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Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial [with consumer summary]
White P, Lewith G, Prescott P, Conway J
Annals of Internal Medicine 2004 Dec 21;141(12):911-919
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Despite substantial increases in its popularity and use, the efficacy of acupuncture for chronic mechanical neck pain remains unproved. OBJECTIVE: To compare acupuncture and placebo for neck pain. DESIGN: A randomized, single-blind, placebo-controlled, parallel-arm trial with 1-year follow-up. SETTING: The outpatient departments of 2 major hospitals in the United Kingdom, 1999 to 2001. PATIENTS: 135 patients 18 to 80 years of age who had chronic mechanical neck pain. Eleven patients withdrew from treatment, and 124 completed the primary end point. MEASUREMENTS: The primary outcome was pain 1 week after treatment, according to a visual analogue scale. Secondary outcomes were pain at other time points, score on the Neck Disability Index and the Short Form-36, and use of analgesic medications. INTERVENTIONS: Patients were randomly assigned to receive, over 4 weeks, 8 treatments with acupuncture or with mock transcutaneous electrical stimulation of acupuncture points using a decommissioned electroacupuncture stimulation unit. RESULTS: Both groups improved statistically from baseline, and acupuncture and placebo had similar credibility. For the primary outcome (weeks 1 to 5), a statistically significant difference in visual analogue scale score in favor of acupuncture (6.3 mm (95% CI 1.4 to 11.3 mm); p = 0.01) was observed between the 2 study groups, after adjustment for baseline pain and other covariates. However, this difference was not clinically significant because it demonstrated only a 12% (CI 3% to 21%) difference between acupuncture and placebo. Secondary outcomes showed a similar pattern. LIMITATIONS: All treatments were provided by 1 practitioner. Although the control was credible, it did not mimic the process of needling. A nonintervention group was not present to control for regression to the mean. CONCLUSIONS: Acupuncture reduced neck pain and produced a statistically, but not clinically, significant effect compared with placebo. The beneficial effects of acupuncture for pain may be due to both nonspecific and specific effects.

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