Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain  Commentary: Controls for acupuncture{---}can we finally see the

doi:10.1136/bmj.322.7302.1574

BMJ 2001;322:1574 ( 30 June )

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Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain

Dominik Irnich, research fellow, ^a Nicolas Behrens, research fellow, ^b Holger Molzen, research fellow, ^d Achim König, consultant orthopaedic surgeon, ^d Jochen Gleditsch, consultant pain therapy, ^a Martin Krauss, statistician, ^c Malte Natalis, consultant orthopaedic surgeon, ^d Edward Senn, professor of physical medicine and rehabilitation, ^e Antje Beyer, head of pain unit, ^a Peter Schöps, head of pain unit. ^b

^a Department of Anaesthesiology, Ludwig-Maximilians University, 81377 Munich, Germany, ^b Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians University, ^c Biometric Center for Therapeutic Studies, 80336 Munich, Germany, ^d Department of Orthopaedics, University of Würzburg, 97074 Würzburg, Germany, ^e Reha Klinik Bellikon, 5454 Bellikon, Switzerland

Correspondence to: D Irnich Dominik.Irnich{at}lrz.uni-muenchen.de

Objectives: To compare the efficacy of acupuncture andconventional massage for the treatment of chronic neckpain.
Design: Prospective, randomised, placebo controlledtrial.
Setting: Three outpatient departments inGermany.
Participants: 177 patients aged 18-85 years with chronicneckpain.
Interventions: Patients were randomly allocated to five treatmentsover three weeks with acupuncture (56), massage (60), or "sham"laser acupuncture(61).
Main outcome measures: Primary outcome measure: maximum pain relatedto motion (visual analogue scale) irrespective of direction ofmovement one week after treatment. Secondary outcome measures:range of motion (3D ultrasound real time motion analyser), painrelated to movement in six directions (visual analogue scale),pressure pain threshold (pressure algometer), changes of spontaneouspain, motion related pain, global complaints (seven point scale),and quality of life (SF-36). Assessments were performed before,during, and one week and three months after treatment. Patients'beliefs in treatment wereassessed.
Results: One week after five treatments the acupuncturegroup showed a significantly greater improvement in motion relatedpain compared with massage (difference 24.22 (95% confidence interval16.5 to 31.9), P=0.0052) but not compared with sham laser (17.28(10.0 to 24.6), P=0.327). Differences between acupuncture andmassage or sham laser were greater in the subgroup who had hadpain for longer than five years (n=75) and in patients with myofascialpain syndrome (n=129). The acupuncture group had the best resultsin most secondary outcome measures. There were no differencesin patients' beliefs intreatment.
Conclusions: Acupuncture is an effective short term treatmentfor patients with chronic neck pain, but there is only limitedevidence for long term effects after fivetreatments.

What is already known on this topic
Acupuncture is a widespread complementary treatment

Evidence from trials have given conflicting results on its use in the treatment of neck pain because of methodological shortcomings and because effects were compared either with alternative treatments or with different sham procedures imitating acupuncture, but not both

What this study adds
Compared with sham laser acupuncture and massage, needle acupuncture has beneficial effects on mobility and pain related to motion in patients with chronic neck pain

Acupuncture was clearly more effective than massage, but differences were not always significant compared with sham laser acupuncture

Acupuncture was the best treatment for patients with the myofascial syndrome and those who had had pain for longer than five years

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