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Different types of verum acupuncture may have different effect sizes depending on what kind of sham they are compared against, concludes a network meta-analysis conducted by an international team of authors. Randomised controlled trials of acupuncture performed using sham interventions generally use one of two types of sham techniques: minimal insertion of acupuncture needles and no additional stimulation (shallow needling control), or sham acupuncture devices that do not penetrate the skin (sham device control). To achieve successful blinding, sham device controlled acupuncture trials also use a sham device base unit (which is necessary to retain the device on the patient’s skin) when performing needling in the verum acupuncture group. However, in shallow needling controlled trials this is not a necessary part of the verum acupuncture treatment. Eight studies were included in the authors’ review, which analysed the comparative effectiveness of these two verum acupuncture modalities in studies of acupuncture for menopausal hot flushes. From their network meta-analysis, the authors found that verum acupuncture in shallow needling controlled trials was more effective than verum acupuncture in the sham device controlled trials. The authors suggest that verum acupuncture in the sham device controlled acupuncture studies may differ from acupuncture in real-world practice. The sham device base unit may interfere with the ability to achieve an appropriate level of stimulation, since the unit allows acupuncture needles to be manipulated with limited depth and direction.

Acupuncture in sham device controlled trials may not be as effective as acupuncture in the real world: a preliminary network meta-analysis of studies of acupuncture for hot flashes in menopausal women. Acupunct Med. 2019 Sep 13:acupmed2018011671


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