 27–53 % ) ( n = 53 ) , and COT 28 % ( 95 % CI 14–42 % ) ( n = 38 ) . The results are significant for verum over sham and verum over COT ( p < 0.01 ) for both the primary and secondary endpoints . The PPP analysis of the primary ( n = 308 ) and secondary endpoints ( n = 360 ) yields similar responder results for verum over sham and verum over COT ( p < 0.01 ) . Descriptive statistics showed greater improvement of shoulder mobility ( abduction and arm‐above‐head test ) for the verum group versus the control group immediately after treatment and after 3 months . The trial indicates that Chinese acupuncture is an effective alternative to conventional orthopaedic treatment for CSP OBJECTIVE To determine the prevalence and characteristics of fibromyalgia in the general population . METHODS A r and om sample of 3,006 persons in Wichita , KS , were characterized according to the presence of no pain , non-widespread pain , and widespread pain . A sub sample of 391 persons , including 193 with widespread pain , were examined and interviewed in detail . RESULTS The prevalence of fibromyalgia was 2.0 % ( 95 % confidence interval [ 95 % CI ] 1.4 , 2.7 ) for both sexes , 3.4 % ( 95 % CI 2.3 , 4.6 ) for women , and 0.5 % ( 95 % CI 0.0 , 1.0 ) for men . The prevalence of the syndrome increased with age , with highest values attained between 60 and 79 years ( > 7.0 % in women ) . Demographic , psychological , dolorimetry , and symptom factors were associated with fibromyalgia . CONCLUSION Fibromyalgia is common in the population , and occurs often in older persons . Characteristic features of fibromyalgia -- pain threshold and symptoms -- are similar in community and clinic population s , but overall severity , pain , and functional disability are more severe in the clinic population BACKGROUND Acupuncture is widely used by patients with low back pain , although its effectiveness is unclear . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with chronic low back pain .  METHODS Patients were r and omized to treatment with acupuncture , minimal acupuncture ( superficial needling at nonacupuncture points ) , or a waiting list control . Acupuncture and minimal acupuncture were administered by specialized acupuncture physicians in 30 outpatient centers , and consisted of 12 sessions per patient over 8 weeks . Patients completed st and ardized question naires at baseline and at 8 , 26 , and 52 weeks after r and omization . The primary outcome variable was the change in low back pain intensity from baseline to the end of week 8 , as determined on a visual analog scale ( range , 0 - 100 mm ) . RESULTS A total of 298 patients ( 67.8 % female ; mean + /- SD age , 59 + /- 9 years ) were included . Between baseline and week 8 , pain intensity decreased by a mean + /- SD of 28.7 + /- 30.3 mm in the acupuncture group , 23.6 + /- 31.0 mm in the minimal acupuncture group , and 6.9 + /- 22.0 mm in the waiting list group . The difference for the acupuncture vs minimal acupuncture group was 5.1 mm ( 95 % confidence interval , -3.7 to 13.9 mm ; P = .26 ) , and the difference for the acupuncture vs waiting list group was 21.7 mm ( 95 % confidence interval , 13.9 - 30.0 mm ; P<.001 ) . Also , at 26 ( P=.96 ) and 52 ( P=.61 ) weeks , pain did not differ significantly between the acupuncture and the minimal acupuncture groups . CONCLUSION Acupuncture was more effective in improving pain than no acupuncture treatment in patients with chronic low back pain , whereas there were no significant differences between acupuncture and minimal acupuncture OBJECTIVE To test the hypothesis that acupuncture improves symptoms of fibromyalgia .  PATIENTS AND METHODS We conducted a prospect i ve , partially blinded , controlled , r and omized clinical trial of patients receiving true acupuncture  compared with a control group of patients who received simulated acupuncture . All patients met American College of Rheumatology criteria for fibromyalgia and had tried conservative symptomatic treatments other than acupuncture .  We measured symptoms with the Fibromyalgia Impact Question naire ( FIQ ) and the Multidimensional Pain Inventory at baseline , immediately after treatment , and at 1 month and 7 months after treatment . The trial was conducted from May 28 , 2002 , to August 18 , 2003 . RESULTS Fifty patients participated in the study : 25 in the acupuncture group and 25 in the control group .  Total fibromyalgia symptoms , as measured by the FIQ , were significantly improved in the acupuncture group compared with the control group during the study period ( P = .01 ) . The largest difference in mean FIQ total scores was observed at 1 month ( 42.2 vs 34.8 in the control and acupuncture groups , respectively ; P = .007 ) . Fatigue and anxiety were the most significantly improved symptoms during the follow-up period . However , activity and physical function levels did not change . Acupuncture was well tolerated , with minimal adverse effects . CONCLUSION This study paradigm allows for controlled and blinded clinical trials of acupuncture . We found that acupuncture significantly improved symptoms of fibromyalgia . Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety OBJECTIVE To investigate the remote effect of acupuncture on the pain intensity and the endplate noise ( EPN ) recorded from a myofascial trigger point ( MTrP ) of the upper trapezius muscle . DESIGN R and omized controlled trial . SETTING University hospital . PARTICIPANTS Patients ( N=20 ) with active MTrPs in upper trapezius muscles and no experience in acupuncture therapy .  INTERVENTIONS Patients were divided into 2 groups . Those in the control group received sham acupuncture , and those in the acupuncture group received modified acupuncture therapy with needle insertion into multiple loci to elicit local twitch responses . The acupuncture points of Wai-guan and Qu-chi were treated . MAIN OUTCOME MEASURES Subjective pain intensity ( numerical pain rating scale ) and mean EPN amplitude in the MTrP of the upper trapezius muscle . RESULTS The pain intensity in the MTrP was significantly reduced after remote acupuncture ( from 7.4+/-0.8 to 3.3+/-1.1 ; P<.001 ) , but not after sham acupuncture ( from 7.4+/-0.8 to 7.1+/-0.9 ; P>.05 ) . The mean EPN amplitude was significantly lower than the pretreatment level after acupuncture treatment ( from 21.3+/-9.5 microV to 9.5+/-3.5 microV ; P<.01 ) , but not after sham acupuncture treatment ( from 19.6+/-7.6 microV to 19.3+/-7.8 microV ; P>.05 ) . The change in the pain intensity was significantly correlated with the change of EPN amplitude ( r=0.685 ) . CONCLUSIONS Both subjective changes in the pain intensity and objective changes of the EPN amplitude in the MTrP region of the upper trapezius muscle were found during and after acupuncture treatment at the remote ipsilateral acupuncture points . This study may further clarify the physiological basis of the remote effectiveness of acupuncture therapy for pain control In patients with myofascial pain , painful trigger points are often treated using dry needling and local anesthetic injections . However , the therapeutic effect of these treatments has been poorly quantified , and the mechanism underlying the effect is poorly understood . In a r and omized , double-blind , double-placebo clinical trial , a pressure algometer was used to measure pain-pressure thresholds in the masseter and temporalis muscles of 30 subjects aged 23 to 53 years with myofascial pain in the jaws , before and after a series of dry needling treatments , local anesthetic injections , and simulated dry needling and local anesthetic treatments ( treatment group A : Procaine + simulated dry needling ; treatment group B : dry needling + simulated local anesthetic ; control group C : simulated local anesthetic + simulated dry needling ) . Subjects rated pain intensity and unpleasantness using visual analogue scales , and the data were analyzed using analysis of variance . Pain pressure thresholds increased slightly after treatment , irrespective of the treatment modality . Pain intensity and unpleasantness scores decreased significantly at the end of treatment in all groups . There were no statistically significant between-group differences in pain pressure thresholds and visual analogue scale scores at the end of treatment . The findings suggest that the general improvement in pain symptoms was the result of nonspecific , placebo-related factors rather than a true treatment effect . Thus , the therapeutic value of dry needling and Procaine in the management of myofascial pain in the jaw muscles is question able & NA ; There is some evidence for the efficacy of acupuncture in chronic low‐back pain ( LBP ) , but it remains unclear whether acupuncture is superior to placebo . In a r and omized , blinded , placebo‐controlled trial , we evaluated the effect of traditional acupuncture in chronic LBP . A total of 131 consecutive out‐ patients of the Department of Orthopaedics , University Goettingen , Germany , ( age=48.1 years , 58.5 % female , duration of pain : 9.6 years ) with non‐radiating LBP for at least 6 months and a normal neurological examination were r and omized to one of three groups over 12 weeks . Each group received active physiotherapy over 12 weeks . The control group ( n=46 ) received no further treatment , the acupuncture group ( n=40 ) received 20 sessions of traditional acupuncture and the sham‐acupuncture group ( n=45 ) 20 sessions of minimal acupuncture . Changes from baseline to the end of treatment and to 9‐month follow‐up were assessed in pain intensity and in pain disability , and secondary in psychological distress and in spine flexion , compared by intervention groups . Acupuncture was superior to the control condition ( physiotherapy ) regarding pain intensity ( P=0.000 ) , pain disability ( P=0.000 ) , and psychological distress ( P=0.020 ) at the end of treatment . Compared to sham‐acupuncture , acupuncture reduced psychological distress ( P=0.040 ) only . At 9‐month follow‐up , the superiority of acupuncture compared to the control condition became less and acupuncture was not different to sham‐acupuncture . We found a significant improvement by traditional acupuncture in chronic LBP compared to routine care ( physiotherapy ) but not compared to sham‐acupuncture . The trial demonstrated a placebo effect of traditional acupuncture in chronic LBP BACKGROUND Acupuncture is a popular complementary and alternative treatment for chronic back pain . Recent European trials suggest similar short-term benefits from real and sham acupuncture needling . This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain . METHODS A total of 638 adults with chronic mechanical low back pain were r and omized to individualized acupuncture , st and ardized acupuncture , simulated acupuncture , or usual care . Ten treatments were provided over 7 weeks by experienced acupuncturists . The primary outcomes were back-related dysfunction ( Rol and -Morris Disability Question naire score ; range , 0 - 23 ) and symptom bothersomeness ( 0 - 10 scale ) . Outcomes were assessed at baseline and after 8 , 26 , and 52 weeks . RESULTS At 8 weeks , mean dysfunction scores for the individualized , st and ardized , and simulated acupuncture groups improved by 4.4 , 4.5 , and 4.4 points , respectively , compared with 2.1 points for those receiving usual care ( P < .001 ) . Participants receiving real or simulated acupuncture were more likely than those receiving usual care to experience clinical ly meaningful improvements on the dysfunction scale ( 60 % vs 39 % ; P < .001 ) . Symptoms improved by 1.6 to 1.9 points in the treatment groups compared with 0.7 points in the usual care group ( P < .001 ) . After 1 year , participants in the treatment groups were more likely than those receiving usual care to experience clinical ly meaningful improvements in dysfunction ( 59 % to 65 % vs 50 % , respectively ; P = .02 ) but not in symptoms ( P > .05 ) . CONCLUSIONS Although acupuncture was found effective for chronic low back pain , tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits . These findings raise questions about acupuncture 's purported mechanisms of action . It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects Background In planning a r and omized controlled trial of acupuncture , we conducted a pilot study using vali date d outcome measures to assess the feasibility of the protocol , and to obtain preliminary data on efficacy and tolerability of 3 different forms of acupuncture treatment as an adjunct for the treatment of chronic pain in patients with Rheumatoid arthritis ( RA ) . Methods The study employs a r and omized , prospect i ve , double-blind , placebo-controlled trial to evaluate the effect of electroacupuncture ( EA ) , traditional Chinese acupuncture ( TCA ) and sham acupuncture ( Sham ) in patients with RA . All patients received 20 sessions over a period of 10 weeks . Six acupuncture points were chosen . Primary outcome is the changes in the pain score . Secondary outcomes included the changes in the ACR core disease measures , DAS 28 score and the number of patients who achieved ACR 20 at week 10 . Results From 80 eligible patients , 36 patients with mean age of 58 ± 10 years and disease duration of 9.3 ± 6.4 years were recruited . Twelve patients were r and omized to each group . Twelve , 10 and 7 patients from the EA , TCA and Sham group respectively completed the study at 20 weeks ( p < 0.03 ) ; all except one of the premature dropouts were due to lack of efficacy . At week 10 , the pain score remained unchanged in all 3 groups . The number of tender joints was significantly reduced for the EA and TCA groups . Physician 's global score was significantly reduced for the EA group and patient 's global score was significantly reduced for the TCA group . All the outcomes except patient 's global score remained unchanged in the Sham group . Conclusion This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial , which in turn will help to clarify the existing evidence base on acupuncture for RA.Trial registration Clinical Trials.gov OBJECTIVES To examine Australian acupuncturists ' perspectives of : chronic  low back pain  outcome domains ; their use of outcome measures to assess chronic low back pain ; and their attitudes and perceptions of barriers to using the existing measures to evaluate acupuncture care for chronic low back pain . DESIGN A postal question naire was used in a cross-sectional survey . PARTICIPANTS 359 r and omly selected Australian acupuncturists . RESULTS 139 question naires were returned ( response rate : 38.7 % ) . The respondents ' demographic characteristics were similar to Australian Bureau of Statistics acupuncturist demographic data . Overall , acupuncturists endorsed a broad approach to assessing acupuncture care for chronic low back pain . However , they had typically used pain severity measures but generally did not use other types of measures . Acupuncturists tended to hold positive attitudes towards using outcome measures . The principal barriers acupuncturists perceived to using outcome measures concerned doubts about whether the concepts which underpin acupuncture practice had been explicitly articulated and whether the available measures capture the specific context and particular outcomes of acupuncture care for chronic low back pain . IMPLICATION S The findings of this study suggest that a broad range of outcome measures are required to adequately assess chronic low back pain acupuncture care outcomes . While numerous outcome measures have been developed that are relevant to chronic low back pain care , whether these measures are appropriate for use by acupuncturists is unclear . Further studies are warranted to explore if established outcome measures are useful to evaluate chronic low back acupuncture care Acupuncture is increasingly used , so it is important to establish whether its benefits outweigh its risks . Numerous case reports of adverse events show that acupuncture is not free of risk , but accurate data from prospect i ve investigations is scarce . A prospect i ve survey was undertaken using intensive event monitoring . Forms were developed for reporting minor events each month and significant events as they occurred . The sample size was calculated to identify any adverse events that occurred more frequently than once in 10,000 consultations . Acupuncturists were recruited from two professional organisations in the UK . Seventy-eight acupuncturists , all doctors or physiotherapists , reported a total of 2178 events occurring in 31,822 consultations , an incidence of 684 per 10,000 consultations . The most common minor adverse events were bleeding , needling pain , and aggravation of symptoms ; aggravation was followed by resolution of symptoms in 70 % of cases . There were 43 significant minor adverse events reported , a rate of 14 per 10,000 , of which 13 ( 30 % ) interfered with daily activities . One patient suffered a seizure ( probably reflex anoxic ) during acupuncture , but no adverse event was classified as serious . Avoidable events included forgotten patients , needles left in patients , cellulitis and moxa burns . In conclusion , the incidence of adverse events following acupuncture performed by doctors and physiotherapists can be classified as minimal ; some avoidable events do occur . Acupuncture seems , in skilled h and s , one of the safer forms of medical intervention OBJECTIVE To determine the efficacy of acupuncture in the treatment of chronic musculoskeletal shoulder pain in subjects with spinal cord injury ( SCI ) . DESIGN R and omized , double blind ( participants , evaluator ) , placebo ( invasive sham ) controlled trial . SETTING Clinical research center . PARTICIPANTS Seventeen manual wheelchair-using subjects with chronic SCI and chronic musculoskeletal shoulder pain . INTERVENTIONS Participants were r and omly assigned to receive 10 treatments of either acupuncture or invasive sham acupuncture ( light needling of nonacupuncture points ) . MAIN OUTCOME MEASURE Changes in shoulder pain intensity were measured using the Wheelchair User 's Shoulder Pain Index . RESULTS Shoulder pain decreased significantly over time in both the acupuncture and the sham acupuncture groups ( P=.005 ) , with decreases of 66 % and 43 % , respectively . There was no significant difference between the 2 groups ( P=.364 ) . There was , however , a medium effect size associated with the acupuncture treatment . CONCLUSIONS There appears to be an analgesic effect or a powerful placebo effect associated with both acupuncture and sham acupuncture . There was a medium treatment effect associated with the acupuncture , which suggests that it may be superior to sham acupuncture . This observation , along with the limited power , indicates that a larger , more definitive r and omized controlled trial using a similar design is warranted UNLABELLED The equivalency of behavioral interventions has led to the consideration of whether patient-related factors influence clinical trial outcomes . The primary purpose of this secondary analysis was to determine if treatment preference and patient expectation were predictors of trial outcomes and if selected patient-satisfaction items were appropriate as outcome measures . Perceived effectiveness , treatment preference , and patient expectation were assessed before r and om assignment , and patient satisfaction was assessed 6 months later . Patient preference was associated with perceived effectiveness for those with no treatment preference and those preferring grade d exposure . Higher patient expectation was associated with higher perceived effectiveness ratings for all treatments in the clinical trial . Patients with no strong treatment preferences had larger 6-month improvements in pain intensity and disability , while patients with higher expectations had lower disability at baseline , 4 weeks , and 6 months . Patient satisfaction rates did not differ based on treatment received . Patient satisfaction was highest with treatment delivery and much lower with treatment effect . Patient satisfaction was uniformly associated with expectations being met , but only satisfaction with treatment effect was associated with lower pain and disability scores . These data support assessment of treatment preference and patient expectation as predictors and patient satisfaction as an outcome measure in low back pain ( LBP ) clinical trials . PERSPECTIVE These data indicate treatment preference potentially impacts rate of improvement for patients with low back pain . Patient expectation did not impact rate of improvement , but those with higher expectations had lower pain and disability scores throughout the trial . Optimal assessment of patient satisfaction should include items that separately consider treatment delivery and effect The cerebral activation pattern due to acupuncture is not completely understood . Although the effect of acupuncture on cerebral haemodynamics has been studied , no previous report has focused on different puncture and stimulation methods . We used functional MRI ( fMRI ) in 15 healthy subjects to investigate cortical activation during stimulation of two real acupoints ( Liv3 and G40 ) and one sham point , needled in a r and om and , for the subjects , blinded order employing rotating and non-rotating methods , using a blocked paradigm on a 1.5 tesla imager . Compared to the non-rotating stimulation method , during rotating stimulation of the real acupoints , we observed an increase in activation in both secondary somatosensory cortical areas , frontal areas , the right side of the thalamus and the left side of the cerebellum ; no such effects of the needling technique were seen while stimulating the sham point . The observation that rotating the needle strengthened the effects of acupuncture only at real acupoints suggests that , as cl aim ed in Chinese traditional medicine , stimulation of these acupoints has a specific effect on cortical neuronal activity , absent with sham acupoints . These specific cerebral activation patterns might explain the therapeutic effects of acupuncture in certain subjects Objective To assess the efficacy of Yamamoto 's acupuncture method on pain , drug intake , functional capacity and quality of life for the treatment of acute non-specific low back pain ( ANLBP ) . Methods A prospect i ve , r and omised , parallel-group , double-blind , placebo-controlled trial was performed in 80 men and women with ANLBP who were r and omly assigned to five acupuncture sessions ( intervention group  ( IG ) , n=40 ) and to five non-penetrating acupuncture sessions ( sham group ( SG ) , n=40 ) . Patients were evaluated at baseline and at 3 , 7 , 14 , 21 and 28 days . The measurements used were : visual analogue scale ( VAS ) for cumulative pain ( before intervention , VAS1 ) and immediate pain ( after intervention , VAS2 ) ; function ( Rol and –Morris Disability Question naire ( RM ) ) ; quality of life ( SF-36 ) ; improvement rating ; and number of anti-inflammatory tablets taken . The primary endpoint was a decrease of at least 2 cm in VAS1 . Results Pain VAS improved significantly in the IG from day 14 onwards compared with the SG , but the difference did not reach the prespecified clinical ly relevant value of 2 cm . The IG was significantly superior to the SG in the following outcomes : cumulative pain , function , pain ( SF-36 ) and vitality ( SF-36 ) at days 14 , 21 and 28 ( p<0.05 ) ; limitation in physical aspects ( SF-36 ) at all times ( p=0.007 and p=0.02 ) ; and functional capacity ( SF-36 ) at days 21 and 28 ( p<0.05 ) . The IG also took significantly fewer anti-inflammatory tablets than the SG ( p=0.004 ) at all evaluation times and the improvement rating was better than the SG ( p<0.001 ) . Conclusions Yamamoto 's new scalp acupuncture was more effective than sham treatment with regard to decrease in pain and anti-inflammatory intake as well as improving functional status and quality of life for patients with ANLBP . Clinical Trials.gov NCT 01124955 OBJECTIVE The purpose of this study was to determine whether acupuncture was more effective than sham acupuncture in the reduction of pain in persons with osteoarthritis ( OA ) of the knee . METHODS Forty subjects ( 20 men , 20 women ) with radiographic evidence of OA of the knee were stratified by gender and r and omly assigned to either the experimental ( real acupuncture ) or control ( sham acupuncture ) groups . Subjects were treated three times per week for 3 weeks and evaluated at three test sessions . Outcome measures were : 1 ) the Pain Rating Index of the McGill Pain Question naire , 2 ) the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index , and 3 ) pain threshold at four sites at the knee . RESULTS The analyses of variance showed that both real and sham acupuncture significantly reduced pain , stiffness , and physical disability in the OA knee , but that there were no significant differences between groups . CONCLUSIONS Acupuncture is not more effective than sham acupuncture in the treatment of OA pain Forty patients , r and omly assigned to an experimental and a control group , participated in a double-blind study to assess the effectiveness of acupuncture in reducing  chronic pain associated with osteoarthritis . The experimental group received treatment at st and ard acupuncture points , and the control group at placebo points . Analysis before and after treatment showed a significant ( P less than 0.05 ) improvement in tenderness and subjective report of pain in both groups as evaluated by two independent observers and in activity by one observer . Comparison of responses to treatment between the two groups showed no significant ( P greater than 0.05 ) difference . Thus , both experimental and control groups showed a reduction in pain after the treatments . These results may reflect the natural course of illness , and various attitudinal and social factors OBJECTIVE A pilot study to assess the feasibility of a trial to investigate the efficacy of acupuncture compared to placebo needling for the treatment of acute low back pain ( LBP ) . As part of this , the study was design ed to establish the credibility of the placebo control , and to provide data to inform a power analysis to determine numbers for a future trial . STUDY DESIGN A pilot patient and assessor blinded r and omized controlled trial . SETTING Primary care health centre facility , South and East Belfast Trust , Northern Irel and . PATIENTS Patients from the physiotherapy waiting list ( n=48 ) with LBP of less than 12 weeks duration . OUTCOME MEASURES Rol and and Morris Disability Question naire ( RMDQ ) , Visual Analogue Scale ( VAS ) , medication use and an exit question naire were completed at baseline , end of treatment , and at 3 months follow up . RESULTS Ninety-four percent ( 45/48 ) of patients completed assigned treatment , 83 % ( 40/48 ) completed 3 months follow-up . The sham needle used here proved to be credible : 91.7 % in the placebo group believed they had received acupuncture , compared to 95.8 % in the verum acupuncture group . Differences in baseline characteristics were accounted for using ANCOVA . There was no significant difference between groups on the RMDQ over time . For pain , the only statistically significant difference was at the 3 months follow up ( worst VAS , point estimate , 18.7 , 95 % CI 1.5 - 36.0 , p=0.034 ) . The majority of patients were taking some form of analgesic medication for LBP at the start of treatment ( n=44 ; 92 % ) , and at the end of treatment the verum acupuncture group were taking significantly fewer tablets of pain control medication ( mean ( S.D. ) : 1.0+/-0.3 ) than the placebo group ( mean ( S.D. ) : 4.2+/-0.6 , p<0.05 ) . Based upon these data , power analysis ( power=90 % , alpha=0.05 , minimal clinical ly important difference ( MCID ) for RMDQ=2.5 points ) indicated that 120 participants ( 60 per group ) would be needed to complete an adequately powered r and omized controlled trial . CONCLUSIONS This study has demonstrated the feasibility of a r and omized controlled trial of penetrating needle acupuncture compared to a non-penetrating sham for the treatment of acute LBP in primary care ; 120 participants would be required in a fully powered trial . The placebo needle used in this study proved to be a credible form of control The aim of this study was to compare the efficacy of electroacupuncture and sham acupuncture in the treatment of patients with chronic neck pain . 31 patients with chronic neck pain were included in a r and omised , controlled trial . Electric stimulation was given for 30 minutes at low frequency ( 1 - 4Hz ) , pulse width of 200 micros , interrupted wave form . Of the 29 patients who completed the therapy , 13 were assigned to conventional acupuncture and 16 to sham acupuncture groups , receiving 3 sessions a week for a total of 10 sessions , each lasting for 30 minutes . Patients were evaluated before and after therapy and 3 months later by Visual Analogue Scale ( VAS ) and the bodily pain subscale of the Short Form Health Survey-36 scale . The treating physician was different from the evaluating physician who , like the patient , was blinded . VAS scores in both groups significantly reduced after therapy and at 3 months post-therapy , but the difference between groups was not significant . In respect of bodily pain , there was a significant improvement in the acupuncture group after therapy ( P<0.01 ) . Stimulation of conventional acupuncture points was not generally superior to needling ofnonspecific points on the neck , and both treatments were associated with improvement of symptoms . Needles inserted into the neck are likely to be an inappropriate sham control for acupuncture The objective of this study was to test the hypothesis that dry needling is more effective than sham dry needling in the treatment of myofascial pain syndrome ( MPS ) . This was a prospect i ve , double-blinded , r and omized-controlled study conducted in an outpatient clinic . Thirty-nine subjects with established myofascial trigger points were r and omized into two groups : study group ( N = 22 ) and placebo group ( N = 17 ) . Dry needling was applied using acupuncture needles , and sham dry needling was applied in the placebo group . The treatment was composed of six sessions which were performed in 4 weeks ; the first four sessions were performed twice a week ( for 2 weeks ) and the last two , once a week ( for 2 weeks ) . The visual analog scale ( VAS ) and Short Form-36 ( SF-36 ) were used . When compared with the initial values , VAS scores of the dry needling group following the first and sixth sessions were significantly lower ( p = 0.000 and p < 0.000 , respectively ) . When VAS scores were compared between the groups , the first assessment scores were found to be similar , but the second and third assessment scores were found to be significantly lower in the dry needling group ( p = 0.034 and p < 0.001 , respectively ) . When SF-36 scores of the groups were compared , both the physical and mental component scores were found to be significantly increased in the dry needling group , whereas only those of vitality scores were found to be increased significantly in the placebo ( sham needling ) group . The present study shows that the dry needling treatment is effective in relieving the pain and in improving the quality of life of patients with MPS & NA ; The study was carried out to examine whether acupuncture treatment can reduce  chronic pain in the neck and shoulders and related headache  , and also to examine whether possible effects are long‐lasting . Therefore , 24 female office workers ( 47±9 years old , mean±SD ) who had had neck and shoulder pain for 12±9 years were r and omly assigned to a test group ( TG ) or a control group ( CG ) . Acupuncture was applied 10 times during 3–4 weeks either at presumed anti‐pain acupoints ( TG ) or at placebo‐points ( CG ) . A physician measured the pain threshold ( PPT ) in the neck and shoulder regions with algometry before the first treatment , and after the last one and six months after the treatments . Question naires on muscle pain and headache were answered at the same occasions and again 3 years after the last treatment . The intensity and frequency of pain fell more for TG than for CG ( Pb≤0.04 ) during the treatment period . Three years after the treatments TG still reported less pain than before the treatments ( Pw<0.001 ) , contrary to what CG did ( Pb<0.04 ) . The degree of headache fell during the treatment period for both groups , but more for TG than for CG ( Pb=0.02 ) . Three years after the treatments the effect still lasted for TG ( Pw<0.001 ) while the degree of headache for CG was back to the pre‐treatment level ( Pb<0.001 ) . PPT of some muscles rose during the treatments for TG and remained higher 6 months after the treatments ( Pw<0.05 ) , which contrasts the situation for CG . Adequate acupuncture treatment may reduce chronic pain in the neck and shoulders and related headache . The effect lasted for 3 years BACKGROUND AND OBJECTIVES To test the hypothesis that dry needling is more effective than sham dry needling in relieving  myofascial pain of the temporom and ibular muscles . MATERIAL AND METHOD Fifty-two subjects with established myofascial trigger points were r and omized into two groups ; study group ( N : 26 ) and placebo group ( N : 26 ) . Dry needling was applied using acupuncture needles . Sham dry needling was applied to the placebo group . Pain pressure threshold was measured with pressure algometry , pain intensity was rated using a 10-cm visual analog scale ( VAS ) and the unassisted jaw opening without pain measurement was performed . Evaluations were done by a physician blinded to the data . RESULTS Of 52 patients assigned , 50 completed the study .  Mean algometric values were significantly higher in the study group when compared to the placebo group ( p values being less than 0.05 ) . There were no differences between the two groups in terms of VAS and unassisted jaw-opening without pain values . CONCLUSION Dry needling appears to be an effective treatment method in relieving the pain and tenderness of myofascial trigger points Context A substantial number of patients use acupuncture to treat the symptoms of fibromyalgia , but previous r and omized trials of this intervention are inconclusive , in part because of control groups that did not permit adequate blinding of the patients . Contribution This study r and omly assigned 100 patients with fibromyalgia to 12 weeks of either true acupuncture treatment or one of 3 types of sham acupuncture . No differences in pain were identified between acupuncture and sham acupuncture . Caution s The study had too few patients to detect small differences between the groups . Patients could use other fibromyalgia therapies , so this study evaluates acupuncture as adjunctive treatment . The Editors Fibromyalgia is a condition of unknown cause that is characterized by chronic , diffuse pain and tenderness to palpation at specific musculoskeletal sites ( 1 ) . It is the second most common rheumatologic condition after osteoarthritis , afflicting 2 % to 4 % of the U.S. population ( 2 ) . Most r and omized , controlled trials of allopathic interventions have not demonstrated sustained benefit , and use of complementary and alternative medicine for fibromyalgia is common ( 3 ) . For example , 60 % to 90 % of patients with fibromyalgia report using 1 or more complementary or alternative treatments ( 4 , 5 ) , and 22 % of these patients have tried acupuncture ( 6 ) . Despite skepticism in western cultures , the literature suggests that acupuncture may alleviate chronic pain ( 7 ) . R and omized , controlled trials of acupuncture face many method ologic challenges , including the identification of appropriate treatment and control groups , blinding of study participants , and the inability to blind practitioners ( 8) . Needle placement and the extent to which needle insertion and stimulation is necessary are also controversial ( 7 - 9 ) . In the only rigorous r and omized , controlled trial of acupuncture for fibromyalgia , 7 of 8 outcome measures significantly improved after 3 weeks of treatment with electroacupuncture ( 10 ) . However , because blinding was not assessed and electroacupuncture involves perceptible current , these promising results could reflect a lack of blinding to treatment condition . Moreover , the study followed patients only during treatment . Because fibromyalgia is a chronic condition , longer-term outcomes should be examined . To address these method ologic problems , we performed a r and omized , controlled trial of acupuncture to treat fibromyalgia that included 3 sham acupuncture treatments to account for the effects of needle insertion and placement . The adequacy of participant blinding was carefully evaluated . We sought to determine whether directed acupuncture that is design ed to treat fibromyalgia relieves pain better than does sham acupuncture in adults with fibromyalgia . On the basis of the scant literature and our clinical experience , we hypothesized a priori that directed acupuncture would result in the greatest clinical improvement . Methods Participants Participants were recruited from the greater Seattle , Washington , metropolitan area between January 2001 and September 2002 . Recruitment strategies included dissemination of information on the study through newspapers , television , advertisements , signs posted at university-affiliated hospitals , and letters to local fibromyalgia support groups and health care providers with large caseloads of patients with fibromyalgia . Potential participants were told that they had an equal chance of being assigned to 1 of 4 acupuncture interventions , none of which have been proven but 1 of which was believed to have the most potential to improve the symptoms of fibromyalgia . The institutional review boards at the participating institutions approved the study , and participants provided written informed consent . Eligible participants were English-speaking adults 18 years of age or older in whom fibromyalgia was diagnosed by a physician and who had a prer and omization global pain score of 4 or greater on a visual analogue scale ( 0 = no pain , 10 = worst pain ever ) . Participants agreed to undergo r and omization and kept use of any fibromyalgia-related pharmacologic and nonpharmacologic therapies constant throughout the study . At the baseline evaluation before r and omization , a research coordinator trained in tender-point examination confirmed the diagnosis of fibromyalgia by using the 1990 criteria of the American College of Rheumatology ( 1 ) . Participants were excluded if they reported other pain-related medical conditions or potential contraindications to acupuncture treatment ( such as bleeding disorders or severe needle phobia ) , were pregnant or breastfeeding , used narcotics ( which could blunt the effects of acupuncture ) , were involved in litigation related to fibromyalgia ( which might reduce their incentive for improvement ) , or had previously received acupuncture ( to maximize blinding ) . R and omization Procedure A research coordinator screened and enrolled participants at an academic research center . After participants completed a baseline evaluation , another research coordinator who was uninvolved with data collection r and omly assigned them to 1 of 4 treatment groups by using a computer-generated , blocked r and om-allocation sequence with a block size of 4 . This research coordinator informed the acupuncture clinic of the treatment assignment . Intervention Eight U.S.-trained and licensed acupuncturists with a median of 10 years of experience ( range , 4 to 18 years ) provided study treatments in their private offices . One investigator trained the acupuncturists in the study procedures to increase their comfort with delivering all 4 treatments and monitored compliance with the protocol throughout the study . Participants were assigned an acupuncturist according to geographic convenience and schedule availability , and every effort was made to have them treated by the same acupuncturist for the entire 12 weeks . The primary acupuncturist was defined as the practitioner from whom a participant received the most treatments . In all groups , participants were asked to attend treatment sessions twice weekly for 12 weeks ( 24 treatments ) . We considered participants who attended 80 % or more ( 19 of 24 ) of acupuncture appointments to have completed a full course of treatment . Outcome measures were collected at regularly scheduled time points from participants who discontinued treatment . Participants received directed acupuncture design ed to treat fibromyalgia according to the practice of Traditional Chinese Medicine or 1 of 3 sham acupuncture treatments . One sham intervention , a control for acupoint specificity , involved acupuncture typically used to treat irregular menses or early menses due to Blood Heat ( an unrelated condition ) according to Traditional Chinese Medicine . Another sham intervention , which was also a control for acupoint specificity , used body locations not recognized as true acupoints or meridians for needling ( sham needling ) . The third sham treatment , a control for needle insertion , consisted of noninsertive simulated acupuncture at the same acupoints used in directed acupuncture ( simulated acupuncture ) . This technique , in which a toothpick in a needle guide-tube is used to mimic needle insertion and withdrawal , has been shown to be indistinguishable from true acupuncture in acupuncture-nave patients with back pain ( 9 ) . Simulated acupuncture more closely duplicates the needle insertion experience than do techniques using placebo needles that require placing adhesive or plastic foam on the skin ( 11 , 12 ) . Acupoints and sham points ( Appendix Figure ) were chosen by a study acupuncturist with 15 years of experience in treating fibromyalgia and were approved by 3 other senior acupuncturists . In all groups that underwent needle insertion , needles were retained at st and ard depths ( 13 ) for 30 minutes at each acupoint . Disposable Chinese , Japanese , or Korean needles ( 34 to 40 gauge ) were used , depending on the practitioner 's preference . In the simulated acupuncture group , participants remained on the table for 30 minutes after simulated insertion and then underwent simulated needle withdrawal . Efforts were made to imitate the sounds of opening needle packs and needle disposal . Acupuncturists were not blinded to the treatments they delivered . To maximize participant blinding , we included only acupuncture-nave persons who could not compare their treatment with previous experiences with acupuncture , limited contact among study participants , restricted conversation between acupuncturists and participants , and blindfolded participants during treatment . All research personnel who collected or analyzed data were unaware of treatment group . At the end of 12 weeks , we collected data to assess the adequacy of blinding . Outcome Measures Demographic measures collected at the baseline evaluation included age , sex , race , education , marital status , and duration of pain and diagnosis of fibromyalgia . Participants also listed the types of therapies they had previously tried for their pain . We grouped this information into manual therapies ( physical , ergonometric , chiropractic , or massage therapy ) , mental health therapies ( psychotherapy or cognitive behavioral therapy ) , dietary changes , or other therapies ( nerve blocks , hypnosis , or biofeedback ) . Outcome measures were collected at baseline ; after 1 , 4 , 8 , and 12 weeks of acupuncture treatment ; and 3 and 6 months after completion of treatment ( weeks 24 and 36 ) . The primary outcome was subjective pain , as measured by a st and ard 10-cm visual analogue scale ( 0 = no pain , 10 = worst pain ever ) . Other outcomes measured by using a visual analogue scale were intensity of fatigue ( 0 = none , 10 = worst ever ) , sleep quality ( 0 = worst ever , 10 = best ever ) , and overall well-being ( 0 = worst ever , 10 = best ever ) . We assessed physical and mental functioning by using the Medical Outcomes Study 36-item Short-Form Health Survey ( 14 ) , which has high reliability and validity in many patient groups , including Introduction There is some evidence for the efficacy of acupuncture , but it remains unclear whether trigger point acupuncture is effective . Our objective was to evaluate the effects of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared with sham acupuncture . Methods Twenty-six consecutive out- patients ( 17 women , 9 men ; age range : 65–91 years ) from the Department of Orthopaedic Surgery , Meiji University of Oriental Medicine , with non-radiating low back pain for at least six months and normal neurological examination , were r and omised to two groups . Each group received one phase of trigger point acupuncture and one of sham acupuncture with a three week washout period between them , over 12 weeks . Group A ( n=13 ) received trigger point acupuncture in the first phase and sham acupuncture in the second . Group B ( n=13 ) received the same interventions in the reverse order . Outcome measures were pain intensity ( visual analogue scale , VAS ) and Rol and Morris Question naire . Results Nineteen patients were included in the analysis . At the end of the first treatment phase , group A receiving trigger point acupuncture scored significantly lower VAS ( P<0.001 ) and Rol and Morris Question naire scores ( P<0.01 ) than the sham control group . There were significant within-group reductions in pain in both groups during the trigger point acupuncture phase but not in the sham treatment phase . However , the beneficial effects were not sustained . Conclusion These results suggest that trigger point acupuncture may have greater short term effects on low back pain in elderly patients than sham acupuncture OBJECTIVES This study aim ed to determine whether a non-penetrating sham needle can serve as an adequate sham control . DESIGN We conducted a r and omised , subject-blind , sham-controlled trial in both acupuncture-naïve and experienced healthy volunteers . SETTING AND INTERVENTIONS Participants were r and omly allocated to receive either real acupuncture ( n=39 )  or non-penetrating sham acupuncture ( n=40 ) on the h and ( LI4 ) , abdomen ( CV12 ) and leg ( ST36 ) . The procedures were st and ardised and identical for both groups . MAIN OUTCOME MEASURES Participants rated acupuncture sensations on a 10-point scale . A blinding index was calculated based on the participants ' guesses on the type of acupuncture they had received ( real , sham or do not know ) for each acupuncture point . The association of knowledge about and experience in acupuncture with correct guessing was also examined . RESULTS The subjects in both groups were similar with respect to age , gender , experience or knowledge about acupuncture . The sham needle tended to produce less penetration , pain and soreness only at LI4 . Blinding appeared to be successfully achieved for ST36 . Although 41 % of participants in the real acupuncture group made correct guesses for LI4 , 31 % guessed incorrectly for CV12 , beyond chance level . People with more experience and knowledge about acupuncture were more likely to correctly guess the type of needle they received at ST36 only , compared to that at the other points . CONCLUSIONS A non-penetrating sham needle may successfully blind participants and thus , may be a credible sham control . However , the small sample size , the different needle sensations , and the degree and direction of unblinding across acupuncture points warrant further studies in Korea as well as other countries to confirm our finding . Our results also justify the incorporation of formal testing of the use of sham controls in clinical trials of acupuncture Summary Acupuncture is a useful and safe adjunctive therapy to pharmacological treatment in the short term management of knee osteoarthritis . Abstract The efficacy of acupuncture as an adjunctive therapy to pharmacological treatment of chronic pain due to knee osteoarthritis was studied with a 3‐armed , single‐blind , r and omized , sham‐controlled trial ; it compared acupuncture combined with pharmacological treatment , sham acupuncture including pharmacological treatment , and pharmacological treatment alone . A total of 120 patients with knee osteoarthritis were r and omly allocated to 3 groups : group I was treated with acupuncture and etoricoxib , group II with sham acupuncture and etoricoxib , and group III with etoricoxib . The primary efficacy variable was the Western Ontario and McMaster Universities ( WOMAC ) index and its subscales at the end of treatment at week 8 . Secondary efficacy variables included the WOMAC index at the end of weeks 4 and 12 , a visual analogue scale ( VAS ) at the end of weeks 4 , 8 , and 12 , and the Short Form 36 version 2 ( SF‐36v2 ) health survey at the end of week 8 . An algometer was used to determine changes in a predetermined unique fixed trigger point for every patient at the end of weeks 4 , 8 , and 12 . Group I exhibited statistically significant improvements in primary and secondary outcome measures , except for Short Form mental component , compared with the other treatment groups . We conclude that acupuncture with etoricoxib is more effective than sham acupuncture with etoricoxib , or etoricoxib alone for the treatment of knee osteoarthritis Tsai C-T , Hsieh L-F , Kuan T-S , Kao MJ , Chou L-W , Hong C-Z : Remote effects of dry needling on the irritability of the myofascial trigger point in the upper trapezius muscle . Objective : To investigate the remote effect of dry needling on the irritability of a myofascial trigger point in the upper trapezius muscle . Design : Thirty-five patients with active myofascial trigger points in upper trapezius muscles were r and omly divided into two groups : 18 patients in the control group received sham needling , and 17 patients in the dry-needling  group received dry needling into the myofascial trigger point in the extensor carpi radialis longus muscle . The subjective pain intensity , pressure pain threshold , and range of motion of the neck were assessed before and immediately after the treatment . Results : Immediately after dry needling in the experimental group , the mean pain intensity was significantly reduced , but the mean pressure threshold and the mean range of motion of cervical spine were significantly increased . There were significantly larger changes in all three parameters of measurement in the dry-needling group than that in the control group . Conclusions : This study demonstrated the remote effectiveness of dry needling . Dry needling of a distal myofascial trigger point can provide a remote effect to reduce the irritability of a proximal myofascial trigger point Abstract In a pooled analysis of four r and omized controlled trials of acupuncture in patients with migraine , tension‐type headache , chronic low back pain , and osteoarthritis of the knee we investigated the influence of expectations on clinical outcome . The 864 patients included in the analysis received either 12 sessions of  acupuncture or minimal ( i.e. sham ) acupuncture ( superficial needling of non‐acupuncture points ) over an 8 week period . Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment . After three acupuncture sessions patients were asked how confident they were that they would benefit from the treatment strategy they were receiving . Patients were classified as responders if the respective main outcome measure improved by at least fifty percent . Both univariate and multivariate analyses adjusted for potential confounders ( such as condition , intervention group , age , sex , duration of complaints , etc . ) consistently showed a significant influence of attitudes and expectations on outcome . After completion of treatment , the odds ratio for response between patients considering acupuncture an effective or highly effective therapy and patients who were more sceptical was 1.67 ( 95 % confidence interval 1.20–2.32 ) . For personal expectations and confidence after the third session , odds ratios were 2.03 ( 1.26–3.26 ) and 2.35 ( 1.68–3.30 ) , respectively . Results from the 6‐month follow‐up were similar . In conclusion , in our trials a significant association was shown between better improvement and higher outcome expectations Background The purpose of this study was to examine the immediate effect of single acupuncture stimulation to the most painful point in patients with low back pain . Method A r and omised , evaluator-blinded , sham controlled clinical trial was conducted in which 31 patients with low back pain were r and omly allocated to either an acupuncture group ( n=15 ) or a sham acupuncture group ( n=16 ) . Both acupuncture and sham acupuncture were performed at the most painful point on the lower back of the subjects . For the acupuncture group , a stainless steel needle was inserted to a depth of 20 mm and manually stimulated ( sparrow pecking method ) for 20 seconds , while for the sham treatment a guide tube without a needle was placed at the point and tapped on the skin . Changes in low back pain were evaluated with a visual analogue scale ( VAS ) and the Schober test . Participants were also asked if they felt the needling sensation or not . The therapy and the evaluation were independently performed by two different acupuncturists . Results VAS score and the Schober test score showed significant improvement after treatment as compared with the sham group ( P=0.02 , 0.001 , respectively ) . There were no significant differences in the needling sensation between the acupuncture and sham group . Conclusion These results suggest that acupuncture at the most painful point gives immediate relief of low back pain OBJECTIVES The objective of this study was to investigate whether typical acupuncture methods such as needle placement , needle stimulation , and treatment frequency were important factors in fibromyalgia symptom improvement . DESIGN / SETTING S/SUBJECTS : A single-site , single-blind , r and omized trial of 114 participants diagnosed with fibromyalgia for at least 1 year was performed . INTERVENTION Participants were r and omized to one of four treatment groups : ( 1 ) T/S needles placed in traditional sites with manual needle stimulation ( n = 29 ) : ( 2 ) T/0 traditional needle location without stimulation ( n = 30 ) ; ( 3 ) N/S needles inserted in nontraditional locations that were not thought to be acupuncture sites , with stimulation ( n = 28 ) ; and ( 4 ) N/0 nontraditional needle location without stimulation ( n = 2 7 ) . All groups received treatment once weekly , followed by twice weekly , and finally three times weekly , for a total of 18 treatments . Each increase in frequency was separated by a 2-week washout period . OUTCOME MEASURES Pain was assessed by a numerical rating scale , fatigue by the Multi-dimensional Fatigue Inventory , and physical function by the Short Form-36 . RESULTS Overall pain improvement was noted with 25%-35 % of subjects having a clinical ly significant decrease in pain ; however this was not dependent upon " correct " needle stimulation ( t = 1.03 ; p = 0.307 ) or location ( t = 0.76 ; p = 0.450 ) . An overall dose effect of treatment was observed , with three sessions weekly providing more analgesia than sessions once weekly ( t = 2.10 ; p = 0.039 ) . Among treatment responders , improvements in pain , fatigue , and physical function were highly codependent ( all p < or = 0.002 ) . CONCLUSIONS Although needle insertion led to analgesia and improvement in other somatic symptoms , correct needle location and stimulation were not crucial Background and Objective : A recent Cochrane review on placebo interventions for all kinds of conditions found that ‘ physical placebos ’ ( which included sham acupuncture ) were associated with larger effects over no-treatment control groups than ‘ pharmacological placebos ’ . We re-analyzed the data from this review to investigate whether effects associated with sham acupuncture differed from those of other ‘ physical placebos ’ . Methods : All trials included in the Cochrane review as investigating ‘ physical placebos ’  were classified as investigating either ( sham ) acupuncture or other physical placebos . The latter group was further subclassified into groups of similar interventions . Data from the Cochrane review were re-entered into the RevMan 5 software for meta- analysis . The primary analysis was a r and om-effects analysis of trials reporting continuous outcomes of trials that used either sham acupuncture or other physical placebos . Results : Out of a total of 61 trials which reported a continuous outcome measure , 19 compared sham acupuncture and 42 compared other physical placebos with a notreatment control group . The trials re-analyzed were highly heterogeneous regarding patients , interventions and outcomes measured . The pooled st and ardized mean difference was –0.41 ( 95 % confidence interval –0.56 , –0.24 ) between sham acupuncture and no treatment and –0.26 ( 95 % CI –0.37 , –0.15 ) between other physical placebos and no treatment ( p value for subgroup differences = 0.007 ) . Significant differences were also observed between subgroups of other physical placebos . Conclusion : Due to the heterogeneity of the trials included and the indirect comparison our results must be interpreted with caution . Still , they suggest that sham acupuncture interventions might , on average , be associated with larger effects than pharmacological and other physical placebos Summary Each of the acupuncture modalities ( true , sham , and placebo ) associated with conventional treatment  achieved a clinical improvement after 3 weeks that was greater than that achieved by conventional treatment alone in patients with acute low back pain , although there were no significant differences among the different forms of stimulus . Abstract Review s of the efficacy of acupuncture as a treatment for acute low back pain have concluded that there is insufficient evidence for its efficacy and that more research is needed to evaluate it . A multicentre r and omized controlled trial was conducted at 4 primary ‐care centres in Spain to evaluate the effects of acupuncture in patients with acute nonspecific low back pain in the context of primary care . A total of 275 patients with nonspecific acute low back pain ( diagnosed by their general practitioner ) were recruited and assigned r and omly to 4 different groups : conventional treatment either alone or complemented by 5 sessions over a 2‐week period of true acupuncture , sham acupuncture , or placebo acupuncture per patient . Patients were treated from February 2006 to January 2008 . The primary outcome was the reduction in Rol and Morris Disability Question naire scores of 35 % or more after 2 weeks ’ treatment . The patients in the 3 types of acupuncture groups were blinded to the treatments , but those who received conventional treatment alone were not . In the analysis adjusted for the total sample ( true acupuncture relative risk 5.04 , 95 % confidence interval 2.24–11.32 ; sham acupuncture relative risk 5.02 , 95 % confidence interval 2.26–11.16 ; placebo acupuncture relative risk 2.57 95 % confidence interval 1.21–5.46 ) , as well as for the sub sample of occupationally active patients , all 3 modalities of acupuncture were better than conventional treatment alone , but there was no difference among the 3 acupuncture modalities , which implies that true acupuncture is not better than sham or placebo acupuncture Recent reports have highlighted the importance of having good evidence on the safety of acupuncture . 1 2 Sound evidence on the risks associated with acupuncture is , however , scarce.3 Our primary aim , therefore , was to describe the type and frequency of adverse events after acupuncture . A secondary aim was to examine mild transient reactions associated with  acupuncture  , some of which may indicate a positive response to treatment . The study involved a prospect i ve postal audit of treatments undertaken during a four week period in 2000 . All 1848 professional acupuncturists who were members of the British Acupuncture Council and were practising in the United Kingdom were invited to record details of adverse events and mild transient reactions after treatment . St and ardised self report forms were used . Participating practitioners also provided information on themselves , including age , sex , length of training , and years of practice . To have a OBJECTIVES To compare the effects of real acupuncture to tender points for neck and shoulder pain and stiffness ( Japanese : katakori ) with those of sham acupuncture . DESIGN R and omized-controlled trial . METHODS Thirty-four volunteers from an acupuncture school with complaints of chronic pain and stiffness , who had no arm symptoms and gave informed consent , were r and omly allocated to acupuncture or sham groups . Acupuncture or sham acupuncture was applied to the tender points once a week for 3 weeks . In the acupuncture group the acupuncture needle was inserted to the muscle , then the sparrow pecking technique was applied five times . Sham acupuncture was done without insertion of the needle . Dull pain and stiffness were evaluated by visual analog scale ( VAS ) before , and every 2 days after the first needling for 1 month . Pressure pain threshold on the tender points was measured before and after each treatment . RESULTS There was no statistical difference of VAS scores between acupuncture and sham groups 9 days after the last treatment . However , the acupuncture group showed significant reduction of VAS scores immediately after and /or 1 day after the real acupuncture treatments ( P<0.01 ) . The effect tended to be prolonged after repeated treatment . Pressure pain thresholds tended to increase after real acupuncture treatment but not after sham acupuncture . CONCLUSIONS Acupuncture applied to tender points appears to have short-term effects on neck and shoulder pain and stiffness , but this study was unable to demonstrate any long-term superiority over sham acupuncture Background There is evidence for the efficacy of acupuncture treatment in knee osteoarthritis , but it remains unclear which acupuncture modes are most effective . We evaluated the effects of trigger point acupuncture on pain and quality of life in knee osteoarthritis patients , compared with acupuncture at st and ard points , and sham acupuncture . Methods Thirty patients ( 27 women , 3 men ; aged 61–82 years ) with non-radiating knee osteoarthritis pain for at least six months and normal neurological examination were r and omised to one of three groups for the study period of 21 weeks . Each group received five acupuncture treatment sessions . The st and ard acupuncture point group ( n=10 ) received treatment at traditional acupuncture points for knee pain ; the trigger point acupuncture group ( n=10 ) received treatment at trigger points ; and the third group ( n=10 ) received sham acupuncture treatment at the trigger points . Outcome measures were pain intensity ( visual analogue scale , VAS ) and WOMAC index ( Western Ontario and McMaster Universities Arthritis Index ) . The groups were compared by the area under the curve method . Results Five patients dropped out of the study because of lack of improvement , and one patient ( in the trigger point acupuncture group ) dropped out because of deterioration of symptoms ; the remaining 24 patients were included in the analysis . After treatment , the trigger point acupuncture group reported less pain intensity on VAS than the st and ard acupuncture or sham treatment group , but both the trigger point acupuncture and st and ard acupuncture groups reported improvement of function of knee . There was a significant reduction in pain intensity between pre-treatment and five weeks after treatment for the trigger point acupuncture ( P<0.01 ) and st and ard acupuncture groups ( P<0.01 ) included in the analysis , but not for the sham treatment group . Group comparison using the area under the curves demonstrated a significant difference only between trigger point acupuncture and sham treatment groups analysed ( P<0.025 for VAS , and P<0.031 for WOMAC ) . Conclusion These results suggest that trigger point acupuncture therapy may be more effective for osteoarthritis of the knee in some elderly patients than st and ard acupuncture therapy Objectives Owing to a lack of a suitable needle procedure , it has been impossible to evaluate the efficacy of acupuncture in clinical studies using double-blind testing . We evaluated the applicability of a new kind of press needle ( Pyonex ) to a double-blind trial by comparing the press needle with a placebo ( lacking the needle element ) . Methods The purpose of the study consisted of 2 phases . In the phase 1 , to evaluate the applicability and efficacy of the press needles , 90 participants who had never been treated using acupuncture were r and omly assigned to receive either the press needle ( n=45 ) or a placebo ( n=45 ) . The applicability was measured using a question naire regarding the perception of penetration , and efficacy was measured using a visual analog scale of low back pain ( LBP ) . When the applicability and efficacy of the press needles were confirmed in phase 1 , the mechanism of LBP relief by the press needles was examined in phase 2 . Results In phase 1 , intergroup comparisons showed no significant differences concerning the perception of penetration . In addition , for patients with LBP , the press needles reduced the subjective evaluation of LBP compared with the placebo ( P<0.05 ) . In phase 2 , visual analog scale results indicated that LBP was reduced significantly more in the press needle group than in the local anesthesia group ( P<0.05 ) . Discussion The participants could not distinguish between the press needle and a placebo , and the data from the press needle group suggested a specific influence on patients with LBP . These findings imply that the press needle and a placebo provide an effective means of realizing a double-blind setting for clinical studies of acupuncture OBJECTIVE To scientifically assess effectiveness and safety of mono-use fu-needle . METHODS Sixty cases of periarthritis of shoulder were r and omly divided into a fu-needle group and a routine acupuncture group . The fu-needle group were treated with fu-needle , and the routine acupuncture group were treated with a needle of 0.38 mm in diameter and 40 mm in length . The articular mobility of the most limited direction , soft tissue pain self-rating score and self-rating score of shoulder tenderness before and after treatment , stabbing times and degree at inserting the needle , scattering and during retention of the needle , and bleeding at withdrawing the needle were compared in the two groups . RESULTS The fu-needle group was better than the routine acupuncture group in improvement of mobility-related pain , tenderness , and the articular mobility of the most limited direction , indicating that the transient effect in the fu-needle group was better than the routine acupuncture group , and the stabbing times and degree at insertion of the needle were less than the routine acupuncture group . And there was no significant difference between the two groups in stabbing times and degree at scattering and retaining the needle and bleeding times in withdrawing the needle . CONCLUSION The superficial needling therapy with mono-use fu-needle is more effective and more safe than the routine acupuncture for treatment of periarthritis of shoulder OBJECTIVES The aim of this study was to evaluate the efficacy of acupuncture as a treatment for chronic shoulder pain and to compare the efficacy of individualized acupuncture to fixed , st and ard point acupuncture treatment . DESIGN The study was a single-blind r and omized , controlled trial . SETTING S/LOCATION The study was conducted in an outpatient rheumatology clinic at the VA Medical Center of Philadelphia . SUBJECTS The participants were adults with shoulder pain for at least 8 weeks with a diagnosis of osteoarthritis or rotator cuff tendonitis and a total Shoulder Pain and Disability Index ( SPADI ) score of > or = 30 . INTERVENTIONS Thirty-one ( 31 ) subjects were r and omized to one of three treatment groups : individualized acupuncture points according to the approaches of Traditional Chinese Medicine ; fixed , st and ard acupuncture points conventionally used for shoulder pain ; and sham nonpenetrating acupuncture . Subjects received 12 treatments over 6 weeks and were reassessed using the SPADI at the end of the 6 weeks . OUTCOME MEASURES The primary outcome evaluated was the mean change in total SPADI score in each group from baseline to 6 weeks . RESULTS After 6 weeks of treatment , the mean total SPADI score improved in all three groups , but the change was clinical ly significant ( > or = 10 points ) only in groups 1 and 2 ( -20.3 and -20.4 , respectively , versus -6.5 in group 3 ) . The treatment effects of groups 1 and 2 compared to the sham acupuncture group were -13.8 ( 95 % confidence interval : -2.2 to -25.4 , p < 0.015 ) and -13.9 ( -2.0 to -25.8 , p < 0.013 ) , respectively . There was no difference between the individualized acupuncture and st and ardized acupuncture treatments . CONCLUSIONS Acupuncture may be an effective treatment for chronic shoulder pain . There may be no difference in efficacy between individualized and st and ardized acupuncture treatment . This suggests that the use of st and ard points may make treatment easier for patient care and for further research studies BACKGROUND Despite the popularity of acupuncture , evidence of its efficacy for reducing pain remains equivocal . OBJECTIVE To assess the efficacy and safety of traditional Chinese acupuncture ( TCA ) compared with sham acupuncture ( needling at defined nonacupuncture points ) and conservative therapy in patients with chronic pain due to osteoarthritis of the knee . DESIGN R and omized , controlled trial . SETTING 315 primary care practice s staffed by 320 practitioners with at least 2 years ' experience in acupuncture . PATIENTS 1007 patients who had had chronic pain for at least 6 months due to osteoarthritis of the knee ( American College of Rheumatology [ ACR ] criteria and Kellgren-Lawrence score of 2 or 3 ) . INTERVENTIONS Up to 6 physiotherapy sessions and as-needed anti-inflammatory drugs plus 10 sessions of TCA , 10 sessions of sham acupuncture , or 10 physician visits within 6 weeks . Patients could request up to 5 additional sessions or visits if the initial treatment was viewed as being partially successful . MEASUREMENTS Success rate , as defined by at least 36 % improvement in Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) score at 26 weeks . Additional end points were WOMAC score and global patient assessment . RESULTS Success rates were 53.1 % for TCA , 51.0 % for sham acupuncture , and 29.1 % for conservative therapy . Acupuncture groups had higher success rates than conservative therapy groups ( relative risk for TCA compared with conservative therapy , 1.75 [ 95 % CI , 1.43 to 2.13 ] ; relative risk for sham acupuncture compared with conservative therapy , 1.73 [ CI , 1.42 to 2.11 ] ) . There was no difference between TCA and sham acupuncture ( relative risk , 1.01 [ CI , 0.87 to 1.17 ] ) . LIMITATIONS There was no blinding between acupuncture and traditional therapy and no monitoring of acupuncture compliance with study protocol . In general , practitioner-patient contacts were less intense in the conservative therapy group than in the TCA and sham acupuncture groups . CONCLUSIONS Compared with physiotherapy and as-needed anti-inflammatory drugs , addition of either TCA or sham acupuncture led to greater improvement in WOMAC score at 26 weeks . No statistically significant difference was observed between TCA and sham acupuncture , suggesting that the observed differences could be due to placebo effects , differences in intensity of provider contact , or a physiologic effect of needling regardless of whether it is done according to TCA principles BACKGROUND A problem acupuncture research has to face is the concept of a control group . If , in control groups , non-acupoint needling is done , physiological acupuncture effects are implied . Therefore the effects shown in this group are often close to those shown in the acupuncture group . In other trials , control groups have received obviously different treatments , such as transcutaneous electrical nervous stimulation or TENS-laser treatment ; it is not clear if the effects of acupuncture are due only to the psychological effects of the treatment . METHODS We developed a placebo acupuncture needle , with which it should be possible to simulate an acupuncture procedure without penetrating the skin . In a cross-over experiment with 60 volunteers we tested whether needling with the placebo needle feels any different from real acupuncture . FINDINGS Of 60 volunteers , 54 felt a penetration with acupuncture  ( mean visual analogue scale [ VAS ] 13.4 ; SD 10.58 ) and 47 felt it with placebo ( VAS 8.86 ; SD 10.55 ) , 34 felt a dull pain sensation ( DEQI ) with acupuncture and 13 with placebo . None of the volunteers suspected that the needle may not have penetrated the skin . INTERPRETATION The placebo needle is sufficiently credible to be used in investigations of the effects of acupuncture INTRODUCTION There is some evidence for the efficacy of acupuncture in chronic neck pain ( CNP ) treatment , but it remains unclear which acupuncture modes are most effective . Objective was to evaluate the effects of trigger point acupuncture on pain and quality of life ( QOL ) in CNP patients compared to three other acupuncture treatments ( acupoints , non-trigger point and sham treatment ) . METHODS Forty out- patients ( 29 women , 11 men ; age range : 47 - 80 years ) from the Department of Orthopaedic Surgery , Meiji University of Oriental Medicine , with non-radiating CNP for at least 6 months and normal neurological examination were r and omised to one of four groups over 13 weeks . Each group received two phases of acupuncture treatment with an interval between them . The acupoint group ( st and ard acupuncture ; SA , n=10 ) received treatment at traditional acupoints for neck pain , the trigger point ( TrP , n=10 ) and non-trigger point ( non-TrP , n=10 ) groups received treatment at tenderness points for the same muscle , while the other acupuncture group received sham treatments on the trigger point ( SH , n=10 ) . Outcome measures were pain intensity ( visual analogue scale ; VAS 0 - 100 mm ) and disease specific question naire ( neck disability index ; NDI , 60-point scale ) . RESULTS After treatment , the TrP group reported less pain intensity and improved QOL compared to the SA or non-TrP group . There was significant reduction in pain intensity between the treatment and the interval for the TrP group ( p<0.01 , Dunnett 's multiple test ) , but not for the SA or non-TrP group . CONCLUSION These results suggest that trigger point acupuncture therapy may be more effective on chronic neck pain in aged patients than the st and ard acupuncture therapy BACKGROUND This paper describes the experiences of 8 licensed acupuncturists in a placebo-controlled r and omized clinical trial ( RCT ) . This information is important to the design and conduct of high- quality trials . METHODS We conducted a RCT ( N=135 ) with a 2-week placebo run-in followed by 4 weeks of twice-weekly treatments comparing genuine to sham acupuncture ( using the Streitberger placebo needle ) in the treatment of arm pain caused by repetitive use . At the end of this study , we conducted written structured interviews with 8 participating acupuncturists . The acupuncturists were not aware of the study 's results at the time of these interviews . The questions focused on their experiences in the study , adherence to study protocol s , their thoughts about the technical and ethical issues involved in using a sham needling device , and their expectations of trial outcomes . The questions were motivated by expressions of concerns the acupuncturists raised in feedback groups during the course of the study , and our desire to improve further trials . RESULTS The acupuncturists differed widely in their comfort levels with the research methods used , their adherence to the study protocol , and their expectations of trial outcomes . CONCLUSIONS We conclude that careful monitoring of acupuncturists , including observation of treatments and frequent meetings to support them throughout the trial , is necessary to maintain a high degree of quality control Objective To observe the clinical effect of acupuncture in treating cervical spondylosis with different syndrome types . Methods One hundred and seventeen patients were r and omized into the treated group : ( 59 cases ) , treated with normal acupuncture , and the control group ( 58 cases ) , treated with sham acupuncture , operated once every other day , 9 times in total ( in 18 days ) as one therapeutic course , and a succeeding 3-month follow-up study was carried out after terminating the therapy . The efficacy of treatment was evaluated with the Northwick Park Neck Pain Question naire ( NPQ ) and Visual Analogue Scale ( VAS ) , and the scores gained in patients with different syndrome types were analyzed with a general linear model . Results The NPQ and VAS : scores showed a linear decreasing tendency in both groups at the time of ending treatment and the 1st month of follow-up , but showed a secondary curve increasing tendency in the 3rd month of follow-up . Multivariate analysis showed the difference was of statistical significance ( P<0.05 ) . However , the analysis through lead-in of syndrome type as an individual influencing factor showed that syndrome type exerts a significant influence on VAS score ( P<0.05 ) , but has insignificant influence on the NPQ score ( P>0.05 ) . Conclusion Acupuncture shows : good immediate effect in treating cervical spondylosis , but its long-term effect is not satisfactory . The difference in syndrome type may have some impact on the effects of acupuncture in alleviating pain , but exerts no evident influence on the comprehensive effect There is conflicting evidence on the efficacy of traditional Chinese acupuncture ( TCA ) , and the role of placebo effects elicited by acupuncturists ' behavior has not been eluci date d. We conducted a 3‐month r and omized clinical trial in patients with knee osteoarthritis to compare the efficacy of TCA with sham acupuncture and to examine the effects of acupuncturists ' communication styles Background : There are different types and parameters of dry needling ( DN ) that can affect its efficacy in the treatment of pain that have not been assessed properly . Objective : To test the hypothesis that either multiple deep intramuscular stimulation therapy multiple deep intramuscular stimulation therapy ( MDIMST ) or TrP lidocaine injection ( LTrP-I ) is more effective than a placebo-sham for the treatment of myofascial pain syndrome ( MPS ) and that MDIMST is more effective than LTrP-I for improving pain relief , sleep quality , and the physical and mental state of the patient . Methods : Seventy-eight females aged 20 to 40 who were limited in their ability to perform active and routine activities due to MPS in the previous 3 months were recruited . The participants were r and omized into 1 of the 3 groups as follows : placebo-sham , LTrP-I , or MDIMST . The treatments were provided twice weekly over 4 weeks using st and ardized MDIMST and LTrP-I protocol s. Results : There was a significant interaction ( time vs. group ) for the main outcomes . Compared with the sham-treated group , MDIMST and LTrP-I administration improved pain scores based on a visual analog scale , the pain pressure threshold ( P<0.001 for all analyses ) , and analgesic use ( P<0.01 for all analyses ) . In addition , when comparing the active groups for these outcomes , MDIMST result ed in better improvement than LTrP-I ( P<0.01 for all analyses ) . In addition , both active treatments had a clinical effect , as assessed by a sleep diary and by the SF-12 physical and mental health scores . Conclusions : This study highlighted the greater efficacy of MDIMST over the placebo-sham and LTrP-I and indicated that both active treatments are more effective than placebo-sham for MPS associated with limitations in active and routine activities OBJECTIVE The purpose of this preliminary study was to examine whether collateral meridian ( CM ) therapy was feasible in treating  knee osteoarthritis ( OA ) pain .  METHODS Twenty-eight patients with knee OA and knee pain were r and omly allocated to 2 groups . The CM group patients received CM therapy , whereas the control patients received placebo treatment for knee pain relief . Patients in the CM group received 2 CM treatments weekly for 3 weeks . The outcome measures were pain intensity on a visual analog scale , and knee function was determined using the Western Ontario and McMaster Universities Osteoarthritis Index . RESULTS In the CM group , the posttreatment visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were lower than those of the control group ; a significant reduction in pain intensity ( P = .02 , P = .01 , respectively ) and improvement in knee function ( P = .04 , P = .03 , respectively ) were shown in the CM group at the second and third week . CONCLUSION Collateral meridian therapy may be feasible and effective for knee OA pain relief and knee function recovery . Therefore , additional r and omized control trials are warranted AIMS To evaluate the effectiveness of acupuncture in treating symptoms associated with myofascial pain of the jaw muscles . METHODS Twenty-eight subjects over the age of 18 and diagnosed with chronic myofascial pain of the jaw muscles were r and omized to receive real ( n = 16 ) or sham ( n = 12 ) acupuncture . Prior to treatment , each subject clenched his or her teeth for 2 minutes . Acupuncture or sham acupuncture was then administered at the Hegu large intestine 4 ( LI4 ) acupoint for 15 minutes . Real acupuncture was given by penetrating the needle through a sticky foam pad at the acupoint . Sham acupuncture was conducted by pricking the skin , without penetration , with a shortened , blunted acupuncture needle through a foam pad placed away from the acupoint . General head and neck pain ratings were obtained before and after treatment on a numerical rating scale . A mechanical pain stimulus on the masseter muscle was given before and after treatment and rated on a visual analog scale to measure pain tolerance level . Paired t tests were performed to detect significant changes in pain levels . RESULTS Subjects receiving real acupuncture experienced a significant reduction in jaw pain ( P = .04 ) , jaw/face tightness ( P = .04 ) , and neck pain ( P = .04 ) , and a significant increase in pain tolerance of the masseter muscle ( P = .001 ) . Subjects were not able to determine whether they received real or sham acupuncture ( P = .69 ) . No significant pain reductions were observed in the sham acupuncture group . CONCLUSION A single acupuncture session using one acupoint at Hegu large intestine 4 significantly reduced most myofascial pain endpoints when compared to sham acupuncture OBJECTIVE To evaluate the clinical efficacy of acupuncture in the treatment of chronic lateral epicondylitis . METHODS In a r and omized , investigator- and patient-blinded , controlled clinical study , 23 patients were treated with real acupuncture and 22 patients received sham acupuncture .  Patients each received 10 treatments , with two treatments per week . The primary outcome variables were maximal strength , pain intensity ( verbal rating scale ) and disability scale ( Disabilities of the Arm , Shoulder and H and question naire ) . Patients were examined at baseline ( 1 week before the start of treatment ) and at follow-up 2 weeks and 2 months after the end of treatment . RESULTS There was no significant difference between the groups at baseline for any outcome parameter . Two weeks and 2 months after the end of treatment , there were significant reductions in pain intensity and improvements in the function of the arm and in maximal strength in both treatment groups . At the 2-week follow-up these differences were significantly greater for all outcome parameters in the group treated with real acupuncture . At 2 months the function of the arm was still better in this group than in the sham acupuncture group ; however , the differences in pain intensity and maximal strength between the groups were no longer significant . CONCLUSION In the treatment of chronic epicondylopathia lateralis humeri , acupuncture in which real acupuncture points were selected and stimulated was superior to non-specific acupuncture with respect to reduction in pain and improvement in the functioning of the arm . These changes are particularly marked at early follow-up The immediate analgesic effect of a single non-segmental acupuncture stimulation treatment on  chronic tennis elbow pain  was studied in a placebo-controlled single-blind trial completed by 48 patients . Before and after treatment , all patients were examined physically by an unbiased independent examiner . Eleven-point box scales were used [ 13 ] for pain measurement . Patients in the verum group were treated at non-segmental distal points ( homolateral leg ) for elbow pain following Chinese acupuncture rules , whereas patients in the placebo group were treated with placebo acupuncture avoiding penetration of the skin with an acupuncture needle . Overall reduction in the pain score was 55.8 % ( S = 2.95 ) in the verum group and 15 % ( S = 2.77 ) in the placebo group . After one treatment 19 out of 24 patients in the verum group ( 79.2 % ) reported pain relief of at least 50 % ( placebo group : six patients out of 24 ) . The average duration of analgesia after one treatment was 20.2 h in the verum group ( S = 21.54 ) and 1.4 h ( S = 3.50 ) in the placebo group . The results are statistically significant ( P < 0.01 ) ; they show that non-segmental verum acupuncture has an intrinsic analgesic effect in the clinical treatment of tennis elbow pain which exceeds that of placebo acupuncture OBJECTIVE To compare therapeutic effects of superficial needling and body acupuncture on knee joint pain .  METHODS Ninety-six cases of knee joint pain were r and omly divided into a treatment group of 48 cases treated with superficial needling , and a control group of 48 cases treated with body acupuncture . RESULTS The cured rate was 66.7 % in the treatment group and 39.6 % in the control group with a significant difference between the two groups ( P<0.01 ) . The total effective rate was 100.0 % in both the two groups . The needed therapeutic times of superficial needling was significantly less than that of the body acupuncture ( P < 0.05 ) . CONCLUSION Superficial needling has a good therapeutic effect on knee joint pain with a shorter therapeutic course Chronic neck myofascial pain syndrome ( MPS ) is a common disorder seen in clinics . There is no gold st and ard method to treat myofascial pain . We investigated the effects of acupuncture on patients with chronic neck MPS by a single-blind r and omized controlled trial . A total of 35 patients were r and omly allocated to an acupuncture group ( AG ) or a sham acupuncture group ( SG ) . Each subject received acupuncture treatment twice per week for three consecutive weeks . The primary outcome measure was quality of life as assessed with Short Form-36 , and secondary outcome measures were neck range of motion ( ROM ) , motion-related pain , and Short-Form McGill Pain Question naire ( SF-MPQ ) , as determined by a blinded investigator . The clinical assessment s were made before treatment ( BT ) and after six acupuncture treatments ( AT ) , as well as four weeks ( F1 ) and 12 weeks ( F2 ) after the end of the treatment . A total of 34 patients completed the trial . The results indicated that there is no significant difference in the ROM , motion-related pain , and SF-MPQ scores between AG and SG at AT , F1 and F2 ( all p > 0.05 ) . However , AG has greater improvement in physical functioning and role emotional of Short Form-36 quality of life at F2 . The results indicate that acupuncture may be used to improve the quality of life in patients with chronic neck MPS Acupuncture treatment of chronic low back pain was studied in a placebo-controlled double-blind crossover trial completed by 77 patients . The patients had significantly increased depression , neuroticism , and hypochondriasis scores . Initial pain levels correlated with state-anxiety , depression , pain duration , and abnormal illness behavior measures , as well as with the intake of psychotropic but not analgesic medication . Overall reduction in pain score was 26 percent for acupuncture and 22 percent for placebo treatment ; the difference was not significant ( p greater than 0.6 ) .  Analgesic drug intake was reduced to a similar extent in both groups . During the first phase of treatment , patients receiving acupuncture had a greater but not significantly different reduction in pain rating scores compared with those receiving placebo ( t = 0.52 ; p greater than 0.6 ) . This group showed significantly lower pain scores ( p less than 0.05 ) in the second phase of the trial while receiving placebo treatment . Overall reduction in individual patient 's pain score was best predicted by initial pain severity ( r = 0.43 ; p less than 0.001 ) and psychotropic drug intake ( r = 0.37 ; p less than 0.001 ) . None of the variables tested predicted which patients would specifically respond to acupuncture or placebo OBJECTIVES To compare the effect of real acupuncture and sham acupuncture in the treatment of temporom and ibulat joint myofascial pain , in order to establish the true efficacy of acupuncture . METHODS A double blind r and omised controlled trial conducted in the TMD Clinic , at the School of Dentistry , The University of Manchester . Twenty-seven patients were assigned to one of two treatment groups . Group 1 received real acupuncture treatment whilst Group 2 received a sham acupuncture intervention . Both the assessor and the patient were blinded regarding the group allocation . Baseline assessment of the outcome variables was made prior to the first treatment session , and was repeated following the last treatment . RESULTS The results demonstrated that real acupuncture had a greater influence on clinical outcome measure of TMJ MP  than those of sham acupuncture , and the majority of these reached a level of statistical significance . CONCLUSION Acupuncture had a positive influence on the signs and symptoms of TMJ MP .  In addition , this study provides evidence that the Park Sham Device was a credible acupuncture control method for trials involving facial acupoints OBJECTIVE This study is aim ed to assess the efficacy of traditional acupuncture for chronic neck pain in patients by comparing the differences in symptoms , dysfunctions and quality of life . METHODS The study used a two-arm , single-blinded , r and omised controlled design . The patients were r and omised to the study group and control group , who respectively received traditional acupuncture and placebo treatment . The Northwick Park Neck Pain Question naire ( NPQ ) , visual analogue scale ( VAS ) , Short Form ( 36 ) Health Survey ( SF-36 ) and doctor 's judgement were applied for measuring effectiveness . The patients ' effectiveness outcome was assessed , respectively , before the intervention , immediately after the intervention , at the end of the first month of follow-up and at the end of the third month of follow-up . The statistical analysis was done on Statistical Package for Social Sciences ( SPSS ) v13 , which included comparison of demographic and clinical homogeneity , the repeated measures approach based on the general linear model ( GLM ) for effectiveness assessment and the sum rank test for doctors ' subjective efficacy judgement . RESULTS Totally , 190 patients were recruited and 178 patients ( 88 in the study group and 90 in the control group ) completed the intervention and follow-up assessment . The scores of NPQ , VAS and SF-36 were improved after the intervention and during follow-up ( P<0.01 vs. before the intervention ) . The patients in the study group had better effectiveness outcome in NPQ , VAS and in the VT , SF and MH domains of SF-36 ( P<0.05 ) . CONCLUSION Traditional acupuncture can relieve pain intensity and improve the quality of daily life with a relative long-term clinical efficacy in patients with chronic neck pain Objective To investigate the benefit of adding acupuncture to a course of advice and exercise delivered by physiotherapists for pain reduction in patients with osteoarthritis of the knee . Design Multicentre , r and omised controlled trial . Setting 37 physiotherapy centres accepting primary care patients referred from general practitioners in the Midl and s , United Kingdom . Participants 352 adults aged 50 or more with a clinical diagnosis of knee osteoarthritis . Interventions Advice and exercise ( n=116 ) , advice and exercise plus true acupuncture ( n=117 ) , and advice and exercise plus non-penetrating acupuncture ( n=119 ) . Main outcome measures The primary outcome was change in scores on the Western Ontario and McMaster Universities osteoarthritis index pain subscale at six months . Secondary outcomes included function , pain intensity , and unpleasantness of pain at two weeks , six weeks , six months , and 12 months . Results Follow-up rate at six months was 94 % . The mean ( SD ) baseline pain score was 9.2 ( 3.8 ) . At six months mean reductions in pain were 2.28 ( 3.8 ) for advice and exercise , 2.32 ( 3.6 ) for advice and exercise plus true acupuncture , and 2.53 ( 4.2 ) for advice and exercise plus non-penetrating acupuncture . Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 ( 95 % confidence interval −1.0 to 0.9 ) for advice and exercise plus true acupuncture and 0.25 ( −0.8 to 1.3 ) for advice and exercise plus non-penetrating acupuncture . Similar non-significant differences were seen at other follow-up points . Compared with advice and exercise alone there were small , statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for non-penetrating acupuncture . Conclusion The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores . Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups , making it unlikely that this was due to acupuncture needling effects . Trial registration Current Controlled Trials IS RCT N88597683 AIMS To compare the effectiveness of dry needling in classically recognized acupuncture points ( " acupuncture " ) with dry needling in skin areas not recognized as acupuncture points ( " sham acupuncture " ) in reducing masseter muscle pain in a group of patients with myofascial pain of the jaw muscles . METHODS Eighteen patients were r and omly assigned to 1 of 2 experimental groups : Ten patients received acupuncture and 8 received sham acupuncture . A visual analog scale ( VAS ) was used to measure changes in masseter muscle pain evoked by mechanical stimulation of the masseter muscle before and after the experiment . RESULTS Both groups showed a statistically significant reduction in VAS pain scores ( P = .001 ) . Seven out of 10 acupuncture subjects had a 10 mm or greater VAS reduction in pain , while 4 out of 8 of the sham acupuncture subjects had that great a pain reduction . There was no significant difference between the 2 groups . CONCLUSION Both acupuncture and sham acupuncture reduced pain evoked by mechanical stimulation of the masseter muscles in myofascial pain patients . However , this reduction in pain was not dependent on whether the needling was performed in st and ard acupuncture points or in other areas of the skin . These results suggest that pain reduction result ing from a noxious stimulus ( i.e. , needling ) may not be specific to the location of the stimulus as predicted by the classical acupuncture literature Objective To compare true and sham acupuncture in their abilities to relieve arm pain and improve arm function in individuals with arm pain due to repetitive use . Methods Participants with persistent arm pain ( N=123 ) were r and omly assigned to true or sham acupuncture groups and received 8 treatments over 4 weeks . The primary outcome was intensity of pain ( 10-point scale ) and secondary outcomes were arm symptoms , arm function , and grip strength . Outcomes were measured during treatment ( at 2 and 4 wk ) and 1 month after treatment ended . Results Arm pain scores improved in both groups during the treatment period , but improvements were significantly greater in the sham group than in the true acupuncture group . This difference disappeared by 1 month after treatment ended . The true acupuncture group experienced more side effects , predominately mild pain at time of treatments . Discussion Sham acupuncture reduced arm pain more than true acupuncture during treatment , but the difference did not persist after 1 month . Mild side effects from true acupuncture may have blunted any positive treatment effects . Overall , this study did not find evidence to support the effectiveness of true acupuncture in treatment of persistent arm pain due to repetitive use BACKGROUND Acupuncture has been shown to be effective in pain relief and anesthesia , and has been suggested for treating various kinds of functional disabilities in traditional Chinese medicine , including knee osteoarthritis ( OA ) . The study aim ed to investigate the immediate effects of acupuncture on gait patterns in patients with knee OA . METHODS Twenty patients with bilateral medial knee OA were assigned evenly and r and omly to a sham group and an experimental group . During the experiment , the experimental group underwent a 30-minute formula electro-acupuncture treatment while the sham group received a sham treatment . Before and after treatment , each subject was evaluated for their knee pain using visual analog scales ( VAS ) and then their performance of level walking using gait analysis . For all the obtained variables , the independent t-test was used for between-group comparisons , while paired t-test was used to investigate the before and after changes . RESULTS All the measured data before acupuncture treatment between the groups were not significantly different . The VAS scores were decreased significantly after acupuncture in both groups , and the mean change of the VAS values of the experiment group was 2 times greater than that of the sham group . After formula acupuncture stimulation , while no significant changes were found in all the gait variables in the sham group , the experimental group had significant increases in the gait speed , step length , as well as in several components of the joint angles and moments . CONCLUSIONS The results of the study suggest that significantly improved gait performance in the experimental group may be associated with pain relief after treatment , but the relatively small decrease of pain in the sham group was not enough to induce significant improvements in gait patterns . Gait analysis combined with the VAS can be useful for the evaluation of the effect of acupuncture treatment for patients with neuromusculoskeletal diseases and movement disorder OBJECTIVES The effectiveness of acupuncture treatment  in patients with osteoarthritis of the hip was tested . DESIGN This is a prospect i ve , r and omized , controlled , patient- and investigator-blinded clinical trial . PATIENTS AND SETTING The study was performed at a university department for physical medicine and rehabilitation . Sixty-seven patients were separated into two treatment groups . INTERVENTIONS Group 1 ( treatment ) had traditional needle placement and manipulation , whereas in group 2 ( control ) needles were placed away from classic positions and not manipulated . In both groups needles were placed within the L2 to L5 dermatomes . Outcome parameters were : pain ( VAS ) , functional impairment ( hip score ) , activity in daily life ( ADL ) and overall satisfaction before treatment , and 2 weeks and 2 months after treatment . RESULTS For all parameters there was a significant improvement versus baseline in both groups 2 weeks and 2 months following treatment , but no significant difference between the two treatment groups . CONCLUSIONS We conclude from these results that needle placement in the area of the affected hip is associated with improvement in the symptoms of osteoarthritis . It appears to be less important to follow the rules of traditional acupuncture techniques AIM Short-term pain reduction from acupuncture in chronic myofascial pain subjects was evaluated using an 11-point ( 0 to 10 ) numeric rating scale , visual analog scale ( VAS ) , and pain rating of mechanical pressure on the masseter muscle . METHODS A single-blind , r and omized , controlled , clinical trial with an independent observer was performed . Fifteen chronic myofascial pain subjects over the age of 18 were r and omly assigned into groups : nine subjects received real acupuncture ; six subjects received sham acupuncture . Each subject clenched his/her teeth for 2 minutes . Acupuncture or sham acupuncture was administered at the Hegu Large Intestine 4 acupoint . Sham acupuncture was conducted by lightly pricking the skin with a shortened , blunted acupuncture needle through a foam pad , without penetrating the skin . The foam pad visually conceals the needle 's point of the entry , so that the subject can not discern which technique is being used . The subjects rated their general pain on a numeric rating scale . A mechanical pain stimulus was applied with an algometer and the subject rated his/her pain on a VAS . Statistical analysis was performed using the repeated measures anova , paired t-tests , and Fisher 's exact test as appropriate . RESULTS There was a statistically significant difference in pain tolerance with acupuncture ( P = 0.027 ) . There was statistically significant reduction in face pain ( P = 0.003 ) , neck pain ( P = 0.011 ) , and headache ( P = 0.015 ) with perception of real acupuncture . CONCLUSION Pain tolerance in the masticatory muscles increased significantly more with acupuncture than sham acupuncture & NA ; This prospect i ve , r and omised controlled trial , with three parallel groups , patient and observer blinded for verum and sham acupuncture and a follow up of 3 months raises the question : “ Does a combination of acupuncture and conservative orthopedic treatment improve conservative orthopedic treatment in chronic low back pain ( LBP ) . 186 in‐ patients of a LBP rehabilitation center with a history of LBP ≥6 weeks , VAS ≥50 mm , and no pending compensation cl aims , were selected ; for the three r and om group 4 weeks of treatment was applied . 174 patients met the protocol criteria and reported after treatment , 124 reported after 3 months follow up . Patients were assorted 4 strata : chronic LBP , ≤0.5 years , 0.5–2 years , 2–5 years , ≥5 years . Analysis was by intention to treat . Group 1 ( Verum+COT ) recieved 12 treatments of verum acupuncture and conservative orthopedic treatment ( COT ) . Group 2 ( Sham+COT ) recieved 12 treatments of non‐specific needling and COT . Group 3 ( nil+COT ) recieved COT alone . Verum‐ and Sham acupuncture were blinded against patient and examiner . The primary endpoints were pain reduction ≥50 % on VAS 3 months after the end of the treatment protocol . Secondary endpoints were pain reduction ≥50 % on VAS and treatment efficacy on a four‐point box scale directly after the end of the treatment protocol and treatment efficacy after 3 months . In the whole sample a pain relief of ≥50 % on VAS was reported directly after the end of treatment protocol : Verum+COT 65 % ( 95%CI 51–77 % ) , Sham+COT 34 % ( 95%ci 22–49 % ) , nil+COT 43 % ( 95%ci 29–58 % ) – results are significant for Verum+COT over Sham+COT ( P≤0.02 ) . The results after 3 months are : Verum+COT 77 % ( 95%ci 62–88 % ) , Sham+COT 29 % ( 95%ci 16–46 % ) , nil+Cot 14 % ( 95%ci 4–30 % ) – effects are significant for Verum+COT over Sham+COT ( P≤0.001 ) and for Verum+COT over nil+COT ( P<0.001 ) . No difference was found in the mobility of the patients nor in the intake of NSAID  diclofenac . Our conclusion is that acupuncture can be an important supplement of conservative orthopedic treatment in the management of chronic LBP
The aims of this systematic review were to study the analgesic effect of real acupuncture and to explore whether sham acupuncture ( SA ) type is related to the estimated effect of real acupuncture for musculoskeletal pain .