A study by 12 researchers at five Chinese institutions, published this month in JAMA Internal Medicine, found that real acupuncture outperforms sham acupuncture in mitigating migraines without aura.
Over the course of 16 weeks, the nearly 250 participants were split into three groups. Some underwent real acupuncture; others were administered fake acupuncture (which pierced parts of the body that aren’t associated with the authentic treatment of the alternative medicine); and others were on a control waiting list. The frequency of migraines, the study found, decreased at a rate of 3.2 (real acupuncture), 2.1 (fake acupuncture), and 1.4 (wait-list).
“Among patients with migraine without aura, true acupuncture may be associated with long-term reduction in migraine recurrence compared with sham acupuncture or assigned to a waiting list,” the authors write.
The study appears to spell good news for patients who suffer from migraines, but Amy Gelfand, an assistant professor of neurology at University of California, San Francisco School of Medicine who wrote an invited commentary for JAMA about the study, cautions against relying on the results. In the commentary, Dr. Gelfand noted that the study “doesn’t convincingly demonstrate acupuncture’s efficacy for migraine prevention,” according to a MedPage article.
In an interview, Dr. Gelfand allowed that acupuncture may be helpful for migraines, but the Chinese study’s design makes it difficult to ascertain whether it helps via activating placebo responses or through a more direct impact.
“That said, acupuncture seems safe, so if patients would like to try it, and if it makes them feel better, they may find that effect valuable regardless of the mechanism of benefit,” she says.
The study design, she says, may have tipped its hat to patients, who could have — for various potential reasons — been able to discern which was true and which was fake acupuncture.
“This is an inherent trial design challenge for this type of treatment, as the fundamental issue in my mind is: How do you blind adequately those people who are providing the acupuncture?” Dr. Gelfand says. “In other words, how do you make it so that they don’t know if they are applying true acupuncture or sham acupuncture, given that they are already experienced acupuncture providers who probably already have an expectation that true acupuncture is better than sham acupuncture?”
One option, she says, would be to use inexperienced acupuncture providers and to tell them to use either treatment A or treatment B, but to avoid telling them if they are administering true or sham acupuncture.
“But then if the study found no difference, some acupuncture specialists might say that it was because the treatments were provided by inexperienced individuals,” she says. “It is a complex problem.”