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Practice, practitioner or placebo? A multifactorial, mixed methods randomized controlled trial of acupuncture

Practice, practitioner or placebo? A multifactorial, mixed methods randomized controlled trial of acupuncture
Practice, practitioner or placebo? A multifactorial, mixed methods randomized controlled trial of acupuncture
The nonspecific effects of acupuncture are well documented; we wished to quantify these factors in osteoarthritic (OA) pain, examining needling, the consultation, and the practitioner. In a prospective randomised, single-blind, placebo-controlled, multifactorial, mixed-methods trial, 221 patients with OA awaiting joint replacement surgery were recruited. Interventions were acupuncture, Streitberger placebo acupuncture, and mock electrical stimulation, each with empathic or nonempathic consultations. Interventions involved eight 30-minute treatments over 4weeks. The primary outcome was pain (VAS) at 1week posttreatment. Face-to-face qualitative interviews were conducted (purposive sample, 27 participants). Improvements occurred from baseline for all interventions with no significant differences between real and placebo acupuncture (mean difference ?2.7mm, 95% confidence intervals ?9.0 to 3.6; P=.40) or mock stimulation (?3.9, ?10.4 to 2.7; P=.25). Empathic consultations did not affect pain (3.0mm, ?2.2 to 8.2; P=.26) but practitioner 3 achieved greater analgesia than practitioner 2 (10.9, 3.9 to 18.0; P=.002). Qualitative analysis indicated that patients’ beliefs about treatment veracity and confidence in outcomes were reciprocally linked. The supportive nature of the trial attenuated differences between the different consultation styles. Improvements occurred from baseline, but acupuncture has no specific efficacy over either placebo. The individual practitioner and the patient’s belief had a significant effect on outcome. The 2 placebos were equally as effective and credible as acupuncture. Needle and nonneedle placebos are equivalent. An unknown characteristic of the treating practitioner predicts outcome, as does the patient’s belief (independently). Beliefs about treatment veracity shape how patients self-report outcome, complicating and confounding study interpretation.

acupuncture, mixed methods, nonspecific effects, placebo, RCT
0304-3959
455-462
White, Peter
f33829fd-24c9-4b44-a148-24eca9d52253
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Prescott, Philip
cf0adfdd-989b-4f15-9e60-ef85eed817b2
Scott, Clare
3b581659-6774-4fc1-84b8-9a62845f9d2d
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
White, Peter
f33829fd-24c9-4b44-a148-24eca9d52253
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Prescott, Philip
cf0adfdd-989b-4f15-9e60-ef85eed817b2
Scott, Clare
3b581659-6774-4fc1-84b8-9a62845f9d2d
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625

White, Peter, Bishop, Felicity L., Prescott, Philip, Scott, Clare, Little, Paul and Lewith, George (2012) Practice, practitioner or placebo? A multifactorial, mixed methods randomized controlled trial of acupuncture. Pain, 153 (2), 455-462. (doi:10.1016/j.pain.2011.11.007).

Record type: Article

Abstract

The nonspecific effects of acupuncture are well documented; we wished to quantify these factors in osteoarthritic (OA) pain, examining needling, the consultation, and the practitioner. In a prospective randomised, single-blind, placebo-controlled, multifactorial, mixed-methods trial, 221 patients with OA awaiting joint replacement surgery were recruited. Interventions were acupuncture, Streitberger placebo acupuncture, and mock electrical stimulation, each with empathic or nonempathic consultations. Interventions involved eight 30-minute treatments over 4weeks. The primary outcome was pain (VAS) at 1week posttreatment. Face-to-face qualitative interviews were conducted (purposive sample, 27 participants). Improvements occurred from baseline for all interventions with no significant differences between real and placebo acupuncture (mean difference ?2.7mm, 95% confidence intervals ?9.0 to 3.6; P=.40) or mock stimulation (?3.9, ?10.4 to 2.7; P=.25). Empathic consultations did not affect pain (3.0mm, ?2.2 to 8.2; P=.26) but practitioner 3 achieved greater analgesia than practitioner 2 (10.9, 3.9 to 18.0; P=.002). Qualitative analysis indicated that patients’ beliefs about treatment veracity and confidence in outcomes were reciprocally linked. The supportive nature of the trial attenuated differences between the different consultation styles. Improvements occurred from baseline, but acupuncture has no specific efficacy over either placebo. The individual practitioner and the patient’s belief had a significant effect on outcome. The 2 placebos were equally as effective and credible as acupuncture. Needle and nonneedle placebos are equivalent. An unknown characteristic of the treating practitioner predicts outcome, as does the patient’s belief (independently). Beliefs about treatment veracity shape how patients self-report outcome, complicating and confounding study interpretation.

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More information

e-pub ahead of print date: 14 December 2011
Published date: February 2012
Keywords: acupuncture, mixed methods, nonspecific effects, placebo, RCT
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 335512
URI: http://eprints.soton.ac.uk/id/eprint/335512
ISSN: 0304-3959
PURE UUID: 4b1d78fd-fe98-4a72-b1ef-a02847e5c93e
ORCID for Felicity L. Bishop: ORCID iD orcid.org/0000-0002-8737-6662

Catalogue record

Date deposited: 12 Mar 2012 14:48
Last modified: 26 Nov 2021 02:46

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Contributors

Author: Peter White
Author: Philip Prescott
Author: Clare Scott
Author: Paul Little
Author: George Lewith

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