Evidence map›Paper›PMID 24705624›Full record

SynthesisPloS one2014

Influence of control group on effect size in trials of acupuncture for chronic pain: a secondary analysis of an individual patient data meta-analysis.

Hugh MacPherson, Emily Vertosick, George Lewith, Klaus Linde, Karen J Sherman, Claudia M Witt, Andrew J Vickers, Acupuncture Trialists' Collaboration

Open access · goldAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
60citing papers in PubMed, 16 pooled it
36.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

60 citing papers in PubMed, 16 syntheses or guidelines pooled it, 125 citations in OpenAlex.

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  8. Acupuncture for symptomatic gastroparesis.The Cochrane database of systematic reviews · 2018
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  10. Effects of non-pharmacological supportive care for hot flushes in breast cancer: a meta-analysis.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2017
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  14. Acupuncture for the prevention of episodic migraine.The Cochrane database of systematic reviews · 2016
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 3 countries.

Hugh MacPhersonDepartment of Health Sciences, University of York, York, United Kingdom.
Emily VertosickMemorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
George LewithFaculty of Medicine, Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom.
Klaus LindeInstitute of General Practice, Technische Universität München, Munich, Germany.
Karen J ShermanGroup Health Research Institute, Seattle, Washington, United States of America.
Claudia M WittCenter for Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany.
Andrew J VickersMemorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
Acupuncture Trialists' Collaboration
Memorial Sloan Kettering Cancer Center · USCharité - Universitätsmedizin Berlin · DEKaiser Permanente Washington Health Research Institute · USTechnical University of Munich · DEUniversity of Southampton · GBUniversity of York · GB

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Nicholas D Socci · 1985 to 2026
$347.4M
Acupuncture Trialists' Collaboration: meta-analysis of chronic pain trialsR01AT006794 · NCCIH · SLOAN-KETTERING INST CAN RESEARCH · PI VICKERS, ANDREW J · 2011 to 2015
$1.6M
Acupuncture Trialists' Collaboration: meta-analysis of chronic pain trialsR21AT004189 · NCCIH · SLOAN-KETTERING INST CAN RESEARCH · PI VICKERS, ANDREW J · 2008 to 2010
$604k
Department of Health RP-PG-0707-10186NCCIH NIH HHS R01 AT006794NCCIH NIH HHS R21 AT004189NCCIH NIH HHS R21 AT004189INCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

backgroundIn a recent individual patient data meta-analysis, acupuncture was found to be superior to both sham and non-sham controls in patients with chronic pain. In this paper we identify variations in types of sham and non-sham controls used and analyze their impact on the effect size of acupuncture.

methodsBased on literature searches of acupuncture trials involving patients with headache and migraine, osteoarthritis, and back, neck and shoulder pain, 29 trials met inclusion criteria, 20 involving sham controls (n = 5,230) and 18 non-sham controls (n = 14,597). For sham controls, we analysed non-needle sham, penetrating sham needles and non-penetrating sham needles. For non-sham controls, we analysed non-specified routine care and protocol-guided care. Using meta-regression we explored impact of choice of control on effect of acupuncture.

findingsAcupuncture was significantly superior to all categories of control group. For trials that used penetrating needles for sham control, acupuncture had smaller effect sizes than for trials with non-penetrating sham or sham control without needles. The difference in effect size was -0.45 (95% C.I. -0.78, -0.12; p = 0.007), or -0.19 (95% C.I. -0.39, 0.01; p = 0.058) after exclusion of outlying studies showing very large effects of acupuncture. In trials with non-sham controls, larger effect sizes associated with acupuncture vs. non-specified routine care than vs. protocol-guided care. Although the difference in effect size was large (0.26), it was not significant with a wide confidence interval (95% C.I. -0.05, 0.57, p = 0.1).

conclusionAcupuncture is significantly superior to control irrespective of the subtype of control. While the choice of control should be driven by the study question, our findings can help inform study design in acupuncture, particularly with respect to sample size. Penetrating needles appear to have important physiologic activity. We recommend that this type of sham be avoided.

Indexed as

Control GroupsEffect Modifier, EpidemiologicAcupuncture TherapyChronic PainHumansNeedlesRegression Analysis

Identifiers

PMID24705624
PMCPMC3976298
OpenAlexW2135791658

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.