Positive Health Online

Abstract

HAMMERSCHLAG, Yo San University of Traditional Chinese Medicine, Santa Monica, California 90401 USA reviews (48 references) controlled clinical trials of acupuncture .

Background

Methodology

Controlled clinical trials of acupuncture are divided into 5 categories, based upon the treatment with which acupuncture is compared: 1)Waiting list or no treatment controls, ethically acceptable for stable, chronic conditions, assess the efficacy of acupuncture relative to the natural history of the condition, but do not control for nonspecific treatment effects; 2) Placebo controls, defined as noninvasive procedures such as inactive transcutaneous electrical nerve stimulation (TENS) or mock needling, assess whether acupuncture has an effect beyond that of the therapeutic milieu; 3) Sham controls, defined as invasive but inappropriate procedures such as shallow needling at nonacupoint sites, assess whether acupuncture efficacy depends upon the style and location of needling; 4) Standard care comparisons assess whether acupuncture performs at least as well as a medication, medical device or physiotherapy; 5) Adjunctive care comparisons assess the efficacy of acupuncture plus standard care relative to standard care alone. From an ethical perspective, active debate surrounds placebo and sham controls, with those arguing against these procedures considering withholding treatment to be improper. These people favour the waiting list and both standard care designs in which all patients receive treatment. Others argue that testing a treatment prior to demonstrating its efficacy against a placebo is equally improper. It should also be considered that most clinical trials of acupuncture have assessed its efficacy by administering a fixed course of treatment based upon biomedical diagnosis.

Results

Conclusion

The challenge for future trials is to design conditions that more closely mimic the application of acupuncture in clinical practice, as individualised treatment informed by its own diagnostic traditions.

References

Hammerschlag R Methodological and ethical issues in clinical trials of acupuncture. J Altern Complement Med 4(2): 159-71 Summer 1998.