Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial. Acupuncture and electro‐acupuncture for people diagnosed with subacromial pain syndrome: A multicentre randomized trial Effects of Acupuncture Treatment on Fibromyalgia Symptoms, Serotonin, and Substance P Levels: A Randomized Sham and Placebo-Controlled Clinical Trial The effects of acupuncture versus sham acupuncture in the treatment of fibromyalgia: a randomized controlled clinical trial. Acupuncture for patients with chronic neck pain Acupuncture in patients with osteoarthritis of the knee: a randomised trial Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) – A pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee Acupuncture in patients with chronic low back pain: a randomized controlled trial. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Acupuncture treatment of chronic low-back pain – a randomized, blinded, placebo-controlled trial with 9-month follow-up Acupuncture for chronic knee pain: a randomized clinical trial. Efficacy and safety of acupuncture for chronic uncomplicated neck pain: A randomised controlled study Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial Delayed Effect of Acupuncture Treatment in OA of the Knee: A Blinded, Randomized, Controlled Trial Acupuncture for Fibromyalgia in Primary Care: A Randomised Controlled Trial A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Comparison of the Effectiveness of Acupuncture Treatment and Local Anaesthetic Injection for Low Back Pain: A Randomised Controlled Clinical Trial A Comparison of Acupuncture with Advice and Exercises on the Symptomatic Treatment of Osteoarthritis of the Hip – a Randomised Controlled Trial A randomized clinical trial of fibromyalgia treatment with acupuncture compared with fluoxetine Acupuncture in Patients With Headache Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a preliminary study. Effects of trigger point acupuncture treatment on temporomandibular disorders: a preliminary randomized clinical trial. Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham-controlled trial Acupuncture in the Management of Chronic Low Back Pain: A Blinded Randomized Controlled Trial Comparison between superficial and deep acupuncture in the treatment of the shoulder's myofascial pain: a randomized and 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 Chronic Tension-Type Headache Treated with Acupuncture, Physical Training and Relaxation Training. Between-Group Differences Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial. Trigger Point Acupuncture Treatment of Chronic Low Back Pain in Elderly Patients – a Blinded Rct Acupuncture for Knee Osteoarthritis – a Randomised Trial Using a Novel Sham Relief of Low Back Pain Immediately after Acupuncture Treatment – a Randomised, Placebo Controlled Trial Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. Pressure pain threshold and needle acupuncture in chronic tension-type headache – a double-blind placebo-controlled study Are Sham Acupuncture Interventions More Effective than (Other) Placebos? A Re-Analysis of Data from the Cochrane Review on Placebo Effects Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial Acupuncture and botulinum toxin A injection in the treatment of chronic migraine: A randomized controlled study Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Efficacy of acupuncture as a treatment for chronic shoulder pain. Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis. Integrating Acupuncture With Exercise-Based Physical Therapy for Knee Osteoarthritis: A Randomized Controlled Trial Acupuncture Needling versus Lidocaine Injection of Trigger Points in Myofascial Pain Syndrome in Elderly Patients – a Randomised Trial Randomized clinical trial of acupuncture for myofascial pain of the jaw muscles. Effectiveness and acceptance of acupuncture in patients with chronic low back pain: results of a prospective, randomized, controlled trial. Comparison of Superficial and Deep Acupuncture in the Treatment of Lumbar Myofascial Pain: A Double-Blind Randomized Controlled Study Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Efficacy of abdominal acupuncture for neck pain: A randomized controlled trial Acupuncture treatment of shoulder impingement syndrome: A randomized controlled trial. The impact of chronic pain in the community. The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a 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 Language bias in randomised controlled trials published in English and German 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 Evidence-based Complementary and Alternative Medicine. Efficacies of Acupuncture and Anti-inflammatory Treatment for Carpal Tunnel Syndrome.
Background Placebo treatment can significantly influence subjective symptoms . However , it is widely believed that response to placebo requires concealment or deception . We tested whether open-label placebo ( non-deceptive and non-concealed administration ) is superior to a no-treatment control with matched patient-provider interactions in the treatment of irritable bowel syndrome ( IBS ) . Methods Two-group , r and omized , controlled three week trial ( August 2009-April 2010 ) conducted at a single academic center , involving 80 primarily female ( 70 % ) patients , mean age 47±18 with IBS diagnosed by Rome III criteria and with a score ≥150 on the IBS Symptom Severity Scale ( IBS-SSS ) . Patients were r and omized to either open-label placebo pills presented as “ placebo pills made of an inert substance , like sugar pills , that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes ” or no-treatment controls with the same quality of interaction with providers . The primary outcome was IBS Global Improvement Scale ( IBS-GIS ) . Secondary measures were IBS Symptom Severity Scale ( IBS-SSS ) , IBS Adequate Relief ( IBS-AR ) and IBS Quality of Life ( IBS-QoL ) . Findings Open-label placebo produced significantly higher mean ( ±SD ) global improvement scores ( IBS-GIS ) at both 11-day midpoint ( 5.2±1.0 vs. 4.0±1.1 , p<.001 ) and at 21-day endpoint ( 5.0±1.5 vs. 3.9±1.3 , p = .002 ) . Significant results were also observed at both time points for reduced symptom severity ( IBS-SSS , p = .008 and p = .03 ) and adequate relief ( IBS-AR , p = .02 and p = .03 ) ; and a trend favoring open-label placebo was observed for quality of life ( IBS-QoL ) at the 21-day endpoint ( p = .08 ) . Conclusion Placebos administered without deception may be an effective treatment for IBS . Further research is warranted in IBS , and perhaps other conditions , to eluci date whether physicians can benefit patients using placebos consistent with informed consent . Trial Registration Clinical Trials.gov 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 BACKGROUND Acupuncture stimulates points on the body , influencing the perception of myofascial pain or altering physiologic functions . OBJECTIVE The aim was to evaluate the effect of electroacupuncture ( EAC ) and acupuncture ( AC ) for myofascial pain of the upper trapezius and cervical range of motion , using SHAM acupuncture as control . METHOD Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were r and omized into EAC , AC , and SHAM groups .  Eight sessions were scheduled and a follow-up was conducted after 28 days . The Visual Analog Scale assessed the intensity of local and general pain . A fleximeter assessed cervical movements . Data were analyzed using paired t or Wilcoxon 's tests , ANOVA or Friedman or Kruskal-Wallis tests and Pearson 's correlation ( α=0.05 ) . RESULTS There was reduction in general pain in the EAC and AC groups after eight sessions ( P<0.001 ) . A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups . Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group ( P<0.05 ) , which showed an increase in left rotation ( P=0.049 ) . The AC group showed increases in inclination ( P=0.005 ) sustained until follow-up and rotation to the right ( P=0.032 ) . CONCLUSION EAC and AC were effective in reducing the pain intensity compared with SHAM . EAC was better than AC for local pain relief . These treatments can assist in increasing cervical range of motion , albeit subtly BACKGROUND Musculoskeletal disorders have been identified globally as the second most common healthcare problem for ' years lived with disability ' , and of these shoulder conditions are amongst the most common , frequently associated with substantial pain and morbidity . Exercise and acupuncture are often provided as initial treatments for musculoskeletal shoulder conditions but their clinical effectiveness is uncertain . This study compared group exercise with group exercise plus either acupuncture or electro-acupuncture in patients with subacromial pain syndrome . METHODS Two hundred and twenty-seven participants were recruited to a three-arm parallel-group r and omized clinical trial . The primary outcome measure was the Oxford Shoulder Score . Follow-up was post treatment , and at 6 and 12 months . Between-group differences ( two comparisons : the exercise group versus each of the acupuncture groups ) were analysed at 6 months . A similar comparison across all follow-up time points was also conducted . Data were analysed on intention-to-treat principles with imputation of missing values . RESULTS Treatment groups were similar at baseline , and all treatment groups demonstrated an improvement over time . Between-group estimates at 6 months were , however , small and non-significant , for both of the comparisons . The analyses across all follow-up time points yielded similar conclusions . There was a high rate of missing values ( 22 % for the Oxford Shoulder Score ) . A sensitivity analysis using complete data gave similar conclusions to the analysis with missing values imputed . CONCLUSIONS In the current investigation , neither acupuncture nor electro-acupuncture were found to be more beneficial than exercise alone in the treatment of subacromial pain syndrome . These findings may support clinicians with treatment planning . SIGNIFICANCE Shoulder pain is common and associated with substantial morbidity . Acupuncture is a popular treatment for shoulder pain . The findings suggest that acupuncture and electro-acupuncture offer no additional benefit over exercise in the treatment of shoulder pain of musculoskeletal origin Objective The aim of this study was to evaluate the effects of acupuncture treatment on serum levels of serotonin and substance P ( SP ) as well as on clinical parameters in patients with fibromyalgia ( FM ) . Methods This is a r and omized controlled clinical trial . Seventy-five women with FM were r and omized into one of three kinds of acupuncture treatment : real acupuncture group ( AcG ) , sham acupuncture group ( ShG ) , and simulated acupuncture group ( SiG ) . Treatments were applied semiweekly for four weeks . The serum levels of serotonin and SP were evaluated before and after the eight sessions . Patients were clinical ly assessed by visual analog scale ( VAS ) , the number of tender points ( NTP ) , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory ( BDI ) , and Nottingham Health Profile ( NHP ) at baseline , after the last treatment , and one and three months after completion of all treatments . Results Serum serotonin values increased significantly after treatment in AcG and ShG ( P < 0.001 and P < 0.01 , respectively ) . The increase in the AcG was also different from both of the other groups ( P < 0.01 ) . While SP levels decreased in the AcG , they increased in the SiG ( P = 0.001 ) . In the AcG , significant improvements were found in almost all clinical outcomes after treatment . These usually continued for three months . In the ShG , there were also significant changes on the NTP , VAS , FIQ , and BDI scores after treatment . Improvements on the NTP and FIQ scores lasted for three months . In the SiG , significant improvements were found only in the NTP , VAS , and BDI scores after treatment . Conclusions Acupuncture , rather than sham or placebo acupuncture , may lead to long-term improvements on clinical outcomes and pain neuromediator values . Changes in serum serotonin and SP levels may be a valuable explanation for acupuncture mechanisms in FM treatment OBJECTIVE The aim of this manuscript is to determine and to compare the efficacy of real acupuncture with sham acupuncture on fibromyalgia ( FM ) treatment . METHODS 50 women with FM were r and omized into 2 groups to receive either true acupuncture or sham acupuncture . Subjects were evaluated with VAS ( at night , at rest , during activity ) , SF-36 , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression scale ( BDI ) , Fatigue Severity Scale ( FSS ) at baseline , 1 month and 2 months after the 1st session . Patients in both groups received 3 sessions in the 1st week , 2 sessions/week during 2 weeks and 1 session/week in the following 5 weeks ( totally 12 sessions ) . RESULTS 25 subjects with a mean age of 47,28±7,86 years were enrolled in true acupuncture group and 25 subjects with a mean age of 43,60±8,18 years were enrolled in sham acupuncture group . Both groups improved significantly in all parameters 1 month after the 1st session and this improvement persisted 2 months after the 1st session ( p<0,05 ) . However , real acupuncture group had better scores than sham acupuncture score in terms of all VAS scores , BDI and FIQ scores either 1 or 2 months after the 1st session ( all p<0,05 ) . CONCLUSION Acupuncture significantly improved pain and symptoms of FM . Although sham effect was important , real acupuncture treatment seems to be effective in treatment of FM & NA ; Acupuncture is widely used by patients with neck pain , but there is a lack of information about its effectiveness in routine medical care . The aim was to investigate the effectiveness of acupuncture in addition to routine care in patients with chronic neck pain compared to treatment with routine care alone . We performed a r and omized controlled multicentre trial plus non‐r and omized cohort in general practice s in Germany . 14,161 patients with chronic neck pain ( duration > 6 months ) . Patients were r and omly allocated to an acupuncture group or a control group receiving no acupuncture . Patients in the acupuncture group received up to 15 acupuncture sessions over three months . Patients who did not consent to r and omization received acupuncture treatment . All subjects were allowed to receive usual medical care in addition to study treatment . Neck pain and disability ( NPAD Scale by Wheeler ) after three months . Of 14,161 patients ( mean age 50.9 ± 13.1 years , 68 % female ) 1880 were r and omized to acupuncture and 1886 to control , and 10,395 included into the non‐r and omized acupuncture group . At three months , neck pain and disability improved by 16.2 ( SE : 0.4 ) to 38.3 ( SE : 0.4 ) ; and by 3.9 ( SE : 0.4 ) to 50.5 ( SE : 0.4 ) , difference 12.3 ( p < 0.001 ) in the acupuncture and control group , respectively . Treatment success was essentially maintained through six months . Non‐r and omized patients had more severe symptoms at baseline and showed higher neck pain and disability improvement compared to r and omized patients . Treatment with acupuncture added to routine care in  patients with chronic neck pain  was associated with improvements in neck pain and disability compared to treatment with routine care alone 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 Study Design . A r and omized controlled clinical trial was conducted . Objective . To compare medication , needle acupuncture , and spinal manipulation for managing chronic ( > 13 weeks duration ) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain . Summary of Background Data . Between February 1999 and October 2001 , 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital ’s multidisciplinary spinal pain unit . Methods . One of three separate intervention protocol s was used : medication , needle acupuncture , or chiropractic spinal manipulation . Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index ( Oswestry ) , the Neck Disability Index ( NDI ) , the Short-Form-36 Health Survey question naire ( SF-36 ) , visual analog scales ( VAS ) of pain intensity and ranges of movement . These instruments were administered again at 2 , 5 , and 9 weeks after the beginning of treatment . Results . R and omization proved to be successful . The highest proportion of early ( asymptomatic status ) recovery was found for manipulation ( 27.3 % ) , followed by acupuncture ( 9.4 % ) and medication ( 5 % ) . Manipulation achieved the best overall results , with improvements of 50 % ( P = 0.01 ) on the Oswestry scale , 38 % ( P = 0.08 ) on the NDI , 47 % ( P < 0.001 ) on the SF-36 , and 50 % ( P < 0.01 ) on the VAS for back pain , 38 % ( P < 0.001 ) for lumbar st and ing flexion , 20 % ( P < 0.001 ) for lumbar sitting flexion , 25 % ( P = 0.1 ) for cervical sitting flexion , and 18 % ( P = 0.02 ) for cervical sitting extension . However , on the VAS for neck pain , acupuncture showed a better result than manipulation ( 50%vs 42 % ) . Conclusions . The consistency of the results provides , despite some discussed shortcomings of this study , evidence that in patients with chronic spinal pain , manipulation , if not contraindicated , results in greater short-term improvement than acupuncture or medication . However , the data do not strongly support the use of only manipulation , only acupuncture , or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain . The results from this exploratory study need confirmation from future larger studies OBJECTIVE To evaluate the effects of st and ardized western acupuncture and physiotherapy on pain and functional ability in patients with severe osteoarthritic knee pain awaiting knee arthroplasty . METHODS Three-arm , assessor-blind , r and omized controlled trial . PARTICIPANTS 181 patients awaiting knee arthroplasty . INTERVENTIONS acupuncture for 6 weeks ; physiotherapy for 6 weeks ; st and ardized advice . MAIN OUTCOME MEASURES Oxford Knee Score question naire ( OKS ) ( primary ) ; 50 m timed walk , and duration of hospital stay following knee arthroplasty . RESULTS There was no baseline difference between groups . At 7 weeks , there was a 10 % reduction in OKS in the acupuncture group which was a significant difference between the acupuncture and the control group : Mean ( s.d . ) acupuncture 36.8 ( 7.20 ) ; physiotherapy 39.2 ( 8.22 ) ; control 40.3 ( 8.48 ) ( P = 0.0497 ) . These effects were no longer present at 12 weeks . There was a trend ( P = 0.0984 ) towards a shorter in-patient stay of 1 day for the physiotherapy group [ mean 6.50 days ( s.d . 2.0 ) ] compared with the acupuncture group [ mean 7.77 days ( s.d . 3.96 ) ] . CONCLUSIONS We have demonstrated that patients with severe knee osteoarthritis can achieve a short-term reduction in OKS when treated with acupuncture . However , we failed to demonstrate any other clinical ly or statically significant effects between the groups . Both interventions can be delivered effectively in an out-patient group setting at a district general hospital . Further study is needed to evaluate the combined effects of these treatments & 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 Context Previous studies of acupuncture for osteoarthritis have had conflicting results . This may have occurred because most studies have included small sample s , a limited number of treatment sessions , or other limitations . Contribution This r and omized , controlled trial compared 24 acupuncture sessions over 26 weeks with sham acupuncture or arthritis education in 570 patients with osteoarthritis of the knee .  Acupuncture led to greater improvements in function but not pain after 8 weeks and in both pain and function after 26 weeks . No adverse effects were associated with acupuncture . Caution s Many participants dropped out of the study , so readers should interpret the findings at 26 weeks with caution . The Editors Osteoarthritis is the most common form of arthritis and is a major cause of morbidity , limitation of activity , and health care utilization , especially in elderly patients ( 1 , 2 ) . Pain and functional limitation are the primary clinical manifestations of osteoarthritis of the knee . Current recommendations for managing osteoarthritis , including guidelines published by the American College of Rheumatology ( 3 ) and European League of Associations of Rheumatology ( 4 ) , focus on relieving pain and stiffness and maintaining or improving physical function as important goals of therapy . No curative therapies exist for osteoarthritis ; thus , both pharmacologic and nonpharmacologic management focus on controlling pain and reducing functional limitation ( 5 ) . Nonpharmacologic therapy , which includes patient education , social support , physical and occupational therapy , aerobic and resistive exercises , and weight loss , is the cornerstone of a multidisciplinary approach to osteoarthritis patient management ( 3 ) . Pharmacologic therapies include nonopioid analgesics ( such as acetaminophen ) , nonsteroidal anti-inflammatory drugs ( NSAIDs ) ( including cyclooxygenase-2 [ COX-2 ] enzyme selective inhibitors ) , topical analgesics ( capsaicin cream ) , opioid analgesics , and intra-articular steroid and hyaluronate injections . Often , these agents are used in combination for additive analgesic efficacy ( 6 ) . Pharmacologic management of osteoarthritis is often ineffective , and agents such as NSAIDs may cause unwanted and dangerous side effects ( 7 , 8) . Complementary and alternative medicine is another approach to treating osteoarthritis ( 9 - 12 ) , particularly in Asian societies ( 13 ) . Many U.S. patients with osteoarthritis also use complementary and alternative medical therapies ( 14 ) . A systematic review of acupuncture and knee osteoarthritis ( 15 ) identified 7 small r and omized , controlled trials published in English . Within the method ologic limitations of the studies , the evidence suggested that acupuncture seemed to alleviate knee pain and function compared with sham acupuncture controls , although 2 trials comparing acupuncture with an active , nonpharmacologic treatment ( physical therapy ) did not indicate such an effect ( 16 , 17 ) . Before conducting our large-scale trial , we completed both a pilot study ( 18 ) and a r and omized , single-blind trial ( 19 ) of the effect of acupuncture on osteoarthritis of the knee . Participants in the uncontrolled pilot study ( n= 12 ) showed statistically significant improvement in both self-reported pain and physical function , as well as performance measures of physical function after 8 weeks of acupuncture treatment and at 12-week follow-up as compared with their baseline ( 18 ) . In our larger r and omized , single-blind trial ( n= 73 ) , which examined the benefit of acupuncture added to st and ard management with NSAIDs , the acupuncture  treatment group experienced statistically significant improvements in self-reported pain and disability scores compared with a st and ard-care control group as late as 4 weeks after the end of treatment ( 19 ) . However , this effect diminished within 18 weeks ( 26 weeks after the beginning of the trial ) after the final acupuncture treatment . Together , however , the previously conducted trials ( both our preliminary studies [ 18 , 19 ] and those referenced in the systematic review [ 15 ] ) have 3 method ologic limitations : lack of credible controls for the placebo effect , inadequate assessment of long-term treatment benefits , and insufficient sample sizes . We tested the hypothesis that an 8-week intensive acupuncture treatment regimen , followed by an 18-week tapering regimen , reduces pain and improves function among patients with knee osteoarthritis as compared with both sham acupuncture and education control groups . Methods Patient Recruitment We recruited patients for this multisite , placebo-controlled trial from March 2000 through December 2003 , primarily through print and radio advertisements . The 3 sites were the Integrative Medicine Clinic of the University of Maryl and School of Medicine , Baltimore , Maryl and ; the Innovative Medical Research Center ( a private research firm ) , Towson , Maryl and ; and the Hospital for Special Surgery , New York City , New York . The institutional review boards of the 3 sites approved the study . We determined the sample size ( n= 570 ) by a power analysis based on our r and omized pilot study ( 19 ) , adjusted by the estimated decrease in effect size result ing from the inclusion of a sham acupuncture group design ed to control for placebo effects . Patients met the following inclusion criteria : age 50 years or older , a diagnosis of osteoarthritis of the knee , radiographic evidence of at least 1 osteophyte at the tibiofemoral joint ( KellgrenLawrence grade 2 ) , moderate or greater clinical ly significant knee pain on most days during the past month , and willingness to be r and omly assigned . Exclusion criteria were the presence of serious medical conditions that precluded participation in study , bleeding disorders that might contraindicate acupuncture , intra-articular corticosteroid or hyaluronate injections ( as well as any knee surgeries or concomitant use of topical capsaicin cream ) during the past 6 months , previous experience with acupuncture , or any planned events ( including total knee replacement ) that would interfere with participation in the study during the following 26 weeks . After a brief telephone screening , patients were scheduled to visit 1 of the 3 participating sites to sign an informed consent statement and undergo a brief rheumatologic examination ( including radiographic examination of affected knees ) by a physician or a nurse practitioner . Because the education course was a group activity , patients were recruited until a cohort of 12 to 21 patients was formed , at which point each cohort at each site was r and omly assigned to 1 of 3 groups by a computer-generated process using r and omly selected blocks of 3 , 6 , and 9 . We assured allocation concealment by using disguised letter codes that were generated and sent to the site coordinators by a central statistical core . We used this procedure to ensure that approximately equal numbers of participants were in each treatment group across the course of the study , to ensure that each cohort would have participants assigned to all 3 treatment groups , and to make the breaking of the group assignment process more difficult . The research assistants who collected assessment s from participants , the participants themselves ( in the true acupuncture and sham acupuncture groups ) , and the statistician were blinded to group assignment . Assessment s were conducted at baseline and 4 , 8 , 14 , and 26 weeks after r and omization . Study Interventions We developed and modified the acupuncture treatment and sham control protocol s from previously reported and vali date d procedures ( 18 - 21 ) . During the trial , 7 acupuncturists were used : 3 at the Integrative Medicine Clinic , 3 at the Innovative Medical Research Center , and 1 at the Hospital for Special Surgery . In general , acupuncturists were assigned to the same participants throughout the 26-week treatment schedule , except for vacation conflicts and staff turnover , and provided approximately the same proportions of true versus sham procedures . All acupuncturists were state-licensed and had at least 2 years of clinical experience . The study 's principal acupuncturist trained and supervised the acupuncturists in performing true or sham procedures and avoiding interactions that could inadvertently communicate group assignment . True Acupuncture The true acupuncture  ( experimental ) group underwent 26 weeks of gradually tapering treatment according to the following schedule : 8 weeks of 2 treatments per week followed by 2 weeks of 1 treatment per week , 4 weeks of 1 treatment every other week , and 12 weeks of 1 treatment per month . We based the acupuncture point selection s on Traditional Chinese Medicine meridian theory to treat knee joint pain , known as the Bi syndrome . These points consisted of 5 local points ( Yanglinquan [ gall bladder meridian point 34 ] , Yinlinquan [ spleen meridian point 9 ] , Zhusanli [ stomach meridian point 36 ] , Dubi [ stomach meridian point 35 ] , and extra point Xiyan ) and 4 distal points ( Kunlun [ urinarybladder , meridian point 60 ] , Xuanzhong [ gall bladder meridian point 39 ] , Sanyinjiao [ spleen meridian point 6 ] , and Taixi [ kidney meridian point 3 ] ) on meridians that traverse the area of pain ( 22 , 23 ) . The same points were treated for each affected leg . If both knees were affected , 9 needles were inserted in each leg . ( The outcome measures were not specifically targeted to whether the patient had osteoarthritis in 1 or both knees , and we observed no differential effects on the basis of the number of knees treated . ) The acupuncturists inserted 1.5-inch ( for local points ) and 1-inch ( for distal points ) 32-gauge ( 0.25-mm diameter ) acupuncture needles to a conventional depth of approximately 0.3 to 1.0 inch , depending on point location . All participants in the treatment group achieved the De-Qi sensation , a local sensation of heaviness , numbness , soreness , or paresthesia that accompanies the insertion and manipulation of needles during acupuncture , at these 9 points . Acupuncturists applied electrical 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 In a r and omized controlled trial plus a nonr and omized cohort , the authors investigated the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic low back pain and assessed whether the effects of acupuncture differed in r and omized and nonr and omized patients . In 2001 , German patients with chronic low back pain were allocated to an acupuncture group or a no-acupuncture control group .  Persons who did not consent to r and omization were included in a nonr and omized acupuncture group . All patients were allowed to receive routine medical care in addition to study treatment .  Back function ( Hannover Functional Ability Question naire ) , pain , and quality of life were assessed at baseline and after 3 and 6 months , and cost-effectiveness was analyzed . Of 11,630 patients ( mean age=52.9 years ( st and ard deviation , 13.7 ) ; 59 % female ) , 1,549 were r and omized to the acupuncture group and 1,544 to the control group ; 8,537 were included in the nonr and omized acupuncture group . At 3 months , back function improved by 12.1 ( st and ard error ( SE ) , 0.4 ) to 74.5 ( SE , 0.4 ) points in the acupuncture group and by 2.7 ( SE , 0.4 ) to 65.1 ( SE , 0.4 ) points among controls ( difference=9.4 points ( 95 % confidence interval 8.3 , 10.5 ) ; p<0.001 ) . Nonr and omized patients had more severe symptoms at baseline and showed improvements in back function similar to those seen in r and omized patients . The incremental cost-effectiveness ratio was euro10,526 ( euros ) per quality -adjusted life year . Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective & 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 IMPORTANCE There is debate about benefits of acupuncture for  knee pain . OBJECTIVE To determine the efficacy of laser and needle acupuncture for  chronic knee pain . DESIGN , SETTING , AND PARTICIPANTS Zelen- design clinical trial ( r and omization occurred before informed consent ) , in Victoria , Australia ( February 2010-December 2012 ) . Community volunteers ( 282 patients aged ≥50 years with chronic knee pain ) were treated by family physician acupuncturists . INTERVENTIONS No acupuncture ( control group , n = 71 ) and needle ( n = 70 ) , laser ( n = 71 ) , and sham laser ( n = 70 ) acupuncture . Treatments were delivered for 12 weeks . Participants and acupuncturists were blinded to laser and sham laser acupuncture . Control participants were unaware of the trial . MAIN OUTCOMES AND MEASURES Primary outcomes were average knee pain ( numeric rating scale , 0 [ no pain ] to 10 [ worst pain possible ] ; minimal clinical ly important difference [ MCID ] , 1.8 units ) and physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , 0 [ no difficulty ] to 68 [ extreme difficulty ] ; MCID , 6 units ) at 12 weeks . Secondary outcomes included other pain and function measures , quality of life , global change , and 1-year follow-up . Analyses were by intention-to-treat using multiple imputation for missing outcome data . RESULTS At 12 weeks and 1 year , 26 ( 9 % ) and 50 ( 18 % ) participants were lost to follow-up , respectively . Analyses showed neither needle nor laser acupuncture  significantly improved pain ( mean difference ; -0.4 units ; 95 % CI , -1.2 to 0.4 , and -0.1 ; 95 % CI , -0.9 to 0.7 , respectively ) or function ( -1.7 ; 95 % CI , -6.1 to 2.6 , and 0.5 ; 95 % CI , -3.4 to 4.4 , respectively ) compared with sham at 12 weeks . Compared with control , needle and laser acupuncture result ed in modest improvements in pain ( -1.1 ; 95 % CI , -1.8 to -0.4 , and -0.8 ; 95 % CI , -1.5 to -0.1 , respectively ) at 12 weeks , but not at 1 year . Needle acupuncture result ed in modest improvement in function compared with control at 12 weeks ( -3.9 ; 95 % CI , -7.7 to -0.2 ) but was not significantly different from sham ( -1.7 ; 95 % CI , -6.1 to 2.6 ) and was not maintained at 1 year . There were no differences for most secondary outcomes and no serious adverse events . CONCLUSIONS AND RELEVANCE In patients older than 50 years with moderate or severe chronic knee pain , neither laser nor needle acupuncture conferred benefit over sham for pain or function . Our findings do not support acupuncture for these patients . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12609001001280 & NA ; Chronic neck pain is highly prevalent . To determine the efficacy and safety of acupuncture , in comparison with transcutaneous nerve stimulation‐placebo ( TENS‐placebo ) in the treatment of chronic uncomplicated neck pain , a single blind prospect i ve study was design ed , to be carried out at a Primary Healthcare Centre , with r and om assignment to two parallel groups and with evaluation and analysis by independent evaluators . A r and om assignment was made from 123 patients of the 149 initially recruited . These patients had been diagnosed with uncomplicated neck pain and experienced neck motion‐related pain intensity equal to or exceeding 30 on a visual analogue scale ( VAS ) from 0 to 100 mm . The treatment with acupuncture was compared with TENS‐placebo , applied over 5 sessions in three weeks . The primary endpoint was the change in maximum pain intensity related to motion of the neck , one week after the final treatment . Sensitivity was analysed per protocol ( PP ) and variant analyses were by intention to treat ( ITT ) . Adjustment was made for confounders by multiple linear regression , including baseline values and rescue therapy . By ITT analysis , the change in the pain‐VAS variable was greater among the experimental group ( 28.1 ( 95 % CI 21.4–34.7 ) ) . The improvements in quality of life ( physical aspect ) , active neck mobility and reduced rescue medication were clinical ly and statistically significant . In the treatment of the intensity of chronic neck pain , acupuncture is more effective than the placebo treatment and presents a safety profile making it suitable for routine use in clinical practice Abstract Objective To determine the effects of a policy of “ use acupuncture ” on headache , health status , days off sick , and use of re sources in patients with chronic headache compared with a policy of “ avoid acupuncture . ” Design R and omised , controlled trial . Setting General practice s in Engl and and Wales . Participants 401 patients with chronic headache , predominantly migraine . Interventions Patients were r and omly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care . Main outcome measures Headache score , SF-36 health status , and use of medication were assessed at baseline , three , and 12 months . Use of re sources was assessed every three months . Results Headache score at 12 months , the primary end point , was lower in the acupuncture group ( 16.2 , SD 13.7 , n = 161 , 34 % reduction from baseline ) than in controls ( 22.3 , SD 17.0 , n = 140 , 16 % reduction from baseline ) . The adjusted difference between means is 4.6 ( 95 % confidence interval 2.2 to 7.0 ; P = 0.0002 ) . This result is robust to sensitivity analysis incorporating imputation for missing data . Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year ( 8 to 38 ) . SF-36 data favoured acupuncture , although differences reached significance only for physical role functioning , energy , and change in health . Compared with controls , patients r and omised to acupuncture used 15 % less medication ( P = 0.02 ) , made 25 % fewer visits to general practitioners ( P = 0.10 ) , and took 15 % fewer days off sick ( P = 0.2 ) . Conclusions Acupuncture leads to persisting , clinical ly relevant benefits for primary care patients with chronic headache , particularly migraine . Expansion of NHS acupuncture services should be considered To assess the efficacy in providing improved function and pain relief by administering 8 weeks of acupuncture as adjunctive therapy to st and ard care in elderly patients with OA of the knee . This r and omized , controlled , blinded trial was conducted on 55 patients with OA of the knee . Forty-one patients completed the study ( 26 females , 15 males , mean age ± SD 71.7 ± 8.6 years ) . Patients were r and omly divided into an intervention group that received biweekly acupuncture treatment ( n = 28 ) and a control group that received sham acupuncture ( n = 27 ) , both in addition to st and ard therapy , for example , NSAIDS , cyclooxygenase-2 inhibitors , acetaminophen , intra-articular hyaluronic acid and steroid injections . Primary outcomes measures were changes in the Knee Society Score ( KSS ) knee score and in KSS function and pain ratings at therapy onset , at 8 weeks ( closure of study ) and at 12 weeks ( 1 month after last treatment ) . Secondary outcomes were patient satisfaction and validity of sham acupuncture  . There was significant improvement in all three scores in both groups after 8 and 12 weeks compared with baseline ( P < .05 ) . Significant differences between the intervention and control groups in the KSS knee score ( P = .036 ) was apparent only after 12 weeks . Patient satisfaction was higher in the intervention group . Adjunctive acupuncture treatment seems to provide added improvement to st and ard care in elderly patients with OA of the knee . Future research should determine the optimal duration of acupuncture treatment in the context of OA Objectives To evaluate the efficacy of an individualised acupuncture protocol for patients with fibromyalgia . Methods R and omised controlled multicentre trial , blinded to participants and to data analysts . Conducted in three primary care centres in southern Spain . A total of 164 participants aged over 17 years and diagnosed with fibromyalgia were enrolled in this trial ; 153 participants completed the study . Participants were r and omly assigned to either the real intervention ( individualised acupuncture , IA ) or the sham intervention ( sham acupuncture , SA ) . In both the IA and SA groups , one session per week ( lasting 20 min ) was provided , in addition to usual pharmacological treatment . The primary outcome was change in pain intensity at 10 weeks . Results Intention-to-treat analysis revealed that the decrease in pain intensity at 10 weeks was greater ( p=0.001 ) in the IA group ( −41.0 % , 95 % CI −47.2 % to −34.8 % ) than in the SA group ( −27.1 % , 95 % CI −33.2 % to −20.9 % ) . During the follow-up period , significant differences ( p<0.01 ) in favour of the IA group persisted at 12 months ( IA : −19.9 % , 95 % CI −24.6 % to −15.1 % ; vs SA : −6.2 % , 95 % CI −11.2 % to −1.2 % ) . Conclusions Individualised acupuncture treatment in primary care in patients with fibromyalgia  proved efficacious in terms of pain relief , compared with placebo treatment . The effect persisted at 1 year , and its side effects were mild and infrequent . Therefore , the use of individualised acupuncture in patients with fibromyalgia is recommended . Trial Registration Number IS RCT N60217348 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 Objective To compare the effectiveness of repeated acupuncture stimulation and local anaesthetic injection at the most painful points in patients with low back pain . Method This r and omised controlled clinical trial involved 26 patients with low back pain r and omly allocated to either an acupuncture group ( n = 13 ) or a local anaesthetic injection group ( n = 13 ) . Both acupuncture and anaesthetic injection were performed at two to five of the most painful points on the lower back once weekly for 4 weeks . In the acupuncture group , a 0.18 mm diameter stainless steel needle was inserted to a depth of 10–20 mm and manual stimulation was applied . In the local anaesthetic injection group , a 0.5 mm diameter needle was inserted to a depth of 10–20 mm and a local anaesthetic was injected . Participants evaluated pain using a Visual Analogue Scale immediately before and after the first treatment , before each subsequent treatment , and at 2 weeks and 4 weeks after completion of treatment . Results There was a significant difference between the two groups in the change in Visual Analogue Scale pain scores ( p<0.01 ) , with acupuncture providing more favourable results than local anaesthetic injection . The reduction in pain score from baseline calculated at each time period was significantly different between the two groups after the first ( p<0.05 ) and final ( p<0.01 ) treatments , and during the follow-up period ( after 2 weeks ( p<0.01 ) and 4 weeks ( p<0.05 ) ) . Conclusion Both injection and acupuncture relieved pain , but acupuncture was superior for the immediate and sustained effects , suggesting that it is a useful treatment for low back pain . The difference in the effects may be attributable to differences in the mechanism of pain suppression Acupuncture is becoming a common technique within the physiotherapy profession as a treatment modality for pain relief ; however , few r and omised controlled trials have been undertaken to assess the effectiveness of acupuncture , particularly in the treatment of osteoarthritis ( OA ) of the hip . Therefore , a r and omised trial to compare the effectiveness of acupuncture with advice and exercises on the symptomatic treatment of OA of the hip was carried out . Thirty-two patients awaiting a total hip arthroplasty were r and omly allocated to either the experimental group , ( A ) , to have six sessions of acupuncture each lasting up to 25 minutes , or the control group , ( B ) , to be given advice and exercises for their hip over a six week period . Group A consisted of three men and 13 women , and group B consisted of four men and eight women . The average age in group A was 66 years and in group B it was 68 years . Patients were assessed for pain and functional ability , using a modified version of the WOMAC question naire , pre-treatment , immediately post-treatment and at eight weeks post-treatment . The pre-treatment WOMAC scores in the two groups were similar ( p=0.85 ) . There was a significant improvement in group A ( decrease in WOMAC score ) immediately post-treatment ( p=0.002 ) and this was maintained at the eight-week follow-up ( p=0.03 ) . There were no significant changes in group B. When the changes in WOMAC scores were compared between groups , a significantly greater improvement was found between pre-treatment and immediately post-treatment in group A , compared with group B ( p=0.02 ) . The changes between pre-treatment and the eight-week follow-up also showed a significant improvement in group A compared with group B ( p=0.03 ) . In conclusion , this trial supports the hypothesis that acupuncture is more effective than advice and exercises in the symptomatic treatment of OA of the hip Background To evaluate the effectiveness of acupuncture and compare it with fluoxetine in treatment of fibromyalgia syndrome ( FMS ) . Methods We conducted a prospect i ve , r and omized clinical trial . Fifteen patients were treated with acupuncture  and compared with a  control group ( n=15 ) of patients who received fluoxetine .  Visual analogue scale , Fibromyalgia Impact Question naire ( FIQ ) and determined number of tender points were used as outcome measurements . Results After four weeks , the acupuncture group was significantly better than the control group in the number of tender points . Total fibromyalgia symptoms were significantly improved in the acupuncture group compared with the control group during the study period ( P= 0.01 ) . The largest difference in mean FIQ total scores was observed at 4 weeks ( 42.2 VS . 34.8 in the control and acupuncture groups , respectively ; P= 0.007 ) . At the end of one year of the follow up , patients who received acupuncture were significantly better than the control group in all measures . Fatigue and anxiety were the most significantly improved symptoms during the follow up period . Discussion Acupuncture significantly improved pain and symptoms of fibromyalgia . Also , we found that acupuncture did not have any side effect and was tolerable 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 There is evidence for the efficacy of acupuncture treatment for chronic shoulder pain , but it remains unclear which acupuncture modes are most effective . We compared the effect of trigger point acupuncture ( TrP ) , with that of sham ( SH ) acupuncture treatments , on pain and shoulder function in patients with chronic shoulder pain . The participants were 18 patients ( 15 women , 3 men ; aged 42 - 65 years ) with nonradiating shoulder pain for at least 6 months and normal neurological findings . The participants were r and omized into two groups , each receiving five treatment sessions . The TrP group received treatment at trigger points for the muscle , while the other group received SH acupuncture treatment on the same muscle . Outcome measures were pain intensity ( visual analogue scale , VAS ) and shoulder function ( Constant-Murley Score : CMS ) . After treatment , pain intensity between pretreatment and 5 weeks after TrP decreased significantly ( p<0.001 ) . Shoulder function also increased significantly between pretreatment and 5 weeks after TrP ( p<0.001 ) . A comparison using the area under the outcome curves demonstrated a significant difference between groups ( p=0.024 ) . Compared with SH acupuncture therapy , TrP therapy appears more effective for chronic shoulder pain We compared the effects of trigger point acupuncture with that of sham acupuncture treatments on pain and oral function in patients with temporom and ibular disorders ( TMDs ) . This 10-week study included 16 volunteers from an acupuncture school with complaints of chronic temporom and ibular joint myofascial pain for at least 6 months . The participants were r and omized to one of two groups , each receiving five acupuncture treatment sessions . The trigger point acupuncture group received treatment at trigger points for the same muscle , while the other acupuncture group received sham treatment on the trigger points . Outcome measures were pain intensity ( visual analogue scale ) and oral function ( maximal mouth opening ) . After treatment , pain intensity was less in the trigger point acupuncture group than in the sham treatment group , but oral function remained unchanged in both groups . Pain intensity decreased significantly between pretreatment and 5 weeks after trigger point ( p<0.001 ) and sham acupunctures ( p<0.050 ) . Group comparison using the area under the curve demonstrated a significant difference between groups ( p=0.0152 ) . Compared with sham acupuncture therapy , trigger point acupuncture therapy may be more effective for chronic temporom and ibular joint myofascial pain Background : There are multiple approaches to the management of chronic prostatitis/chronic pelvic pain syndrome ( CP/CPPS ) ; and lately the data suggesting the ability of acupuncture treatment to decrease pain , positively impact quality of life and potentially modulate inflammation has suggested it as a potential therapeutic option for men with CP/CPPS . We conducted this study to determine whether acupuncture is really an effective therapeutic modality for CP/CPPS in terms of > 50 % decrease in total National Institutes of Health Chronic Prostatitis Symptom Index ( NIH-CPSI ) score from baseline compared with sham . Methods : One hundred patients with CP/CPPS ( category III B ) in an outpatient urology clinic were r and omized to receive acupuncture at either seven acupoints bilaterally or sham points adjacent to these points . NIH-CPSI was completed by each patient before and 6 , 8 , 16 , 24 weeks after the treatment . Mean values of total CPSI score and subscores after the treatment and on follow-up following the treatment were compared . Results : Of the acupuncture participants , 92 % were NIH-CPSI responders ( > 50 % decrease in total NIH-CPSI score from baseline ) compared with 48 % of sham participants , 8 weeks after the end of the therapy . Both groups experienced significant decrease in CPSI subscores throughout the whole follow-up period ; however , the decline remained significantly greater in the active acupuncture group as compared with the sham group . Conclusions : Our results show that the use of acupuncture in treatment of men with CP/CPPS symptoms result ed in a significant decrease in total NIH-CPSI scores Objective To assess the efficacy of acupuncture in the treatment of chronic low back pain .  Methods Patients ( n = 60 ) with chronic low back pain were recruited and r and omly allocated to either Acupuncture therapy or Placebo transcutaneous electrical nerve stimulation ( TENS ) groups . Patients were treated weekly for 6 weeks , and blinded assessment s were carried out pre- and post-treatment using the McGill Pain Question naire ( MPQ ) and visual analog scales ( VAS ) for pain , the Short-form 36 quality -of-life question naire , and a simple range of motion measurement .  A total of 46 patients completed the trial and were followed up at 6 months . Results Analysis of results using t tests showed that in both groups there were significant pre-post improvements for all scores , except for MPQ scores in the Placebo-TENS group . There was no significant difference between the 2 groups for any of the outcome measures at the end of treatment . Results from the 6-month follow-up would suggest that the response was better in the acupuncture group . Discussion Further research is necessary to fully assess the efficacy of this treatment in combating chronic low back pain using larger sample sizes or alternative control groups The principle aim of the present work is the evaluation of the importance of the variable " depth " of needle insertion in the determination of acupuncture 's therapeutic results . A r and omized clinical trial carried out on 44 patients belonging to two groups of 22 each , suffering from shoulder myofascial pain : group A : superficial acupuncture ; group B : deep acupuncture .  All of them subjected to the same model of treatment with 13 needles and the treatment of the most painful 4 trigger points ( TP ) found in the shoulder 's area . In the group A patients , the needles were introduced in the skin at a depth of 2 mm , on the TP . In the group B patients , the needles were placed deeply both in the muscular acupuncture points and in the TP . The treatment was planned for a cycle of 8 sessions , the first 4 to be performed twice a week , the last 4 weekly . The intensity of pain was evaluated with the McGill Pain Question naire before beginning the therapy , at the end of the therapy , and at the follow-up after 1 and 3 months . Both techniques had efficacy in controlling pain . A statistically significant difference rose between the two needling techniques at the end of the treatment and at the follow up after one and three months . Deep acupuncture shows to be better at all times and this underlines the importance of the muscular afferences in acupunctural stimulation in the control of pain 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 The aim of this study was to compare acupuncture , relaxation training and physical training in the treatment of chronic tension-type headache ( CTTH ) . The study comprised 90 consecutive patients with CTTH who were r and omly allocated to acupuncture , relaxation training or physical training .  Headache intensity , headache-free days and headache-free periods were registered using a visual analogue scale and a headache diary . The measurements were made 4 weeks before , immediately after , and 3 and 6 months after the treatment period . Immediately after the last treatment , the number of headache-free periods and of headache-free days was higher in the relaxation group compared with the acupuncture group . There were no other significant differences between the groups at any time point . The clinical implication s of our findings are that relaxation training induced the most pronounced effects directly after the treatment period , compared with acupuncture and physical training OBJECTIVE Evaluate the efficacy of acupuncture associated with physiotherapy for patients with painful shoulder . METHODS In a multicentre controlled r and omized study , participants were recruited with a clinical diagnosis of unilateral subacromial syndrome from six rehabilitation medicine departments belonging to the Public Health System in two Spanish regions . All participants received 15 sessions of physiotherapy during the 3 weeks that the treatment lasted and were r and omized to additionally receive , once a week , acupuncture or mock TENS ( transcutaneous electrical nerve stimulation ) . The primary outcome measure was the change in the Constant-Murley Score ( CMS ) for functional assessment of the shoulder , at 4 weeks after r and omization . This study is registered as an International St and ard R and omized Controlled Trial , number IS RCT N28687220 . RESULTS A total of 425 patients were recruited . The mean score ( s.d . ) on the CMS had increased by 16.6 ( 15.6 ) points among the acupuncture group , compared with 10.6 ( 13.5 ) points in the control group , and the mean difference between the two groups was statistically significant ( 6.0 points ; 95 % CI 3.2 , 8.8 points ; P < 0.001 ) . By the end of the treatment , 53 % of the patients in the acupuncture group had decreased their consumption of analgesics , compared with a corresponding 30 % among the control group ( P < 0.001 ) . CONCLUSIONS Single-point acupuncture in association with physiotherapy improves shoulder function and alleviates pain , compared with physiotherapy as the sole treatment . This improvement is accompanied by a reduction in the consumption of analgesic medicaments Objective There is some evidence for the efficacy of acupuncture in chronic low back pain , but it remains unclear which acupuncture modes are most effective . Our objective was to evaluate the effects of two different modes of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared to st and ard acupuncture treatment . Methods Thirty five consecutive out- patients ( 25 women , 10 men ; age range : 65–81 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 one of three groups over 12 weeks . Each group received two phases of acupuncture treatment with an interval between them . Nine patients dropped out during the course of the study . The st and ard acupuncture group ( n=9 ) received treatment at traditional acupuncture points for low back pain , while the other acupuncture groups received superficial ( n=9 ) or deep ( n=9 ) treatments on trigger points . Outcome measures were VAS pain intensity and Rol and Morris Question naire . Results After treatment , the group that received deep needling to trigger points reported less pain intensity and improved quality of life compared to the st and ard acupuncture group or the group that received superficial needling to trigger points , but the differences were not statistically significant . There was a significant reduction in pain intensity between the treatment and interval in the group that received deep needling to trigger points ( P<0.01 ) , but not in the st and ard acupuncture group or the group that received superficial needling to trigger points . Conclusion These results suggest that deep needling to trigger points may be more effective in the treatment of low back pain in elderly patients than either st and ard acupuncture therapy , or superficial needling to trigger points Background Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis  is equivocal . Objective To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee . Design R and omised , controlled trial . Setting Two outpatient clinics ( an integrative medicine facility and a rheumatology facility ) located in academic teaching hospitals and one clinical trials facility . Patients 570 patients with osteoarthritis of the knee ( mean age [ ±SD ] , 65.5 ± 8.4 years ) . Intervention 23 true acupuncture sessions over 26 weeks . Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks . Measurements Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain and function scores at 8 and 26 weeks . Secondary outcomes were patient global assessment , 6-minute walk distance , and physical health scores of the 36-Item Short-Form Health Survey ( SF-36 ) . Results Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks ( mean difference , −2.9 [ 95 % CI , −5.0 to −0.8 ] ; P=0.01 ) but not in WOMAC pain score ( mean difference , −0.5 [ CI , −1.2 to 0.2 ] ; P=0.18 ) or the patient global assessment ( mean difference , 0.16 [ CI , −0.02 to 0.34 ] ; P > 0.2 ) . At 26 weeks , the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score ( mean difference , −2.5 [ CI , −4.7 to −0.4 ] ; P=0.01 ) , WOMAC pain score ( mean difference , −0.87 [ CI , −1.58 to −0.16 ] ; P=0.003 ) , and patient global assessment ( mean difference , 0.26 [ CI , 0.07 to 0.45 ] ; P=0.02 ) . Limitations At 26 weeks , 43 % of the participants in the education group and 25 % in each of the true and sham acupuncture groups were not available for analysis . Conclusions Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups 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 BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome ( CP/CPPS ) afflicts 2%-10 % of adult men . Available therapies offer little or no proven benefit . Because acupuncture represents an attractive " natural " therapy , we compared the efficacy of acupuncture to sham acupuncture for CP/CPPS . METHODS Participants met US National Institutes of Health ( NIH ) consensus criteria for CP/CPPS , were aged > or = 20 years old , and had a total score > or = 15 on the NIH Chronic Prostatitis Symptom Index ( NIH-CPSI ) and symptoms for at least 3 of the preceding 6 months . They were r and omized 1:1 to acupuncture or sham acupuncture . Treatment consisted of twice-weekly 30-minute sessions for 10 weeks ( 20 sessions total ) without needle stimulation , herbs , or adjuvants . The primary response criterion was a 6-point decrease from baseline to week 10 in NIH-CPSI total score ( range 0 - 43 ) . RESULTS Thirty-two ( 73 % ) of 44 participants responded in the acupuncture group compared with 21 ( 47 % ) of 45 sham group participants ( relative risk 1.81 , 95 % confidence interval , 1.3 - 3.1 , P = .02 ) . Long-term responses 24 weeks after completing therapy without additional treatment occurred in 14 ( 32 % ) of 44 acupuncture group participants and in 6 ( 13 % ) of 45 sham group participants ( relative risk 2.39 , 95 % confidence interval , 1.0 - 5.6 , P = .04 ) . CONCLUSIONS After 10 weeks of treatment , acupuncture proved almost twice as likely as sham treatment to improve CP/CPPS symptoms . Participants receiving acupuncture were 2.4-fold more likely to experience long-term benefit than were participants receiving sham acupuncture 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 & NA ; In order to examine the role of muscular mechanisms in chronic tension‐type headache  a study with needle acupuncture was performed . Needle acupuncture could be of therapeutic value because it has shown some positive effects in myofascial pain syndromes . We performed a double‐blind , placebo‐controlled study with 39 patients ( mean age 49.0 years , SD=14.8 ) fulfilling the International Headache Society criteria for chronic tension‐type headaches . Participants were r and omly assigned to verum or placebo condition . Six weeks after end of treatment no significant differences between placebo and verum could be observed with respect to visual analogue scale and frequency of headache attacks . Nevertheless , pressure pain thresholds significantly increased for the verum group . The findings of our study support the hypothesis that peripheral mechanisms – such as increased muscle tenderness – only play a minor role in the pathogenesis of chronic tension‐type headache 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 A multicentre , r and omized clinical trial was undertaken to test the hypothesis that acupuncture is more efficacious than sham control procedure in the prevention of  episodic tension-type headache . Fifty subjects were r and omized to receive a course of treatment with either brief acupuncture or a sham procedure . Subjects were followed up for 3 months . Changes in headache were assessed by daily diary , the primary outcome measure being the number of days with headache . No significant differences were found between the changes in the two groups for any measure at any time point . Results also show that patient blinding was successful . In conclusion , this study does not provide evidence that this form of acupuncture is effective in the prevention of episodic tension-type headache Background : Migraine is a common type of headache . Sometimes adequate pain relief is not achieved by conventional treatments . Acupuncture and botulinum toxin-A injection are known as non-pharmacological interventions for this purpose . The aim of this research was to compare the effect of acupuncture with botulinum toxin-A injection and pharmacological treatment in controlling chronic migraine . Methods : This clinical trial was conducted on patients with chronic migraine in the North of Iran during 2014 - 2015 . Eligible patients were r and omly allocated to groups receiving acupuncture ( A ) or botulinum toxin A ( B ) and controls ( C ) by design ed quadripartite blocks . All patients were evaluated at baseline , one , two and three months after treatment using visual analogue scale ( VAS ) score and other parameters . The analysis of data was performed in SPSS software Version 19 . Results : One hundred fifty patients ( 48 males and 102 females ) completed this study . During the 3- month study , the pain severity significantly diminished in three groups ( P=0.0001 ) , with greater reduction in group A ( P=0.0001 ) . The number of days per month with migraine , absence from work and the need for medication significantly decreased in three groups at 3 times of evaluation ( p<0.05 ) with fewer side effects in group A ( P=0.021 ) . Conclusion : Acupuncture , botulinum toxin-A injection and pharmacological treatment have beneficial effects on chronic migraine ; however , acupuncture showed more effectiveness and fewer complications OBJECTIVE To investigate the effectiveness of acupuncture in addition to routine care , compared with routine care alone , in the treatment of patients with chronic pain due to osteoarthritis ( OA ) of the knee or hip . METHODS In a r and omized , controlled trial , patients with chronic pain due to OA of the knee or hip were r and omly allocated to undergo up to 15 sessions of acupuncture in a 3-month period or to a control group receiving no acupuncture . Another group of patients who did not consent to r and omization underwent acupuncture treatment . All patients were allowed to receive usual medical care in addition to the study treatment . Clinical OA severity ( Western Ontario and McMaster Universities Osteoarthritis Index [ WOMAC ] ) and health-related quality of life ( Short Form 36 ) were assessed at baseline and after 3 months and 6 months . RESULTS Of 3,633 patients ( mean + /- SD age 61.8 + /- 10.8 years ; 61 % female ) , 357 were r and omized to the acupuncture group and 355 to the control group , and 2,921 were included in the nonr and omized acupuncture group . At 3 months , the WOMAC had improved by a mean + /- SEM of 17.6 + /- 1.0 in the acupuncture group and 0.9 + /- 1.0 in the control group ( 3-month scores 30.5 + /- 1.0 and 47.3 + /- 1.0 , respectively [ difference in improvement 16.7 + /- 1.4 ; P < 0.001 ] ) . Similarly , quality of life improvements were more pronounced in the acupuncture group versus the control group ( P < 0.001 ) . Treatment success was maintained through 6 months . The changes in outcome in nonr and omized patients were comparable with those in r and omized patients who received acupuncture . CONCLUSION These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA-associated pain of the knee or hip 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 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 OBJECTIVES In a r and omized controlled multicenter trial extending over 24 weeks , we investigated whether acupuncture is as effective and safe as metoprolol in the prophylactic treatment of migraine under conditions similar to routine care . METHODS One hundred fourteen migraine patients could be r and omized to treatment over 12 weeks either with acupuncture ( 8 to 15 sessions ) or metoprolol ( 100 to 200 mg daily ) . Main outcome measure was the difference in the number of migraine days between baseline and the weeks 9 to 12 after r and omization ( derived from a headache diary ) . RESULTS Two of 59 patients r and omized to acupuncture  withdrew prematurely from the study compared to 18 of 55 r and omized to metoprolol . The number of migraine days decreased by 2.5 + /- 2.9 days ( baseline 5.8 + /- 2.5 days ) in the acupuncture group compared to 2.2 + /- 2.7 days ( baseline 5.8 + /- 2.9 days ) in the metoprolol group ( P= .721 ) . The proportion of responders ( reduction of migraine attacks by > or = 50 % ) was 61 % for acupuncture and 49 % for metoprolol . Both physicians and patients reported fewer adverse effects in the acupuncture group . CONCLUSIONS Due to missing the recruitment target ( 480 patients ) and the high drop-out in the metoprolol group the results must be interpreted with caution . Still , they suggest that acupuncture might be an effective and safe treatment option for patients unwilling or unable to use drug prophylaxis Background Knee osteoarthritis is a chronic disease associated with significant morbidity and economic cost . The efficacy of acupuncture in addition to traditional physical therapy has received little study . Objective The objective of this study was to compare the efficacy and safety of integrating a st and ardized true acupuncture protocol versus nonpenetrating acupuncture into exercise-based physical therapy ( EPT ) . Methods This was a r and omized , double-blind , controlled trial at 3 physical therapy centers in Philadelphia , PA . We studied 214 patients ( 66 % African Americans ) with at least 6 months of chronic knee pain and x-ray – confirmed Kellgren scores of 2 or 3 . Patients received 12 sessions of acupuncture directly following EPT over 6 to 12 weeks . Acupuncture was performed at the same 9 points dictated by the traditional Chinese “ Bi ” syndrome approach to knee pain , using either st and ard needles or Streitberger non – skin-puncturing needles . The primary outcome was the proportion of patients with at least a 36 % improvement in Western Ontario and McMaster Universities Osteoarthritis Index score at 12 weeks . Results Both treatment groups showed improvement from combined therapy with no difference between true ( 31.6 % ) and nonpenetrating acupuncture ( 30.3 % ) in Western Ontario and McMaster Universities Osteoarthritis Index response rate ( P = 0.5 ) or report of minor adverse events . A multivariable logistic regression prediction model identified an association between a positive expectation of relief from acupuncture and reported improvement . No differences were noted by race , sex , or age . Conclusions Puncturing acupuncture needles did not perform any better than nonpuncturing needles integrated with EPT . Whether EPT , acupuncture , or other factors accounted for any improvement noted in both groups could not be determined in this study . Expectation for relief was a predictor of reported benefit Aim To compare the efficacy of acupuncture needling and 0.5 % lidocaine injection of trigger points in myofascial pain syndrome of elderly patients . Methods Thirty nine participants with myofascial pain syndrome of one or both upper trapezius muscles were r and omised to treatment with either acupuncture needling ( n=18 ) or 0.5 % lidocaine injection ( n=21 ) at all the trigger points on days 0 , 7 and 14 , in a single-blinded study . Pain scores , range of neck movement , pressure pain intensity and depression were measured up to four weeks from the first treatment . Results Local twitch responses were elicited at least once in 94.9 % of all subjects . Both groups improved , but there was no significant difference in reduction of pain in the two groups at any time point up to one month . Overall , the range of cervical movement improved in both groups , apart from extension in the acupuncture needling group . Changes in depression showed only trends . Conclusion There was no significant difference between acupuncture needling and 0.5 % lidocaine injection of trigger points for treating myofascial pain syndrome in elderly patients 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 investigate the effectiveness of additional acupuncture in patients with chronic low back pain participating in an inpatient rehabilitation program . DESIGN Patients were r and omly assigned to one of two groups ( A and B ) , both receiving a st and ard rehabilitation program according to German guidelines . Patients in group A additionally underwent acupuncture twice weekly , conducted by two Chinese physicians with education in Traditional Chinese Medicine ( TCM ) . At the beginning and end of the program , as well as at 3 months after , patients completed question naires about health-related quality of life ( Short-Form 36 Health Survey [ SF-36 ] ) , sociodemographic and clinical data , attitude towards TCM , pain , and adverse events . SETTING Inpatient rehabilitation clinic in Germany . PATIENTS Patients with chronic low back pain participating in an inpatient rehabilitation program . OUTCOME MEASURES Acceptance of acupuncture , health-related quality of life , and pain/symptoms . RESULTS One hundred and forty-three patients were analyzed : 74 in group A ( intervention ) and 69 in group B ( controls ) ; 67 % were men and 33 % were women , with a mean age of 50.7 years .  Acceptance of TCM  was excellent : 89 % of the patients would want TCM to be integrated into st and ard inpatient rehabilitation , and 83 % would even have paid for TCM if necessary . Responses to SF-36 question naires showed that group A reported significantly better physical functioning , general health , vitality , and emotional role than group B. Pain outcomes in group A were superior to those in group B. Specifically , pain with sitting/st and ing , pain upon carrying loads of 10 kg or more , and prickling in h and s and feet were significantly diminished . CONCLUSION Acupuncture was highly accepted and had positive effects in patients with chronic low back pain . These results show that acupuncture can be an effective , well-tolerated therapy with no major adverse events Objective The aim of the study was to compare the therapeutic effect of the superficial and in-depth insertion of acupuncture needles in the treatment of patients with chronic lumbar myofascial pain . Design A prospect i ve r and omized double-blind study of superficial and deep acupuncture was conducted . Setting The study was conducted in the Pain Service Unit of the University of Padova . Patients The study comprised 42 patients with lumbar myofascial pain who were divided into two equal groups ( A and B ) . InterventionIn group A , the needle was introduced in the skin at a depth of 2 mm , whereas in group B the needle was placed deeply into muscular tissue . The treatment was planned for a cycle of eight sessions . Outcome Measures The intensity of pain was evaluated with the McGill Pain Question naire before and after treatment and at the 3-month follow-up examination . Results Although at the end of the treatment there was no evidence of significant statistical differences between the two different groups , pain reduction was greater in the group treated with deep acupuncture . A statistical difference existed between the two groups at the 3-month follow up , with a better result in the deeply stimulated group . Conclusions Clinical results show that deep stimulation has a better analgesic effect when compared with superficial stimulation OBJECTIVES To test whether patients with persistent non-specific low back pain , when offered access to traditional acupuncture care alongside conventional primary care , gained more long-term relief from pain than those offered conventional care only , for equal or less cost . Safety and acceptability of acupuncture care to patients , and the heterogeneity of outcomes were also tested . DESIGN A pragmatic , two parallel group , r and omised controlled trial . Patients in the experimental arm were offered the option of referral to the acupuncture service comprising six acupuncturists . The control group received usual care from their general practitioner ( GP ) . Eligible patients were r and omised in a ratio of 2:1 to the offer of  acupuncture to allow between-acupuncturist effects to be tested . SETTING Three non-NHS acupuncture clinics , with referrals from 39 GPs working in 16 practice s in York , UK . PARTICIPANTS Patients aged 18 - 65 years with non-specific low back pain of 4 - 52 weeks ' duration , assessed as suitable for primary care management by their general practitioner . INTERVENTIONS The trial protocol allowed up to ten individualised acupuncture treatments per patient . The acupuncturist determined the content and the number of treatments according to patient need . MAIN OUTCOME MEASURES The Short Form 36 ( SF-36 ) Bodily Pain dimension ( range 0 - 100 points ) , assessed at baseline , and 3 , 12 and 24 months . The study was powered to detect a 10-point difference between groups at 12 months post-r and omisation . Cost -- utility analysis was conducted at 24 months using the EuroQoL 5 Dimensions ( EQ-5D ) and a preference-based single index measure derived from the SF-36 ( SF-6D ) . Secondary outcomes included the McGill Present Pain Index ( PPI ) , Oswestry Pain Disability Index ( ODI ) , all other SF-36 dimensions , medication use , pain-free months in the past year , worry about back pain , satisfaction with care received , and safety and acceptability of acupuncture care . RESULTS A total of 159 patients were in the ' acupuncture offer ' arm and 80 in the ' usual care ' arm . All 159 patients r and omised to the offer of acupuncture care chose to receive acupuncture treatment , and received an average of eight acupuncture treatments within the trial . Analysis of covariance , adjusting for baseline score , found an intervention effect of 5.6 points on the SF-36 Pain dimension [ 95 % confidence interval ( CI ) -1.3 to 12.5 ] in favour of the acupuncture group at 12 months , and 8 points ( 95 % CI 0.7 to 15.3 ) at 24 months . No evidence of heterogeneity of effect was found for the different acupuncturists . Patients receiving acupuncture care did not report any serious or life-threatening events . No significant treatment effect was found for any of the SF-36 dimensions other than Pain , or for the PPI or the ODI . Patients receiving  acupuncture care reported a significantly greater reduction in worry about their back pain at 12 and 24 months compared with the usual care group . At 24 months , the acupuncture care group was significantly more likely to report 12 months pain free and less likely to report the use of medication for pain relief . The acupuncture service was found to be cost-effective at 24 months ; the estimated cost per quality -adjusted ( QALY ) was 4241 pounds sterling ( 95 % CI 191 pounds sterling to 28,026 pounds sterling ) using the SF-6D scoring algorithm based on responses to the SF-36 , and 3598 pounds sterling ( 95 % CI 189 pounds sterling to 22,035 pounds sterling ) using the EQ-5D health status instrument . The NHS costs were greater in the acupuncture care group than in the usual care group . However , the additional re source use was less than the costs of the acupuncture treatment itself , suggesting that some usual care re source use was offset . CONCLUSIONS Traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain . Acupuncture care and usual care were both associated with clinical ly significant improvement at 12- and 24-month follow-up . Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up . No benefits relating to function or disability were identified . GP referral to a service providing traditional acupuncture care offers a cost-effective intervention for reducing low back pain over a 2-year period . Further research is needed to examine many aspects of this treatment including its impact compared with other possible short-term packages of care ( such as massage , chiropractic or physiotherapy ) , various aspects of cost-effectiveness , value to patients and implementation protocol Objective This study aims to provide evidence regarding the clinical efficacy of abdominal acupuncture for neck pain . Methods This r and omized , patient and assessor-blind , sham-controlled trial was conducted at a Chinese medicine center in Hong Kong between November 2014 and March 2016 . A total of 154 eligible participants ( age range , 18–65 years ) with neck pain were r and omly assigned to receive abdominal ( n = 77 ) or non-penetrating sham abdominal ( sham group ; n = 77 ) acupuncture . Each participant was administered treatment over six sessions by Registered Chinese Medicine Practitioners , in accordance with a st and ardized protocol . The primary outcome was mean improvement in neck pain disability scores evaluated by the Northwick Park Neck Pain Question naire ( NPQ ) . Secondary outcomes included intensity of neck pain and health-related quality -of-life measures . The outcomes were assessed at baseline and at 2 and 6 weeks from baseline . Patients in the abdominal acupuncture group received additional follow-up evaluation at 14 weeks from baseline . Outcomes were evaluated by intention-to-treat analysis . Results All participants provided informed consent for treatment and follow-up evaluation . Patients who received abdominal acupuncture exhibited greater improvement in NPQ scores than those who received sham treatment at both 2 and 6 weeks from baseline ( intergroup mean differences , -5.75 ; 95 % confidence interval [ CI ] , -9.48 to -2.03 ; P = 0.008 and -8.65 ; 95 % CI , -12.13 to -5.16 ; P < 0.001 , respectively ) . The improvement in NPQ scores in the abdominal acupuncture group was even more significant at 14 weeks from baseline . Patients in the abdominal acupuncture group also exhibited significantly greater improvements in intensity of neck pain and a few quality -of-life measures than those in the sham abdominal acupuncture group , without any serious adverse events . Conclusion These findings suggest that abdominal acupuncture is an effective alternative treatment for neck pain . Trial registration Chinese Clinical Trial Registry ChiCTR-TRC-14004932 BACKGROUND Shoulder pain or omalgia is one of the main types of osteoarticular pain that can be observed in every-day clinical practice , frequently causing significant functional impairment . The most common cause of shoulder pain is impingement syndrome . OBJECTIVE To decrease the intensity of short- and mid-term pain in the injured shoulder by means of acupuncture . METHOD R and omized controlled trial with two groups of participants : one group received true acupuncture ( TA ) and the other received acupuncture at sham points ( SA ) . The treatment was carried out over 4 weeks , with the participants receiving a session every week . The results were measured immediately after the treatment ( T1 ) and 3 months later ( T2 ) . To evaluate the results , we used the 100 mm Visual Analogue Scale ( VAS ) , and to assess the functionality of the shoulder we employed the UCLA question naire ( 0 - 35 points ) . RESULTS A total of 68 participants were included in the analysis ( TA , n=35 ; SA , n=33 ) , with a mean age of 33.4 years ( SD 12.53 ) . We found significant differences in the analyzed results between the two groups , as we observed a decrease on the intensity of pain for the TA group of 44.13 mm at T1 ( CI 95 % 36.7 ; 51.5 ) and 87.58 mm at T2 ( CI 95 % 28.32 ; 46.81 ) , while the decrease in the FA group was of 19.84 mm at T1 ( CI 95 % 12.2 ; 27.4 ) and 20 mm at T2 ( CI 95 % 10.9 ; 29.09 ) . When the UCLA scores were analyzed , the results were clinical ly meaningful in support of TA in terms of functional assessment of the shoulder . No adverse effects were reported . CONCLUSIONS The use of acupuncture to treat impingement syndrome seems to be a safe and reliable technique to achieve clinical ly significant results and could be implemented in the therapy options offered by the health services BACKGROUND Chronic pain is known to be very common in the community . Less is known about the epidemiology of more significant or severe chronic pain . The impact of chronic pain in the community , in terms of general health , employment and interference with daily activity , has not been quantified . OBJECTIVES The aim of this study was to describe the prevalence and distribution in the community of chronic pain defined as ' significant ' and ' severe ' , and to explore the impact of chronic pain on health and activity . METHODS A question naire survey was carried out of a sample drawn from the general population in the Grampian region of SCOTL AND : Question naires were sent to a r and om sample of 4611 individuals aged 25 years and over , stratified for age and gender , selected from the practice lists of 29 general practice s ( total practice population 136,383 ) . The study instrument included a case definition question naire , from which were identified individuals with ' any chronic pain ' ( pain of at least 3 months duration ) . The instrument also included a  level of expressed need question  naire and the chronic pain grade question  naire , from which were derived definitions for ' significant chronic pain ' ( based on the reported need for treatment and professional advice ) and ' severe chronic pain ' ( based on reported intensity and pain-related disability ) . The SF-36 general health question naire and demographic questions were also included . RESULTS Of the sample , 14.1 % reported ' significant chronic pain ' , and this was more prevalent among women and older age groups . A total of 6.3 % reported ' severe chronic pain ' , and this was more common in older age groups . On multiple logistic regression modelling , female gender , housing tenure , employment category and educational attainment were found to be independently associated with both ' significant ' and ' severe ' chronic pain . The presence of ' any ' , ' significant ' and ' severe ' chronic pain had progressively more marked adverse associations with employment , interference with daily activities and all measured dimensions of general health . CONCLUSIONS Comparison of the epidemiology of ' significant chronic pain ' and ' severe chronic pain ' with ' any chronic pain ' allows an underst and ing of the more clinical ly important end of the chronic pain spectrum . These results support the suggestion that chronic pain is multidimensional , both in its aetiology and in its effects , particularly at this end of the spectrum . This must be addressed in management and in further research 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 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 Some r and omised controlled trials ( RCTs ) done in German-speaking Europe are published in international English- language journals and others in national German- language journals . We assessed whether authors are more likely to report trials with statistically significant results in English than in German . METHODS We studied pairs of RCT reports , matched for first author and time of publication , with one report published in German and the other in English . Pairs were identified from reports round in a manual search of five leading German- language journals and from reports published by the same authors in English found on Medline .  Quality of methods and reporting were assessed with two different scales by two investigators who were unaware of authors ' identities , affiliations , and other characteristics of trial reports . Main study endpoints were selected by two investigators who were unaware of trial results . Our main outcome was the number of pairs of studies in which the levels of significance ( shown by p values ) were discordant . FINDINGS 62 eligible pairs of reports were identified but 19 ( 31 % ) were excluded because they were duplicate publications . A further three pairs ( 5 % ) were excluded because no p values were given . The remaining 40 pairs were analysed . Design characteristics and quality features were similar for reports in both language s. Only 35 % of German- language articles , compared with 62 % of English- language articles , reported significant ( p < 0.05 ) differences in the main endpoint between study and control groups ( p = 0.002 by McNemar 's test ) . Logistic regression showed that the only characteristic that predicted publication in an English- language journal was a significant result . The odds ratio for publication of trials with significant results in English was 3.75 ( 95 % CI 1.25 - 11.3 ) . INTERPRETATION Authors were more likely to publish RCTs in an English- language journal if the results were statistically significant . English language bias may , therefore , be introduced in review s and meta-analyses if they include only trials reported in English . The effort of the Cochrane Collaboration to identify as many controlled trials as possible , through the manual search of many medical journals published in different language s will help to reduce such bias 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 We introduce the current research on complementary and alternative medicine ( CAM ) in the West , which we refer to as Evidence -based CAM ( EBCAM ) , and discuss its characteristics , problems , and perspectives . Compared with the common attitude of CAM research ers in Japan , that of EBCAM research ers is more objective and often self-critical . EBCAM research is still developing because r and omized controlled trials on CAM have many method ological flaws . Caution should be employed in interpreting provisional conclusions of relevant systematic review s. CAM research ers in Japan should view the case report method from a perspective other than efficacy . Also , they will have to prepare evidence in response to dem and s from CAM consumers . Priority of research subjects from various kinds of CAM should be decided according to their popularity . Therefore , a large-scale survey on CAM use in Japan is essential This study compared the efficacies of acupuncture and anti-inflammatory treatment in patients with carpal tunnel syndrome ( CTS ) . Fifty patients with mild to moderate CTS were r and omly divided into two groups . Both groups received night wrist splints as the st and ard conservative treatment for 1 month . The acupuncture group also received eight sessions of acupuncture therapy ( twice a week for 4 weeks ) . The control group received 400 mg of ibuprofen three times a day for 10 days . The visual analog scale ( VAS ) score , the score on the Boston Carpal Tunnel Question naire for Functional Status and Symptom Severity ( BCTQ FUNCT and SYMPT ) , and the electrodiagnostic findings were evaluated at baseline and 1 month after treatment . At the final follow up , significant improvements were found in both groups ( p < 0.05 ) . Statistically significant improvements were observed in the VAS score , the score on the global BCTQ FUNCT and SYMPT , and the electrodiagnostic findings , but not in the distal motor latency ( DML ) , in the acupuncture group ( p < 0.05 ) . Our findings indicate that acupuncture affected the score on the global BCTQ FUNCT and SYMPT , the VAS score , and the electrodiagnostic findings , except the DML , more than ibuprofen did and that acupuncture might be an effective treatment for CTS
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