Does the outcome of acupuncture differ according to the location of sham needling points in acupuncture trials for migraine? A systematic review and network meta-analysis

Abstract

Various acupuncture clinical trials have been conducted on migraine; however, the conclusions remain controversial especially when acupuncture was compared with sham acupuncture. Sham acupuncture is sometimes performed at the same acupuncture points used for verum acupuncture despite the evidence on acupuncture point specificity. Four databases were searched for sham acupuncture or waiting list-controlled acupuncture trials for migraine on December 25, 2023. Sham acupuncture was classified according to the needling points: sham acupuncture therapy at verum points (SATV) or at sham points (SATS). Network meta-analysis was performed based on the frequentist framework for headache pain intensity and response rate. A total of 18 studies involving 1936 participants were analyzed. Headache pain intensity and response rate were significantly improved in verum acupuncture compared with SATS. However, there was no significant difference between SATV and verum acupuncture. When comparing SATS and SATV, there was no significant difference in headache pain intensity and response rate; however, the results were in favor of SATV. The effect of the risk of bias on the certainty of evidence between verum and sham acupunctures was judged to be generally low. SATV should not be misused as a placebo control to evaluate the efficacy of acupuncture.

Keywords

acupuncture therapy / migraine / migraine disorders / sham acupuncture / placebo

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Acknowledgements

BL, HWL, and MSL were supported by the Korea Institute of Oriental Medicine (Nos. KSN2121211 and KSN23314112). LSW was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health (No. R24 AT001293). The funders had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, the preparation, review, and approval of the manuscript, or the decision to submit the manuscript for publication.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-024-1109-z and is accessible for authorized users.

Compliance with ethics guidelines

Conflicts of interest Boram Lee, Chan-Young Kwon, Hye Won Lee, Arya Nielsen, L Susan Wieland, Tae-Hun Kim, Stephen Birch, Terje Alraek and Myeong Soo Lee declare that they have no conflict of interest.

This manuscript is a review article and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee.

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