Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck painCommentary: Controls for acupuncture—can we finally see the light?

doi:10.1136/bmj.322.7302.1574

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Abstract

Objectives: To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain.

Design: Prospective, randomised, placebo controlled trial.

Setting: Three outpatient departments in Germany.

Participants: 177 patients aged 18–85 years with chronic neck pain.

Interventions: Patients were randomly allocated to five treatments over three weeks with acupuncture (56), massage (60), or “sham” laser acupuncture (61).

Main outcome measures: Primary outcome measure: maximum pain related to motion (visual analogue scale) irrespective of direction of movement one week after treatment. Secondary outcome measures: range of motion (3D ultrasound real time motion analyser), pain related to movement in six directions (visual analogue scale), pressure pain threshold (pressure algometer), changes of spontaneous pain, 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 were assessed.

Results: One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage (difference 24.22 (95% confidence interval 16.5 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 and massage or sham laser were greater in the subgroup who had had pain for longer than five years (n=75) and in patients with myofascial pain syndrome (n=129). The acupuncture group had the best results in most secondary outcome measures. There were no differences in patients' beliefs in treatment.

Conclusions: Acupuncture is an effective short term treatment for patients with chronic neck pain, but there is only limited evidence for long term effects after five treatments.

What is already known on this topic

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

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

Footnotes

Accepted 15 March 2001

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

Dominik Irnich, research fellowa (Dominik.Irnich{at}lrz.uni-muenchen.de),
Nicolas Behrens, research fellowb,
Holger Molzen, research fellowd,
Achim König, consultant orthopaedic surgeond,
Jochen Gleditsch, consultant pain therapya,
Martin Krauss, statisticianc,
Malte Natalis, consultant orthopaedic surgeond,
Edward Senn, professor of physical medicine and rehabilitatione,
Antje Beyer, head of pain unita,
Peter Schöps, head of pain unitb

^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
British Medical Acupuncture Society, Royal London Homoeopathic Hospital, London WC1N 3HR

Correspondence to: D Irnich

Accepted 15 March 2001