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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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Takakura N, Takayama M, Kawase A, Kaptchuk TJ, Kong J, Vangel M, Yajima H. Acupuncture for Japanese Katakori (Chronic Neck Pain): A Randomized Placebo-Controlled Double-Blind Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2141. [PMID: 38138244 PMCID: PMC10745119 DOI: 10.3390/medicina59122141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Although acupuncture is listed as a beneficial treatment for neck/shoulder stiffness, which has increased with the spread of information technology, to date, evidence of its efficacy under double-blind conditions has not been shown. This study aimed to assess whether acupuncture treatment with superficial skin piercing is superior to placebo treatment. Materials and Methods: A randomized, double-blind (practitioner-patient) placebo-controlled trial was performed at a single center with four arms (ISRCTN76896018). Four hundred patients with essential neck/shoulder stiffness were randomly assigned to penetrating needle treatment (acupuncture ritual and skin penetration), skin-touch needle treatment (acupuncture ritual and skin touch), no-touch needle treatment (acupuncture ritual alone), and no-treatment control. Each of the six acupuncturists applied a needle to each of the four acupoints in the neck/shoulder of 50 patients. Results: Each of the three treatments significantly (p = 0.01) improved neck/shoulder stiffness compared with the no-treatment control immediately and 24 h after treatment. There was a significant improvement in penetrating needle treatment over no-touch needle treatment 24 h later. However, there was no significant difference between the penetrating and skin-touch and skin-touch vs. no-touch. Conclusions: All treatments that received the ritual of acupuncture were better than the no-treatment control. Only genuine acupuncture involves the specific effects of needle insertion into the body. The acupuncture ritual had a significant impact on the subjective improvement of neck/shoulder stiffness; however, improvement with ritual alone versions of placebo acupuncture was not maintained as with superficial skin piercing. Our study provides important evidence of acupuncture efficacy and information regarding inert no-touch placebo control in acupuncture research.
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Affiliation(s)
- Nobuari Takakura
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo 135-0063, Japan; (M.T.); (H.Y.)
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo 135-0063, Japan; (M.T.); (H.Y.)
- Japan School of Acupuncture, Moxibustion, and Physiotherapy, 20-1 Sakuragaokacho, Shibuya-ku, Tokyo 150-0021, Japan;
| | - Akiko Kawase
- Japan School of Acupuncture, Moxibustion, and Physiotherapy, 20-1 Sakuragaokacho, Shibuya-ku, Tokyo 150-0021, Japan;
| | - Ted J. Kaptchuk
- Program in Placebo Studies & Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA;
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA;
| | - Mark Vangel
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA;
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, 2-9-1 Ariake, Koto-ku, Tokyo 135-0063, Japan; (M.T.); (H.Y.)
- Japan School of Acupuncture, Moxibustion, and Physiotherapy, 20-1 Sakuragaokacho, Shibuya-ku, Tokyo 150-0021, Japan;
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3
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Shinohara D, Shinozaki N, Takahashi R, Imai K. Evaluation of Newly Developed Sham Acupuncture Needle with a Special Focus on Needling Sensation: a Randomized Controlled Trial. J Acupunct Meridian Stud 2023; 16:30-39. [PMID: 36804819 DOI: 10.51507/j.jams.2023.16.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/26/2022] [Accepted: 01/26/2023] [Indexed: 02/22/2023] Open
Abstract
Background Most non-penetrating sham and placebo acupuncture needles comprise a traditional pedestal for fixing the guide tube that makes these needles difficult to operate independently. We developed a simple sham acupuncture needle to overcome this problem and focused on managing the needling sensation. Objectives To ascertain how differently participants feel sham and real needles and to evaluate whether sham needles are effective in clinical trials. Methods After enrolling 64 healthy volunteers who had experienced and were knowledgeable about acupuncture, the practitioner randomly used real and sham needles at four sites (bilateral LI4 and LI10) on the participants' forearms. A custom-made sham blunt stainless acupuncture needle (40 mm, 0.80 mm) that was inserted into a guide tube was used. Immediately after needling, the participants were questioned in regard to their identification of the needle, skin penetration sensation, and de qi. Results The sham needle resulted in 62.5% blinding. Inequivalent sensations were elicited by the sham needles compared to the real needles. Women reported similar needling sensations from the sham and real needles. Conclusion This study achieved comparatively higher sham-needle blinding and is therefore worthy of use in clinical trials. The mutual independence of the sham needle from the real needle was mediated presumably by interindividual differences among the participants and the needling sites. Sex differences in sensation were likely related to the blinding capability of the sham needle.
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Affiliation(s)
- Daiyu Shinohara
- Department of Acupuncture and Moxibustion, Graduate School of Health Sciences, Teikyo Heisei University, Tokyo, Japan
| | - Namiki Shinozaki
- Department of Acupuncture and Moxibustion, Graduate School of Health Sciences, Teikyo Heisei University, Tokyo, Japan
| | - Ryo Takahashi
- Department of Acupuncture and Moxibustion, Graduate School of Health Sciences, Teikyo Heisei University, Tokyo, Japan
| | - Kenji Imai
- Department of Acupuncture and Moxibustion, Graduate School of Health Sciences, Teikyo Heisei University, Tokyo, Japan.,Department of Acupuncture and Moxibustion, Faculty of Health Care, Teikyo Heisei University, Tokyo, Japan.,Research Institute of Oriental Medicine, Teikyo Heisei University, Tokyo, Japan
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4
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Zhang YQ, Jiao RM, Witt CM, Lao L, Liu JP, Thabane L, Sherman KJ, Cummings M, Richards DP, Kim EKA, Kim TH, Lee MS, Wechsler ME, Brinkhaus B, Mao JJ, Smith CA, Gang WJ, Liu BY, Liu ZS, Liu Y, Zheng H, Wu JN, Carrasco-Labra A, Bhandari M, Devereaux PJ, Jing XH, Guyatt G. How to design high quality acupuncture trials-a consensus informed by evidence. BMJ 2022; 376:e067476. [PMID: 35354583 PMCID: PMC8965655 DOI: 10.1136/bmj-2021-067476] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An international panel including patients, clinicians, researchers, acupuncture and surgery trialists, statisticians, and experts in clinical epidemiology and methodology have developed new guidance for randomised controlled trials in acupuncture. It addresses the most prevalent and critical concerns of current acupuncture trials and will help funding agencies, trial registers, and journal editors to evaluate the relevance, importance, and quality of submitted trial proposals and completed trials
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Affiliation(s)
- Yu-Qing Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- CEBIM (Center for Evidence-Based Integrative Medicine)-Clarity Collaboration, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo, China
| | - Rui-Min Jiao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- China Center for Evidence-Based Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lixing Lao
- Virginia University of Integrative Medicine, Fairfax, VA, USA
| | - Jian-Ping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lehana Thabane
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA
- Department of Epidemiology, University of Washington, Seattle WA, USA
| | | | - Dawn P Richards
- Patient and Public Engagement, Clinical Trials Ontario, Toronto, ON, Canada
| | - Eun-Kyung Anna Kim
- Department of Western Medicine, Virginia University of Integrative Medicine, Fairfax, VA, USA
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Seoul, Republic of Korea
- Korean Medicine Hospital, Seoul, Republic of Korea
- Kyung Hee University, Seoul, Republic of Korea
| | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science and Technology, Daejeon, Republic of Korea
| | | | - Benno Brinkhaus
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jun J Mao
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, New York, NY USA
| | - Caroline A Smith
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Wei-Juan Gang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- China Center for Evidence-Based Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bao-Yan Liu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhi-Shun Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hui Zheng
- School of Acupuncture-Moxibustion and Tuina/The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Jia-Ni Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Alonso Carrasco-Labra
- Center for Integrative Global Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohit Bhandari
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Philip J Devereaux
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Xiang-Hong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- China Center for Evidence-Based Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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5
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Sollie M, Pind R, Madsen CB, Sørensen JA. Acupuncture (superficial dry-needling) as a treatment for chronic postherpetic neuralgia - a randomized clinical trial. Br J Pain 2022; 16:96-108. [PMID: 35111318 PMCID: PMC8801694 DOI: 10.1177/20494637211023075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia is a painful condition where finding sufficient treatment poses a great challenge. Acupuncture is often used as an alternative treatment for these pains, yet no randomized trials, using a sham-placebo have been performed to confirm its effect. Our objective was to investigate the efficacy of acupuncture compared to sham-acupuncture when treating chronic postherpetic dermal pain. METHODS We performed a sham-controlled double-blinded randomized clinical trial (RCT) with two arms. The intervention group received superficial dry-needling, and the control group received sham acupuncture using blunted needles. Twenty-six patients received two treatments. They filled out questionnaires at baseline and 1 month after treatment: (1) average and maximum pain (Numeric Rating Scale), (2) neuropathic pain (Neuropathic Pain Scale Inventory) and (3) Quality of Life (QoL) (Short-form 36). RESULTS Thirteen patients were allocated to the intervention group and 15 to the control group. We did not detect any significant changes in levels of pain and neuropathic pain. One QoL parameter, regarding emotional problems, reached a level of statistical significance. The sham-blinding was successful. This is the first RCT on the effect of acupuncture (superficial dry-needling) on postherpetic neuralgia (PHN), using a sham procedure as control. We observed no significant changes or tendencies in the measured levels of pain. One QoL parameter had significant improvement in the intervention group compared to the control group. CONCLUSION In conclusion, acupuncture was not superior to treatment with sham acupuncture. Though individual patients may experience some pain relief from acupuncture, our results do not support the routine use of this type of acupuncture to treat PHN.
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Affiliation(s)
- Martin Sollie
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark,University of Southern Denmark, Odense, Denmark,OPEN – Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark,Martin Sollie, Research Unit for Plastic Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | | | - Christoffer Bing Madsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark,University of Southern Denmark, Odense, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark,University of Southern Denmark, Odense, Denmark,OPEN – Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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6
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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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7
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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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8
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Eigenschink M, Dearing L, Dablander TE, Maier J, Sitte HH. A critical examination of the main premises of Traditional Chinese Medicine. Wien Klin Wochenschr 2020; 132:260-273. [PMID: 32198544 PMCID: PMC7253514 DOI: 10.1007/s00508-020-01625-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/26/2020] [Indexed: 12/19/2022]
Abstract
Traditional Chinese Medicine (TCM) consists of a plethora of therapeutic approaches aiming to both characterize and treat diseases. Its utilization has gained significant popularity in the western world and is even backed by the World Health Organization's decision to include TCM diagnostic patterns into the new revision of the International Classification of Diseases code, the global standard for diagnostic health information. As these developments and potentially far-reaching decisions can affect modern healthcare systems and daily clinical work as well as wildlife conservation, its underlying factual basis must be critically examined. This article therefore provides an overview of the evidence underlying the basic TCM concepts, such as Qi, meridians, acupuncture, pulse and tongue diagnostics as well as traditional herbal treatments. Moreover, it discusses whether scientific literature on TCM reflects the current standard for evidence-based research, as described in good scientific practice and good clinical practice guidelines. Importantly, misinformation regarding the therapeutic efficacy of animal-derived substances has lead and currently leads to problems with wildlife preservation and animal ethics. Nevertheless, the (re-)discovery of artemisinin more than 50 years ago introduced a novel development in TCM: the commingling of Eastern and Western medicine, the appreciation of both systems. The need for more rigorous approaches, fulfilment of and agreement to current guidelines to achieve high-quality research are of utmost relevance. Thereby, ancient knowledge of herbal species and concoctions may serve as a possible treasure box rather than Pandora's box.
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Affiliation(s)
| | - Lukas Dearing
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria
| | - Tom E Dablander
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria
| | - Julian Maier
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria
| | - Harald H Sitte
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria.
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University Vienna, Waehringer Straße 13A, 1090, Vienna, Austria.
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9
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Braithwaite FA, Walters JL, Li LSK, Moseley GL, Williams MT, McEvoy MP. Blinding Strategies in Dry Needling Trials: Systematic Review and Meta-Analysis. Phys Ther 2019; 99:1461-1480. [PMID: 31373369 DOI: 10.1093/ptj/pzz111] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/21/2019] [Accepted: 03/23/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Blinding of participants and therapists in trials of physical interventions is a significant and ongoing challenge. There is no widely accepted sham protocol for dry needling. PURPOSE The purpose of this review was to summarize the effectiveness and limitations of blinding strategies and types of shams that have been used in dry needling trials. DATA SOURCES Twelve databases were searched from inception to February 2016. STUDY SELECTION Trials that compared active dry needling with a sham that simulated dry needling were included. DATA EXTRACTION The main domains of data extraction were participant/therapist details, intervention details, blinding strategies, blinding assessment outcomes, and key conclusions of authors. Reported blinding strategies and sham types were synthesized descriptively, with available blinding effectiveness data synthesized using a chance-corrected measurement of blinding (blinding index). DATA SYNTHESIS The search identified 4894 individual publications with 27 trials eligible for inclusion. In 22 trials, risk of methodological bias was high or unclear. Across trials, blinding strategies and sham types were heterogeneous. Notably, no trials attempted therapist blinding. Sham protocols have focused on participant blinding using strategies related to group standardization and simulation of tactile sensations. There has been little attention given to the other senses or cognitive strategies to enhance intervention credibility. Nonpenetrating sham types may provide effective participant blinding. LIMITATIONS Trials were clinically and methodologically diverse, which limited the comparability of blinding effectiveness across trials. Reported blinding evaluations had a high risk of chance findings with power clearly achieved in only 1 trial. CONCLUSIONS Evidence-based consensus on a sham protocol for dry needling is required. Recommendations provided in this review may be used to develop sham protocols so that future protocols are more consistent and potentially more effective.
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Affiliation(s)
- Felicity A Braithwaite
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Julie L Walters
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lok Sze Katrina Li
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - G Lorimer Moseley
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Marie T Williams
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Maureen P McEvoy
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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10
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Takakura N, Takayama M, Nishiwaki M, Yajima H. Blinding Indices and Blinding Scenarios of Practitioners and Patients with Acupuncture Needles for Double Blinding. Acupunct Med 2018; 36:123-124. [DOI: 10.1136/acupmed-2017-011430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Nobuari Takakura
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
- Department of Physiology, Showa University School of Medicine, Tokyo, Japan
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
- Department of Physiology, Showa University School of Medicine, Tokyo, Japan
| | - Masako Nishiwaki
- 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
- Department of Physiology, Showa University School of Medicine, Tokyo, Japan
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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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12
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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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14
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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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15
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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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Bello S, Wei M, Hilden J, Hróbjartsson A. The matching quality of experimental and control interventions in blinded pharmacological randomised clinical trials: a methodological systematic review. BMC Med Res Methodol 2016; 16:18. [PMID: 26873063 PMCID: PMC4752749 DOI: 10.1186/s12874-016-0111-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/16/2016] [Indexed: 02/05/2023] Open
Abstract
Background Blinding is a pivotal method to avoid bias in randomised clinical trials. In blinded drug trials, experimental and control interventions are often designed to be matched, i.e. to appear indistinguishable. It is unknown how often matching procedures are inadequate, so we decided to systematically identify and analyse studies of matching quality in drug trials. Our primary objective was to assess the proportion of studies that concluded that the matching was inadequate; our secondary objective was to describe mechanisms for inadequate matching. Methods Systematic review. We searched PubMed, Google Scholar and Web of Science Citation Index for studies that assessed whether supposedly indistinguishable interventions (experimental and control) in randomized clinical drug trials could be distinguished based on physical properties (e.g. appearance or smell). Two persons decided on study eligibility and extracted data independently. Our primary analysis was based on the conclusions of each study. In supportive analyses, we defined a low and a high threshold for inadequate matching. We summarised results qualitatively. Results We included studies of 36 trials, of which 28 (78 %) were published before 1977. The studies differed considerably with regard to design, methodology and analysis. Sixteen of the 36 studies (44 %) concluded inadequate matching. When we adapted high or low thresholds for inadequate matching, the number of trials with inadequate matching was reduced to 12 (33 %) or increased to 26 (72 %). Inadequate matching was concluded in 7 of 22 trials (32 %) based on a defined cohort of trials. Inadequate matching was concluded in 9 of 14 trials (64 %) which were not based on a trial cohort, and therefore at a higher risk of publication bias. The proportion of inadequate matching did not seem to depend on publication year. Typical mechanisms of inadequate matching were differences in taste or colour. Conclusion We identified matching quality studies of 36 randomized clinical drug trials. Sixteen of the 36 studies (44 %) concluded inadequate matching. Few studies of matching quality in contemporary trials have been published, but show similar results as found for older trials. Inadequate matching in drug trials may be more prevalent than commonly believed. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0111-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Segun Bello
- The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. .,Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan/Ibadan Centre for Evidence-based Medicine, University College Hospital, Ibadan, Nigeria.
| | - Maoling Wei
- The Chinese Cochrane Centre, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, P.R. China.
| | - Jørgen Hilden
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
| | - Asbjørn Hróbjartsson
- The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. .,Centre for Evidence-based Medicine, University of Southern Denmark/Odense University Hospital, Odense, Denmark.
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17
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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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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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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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To M, Alexander C. The effects of Park sham needles: a pilot study. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2015; 13:20-4. [PMID: 25609368 DOI: 10.1016/s2095-4964(15)60153-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND When performing clinical trials involving acupuncture, it can be difficult to choose a placebo control. OBJECTIVE To validate the Park sham needle for use as a double-blind control intervention. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS Two different methods were employed. First, a researcher blinded to needle type administered the Park sham or a real needle, chosen at random, on the arms of 16 healthy volunteers. The researcher and the volunteers independently recorded which needle type they thought had been applied at each acupuncture point. Second, 19 patients with shoulder impingement syndrome were randomly assigned to receive acupuncture applied with the real needle or the Park sham needle, once a week for 6 weeks alongside a course of physiotherapy. At the end of the 6 sessions the patients recorded which needle type they thought was being used. The results were analyzed with a Fisher's exact test. This study was carried out in the Outpatient Department of Physiotherapy in Charing Cross Hospital, London, UK, on healthy volunteers and patients with shoulder impingement pain. The age range was 23 to 54 and 22 to 74 years respectively. RESULTS Of the healthy volunteers, there was no difference (P=0.23) between the number of needles that were correctly (n=43) or incorrectly identified (n=53). All patients thought that they had received the real needles. The researcher correctly identified all needles that were applied. CONCLUSION The researcher delivering the acupuncture recognized the needle type. However, both healthy and patient volunteers were blind to the needle type. This demonstrates that the Park sham needle is an effective single-blind control. It should be noted that the number of patients recruited was small and the study was underpowered to detect an effect of treatment.
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Affiliation(s)
- May To
- Department of Physiotherapy, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK; E-mail:
| | - Caroline Alexander
- Department of Physiotherapy, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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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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Birch S. Historical and clinical perspectives on de qi: exposing limitations in the scientific study of de qi. J Altern Complement Med 2014; 21:1-7. [PMID: 25423501 DOI: 10.1089/acm.2014.0267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
De qi is a concept most often associated with patient experiences during needling in acupuncture treatment. A review of the early historical literature on acupuncture shows that texts tended to describe de qi and its associated concept, qi zhi more in terms of practitioner-based phenomena and that this is something more in the realm of the experienced practitioner (i.e., it is skill based). Many modern authors in Asia and the West also describe the importance of practitioner-based experiences in the de qi of acupuncture, further implying that this may lie at the heart of the treatment effects of acupuncture. A review of scientific studies on de qi shows that qualitative studies have focused almost exclusively on patient-based aspects of de qi while quantitative studies have focused exclusively on them. There thus exists a gap in current research on the phenomenon of de qi that possibly reveals weakness in the wider study of acupuncture. It is important that precise qualitative studies of the practitioner-based aspects of de qi begin soon and as they become better understood, quantitative research also is initiated. This research will not only better inform clinical trials and physiologic research of acupuncture in general but could contribute significantly to rethinking of how to train practitioners.
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Affiliation(s)
- Stephen Birch
- Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College , Oslo, Norway
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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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Placebo acupuncture devices: considerations for acupuncture research. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:628907. [PMID: 23840261 PMCID: PMC3690239 DOI: 10.1155/2013/628907] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/24/2013] [Indexed: 11/17/2022]
Abstract
Determining an appropriate control for use in acupuncture research remains one of the largest methodological challenges acupuncture researchers face. In general, acupuncture controls fall under one of two categories: (1) sham acupuncture, in which the skin is punctured with real acupuncture needles either fully at nonacupoint locations or shallowly at acupoint locations or both and (2) placebo acupuncture, which utilizes nonpenetrating acupuncture devices. In this study, we will focus on non-penetrating placebo acupuncture devices (blunted-needle and nonneedle devices) that are currently available in acupuncture research. We will describe each device and discuss each device's validation and application in previous studies. In addition, we will outline the advantages and disadvantages of these devices and highlight how the differences among placebo devices can be used to isolate distinct components of acupuncture treatment and investigate their effects. We would like to emphasize that there is no single placebo device that can serve as the best control for all acupuncture studies; the choice of an acupuncture control should be determined by the specific aim of the study.
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Vase L, Baram S, Takakura N, Yajima H, Takayama M, Kaptchuk TJ, Schou S, Jensen TS, Zachariae R, Svensson P. Specifying the nonspecific components of acupuncture analgesia. Pain 2013; 154:1659-1667. [PMID: 23707680 DOI: 10.1016/j.pain.2013.05.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/09/2013] [Accepted: 05/02/2013] [Indexed: 12/19/2022]
Abstract
It is well known that acupuncture has pain-relieving effects, but the contribution of specific and especially nonspecific factors to acupuncture analgesia is less clear. One hundred one patients who developed pain of ≥ 3 on a visual analog scale (VAS, 0 to 10) after third molar surgery were randomized to receive active acupuncture, placebo acupuncture, or no treatment for 30 min with acupuncture needles with potential for double-blinding. Patients' perception of the treatment (active or placebo) and expected pain levels (VAS) were assessed before and halfway through the treatment. Looking at actual treatment allocation, there was no specific effect of active acupuncture (P=.240), but there was a large and significant nonspecific effect of placebo acupuncture (P<.001), which increased over time. Interestingly, however, looking at perceived treatment allocation, there was a significant effect of acupuncture (P<.001), indicating that patients who believed they received active acupuncture had significantly lower pain levels than those who believed they received placebo acupuncture. Expected pain levels accounted for significant and progressively larger amounts of the variance in pain ratings after both active and placebo acupuncture (up to 69.8%). This is the first study to show that under optimized blinding conditions, nonspecific factors such as patients' perception of and expectations toward treatment are central to the efficacy of acupuncture analgesia and that these factors may contribute to self-reinforcing effects in acupuncture treatment. To obtain an effect of acupuncture in clinical practice, it may therefore be important to incorporate and optimize these factors.
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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 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 Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus, Denmark
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Blinding measured: a systematic review of randomized controlled trials of acupuncture. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:708251. [PMID: 23533515 PMCID: PMC3603669 DOI: 10.1155/2013/708251] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/06/2013] [Accepted: 01/06/2013] [Indexed: 12/02/2022]
Abstract
Background. There is no agreement among researchers on viable controls for acupuncture treatment, and the assessment of the effectiveness of blinding and its interpretation is rare. Purpose. To systematically assess the effectiveness of blinding (EOB) in reported acupuncture trials; to explore results of RCTs using a quantitative measure of EOB. Data Sources. A systematic review of published sham RCTs that assessed blinding. Study Selection. Five hundred and ninety studies were reviewed, and 54 studies (4783 subjects) were included. Data Extraction. The number of patients who guessed their treatment identity was extracted from each study. Variables with possible influence on blinding were identified. Data Synthesis. The blinding index was calculated for each study. Based on blinding indexes, studies were congregated into one of the nine blinding scenarios. Individual study characteristics were explored for potential association with EOB. Limitations. There is a possibility of publication or reporting bias. Conclusions. The most common scenario was that the subjects believed they received verum acupuncture regardless of the actual treatment received, and overall the subject blinding in the acupuncture studies was satisfactory, with 61% of study participants maintaining ideal blinding. Objectively calculated blinding data may offer meaningful and systematic ways to further interpret the findings of RCTs.
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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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Takakura N, Takayama M, Kawase A, Yajima H. Double Blinding with a New Placebo Needle: A Validation Study on Participant Blinding. Acupunct Med 2011; 29:203-7. [DOI: 10.1136/aim.2010.002857] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background A no-touch control needle in which the needle tip cannot reach the skin has been designed, and has been validated for practitioner blinding in a previous study but not for participant blinding. Objective To test whether the no-touch control needle can effectively blind subjects. Methods An acupuncturist applied, in turn, a no-touch control, skin-touch placebo and penetrating needle in one forearm of 80 healthy subjects. After removing each needle, the subjects were asked to judge the type of needle and rate the sensation of skin penetration/penetration-like or skin pressure/pressure-like pain on a 100 mm visual analogue scale. Results The subjects correctly identified 67% of needles overall. 17 of the 80 no-touch control needles were judged as skin-touch, and one as penetrating. In addition, six skin-touch placebo needles, and no penetrating needles, were judged as no-touch. Half of the 80 skin-touch placebo needles and 65 of the 80 penetrating needles and two no-touch control needles elicited pain. Of 240 needles, the practitioner identified 120 correctly that did not fit the probability of 1/3 (χ2=30.00, p<0.01). Conclusions The no-touch control needles may be used as a blind control for the acupuncture procedure, or to test the physiological effect of the skin-touch needles, but are not suitable for double-blind testing of the needle effect.
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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, The Educational Foundation of Hanada Gakuen, Tokyo, Japan
- Second Department of Physiology, Showa University School of Medicine, Tokyo, Japan
- The Foundation for Oriental Medicine Research, Tokyo, Japan
- Japan School of Acupuncture, Moxibustion and Physiotherapy, The Educational Foundation of Hanada Gakuen, Tokyo, Japan
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, The Educational Foundation of Hanada Gakuen, Tokyo, Japan
- Second Department of Physiology, Showa University School of Medicine, Tokyo, Japan
- The Foundation for Oriental Medicine Research, Tokyo, Japan
- Japan School of Acupuncture, Moxibustion and Physiotherapy, The Educational Foundation of Hanada Gakuen, Tokyo, Japan
| | - Akiko Kawase
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, The Educational Foundation of Hanada Gakuen, Tokyo, Japan
- Second Department of Physiology, Showa University School of Medicine, Tokyo, Japan
- The Foundation for Oriental Medicine Research, Tokyo, Japan
- Japan School of Acupuncture, Moxibustion and Physiotherapy, The Educational Foundation of Hanada Gakuen, Tokyo, Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, The Educational Foundation of Hanada Gakuen, Tokyo, Japan
- Second Department of Physiology, Showa University School of Medicine, Tokyo, Japan
- The Foundation for Oriental Medicine Research, Tokyo, Japan
- Japan School of Acupuncture, Moxibustion and Physiotherapy, The Educational Foundation of Hanada Gakuen, Tokyo, Japan
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Tan CW, Sheehan P, Santos D. Discrimination accuracy between real and sham needles using the Park sham device in the upper and lower limbs. Acupunct Med 2011; 29:208-14. [PMID: 21652672 DOI: 10.1136/aim.2010.003210] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the blinding effectiveness of the Park sham acupuncture device using participants' ability to discriminate between the real and sham acupuncture needles in the (1) upper limb (TE points) compared with pure guessing and (2) lower limb (BL points) compared with pure guessing. METHODS 20 healthy acupuncture-naïve university students and staff were recruited through convenience sampling. Participants made Yes-No judgements on whether the real or sham needle was administered to four TE acupoints on the dominant upper limb, and four acupoints along the BL meridian on the dominant lower limb. The proportion of correct judgements, P(C), for each participant was calculated to indicate the discrimination accuracy of participants in distinguishing between the real and sham needles. Separate P(C) were computed for the upper limb acupoints and lower limb acupoints. The data were also pooled to calculate a P(C) for a combination of both body regions. RESULTS The participants' discrimination accuracy between the real and sham needles was not statistically significant from P(C)=0.5 (chance level) for the lower limb alone and combined body regions' acupoint comparisons (lower limb: t(19)=0.00, unadjusted p=1.00; combined: t(19)=1.75, unadjusted p=0.10). However, the participants' discrimination accuracy was statistically significant from P(C)=0.5 for the upper limb acupoints alone comparison (t(19)=2.36, unadjusted p=0.03). CONCLUSIONS This study showed that the Park sham device is more likely to blind participants in differentiating between the real and sham needles in the lower limb (BL meridian) acupoints than in the upper limb (TE meridian). However, the participants' ability to differentiate between the needle types for the upper limb acupoints was significantly different from chance levels.
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Affiliation(s)
- Chee-Wee Tan
- Queen Margaret University Edinburgh, Queen Margaret University Drive, Edinburgh EH21 6UU, UK.
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Skjeie H, Skonnord T, Fetveit A, Brekke M. A pilot study of ST36 acupuncture for infantile colic. Acupunct Med 2011; 29:103-7. [PMID: 21450707 DOI: 10.1136/aim.2010.003590] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a pilot study to assess the feasibility of a proposed design of an acupuncture trial to relieve symptoms of infantile colic. METHOD An open randomised single-blinded controlled trial, using standardised bilateral treatment of the acupuncture point ST36. Infants fulfilling Wessel's definition of infantile colic were included. PATIENTS were randomised to active treatment or to no-treatment control. General practitioners (GPs) educated in Western medical acupuncture did the interventions. Parents and GPs' assistants were blinded. Active treatment was the bilateral insertion of 0.20×15 mm Seirin needles to 12 mm depth at ST36. The intervention consisted of daily treatments of 30 s duration for three consecutive workdays. Blinding was done with a red point mark on the skin and circular adhesive dressing covering. The parents were asked two blinding validation questions in the course of the study period. The primary end point was the effect of the intervention assessed as change in crying time per 24 h measured with a crying registration form. RESULTS The authors improved the standardisation and changed the blinding procedure as a result of the pilot study. Blinding validation questions were considered necessary. The changes made in the main study protocol are discussed. CONCLUSION The pilot study led to important changes that were implemented into the final trial protocol. Blinding validation is essential in no-treatment controlled trials of acupuncture on infants, where the parents are blinded assessors of symptom reduction. The authors suggest that blinding validation questions, and the answers to these questions, should be reported. Clinical Trial Registry Identifier: NCT00907621.
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Affiliation(s)
- Holgeir Skjeie
- Department of General Practice/Family Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
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Jung A, Shin BC, Lee MS, Sim H, Ernst E. Acupuncture for treating temporomandibular joint disorders: a systematic review and meta-analysis of randomized, sham-controlled trials. J Dent 2011; 39:341-50. [PMID: 21354460 DOI: 10.1016/j.jdent.2011.02.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 02/13/2011] [Accepted: 02/21/2011] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The aim of this article was to assess the clinical evidence for or against acupuncture and acupuncture-like therapies as treatments for temporomandibular joint disorder (TMD). DATA This systematic review includes randomized clinical trials (RCTs) of acupuncture as a treatment for TMD compared to sham acupuncture. The search terms were selected according to medical subject heading (MeSH). SOURCES Systematic searches were conducted in 13 electronic databases up to July 2010; Medline, PubMed, The Cochrane Library 2010 (Issue 7), CINAHL, EMBASE, seven Korean Medical Databases and a Chinese Medical Database. STUDY SELECTION All parallel or cross-over RCTs of acupuncture for TMD were searched without language restrictions. Studies in which no clinical data and complex interventions were excluded. Finally, total of 7 RCTs met our inclusion criteria. CONCLUSIONS In conclusion, our systematic review and meta-analysis demonstrate that the evidence for acupuncture as a symptomatic treatment of TMD is limited. Further rigorous studies are, however, required to establish beyond doubt whether acupuncture has therapeutic value for this indication.
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Affiliation(s)
- Aram Jung
- School of Korean Medicine, Pusan National University, Yangsan, South Korea
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A Methodological Framework for Evaluating the Evidence for Complementary and Alternative Medicine (CAM) for Cancer. Cancers (Basel) 2011; 3:773-88. [PMID: 24212640 PMCID: PMC3756389 DOI: 10.3390/cancers3010773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 02/05/2011] [Accepted: 02/21/2011] [Indexed: 12/04/2022] Open
Abstract
In spite of lacking evidence for effects on cancer progression itself, an increasing number of cancer patients use various types of complementary and alternative medicine (CAM). There is disagreement between CAM practitioners, researchers and clinical oncologists, as to how evidence concerning effects of CAM can and should be produced, and how the existing evidence should be interpreted. This represents a considerable challenge for oncologists; both in terms of patient needs for an informed dialogue regarding CAM, and because some types of CAM may interact with standard treatments. There is a need for insight into which kinds of CAM may work, for whom they work, what the possible effects and side-effects are, and in what ways such effects may come about. The present article presents a framework for evaluating effects of CAM by suggesting a taxonomy of different levels of evidence related to different types of research questions and discussing the relevance of different research methodologies for different types of effects.
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Takakura N, Takayama M, Kawase A, Kaptchuk TJ, Yajima H. Double blinding with a new placebo needle: a further validation study. Acupunct Med 2010; 28:144-8. [PMID: 20530096 PMCID: PMC2933308 DOI: 10.1136/aim.2009.001230] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The masking properties of a new, non-penetrating, double-blind placebo acupuncture needle were demonstrated. Practitioners correctly identified some of the needles; if they were confident in this opinion, they would be unblinded. OBJECTIVE To investigate the clues that led to correct identification, and the confidence in this decision. METHODS Ten acupuncture practitioners, blindly and randomly, applied 10 each of three types of needle to the shoulder: blunt, non-penetrating needles that pressed the skin ('skin-touch placebo needle'); new non-penetrating needles that penetrated soft material (stuffing) but did not reach the skin ('non-touch control needle'); matching penetrating needles. Afterwards, practitioners were asked to judge the type of needle, their confidence in their decision and what clues led them to their judgements. RESULTS Of the 30 judgements made by each practitioner, the mean number of correct, incorrect and unidentifiable answers were 10.4 (SD 3.7), 15.2 (SD 4.9) and 4.4 (SD 6.1), respectively. There was no significant difference in the confidence scores for 104 correct (mean, 54.0 (SD 20.2)%) and 152 incorrect (mean, 50.3 (SD 24.3)%) judgements. Twelve needles were identified with 100% confidence-three correct, and nine incorrect. For needles correctly identified, the proportions of non-touch (p = 0.14) and skin-touch (p = 0.17), needles were no greater than chance, but the proportion of penetrating needles correctly identified exceeded chance (p < 0.01). 53% of judgements were made from the "feeling of needle insertion", but 57% of these were wrong. CONCLUSION Practitioners had a slight tendency to guess the penetrating needles correctly, but were uncertain about most of their judgments, posing only a very small risk to double 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, 2-9-1 Ariake, Koto-ku, Tokyo 135-0063, Japan.
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Kreiner M, Zaffaroni A, Alvarez R, Clark G. Validation of a simplified sham acupuncture technique for its use in clinical research: a randomised, single blind, crossover study. Acupunct Med 2010; 28:33-6. [PMID: 20351375 DOI: 10.1136/aim.2009.001735] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The validity of a new sham acupuncture technique was tested on acupuncture naïve healthy subjects. METHODS The procedure was tested in accupoints LI4 and ST6 in a randomised, single blind and crossover study. The participants were blind to which technique they received. 32 healthy volunteers (15 men, 17 women, aged between 20 and 62 years, mean age 34 years) were recruited at the Universidad de la República, Uruguay. Interventions Participants were randomly assigned to one of two groups: (1) real acupuncture or (2) sham acupuncture. After 30 min, the patients were 'needled' again in a crossover design. Main outcome measures A yes/no questionnaire was used to assess the credibility and characteristics of the procedure. RESULTS For the credibility question (do you think you received real acupuncture?) no statistically significant group differences were evident before or after the crossover. Subjects who answered yes to this question ranged from 14/16 (87.5%) before crossover to 10/16 (62.5%) after crossover for the sham and 12/16 (75%) before crossover to 15/16 (93.8%) after crossover for the real acupuncture. The question that showed a significant difference (only after crossover) was the question, "did you feel the needle penetrating the skin?"; after crossover 12/16 (75%) subjects in the real acupuncture group said yes and 2/16 (12%) subjects in the sham group said yes to this question (p<0.01). CONCLUSIONS These data suggests that this method is credible and constitutes a simple and inexpensive technique for use as a control in clinical research in acupuncture naïve subjects.
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Affiliation(s)
- Marcelo Kreiner
- Department of General and Oral Physiology, Universidad de la República, School of Dentistry, Ramón Masini 3381, Montevideo 11300, Uruguay.
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Enck P, Klosterhalfen S, Zipfel S. Acupuncture, psyche and the placebo response. Auton Neurosci 2010; 157:68-73. [PMID: 20359961 DOI: 10.1016/j.autneu.2010.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 03/08/2010] [Indexed: 12/18/2022]
Abstract
With growing use of acupuncture treatment in various clinical conditions, the question has been posed whether the reported effects reflect specific mechanisms of acupuncture or whether they represent placebo responses, as they often are similar in effect size and resemble similarities to placebo analgesia and its mechanisms. We reviewed the available literature for different placebos (sham procedures) used to control the acupuncture effects, for moderators and potential biases in respective clinical trials, and for central and peripheral mechanisms involved that would allow differentiation of placebo effects from acupuncture and sham acupuncture effects. While the evidence is still limited, it seems that biological differences exist between a placebo response, e.g. in placebo analgesia, and analgesic response during acupunture that does not occur with sham acupuncture. It seems advisable that clinical trials should include potential biomarkers of acupuncture, e.g. measures of the autonomic nervous system function to verify that acupuncture and sham acupuncture are different despite similar clinical effects.
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Affiliation(s)
- Paul Enck
- University Hospital Tübingen, Dept. of Psychosomatic Medicine, Tübingen, Germany.
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Tan CW, Christie L, St-Georges V, Telford N. Discrimination of real and sham acupuncture needles using the park sham device: a preliminary study. Arch Phys Med Rehabil 2010; 90:2141-5. [PMID: 19969182 DOI: 10.1016/j.apmr.2009.08.142] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 08/18/2009] [Accepted: 08/18/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Tan C-W, Christie L, St-Georges V, Telford N. Discrimination of real and sham acupuncture needles using the Park sham device: a preliminary study. OBJECTIVE To evaluate the blinding effectiveness of the Park sham acupuncture device using participants' ability to discriminate between the real and sham acupuncture needles. DESIGN The design was a yes-no experiment. Judgments were made on whether the real or sham acupuncture needle was administered. SETTING University laboratory. PARTICIPANTS Healthy, acupuncture-naive university students and staff (N=20; median age, 22y; range, 18-48y) recruited through convenience sampling. INTERVENTIONS Participants made yes-no judgments on whether the real or sham needle was administered to 8 acupoints (4 traditional and 4 nontraditional) along the Pericardium meridian (Pericardium 3 to Pericardium 6) on the dominant forearm. MAIN OUTCOME MEASURES The accuracy index, d', of participants' ability to discriminate between the real and sham needles (discriminability) was computed for the traditional alone, the nontraditional alone, and a combination of both types of acupoints. RESULTS The participants' d' between the real and sham needles was not statistically significant from d' equal to 0 for the combined traditional and nontraditional acupoints comparison and the nontraditional acupoints alone comparison (combined, t(19)=1.20, P=.25; nontraditional, t(19)=.16, P=.87). However, the participants' d' was statistically significant from d' equal to 0 for the traditional acupoints comparison (t(19)=2.096, P=.049). CONCLUSIONS The Park sham acupuncture device appears to be effective in blinding participants to real acupuncture intervention when it is applied to the nontraditional acupoints and when traditional and nontraditional acupoints are combined on the forearm along the pericardium meridian. However, the sham device does not appear to blind participants effectively when traditional acupoints alone are used for the same context.
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Affiliation(s)
- Chee-Wee Tan
- School of Health Sciences, Queen Margaret University Edinburgh, Edinburgh, United Kingdom.
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Borud E, White A. A review of acupuncture for menopausal problems. Maturitas 2010; 66:131-4. [PMID: 20060667 DOI: 10.1016/j.maturitas.2009.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 12/10/2009] [Indexed: 11/24/2022]
Abstract
Acupuncture is one of the complementary therapies that are increasingly used by women with menopausal hot flushes. Acupuncture can be understood as a form of neurological stimulation. Clinical trials of acupuncture use different control groups according to whether they wish to provide practical information on the role of acupuncture in health care, or theoretical information on the specific needle effect. Controls for the latter research question are highly problematic, and no convincingly inert 'placebo' needle has yet been designed. For natural menopause, one large study has shown acupuncture to be superior to self-care alone in reducing the number of hot flushes and improving the quality of life; five small studies have been unable to demonstrate that the effect of acupuncture is limited to any particular points, as traditional theory would suggest; and one study showed acupuncture was superior to blunt needle for flash frequency but not intensity. For flushes associated with induced menopause, clearly acupuncture is useful for reducing flushes in clinical practice, but there is mixed evidence on the nature of the effect: one trial found genuine acupuncture superior to control needling, but another showed no significant difference between acupuncture and blunt needle. The possible mechanisms of acupuncture for hot flushes are discussed. Current evidence clearly justifies further research into the most cost effective form of acupuncture for treating hot flushes.
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Affiliation(s)
- Einar Borud
- The National Research Center in Complementary and Alternative Medicine, University of Tromsø, Tromsø, Norway.
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