• Rui Zhou, Yan-Juan Zhu, Xian Chen, Hao-Chuan Ma, Yi-Hong Liu, Xue-Song Chang, Ya-Dong Chen, Ya-Ya Yu, Zhen-Zhen Xiao, Li-Rong Liu, Yong Li, and Hai-Bo Zhang.
• Guangzhou University of Chinese Medicine, Guangzhou, China.
• Pain Med. 2023 Apr 3; 24 (4): 382396382-396.

BackgroundAlong with increasing research on acupuncture for chronic pain, the validity of sham acupuncture (SA) has also been argued.MethodsNine databases were searched for randomized controlled trials (RCTs) from the inception dates of the databases to July 5, 2022. With Markov Chain Monte Carlo methods, a Bayesian multiple-treatment network meta-analysis (NMA) with random-effects model was conducted.ResultsA total of 62 RCTs with 6,806 patients and four kinds of treatments (real acupuncture [RA], non-acupuncture [NA], penetrative SA [PSA], and non-penetrative SA [NPSA]) were included. The results indicated that both NPSA and PSA were not superior to NA in improving chronic pain (NPSA: mean difference [MD]= -4.77, 95% confidence interval [CI] -11.09 to 1.52; PSA: MD= -4.96, 95% CI -10.38 to 0.48). After NPSA and PSA were combined into the SA group, the weak trend of pain relief from SA was still not statistically significant (MD= -4.91, 95% CI -9.93 to 0.05). NPSA and PSA had similar effects (MD= 0.18, 95% CI -5.45 to 5.81). RA was significantly associated with pain relief, compared with NPSA and PSA (NPSA: MD= -12.03, 95% CI -16.62 to -7.41; PSA: MD= -11.85, 95% CI -15.48 to -8.23). The results were generally consistent regardless of pain phenotype, frequency, duration, acupuncture methods, analgesic intake, or detection bias.ConclusionThese results suggested that acupuncture was significantly associated with reduced chronic pain. The two kinds of placebo acupuncture, NPSA and PSA, have similar effects. Both NPSA and PSA, with a weak but not significant effect, are appropriate to be inert placebo controls in RCTs for chronic pain.© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.

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