Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain

Dominik Irnich, research fellow, ^a Nicolas Behrens, research fellow, ^b Holger Molzen, research fellow, ^d Achim König, consultant orthopaedic surgeon, ^d Jochen Gleditsch, consultant pain therapy, ^a Martin Krauss, statistician, ^c Malte Natalis, consultant orthopaedic surgeon, ^d Edward Senn, professor of physical medicine and rehabilitation, ^e Antje Beyer, head of pain unit, ^a Peter Schöps, head of pain unit. ^b

^a Department of Anaesthesiology, Ludwig-Maximilians University, 81377 Munich, Germany, ^b Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians University, ^c Biometric Center for Therapeutic Studies, 80336 Munich, Germany, ^d Department of Orthopaedics, University of Würzburg, 97074 Würzburg, Germany, ^e Reha Klinik Bellikon, 5454 Bellikon, Switzerland

Correspondence to: D Irnich [log in to unmask]

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.

Edward E. Rylander, M.D.

Diplomat American Board of Family Practice.

Diplomat American Board of Palliative Medicine.