Acupuncture in Sham Device Controlled Trials May Not Be as Effective as Acupuncture in the Real World: A Preliminary Network Meta-analysis

摘要

Background and objective: Randomized controlled acupuncture trials performed to control for the placebo effect have mostly used two types of sham techniques: techniques with minimal insertion of acupuncture needles with no additional stimulation (shallow needling control) and techniques with sham acupuncture devices that do not penetrate the skin (sham device control). In this study, we analyzed the estimated comparative effect of these two verum acupuncture modalities in menopausal hot flush studies that used two types of sham control treatments. Methods: We conducted a network meta-analysis that included randomized acupuncture controlled trials for hot flashes. Electronic databases, including Medline, EMBASE, Cochrane Library and AMED, were searched until March 2017. Data were extracted using the predefined data extraction tool by two independent reviewers. The risk of bias was assessed using Cochrane Risk of Bias Tool for Randomized Controlled Trials. A five-node network meta-analysis was conducted based on the frequentist framework. Results: In this review, eight studies were included. From the network meta-analysis, we found that verum acupuncture in the shallow needling controlled trials is more effective than verum acupuncture in the sham device controlled trials (SMD 7.27, 95% CI [9.11, 5.43]). Significant heterogeneity and inconsistency were not observed among the included studies or the comparisons. Conclusions: From this preliminary analysis, we found that different verum acupunctures may have different effect sizes that can result in different effects on the severity of menopausal hot flashes in patients.