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Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck painCommentary: Controls for acupuncture—can we finally see the light?
Open accessAbstract
Objectives: To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain. Design: Prospective, randomised, placebo controlled trial. Setting: Three outpatient departments in Germany. Participants: 177 patients aged 18–85 years with chronic neck pain. Interventions: Patients were randomly allocated to five treatments over three weeks with acupuncture (56), massage (60), or “sham” laser acupuncture (61). Main outcome measures: Primary outcome measure: maximum pain related to motion (visual analogue scale) irrespective of direction of movement one week after treatment. Secondary outcome measures: range of motion (3D ultrasound real time motion analyser), pain related to movement in six directions (visual analogue scale), pressure pain threshold (pressure algometer), changes of spontaneous pain, motion related pain, global complaints (seven point scale), and quality of life (SF-36). Assessments were performed before, during, and one week and three months after treatment. Patients' beliefs in treatment were assessed. Results: One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage (difference 24.22 (95% confidence interval 16.5 to 31.9), P=0.0052) but not compared with sham laser (17.28 (10.0 to 24.6), P=0.327). Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years (n=75) and in patients with myofascial pain syndrome (n=129). The acupuncture group had the best results in most secondary outcome measures. There were no differences in patients' beliefs in treatment. Conclusions: Acupuncture is an effective short term treatment for patients with chronic neck pain, but there is only limited evidence for long term effects after five treatments. What is already known on this topic: Acupuncture is a widespread complementary treatment Evidence from trials have given conflicting results on its use in the treatment of neck pain because of methodological shortcomings and because effects were compared either with alternative treatments or with different sham procedures imitating acupuncture, but not both What this study adds: Compared with sham laser acupuncture and massage, needle acupuncture has beneficial effects on mobility and pain related to motion in patients with chronic neck pain Acupuncture was clearly more effective than massage, but differences were not always significant compared with sham laser acupuncture Acupuncture was the best treatment for patients with the myofascial syndrome and those who had had pain for longer than five years
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“Although all studies adopted random assignment of patients, eight trials did not use adequate method of allocation concealment [17–20, 23, 25, 30, 31].”
From Efficacy of Massage Therapy on Pain and Dysfunction in Patients with Neck Pain: A Systematic Review and Meta‐Analysis (2014) · cites this paper as [17]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“With regard to pain relief, two RCTs assessed short-term effects of MT compared with acupuncture after 12 weeks of follow-up (n = 111; SMD, −0.10; 95% CI −0.47 to 0.28, in Figure 4) [17]”
From Efficacy of Massage Therapy on Pain and Dysfunction in Patients with Neck Pain: A Systematic Review and Meta‐Analysis (2014) · cites this paper as [17]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“One study reported that 21% of the participants experienced low blood pressure following treatment [17].”
From Efficacy of Massage Therapy on Pain and Dysfunction in Patients with Neck Pain: A Systematic Review and Meta‐Analysis (2014) · cites this paper as [17]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The meta-analysis did not show favorable effects of MT on pain reduction (n = 308; SMD, 0.13; 95% CI, −0.38 to 0.63; P = 0.63; heterogeneity: χ 2 = 12.70, P = 0.005, I 2 = 76%; Figure 2(a)).”
From Massage Therapy for Neck and Shoulder Pain: A Systematic Review and Meta-Analysis (2013) · cites this paper as [8]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The meta-analysis did not show significant effects of MT on pain in followup (n = 131; SMD, −0.09; 95% CI, −0.43 to 0.26; P = 0.62; heterogeneity: χ 2 = 0.14, P = 0.71, I 2 = 0%; Figure 3).”
From Massage Therapy for Neck and Shoulder Pain: A Systematic Review and Meta-Analysis (2013) · cites this paper as [8]
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“Thirteen of them were included in the meta-analysis [17–21, 23, 25–31].”
From Efficacy of Massage Therapy on Pain and Dysfunction in Patients with Neck Pain: A Systematic Review and Meta‐Analysis (2014) · cites this paper as [17]
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“Another possible source of bias is that the more negative trials of MT for neck and shoulder pain may be never published in the peer-reviewed literature, so there were only two negative studies in our review [8, 15].”
From Massage Therapy for Neck and Shoulder Pain: A Systematic Review and Meta-Analysis (2013) · cites this paper as [8]
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“In the other two studies, MT did not show better immediate effects than acupuncture (or sham laser acupuncture) [8] or activator trigger point therapy [15].”
From Massage Therapy for Neck and Shoulder Pain: A Systematic Review and Meta-Analysis (2013) · cites this paper as [8]
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“Twelve high-quality studies were included.”
From Massage Therapy for Neck and Shoulder Pain: A Systematic Review and Meta-Analysis (2013) · cites this paper as [8]
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Metadata
- Authors
- Irnich, D., Cummings, M., Behrens, N., Molzen, H., König, A., Gleditsch, J., Krauss, M., Natalis, M., Senn, E., Beyer, A., & Schöps, P.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- Corresponding author
- Irnich, Dominik
- ORCID
- Cummings, Mike
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2001-06-30
- Volume
- 322
- Issue
- 7302
- Pages
- 1574
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC33515
- OpenAlex
- W1520657679
- Cited by
- 313
- References
- 39
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 8 · 2023: 7 · 2022: 5 · 2021: 5 · 2020: 11 · 2019: 12 · 2018: 6 · 2017: 10 · 2016: 12 · 2015: 10 · 2014: 14 · 2013: 19 · 2012: 17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Bundesministerium für Bildung und Forschung
- Bundesministerium für Forschung und Technologie
- Julius-Maximilians-Universität Würzburg
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Acupuncture Treatment Research Studies
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Myofascial pain diagnosis and treatment
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- acupuncture, chronic neck pain, massage, myofascial pain syndrome, range of motion, pressure pain threshold, treatment beliefs, complementary therapy, quality of life, long-term treatment outcomes, patient satisfaction
- MeSH terms
- Adult, Aged, Aged, 80 and over, Chronic Disease, Facial Neuralgia, Female, Humans, Male, Massage, Middle Aged, Prospective Studies, Acupuncture Analgesia, Confidence Intervals, Chi-Square Distribution, Neck Pain, Laser Therapy
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