针刺临床研究中的安慰剂效应

Placebo control is designed to evaluate the specific effect of one intervention.Relevant studies showed that acupuncture has a considerable placebo effect affected by many factors.In this paper,the relevant articles of acupuncture placebo studies all around the world were reviewed comprehensively to clarify the definition of acupuncture placebo effect and its psychological mechanism.The factors of acupuncture placebo effect were discussed in view of three aspects,i.e.types of sham acupuncture as control,patient-doctor interaction and outcome types.Eventually,the issues encountered in current studies of acupuncture placebo effect were described,e.g.lack of relevant studies especially with systematic and in-depth approaches in this field,inappropriate classification of specific non-needling effect relevant with acupuncture theory,and inaccurate assessment of acupuncture placebo effect due to the dificulty of sham-acupuncture design.In order to drive the future research direction of acupuncture placebo effect,it is suggested that more attention should be paid on the topic,including but not limited to correct recognition of the holistic effect of acupuncture,the appropriate design of sham acupuncture and in-depth research of mechanism of acupuncture placebo effect and its contributing factors.

Placebo response of sham acupuncture in patients with primary dysmenorrhea:A meta-analysis

Background The placebo response of sham acupuncture in patients with primary dysmenorrhea is a substantial factor associated with analgesia.However,the magnitude of the placebo response is unclear.Objective This meta-analysis assessed the effects of sham acupuncture in patients with primary dysmenorrhea and the factors contributing to these effects.Search strategy PubMed,Embase,Web of Science,and Cochrane CENTRAL databases were searched from inception up to August 20,2022.Inclusion criteria Randomized controlled trials(RCTs)using sham acupuncture as a control for female patients of reproductive age with primary dysmenorrhea were included.Data extraction and analysis Pain intensity,retrospective symptom scale,and health-related quality of life were outcome measures used in these trials.Placebo response was defined as the change in the outcome of interest from baseline to endpoint.We used standardized mean difference(SMD)to estimate the effect size of the placebo response.Results Thirteen RCTs were included.The pooled placebo response size for pain intensity was the largest(SMD=−0.99;95%confidence interval[CI],−1.31 to−0.68),followed by the retrospective symptom scale(Total frequency rating score:SMD=−0.20;95%CI,−0.80 to−0.39.Average severity score:SMD=−0.35;95%CI,−0.90 to−0.20)and physical component of SF-36(SMD=0.27;95%CI,−0.17 to 0.72).Studies using blunt-tip needles,single-center trials,studies with a low risk of bias,studies in which patients had a longer disease course,studies in which clinicians had<5 years of experience,and trials conducted outside Asia were more likely to have a lower placebo response.Conclusion Strong placebo response and some relative factors were found in patients with primary dysmenorrhea.PROSPERO registration number:CRD42022304215.

Acupuncture versus oral medicine for women with diminished ovarian reserve:A cohort study

Objective:To observe whether electro-acupuncture(EA) is better in improving hormone levels among women with diminished ovarian reserve(DOR) compared with oral medicine [Chinese herbs with or without hormone replacement therapy(HRT)] that is often used in gynecology clinics in China.Methods:Eligible participants entered the EA group or medication group according to their preferences.Participants in the EA group received EA treatment,and participants the medication group received herbal decoction alone or combined with HRT.Reproductive hormone levels of the participants were tested before and during treatment in both groups.Results:A total of 80 women with DOR were screened and 57 cases were included(29 in the EA group and 28 in the medication group) in the final analysis.The differences in the change from baseline between the EA and medication group in mean follicle-stimulating hormone(FSH) levels were-6.6(95% Cl,-17.03 to 3.72),(P=0.848) and-7.09(95% CI,-15.86 to 1.66),(P=0.539) at weeks 12 and 24,respectively.The proportion of women with regular FSH levels in the EA and medication group was 51.3% vs 32.1% at week 12(P=0.134) and 51.3% vs 25.0% at week 24(P=0.038).Conclusion:EA might influence regulating the levels of FSH,luteinizing hormone(LH),estrogen and the FSH/LH ratio,and no difference was found between the effects of EA and oral medicine in changes of reproductive hormone levels.