PURPOSE: Chronic neck pain (CNP) is a common but challenging symptom in clinical practice. Acupuncture is widely used in alleviating the symptoms of CNP. The main objective of this study was to evaluate the efficacy and safety of electroacupuncture (EA) in patients with CNP and to quantify the specific effects of EA by controlling for placebo effects. PATIENTS AND METHODS: A randomized sham-controlled trial was conducted at the outpatient departments of single hospital in China from November 2019 to November 2020 and a total of 105 participants with CNP were enrolled. Participants were randomly assigned (1:1:1) to the EA group, sham electroacupuncture (SEA) group and waiting list (WL) group. The primary outcome was change in the Northwick Park Neck Pain Questionnaire (NPQ). Secondary outcomes included McGill Pain Questionnaire (MG), visual analogue scale (VAS) and pain threshold (PT). RESULTS: This randomized clinical trial included 98 patients. The EA group demonstrated a greater reduction in NPQ scores compared to the SEA group after 10 sessions (-7.2564, 95% CI -12.2875 to -2.2253, p = 0.0054) and at 3-month follow up (-7.0090, 95% CI -10.5039 to -3.5140, p = 0.0002). After 10 sessions, the EA and SEA groups exhibited greater reductions in NPQ scores compared to the WL group (EA versus WL: p < 0.001, (95% CI 6.570 to 15.503); SEAversus WL: p = 0.027, (95% CI 0.578 to 9.580)). However, the EA group achieved clinically significant NPQ improvements (> 25%), whereas the SEA group failed to meet this criterion. CONCLUSION: This randomized clinical trial found that, in patients with CNP, EA significantly improved the symptoms compared with SEA and WL groups both immediately and cumulatively (at 5 weeks), and these benefits persisted through week 17. These comparisons demonstrated that EA's clinical benefits exceeded placebo effects.

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