Acupuncture versus Placebo for the Treatment of Chronic Mechanical Neck Pain

A Randomized, Controlled Trial

21 December 2004 | Volume 141 Issue 12 | Pages 911-919

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.

Editors' Notes Context Chronic neck pain is a common, disabling condition and is difficult to treat. Because traditional therapies, such as physical therapy and nonsteroidal anti-inflammatory drugs, have limited effectiveness and can have adverse effects, many patients seek alternative therapies, such as acupuncture. Contribution This randomized, controlled trial of acupuncture versus sham transcutaneous electrical stimulation for patients with chronic mechanical neck pain identified no clinically significant benefit of acupuncture over placebo with respect to pain, function, or analgesic use. Implications Acupuncture did not lead to clinically significant improvement in chronic mechanical neck pain when compared with placebo. –The Editors

 

Author and Article Information

From University of Southampton, Southampton, United Kingdom.

Acknowledgments: The authors thank Professor C. Cooper (Medical Research Council) and Dr. R. Ellis (Southampton General Hospital) for support with this project.

Grant Support: The study protocol was developed in 1997 and was funded by the Henry Smiths Charity and the Hospital Savings Association in 1998. Recruitment began in 1999 and was completed in 2001. Dr. Lewith's post was supported by the Laing Foundation.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Peter White, PhD, BSc, MCSP, Complementary Medicine Research Unit, Mail Primary Medical Care, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, United Kingdom; e-mail, pjw1{at}soton.ac.uk.

Current Author Addresses: Drs. White and Lewith: Complementary Medicine Research Unit, Mail Primary Medical Care, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, United Kingdom.

Dr. Prescott: School of Mathematics, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom.

Dr. Conway: School of Health Professions, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom.

Author Contributions: Conception and design: P. White, G. Lewith, J. Conway.

Analysis and interpretation of the data: P. White, G. Lewith, P. Prescott, J. Conway.

Drafting of the article: P. White, G. Lewith, P. Prescott.

Critical revision of the article for important intellectual content: P. White, G. Lewith.

Final approval of the article: P. White, G. Lewith.

Statistical expertise: G. Lewith, P. Prescott.

Obtaining of funding: G. Lewith.

Administrative, technical, or logistic support: G. Lewith, J. Conway.

Collection and assembly of data: P. Prescott.

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