The relation between quality of clinical trials and acupuncture efficacy

David Gonçalves Nordon


Introduction: Clinical trials of acupuncture not always have concordant results, mostly due to their great heterogeneity. Two indexes have been developed to analyze the quality of acupuncture trials. This study hypothesizes that, the more adequate the intervention and the control techniques, the more efficacious the acupuncture. Methods: Both indexes were applied to 27 randomized clinical trials comparing acupuncture to placebo. Results were compared by using the Mann-Whitney test. Results: Studies favorable to acupuncture had a intervention score’s median of 11.5; for the unfavorable ones, it was 7, p: 0.0017. Articles with and without statistically significant differences, though, had the same median for their scores in the control index: 6. Discussion: There is a positive relation between a better score for acupuncture technique and a statistically significant difference between acupuncture and interventional control. However, due to the little heterogeneity in the degree of physiological effect from each article, the control index had no statistical significance. Conclusion: This study established that, among acupuncture RCT controlled by placebo or sham of moderate physiological effect, the adequacy of the technique is more important than the adequacy of control in establishing a statistically significant difference between acupuncture and interventional control.


acupuntura; placebo; eficácia

Texto completo:



Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, et al. Does quality of reports of randomized trials affect estimates of intervention efficacy reported in meta-analyses? Lancet. 1998;352:609-13.

Moher D, Fortin P, Jadad AR, Jünl P, Klassen T, Lorier JL, et al. Completeness of reporting of trials published in language other than English: implications for conduct and reporting of systematic reviews. Lancet. 1996;347:363-6.

Birch S. Systematic reviews of acupuncture – are there problems with these? Clin Acupunct Oriental Med. 2001;2:17-22.

Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AMK, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004;141:901-10.

Haake M, Müller H-H, Schade-Brittinger C, Baster HD, Schäfer H, Maier C, et al. German acupuncture trials (GERAC) for chronic low back pain. Randomized, multicentre, blinded, parallel-group Trial with 3 groups. Arch Intern Med. 2007;167(17):1892-8.

Alecrim-Andrade J, Maciel-Júnior JA, Cladellas XC, Correa-Filho HR, Machado HC. Acupuncture in migraine prophylaxis: a randomized sham-controlled trial. Cephalalgia. 2006;26:520-9.

White AR, Resch K-L, Chan JCK, Norris CD, Modi SK, Pate JN, et al. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia. 2000;20:632-7.

Endres HG, Böwing G, Diener HC, Lange S, Maier C, Molsberger A, et al. Acupuncture for tension-type headache: a multicentre, sham-controlled, patient and observer-blinded, randomised Trial. J Headache Pain. 2007;8:306-14.

Xue CCL, Dong L, Polus B, English RA, Zheng Z, Da Costa C, et al. Electroacupuncture for tension-type headache on distal acupoints only: a randomized, controlled, crossover Trial. Headache. 2004;44:333-41.

Diener HC, Kronfeld K, Boewing G, Lungenhausen M, Maier C, Molserberg A, et al. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre, randomized, controlled clinical trial. Lancet Neurol. 2006;5:310-6.

Facco E, Ligueri A, Petti F, Zanette G, Coluzzi F, Nardin M, et al. Traditional acupuncture in migraine: a controlled, randomised study. Headache. 2008;48:398-407.

Wong RHL, Lee TW, Sihoe ADL, Wan IY, Ng CSH, Chan SKC, et al. Analgesic effect of electroacupuncture in postthoracotomy pain: a prospective randomized Trial. Ann Thorac Surg. 2006;81:2031-6.

Molsberger AF, Mow J, Pawelec DB, Winkler J. Does acupuncture improve the orthopedic management of chronic low back pain – a randomized, blinded, controlled trial with 3 months fllow-up. Pain. 2002;99:579-87.

Leibing E, Leonhardt U, Köster G, Goerlitz A, Rosenfeldt JA, Hilgers R, et al. Acupuncture treatment of chronic low-back pain – a randomized, blinded, placebo-controlled Trial with 9-month follow-up. Pain. 2002;96:189-96.

Scharf HP, Monsmann U, Streitberger K, Wilte S, Krämer J, Maier C, et al. Acupuncture and knee osteoarthritis – a three-armed randomized Trial. Ann Intern Med. 2006;145:12-20.

Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomized trial. Lancet. 2005;366:136-43.

Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, et al. Acupuncture in patients with tension-type headache: a randomised controlled Trial. BMJ. 2005;331:376-9.

Vas J, Méndez C, Perea ME, Vega E, Panadero MD, León JM et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: a randomized controlled Trial. BMJ. 2004;329(7476):1216.

Karst M, Reinhard M, Thum P, Wiese B, Rolling J, Fink M. Needle acupuncture in tension-type headache: a randomized, placebo-controlled study. Cephalalgia. 2001;21:637-42.

Alecrim-Andrade J, Maciel Júnior J, Carnè X, Vasconcelos GMS, Correa Filho HP. Acupuncture in migraine prevention a randomized sham controlled study with 6-months posttreatment follow-up. Clin J Pain. 2008;24(2):98-105.

Gosman-Hedström G, Clarsson L, Lingenstierna U, Carlsson J, Olausson B, Fritzell M et al. Effects of acupuncture treatment on daily life activities and quality of life. A controlled, prospective and randomized study of acute stroke patients. Stroke. 1998;29:2100-8.

Fink MG, Kunbsebeck H, Wipperman B, Gehrke A. Non-specific effects of traditional Chinese acupuncture in osteoarthritis of the hip. Complement Ther Med. 2001;9:82-8.

Assefi NP, Sherman KJ, Jacobsen C, Goldberg J, Smith WR, Buchwald D. A randomized clinical Trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med. 2005;143:10-9.

Lao L, Bergman S, Langenberg P, Wong RH, Berman B. Efficacy of Chinese acupuncture on postoperative oral surgery pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79:423-8.

Jubb RW, Tukmachi ES, Jones PW, Dempsey E, Waterhouse L, Brailsford S. A blinded randomized trial of acupuncture (manual and electroacupuncture) compared with a non-penetrating sham for the symptoms of osteoarthritis of the knee. Acupunct Med. 2008;26(2):69-78.

Lee SW, Lion ML, Yuen KH, Leong WS, Chee C, Cheah PY, et al. Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. Am J Med. 2008;121:79e1-79e8.

Manheimer E, Lim B, Lao L, Berman B. Acupuncture for knee osteoarthritis – a randomised Trial using a novel sham. Acupunct Med. 2006;24(Suppl):S7-14.

Kennedy S, Baxter GD, Kerr DP, Bradbury I, Park J, McDonough SM. Acupuncture for acute non-specific low back pain: a pilot randomized non-penetrating sham controlled trial. Complement Ther Med. 2008;16:139-46.

Inoue M, Kitakoji H, Ishizali N, Tawa M, Yano T, Katsumi Y, et al. Relief of low back pain immediately after acupuncture treatment – a randomized, placebo controlled trial. Acupunct Med. 2006;24(3):103-8.

Wayne PM, Kerr CE, Schnyer RN, Legedza ATR, Savestky-German J, Shields MH, et al. Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. J Pediatr Adolesc Gynecol. 2008;21:247-57.

Nordon DG, Gianini RJ, Azevedo GR. Development and validation of an index for evaluating the quality of acupuncture articles. Rev Fac Ciênc Méd Sorocaba. 2012;14(2):59-63.

Nordon DG, Gianini RJ, Azevedo GR. Development and Validation of an Index of the Adequacy of the Control Technique for Acupuncture Studies. Rev Fac Ciênc Méd Sorocaba. 2013;15(1):186-91.

Métricas do artigo

Carregando Métricas ...

Metrics powered by PLOS ALM


  • Não há apontamentos.

Direitos autorais

Apoio: ..............................................................................................................................................


Fundação São Paulo - Hospital universitário



Rev. Fac. Ciênc. Méd. Sorocaba, Sorocaba, SP, Brasil, e-ISSN 1984-4840

A Revista da Faculdade de Ciências Médicas de Sorocaba está licenciada com uma Licença Creative Commons - Atribuição 4.0 Internacional.