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Systematic review and meta-analysis
Acupuncture is superior to sham for painful conditions
  1. Adrian White1,
  2. Jens Foell2
  1. 1Primary Care, Peninsula Schools of Medicine and, Dentistry, Plymouth University, Plymouth, UK
  2. 2Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  1. Correspondence to: Dr Adrian White
    Peninsula Schools of Medicine and, Dentistry, Plymouth University, Tamar Science Park, Plymouth PL68BX, UK; adrian.white{at}

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Commentary on: Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture Trialists’ Collaboration. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012;172:1444–53.


Acupuncture is controversial. Even if one assumes its overall effectiveness, common explanations for its causal impact are biologically implausible. Hence acupuncture is often dismissed as ‘no more than a placebo’, and this allegation is difficult to disprove as placebo-controlled trials are problematic. ‘Placebo’ needles stimulate sensory nerves and are possibly a less active treatment, ‘sham’ rather than ‘placebo’.1 Small differences between treatments require large sample sizes, as achieved by meta-analysis. Previous meta-analyses concentrated on finding all trials, but poor quality limited the conclusions.


This is a systematic review of randomised controlled trials (RCTs) of chronic headache and musculoskeletal conditions that had unambiguous allocation concealment and were assessed for risk of bias from blinding. The authors …

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