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Authors of a large systematic review carried out in China have concluded that sham acupuncture may not be appropriate as a control intervention for assessing the effectiveness of acupuncture. Sixty-one randomised controlled trials (involving 20,389 total participants) that included acupuncture either as the sole or an adjunctive treatment for chronic pain, were analysed and ranked based on STRICTA and Cochrane standards. The authors found good evidence that receiving acupuncture is better than not receiving treatment or being placed on a waiting list in terms of pain control, and reasonable evidence that it results in better outcomes than conventional or usual care. The observed benefits of real acupuncture were limited when compared with placebo treatments that involve the expectation of needling (either real or sham), including deep needling at non-acupoints, superficial needling and non-penetrating needling.

Classic Chinese Acupuncture versus Different Types of Control Groups for the Treatment of Chronic Pain: Review of Randomized Controlled Trials (2000-2018). Evid Based Complement Alternat Med. 2019 Dec 4;2019:6283912.