Risk factors for neck pain: a longitudinal study in the general population Group analysis versus individual response: the inferential limits of randomized controlled trials. Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis. Placebo acupuncture as a form of ritual touch healing: A neurophenomenological model CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. Safety of Acupuncture: Results of a Prospective Observational Study with 229,230 Patients and Introduction of a Medical Information and Consent Form Acupuncture for Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. “Maybe I Made Up the Whole Thing”: Placebos and Patients’ Experiences in a Randomized Controlled Trial Acupuncture in Patients With Headache Psychological distress mediates the effect of pain on function Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome Clinical observation on acupuncture treatment of intractable insomnia. Acupuncture for Depression During Pregnancy: A Randomized Controlled Trial Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report. Childhood victimization and pain in adulthood: a prospective investigation Chronic widespread pain is associated with slower cognitive processing speed in middle-aged and older European men Assessment of a traditional acupuncture therapy for chronic neck pain: a pilot randomised controlled study.
& NA ; The objective of the study was to examine the 1‐year cumulative incidence of episodic neck pain and to explore its associations with individual risk factors , including a history of previous neck injury . A baseline cross‐sectional survey of an adult general population sample made up of all 7669 adults aged 18–75 years , registered with two family practice s in South Manchester , United Kingdom , identified the study population of adults with no current neck pain . This study population was surveyed again 12 months later to identify all those who had experienced neck pain during the follow‐up period . At follow‐up , cumulative 1‐year episode incidence of neck pain was estimated at 17.9 % ( 95 % confidence interval 16.0–19.7 % ) . Incidence was independent of age , but was more common in women . A history of previous neck injury at baseline was a significant risk factor for subsequent neck pain in the follow‐up year ( risk ratio 1.7 , 95 % confidence interval 1.2–2.5 ) , independent of gender and psychological status . Other independent baseline risk factors for subsequent neck pain included number of children , poor self‐assessed health , poor psychological status and a past history of low back pain . We have carried out a prospect i ve study in a general population sample and demonstrated that established risk factors for chronic pain predict future episodes of neck pain , and shown that in addition a history of neck injury is an independent and distinct risk factor . This finding may have major public health and medicolegal implication The r and omized controlled trial ( RCT ) is the gold st and ard for assessing the efficacy of medical treatments . Over the past 50 years , RCT methodology has proven to be quite successful in identifying effective treatments and weeding out ineffective ones , thus transforming medicine from an intuitive art into an empirical science . However , the enormous success of the RCT has inadvertently contributed to a common inferential error that is insufficiently appreciated by some clinicians and research ers . Although RCTs can effectively distinguish between placebo and active treatment effects at the level of the group , contrary to intuition , this same disentanglement is much more difficult to achieve at the level of the individual . For individual patients it is surprisingly difficult to determine who is a treatment responder and who is not . Using data from a recent RCT , we illustrate the problem and detail its negative effects for research and clinical practice . Finally , we suggest strategies for minimizing these negative effects STUDY OBJECTIVES Osteoarthritis pain affects more than half of all older adults , many of whom experience co-morbid sleep disturbance . Pain initiates and exacerbates sleep disturbance , whereas disturbed sleep maintains and exacerbates pain , which implies that improving the sleep of patients with osteoarthritis may also reduce their pain . We examined this possibility in a secondary analysis of a previously published r and omized controlled trial of cognitive behavioral therapy for insomnia ( CBT-I ) in patients with osteoarthritis and co-morbid insomnia . METHODS Twenty-three patients ( mean age 69.2 years ) were r and omly assigned to  CBT-I  and 28 patients ( mean age 66.5 years ) to an attention control . Neither directly addressed pain management . Twelve subjects crossed over to CBT-I after control treatment .  Sleep and pain were assessed by self-report at baseline , after treatment , and ( for CBT-I only ) at 1-year follow-up . RESULTS CBT-I subjects reported significantly improved sleep and significantly reduced pain after treatment . Control subjects reported no significant improvements . One-year follow-up found maintenance of improved sleep and reduced pain for both the CBT-I group alone and among subjects who crossed over from control to CBT-I. CONCLUSIONS CBT-I but not an attention control , without directly addressing pain control , improved both immediate and long-term self-reported sleep and pain  in older patients with osteoarthritis and comorbid insomnia . These results are unique in suggesting the long-term durability of CBT-I effects for co-morbid insomnia . They also indicate that improving sleep , per se , in patients with osteoarthritis may result in decreased pain . Techniques to improve sleep may be useful additions to pain management programs in osteoarthritis , and possibly other chronic pain conditions as well Evidence that placebo acupuncture is an effective treatment for  chronic pain  presents a puzzle : how do placebo needles appearing to patients to penetrate the body , but instead sitting on the skin 's surface in the manner of a tactile stimulus , evoke a healing response ? Previous accounts of ritual touch healing in which patients often described enhanced touch sensations ( including warmth , tingling or flowing sensations ) suggest an embodied healing mechanism . In this qualitative study , we asked a subset of patients in a singleblind r and omized trial in irritable bowel syndrome to describe their treatment experiences while undergoing placebo treament . Analysis focused on patients ' unprompted descriptions of any enhanced touch sensations ( e.g. , warmth , tingling ) and any significance patients assigned to the sensations . We found in 5/6 cases , patients associated sensations including " warmth " and " tingling " with treatment efficacy . The conclusion offers a " neurophenomenological " account of the placebo effect by considering dynamic effects of attentional filtering on early sensory cortices , possibly underlying the phenomenology of placebo acupuncture Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials Background : To evaluate the safety of acupuncture in a large number of patients receiving conventional health care and , based on these results , to develop a new medical consent form for acupuncture . Methods : The prospect i ve observational study included patients who received acupuncture treatment for chronic osteoarthritis pain of the knee or hip , low back pain , neck pain or headache , allergic rhinitis , asthma , or dysmenorrhoea . After treatment , all patients documented adverse events associated with acupuncture ( defined as adverse effects ) . Patients who reported a need for treatment due to an adverse effect completed an additional st and ardised question naire on the most important adverse effect . Based on this data and considering ethical and legal aspects a new consent form was developed . Results : A total of 229,230 patients received on average 10.2 ± 3.0 acupuncture treatments . Altogether , 19,726 patients ( 8.6 % ) reported experiencing at least one adverse effect and 4,963 ( 2.2 % ) reported one which required treatment . Common adverse effects were bleedings or haematoma ( 6.1 % of patients , 58 % of all adverse effects ) , pain ( 1.7 % ) and vegetative symptoms ( 0.7 % ) . Two patients experienced a pneumothorax ( one needed hospital treatment , the other observation only ) . The longest duration of a side effect was 180 days ( nerve lesion of the lower limb ) . The result ing medical consent form consists of five modules : Introduction to acupuncture and moxibustion , Risks of acupuncture treatment , Conditions which can increase the risk , Doctor ’s statement , and Consent . Conclusion : Acupuncture provided by physicians is a relatively safe treatment and the proposed consent form could support both patients and professionals in the process of obtaining informed consent The purpose of the study was to evaluate the potential efficacy and acceptability of acupuncture for  posttraumatic stress disorder ( PTSD ) . People diagnosed with PTSD were r and omized to either an empirically developed acupuncture treatment ( ACU ) , a group cognitive-behavioral therapy ( CBT ) , or a wait-list control ( WLC ) . The primary outcome measure was self-reported PTSD symptoms at baseline , end treatment , and 3-month follow-up . Repeated measures MANOVA was used to detect predicted Group X Time effects in both intent-to-treat ( ITT ) and treatment completion models . Compared with the WLC condition in the ITT model , acupuncture provided large treatment effects for PTSD ( F [ 1 , 46 ] = 12.60 ; p < 0.01 ; Cohen ’s d = 1.29 ) , similar in magnitude to group CBT ( F [ 1 , 47 ] = 12.45 ; p < 0.01 ; d = 1.42 ) ( ACU vs. CBT , d = 0.29 ) . Symptom reductions at end treatment were maintained at 3-month follow-up for both interventions . Acupuncture may be an efficacious and acceptable nonexposure treatment option for PTSD . Larger trials with additional controls and methods are warranted to replicate and extend these findings 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 Patients in the placebo arms of r and omized controlled trials ( RCT ) often experience positive changes from baseline . While multiple theories concerning such “ placebo effects ” exist , peculiarly , none has been informed by actual interviews of patients undergoing placebo treatment . Here , we report on a qualitative study ( n = 27 ) embedded within a RCT ( n = 262 ) in patients with irritable bowel syndrome . Besides identical placebo acupuncture treatment in the RCT , the qualitative study patients also received an additional set of interviews at the beginning , midpoint , and end of the trial . Interviews of the 12 qualitative subjects who underwent and completed placebo treatment  were transcribed . We found that patients ( 1 ) were persistently concerned with whether they were receiving placebo or genuine treatment ; ( 2 ) almost never endorsed “ expectation ” of improvement but spoke of “ hope ” instead and frequently reported despair ; ( 3 ) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous , progressive symptom improvement to tentative impressions of benefit ; and ( 4 ) often worried whether their improvement was due to normal fluctuations or placebo effects . The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life . Immersion in this RCT was a co-mingling of enactment , embodiment and interpretation involving ritual performance and evocative symbols , shifts in bodily sensations , symptoms , mood , daily life behaviors , and social interactions , all accompanied by self-scrutiny and re- appraisal . The placebo effect involved a spectrum of factors and any single theory of placebo — e.g . expectancy , hope , conditioning , anxiety reduction , report bias , symbolic work , narrative and embodiment — provides an inadequate model to explain its salubrious benefits We aim ed to investigate the effectiveness of acupuncture in addition to routine care in patients with primary headache ( > 12 months , two or more headaches/month ) compared with treatment with routine care alone and whether the effects of acupuncture differ in r and omized and non-r and omized patients . In a r and omized controlled trial plus non-r and omized cohort , patients with headache were allocated to receive up to 15 acupuncture sessions over 3 months or to a control group receiving no acupuncture during the first 3 months . Patients who did not consent to r and omization received acupuncture treatment immediately . All subjects were allowed usual medical care in addition to study treatment . Number of days with headache , intensity of pain and health-related quality of life ( SF-36 ) were assessed at baseline , and after 3 and 6 months using st and ardized question naires . Of 15 056 headache patients ( mean age 44.1 ± 12.8 years , 77 % female ) , 1613 were r and omized to acupuncture and 1569 to control , and 11 874 included in the non-r and omized acupuncture group . At 3 months , the number of days with headache decreased from 8.4 ± 7.2 ( estimated mean ± S.E. ) to 4.7 ± 5.6 in the acupuncture group and from 8.1 ± 6.8 to 7.5 ± 6.3 in the control group ( P < 0.001 ) . Similarly , intensity of pain and quality of life improvements were more pronounced in the acupuncture vs. control group ( P < 0.001 ) . Treatment success was maintained through 6 months . The outcome changes in non-r and omized patients were similar to those in r and omized patients . Acupuncture plus routine care in patients with headache was associated with marked clinical improvements compared with routine care alone & NA ; As part of a larger longitudinal study , the current analyses characterize the relationship among pain , psychological distress , and  physical function after major lower extremity trauma .  Structural equation modeling techniques were utilized to analyze data from a prospect i ve 2‐year observational study of 327 patients treated at 8 level I trauma centers . Data were gathered at 3 , 6 , 12 , and 24 months after injury . In the models tested , higher levels of depressive and anxious distress at the preceding time point was related to lower levels of functioning at 6 , 12 , and 24 months , and higher levels of pain at the preceding time point were related to lower levels of functioning at 6 and 12 months , but not at 24 months . A reverse model in which lower levels of functioning led to higher levels of psychological distress or pain was tested and did not fit the data . The combination of depressive and anxious distress plays an increasingly important role in mediating the impact of pain on physical function as the recovery from lower extremity trauma progresses from early to later stages . Both pain and psychological distress contribute to reduced function during the first year after a serious injury ; however , as recovery proceeds , the role of psychological distress in determining function increases . Longitudinal data on patients with severe leg trauma demonstrates that as recovery proceeds , psychological distress plays an increasingly important role in mediating the impact of pain on function Objective To investigate whether placebo effects can experimentally be separated into the response to three components— assessment and observation , a therapeutic ritual ( placebo treatment ) , and a supportive patient-practitioner relationship— and then progressively combined to produce incremental clinical improvement in patients with irritable bowel syndrome . To assess the relative magnitude of these components . Design A six week single blind three arm r and omised controlled trial . Setting Academic medical centre . Participants 262 adults ( 76 % women ) , mean ( SD ) age 39 ( 14 ) , diagnosed by Rome II criteria for and with a score of ≥150 on the symptom severity scale . Interventions For three weeks either waiting list ( observation ) , placebo acupuncture alone ( “ limited ” ) , or placebo acupuncture with a patient-practitioner relationship augmented by warmth , attention , and confidence ( “ augmented ” ) . At three weeks , half of the patients were r and omly assigned to continue in their originally assigned group for an additional three weeks . Main outcome measures Global improvement scale ( range 1 - 7 ) , adequate relief of symptoms , symptom severity score , and quality of life . Results At three weeks , scores on the global improvement scale were 3.8 ( SD 1.0 ) v 4.3 ( SD 1.4 ) v 5.0 ( SD 1.3 ) for waiting list versus “ limited ” versus “ augmented , ” respectively ( P<0.001 for trend ) . The proportion of patients reporting adequate relief showed a similar pattern : 28 % on waiting list , 44 % in limited group , and 62 % in augmented group ( P<0.001 for trend ) . The same trend in response existed in symptom severity score ( 30 ( 63 ) v 42 ( 67 ) v 82 ( 89 ) , P<0.001 ) and quality of life ( 3.6 ( 8.1 ) v 4.1 ( 9.4 ) v 9.3 ( 14.0 ) , P<0.001 ) . All pairwise comparisons between augmented and limited patient-practitioner relationship were significant : global improvement scale ( P<0.001 ) , adequate relief of symptoms ( P<0.001 ) , symptom severity score ( P=0.007 ) , quality of life ( P=0.01 ) . Results were similar at six week follow-up . Conclusion Factors contributing to the placebo effect can be progressively combined in a manner resembling a grade d dose escalation of component parts . Non-specific effects can produce statistically and clinical ly significant outcomes and the patient-practitioner relationship is the most robust component . Trial registration Clinical Trials NCT00065403 OBJECTIVE To observe the effects of acupuncture for treatment of  intractable insomnia .  METHODS Totally 90 patients were r and omly divided into a treatment group ( 50 cases ) , treated by the body acupuncture plus auricular-plaster therapy , and a control group ( 40 cases ) , the Baihui ( GV 20)-through-Sishencong ( EX-HN1 ) . puncture , auricular-plaster therapy and moxibustion on the back-shu points were not used in the control group . The clinical effects were observed . RESULTS The total effective rate was 98.0 % in the treatment group and 77.5 % in the control group . The therapeutic effect in the treatment group was much better than that in the control group ( P < 0.01 ) . CONCLUSION The body acupuncture plus auricular-plaster therapy may show better effect for intractable insomnia OBJECTIVE : To estimate the efficacy of acupuncture for depression during pregnancy in a r and omized controlled trial . METHODS : A total of 150 pregnant women who met Diagnostic and Statistical Manual of Mental Disorders ( Fourth Edition ) criteria for major depressive disorder were r and omized to receive either acupuncture specific for depression or one of two active controls : control acupuncture or massage . Treatments lasted 8 weeks ( 12 sessions ) . Junior acupuncturists , who were not told about treatment assignment , needled participants at points prescribed by senior acupuncturists . All treatments were st and ardized . The primary outcome was the Hamilton Rating Scale for Depression , administered by masked raters at baseline and after 4 and 8 weeks of treatment . Continuous data were analyzed using mixed effects models and by intent to treat . RESULTS : Fifty-two women were r and omized to acupuncture specific for depression , 49 to control acupuncture , and 49 to  massage . Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity ( P<.05 ) compared with the combined controls ( Cohen 's d=0.39 , 95 % confidence interval [ CI ] 0.01–0.77 ) or control acupuncture alone ( P<.05 ; Cohen 's d=0.46 , 95 % CI 0.01–0.92 ) . They also had significantly greater response rate ( 63.0 % ) than the combined controls ( 44.3 % ; P<.05 ; number needed to treat , 5.3 ; 95 % CI 2.8–75.0 ) and control acupuncture alone ( 37.5 % ; P<.05 : number needed to treat , 3.9 ; 95 % CI 2.2–19.8 ) . Symptom reduction and response rates did not differ significantly between controls ( control acupuncture , 37.5 % ; massage , 50.0 % ) . CONCLUSION : The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in st and ard depression treatments of similar length and could be a viable treatment option for depression during pregnancy . CLINICAL TRIAL REGISTRATION : Clinical trials.gov , www . clinical trials.gov , NCT00186654 . LEVEL OF EVIDENCE : The response to acupuncture of 18 anxious adult subjects who complained of insomnia was assessed in an open prepost clinical trial study . Five weeks of acupuncture treatment was associated with a significant ( p = 0.002 ) nocturnal increase in endogenous melatonin secretion ( as measured in urine ) and significant improvements in polysomnographic measures of sleep onset latency ( p = 0.003 ) , arousal index ( p = 0.001 ) , total sleep time ( p = 0.001 ) , and sleep efficiency ( p = 0.002 ) . Significant reductions in state ( p = 0.049 ) and trait ( p = 0.004 ) anxiety scores were also found . These objective findings are consistent with clinical reports of acupuncture 's relaxant effects .  Acupuncture treatment may be of value for some categories of anxious patients with insomnia & NA ; Evidence of the relationship between childhood abuse and pain problems in adulthood has been based on cross‐sectional studies using retrospective self‐reports of childhood victimization . The objective of the current study was to determine whether childhood victimization increases risk for adult pain complaints , using prospect i ve information from documented cases of child abuse and neglect . Using a prospect i ve cohort design , cases of early childhood abuse or neglect documented between 1967 and 1971 ( n=676 ) and demographically matched controls ( n=520 ) were followed into young adulthood . The number of medically explained and unexplained pain complaints reported at follow‐up ( 1989–1995 ) was examined . Assessed prospect ively , physically and sexually abused and neglected individuals were not at risk for increased pain symptoms . The odds of reporting one or more unexplained pain symptoms was not associated with any childhood victimization or specific types ( i.e. sexual abuse , physical abuse , or neglect ) . In contrast , the odds of one or more unexplained pain symptoms was significantly associated with retrospective self‐reports of all specific types of childhood victimization . These findings indicate that the relationship between childhood victimization and pain symptoms in adulthood is more complex than previously thought . The common assumption that medically unexplained pain is of psychological origin should be question ed . Additional research conducting comprehensive physical examinations with victims of childhood abuse and neglect is recommended & NA ; Evidence from clinic‐based studies suggests that the fibromyalgia syndrome ( FMS ) is associated with impairment in cognitive function though the mechanism is unclear . The aim of this analysis was to determine whether there is a similar association between chronic widespread pain ( CWP ) , a cardinal feature of FMS , and impaired cognition in a community setting . Men ( n = 3369 , 40–79 years ) were recruited from population registers in eight centres for participation in the European Male Ageing Study ( EMAS ) . The subjects completed a pain question naire and pain manikin , with the presence of CWP defined using the American College of Rheumatology criteria . The cognitive functions measured were visuospatial‐constructional ability and visual memory ( Rey‐Osterrieth Complex Figure [ ROCF ] ) ; visual recognition ( Camden Topographical Recognition Memory test [ CTRM ] ) ; and psychomotor processing speed ( Digit‐Symbol Substitution test [ DSST ] ) . We restricted our analysis to those subjects reporting pain that satisfied the criteria for CWP and those who were pain free . Of these 1539 men [ mean ( SD ) age 60 ( 11 ) years ] , 266 had CWP .  All cognitive test scores declined cross‐sectionally with age ( P < 0.05 ) . In age‐adjusted linear regressions men with CWP had a lower DSST score ( & bgr ; = −2.4 , P < 0.001 ) compared to pain‐free subjects . After adjustment for lifestyle and health factors the association between pain status and the DSST score was attenuated but remained significant ( & bgr ; = −1.02 , P = 0.04 ) . There was no association between CWP and the ROCF‐copy , ROCF‐recall or CTRM scores . CWP is associated with slower psychomotor processing speed among community‐dwelling European men . Prospect i ve studies are required to confirm this observation and explore possible mechanisms for the association 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
Background Co-morbid symptoms ( for example , chronic pain , depression , anxiety , and fatigue ) are particularly common in military fighters returning from the current conflicts , who have experienced physical and /or psychological trauma .
These overlapping conditions cut across the boundaries of mind , brain and body , result ing in a common symptomatic and functional spectrum of physical , cognitive , psychological and behavioral effects referred to as the ‘ Trauma Spectrum Response ’ ( TSR ) .
While acupuncture has been shown to treat some of these components effectively , the current literature is often difficult to interpret , inconsistent or of variable quality .