German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Acupuncture for chronic low back pain in older patients: a randomized, controlled trial. A Blinded Randomised Trial of Acupuncture (Manual and Electroacupuncture) Compared with a Non-Penetrating Sham for the Symptoms of Osteoarthritis of the Knee The Effect of Acupuncture on the Symptoms of Knee Osteoarthritis - An Open Randomised Controlled Study Acupuncture for chronic neck pain: a pilot for a randomised controlled trial Acupuncture for patients with chronic neck pain A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Acupuncture in patients with osteoarthritis of the knee: a randomised trial Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial 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 A pilot study on using acupuncture and transcutaneous electrical nerve stimulation (TENS) to treat knee osteoarthritis (OA) 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. Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain. The effects of electro-acupuncture and transcutaneous electrical nerve stimulation on patients with painful osteoarthritic knees: a randomized controlled trial with follow-up evaluation. Acupuncture treatment of chronic low-back pain – a randomized, blinded, placebo-controlled trial with 9-month follow-up Sham device v inert pill: randomised controlled trial of two placebo treatments Efficacy and safety of acupuncture for chronic uncomplicated neck pain: A randomised controlled study Statistical Reanalysis of Four Recent Randomized Trials of Acupuncture for Pain Using Analysis of Covariance Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial Acupuncture in patients with tension-type headache: randomised controlled trial Acupuncture for pain and osteoarthritis of the knee: a pilot study for an open parallel-arm randomised controlled trial Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain Acupuncture in Migraine Prevention: A Randomized Sham Controlled Study With 6-months Posttreatment Follow-up Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: a randomized controlled trial. Acupuncture in Patients With Headache Tension neck syndrome treated by acupuncture combined with physiotherapy: a comparative clinical trial (pilot study). The acupuncture treatment of low back pain: a randomized controlled study. Acupuncture for patients with migraine: a randomized controlled trial. A randomized, controlled trial of acupuncture for chronic daily headache. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial The Short- and Long-Term Benefit in Chronic Low Back Pain Through Adjuvant Electrical Versus Manual Auricular Acupuncture Acupuncture for the treatment of pain of osteoarthritic knees. Acupuncture for acute non-specific low back pain: a pilot randomised non-penetrating sham controlled trial. Acupuncture in the Management of Chronic Low Back Pain: A Blinded Randomized Controlled Trial The Practice of Acupuncture: Who Are the Providers and What Do They Do? Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Comparison between superficial and deep acupuncture in the treatment of the shoulder's myofascial pain: a randomized and controlled study. Effect of acupuncture treatment on chronic neck and shoulder pain in sedentary female workers: a 6-month and 3-year follow-up study Acupuncture treatment of severe knee osteoarthrosis. A long‐term study Needle Acupuncture in Tension-Type Headache: A Randomized, Placebo-Controlled Study A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly Effects of Trigger Point Acupuncture on Chronic Low Back Pain in Elderly Patients – a Sham-Controlled Randomised Trial Treatment of patients with chronic headaches in a hospital for traditional Chinese medicine in Germany. A randomised, waiting list controlled trial. The effectiveness of electroacupuncture versus electrical heat acupuncture in the management of chronic low-back pain. 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 The effect of electroacupuncture on opioid-like medication consumption by chronic pain patients: a pilot randomized controlled clinical trial. Relief of Low Back Pain Immediately after Acupuncture Treatment – a Randomised, Placebo Controlled Trial Traditional acupuncture in migraine: a controlled, randomized study. Are Sham Acupuncture Interventions More Effective than (Other) Placebos? A Re-Analysis of Data from the Cochrane Review on Placebo Effects Effects of acupuncture versus ultrasound in patients with impingement syndrome: randomized clinical trial. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial Relief of chronic neck and shoulder pain by manual acupuncture to tender points--a sham-controlled randomized trial. Trigger Point Acupuncture for Treatment of Knee Osteoarthritis – a Preliminary Rct for a Pragmatic Trial Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Introducing a placebo needle into acupuncture research 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. A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient‐provider communication Role of the Needling per se in Acupuncture as Prophylaxis for Menstrually Related Migraine: A Randomized Placebo-Controlled Study Efficacy of periosteal stimulation therapy for the treatment of osteoarthritis-associated chronic knee pain: an initial controlled clinical trial. Acupuncture Needling versus Lidocaine Injection of Trigger Points in Myofascial Pain Syndrome in Elderly Patients – a Randomised Trial Comparison of Superficial and Deep Acupuncture in the Treatment of Lumbar Myofascial Pain: A Double-Blind Randomized Controlled Study The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low-back pain. Acupuncture for Chronic Low Back Pain: A Randomized Placebo-Controlled Study With Long-Term Follow-Up Acupuncture for frozen shoulder. Effects of acupuncture and placebo TENS in addition to exercise in treatment of rotator cuff tendinitis Chronic neck pain: a comparison of acupuncture treatment and physiotherapy. Acupuncture for chronic shoulder pain. An experimental study with attention to the role of placebo and hypnotic susceptibility. Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial Does acupuncture improve the orthopedic management of chronic low back pain – a randomized, blinded, controlled trial with 3 months follow up The acupuncture treatment of neck pain: a randomized controlled study. Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis Comparison Between Electro-Acupuncture and Hydrotherapy, Both in Combination With Patient Education and Patient Education Alone, on the Symptomatic Treatment of Osteoarthritis of the Hip
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 OBJECTIVE To determine if acupuncture is an effective , safe adjunctive treatment to st and ard therapy for chronic low back pain ( LBP ) in older patients . METHODS The inclusion criteria for subjects were : ( i ) LBP > or = 12 weeks and ( ii ) age > or = 60 yr ; the exclusion criteria were ( i ) spinal tumour , infection or fracture and ( ii ) associated neurological symptoms . The subjects were r and omized to two groups . The control group of subjects continued their usual care as directed by their physicians , i.e. NSAIDs , muscle relaxants , paracetamol and back exercises . Subjects in the acupuncture group in addition received biweekly acupuncture with electrical stimulation for 5 weeks . Outcome was measured by the modified Rol and Disability Question naire ( RDQ ) at weeks 0 , 2 , 6 and 9 . The primary outcome measure was change in RDQ score between weeks 0 and 6 . RESULTS Fifty-five patients were enrolled , with eight drop-outs . Twenty-four subjects were r and omized to the acupuncture group and 23 were r and omized to the control group . Acupuncture subjects had a significant decrease in RDQ score of 4.1 + /- 3.9 at week 6 , compared with a mean decrease of 0.7 + /- 2.8 in the control group ( P = 0.001 ) . This effect was maintained for up to 4 weeks after treatment at week 9 , with a decrease in RDQ of 3.5 + /- 4.4 from baseline , compared with 0.43 + /- 2.7 in the control group ( P = 0.007 ) . The mean global transition score was higher in the acupuncture group , 3.7 + /- 1.2 , indicating greater improvement , compared with the score in the control group , 2.5 + /- 0.9 ( P < 0.001 ) . Fewer acupuncture subjects had medication-related side-effects compared with the control group . CONCLUSIONS Acupuncture is an effective , safe adjunctive treatment for chronic LBP in older patients Objectives To compare the effect of acupuncture ( manual and electroacupuncture ) with that of a non-penetrating sham ( ‘ placebo ’ needle ) in patients with osteoarthritic knee pain and disability who are blind to the treatment allocation . Methods Acupuncture naive patients with symptomatic and radiological evidence of osteoarthritis of the knee were r and omly allocated to a course of either acupuncture or non-penetrating sham acupuncture using a sheathed ‘ placebo ’ needle system . Acupuncture points for pain and stiffness were selected according to acupuncture theory for treating Bi syndrome . Both manual and electrical stimulation were used . Response was assessed using the WOMAC index for osteoarthritis of the knee , self reported pain scale , the EuroQol score and plasma β-endorphin . The effectiveness of blinding was assessed . Results There were 34 patients in each group . The primary end point was the change in WOMAC pain score after the course of treatment . Comparison between the two treatment groups found a significantly greater improvement with acupuncture ( mean difference 60 , 95 % CI 5 to 116 , P=0.035 ) than with sham . Within the acupuncture group there was a significant improvement in pain ( baseline 294 , mean change 95 , 95 % CI 60 to 130 , P<0.001 ) which was not seen by those who had sham acupuncture ( baseline 261 , mean change 35 , 95 % CI-10 to 80 , P=0.12 ) . Similar effects within group , but not between groups , were seen with the secondary end points of WOMAC stiffness , WOMAC function , and self reported pain . One month after treatment the between group pain difference had been lost ( mean difference 46 ; 95 % CI −9 to 100 , P=0.10 ) although the acupuncture group was still benefiting compared to baseline ( mean difference 59 ; 95 % CI 16 to 102 , P=0.009 ) . The EuroQol score , a generic measure of health related quality of life , was not altered by the treatments . A minority of patients correctly guessed their treatment group ( 41 % in the acupuncture group and 44 % in the control group ) . Plasma β-endorphin levels were not affected by either treatment . Conclusions Acupuncture gives symptomatic improvement for patients with osteoarthritis of the knee , and is significantly superior to non-penetrating sham acupuncture . The study did not confirm earlier reports of release of plasma β-endorphin during acupuncture Background Using an open r and omised controlled study , we examined the effectiveness of manual and electroacupuncture on symptom relief for patients with osteoarthritis of the knee . Methods Patients with symptomatic osteoarthritis of the knee were r and omised to one of three treatment groups . Group A had acupuncture alone , group B had acupuncture but continued on their symptomatic medication , and group C used their symptomatic medication for the first five weeks and then had a course of acupuncture added . Patients receiving acupuncture were treated twice weekly over five weeks . Needles were inserted ( with manual and electrical stimulation ) in acupuncture points for pain and stiffness , selected according to traditional acupuncture theory for treating Bi syndrome . Patients were assessed by a blinded observer before treatment , after five weeks ’ treatment and at one month follow up , using a visual analogue pain scale ( VAS ) and the Western Ontario McMaster ( WOMAC ) question naire for osteoarthritis of the knee . Results The 30 patients in our study were well matched for age , body mass index , disease duration , baseline VAS pain score and baseline WOMAC scores . Repeated measure analyses gave a highly significant improvement in pain ( VAS ) after the courses of acupuncture in groups A ( P=0.012 ) and B ( P=0.001 ) ; there was no change in group C until after the course of acupuncture , when the improvement was significant ( P=0.001 ) . Similarly significant changes were seen with the WOMAC pain and stiffness scores . These benefits were maintained during the one month after the course of acupuncture . Patients ’ rating of global assessment was higher than that of the acupuncturist . Conclusion We conclude that manual and electroacupuncture causes a significant improvement in the symptoms of osteoarthritis  of the knee , either on its own or as an adjunct therapy , with no loss of benefit after one month Background Acupuncture is increasingly being used for many conditions including chronic neck pain . However the evidence remains inconclusive , indicating the need for further well- design ed research . The aim of this study was to conduct a pilot r and omised controlled parallel arm trial , to establish key features required for the design and implementation of a large-scale trial on acupuncture for chronic neck pain . Methods Patients whose GPs had diagnosed neck pain were recruited from one general practice , and r and omised to receive usual GP care only , or acupuncture  ( up to 10 treatments over 3 months ) as an adjunctive treatment to usual GP care . The primary outcome measure was the Northwick Park Neck Pain Question naire ( NPQ ) at 3 months . The primary analysis was to determine the sample size for the full scale study . Results Of the 227 patients with neck pain identified from the GP data base , 28 ( 12.3 % ) consenting patients were eligible to participate in the pilot and 24 ( 10.5 % ) were recruited to the trial . Ten patients were r and omised to acupuncture , receiving an average of eight treatments from one of four acupuncturists , and 14 were r and omised to usual GP care alone . The sample size for the full scale trial was calculated from a clinical ly meaningful difference of 5 % on the NPQ and , from this pilot , an adjusted st and ard deviation of 15.3 % . Assuming 90 % power at the 5 % significance level , a sample size of 229 would be required in each arm in a large-scale trial when allowing for a loss to follow-up rate of 14 % . In order to achieve this sample , one would need to identify patients from data bases of GP practice s with a total population of 230,000 patients , or approximately 15 GP practice s roughly equal in size to the one involved in this study ( i.e. 15,694 patients ) . Conclusion This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial , which in turn will help to clarify the existing evidence base on acupuncture for neck pain & 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 OBJECTIVE The purpose of this study was to investigate the efficacy of acupuncture as an adjunctive therapy to st and ard care for the relief of pain and dysfunction in elderly patients with osteoarthritis ( OA ) of the knee . METHODS Seventy-three patients with symptomatic OA of the knee were r and omly assigned to treatment ( acupuncture ) or st and ard care ( control ) . Analysis was performed on last score carried forward to account for patients who dropped out before completion . Patients self-scored Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and Lequesne indices at baseline and at 4 , 8 and 12 weeks . Patients in the control group were offered acupuncture treatment after 12 weeks . The data for these patients are pooled with those from the original acupuncture group for within-group analysis . RESULTS Patients r and omized to acupuncture improved on both WOMAC and Lequesne indices compared to those who received st and ard treatment alone . Significant differences on total WOMAC Scale were seen at 4 and 8 weeks . There appears to be a slight decline in effect at 4 weeks after cessation of treatment ( 12 weeks after first treatment ) . No adverse effects of acupuncture were reported . CONCLUSION These data suggest that acupuncture is an effective and safe adjunctive therapy to conventional care for patients with OA of the knee 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 Acupuncture treatment is frequently sought for  tension-type headache ( TTH )  , but there is conflicting evidence as to its effectiveness . This r and omised , controlled , multicentre , patient- and observer-blinded trial was carried out in 122 outpatient practice s in Germany on 409 patients with TTH , defined as ≥0 headache days per month of which ≤1 included migraine symptoms . Interventions were verum acupuncture according to the practice of traditional Chinese medicine or sham acupuncture consisting of superficial needling at nonacupuncture points . Acupuncture was administered by physicians with specialist acupuncture training . Ten 30-min sessions were given over a six-week period , with additional sessions available for partial response . Response was defined as > 50 % reduction in headache days/month at six months and no use of excluded concomitant medication or other therapies . In the intent-to-treat analysis ( all 409 patients ) , 33 % of verum patients and 27 % of sham controls ( p=0.18 ) were classed as responders . Verum was superior to sham for most secondary endpoints , including headache days ( 1.8 fewer ; 95 % CI 0.6 , 3.0 ; p=0.004 ) and the International Headache Society response criterion ( 66 % vs. 55 % response , risk difference 12 % , 95 % CI : 2%-21 % ; p=0.024 ) . ) . The relative risk on the primary and secondary response criterion was very similar ( ∼0.8 ) ; the difference in statistical significance may be due to differences in event rate . TTH improves after acupuncture treatment . However , the degree to which treatment benefits depend on psychological compared to physiological effects and the degree to which any physiological effects depend on needle placement and insertion depth are unclear 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 Background The present study tests whether a combined treatment of acupuncture and transcutaneous electrical nerve stimulation ( TENS ) is more effective than acupuncture or TENS alone for treating knee osteoarthritis ( OA ) . Methods Thirty-two patients with knee OA were r and omly allocated to four groups . The acupuncture group ( ACP ) received only acupuncture treatment at selected acupoints for knee pain ; the TENS group ( TENS ) received only TENS treatment at pain areas ; the acupuncture and TENS group ( A&T ) received both acupuncture and TENS treatments ; the control group ( CT ) received topical poultice ( only when necessary ) . Each group received specific weekly treatment five times during the study . Outcome measures were pain intensity in a visual analogue scale ( VAS ) and knee function in terms of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Results The ACP , TENS and A&T groups reported lower VAS and WOMAC scores than the control group . Significant reduction in pain intensity ( P = 0.039 ) and significant improvement in knee function ( P = 0.008 ) were shown in the A&T group . Conclusion Combined acupuncture and TENS treatment was effective in pain relief and knee function improvement for the sample d patients suffering from knee OA 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 Abstract Objectives : To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain . Design : Prospect i ve , r and omised , placebo controlled trial . Setting : Three outpatient departments in Germany . Participants : 177 patients aged 18–85 years with chronic neck pain . Interventions : Patients were r and omly allocated to five treatments over three weeks with acupuncture ( 56 ) , massage ( 60 ) , or “ sham ” laser acupuncture ( 61 ) . Main outcome measures : Primary outcome measure : maximum pain related to motion ( visual analogue scale ) irrespective of direction of movement one week after treatment . Secondary outcome measures : range of motion ( 3D ultrasound real time motion analyser ) , pain related to movement in six directions ( visual analogue scale ) , pressure pain threshold ( pressure algometer ) , changes of spontaneous pain , motion related pain , global complaints ( seven point scale ) , and quality of life ( SF-36 ) . Assessment s were performed before , during , and one week and three months after treatment . Patients ' beliefs in treatment were assessed . Results : One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage ( difference 24.22 ( 95 % confidence interval 16.5 to 31.9 ) , P=0.0052 ) but not compared with sham laser ( 17.28 ( 10.0 to 24.6 ) , P=0.327 ) . Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years ( n=75 ) and in patients with myofascial pain syndrome ( n=129 ) . The acupuncture group had the best results in most secondary outcome measures . There were no differences in patients ' beliefs in treatment . Conclusions : Acupuncture is an effective short term treatment for patients with chronic neck pain , but there is only limited evidence for long term effects after five treatments . What is already known on this topic Acupuncture is a widespread complementary treatment Evidence from trials have given conflicting results on its use in the treatment of neck pain because of method ological shortcomings and because effects were compared either with alternative treatments or with different sham procedures imitating acupuncture , but not both What this study adds Compared with sham laser acupuncture and massage , needle acupuncture has beneficial effects on mobility and pain related to motion in patients with chronic neck pain Acupuncture was clearly more effective than massage , but differences were not always significant compared with sham laser acupuncture Acupuncture was the best treatment for patients with the myofascial syndrome and those who had had pain for longer than five OBJECTIVES To examine the relative effectiveness of electro-acupuncture ( EA ) and transcutaneous electrical nerve stimulation ( TENS ) in alleviating osteoarthritic (OA)-induced knee pain .  DESIGN Single-blinded , r and omized controlled study . SUBJECTS Twenty-four ( 24 ) subjects ( 23 women and 1 man ) , mean age 85 , were recruited from eight subsidized Care & Attention Homes for the elderly . INTERVENTIONS Subjects were r and omly assigned to the EA , TENS , or control groups . Subjects in the EA group ( n = 8) received low-frequency EA ( 2 Hz ) on two acupuncture points ( ST-35 , Dubi and EX-LE-4 , Neixiyan ) of the painful knee for 20 minutes . Subjects in the TENS group ( n = 8) received low-frequency TENS of 2 Hz and pulse width of 200 micros on the same acupuncture points for 20 minutes . In both treatment groups , electrical treatment was carried out for a total of eight sessions in 2 weeks . Eight subjects received osteoarthritic knee care and education only in a control group . All subjects were evaluated before the first treatment , after the last treatment , and at 2-week follow-up periods . RESULTS After eight sessions of treatment , there was significant reduction of knee pain in both EA group and TENS group , as measured by the Numeric Rating Scale ( NRS ) of pain ( p < 0.01 ) . Prolonged analgesic effect was maintained in the EA and the TENS groups at a 2-week follow-up evaluation . The Timed Up- and -Go Test ( TUGT ) score of the EA group was significantly lower than that of the control group ( p < 0.05 ) , but such change was not observed in the TENS group . CONCLUSIONS Both EA and TENS treatments were effective in reducing OA-induced knee pain .  EA had the additional advantage of enhancing the TUGT results as opposed to TENS treatment or no treatment , which did not produce such corollary effect & 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 Abstract Objective To investigate whether a sham device ( a vali date d sham acupuncture needle ) has a greater placebo effect than an inert pill in patients with persistent arm pain . Design A single blind r and omised controlled trial created from the two week placebo run-in periods for two nested trials that compared acupuncture and amitriptyline with their respective placebo controls . Comparison of participants who remained on placebo continued beyond the run-in period to the end of the study . Setting Academic medical centre . Participants 270 adults with arm pain due to repetitive use that had lasted at least three months despite treatment and who scored ≥3 on a 10 point pain scale . Interventions Acupuncture with sham device twice a week for six weeks or placebo pill once a day for eight weeks . Main outcome measures Arm pain measured on a 10 point pain scale . Secondary outcomes were symptoms measured by the Levine symptom severity scale , function measured by Pransky 's upper extremity function scale , and grip strength . Results Pain decreased during the two week placebo run-in period in both the sham device and placebo pill groups , but changes were not different between the groups ( −0.14 , 95 % confidence interval −0.52 to 0.25 , P = 0.49 ) . Changes in severity scores for arm symptoms and grip strength were similar between groups , but arm function improved more in the placebo pill group ( 2.0 , 0.06 to 3.92 , P = 0.04 ) . Longitudinal regression analyses that followed participants throughout the treatment period showed significantly greater downward slopes per week on the 10 point arm pain scale in the sham device group than in the placebo pill group ( −0.33 ( −0.40 to −0.26 ) v −0.15 ( −0.21 to −0.09 ) , P = 0.0001 ) and on the symptom severity scale ( −0.07 ( −0.09 to −0.05 ) v −0.05 ( −0.06 to −0.03 ) , P = 0.02 ) . Differences were not significant , however , on the function scale or for grip strength . Reported adverse effects were different in the two groups . Conclusions The sham device had greater effects than the placebo pill on self reported pain and severity of symptoms over the entire course of treatment but not during the two week placebo run in . Placebo effects seem to be malleable and depend on the behaviours embedded in medical rituals & 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 Objectives : Acupuncture has been promoted for the treatment of chronic pain . Though many r and omized trials have been conducted , these have been criticized for deficiencies of methodology , acupuncture technique , and sample size . Somewhat less emphasis has been placed on methods of statistical analysis . This paper describes 4 recent r and omized trials of acupuncture for musculoskeletal or headache pain . Each trial used statistical methods that did not adjust for baseline pain scores and were thus of suboptimal power . The objective of this study is to reanalyze the trials using analysis of covariance ( ANCOVA ) . Methods : Raw data for the 4 trials were obtained from the original authors . Data were reanalyzed by ANCOVA . Results : For 2 trials — acupuncture versus placebo for chronic headache and acupuncture versus transcutaneous electric nerve stimulation for back pain — re analysis did not change the conclusion of no difference between groups , but showed that clinical ly significant differences between groups could not ruled out . Re analysis of a trial of acupuncture versus placebo for shoulder pain slightly strengthened the evidence of acupuncture effectiveness . Re analysis of the fourth trial , which compared acupuncture to placebo acupuncture and massage for neck pain , reversed the results of the original paper : re analysis found acupuncture to be effective and that its effectiveness could not be ascribed to a placebo effect . Discussion : Future trials of acupuncture and other modalities for pain should use efficient statistical methods . ANCOVA is more efficient than unadjusted analysis where used appropriately 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 Abstract Objective To investigate the effectiveness of acupuncture compared with minimal acupuncture and with no acupuncture in patients with tension-type headache . Design Three armed r and omised controlled multicentre trial . Setting 28 outpatient centres in Germany . Participants 270 patients ( 74 % women , mean age 43 ( SD 13 ) years ) with episodic or chronic tension-type headache . Interventions Acupuncture , minimal acupuncture ( superficial needling at non-acupuncture points ) , or waiting list control . Acupuncture and minimal acupuncture were administered by specialised physicians and consisted of 12 sessions per patient over eight weeks . Main outcome measure Difference in numbers of days with headache between the four weeks before r and omisation and weeks 9 - 12 after r and omisation , as recorded by participants in headache diaries . Results The number of days with headache decreased by 7.2 ( SD 6.5 ) days in the acupuncture group compared with 6.6 ( SD 6.0 ) days in the minimal acupuncture group and 1.5 ( SD 3.7 ) days in the waiting list group ( difference : acupuncture v minimal acupuncture , 0.6 days , 95 % confidence interval -1.5 to 2.6 days , P = 0.58 ; acupuncture v waiting list , 5.7 days , 3.9 to 7.5 days , P < 0.001 ) . The proportion of responders ( at least 50 % reduction in days with headache ) was 46 % in the acupuncture group , 35 % in the minimal acupuncture group , and 4 % in the waiting list group . Conclusions The acupuncture intervention investigated in this trial was more effective than no treatment but not significantly more effective than minimal acupuncture for the treatment of tension-type headache . Trial registration number IS RCT N9737659 Background There is some evidence that acupuncture for pain and osteoarthritis ( OA ) of the knee is more than a placebo , and short term clinical benefits have been observed when acupuncture is compared to usual care . However there is insufficient evidence on whether clinical benefits of acupuncture are sustained over the longer term . In this study our key objectives are to inform the design parameters for a fully powered pragmatic r and omised controlled trial . These objectives include establishing potential recruitment rates , appropriate vali date d outcome measures , attendance levels for acupuncture treatment , loss to follow up and the sample size for a full scale trial . Methods Potential participants aged over 50 with pain and osteoarthritis of the knee were identified from a GP data base . Eligible patients were r and omised to either ' acupuncture plus usual care ' and ' usual care ' alone  , with allocation appropriately concealed . Acupuncture consisted of up to 10 sessions usually weekly . Outcome measures included Western Ontario and McMaster Universities ( WOMAC ) index with the sample size for a full scale trial determined from the variance . Results From the GP data base of 15,927 patients , 335 potential trial participants were identified and invited to participate . After screening responses , 78 ( 23 % ) were identified as eligible and 30 patients who responded most promptly were r and omised to ' acupuncture plus usual care '  ( 15 patients ) and ' usual care ' alone ( 15 patients ) . Attendance for acupuncture appointments was high at 90 % of the maximum . Although the trial was not powered to detect significant changes in outcome , the WOMAC pain index showed a statistically significant reduction at 3 months in the acupuncture group compared to usual care . This was not sustained at 12 months . The sample size for a fully powered two-arm trial was estimated to be 350 . Conclusion This pilot study provided the evidence that a fully powered study to explore the longer term impact of acupuncture would be worthwhile , and relevant design features for such a trial were determined . Trial registration numberIS RCT N25134802 OBJECTIVE To assess the long-term benefits of medication , needle acupuncture , and spinal manipulation as exclusive and st and ardized treatment regimens in patients with chronic ( > 13 weeks ) spinal pain syndromes . STUDY DESIGN Extended follow-up ( > 1 year ) of a r and omized clinical trial was conducted at the multidisciplinary spinal pain unit of Townsville 's General Hospital between February 1999 and October 2001 . PATIENTS AND METHODS Of the 115 patients originally r and omized , 69 had exclusively been treated with the r and omly allocated treatment during the 9-week treatment period ( results at 9 weeks were reported earlier ) . These patients were followed up and assessed again 1 year after inception into the study reapplying the same instruments ( ie , Oswestry Back Pain Index , Neck Disability Index , Short-Form-36 , and Visual Analogue Scales ) . Question naires were obtained from 62 patients reflecting a retention proportion of 90 % . The main analysis was restricted to 40 patients who had received exclusively the r and omly allocated treatment for the whole observation period since r and omization . RESULTS Comparisons of initial and extended follow-up question naires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based long-term benefit : 5 of the 7 main outcome measures showed significant improvements compared with only 1 item in each of the acupuncture and the medication groups . CONCLUSIONS In patients with chronic spinal pain syndromes , spinal manipulation , if not contraindicated , may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit Abstract Objective To evaluate the cost effectiveness of acupuncture in the management of  chronic headache  . Design Cost effectiveness analysis of a 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 from appropriately trained physiotherapists , or to usual care alone . Main outcome measure Incremental cost per quality adjusted life year ( QALY ) gained . Results Total costs during the one year period of the study were on average higher for the acupuncture group ( £ 403 ; $ 768;€598 ) than for controls ( £ 217 ) because of the acupuncture practitioners ' costs . The mean health gain  from acupuncture during the one year of the trial was 0.021 quality adjusted life years ( QALYs ) , leading to a base case estimate of £ 9180 per QALY gained . This result was robust to sensitivity analysis . Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial . Conclusions Acupuncture for chronic headache improves health related quality of life at a small additional cost ; it is relatively cost effective compared with a number of other interventions provided by the NHS 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 Abstract Objective To determine whether a short course of traditional acupuncture improves longer term outcomes for patients with persistent non-specific low back pain in primary care . Design Pragmatic , open , r and omised controlled trial . Setting Three private acupuncture clinics and 18 general practice s in York , Engl and . Participants 241 adults aged 18 - 65 with non-specific low back pain of 4 - 52 weeks ' duration . Interventions 10 individualised acupuncture treatments from one of six qualified acupuncturists ( 160 patients ) or usual care only ( 81 patients ) . Main outcome measures The primary outcome was SF-36 bodily pain , measured at 12 and 24 months . Other outcomes included reported use of analgesics , scores on the Oswestry pain disability index , safety , and patient satisfaction . Results 39 general practitioners referred 289 patients of whom 241 were r and omised . At 12 months average SF-36 pain scores increased by 33.2 to 64.0 in the acupuncture group and by 27.9 to 58.3 in the control group . Adjusting for baseline score and for any clustering by acupuncturist , the estimated intervention effect was 5.6 points ( 95 % confidence interval −0.2 to 11.4 ) at 12 months ( n = 213 ) and 8.0 points ( 2.8 to 13.2 ) at 24 months ( n = 182 ) . The magnitude of the difference between the groups was about 10%-15 % of the final pain score in the control group . Functional disability was not improved . No serious or life threatening events were reported . Conclusions Weak evidence was found of an effect of acupuncture on persistent non-specific low back pain at 12 months , but stronger evidence of a small benefit at 24 months . Referral to a qualified traditional acupuncturist for a short course of treatment seems safe and acceptable to patients with low back pain . Trial registration IS RCT N80764175 [ controlled-trials.com ] Objective To assess the efficacy of acupuncture in migraine prophylaxis . Methods Thirty-seven patients with migraine were enrolled in a r and omized control trial at the Headache clinic located in a University Hospital .  Real and sham acupuncture groups received 16 acupuncture sessions over 3 months . Treatment was individualized in the real acupuncture group and minimal acupuncture was used in the sham group . The primary end point was the percentage of patients with a ≥50 % reduction in their migraine attack frequency in the second , third , fourth , fifth , and sixth ( months ) compared with the first one ( baseline period ) . Primary and secondary end points were measured comparing headache diaries . Results Real acupuncture group showed improvement with significant differences compared with the sham acupuncture group in the primary efficacy end point ( P=0.021 ) at the second month of the treatment . Differences also appeared in 2 secondary end points : number of days with migraine per month ( P=0.007 ) in the second month and the percentage of patients with ≥40 % reduction in migraine attack frequency in the first ( P=0.044 ) and second months ( P=0.004 ) of the treatment . These differences disappeared in the third ( last ) month of the treatment as a consequence of the high improvement of the sham acupuncture group . Comparisons within each group showed that several migraine parameters evaluated improved significantly in both groups . Conclusions Individualized treatment based on traditional Chinese medicine plays a role in preventing migraine attacks . Nevertheless , sham acupuncture had similar effects . Major conclusions were limited by the small sample sizes however the observed trends may contribute to design future trials OBJECTIVES To investigate whether acupuncture is superior to placebo and equivalent to sumatriptan for the early treatment of an acute migraine attack . DESIGN R and omized , partly double-blind ( sumatriptan versus placebo ) trial . SETTING Two hospitals in Germany ( one specialized in traditional Chinese medicine and one in the treatment of headache ) . SUBJECTS A total of 179 migraineurs experiencing the first symptoms of a developing migraine attack . INTERVENTIONS Traditional Chinese acupuncture , sumatriptan ( 6 mg subcutaneously ) or placebo injection . MAIN OUTCOME MEASURE Number of patients in whom a full migraine attack ( defined as severe migraine headache ) within 48 h was prevented . In patients who developed a  migraine  attack in spite of early treatment , acupuncture and sumatriptan were applied a second time , whilst patients initially r and omized to placebo received sumatriptan . RESULTS A full migraine attack was prevented in 21 of 60 ( 35 % ) patients receiving acupuncture , 21 of 58 ( 36 % ) patients receiving sumatriptan and 11 of 61 ( 18 % ) patients receiving placebo ( relative risk of having a full attack 0.79 ( 95 % CI , 0.64 - 0.99 ) for acupuncture versus placebo , and 0.78 ( 95 % CI , 0.62 - 0.98 ) for sumatriptan versus placebo ) . Response to the second intervention in patients who developed a full attack was better with sumatriptan ( 17/31 patients who received sumatriptan twice and 37/46 patients who had had placebo first ) than with acupuncture ( 4/31 ) . The number of patients reporting side-effects was 14 in the acupuncture group , 23 in the sumatriptan group and 10 in the placebo group . CONCLUSIONS In this trial acupuncture and sumatriptan were more effective than a placebo injection in the early treatment of an acute migraine attack . When an attack could not be prevented , sumatriptan was more effective than acupuncture at relieving headache 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 OBJECTIVE To evaluate the effect of acupuncture combined with physiotherapy in comparison with acupuncture and physiotherapy performed alone in different parameters ; pain intensity , muscle tension , functional disability and muscle strength in the treatment of tension neck syndrome ( TNS ) . DESIGN A prospect i ve , comparative clinical trial . SETTING Acupuncture and Rehabilitation Department . BACKGROUND TNS can occur in computer users .  Acupuncture has been one alternative treatment in physiotherapeutic rehabilitation of musculoskeletal disorders . SUBJECTS Forty-six patients with TNS . INTERVENTIONS Patients were allocated into three groups : Group-1 received physiotherapy ( therapeutic exercises ) combined with acupuncture ; Group-2 , acupuncture alone , and Group-3 , physiotherapy alone ; over a period of 10 weeks , with one or two sessions weekly . OUTCOME ASSESSMENT All patients had completed the protocol s and were assessed using a visual analogue scale for pain intensity ( VASpain ) and muscle tension ( VASmt ) , the Neck Disability Index : Brazilian Portuguese version for functional disability , and the cranio-cervical Flexion Test for isometric neck muscle strength ( INMS ) ; in the periods before treatment ( baseline ) , after 10 weeks of treatment , and after 6 months of follow-up . RESULTS All groups showed significant improvement ( p < 0.001 ) in these parameters after 10 weeks of treatment and after 6 months of follow-up . Group-1 was superior to Group-3 in pain and functional disability improvements ( p<0.05 ) ; and Group-1 was superior to both Group-2 ( p < 0.01 ) and Group-3 ( p < 0.05 ) in INMS . After 6 months of follow-up , the improvements of all groups were maintained ( p < 0.05 ) . CONCLUSION The data suggested that acupuncture effect may facilitate and /or enhance physiotherapy performance in musculoskeletal rehabilitation for tension neck syndrome The acupuncture treatment situation was beneficial to the majority of people with low back pain .  This was shown by the use of short-term controls and long-term controls , although the latter were not intended in the study design . After acupuncture , there was a 51 % pain reduction in the average pain score in the Immediate Treatment Group . The short-term controls , the Delayed Treatment Group , had no reduction whatsoever in their pain scores at the comparable followup period . Later , the Delayed Treatment Group bere also treated by acupuncturists , and reported 62 % less pain . When these two treatment groups were compared at 40 weeks with long-term controls ( Inadequate Treatment Group ) , the Inadequate Treatment Group still had the same pain scores , on the average , as when they enrolled in the study . Both treatment groups , on the average , had 30 % lower pain scores . Furthermore , 58 % of the treatment groups felt that they were definitely improved at 40 weeks , while only 11 % of the Inadequate Treatment Group felt definitely improved at 40 weeks CONTEXT Acupuncture is widely used to prevent migraine attacks , but the available evidence of its benefit is scarce . OBJECTIVE To investigate the effectiveness of acupuncture compared with sham acupuncture and with no acupuncture in patients with migraine . DESIGN , SETTING , AND PATIENTS Three-group , r and omized , controlled trial ( April 2002-January 2003 ) involving 302 patients ( 88 % women ) , mean ( SD ) age of 43 ( 11 ) years , with migraine headaches , based on International Headache Society criteria . Patients were treated at 18 outpatient centers in Germany . INTERVENTIONS Acupuncture , sham acupuncture , or waiting list control . Acupuncture and sham acupuncture were administered by specialized physicians and consisted of 12 sessions per patient over 8 weeks . Patients completed headache diaries from 4 weeks before to 12 weeks after r and omization and from week 21 to 24 after r and omization . MAIN OUTCOME MEASURES Difference in headache days of moderate or severe intensity between the 4 weeks before and weeks 9 to 12 after r and omization . RESULTS Between baseline and weeks 9 to 12 , the mean ( SD ) number of days with headache of moderate or severe intensity decreased by 2.2 ( 2.7 ) days from a baseline of 5.2 ( 2.5 ) days in the acupuncture group compared with a decrease to 2.2 ( 2.7 ) days from a baseline of 5.0 ( 2.4 ) days in the sham acupuncture group , and by 0.8 ( 2.0 ) days from a baseline if 5.4 ( 3.0 ) days in the waiting list group . No difference was detected between the acupuncture and the sham acupuncture groups ( 0.0 days , 95 % confidence interval , -0.7 to 0.7 days ; P = .96 ) while there was a difference between the acupuncture group compared with the waiting list group ( 1.4 days ; 95 % confidence interval ; 0.8 - 2.1 days ; P<.001 ) . The proportion of responders ( reduction in headache days by at least 50 % ) was 51 % in the acupuncture group , 53 % in the sham acupuncture group , and 15 % in the waiting list group . CONCLUSION Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control BACKGROUND Approximately 4 % of adults experience headaches nearly every day . Nonpharmacologic interventions for frequent headaches may be appropriate because medical management alone is often ineffective . OBJECTIVE To assess the efficacy of acupuncture as an adjunct to medical management for  chronic daily headache ( CDH ) . METHODS We conducted a r and omized , controlled trial of 74 patients with CDH that compared medical management provided by neurologists to medical management plus 10 acupuncture treatments .  Primary outcome measures were daily pain severity and headache-related quality of life ( QoL ) . RESULTS Patients who received only medical management did not demonstrate improvement in any of the st and ardized measures . Daily pain severity scores trended downward but did not differ between treatment groups ( P= .60 ) . Relative to medical management only , medical management plus acupuncture was associated with an improvement of 3.0 points ( 95 % CI , 1.0 to 4.9 ) on the Headache Impact Test and an increase of 8 or more points on the role limitations due to physical problems , social functioning , and general mental health domains of the Short Form 36 Health Survey . Patients who received acupuncture were 3.7 times more likely ( CI , 1.7 to 8.1 ) to report less suffering from headaches at 6 weeks ( absolute risk reduction 46 % ; number needed to treat 2 ) . CONCLUSION Headache-specialty medical management alone was not associated with improved clinical outcomes among our study population . Supplementing medical management with acupuncture , however , result ed in improvements in health-related QoL and the perception by patients that they suffered less from headaches BACKGROUND Our aim was to assess the efficacy of a part-st and ardised verum acupuncture procedure , in accordance with the rules of traditional Chinese medicine , compared with that of part-st and ardised sham acupuncture and st and ard migraine prophylaxis with beta blockers , calcium-channel blockers , or antiepileptic drugs in the reduction of migraine days 26 weeks after the start of treatment . METHODS This study was a prospect i ve , r and omised , multicentre , double-blind , parallel-group , controlled , clinical trial , undertaken between April 2002 and July 2005 . Patients who had two to six migraine attacks per month were r and omly assigned  verum acupuncture ( n=313 ) , sham acupuncture ( n=339 ) , or st and ard therapy ( n=308 ) . Patients received ten sessions of acupuncture treatment in 6 weeks or continuous prophylaxis with drugs . Primary outcome was the difference in migraine days between 4 weeks before r and omisation and weeks 23 - 26 after r and omisation . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N52683557 . FINDINGS Of 1295 patients screened , 960 were r and omly assigned to a treatment group . Immediately after r and omisation , 125 patients ( 106 from the st and ard group ) withdrew their consent to study participation . 794 patients were analysed in the intention-to-treat popoulation and 443 in the per- protocol population . The primary outcome showed a mean reduction of 2 .3 days ( 95 % CI 1.9 - 2.7 ) in the verum acupuncture group , 1.5 days ( 1.1 - 2.0 ) in the sham acupuncture group , and 2.1 days ( 1.5 - 2.7 ) in the st and ard therapy group . These differences were statistically significant compared with baseline ( p<0.0001 ) , but not across the treatment groups ( p=0.09 ) . The proportion of responders , defined as patients with a reduction of migraine days by at least 50 % , 26 weeks after r and omisation , was 47 % in the verum group , 39 % in the sham acupuncture group , and 40 % in the st and ard group ( p=0.133 ) . INTERPRETATION Treatment outcomes for migraine do not differ between patients treated with sham acupuncture , verum acupuncture , or st and ard therapy Acupuncture is an established adjuvant analgesic modality for the treatment of chronic pain .  Electrical stimulation of acupuncture points is considered to increase acupuncture analgesia . In this prospect i ve , r and omized , double-blind , controlled study we tested the hypothesis that auricular electroacupuncture ( EA )  relieves pain more effectively than conventional manual auricular acupuncture ( CO ) in chronic low back pain patients with insufficient pain relief ( visual analogue scale [ VAS ] ≥5 ) treated with st and ardized analgesic therapy . Disposable acupuncture needles were inserted in the auricular acupuncture points 29 , 40 , and 55 of the dominant side and connected to a newly developed battery-powered miniaturized stimulator worn behind the ear . Patients were r and omized into group EA ( n = 31 ) with continuous low-frequency auricular EA ( 1 Hz biphasic constant current of 2 mA ) and group CO ( n = 30 ) without electrical stimulation ( sham-electroacupuncture ) . Treatment was performed once weekly for 6 wk , and in each group needles were withdrawn 48 h after insertion . During the study period and a 3-mo follow-up , patients were asked to complete the McGill question naire . Psychological well being , activity level , quality of sleep , and pain intensity were assessed by means of VAS ; moreover , analgesic drug consumption was documented . Pain relief was significantly better in group EA during the study and the follow-up period as compared with group CO . Similarly , psychological well-being , activity , and sleep were significantly improved in group EA versus group CO , the consumption of analgesic rescue medication was less , and more patients returned to full-time employment . Neuropathic pain in particular improved in patients treated with EA . There were no adverse side effects . These results are the first to demonstrate that continuous EA stimulation of auricular acupuncture points improves the treatment of chronic low back pain in an outpatient population OBJECTIVE The purpose of this study was to determine whether acupuncture was more effective than sham acupuncture in the reduction of pain in persons with osteoarthritis ( OA ) of the knee . METHODS Forty subjects ( 20 men , 20 women ) with radiographic evidence of OA of the knee were stratified by gender and r and omly assigned to either the experimental ( real acupuncture ) or control ( sham acupuncture ) groups . Subjects were treated three times per week for 3 weeks and evaluated at three test sessions . Outcome measures were : 1 ) the Pain Rating Index of the McGill Pain Question naire , 2 ) the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index , and 3 ) pain threshold at four sites at the knee . RESULTS The analyses of variance showed that both real and sham acupuncture significantly reduced pain , stiffness , and physical disability in the OA knee , but that there were no significant differences between groups . CONCLUSIONS Acupuncture is not more effective than sham acupuncture in the treatment of OA pain OBJECTIVE A pilot study to assess the feasibility of a trial to investigate the efficacy of acupuncture compared to placebo needling for the treatment of acute low back pain ( LBP ) . As part of this , the study was design ed to establish the credibility of the placebo control , and to provide data to inform a power analysis to determine numbers for a future trial . STUDY DESIGN A pilot patient and assessor blinded r and omized controlled trial . SETTING Primary care health centre facility , South and East Belfast Trust , Northern Irel and . PATIENTS Patients from the physiotherapy waiting list ( n=48 ) with LBP of less than 12 weeks duration . OUTCOME MEASURES Rol and and Morris Disability Question naire ( RMDQ ) , Visual Analogue Scale ( VAS ) , medication use and an exit question naire were completed at baseline , end of treatment , and at 3 months follow up . RESULTS Ninety-four percent ( 45/48 ) of patients completed assigned treatment , 83 % ( 40/48 ) completed 3 months follow-up . The sham needle used here proved to be credible : 91.7 % in the placebo group believed they had received acupuncture , compared to 95.8 % in the verum acupuncture group . Differences in baseline characteristics were accounted for using ANCOVA . There was no significant difference between groups on the RMDQ over time . For pain , the only statistically significant difference was at the 3 months follow up ( worst VAS , point estimate , 18.7 , 95 % CI 1.5 - 36.0 , p=0.034 ) . The majority of patients were taking some form of analgesic medication for LBP at the start of treatment ( n=44 ; 92 % ) , and at the end of treatment the verum acupuncture group were taking significantly fewer tablets of pain control medication ( mean ( S.D. ) : 1.0+/-0.3 ) than the placebo group ( mean ( S.D. ) : 4.2+/-0.6 , p<0.05 ) . Based upon these data , power analysis ( power=90 % , alpha=0.05 , minimal clinical ly important difference ( MCID ) for RMDQ=2.5 points ) indicated that 120 participants ( 60 per group ) would be needed to complete an adequately powered r and omized controlled trial . CONCLUSIONS This study has demonstrated the feasibility of a r and omized controlled trial of penetrating needle acupuncture compared to a non-penetrating sham for the treatment of acute LBP in primary care ; 120 participants would be required in a fully powered trial . The placebo needle used in this study proved to be a credible form of control 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 PURPOSE This study provides basic information about the training and practice s of licensed acupuncturists .  METHODS R and omly selected licensed acupuncturists in Massachusetts and Washington state were interviewed and asked to record information on 20 consecutive patient visits . RESULTS Most acupuncturists in both states had 3 or 4 years of academic acupuncture training and had received additional “ postgraduate ” training as well . Acupuncturists treated a wide range of conditions , including musculoskeletal problems ( usually back , neck , and shoulder ) ( 33 % in Massachusetts and 47 % in Washington ) , general body symptoms ( 12 % and 9 % , respectively ) such as fatigue , neurological problems ( 10 % and 12 % , respectively ) ( eg , headaches ) , and psychological complaints ( 10 % and 8 % , respectively ) ( especially anxiety and depression ) . Traditional Chinese medicine ( TCM ) was the predominant style of acupuncture used in both states ( 79 % and 86 % , respectively ) . Most visits included a traditional diagnostic assessment ( more than 99 % ) , regular  body acupuncture  ( 95 % and 93 % , respectively ) , and additional treatment modalities ( 79 % and 77 % , respectively ) . These included heat and lifestyle advice ( 66 % and 65 % , respectively ) , most commonly dietary advice and exercise recommendations . Chinese herbs were used in about one third of visits . Although most patients self-referred to acupuncture , about one half received concomitant care from a physician . Acupuncturists rarely communicated with the physicians of their patients who were providing care for the same problem . CONCLUSIONS This study contributes new information about acupuncturists and the care they provide that should be useful to clinicians interested in becoming more knowledgeable about complementary or alternative medical therapies available to their patients BACKGROUND Because the value of popular forms of alternative care for chronic back pain remains uncertain , we compared the effectiveness of acupuncture , therapeutic massage , and self-care education for persistent back pain . METHODS We r and omized 262 patients aged 20 to 70 years who had persistent back pain to receive Traditional Chinese Medical acupuncture ( n = 94 ) , therapeutic massage  ( n = 78 ) , or self-care educational material s  ( n = 90 ) . Up to 10 massage or acupuncture visits were permitted over 10 weeks . Symptoms ( 0 - 10 scale ) and dysfunction ( 0 - 23 scale ) were assessed by telephone interviewers masked to treatment group . Follow-up was available for 95 % of patients after 4 , 10 , and 52 weeks , and none withdrew for adverse effects . RESULTS Treatment groups were compared after adjustment for prer and omization covariates using an intent-to-treat analysis . At 10 weeks , massage was superior to self-care on the symptom scale ( 3.41 vs 4.71 , respectively ; P = .01 ) and the disability scale ( 5.88 vs 8.92 , respectively ; P<.001 ) . Massage was also superior to acupuncture on the disability scale ( 5.89 vs 8.25 , respectively ; P = .01 ) . After 1 year , massage was not better than self-care but was better than acupuncture ( symptom scale : 3.08 vs 4.74 , respectively ; P = .002 ; dysfunction scale : 6.29 vs 8.21 , respectively ; P = .05 ) . The massage group used the least medications ( P<.05 ) and had the lowest costs of subsequent care . CONCLUSIONS Therapeutic massage was effective for persistent low back pain , apparently providing long-lasting benefits . Traditional Chinese Medical acupuncture was relatively ineffective . Massage might be an effective alternative to conventional medical care for persistent back pain 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 & NA ; The study was carried out to examine whether acupuncture treatment can reduce  chronic pain in the neck and shoulders and related headache  , and also to examine whether possible effects are long‐lasting . Therefore , 24 female office workers ( 47±9 years old , mean±SD ) who had had neck and shoulder pain for 12±9 years were r and omly assigned to a test group ( TG ) or a control group ( CG ) . Acupuncture was applied 10 times during 3–4 weeks either at presumed anti‐pain acupoints ( TG ) or at placebo‐points ( CG ) . A physician measured the pain threshold ( PPT ) in the neck and shoulder regions with algometry before the first treatment , and after the last one and six months after the treatments . Question naires on muscle pain and headache were answered at the same occasions and again 3 years after the last treatment . The intensity and frequency of pain fell more for TG than for CG ( Pb≤0.04 ) during the treatment period . Three years after the treatments TG still reported less pain than before the treatments ( Pw<0.001 ) , contrary to what CG did ( Pb<0.04 ) . The degree of headache fell during the treatment period for both groups , but more for TG than for CG ( Pb=0.02 ) . Three years after the treatments the effect still lasted for TG ( Pw<0.001 ) while the degree of headache for CG was back to the pre‐treatment level ( Pb<0.001 ) . PPT of some muscles rose during the treatments for TG and remained higher 6 months after the treatments ( Pw<0.05 ) , which contrasts the situation for CG . Adequate acupuncture treatment may reduce chronic pain in the neck and shoulders and related headache . The effect lasted for 3 years Purpose : Acupuncture treatment of patients waiting for arthroplasty surgery . Methods : 29 patients with a total of 42 osteoarthritic knees were r and omized to two groups . Group A was treated while Group B served as a no‐treatment control group . After 9 weeks Group B was treated too . Analgesic consumption , pain and objective measurements were registered . All objective measures were done by investigators who were “ blinded ” as to Group A & B. In the second part of the study 17 patients ( 26 knees ) continued with treatments once a month . Registration of analgesic consumption , pain and objective measurements continued . Total study period 49 weeks . Results : Comparing Group A to B there was a significant reduction in pain , analgesic consumption and in most objective measures . In Group A + B combined there was an 80 % subjective improvement , and a significantly increased knee range movement – an increase mainly in the worst knees . Results were significantly better in those who had not been ill for a long time . In the second part of the study , it was shown that it was possible to maintain the improvements . Conclusions : Acupuncture can ease the discomfort while waiting for an operation and perhaps even serve as an alternative to surgery . Seven patients have responded so well that at present they do not want an operation . ( USD 9000 saved per operation ) A study with needle acupuncture was performed in tension-type headache employing a new placebo acupuncture method .  Sixty-nine patients ( mean age 48.1 years , sd = 14.1 ) fulfilling the International Headache Society criteria for tension-type headache were r and omly assigned to verum or placebo condition . No significant differences between placebo and verum with respect to visual analogue scale and frequency of headache attacks could be observed immediately , 6 weeks and 5 months after the end of treatment . There was a significant but weak improvement in quality of life parameters ( clinical global impressions , Nottingham Health Profile ) after verum treatment . In decision tree analyses , the changes in clinical global impressions and headache frequency depended significantly on primary headache frequency with a limit value of 24.5 days headache per month . High values in the von Zerssen Depression Score result ed in high mean visual analogue scale values Sixty patients aged 60 or over with back pain for at least 6 months were recruited from General Practitioner referrals and r and omized to 4 weeks of treatment with acupuncture or transcutaneous electrical nerve stimulation ( TENS ) .  All treatments were administered by the same physiotherapist and both groups had the same contact with him . The following were measured at baseline , completion and at a 3-month follow-up by an independent observer blinded to treatment received : ( 1 ) pain severity on visual analogue scale ( VAS ) ; ( 2 ) pain subscale of Nottingham Health Profile ( NHP ) ; ( 3 ) number of analgesic tablets consumed in previous week ; ( 4 ) spinal flexion from C7 to S1 . Thirty-two patients were r and omized to acupuncture and 28 to TENS ; only three withdrew ( two from acupuncture , one from TENS ) . Significant improvements were shown on VAS ( P < 0.001 ) , NHP ( P < 0.001 ) and tablet count ( P < 0.05 ) between baseline and completion in both groups , these improvements remaining significant comparing baseline with follow-up with a further non-significant improvement in VAS and NHP in the acupuncture group . The acupuncture but not the TENS patients showed a small but statistically significant improvement ( P < 0.05 ) in mean spinal flexion between baseline and completion which was not maintained at follow-up . Thus in these elderly patients with chronic back pain both acupuncture and TENS had demonstrable benefits which outlasted the treatment period . Acupuncture may improve spinal flexion . This trial can not exclude the possibility that both treatments are ' placebos ' 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 OBJECTIVE To investigate the effectiveness of a clinical treatment program with traditional Chinese medicine for migraine and tension-type headache . METHODS Ninety-one patients with migraine , episodic or chronic tension-type headache according to the criteria of the International Headache Society were r and omised into an experimental or a waiting list control group . Patients in the experimental group were treated 4 weeks in a hospital for traditional Chinese medicine after a baseline period of one month . Patients in the waiting list group continued their previous headache treatment . Main outcome measure was the difference in the number of days with headache of at least moderate intensity during baseline ( month 1 ) and month 7 . RESULTS The difference in the number of days with headache of at least moderate intensity was 5.6 ( S.D. , 6.1 ) days in the experimental group and 1.2 ( S.D. , 4.5 ) days in the waiting list group ( P < 0.001 ) . A reduction of more than 50 % in headache days was observed in 52 % of the patients in the experimental group and 16 % in the waiting list group . Patients with migraine and a combination of migraine and episodic tension-type headaches  improved more than patients with other headaches . CONCLUSION The results of this study indicate that  treatment  in the hospital for traditional Chinese medicine in Kotzting is associated with lasting improvements in the majority of patients DESIGN Forty-two ( 42 ) subjects suffering from chronic low-back pain were matched with the nature of their occupations and then r and omly allocated into : ( 1 ) an electroacupuncture group ( EA ) ; ( 2 ) an electrical heat acupuncture ( EH ) group or ; ( 3 ) a control group . INTERVENTIONS Subjects in the EA group and the EH group received treatment for 20 minutes on a total of 6 acupuncture points . Treatment was delivered twice per week for 4 weeks ( a total of 8 sessions ) . Back exercise was taught to all subjects including the control group as a home program . OUTCOMES MEASURES A numerical rating scale of pain ( NPRS ) , straight leg raise ( SLR ) , and Rol and Morris Disability Question naire ( RMDQ ) were recorded . RESULTS There were significant reduction of NPRS within the EA ( p = 0.000 ) , EH ( p = 0.000 ) , and control ( p = 0.013 ) groups across sessions . Significant between-group differences were shown in session 4 ( p = 0.006 ) , session 8 ( p = 0.001 ) , and 1-month follow-up sessions ( p = 0.001 ) . Posthoc tests showed that the NPRS of the EH group was significantly lower than that of the EA group and the control group by session 4 ( p = 0.004 ) . After session 8 , the NPRS of both the EA group ( p = 0.003 ) and the EH group ( p = 0.001 ) were significantly lower than that of the control group . Such a difference was maintained at least up to the 1-month follow-up . Only the EA group had significant improvement in the measurement of SLR across sessions ( p = 0.000 ) . The between-group difference reached significance level in session 8 ( p = 0.001 ) and at 1-month follow-up ( p = 0.002 ) . Posthoc tests showed that EA group had significantly greater gain than the EH group and the control group . For the RMDQ score , the improvement was statistically significant within each of the three groups over time ( p = 0.000 ) . However , the between-group difference did not reach statistical significance . CONCLUSIONS Our findings suggest that 4 sessions of EH treatment over 2 weeks produced significantly greater reduction in the NPRS than that of the EA or the control . However , EA produced greater improvement in SLR and reduction in RMDQ score than that of the EH and the control 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 Opioid-like medications ( OLM ) are commonly used by patients with various types of chronic pain , but their long-term benefit is question able . Electroacupuncture ( EA ) has been previously shown beneficial in reducing post-operative acute OLM consumption . In this pilot r and omized controlled trial , the effect of EA on OLM usage and associated side effects in chronic pain patients was evaluated . After a two-week baseline assessment , participants using OLM for their non-malignant chronic pain were r and omly assigned to receive either real EA ( REA , n=17 ) or sham EA ( SEA , n=18 ) treatment twice weekly for 6 weeks before entering a 12-week follow-up . Pain , OLM consumption and their side effects were recorded daily . Participants also completed the McGill Pain Question naire ( MPQ ) , SF-36 and Beck Depression Inventory ( BDI ) at baseline , and at the 5th , 8th , 12th , 16th and 20th week . Nine participants withdrew during the treatment period with another three during the follow-up period . Intention to treat analysis was applied . At the end of treatment period , reductions of OLM consumption in REA and SEA were 39 % and 25 % , respectively ( p=0.056 ) , but this effect did not last more than 8 weeks after treatment . There was no difference between the two groups with respect to reduction of side effects and pain and the improvement of depression and quality of life . In conclusion , REA demonstrates promising short-term reduction of OLM for participants with chronic non-malignant pain , but such effect needs to be confirmed by trials with adequate sample sizes 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 OBJECTIVE To check the effectiveness of a true acupuncture treatment according to traditional Chinese medicine ( TCM ) in migraine without aura , comparing it to a st and ard mock acupuncture protocol , an accurate mock acupuncture healing ritual , and untreated controls . BACKGROUND Migraine prevalence is high and affects a relevant rate of adults in the productive phase of their life . Acupuncture has been increasingly advocated and used in Western countries for migraine treatment , but the evidence of its effectiveness still remains weak . A large variability of treatments is present in published studies and no acupoint selection according to TCM has been investigated so far ; therefore , the low level of evidence of acupuncture effectiveness might partly depend on inappropriate treatment . DESIGN AND METHODS A prospect i ve , r and omized , controlled study was performed in 160 patients suffering from migraine without aura , assessed according to the ICD-10 classification . The patients were divided into the following 4 groups : ( 1 ) group TA , treated with true acupuncture ( according to TCM ) plus Rizatriptan ; ( 2 ) group RMA , treated with ritualized mock acupuncture plus Rizatriptan ; ( 3 ) group SMA , treated with st and ard mock acupuncture plus Rizatriptan ; ( 4 ) group R , without prophylactic treatment with relief therapy only ( Rizatriptan ) . The MIDAS Question naire was administered before treatment ( T0 ) , at 3 ( T1 ) and 6 months ( T2 ) from the beginning of treatment , and the MIDAS Index ( MI ) was calculated .  Rizatriptan intake was also checked in all groups of patients at T0 , T1 , and T2 . Group TA and RMA were evaluated according to TCM as well ; then , the former was su bmi tted to true acupuncture and the latter to mock acupuncture treatment resembling the same as TA . The statistical analysis was conducted with factorial ANOVA and multiple tests with a Bonferroni adjustment . RESULTS A total of 127 patients completed the study ( 33 dropouts ) : 32 belonged to group TA , 30 to group RMA , 31 to group SMA , and 34 to group R. Before treatment the MI ( T(0 ) ) was moderate to severe with no significant intergroup differences . All groups underwent a decrease of MI at T(1 ) and T(2 ) , with a significant group difference at both T(1 ) and T(2 ) compared to T(0 ) ( P < .0001 ) . Only TA provided a significant improvement at both T(1 ) and T(2 ) compared to R ( P < .0001 ) . RMA underwent a transient improvement of MI at T(1 ) . The Rizatriptan intake paralleled the MI in all groups . CONCLUSIONS TA was the only treatment able to provide a steady outcome improvement in comparison to the use of only Rizatriptan , while RMA showed a transient placebo effect at T1 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 BACKGROUND AND PURPOSE There is no definitive evidence for the efficacy of the physical therapy interventions used for patients with impingement syndrome . The purpose of this study was to compare manual acupuncture and continuous ultrasound , both applied in addition to home exercises , for patients diagnosed with impingement syndrome . SUBJECTS AND METHODS Eighty-five patients with clinical signs of impingement syndrome were r and omly assigned to either a group that received acupuncture ( n=44 ) or a group that received ultrasound ( n=41 ) . Both interventions were given by physical therapists twice a week for 5 weeks in addition to a home exercise program . Scores from 3 shoulder disability measures , combined in the analysis , measured change during a period of 12 months . RESULTS Both groups improved , but the acupuncture group had a larger improvement in the combined score . DISCUSSION AND CONCLUSION The results suggest that acupuncture is more efficacious than ultrasound when applied in addition to home exercises 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 OBJECTIVES To compare the effects of real acupuncture to tender points for neck and shoulder pain and stiffness ( Japanese : katakori ) with those of sham acupuncture . DESIGN R and omized-controlled trial . METHODS Thirty-four volunteers from an acupuncture school with complaints of chronic pain and stiffness , who had no arm symptoms and gave informed consent , were r and omly allocated to acupuncture or sham groups . Acupuncture or sham acupuncture was applied to the tender points once a week for 3 weeks . In the acupuncture group the acupuncture needle was inserted to the muscle , then the sparrow pecking technique was applied five times . Sham acupuncture was done without insertion of the needle . Dull pain and stiffness were evaluated by visual analog scale ( VAS ) before , and every 2 days after the first needling for 1 month . Pressure pain threshold on the tender points was measured before and after each treatment . RESULTS There was no statistical difference of VAS scores between acupuncture and sham groups 9 days after the last treatment . However , the acupuncture group showed significant reduction of VAS scores immediately after and /or 1 day after the real acupuncture treatments ( P<0.01 ) . The effect tended to be prolonged after repeated treatment . Pressure pain thresholds tended to increase after real acupuncture treatment but not after sham acupuncture . CONCLUSIONS Acupuncture applied to tender points appears to have short-term effects on neck and shoulder pain and stiffness , but this study was unable to demonstrate any long-term superiority over sham acupuncture Background There is evidence for the efficacy of acupuncture treatment in knee osteoarthritis , but it remains unclear which acupuncture modes are most effective . We evaluated the effects of trigger point acupuncture on pain and quality of life in knee osteoarthritis patients , compared with acupuncture at st and ard points , and sham acupuncture . Methods Thirty patients ( 27 women , 3 men ; aged 61–82 years ) with non-radiating knee osteoarthritis pain for at least six months and normal neurological examination were r and omised to one of three groups for the study period of 21 weeks . Each group received five acupuncture treatment sessions . The st and ard acupuncture point group ( n=10 ) received treatment at traditional acupuncture points for knee pain ; the trigger point acupuncture group ( n=10 ) received treatment at trigger points ; and the third group ( n=10 ) received sham acupuncture treatment at the trigger points . Outcome measures were pain intensity ( visual analogue scale , VAS ) and WOMAC index ( Western Ontario and McMaster Universities Arthritis Index ) . The groups were compared by the area under the curve method . Results Five patients dropped out of the study because of lack of improvement , and one patient ( in the trigger point acupuncture group ) dropped out because of deterioration of symptoms ; the remaining 24 patients were included in the analysis . After treatment , the trigger point acupuncture group reported less pain intensity on VAS than the st and ard acupuncture or sham treatment group , but both the trigger point acupuncture and st and ard acupuncture groups reported improvement of function of knee . There was a significant reduction in pain intensity between pre-treatment and five weeks after treatment for the trigger point acupuncture ( P<0.01 ) and st and ard acupuncture groups ( P<0.01 ) included in the analysis , but not for the sham treatment group . Group comparison using the area under the curves demonstrated a significant difference only between trigger point acupuncture and sham treatment groups analysed ( P<0.025 for VAS , and P<0.031 for WOMAC ) . Conclusion These results suggest that trigger point acupuncture therapy may be more effective for osteoarthritis of the knee in some elderly patients than st and ard acupuncture therapy 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 BACKGROUND A problem acupuncture research has to face is the concept of a control group . If , in control groups , non-acupoint needling is done , physiological acupuncture effects are implied . Therefore the effects shown in this group are often close to those shown in the acupuncture group . In other trials , control groups have received obviously different treatments , such as transcutaneous electrical nervous stimulation or TENS-laser treatment ; it is not clear if the effects of acupuncture are due only to the psychological effects of the treatment . METHODS We developed a placebo acupuncture needle , with which it should be possible to simulate an acupuncture procedure without penetrating the skin . In a cross-over experiment with 60 volunteers we tested whether needling with the placebo needle feels any different from real acupuncture . FINDINGS Of 60 volunteers , 54 felt a penetration with acupuncture  ( mean visual analogue scale [ VAS ] 13.4 ; SD 10.58 ) and 47 felt it with placebo ( VAS 8.86 ; SD 10.55 ) , 34 felt a dull pain sensation ( DEQI ) with acupuncture and 13 with placebo . None of the volunteers suspected that the needle may not have penetrated the skin . INTERPRETATION The placebo needle is sufficiently credible to be used in investigations of the effects of acupuncture INTRODUCTION There is some evidence for the efficacy of acupuncture in chronic neck pain ( CNP ) treatment , but it remains unclear which acupuncture modes are most effective . Objective was to evaluate the effects of trigger point acupuncture on pain and quality of life ( QOL ) in CNP patients compared to three other acupuncture treatments ( acupoints , non-trigger point and sham treatment ) . METHODS Forty out- patients ( 29 women , 11 men ; age range : 47 - 80 years ) from the Department of Orthopaedic Surgery , Meiji University of Oriental Medicine , with non-radiating CNP for at least 6 months and normal neurological examination were r and omised to one of four groups over 13 weeks . Each group received two phases of acupuncture treatment with an interval between them . The acupoint group ( st and ard acupuncture ; SA , n=10 ) received treatment at traditional acupoints for neck pain , the trigger point ( TrP , n=10 ) and non-trigger point ( non-TrP , n=10 ) groups received treatment at tenderness points for the same muscle , while the other acupuncture group received sham treatments on the trigger point ( SH , n=10 ) . Outcome measures were pain intensity ( visual analogue scale ; VAS 0 - 100 mm ) and disease specific question naire ( neck disability index ; NDI , 60-point scale ) . RESULTS After treatment , the TrP group reported less pain intensity and improved QOL compared to the SA or non-TrP group . There was significant reduction in pain intensity between the treatment and the interval for the TrP group ( p<0.01 , Dunnett 's multiple test ) , but not for the SA or non-TrP group . CONCLUSION These results suggest that trigger point acupuncture therapy may be more effective on chronic neck pain in aged patients than the st and ard acupuncture therapy 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 There is conflicting evidence on the efficacy of traditional Chinese acupuncture ( TCA ) , and the role of placebo effects elicited by acupuncturists ' behavior has not been eluci date d. We conducted a 3‐month r and omized clinical trial in patients with knee osteoarthritis to compare the efficacy of TCA with sham acupuncture and to examine the effects of acupuncturists ' communication styles The objectives were to introduce a new method for controlled trials of acupuncture in the field of headache research and to examine the role of needling per se . Women with menstrually related migraine were r and omized to three months of treatment with verum or placebo needles . Three st and ard size casts were moulded to secure the placebo needles in the head . No significant differences were found between the verum group ( n = 15 ) and the placebo group ( n = 13 ) during treatment or follow up three and six months later , either in the attack frequency or in the number of days per month with migraine , headache intensity or drug-use . The casts held the needles exactly in place despite movements of the head , and are vali date d as practical , hygienic and extremely durable . This method is satisfactory for controlled studies of acupuncture in headache . It is possible that the positive results in earlier clinical trials on acupuncture in migraine are attributable to other mechanisms than needling of subcutaneous tissue OBJECTIVES To examine the efficacy of periosteal stimulation therapy ( PST , osteopuncture ) for the treatment of  chronic pain associated with advanced knee osteoarthritis . DESIGN R and omized , controlled clinical trial . SETTING Outpatient pain clinic . PARTICIPANTS Eighty-eight community-dwelling older adults with moderate knee pain or greater for 3 months or longer and Kellgren-Lawrence ( K-L ) grade 2 through 4 radiographic severity ( 80 % had K-L 4 ) . INTERVENTION Participants were r and omized to receive PST or control PST once a week for 6 weeks . MEASUREMENTS Pain severity and self-reported function ( Western Ontario and McMasters University Osteoarthritis Index ( WOMAC ) ) and physical performance ( Short Physical Performance Battery ( SPPB ) ) were assessed at baseline , after the last PST session ( post ) , and 3 months later ( follow-up ) . Pain severity was also assessed monthly using the multidimensional pain inventory short form . RESULTS Pain was reduced significantly more in the PST group than in the control PST group at post ( P=.003 ; mean WOMAC pain subscale baseline 9.4 vs 6.4 ) and 1 month later ( P<.001 ) , but by 2 months , pain levels had regressed to pre-intervention levels . The group-by-time interaction for the WOMAC function scale was significant at post ( P=.04 ) but not at follow-up ( P=.63 ) . No significant group differences were found for the SPPB . Neither analgesic use nor global improvement differed between groups . There were four treatment dropouts . CONCLUSION PST affords short-term modest pain reduction for older adults with advanced knee OA . Future research should test the effectiveness of booster treatments in sustaining analgesic benefits and of combining PST with therapeutic exercise in ameliorating disability risk 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 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 determine the effect of a series of electro-acupuncture ( EA ) treatment in conjunction with exercise on the pain , disability , and functional improvement scores of patients with chronic low-back pain ( LBP ) . DESIGN A blinded prospect i ve r and omized controlled study . SUBJECTS AND INTERVENTIONS A total of 52 patients were r and omly allocated to an exercise group ( n = 26 ) or an exercise plus EA group ( n = 26 ) and treated for 12 sessions . OUTCOME MEASURES Numerical Rating Scale ( NRS ) , Aberdeen LBP scale , lumbar spinal active range of movement ( AROM ) , and the isokinetic strength were assessed by a blinded observer . Repeated measures analysis of variance ( R-ANOVA ) with factors of group and time was used to compare the outcomes between the two groups at baseline ( before treatment ) , immediately after treatment , 1-month follow-up , and 3-month follow-up . The level of significance was set at p = 0.05 . RESULTS Significantly better scores in the NRS and Aberdeen LBP scale were found in the exercise plus EA group immediately after treatment and at 1-month follow-up . Higher scores were also seen at 3-month follow-up . No significant differences were observed in spinal AROM and isokinetic trunk concentric strength between the two groups at any stage of follow-up . CONCLUSIONS This study provides additional data on the potential role of EA in the treatment of LBP , and indicates that the combination of EA and back exercise might be an effective option in the treatment of pain and disability associated with chronic LBP Objective The authors sought to determine whether a series of needle acupuncture treatments produced long-term relief of  chronic low back pain .  Design A blinded placebo-controlled study with an independent observer . The patients were r and omized to receive manual acupuncture , electroacupuncture , or active placebo ( mock transcutaneous electrical nerve stimulation ) . Subjects were examined and monitored by an investigator who was blinded to the treatment given . Setting A tertiary-level pain clinic at a Swedish university hospital . Patients Fifty consecutive patients ( 33 women , 17 men ; mean age , 49.8 years ) with chronic low back pain ( mean pain duration , 9.5 years ) and without rhizopathy or history of acupuncture treatment were included in the study . Interventions Treatments were given once per week for 8 weeks . Two further treatments were given during the follow-up assessment period of 6 months or longer . Outcome Measures The independent observer made a global assessment of the patients 1 , 3 , and 6 months after treatment . The patients kept pain diaries to score pain intensity twice daily , analgesic intake , and quality of sleep daily , and activity level weekly . Results At the 1-month independent assessment , 16 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement ( p < 0.05 ) . At the 6-month follow-up assessment , 14 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement ( p < 0.05 ) . A significant decrease in pain intensities occurred at 1 and 3 months in the acupuncture groups compared with the placebo group . There was a significant improvement in return to work , quality of sleep , and analgesic intake in subjects treated with acupuncture . Conclusions The authors found a long-term pain-relieving effect of needle acupuncture compared with true placebo in some patients with chronic nociceptive low back pain This r and omised controlled trial was undertaken to evaluate the effectiveness of  acupuncture  as a treatment for frozen shoulder . Thirty-five patients with a diagnosis of frozen shoulder were r and omly allocated to an exercise group or an exercise plus acupuncture group and treated for a period of 6 weeks . Functional mobility , power , and pain were assessed by a blinded assessor using the Constant Shoulder Assessment , at baseline , 6 weeks and 20 weeks . Analysis was based on the intention-to-treat principle . Compared with the exercise group , the exercise plus acupuncture group experienced significantly greater improvement with treatment . Improvements in scores by 39.8 % ( st and ard deviation , 27.1 ) and 76.4 % ( 55.0 ) were seen for the exercise and the exercise plus acupuncture groups , respectively at 6 weeks ( P=0.048 ) , and were sustained at the 20-week re- assessment ( 40.3 % [ 26.7 ] and 77.2 % [ 54.0 ] , respectively ; P=0.025 ) . We conclude that the combination of acupuncture with shoulder exercise may offer effective treatment for frozen shoulder Objective : To compare the effect of acupuncture with placebo transcutaneous electrical nerve stimulation ( TENS ) when added to the exercise treatment of rotator cuff tendinitis with respect to pain , shoulder movements and function . Design : Prospect i ve alternate allocation controlled trial . Setting : Outpatient department . Patients : Thirty-three patients ( 12 women and 21 men ) were included in the study . All had clinical ly diagnosed rotator cuff tendinitis . Intervention : Both groups underwent a st and ardized training programme . Each patient received in addition either 10 treatments with acupuncture or placebo TENS , 1 - 2 times per week . Main outcome measures : The parameters investigated were intensity of pain ( measured with visual analogue scale ) , active , passive as well as functional movements in the shoulder ( h and in neck ( HIN ) and pour out of a pot ( POP ) ) . Patients were tested before treatment , after treatment and at a six-month follow-up . Medicine intake , ability to lie on the affected side and sleep disturbances were evaluated . A subjective assessment was made after the treatment and at follow-up . Results : Sixteen patients had acupuncture , 17 placebo TENS . Eight patients endured pain at rest in the placebo TENS group , and 10 in the acupuncture group . After treatment both groups improved , the improvement persisted at the six-month follow-up . Both groups increased range of movement . Except for the functional test HIN in the acupuncture group , there were no differences between the groups regarding other parameters investigated directly after treatment or at six-month follow-up . Conclusion : There is no difference between the effect of additional acupuncture treatment and placebo TENS in the treatment of rotator cuff tendinitis OBJECTIVE To evaluate the effectiveness of acupuncture , as compared with physiotherapy , in the management of  chronic neck pain .  DESIGN Seventy adult patients with non-inflammatory neck pain of > 6 weeks duration and with no abnormal neurology were r and omly assigned to receive either of the treatments . Thirty-five patients were included in each group . OUTCOME MEASURES Pain by visual analogue scale and neck pain question naire , improvement in range of movement of neck relative to baseline , and well-being ( general health question naire ) . Measurements were recorded at the start of treatment , at 6 weeks and at 6 months . RESULTS Both treatment groups improved in all criteria . Acupuncture was slightly more effective in patients who had higher baseline pain scores . CONCLUSIONS Both acupuncture and physiotherapy are effective forms of treatment . Since an untreated control group was not part of the study design , the magnitude of this improvement can not be quantified One half of 42 subjects treated for painful shoulders received classic acupuncture , and one half received a placebo in which the needles did not penetrate the skin . Half of each of these groups was treated in a positive setting to encourage the subject , and half in a negative setting design ed to keep encouragement at a minimum . All patients were independently rated for  susceptibility to hypnosis .  Although range of motion did not improve , the majority of patients reported significant improvement in shoulder discomfort to a blind evaluator after treatment ; placebo and acupuncture groups did not differ in this respect , however . The positive and negative setting s did not affect treatment outcome . In all groups , those who were not rated as highly susceptible to hypnosis tended to fail to achieve the highest levels of relief , but such differences were not statistically significant Objective To investigate the benefit of adding acupuncture to a course of advice and exercise delivered by physiotherapists for pain reduction in patients with osteoarthritis of the knee . Design Multicentre , r and omised controlled trial . Setting 37 physiotherapy centres accepting primary care patients referred from general practitioners in the Midl and s , United Kingdom . Participants 352 adults aged 50 or more with a clinical diagnosis of knee osteoarthritis . Interventions Advice and exercise ( n=116 ) , advice and exercise plus true acupuncture ( n=117 ) , and advice and exercise plus non-penetrating acupuncture ( n=119 ) . Main outcome measures The primary outcome was change in scores on the Western Ontario and McMaster Universities osteoarthritis index pain subscale at six months . Secondary outcomes included function , pain intensity , and unpleasantness of pain at two weeks , six weeks , six months , and 12 months . Results Follow-up rate at six months was 94 % . The mean ( SD ) baseline pain score was 9.2 ( 3.8 ) . At six months mean reductions in pain were 2.28 ( 3.8 ) for advice and exercise , 2.32 ( 3.6 ) for advice and exercise plus true acupuncture , and 2.53 ( 4.2 ) for advice and exercise plus non-penetrating acupuncture . Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 ( 95 % confidence interval −1.0 to 0.9 ) for advice and exercise plus true acupuncture and 0.25 ( −0.8 to 1.3 ) for advice and exercise plus non-penetrating acupuncture . Similar non-significant differences were seen at other follow-up points . Compared with advice and exercise alone there were small , statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for non-penetrating acupuncture . Conclusion The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores . Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups , making it unlikely that this was due to acupuncture needling effects . Trial registration Current Controlled Trials IS RCT N88597683 & 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 Thirty patients with cervical spine pain syndromes persisting a mean of 8 years were assigned r and omly into equal treatment and control groups . After 12 weeks , 12 of 15 ( 80 % ) of the treated group felt improved , some dramatically , with a mean 40 % reduction of pain score , 54 % reduction of pain pills , 68 % reduction of pain hours per day and 32 % less limitation of activity . Two of 15 ( 13 % ) of the control group reported slight improvement after 12.8 weeks . The control group had a mean 2 % worsening of the pain score , 10 % reduction in pain pills , no lessening of pain hours and 12 % less limitation of activity Acupuncture has gained increasing attention in the treatment of  chronic pain .  The lack of a satisfying placebo method has made it impossible to show whether needling is an important part of the method or whether the improvement felt by the patient is due to the therapeutic setting and psychological phenomena . Also , the effectiveness of acupuncture has not been demonstrated sufficiently . We treated 52 sportsmen with rotator cuff tendinitis in a r and omised single-blind clinical trial using a new placebo-needle as control . Patients were treated for 4 weeks . The primary endpoint of the trial was the change in the modified Constant-Murley-score from the baseline . Assessment of the treatment outcome was made by experienced orthopaedists not informed of the treatment allocation . Acupuncture with penetration of the skin was shown to be more effective than a similar therapeutic setting with placebo needling in the treatment of pain . The  acupuncture-group  improved 19.2 Constant-Murley-score points ( SD 16.1 , range from -13 to 50 ) , the  control-group  improved 8.37 points ( SD 14.56 , range from -20 to 41 ) , ( P=0.014 ; C.I. 2.3;19.4 ) . This study showed that needling is an important part of the acupuncture effect in the treatment of  chronic shoulder pain in athletes . No conclusions can be derived from this study concerning the importance of choosing points and the rules of Traditional Chinese Medicine . Using the new placebo method as control for other ailments could improve the evidence of specific  acupuncture effects beyond pain treatment Objectives : The aim of the study was to evaluate the therapeutic effect of electro-acupuncture ( EA ) and hydrotherapy , both in combination with patient education or with patient education alone , in the treatment of osteoarthritis in the hip . Methods : Forty-five patients , aged 42–86 years , with radiographic changes consistent with osteoarthritis in the hip , pain related to motion , pain on load , and ache were chosen . They were r and omly allocated to EA , hydrotherapy , both in combination with patient education , or patient education alone . Outcome measures were the disability rating index ( DRI ) , global self-rating index ( GSI ) , and visual analogue scale ( VAS ) . Assessment s were done before the intervention and immediately after the last treatment and 1 , 3 , and 6 months after the last treatment . Results : Pain related to motion and pain on load was reduced up to 3 months after last the treatment in the hydrotherapy group and up to 6 months in the EA group . Ache during the day was significantly improved in both the EA and hydrotherapy group up to 3 months after the last treatment . Ache during the night was reduced in the hydrotherapy group up to 3 months after the last treatment and in the EA group up to 6 months after . Disability in functional activities was improved in EA and hydrotherapy groups up to 6 months after the last treatment . Quality of life was also improved in EA and hydrotherapy groups up to 3 months after the last treatment . There were no changes in the education group alone . Discussion : In conclusion , EA and hydrotherapy , both in combination with patient education , induce long-lasting effects , shown by reduced pain and ache and by increased functional activity and quality of life , as demonstrated by differences in the pre- and post-treatment assessment
BACKGROUND Although acupuncture is widely used for chronic pain , there remains considerable controversy as to its value .
We aim ed to determine the effect size of acupuncture for 4 chronic pain conditions : back and neck pain , osteoarthritis , chronic headache , and shoulder pain .