1
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Lim SM, Go E. A systematic review of sham acupuncture validation studies. BMC Complement Med Ther 2024; 24:215. [PMID: 38840076 PMCID: PMC11155071 DOI: 10.1186/s12906-024-04506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Acupuncture is widely used worldwide; however, studies on its effectiveness have been impeded by limitations regarding the design of appropriate control groups. In clinical research, noninvasive sham acupuncture techniques can only be applied through validation studies. Therefore, this systematic review aimed to evaluate the scope of existing literature on this topic to identify trends. METHODS We queried Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials databases from inception to July 2022 for relevant articles. Author names were used to identify additional relevant articles. Two independent reviewers assessed the identified articles based on the inclusion and exclusion criteria. The following data were extracted: study design, information regarding acupuncturists and participants, general and treatment-related characteristics of the intervention and control groups, participants' experience of acupuncture, and research findings. RESULTS The database query yielded 673 articles, of which 29 articles were included in the final review. Among these, 18 involved the use of one of three devices: Streitberger (n = 5), Park (n = 7), and Takakura (n = 6) devices. The remaining 11 studies used other devices, including self-developed needles. All the included studies were randomized controlled trials. The methodological details of the included studies were heterogeneous with respect to outcomes assessed, blinding, and results. CONCLUSIONS Sham acupuncture validation studies have been conducted using healthy volunteers, with a focus on blind review and technological developments in sham acupuncture devices. However, theren may be language bias in our findings since we could not query Chinese and Japanese databases due to language barriers. There is a need for more efforts toward establishing control groups suitable for various acupuncture therapy interventions. Moreover, there is a need for more rigorous sham acupuncture validation studies, which could lead to higher-quality clinical studies.
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Affiliation(s)
- Sung Min Lim
- Department of Clinical Research on Rehabilitation, Korea National Rehabilitation Research Institute, 58 Samgaksan-Ro, Gangbuk-Gu, Seoul, 142-070, Republic of Korea
| | - Eunji Go
- Department of Clinical Research on Rehabilitation, Korea National Rehabilitation Research Institute, 58 Samgaksan-Ro, Gangbuk-Gu, Seoul, 142-070, Republic of Korea.
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2
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Tan MY, Mo CY, Zhao Q. Efficacy and safety of acupuncture in the treatment of urinary incontinence after prostate surgery: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e072516. [PMID: 37597872 PMCID: PMC10441104 DOI: 10.1136/bmjopen-2023-072516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/02/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a common complication after prostate surgery. Acupuncture treatment (AT) has been proposed as an alternative therapy for this condition. The purpose of this protocol aims to outline a systematic review and meta-analysis that aims to evaluate the effectiveness and safety of AT in patients with postprostate surgery UI. METHODS We will search for randomised controlled trials (RCTs) in eight databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang database, SinoMed and VIP database. Additionally, we will search two clinical trial registration platforms, namely the WHO's International Clinical Trials Registry Platform and the Chinese Clinical Trial Registry. The search will include articles from the inception of these databases until 30 September 2023. The extracted data will then be imported into the Stata V.15.0 software. Two authors will independently review the literature, collect data and use the Grades of Recommendation, Assessment, Development and Evaluation and the Cochrane Risk of Bias 2 tool to evaluate the risk of bias and the quality of the evidence. Outcomes for RCTs will include at least one of the following: International Consultation Incontinence Questionnaire-Urinary Incontinence Short Form, Individualised Care for People with long-term health conditions-Capability measure for Adults, Score of Frequency Incontinence Quality of Life Questionnaire, Patient Global Impression of Improvement, Visual Analogue Scale, Numeric Rating Scale, 1- hour pad test, Self-Rating Anxiety Scale, total efficiency and adverse event. We will use random or fixed effect models to analyse data according to heterogeneity. If significant heterogeneity exists along with sufficient data, we will perform subgroup analyses to identify the source of heterogeneity. ETHICS AND DISSEMINATION Ethical approval is not required for this study because the data we will extract are from published articles. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022382806.
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Affiliation(s)
- Mo-Yao Tan
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
| | - Chao-Yue Mo
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Zhao
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
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3
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Ruan H, Zhang H, Feng Z, Li X, Han W, Si Y, Li J. Assessment of Completeness of Reporting in Randomized Controlled Trials of Acupuncture Therapy for Chronic Obstructive Pulmonary Disease. Int J Gen Med 2022; 15:5335-5348. [PMID: 35669592 PMCID: PMC9166958 DOI: 10.2147/ijgm.s356666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To assess the completeness of reporting in randomized controlled trials (RCTs) of acupuncture therapy (AT) for chronic obstructive pulmonary disease (COPD). Methods We systematically searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), WANFANG Data, and China Biology Medicine (CBM) for studies published from their inception to May 8, 2021. The completeness of reporting was evaluated by CONSORT statement and STRICTA guidelines. Univariate and multivariate regression analyses were performed to preliminarily explore the factors related to completeness of reporting. Results A total of 44 RCTs were included. The overall quality score (OQS) based on the CONSORT statement and STRICTA guidelines ranged from 3 to 26 and 7 to 14, with a median of 10 and 11, respectively. Among the 35 items of the CONSORT statement, 10 items were fully reported with reporting rate > 70%, and 11 items were poorly reported at a rate < 5%. Among the 17 items of the STRICTA guidelines, 10 items were adequately reported with > 70%, and only 3 items were incompletely reported at a rate < 20%. The agreement of most items was determined as “good”, “substantial”, or “moderate”. By regression analysis, publication language (β coefficient: 6.432, 95% CI: 3.202 to 9.663, P <0.001) and funding source (β coefficient: 3.159, 95% CI: 1.045 to 5.273, P =0.004) acted as independent predictors of completeness of reporting according to the CONSORT statement. However, no variables associated with the STRICTA guidelines were identified. Conclusion The completeness of reporting of AT for COPD was inadequate. The condition relatively improved for trials with publication in the English language and funding source. By recommendation, reports should be strictly standardized in accordance with the CONSORT statement and STRICTA guidelines to improve the clinical research evidence of AT for COPD.
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Affiliation(s)
- Huanrong Ruan
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China
| | - Hailong Zhang
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, People's Republic of China
| | - Zhenzhen Feng
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, People's Republic of China
| | - Xuanlin Li
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China
| | - Weihong Han
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China
| | - Yimei Si
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China
| | - Jiansheng Li
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People's Republic of China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, People's Republic of China
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4
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Morrow EM, Theologis T, Kothari A. Construction and validation of sham insoles used in clinical trials: A systematic review. Prosthet Orthot Int 2022; 46:121-133. [PMID: 35019884 DOI: 10.1097/pxr.0000000000000091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Insoles are commonly prescribed to treat pathologies in a variety of patient groups; however, there is limited evidence to guide clinical decision-making. A well-validated sham insole is critical to conducting a double-blind placebo-controlled trial. OBJECTIVES The aims were to establish: (1) How are sham insoles constructed? (2) What measures are undertaken to ensure adequate blinding? (3) What methods are used to validate the biomechanical effects? STUDY DESIGN A systematic search of the methodology of level I-II therapeutic evidence. METHODS Searches were conducted in MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials. Inclusion criteria were placebo-controlled clinical trials, sham insoles used, treatment insoles alter biomechanics, treatment insoles meet the ISO definition of foot orthotics, sham and treatment insoles tested in normal walking, and article available in English. RESULTS The search generated 270 results. Twenty-four trials were included. 19% of sham insoles were described sufficiently to be replicated. The most common sham construction characteristics were full length, ethylene-vinyl acetate material, and flat insoles. 58% of studies were double-blinded; however, many did not describe any blinding methods. There is evidence that blinding the intervention details and a similar insole appearance is effective to blind participants. 13% of studies included a shoe-only condition to allow assessment of the biomechanical effects of sham insoles. CONCLUSIONS There is inconsistent construction, blinding, and biomechanical validation of sham insoles. This casts a substantial doubt on the quality and reliability of the evidence base to support the prescription of insoles.
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Affiliation(s)
- Eileen Mairi Morrow
- Paediatric Orthopaedics Department, Oxford University Hospitals NHS Foundation Trust, NDORMS, University of Oxford, Oxford, UK
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5
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Fei YT, Cao HJ, Xia RY, Chai QY, Liang CH, Feng YT, Du YR, Yu MK, Guyatt G, Thabane L, Lao LX, Liu JP, Zhang YQ. Methodological challenges in design and conduct of randomised controlled trials in acupuncture. BMJ 2022; 376:e064345. [PMID: 35217507 PMCID: PMC8868049 DOI: 10.1136/bmj-2021-064345] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Yu-Tong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing GRADE Centre, Beijing, China
| | - Hui-Juan Cao
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing GRADE Centre, Beijing, China
| | - Ru-Yu Xia
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing GRADE Centre, Beijing, China
| | - Qian-Yun Chai
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing GRADE Centre, Beijing, China
| | - Chang-Hao Liang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing GRADE Centre, Beijing, China
| | - Yu-Ting Feng
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing GRADE Centre, Beijing, China
| | - Yi-Ran Du
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ming-Kun Yu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing GRADE Centre, Beijing, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Li-Xing Lao
- Virginia University of Integrative Medicine, Virginia, USA
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing GRADE Centre, Beijing, China
| | - Yu-Qing Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
- Ningbo GRADE Centre, University of Nottingham Ningbo, China
- Chinese Academy of Medical Sciences, Beijing, China
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6
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Li H, Schlaeger JM, Jang MK, Lin Y, Park C, Liu T, Sun M, Doorenbos AZ. Acupuncture Improves Multiple Treatment-Related Symptoms in Breast Cancer Survivors: A Systematic Review and Meta-Analysis. J Altern Complement Med 2021; 27:1084-1097. [PMID: 34449251 DOI: 10.1089/acm.2021.0133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction: Acupuncture has demonstrated effectiveness for symptom management among breast cancer survivors. This meta-analysis aims to evaluate the effect of acupuncture on treatment-related symptoms among breast cancer survivors. Methods: The authors searched PubMed, CINAHL, and EMBASE for relevant randomized clinical trials (RCTs) of acupuncture for managing treatment-related symptoms published in English through June 2021. They appraised the quality of each article using the Cochrane Collaboration Risk of Bias Criteria. The primary outcomes were pain, hot flashes, sleep disturbance, fatigue, depression, lymphedema, and neuropathy as individual symptoms. They also evaluated adverse events reported in acupuncture studies. Results: Of 26 selected trials (2055 patients), 20 (1709 patients) were included in the meta-analysis. Acupuncture was more effective than control groups in improving pain intensity [standardized mean difference (SMD) = -0.60, 95% confidence intervals (CI) -1.06 to -0.15], fatigue [SMD = -0.62, 95% CI -1.03 to -0.20], and hot flash severity [SMD = -0.52, 95% CI -0.82 to -0.22]. The subgroup analysis indicated that acupuncture showed trends but not significant effects on all the treatment-related symptoms compared with the sham acupuncture groups. Compared with waitlist control and usual care groups, the acupuncture groups showed significant reductions in pain intensity, fatigue, depression, hot flash severity, and neuropathy. No serious adverse events were reported related to acupuncture intervention. Mild adverse events (i.e., bruising, pain, swelling, skin infection, hematoma, headache, menstrual bleeding) were reported in 11 studies. Conclusion: This systematic review and meta-analysis suggest that acupuncture significantly reduces multiple treatment-related symptoms compared with the usual care or waitlist control group among breast cancer survivors. The safety of acupuncture was inadequately reported in the included studies. Based on the available data, acupuncture seems to be generally a safe treatment with some mild adverse events. These findings provide evidence-based recommendations for incorporating acupuncture into clinical breast cancer symptom management. Due to the high risk of bias and blinding issues in some RCTs, more rigorous trials are needed to confirm the efficacy of acupuncture in reducing multiple treatment-related symptoms among breast cancer survivors.
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Affiliation(s)
- Hongjin Li
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA.,Department of Cancer Prevention and Control, University of Illinois Cancer Center, Chicago, IL, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Min Kyeong Jang
- Department of Cancer Prevention and Control, University of Illinois Cancer Center, Chicago, IL, USA.,Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Yufen Lin
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Chang Park
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Tingting Liu
- Eleanor Mann School of Nursing, University of Arkansas, Little Rock, AR, USA
| | - Min Sun
- Department of Hematology and Oncology, Hillman Cancer Center, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ardith Z Doorenbos
- Department of Cancer Prevention and Control, University of Illinois Cancer Center, Chicago, IL, USA.,Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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7
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Steffen AD, Burke LA, Pauls HA, Suarez ML, Yao Y, Kobak WH, Takayama M, Yajima H, Kaptchuk TJ, Takakura N, Wilkie DJ, Schlaeger JM. Double-blinding of an acupuncture randomized controlled trial optimized with clinical translational science award resources. Clin Trials 2020; 17:545-551. [PMID: 32650673 PMCID: PMC7529889 DOI: 10.1177/1740774520934910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinical trial articles often lack detailed descriptions of the methods used to randomize participants, conceal allocation, and blind subjects and investigators to group assignment. We describe our systematic approach to implement and measure blinding success in a double-blind phase 2 randomized controlled trial testing the efficacy of acupuncture for the treatment of vulvodynia. METHODS Randomization stratified by vulvodynia subtype is managed by Research Electronic Data Capture software's randomization module adapted to achieve complete masking of group allocation. Subject and acupuncturist blinding assessments are conducted multiple times to identify possible correlates of unblinding. RESULTS At present, 48 subjects have been randomized and completed the protocol resulting in 87 subject and 206 acupuncturist blinding assessments. DISCUSSION Our approach to blinding and blinding assessment has the potential to improve our understanding of unblinding over time in the presence of possible clinical improvement.
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Affiliation(s)
- Alana D Steffen
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Larisa A Burke
- Office of Research Facilitation, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Heather A Pauls
- Office of Research Facilitation, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Marie L Suarez
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - William H Kobak
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nobuari Takakura
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Judith M Schlaeger
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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8
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Vase L. Can insights from placebo and nocebo mechanisms studies improve the randomized controlled trial? Scand J Pain 2020; 20:451-467. [PMID: 32609651 DOI: 10.1515/sjpain-2019-0183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Indexed: 11/15/2022]
Abstract
Background and aims The randomized controlled trial (RCT) is currently facing several challenges, one of these being that the placebo response appears to be increasing in RCTs, thereby making it difficult to demonstrate an effect of potentially new treatments over placebo. This problem has primarily been approached by predicting the magnitude of the placebo response via stable factors, such as demographic variables, and/or by developing complex designs aimed at reducing the placebo response in the hope that it will improve the test of the active treatment. Yet, the success of this approach has so far been limited. Methods A new approach toward improving the RCT is put forward based on placebo and nocebo mechanism studies, i.e. studies that investigate the mechanisms underlying placebo analgesia and nocebo hyperalgesia. In a series of meta-analyses the magnitude of placebo and nocebo effects were determined. Experimental studies across nociplastic and neuropathic pain conditions and across pharmacological and acupuncture treatments investigated psychological and neurobiological mechanisms underlying these effects. The obtained results were used to make approximations of expectations to see if that could predict the placebo response in RCTs and function as a new way of tapping into the placebo component of treatment effects. Results The magnitude of placebo and nocebo effects is large and highly variable. Placebo effects exist across chronic pain conditions with varying degrees of known etiology as well as across pharmacological and non-pharmacological treatments. Patients' perception of the treatment, the verbal suggestions given for pain relief, and the patients' expectations toward pain relief contribute to the magnitude of the placebo effect and to pain relief following placebo interventions. Also, unintentional unblinding and patients' perception of a treatment markedly influence the treatment outcome. By making approximations of expectations toward treatment effects it was possible to predict the magnitude of the placebo response in RCTs. Conclusions and implications The new approach of tapping into or directly asking patients about their perception and expectations toward a treatment, along with the account of the natural history of pain, has the potential to improve the information that can be obtained from RCTs. Thus, by interfacing insights from placebo and nocebo mechanism studies, it may be possible to enhance the information that can be obtained from RCTs and to account for a large part of the variability in the placebo component of the overall treatment effect. This approach has the potential to improve the scientific evaluation of treatments, as well as to illustrate how the effect of treatments can be optimized in clinical practice, which is the crux of evidence-based medicine.
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Affiliation(s)
- Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 11, Building 1350, DK-8000 Aarhus C, Denmark
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9
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Tan CW, Santos D. Contribution of Vision, Touch, and Hearing to the Use of Sham Devices in Acupuncture-Related Studies. J Acupunct Meridian Stud 2019; 13:25-32. [PMID: 31877377 DOI: 10.1016/j.jams.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/22/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022] Open
Abstract
This study investigates whether visual deprivation influences participants' accuracy in differentiating between real and sham acupuncture needles. It also evaluates the relative contributions of tactile, visual, and auditory cues that participants use in their decision-making processes. In addition, a simple sensory decision-making model for research using acupuncture sham devices as comparative controls is proposed. Forty healthy individuals underwent two conditions (blindfolded and sighted) in random sequence. Four sham and four real needles were randomly applied to the participants' lower limb acupoints (ST32 to ST39). Participants responded which needle type was applied. Participants then verbally answered a questionnaire on which sensory cues influenced their decision-making. The proportion of correct judgments, P(C), was calculated to indicate the participants' accuracy in distinguishing between the needle types. Visual deprivation did not significantly influence the participants' discrimination accuracy. Tactile cues were the dominant sensory modality used in decision-making, followed by visual and auditory cues. Sharp and blunt sensations were associated with the real and sham needles, respectively, for both conditions. This study confirmed that tactile cues were the main sensory modalities used in participant decision-making during acupuncture administration. Also, short-term blindfolding of participants during procedures will unlikely influence blinding effectiveness. CLINICAL TRIAL REGISTRATION NUMBER: Not applicable. This study does not fall under the definition of a clinical trial under the ICMJE guidelines.
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Affiliation(s)
- Chee-Wee Tan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
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10
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11
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Zhang GS, Zhang CS, Tan HY, Wang Y, DaCosta C, Zhang AL, Xue CC, Xie YM. Systematic Review of Acupuncture Placebo Devices with a Focus on the Credibility of Blinding of Healthy Participants And/Or Acupuncturists. Acupunct Med 2018; 36:204-214. [DOI: 10.1136/acupmed-2017-011484] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2017] [Indexed: 11/04/2022]
Abstract
Background An ideal placebo design in clinical research should resemble the intervention under investigation to facilitate blinding, yet remain clinically inert. With regard to physical interventions such as acupuncture, a true placebo device has not been developed and validated. Since 1998, researchers have designed several placebo acupuncture devices (PADs). The three most widely used PADs are the Streitberger, the Park and the Takakura device. Aim This review focuses on evaluating studies of these devices, in the context of credibility of blinding (COB), assessment of penetrating pain or sensation, and de qi sensation. Methods Electronic database searches were conducted in four English and two Chinese databases from their inception until November 2016. All studies included in the review were conducted on healthy participants and compared verum manual acupuncture with any of the aforementioned PADs with respect to one or more of the above three outcomes related to blinding effect. Results The synthesised analyses of the 15 included studies showed that the Streitberger and Park placebo devices may not blind participants successfully when tested at a sensitive acupuncture point (LI4). In terms of penetrating sensation, there were significant differences between these two placebo devices and verum acupuncture when applied at this point. The Takakura device was the only PAD that had the potential to blind the acupuncturist. However, the blinding analyses of all outcome measures were inconsistent. Conclusion Overall, there were insufficient data to confirm the blinding effects of these skin-contact PADs as each device was associated with limitations that warrant further design improvements.
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Affiliation(s)
- George Shengxi Zhang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Claire Shuiqing Zhang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Hsiewe Ying Tan
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Yanyi Wang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Cliff DaCosta
- School of Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Anthony Lin Zhang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Charlie Changli Xue
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Yi Min Xie
- Centre for Innovative Structures and Materials, School of Engineering, RMIT University, Melbourne, Victoria, Australia
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Schlaeger JM, Stoffel CL, Bussell JL, Cai HY, Takayama M, Yajima H, Takakura N. Moxibustion for Cephalic Version of Breech Presentation. J Midwifery Womens Health 2018; 63:309-322. [DOI: 10.1111/jmwh.12752] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 11/29/2022]
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Takakura N, Takayama M, Nasu M, Nishiwaki M, Kawase A, Yajima H. Patient blinding with blunt tip placebo acupuncture needles: comparison between 1 mm and 2 mm skin press. JOURNAL OF INTEGRATIVE MEDICINE 2018; 16:164-171. [PMID: 29753429 DOI: 10.1016/j.joim.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/05/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To investigate the influence of the depth of skin press in blunt tip placebo acupuncture needles on patient blinding and its relationship to needle diameter. METHODS Forty healthy volunteers were enrolled as subjects for patient blinding. Four acupuncturists applied the following needles randomly at three points in each forearm: 0.18 mm and 0.25 mm diameter penetrating needles inserted to a depth of 5 mm, and 0.18 mm and 0.25 mm diameter skin-touch needles depressing the skin at the acupoint to a depth of 1 mm and 2 mm from the skin surface. The subjects reported their guesses at the nature of needles they received, and rated needle pain and de qi. A blinding index was calculated to define the success of blinding for subjects. RESULTS The blinding status of subjects for 1 mm press needles of 0.18 mm diameter was "random guess", but "unblinded" for 1 mm press needles of 0.25 mm diameter. For 2 mm press needles of both diameters, the blinding status was "opposite guess" and the blinding status for penetrating needles of both diameters was "unblinded." The percentages of "felt pain" with 2 mm press needles of both diameters were similar to that with penetrating needles, but those were not similar for 1 mm press needles. The frequency of de qi occurrence with 2 mm press needles of 0.18 mm diameter was similar to that of penetrating needles of both diameters. CONCLUSION Placebo needles of 2 mm press made more subjects guess that the needles penetrated the skin than 1 mm press needles. The use of small diameter needles increased patient blinding.
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Affiliation(s)
- Nobuari Takakura
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan; Department of Physiology, Showa University School of Medicine, Tokyo 142-8555, Japan; Japan School of Acupuncture, Moxibustion and Physiotherapy, Tokyo 150-0031, Japan.
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan; Department of Physiology, Showa University School of Medicine, Tokyo 142-8555, Japan; Japan School of Acupuncture, Moxibustion and Physiotherapy, Tokyo 150-0031, Japan
| | - Morihiro Nasu
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan
| | - Masako Nishiwaki
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan
| | - Akiko Kawase
- Japan School of Acupuncture, Moxibustion and Physiotherapy, Tokyo 150-0031, Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan; Department of Physiology, Showa University School of Medicine, Tokyo 142-8555, Japan; Japan School of Acupuncture, Moxibustion and Physiotherapy, Tokyo 150-0031, Japan
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A Double-Blind Study on Acupuncture Sensations with Japanese Style of Acupuncture: Comparison between Penetrating and Placebo Needles. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:8128147. [PMID: 29849728 PMCID: PMC5941723 DOI: 10.1155/2018/8128147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/02/2018] [Accepted: 01/14/2018] [Indexed: 01/17/2023]
Abstract
To investigate the acupuncture sensations elicited by the Japanese style of acupuncture, penetrating acupuncture and skin-touch placebo needles were randomly administered at various insertion depths (5 and 10 mm for the penetrating needles and 1 and 2 mm for the placebo needles) at LI4 to 50 healthy subjects. Among the 12 acupuncture sensations in the Massachusetts General Hospital Acupuncture Sensation Scale (MASS), “heaviness” was the strongest and most frequently reported sensation with the 10 mm needles, but not with the 5 mm needles. There were no significant differences in number of sensations elicited, MASS index, range of spreading, and intensity of needle pain for 5 mm penetration versus 1 mm skin press and 10 mm penetration versus 2 mm skin press. The MASS index with 2 mm skin-touch needles was significantly larger than that with 1 mm skin-touch and 5 mm penetrating needles. The factor structures in the 12 acupuncture sensations between penetrating and skin-touch needles were different. The acupuncture sensations obtained in this study under satisfactorily performed double-blind (practitioner–patient) conditions suggest that a slight difference in insertion depth and skin press causes significant differences in quantity and quality of acupuncture sensations.
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Schlaeger JM, Takakura N, Yajima H, Takayama M, Steffen AD, Gabzdyl EM, Nisi RA, McGowan Gruber K, Bussell JM, Wilkie DJ. Double-blind acupuncture needles: a multi-needle, multi-session randomized feasibility study. Pilot Feasibility Stud 2018; 4:72. [PMID: 29686883 PMCID: PMC5897935 DOI: 10.1186/s40814-018-0265-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/22/2018] [Indexed: 01/28/2023] Open
Abstract
Background Efficacy of acupuncture is difficult to demonstrate without a feasible double-blind milieu. Double-blind acupuncture needles have been validated in single session protocols with one or two needles but not been tested in a protocol requiring many needles and repeated sessions. Methods We determined the feasibility of a 13-needle, 10-session study protocol. Feasibility focused on (1) enrolling and retaining participants; (2) two acupuncturists accurately implementing a double-blind, multi-needle, multi-session protocol; (3) participants completing measures; and (4) protocol acceptability to participants. In this double-blind randomized controlled pilot study, participants were randomized 1:1 to a penetrating needle group or a skin-touch placebo control group. Results Six women with vulvodynia (mean age 31.5 ± 8 years; five white, non-Latina, one black/African American) met the eligibility requirements, consented to participation, and were enrolled. All six participants (100%) completed the 10-session study protocol in 5 weeks without missing any treatment sessions. Per observed checklist documented technique, two acupuncturists flawlessly administered the 13-needle, 10-session acupuncture protocol; no needles malfunctioned. Six participants attended all sessions and completed 99% of measurement items. One participant did not like acupuncture (60% acceptability score) and five liked acupuncture (100% acceptability scores); the mean acceptability score was 93.3%. Conclusion Study feasibility was supported. This protocol can be used in a double-blind efficacy trial of acupuncture for vulvodynia. Trial registration ClinicalTrials.gov, NCT02704234. Registered 30 November 2015.
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Affiliation(s)
- Judith M Schlaeger
- 1Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen (M/C 802), Chicago, IL 60612 USA
| | - Nobuari Takakura
- 2Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo, 135-0063 Japan
| | - Hiroyoshi Yajima
- 2Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo, 135-0063 Japan
| | - Miho Takayama
- 2Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo, 135-0063 Japan
| | - Alana D Steffen
- 1Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen (M/C 802), Chicago, IL 60612 USA
| | - Elizabeth M Gabzdyl
- 1Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen (M/C 802), Chicago, IL 60612 USA
| | - Robyn A Nisi
- 1Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen (M/C 802), Chicago, IL 60612 USA
| | - Kathleen McGowan Gruber
- 1Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen (M/C 802), Chicago, IL 60612 USA
| | - Jason M Bussell
- 3Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Diana J Wilkie
- 4Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, 1225 Center Drive, Gainesville, FL 32610 USA
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Sham Electroacupuncture Methods in Randomized Controlled Trials. Sci Rep 2017; 7:40837. [PMID: 28106094 PMCID: PMC5247761 DOI: 10.1038/srep40837] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 12/13/2016] [Indexed: 01/04/2023] Open
Abstract
Sham electroacupuncture (EA) control is commonly used to evaluate the specific effects of EA in randomized-controlled trials (RCTs). However, establishing an inert and concealable sham EA control remains methodologically challenging. Here, we aimed to systematically investigate the sham EA methods. Eight electronic databases were searched from their inception to April 2015. Ten out of the 17 sham EA methods were identified from 94 RCTs involving 6134 participants according to three aspects: needle location, depth of needle insertion and electrical stimulation. The top three most frequently used types were sham EA type A, type L and type O ordinally. Only 24 out of the 94 trials reported credibility tests in six types of sham EA methods and the results were mainly as follows: sham EA type A (10/24), type B (5/24) and type Q (5/24). Compared with sham EA controls, EA therapy in 56.2% trials reported the specific effects, of which the highest positive rate was observed in type N (3/4), type F (5/7), type D (4/6) and type M (2/3). In conclusion, several sham EA types were identified as a promising candidate for further application in RCTs. Nonetheless, more evidence for inert and concealable sham EA control methods is needed.
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17
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Affiliation(s)
- S W Choi
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong, HKSAR
| | - D M H Lam
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, HKSAR
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18
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Zhang CS, Tan HY, Zhang GS, Zhang AL, Xue CC, Xie YM. Placebo Devices as Effective Control Methods in Acupuncture Clinical Trials: A Systematic Review. PLoS One 2015; 10:e0140825. [PMID: 26536619 PMCID: PMC4633221 DOI: 10.1371/journal.pone.0140825] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/29/2015] [Indexed: 12/27/2022] Open
Abstract
While the use of acupuncture has been recognised by the World Health Organisation, its efficacy for many of the common clinical conditions is still undergoing validation through randomised controlled trials (RCTs). A credible placebo control for such RCTs to enable meaningful evaluation of its efficacy is to be established. While several non-penetrating acupuncture placebo devices, namely the Streitberger, the Park and the Takakura Devices, have been developed and used in RCTs, their suitability as inert placebo controls needs to be rigorously determined. This article systematically reviews these devices as placebo interventions. Electronic searches were conducted on four English and two Chinese databases from their inceptions to July 2014; hand searches of relevant references were also conducted. RCTs, in English or Chinese language, comparing acupuncture with one of the aforementioned devices as the control intervention on human participants with any clinical condition and evaluating clinically related outcomes were included. Thirty-six studies were included for qualitative analysis while 14 were in the meta-analysis. The meta-analysis does not support the notion of either the Streitberger or the Park Device being inert control interventions while none of the studies involving the Takakura Device was included in the meta-analysis. Sixteen studies reported the occurrence of adverse events, with no significant difference between verum and placebo acupuncture. Author-reported blinding credibility showed that participant blinding was successful in most cases; however, when blinding index was calculated, only one study, which utilised the Park Device, seemed to have an ideal blinding scenario. Although the blinding index could not be calculated for the Takakura Device, it was the only device reported to enable practitioner blinding. There are limitations with each of the placebo devices and more rigorous studies are needed to further evaluate their effects and blinding credibility.
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Affiliation(s)
- Claire Shuiqing Zhang
- Traditional and Complementary Medicine Research Program, RMIT Health Innovations Research Institute, School of Health Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Hsiewe Ying Tan
- Traditional and Complementary Medicine Research Program, RMIT Health Innovations Research Institute, School of Health Sciences, RMIT University, Bundoora, Victoria, Australia
| | - George Shengxi Zhang
- Traditional and Complementary Medicine Research Program, RMIT Health Innovations Research Institute, School of Health Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Anthony Lin Zhang
- Traditional and Complementary Medicine Research Program, RMIT Health Innovations Research Institute, School of Health Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Charlie Changli Xue
- Traditional and Complementary Medicine Research Program, RMIT Health Innovations Research Institute, School of Health Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Yi Min Xie
- Centre for Innovative Structures and Materials, School of Civil, Environmental and Chemical Engineering, RMIT University, Melbourne, Victoria, Australia
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19
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Takakura N, Takayama M, Yajima H. The difference of Park and Streitberger single-blind needles from Takakura double-blind needle. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2015; 13:212-4. [PMID: 26165365 DOI: 10.1016/s2095-4964(15)60189-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nobuari Takakura
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan; E-mail:
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan
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20
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White A, Burton S, Langweiler M, Meinen M. Summaries of Recent Papers. Acupunct Med 2015. [DOI: 10.1136/acupmed-2015-010891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Adrian White
- Primary Care Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, UK
| | | | - Mark Langweiler
- Welsh Institute of Chiropractic, University of South Wales, Treforest, UK
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21
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Kim S, Lee S, Choi S, Park J, Kim S. Discrimination accuracy between real and sham press needles in the hands. Acupunct Med 2015; 33:293-8. [PMID: 26044714 DOI: 10.1136/acupmed-2014-010678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the blinding effectiveness of a modified blunt sham press needle on the basis of the ability of subjects to discriminate between real and sham acupuncture needles compared with their discrimination ability based on pure guessing, and to define differences between senses (touch and vision) in the rates of correctly identified needles. METHODS Sixty-three healthy students and staff members were recruited through convenience sampling. First, real or sham acupuncture was randomly administered to the left LI4 point while subjects could not observe the needle tip. A real or sham needle tip was then shown to the subjects. Finally, a random combination of real or sham acupuncture needles were randomly administered to the left and right LI4 points, this time with the subjects observing the procedure. In all conditions the subjects gave their judgement as Yes or No in response to questions asking them to identify the needle type. The proportion of correct judgements (P(C)) was computed for the last part of the trial in left and right LI4 points, and the rates of correctly identified needles for each trial were obtained. RESULTS The subjects' accuracy of discrimination between the real and sham acupuncture needles in left and right LI4 points was not significantly different from that based on pure guess (P(C)=0.50 (chance level)), which indicates complete inability to discriminate between needles. The rates of correctly identified needles using touch, vision and a combination of both senses were not significantly different (p=0.807). CONCLUSIONS The findings from this study show that this sham acupuncture device successfully blinded subjects to real and sham press needles, suggesting that it is effective for subject blinding in studies on acupuncture using press needles, and facilitating evaluation of the effects of acupuncture in placebo-controlled trials using a rigorous scientific research methodology.
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Affiliation(s)
- Sungha Kim
- Korean Medicine Life Science, University of Science and Technology, Daejeon, Republic of Korea Korea Medicine Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sanghun Lee
- Korea Medicine Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sunmi Choi
- Korea Medicine Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jeonghwan Park
- Korea Medicine Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sungchul Kim
- Department of Acupuncture & Moxibustion, Wonkwang University Gwangju Medical Hospital, Gwangju, Republic of Korea
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Juel J, Liguori S, Liguori A, Valeriani M, Graversen C, Olesen SS, Drewes AM. A New Method for Sham-Controlled Acupuncture in Experimental Visceral Pain - a Randomized, Single-Blinded Study. Pain Pract 2015; 16:669-79. [DOI: 10.1111/papr.12309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 03/02/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Jacob Juel
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
| | | | - Aldo Liguori
- Istituto Paracelso; Rome Italy
- Department of Anatomic, Histologic; Forensic Medicine and Locomotor System Sciences; Faculty of Pharmacy and Medicine; Sapienza University; Rome Italy
| | - Massimiliano Valeriani
- Department of Neurology; Paediatric Hospital Bambino Gesù; Rome Italy
- Center for Sensory-Motor Interaction; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
| | - Carina Graversen
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Søren S. Olesen
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Asbjørn M. Drewes
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
- Center for Sensory-Motor Interaction; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
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Is Skin-Touch Sham Needle Not Placebo? A Double-Blind Crossover Study on Pain Alleviation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:152086. [PMID: 26064153 PMCID: PMC4439487 DOI: 10.1155/2015/152086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/12/2015] [Accepted: 04/14/2015] [Indexed: 12/03/2022]
Abstract
It remains an open question whether placebo/sham acupuncture, in which the needle tip presses the skin, can be used as a placebo device for research on pain. We compare the analgesic effect of the skin-touch placebo needle with that of the no-touch placebo needle, in which the needle tip does not touch the skin, in a double-blind crossover manner including no-treatment control in 23 healthy volunteers. The subjects received painful electrical stimulation in the forearm before and during needle retention to the LI 4 acupoint and after the removal of the needle and rated pain intensity using a visual analogue scale. We found no significant difference in analgesic effects among the skin-touch placebo needle, no-touch placebo needle, and no-treatment control at every point before, during, and after the treatments (p > 0.05). The results indicate that the skin-touch placebo needle can be used as a placebo device in clinical studies on pain.
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Vase L, Baram S, Takakura N, Takayama M, Yajima H, Kawase A, Schuster L, Kaptchuk TJ, Schou S, Jensen TS, Zachariae R, Svensson P. Can acupuncture treatment be double-blinded? An evaluation of double-blind acupuncture treatment of postoperative pain. PLoS One 2015; 10:e0119612. [PMID: 25747157 PMCID: PMC4352029 DOI: 10.1371/journal.pone.0119612] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/01/2015] [Indexed: 12/30/2022] Open
Abstract
Blinding protects against bias but the success of blinding is seldom assessed and reported in clinical trials including studies of acupuncture where blinding represents a major challenge. Recently, needles with the potential for double-blinding were developed, so we tested if acupuncture can be double-blinded in a randomized study of sixty-seven patients with acute pain ≥ 3 (0-10 scale following third molar removal) who received active acupuncture with a penetrating needle or placebo acupuncture with a non-penetrating needle. To test if acupuncture was administered double-blind, patients and acupuncturists were asked about perceived treatment allocation at the end of the study. To test if there were clues which led to identification of the treatment, deep dull pain associated with needle application and rotation (termed “de qi” in East Asian medicine), and patients’ pain levels were assessed. Perceived treatment allocation depended on actual group allocation (p < 0.015) for both patients and acupuncturists, indicating that the needles were not successful in double-blinding. Up to 68% of patients and 83% of acupuncturists correctly identified the treatment, but for patients the distribution was not far from 50/50. Also, there was a significant interaction between actual or perceived treatment and the experience of de qi (p = 0.027), suggesting that the experience of de qi and possible non-verbal clues contributed to correct identification of the treatment. Yet, of the patients who perceived the treatment as active or placebo, 50% and 23%, respectively, reported de qi. Patients’ acute pain levels did not influence the perceived treatment. In conclusion, acupuncture treatment was not fully double-blinded which is similar to observations in pharmacological studies. Still, the non-penetrating needle is the only needle that allows some degree of practitioner blinding. The study raises questions about alternatives to double-blind randomized clinical trials in the assessment of acupuncture treatment.
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Affiliation(s)
- Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Sara Baram
- Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
- Section of Oral and Maxillofacial Surgery and Oral Pathology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - Nobuari Takakura
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Akiko Kawase
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Lars Schuster
- The Acupuncture Academy, Copenhagen and Aarhus, Denmark
| | - Ted J. Kaptchuk
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Søren Schou
- Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | | | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Svensson
- Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
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Takayama M, Yajima H, Kawase A, Homma I, Izumizaki M, Takakura N. The Potential of Double Blinding with Two Placebo Acupuncture Needles: A Randomized Controlled Pilot-Trial. MEDICINES 2014; 2:11-27. [PMID: 28933379 PMCID: PMC5532973 DOI: 10.3390/medicines2010011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/24/2014] [Indexed: 12/02/2022]
Abstract
Background: Whether acupuncture treatment employing multiple penetrating, skin-touch placebo, or no-touch placebo needles designed for double blinding actually do blind practitioners and patients has not been investigated. We aimed to investigate this question. Subjects: 120 patients with functional neck/shoulder stiffness but in otherwise healthy condition were randomly assigned to a treatment using four penetrating, four skin-touch placebo, or four no-touch placebo needles. Each of six acupuncturists applied four needles to four acupoints in the neck/shoulder of 20 patients. Acupuncturists and patients were asked to guess the treatment mode and their confidence in their guesses on 100 mm visual analog scales. Results: The kappa coefficients between practitioner guesses and treatment type and between patient guesses and treatment type were 0.15 and 0.44, respectively. The median score of practitioner confidence was 46.8, and no significant difference in confidence between correct and incorrect guesses was revealed for any treatment. The median score of patient confidence for correct guesses was 77.6. The kappa coefficient between practitioner and patient guesses was 0.06. Conclusions: The practitioners were blinded to the nature of treatment using the same multiple needles, but patient blinding was insufficient. Further improvement is necessary to achieve satisfactory patient blinding with these acupuncture needles.
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Affiliation(s)
- Miho Takayama
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo 135-0063, Japan.
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
- Japan School of Acupuncture, Moxibustion and Physiotherapy, 20-1 Sakuragaokacho, Shibuya-ku, Tokyo 150-0031, Japan.
- The Foundation for Oriental Medicine Research, 28-9 Sakuragaokacho, Shibuya-ku, Tokyo 150-0031, Japan.
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo 135-0063, Japan.
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
- Japan School of Acupuncture, Moxibustion and Physiotherapy, 20-1 Sakuragaokacho, Shibuya-ku, Tokyo 150-0031, Japan.
- The Foundation for Oriental Medicine Research, 28-9 Sakuragaokacho, Shibuya-ku, Tokyo 150-0031, Japan.
| | - Akiko Kawase
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
- Japan School of Acupuncture, Moxibustion and Physiotherapy, 20-1 Sakuragaokacho, Shibuya-ku, Tokyo 150-0031, Japan.
- The Foundation for Oriental Medicine Research, 28-9 Sakuragaokacho, Shibuya-ku, Tokyo 150-0031, Japan.
| | - Ikuo Homma
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
- The Foundation for Oriental Medicine Research, 28-9 Sakuragaokacho, Shibuya-ku, Tokyo 150-0031, Japan.
- Department of Nursing, Faculty of Nursing, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo 135-0063, Japan.
| | - Masahiko Izumizaki
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
| | - Nobuari Takakura
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo 135-0063, Japan.
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
- Japan School of Acupuncture, Moxibustion and Physiotherapy, 20-1 Sakuragaokacho, Shibuya-ku, Tokyo 150-0031, Japan.
- The Foundation for Oriental Medicine Research, 28-9 Sakuragaokacho, Shibuya-ku, Tokyo 150-0031, Japan.
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Mechanisms for alternative treatments in Parkinson's disease: acupuncture, tai chi, and other treatments. Curr Neurol Neurosci Rep 2014; 14:451. [PMID: 24760476 DOI: 10.1007/s11910-014-0451-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
At least 40% of patients with Parkinson's disease (PD) use one or more forms of alternative therapy (AT) to complement standard treatments. This article reviews the commonest forms of AT for PD, including acupuncture, tai chi, yoga, mindfulness, massage, herbal medicine, and cannabis. We discuss the current evidence for the clinical efficacy of each AT and discuss potential mechanisms, including those suggested by animal and human studies. With a few notable exceptions, none of the treatments examined were investigated rigorously enough to draw definitive conclusions about efficacy or mechanism. Tai chi, acupuncture, Mucuna pruriens, cannabinoids, and music therapy have all been proposed to work through specific mechanisms, although current evidence is insufficient to support or refute these claims, with the possible exception of Mucuna pruriens (which contains levodopa). It is likely that most ATs predominantly treat PD patients through general mechanisms, including placebo effects, stress reduction, and improved mood and sleep, and AT may provide patients with a greater locus of control regarding their illness.
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Takakura N, Takayama M, Kawase A, Kaptchuk TJ, Kong J, Yajima H. Design of a randomised acupuncture trial on functional neck/shoulder stiffness with two placebo controls. Altern Ther Health Med 2014; 14:246. [PMID: 25027157 PMCID: PMC4223566 DOI: 10.1186/1472-6882-14-246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 07/09/2014] [Indexed: 11/16/2022]
Abstract
Background Functional neck/shoulder stiffness is one of the most well-known indications for acupuncture treatment in Japan. There is little evidence for the effectiveness of acupuncture treatment for functional neck/shoulder stiffness. Research using two different placebos may allow an efficient method to tease apart the components of real acupuncture from various kinds of ‘non-specific’ effects such as ritual with touch or ritual alone. Herein, we describe a protocol of an ongoing, single-centre, randomised, placebo-controlled trial which aims to assess whether, in functional neck/shoulder stiffness, acupuncture treatment with skin piercing has a specific effect over two types of placebo: skin-touching plus ritual or ritual alone. Methods Six acupuncturists and 400 patients with functional neck/shoulder stiffness are randomly assigned to four treatment groups: genuine acupuncture penetrating the skin, skin-touch placebo or no-touch placebo needles in a double-blind manner (practitioner-patient blinding) or no-treatment control group. Each acupuncturist applies a needle to each of four acupoints (Bladder10, Small Intestine14, Gallbladder21 and Bladder42) in the neck/shoulder to 50 patients. Before, immediately after and 24 hours after the treatment, patients are asked about the intensity of their neck/shoulder stiffness. After the treatment, practitioners and patients are asked to guess whether the treatment is “penetrating”, “skin-touch” or “no-touch” or to record “cannot identify the treatment”. Discussion In addition to intention-to-treat analysis, we will conduct subgroup analysis based on practitioners’ or patients’ guesses to discuss the efficacy and effectiveness of treatments with skin piercing and various placebo controls. The results of practitioner and patient blinding will be discussed. We believe this study will further distinguish the role of different components of acupuncture. Trial registration Current Controlled Trial ISRCTN76896018
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Galli T, Chiavegato L, Liebano R. Effects of TENS in living kidney donors submitted to open nephrectomy: A randomized placebo-controlled trial. Eur J Pain 2014; 19:67-76. [DOI: 10.1002/ejp.521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2014] [Indexed: 11/07/2022]
Affiliation(s)
- T.T. Galli
- Master's and Doctoral Programs in Physical Therapy; Universidade Cidade de São Paulo (UNICID); Brazil
| | - L.D. Chiavegato
- Master's and Doctoral Programs in Physical Therapy; Universidade Cidade de São Paulo (UNICID); Brazil
| | - R.E. Liebano
- Master's and Doctoral Programs in Physical Therapy; Universidade Cidade de São Paulo (UNICID); Brazil
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Double-blind acupuncture needle: a potential tool to investigate the nature of pain and pleasure. ISRN PAIN 2013; 2013. [PMID: 24288658 PMCID: PMC3839571 DOI: 10.1155/2013/825751] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background. Most of our knowledge about similarities in the neural processing of painful and pleasant sensations in the brain derives from studying each phenomenon separately. Patients often feel pain induced by acupuncture, which is noxious stimulation having the symbolic message of the cure, as pleasant. Objectives. We investigated whether the double-blind acupuncture needles are a potential tool to investigate coinciding pain and pleasant events. Methods. Participants were 109 healthy acupuncture students. An acupuncturist applied the double-blind placebo and the matching penetrating needle at bilateral forearm of each subject, one needle on each side of the arm. We asked the subjects to rate the pain associated with needle application and its unpleasantness or pleasantness on a visual analogue scale. Results. Of 65 penetrating needle applications that elicited pain, 29 (45%) subjects did not describe the pain as being unpleasant, and interestingly, 18 (28%) subjects described the needle insertion as pleasant. There was no significant difference in reported pain intensity between penetrating needles elicited pain that elicited a pleasant sensation and those that elicited an unpleasant sensation (P = 0.34). Conclusions. The double-blind acupuncture needles can be a potential tool for investigating the concomitant hedonic (pleasure) experience of pain.
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30
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Liebano RE, Vance CG, Rakel BA, Lee JE, Cooper NA, Marchand S, Walsh DM, Sluka KA. Transcutaneous electrical nerve stimulation and conditioned pain modulation influence the perception of pain in humans. Eur J Pain 2013; 17:1539-46. [PMID: 23650092 DOI: 10.1002/j.1532-2149.2013.00328.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Research in animal models suggests that transcutaneous electrical nerve stimulation (TENS) and conditioned pain modulation (CPM) produce analgesia via two different supraspinal pathways. No known studies have examined whether TENS and CPM applied simultaneously in human subjects will enhance the analgesic effect of either treatment alone. The purpose of the current study was to investigate whether the simultaneous application of TENS and CPM will enhance the analgesic effect of that produced by either treatment alone. METHODS Sixty healthy adults were randomly allocated into two groups: (1) CPM plus active TENS; (2) CPM plus placebo TENS. Pain threshold for heat (HPT) and pressure (PPT) were recorded from subject's left forearm at baseline, during CPM, during active or placebo TENS, and during CPM plus active or placebo TENS. CPM was induced by placing the subjects' contralateral arm in a hot water bath (46.5 °C) for 2 min. TENS (100 μs, 100 Hz) was applied to the forearm for 20 min at a strong but comfortable intensity. RESULTS Active TENS alone increased PPT (but not HPT) more than placebo TENS alone (p = 0.011). Combining CPM and active TENS did not significantly increase PPT (p = 0.232) or HPT (p = 0.423) beyond CPM plus placebo TENS. There was a significant positive association between PPT during CPM and during active TENS (r(2) = 0.46; p = 0.003). CONCLUSIONS TENS application increases PPT; however, combining CPM and TENS does not increase the CPM's hypoalgesic response. CPM effect on PPT is associated with the effects of TENS on PPT.
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Affiliation(s)
- R E Liebano
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
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Hochstrasser RJ, Endler PC, Klein SD. Introduction of two novel devices for investigating the influence of non-mechanical components such as therapeutic qi in acupuncture. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2013; 11:168-74. [DOI: 10.3736/jintegrmed2013030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Takakura N, Takayama M, Kawase A, Yajima H. Tapping-in method (skin penetration technique) with a placebo needle for double-blind acupuncture trials. J Altern Complement Med 2012; 19:308-12. [PMID: 23098695 DOI: 10.1089/acm.2012.0056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigated the effect of acupuncture needles developed for double-blind (practitioner-patient blinding) trials employing a tapping-in method that is commonly used to penetrate the skin in Japanese-style acupuncture. DESIGN, SUBJECTS, AND INTERVENTIONS: An acupuncturist applied a penetrating, a skin-touch placebo, and a no-touch control needle designed to blind both practitioners and patients in the forearm in 80 healthy subjects (patients) by tapping-in method. SETTING The setting was a practice room of the Japan School of Acupuncture, Moxibustion and Physiotherapy, Tokyo, Japan. OUTCOME MEASURES The outcome measures were the acupuncturist's and subjects' guesses at the type of needles and confidence of their guesses on a 100-mm visual analogue scale (VAS). The subjects were asked about pain with needle application. RESULTS The number of correct/incorrect guesses (the latter including unidentified) of the acupuncturist were 73/167 with a confidence of 55.2 ± 16.9 (mean ± standard deviation) on the VAS. The subjects identified 148 needles correctly and 92 needles incorrectly, the mean confidence being 71.0 ± 28.4. There were a few penetrating and skin-touch placebo needles that the subjects guessed as "no-touch." Whereas few of the 80 no-touch control needles were guessed as "penetrating," 16% of them were guessed as "skin-touch" and 11% were reported as "unidentifiable" by the subjects. Forty percent (40%) of the penetrating needles and 50% of the skin-touch placebo needles did not elicit skin penetration pain. CONCLUSIONS The effect of practitioner blinding employing the needles for double blinding with the tapping-in method was satisfactory. It was difficult to blind the subjects when no-touch control needles together with penetrating and skin-touch placebo needles were used.
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Affiliation(s)
- Nobuari Takakura
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan.
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Park JJ, Bang H. Methodological Advances Needed in Analysis and Interpretation of Sham Acupuncture Validation Studies. Acupunct Med 2011; 29:168-9. [DOI: 10.1136/acupmed-2011-010057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jongbae J Park
- Asian Medicine & Acupuncture Research, Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Heejung Bang
- Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, USA
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