pain
Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition with limited therapeutic options. Although electroacupuncture has demonstrated potential analgesic effects, high-quality evidence from rigorous randomized clinical trials remains limited.
This multicenter, randomized, sham-controlled clinical trial determined whether electroacupuncture reduces pain severity compared with sham electroacupuncture and evaluated its safety in patients with PHN. It took place at 7 tertiary hospitals in China and enrolled participants from October 2020 to July 2022, with the last follow-up in September 2022. Data analyses were performed from August to December 2025. Participants with PHN aged 45 to 75 years and moderate to severe pain (11-point Numeric Rating Scale [NRS-11] score ≥4) were recruited. Of 1072 patients screened, 624 were excluded. The remaining 448 participants were randomized to electroacupuncture (n = 225) or sham electroacupuncture (n = 223); 383 participants (85.49%) completed the trial. Patients received 20 sessions of electroacupuncture or sham electroacupuncture over 4 weeks, followed by a 4-week posttreatment follow-up. The primary outcome was the change in the NRS-11 scores from baseline to week 4, with responders defined as participants achieving a 30% or more reduction in NRS-11 scores.
Of 448 participants, the mean (SD) age was 63.19 (9.26) years, 233 (52.01%) were male, and 215 were female (47.99%). At week 4, the electroacupuncture group had a greater decrease in the NRS-11 scores (−1.52) than the sham electroacupuncture group (−0.99) with an adjusted mean difference of −0.53 (95% CI, −0.61 to −0.43; P < .001), and the responder rate was significantly higher in the electroacupuncture group (46.68%) than in the sham electroacupuncture group (24.28%) (adjusted risk difference, 22.40%; 95% CI, 13.02%-31.79%; P < .001). These treatment benefits persisted through a 1-month follow-up; no clinically significant adverse events were observed.
The authors concluded that, among patients with PHN in this study, electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes. These benefits suggest that electroacupuncture may be a useful nonpharmacological option for integrated management of PHN.
Here are a few points of concern and criticism:
- The authors state that the study was funded by the Evidence-Based Capacity Building Project for Traditional Chinese Medicine from National Administration of Traditional Chinese Medicine, the National Natural Science Foundation of China, the Natural Science Foundation of Jiangsu Province, Young Elite Scientists Sponsorship Program by China Association of Chinese Medicine, Youth Talent Project of Jiangsu Province Administration of Traditional Chinese Medicine, and Nanjing University of Chinese Medicine Double-Hundred Talent Program. Yet, they insist they had no conflict of interest.
- Acupuncture studies from China are as good as never negative. As frequently noted on this blog, the vast majority of Chinese studies seem to rely on falsified data.
- The authors imply that their study was patient-blind; yet there is no way that this is true: 1) The verum was administered to elicit ‘de-qi’, while the sham was not. 2) The electrical current in the verum group induced mild muscle twitching, while the sham group had no such experience. This means the verum patients knew the were receiving verum and thus were expecting an effective therapy. By contrast, the control group would have comprehended that they were given a placebo and were disappointed. These effects inevitably contribute to the outcome. In fact, I would agruge that they suffice in bringing them about without any contribution of a specific acupuncture effect. At the very minimum, the authors should have discussed these issues fully and critically.
- The acupuncturists of this study were also not blind. It is possible – I would argue, even likely – that they influenced patients to report or experience more positive results. Again, I would suggest that such effects suffice to generate a false-positive outcome.
- Even if there was a true effect of the verum beyond placebo, the question is, was it caused by acupuncture or the electrical current? There is a sizable body of evidence suggestion that electrotherapy might be effective for PHN!
In conclusion, the assertion that “electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes” is uncritical, promotional and unjustified. I am once again dismayed that a reputable journal publishes such overt rubbish.
Chronic non-specific low back pain (CNSLBP) is a major cause of disability worldwide. Conventional pharmacological treatments offer limited benefits and carry potential risks, prompting interest in alternative approaches, including homeopathy. The objective of this study was to evaluate the short-term efficacy and safety of a standardised homeopathic biotherapic (Lumbar Vertebra, LM2 potency) for CNSLBP.
A randomised, double-blind, crossover, placebo-controlled clinical trial was conducted with 120 participants diagnosed with CNSLBP. Participants received both the biotherapic and placebo in two treatment phases separated by a washout period. The primary outcome was pain intensity (numeric rating scale); secondary outcomes included functional disability (Oswestry Disability Index), adverse events and use of pain medications. Data were analysed using random effects generalised linear models.
Both the biotherapic and placebo interventions led to significant within-group reductions in pain and disability (p = 0.001 and p < 0.001 respectively). However, no statistically significant differences were observed between the two interventions for either outcome (pain: p = 0.435; disability: p = 0.840). The magnitude of change in pain intensity did not reach the pre-defined minimal clinically important difference (MCID), and mean pain scores at the study endpoint remained above the inclusion threshold. Adverse events were mild and comparable across groups.
The authors concluded that no specific effect of the Lumbar Vertebra LM2 biotherapic was demonstrated. Improvements are likely due to non-specific effects such as the therapeutic environment, patient expectations and placebo response. Clinicians should consider the substantial role of non-specific responses in CNSLBP and avoid medications with unfavourable risk–benefit profiles.
One the one hand, the authors from the Department of Medicine, Federal University of São Carlos, São Carlos, Sao Paulo, the School Health Unit, Federal University of São Carlos, São Carlos, Sao Paulo, and the epartment of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil should be congratulated for publishing a squarely negative result in the journal ‘Homeopathy’ that is known for publishing even the most implausible positive findings.
On the other hand, one might criticise them: why on earth did they ever conceive the hypothesis that homeopathy in general or “Lumbar Vertebra LM2 biotherapic” in particular might be effective for CNSLBP (the study did not receive any funding or financial support, apart from the study medications donated by HN-Cristiano Pharmacy (Santana, São Paulo, Brazil), which had no role in the study design, data collection, analysis, interpretation or discussion of the results)? I have never met a homeopaths who would make such a claim, and one could easily argue that such a trial is an unethical waste of resources.
This study was conducted to determine the effect of Reiki performed on children with leukemia between the ages of 5-7 years on pain, vital signs, oxygen saturation, and quality of life. It was a double-blind, pre-test-post-test randomized controlled experimental study. The research sample consisted of 66 children with leukemia aged 5-7 years who were hospitalized in pediatric oncology wards of a university hospital between December 2020 and November 2021. The balanced block randomization method was used for randomization. The data were collected using Information Form, Wong-Baker FACES Pain Scale (W-BPS), Vital Signs Follow-up Form, The Pediatric Quality of Life Inventory (PedsQL) 3.0 Cancer Module. Reiki was performed to the Reiki group for 20-30 min once per day, for 3 consecutive days and pseudo-Reiki was applied to the pseudo-Reiki group by an independent nurse during the same application period.
There was no statistically significant difference in vital signs (heart rate, respiratory rate, body temperature) and SpO2 values among the groups (p > 0.05). However, both children’s and mothers’ evaluations on days 1, 2, and 3 after the intervention showed that pain scores in the Reiki group were significantly lower than in the pseudo-Reiki and control groups (p < 0.001), and quality of life was significantly higher (child:p < 0.001; mother:p < 0.01) compared to the pseudo-Reiki and control groups.
The authors concluded that Reiki did not affect the vital signs of the children but was effective in reducing pain and increasing the quality of life compared with the pseudo Reiki and control groups. It is recommended that Reiki therapy be used in addition to medical treatment to reduce pain and improve quality of life in children with leukemia aged 5-7 years.
The whole point of having a control group receiving pseudo-Reiki is to control for placebo effects. For this purpose, it is necessary to fool the patients well and make sure that they are unable to tell Reiki from pseudo-Reiki. I would guess – I have no aceess to the full paper – that this was not the case in this study. If I am correct, the positive outcome is likely to be due to expectation of a positive healing effect and unrelated to any specific effect of Reiki.
In any case, it is irresponsible nonsense to recommend Reiki – or any therapy – on the basis of just one positive study. For that one would need several independent confirmations with high quality studies that firmly establish a cause effect relationship. The current study does not fall into that category, and I am not aware of a single trial that does.
When a top journal like PNAS (Procedings of the Nationsl Academy of Science) publishes an article entitled “What’s the science behind acupuncture?“, I must take notice. Here is my take on the (sadly disappointing) effort:
My very short summary of the paper (I do encourange my readers to read it in full)
The article starts from the premise that acupuncture is proven to work, an assumption that – as we will see in a minute – is not based on sound evidence. It describes the evolution of acupuncture from a traditional practice rooted in ancient concepts like “qi” and “meridians” to a modern medical treatment increasingly validated by science. It argues that practitioners like Min Chen are today able to provide evidence-based explanations for their work. While early clinical trials were plagued by the “sham” acupuncture paradox, the text argues that more recent, rigorous studies and technological projects are bridging the gap between Eastern philosophy and evidence-based medicine, suggesting that acupuncture’s effects are physiological realities rather than mere placebo.
My concerns of the paper
The article attempts to bridge the gap between Traditional Chinese Medicine (TCM) and conventional medicine suggesting that several anatomical discoveries “correspond” to ancient meridians. This, however, is a post hoc ergo propter hoc fallacy. Finding a morphological structure (e.g. fascia) and claiming it represents the meridian system ignores that meridians were conceptualized as functional energetic conduits, not anatomical vessels. Citing an 80% overlap between acupoints and connective tissue planes lacks specificity. Given the ubiquity of connective tissue in the human frame, any randomized point on the body would likely “overlap” with a tissue plane, rendering the “meridian” map a possible exercise in pattern-seeking rather than anatomical discovery.
The paper acknowledges the “most puzzling” finding that sham acupuncture often produces results comparable to “true” acupuncture. This, it would seem to me, invalidates the foundational TCM theory of specific “acupoints” and “meridians” is invalidated. Yet, the article suggests that sham acupuncture is “not a true placebo” because it also triggers biological pathways. If needling anywhere produces an effect, acupuncture is merely a generalized, non-specific neuro-modulatory stimulus.
The article quotes Chen on “harmonizing organ functions” and “regulating qi” as well as researchers referring to “fibroblast activation” and “vagus nerve stimulation”. The author seems to consider both to be true; yet they seem mutually exclusive. Translating metaphysical concepts into physical phenomena does not “validate” the original theory but merely replaces it.
The article employs the opioid crisis to justify the rise of acupuncture. Yes, the need for non-pharmacological pain management is urgent, but clinical necessity does not equate to scientific validity. The text quotes the “lasting benefits” observed in some meta-analyses without discussing the often fatal flaws in these papers. Furthermore, it fails to cite the substantial body of evidence suggesting that acupuncture is not effective. Moreover, it hardly mentions the small effect sizes and hence limited clinical usefulness found in the positive studies.
The final section of the paper essentially rebrands acupuncture as “bioelectronic medicine”. If its mechanism of action is purely the electrical stimulation of the vagus nerve or the release of endogenous opioids, then the TCM concepts are all but superfluous. If a cheap and wearable TENS unit is more or less equivalent, the “meridian” and “qi” myths are obsolete.
In summary, the paper reads, I fear, only marginally better than a Chinese government promotional text – most disappointing for an article published in a journal of high standing. It attempts to preserve the cultural prestige of TCM while stripping it of its internal logic in order to make it compatible with science. For acupuncture to gain a true “scientific footing”, research must, in my view, move beyond finding “tantalizing” correlations. It should address fundamental problems, e.g.:
- As long as we have no convincing proof that acupuncture works beyond placebo, discussions about its mechanisms are futile.
- If qi, acupoints and meridians are illusions and irrelevant for the clinical outcome, then the science is not validating acupuncture but merely re-discovering a well-known non-specific form of peripheral nerve stimulation.
White phosphorus is a wax-like chemical substance that ignites spontaneously when exposed to oxygen. It burns at extremely high temperatures and continues to burn as long as it is exposed to air. Using it as an incendiary weapon specifically targeted at civilian populations is illegal – yet, this is exactly what Israel has recently been accused of doing.
International observers like Human Rights Watch and the UN have documented airburst WP munitions exploding directly over residential homes in towns like Yohmor, Lebanon, causing human injuries and fires in civilian cars and buildings. While the Israeli military maintains that these shells are used legally to create smokescreens, observers argue that deploying them in populated areas is inherently “indiscriminate” and illegal under international law, especially since non-incendiary alternatives exist.
WP is distinct from most other conventional weapons because it causes harm through three simultaneous channels: thermal (heat), chemical (corrosive), and systemic (poisoning):
- The most immediate harm is the thermal burn. White phosphorus ignites at around 30°C and burns at up to 800°C. Because WP is lipid-soluble, it melts through skin and fat layers and “eats” its way down until it hits bone. If a fragment of WP is embedded in a wound, it will stop burning once it is completely cut off from oxygen. If a surgeon then opens the wound to remove it, the phosphorus re-ignites upon contact with the air, potentially injuring medical staff.
- Even a small burn covering less than 10% of the body can be fatal because the body absorbs WP into the bloodstream. This causes a massive shift in electrolytes, specifically causing hypocalcemia. This can lead to fatal heart arrhythmias or cardiac arrest. In addition, WP is a potent toxin that causes “fatty degeneration” of the liver and renal failure. Victims may thus survive the initial burn only to die days later from internal organ failure.
- When WP burns, it produces a thick, white smoke of phosphorus pentoxide. Inhaling this smoke reacts with the moisture in the lungs to form phosphoric acid. This causes severe chemical burns to the throat and lungs, leading to pulmonary edema and eventually suffocation.
- WP particles can remain dormant in the soil. If a farmer plows the field and unearths a fragment months later, it can reignite and start a fire or cause injury.
In addition WP also destroys the planet. While the phosphorus pentoxide smoke dissipates, the elemental phosphorus in water or soil is toxic to aquatic life and birds. In waters with low oxygen, WP can persist for years.
Other than Israel, the following countries have recently used WP in these conflicts:
- Iraq (2004): During the Second Battle of Fallujah, U.S. forces used WP to “flush out” insurgents from hidden positions so they could be targeted with high explosives—a tactic known as “shake and bake.” After initial denials, the Pentagon confirmed its use as an incendiary weapon against combatants.
- Vietnam & Korea: The U.S. used WP extensively in both conflicts for smoke screens, marking targets, and as an anti-personnel weapon.
- Syria (2017): During the battle to retake Raqqa from ISIS, the U.S.-led coalition was accused by Human Rights Watch of using air-dropped WP, which raised concerns about the risk to civilians in the densely populated city.
- Ukraine (2022–2026): Russia has been repeatedly accused by Ukrainian officials and international observers of using WP or similar incendiary munitions (like thermite) in cities such as Mariupol, Bakhmut, and more recently in Donetsk (2026). Russia typically maintains that its munitions are for illumination or smoke, or denies their use entirely.
- Chechnya: Russian forces used WP during the First and Second Chechen Wars (1994–2000), particularly during the siege of Grozny.
- Syria: Working alongside the Syrian government, Russian forces were frequently accused of using incendiary weapons, including phosphorus, on rebel-held areas.
- Nagorno-Karabakh (2020): During the 44-day war, Armenia accused Azerbaijan of using white phosphorus to burn down forests where Armenian soldiers were allegedly sheltering. Azerbaijan denied this and countered with its own accusations that Armenia had used the substance in 2016 and 2020.
- Yemen (2016): The Saudi-led coalition was reported to have used U.S.-supplied white phosphorus in its campaign against Houthi rebels. While the coalition claimed it was for marking and smoke screens, images emerged suggesting it was being used near civilian areas.
In recent decades, acupuncture has attracted extensive research spanning an astonishingly wide array of medical conditions, from chronic pain and neurological disorders to infectious diseases and psychiatric ailments. However, the proposed mechanisms of action—ranging from peripheral sensory stimulation to central nervous system modulation—fail to provide a coherent, biologically plausible explanation for efficacy across this disparate spectrum (Zhao et al., 2022; WHO, 2003).
The aim of this post is to examine the breadth of published acupuncture trials, delineate the leading scientific hypotheses for its mode of action, and outline the profound implausibility of these mechanisms universally applying to such varied pathologies, ultimately framing acupuncture as non-specific rather than a specific therapeutic modality (Meissner et al., 2019; Ernst, 2018).
Acupuncture has been subjected to thousands of randomized clinical trials (RCTs) and systematic reviews across virtually every medical specialty. A comprehensive 2022 evidence map published in BMJ Open synthesized 120 systematic reviews, encompassing 1,402 individual RCTs and addressing 77 distinct conditions within 12 broad therapeutic categories (Zhao et al., 2022). These categories include neurological disorders, musculoskeletal conditions, cardiovascular diseases, and beyond, reflecting a research enthusiasm that transcends conventional biomedical boundaries.
Neurological applications dominate, with trials targeting stroke sequelae such as hemiplegia and aphasia, vascular dementia symptoms, migraines, tension headaches, and facial nerve palsies like Bell’s palsy (Li et al., 2022; Zhao et al., 2022; WHO, 2003). Musculoskeletal trials are equally prolific, examining low back pain, knee osteoarthritis, fibromyalgia, tennis elbow (lateral epicondylitis), sciatica, shoulder periarthritis, rheumatoid arthritis, and even gouty arthritis (Li et al., 2022; Zhao et al., 2022; Choi et al., 2019; Lam et al., 2020; WHO, 2003). Cardiovascular research has probed essential hypertension, primary hypotension, and pain from thromboangiitis obliterans (Shanghai Medical Clinic, 2025; WHO, 2003). Gynecological and obstetric domains feature prominently, including dysmenorrhea, labor induction, breech presentation correction, pregnancy-related nausea and vomiting, and fertility enhancement (e.g., improved clinical pregnancy rates in IVF protocols) (Zhao et al., 2022; Shanghai Medical Clinic, 2025; Smith et al., 2021; Carr, 2022; WHO, 2003).
Acupuncture trials also extend to psychiatric conditions like generalized anxiety disorder (especially in perimenopause), depression, and other mental disturbances (Zhao et al., 2022; Zhang et al., 2025; WHO, 2003); respiratory issues such as allergic rhinitis and hay fever (Li et al., 2022; Shanghai Medical Clinic, 2025; WHO, 2003); gastrointestinal disorders including acute and chronic gastritis, biliary colic, and postoperative nausea/vomiting (Zhao et al., 2022; Shanghai Medical Clinic, 2025; WHO, 2003); urogenital and nephrological problems like renal colic and radiation-induced leucopenia (often in renal contexts) (Shanghai Medical Clinic, 2025; WHO, 2003); infectious diseases such as acute bacillary dysentery, pertussis (whooping cough), and epidemic hemorrhagic fever (WHO, 2003); pediatric applications, albeit more limited, for post-extubation pain relief and whooping cough (ClinicalTrials.gov, 2013; WHO, 2003); and oncology support for cancer-related fatigue and chemotherapy/radiation side effects (Zhao et al., 2022; Shanghai Medical Clinic, 2025). Additional niches include ear-nose-throat conditions (e.g., rhinitis), eye disorders, connective tissue diseases, metabolic/nutritional imbalances, and skin pathologies (Zhao et al., 2022; WHO, 2003).
This extraordinarily wide spectrum, drawn from seminal analyses like the World Health Organization’s (WHO) 2003 review of controlled clinical trials (WHO, 2003) and Cochrane overviews on pain (Choi et al., 2019; Lee et al., 2011), clearly demonstrates that acupuncture is considered by its proponents to be a ‘cure all’. This begs the question whether such an assumption can be reasonable. The effect sizes are typically modest, and true acupuncture is often no different from sham interventions (e.g., superficial needling at non-acupoints), suggesting limited specific efficacy (Lee et al., 2011).
The scientific literature proposes a constellation of mechanisms to explain how acupuncture might work, integrating peripheral, spinal, supraspinal, and systemic processes. These are often conceptualized through the “Neural Acupuncture Unit” (NAU) model, which posits low-threshold mechanosensitive afferents (Aδ and C fibers) at acupoints converging with brain networks to elicit bidirectional signaling (Zhang et al., 2012).
- Peripheral and Local Mechanisms. Needle manipulation is claimed to induce immediate tissue responses: adenosine triphosphate (ATP) breakdown to adenosine activates A1 receptors, dampening nociceptor firing (Kelly & Suckley, 2016); axonal reflexes release neuropeptides like substance P and calcitonin gene-related peptide (CGRP), modulating local inflammation; and stromal cells exhibit cytoskeleton remodeling, with collagen fibers “wrapping” around needles to propagate mechanical signals (Kelly & Suckley, 2016; Zhang et al., 2012; Li et al., 2025). The characteristic deqi sensation (aching, soreness) correlates with these events, potentially amplifying sensory input (Staud & Price, 2014).
- Spinal Cord Level. Ascending afferents are said to activate the gate control system, presynaptic inhibition, and diffuse noxious inhibitory controls (DNIC), releasing endogenous opioids (β-endorphin, enkephalins, dynorphins), serotonin, norepinephrine, and acetylcholine to suppress nociceptive transmission in the dorsal horn (Kelly & Suckley, 2016; Zhang et al., 2012; Staud & Price, 2014). This underpins analgesia and autonomic regulation, such as reduced sympathetic outflow (Kelly & Suckley, 2016).
- Central Nervous System Modulation. Functional neuroimaging (fMRI, PET) reveals deactivated limbic hyperactivity (amygdala, anterior cingulate), normalized hypothalamic-pituitary-adrenal (HPA) axis activity, and enhanced prefrontal connectivity, particularly in pain, stress, and mood disorders (Kelly & Suckley, 2016; Zhang et al., 2012; Wang et al., 2025). Top-down expectancy modulates descending inhibitory pathways, integrating with reward and mirror neuron systems (Zhang et al., 2012).
- Systemic and Humoral Effects. Acupuncture is also thought to influence immune homeostasis by shifting cytokine profiles (e.g., ↑IL-10, ↓TNF-α, ↓IL-6), autonomic balance (vagal enhancement), and endocrine axes, providing a basis for visceral, metabolic, and inflammatory conditions (Kelly & Suckley, 2016; Li et al., 2025). Recent integrative studies emphasize network pharmacology, where multi-point stimulation perturbs interconnected pathways (Li et al., 2025).
These potential mechanisms have been empirically observed in animal models and/or human imaging studies. They might offer a partial rationale, primarily for analgesia and stress-related syndromes (Kelly & Suckley, 2016; Zhang et al., 2012). The question, however, is whethr they can provide a full explanation for acupuncture’s efficacy in all the above-named conditions.
No synthesis of these mechanisms plausibly accounts for acupuncture’s claimed benefits across unrelated conditions, exposing a core scientific paradox. Musculoskeletal pain might align with local adenosine/opioid effects and spinal gating (Kelly & Suckley, 2016), but how do these explain microbial clearance in bacillary dysentery, hypertensive vascular remodeling, or synaptic imbalances in major depression? (Meissner et al., 2019; Ernst, 2018). Gynecological infertility involves ovarian endocrinology, distant from needle-evoked sensory cues; infectious pertussis implicates Bordetella immunity, not HPA modulation (WHO, 2003; Meissner et al., 2019). This biological implausibility echoes homeopathy critiques: a single intervention cannot verifiably target such heterogeneous pathophysiologies without invoking non-specific forces (Fabrizio et al., 2010).
Trial data reinforce these doubts: meta-analyses consistently show that verum acupuncture is hardly different from sham acupuncture, and sham elicit up to 80% of verum’s effects (Kelly & Suckley, 2016; Meissner et al., 2019; Fabrizio et al., 2010; Kaptchuk et al., 2013). Such considerations implicate patient and therapist expectations, therapeutic ritual, and patient-practitioner alliance as the true mechanism behing the observed outcomes (Meissner et al., 2019; Kaptchuk et al., 2013). Neuroimaging effects often mirror expectancy manipulations in non-needling studies, suggesting top-down confounds (Fabrizio et al., 2010). Lab phenomena (e.g., adenosine release) occur but yield trivial clinical effects, dwarfed by psychosocial amplification (Fabrizio et al., 2010).
Acupuncture’s elaborate ritual maximizes contextual healing, outperforming inert pills but lacking disease-modifying specificity (Meissner et al., 2019; Ernst, 2018). Paradoxes abound—positive preclinical signals evaporate in blinded RCTs; cultural bias inflates Asian trial positives; poor sham penetration and blinding failures perpetuate illusions (Fabrizio et al., 2010; Ernst, 2018). For non-pain conditions, evidence thins further, with publication bias and flexible outcome reporting inflating apparent successes (Fabrizio et al., 2010).
Acupuncture carries risks including minor issues like bleeding, needle site pain, vegetative reactions (e.g., dizziness or nausea), and symptom aggravation, alongside rarer serious events such as pneumothorax, infections, or organ injury. Overall, at least one adverse event in 9.31% of patients undergoing a treatment series or 7.57% of treatments, with half of these being mild local reactions. Serious adverse events seem to be uncommon. Reliable prevalence figures do not exist because there is no adequate surveillance system in place (Ernst 2006).
Acupuncture’s trial proliferation signals cultural and patient-driven demand rather than mechanistic or evidential triumph. Its broad therapeutic claims by far overreach evidence (Staud & Price, 2014). Rigorous advancement would require objective biomarkers (e.g., cytokine assays, EEG), dose-response optimization, adaptive sham designs, and large pragmatic trials stratifying contextual from specific effects (Zhang et al., 2012; Fabrizio et al., 2010). Until compelling evidence exists, acupuncture remains a testament to human suggestibility’s power, but not a biomedical panacea.
References
- Carr, D. (2022). Acupuncture as Treatment for Female Infertility. Medical Acupuncture, 34(1), 12-21.
- Choi, D., et al. (2019). Cochrane reviews on acupuncture therapy for pain: a snapshot of the current evidence. Systematic Reviews, 8, 231.
- ClinicalTrials.gov. (2013). Pediatric Laser Acupuncture and Renal Biopsy (NCT01879826).
- Ernst, E. (2006). Acupuncture–a critical analysis. J Intern Med, 259(2):125-37.
- Ernst, E. (2018). Acupuncture Research: The Problem. Pain Medicine, 19(6), 1287-1288.
- Fabrizio, P., et al. (2010). Paradoxes in Acupuncture Research: Strategies for Moving Forward. Explore (NY), 6(4), 231-239.
- Kaptchuk, T. J., et al. (2013). Are All Placebo Effects Equal? Placebo Pills, Sham Acupuncture, or Placebo Needle in Irritable Bowel Syndrome. PLoS ONE, 8(7), e67485.
- Kelly, R., & Suckley, S. (2016). Mechanisms of acupuncture. European Journal of Integrative Medicine, 20, 1-11.
- Lam, M., et al. (2020). Acupuncture and Chronic Musculoskeletal Pain. Medical Acupuncture, 32(6), 357-366.
- Lee, M. S., et al. (2011). Acupuncture for pain: an overview of Cochrane reviews. Chinese Journal of Integrative Medicine, 17(3), 187-189.
- Li, T., et al. (2022). Evidence on acupuncture therapies is underused in clinical practice. Frontiers in Medicine.
- Li, Y., et al. (2025). Integrative research on the mechanisms of acupuncture. Neural Regeneration Research.
- Meissner, K., et al. (2019). Acupuncture for the Treatment of Pain – A Mega-Placebo? Frontiers in Neuroscience, 13, 1119.
- Shanghai Medical Clinic. (2025). WHO Approved Acupuncture List of Conditions.
- Smith, C. A., et al. (2021). An Overview of Systematic Reviews of Acupuncture for Respiratory Diseases. Frontiers in Public Health.
- Staud, R., & Price, D. D. (2014). Acupuncture therapy: mechanism of action, efficacy, and safety. International Review of Neurobiology, 111, 171-189.
- Wang, L., et al. (2025). Possible antidepressant mechanism of acupuncture. Frontiers in Neuroscience, 19, 1512073.
- WHO. (2003). Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials.
- Zhang, R., et al. (2012). Neural Acupuncture Unit: A New Concept for Interpreting Effects and Mechanisms of Acupuncture. Evidence-Based Complementary and Alternative Medicine, 2012, 429412.
- Zhang, Y., et al. (2025). Patient-reported outcome tools of acupuncture clinical trials. Journal of Pain Research.
- Zhao, C., et al. (2022). Evidence mapping and overview of systematic reviews of the effects of acupuncture therapies. BMJ Open, 12(6), e056803.
The aim of this study was to determine the effectiveness of spinal manipulation and clinician-supported biopsychosocial self-management vs medical care for adults with increased risk of chronic disabling LBP.
This 2 × 2 factorial randomized clinical trial enrolled participants in 3 research clinics at the Universities of Minnesota and Pittsburgh from November 2018 to May 2023; final follow-up was in June 2024. Adults with acute or subacute LBP at moderate to high risk of chronicity based on the STarT Back tool were randomized to 1 of 4 groups, with interventions lasting up to 8 weeks. Statistical analysis was conducted from November 2024 to June 2025.
These interventions were:
- Spinal manipulation therapy (n = 201),
- supported self-management (n = 305),
- combined supported self-management with spinal manipulation (n = 193),
- guideline-based medical care (n = 301).
Physical therapists and chiropractors provided spinal manipulation and supported self-management.
The 2 primary outcomes averaged over a follow-up of 1 year were monthly low back disability (Roland-Morris Disability Questionnaire) and weekly pain intensity (numerical rating scale). Secondary analysis examined the proportion of participants achieving a 50% or higher reduction in the primary outcome measures.
Among the 1000 participants randomized (mean [SD] age, 47 [16] years; 58% female), 93% completed the trial. The omnibus test for differences across the 4 treatment groups was statistically significant for disability (P = .001; supported self-management, 4.7; spinal manipulation, 5.5; combined supported self-management with spinal manipulation, 4.8; medical care, 5.9) but not pain intensity (P = .16; supported self-management, 2.8; spinal manipulation, 3.0; combined supported self-management with spinal manipulation, 2.8; medical care, 3.0). Averaged over 12 months, LBP disability was significantly lower compared with medical care for supported self-management (mean difference, −1.2 [95% CI, −1.9 to −0.5]) and supported self-management with spinal manipulation (mean difference, −1.1 [95% CI, −1.9 to −0.3]) but not spinal manipulation alone (mean difference, −0.4 [95% CI, −1.2 to 0.4]). Group differences in pain intensity were not statistically significant; point estimates ranged from −0.2 to 0. Both supported self-management groups had higher proportions of patients achieving a 50% or greater reduction in disability (supported self-management, 67%; spinal manipulation, 54%; combined supported self-management with spinal manipulation, 65%; medical care, 54%).
The authors concluded that for patients with acute or subacute LBP at increased risk of chronic disabling LBP, clinician-supported biopsychosocial self-management showed statistically significant but small reductions in disability, but not pain, vs medical care over 1-year follow-up, and spinal manipulation alone showed no significant difference for either outcome.
These findings are very bad news for chiropractors (the profession that uses spinal manipulations more than any other): spinal manipulation does not generate effects that are in the least convincing. This is particularly remarkable, since the study was not blinded. It means that, even the undoubtedly powerful placebo effect associated with spinal manipulation did not render the outcome more favourable.
I said it many times, and I will say it again: For LBP, many therapies generate similarly marginally positive effects but no treatment is truly convincing. In this situation, we should choose one that is at least inexpensive and free of severe adverse effects. And that evidently cannot be spinal manipulation!
Calcaneal spur is a common cause of chronic heel pain and functional disability. This double-blind, randomized, placebo-controlled trial aimed to evaluate the efficacy and safety of individualized homeopathic (IH) medicines compared to placebo (PL) in managing this condition.
128 participants with chronic heel pain from calcaneal spur were randomly assigned to receive either IH (n = 64) or an identical PL (n = 64) for 6 months. Both groups received standard advice on general management (such as foot exercises and contrast baths). The primary outcome was the change in pain intensity from baseline measured on a 100-mm visual analog scale (VAS). The secondary outcome was the change in lower extremity function measured by the Lower Extremity Functional Scale (LEFS). Outcomes were assessed at baseline, 3 months, and 6 months. Analysis was done using an intention-to-treat approach with a mixed-effects model for repeated measures.
The analysis revealed a statistically significant group × time interaction for VAS pain scores (F-value = 35.12, p < 0.001). At 6 months, the IH group showed a significantly greater mean reduction in pain compared to the PL group (mean difference: −33.28; 95% confidence interval [CI]: −44.3 to −22.2; p < 0.001). Similarly, a significant group × time interaction was observed for LEFS scores (F-value = 33.87, p < 0.001). At 6 months, the IH group had a greater improvement in function (mean difference: 13.78; 95% CI: 9.1–18.4; p < 0.001). Both results were clinically significant. No serious adverse events were reported.
The authors concluded that individualized homeopathy resulted in statistically and clinically significant improvements in pain and function for patients with calcaneal spur compared to PL. These findings suggest that homeopathy may be a viable treatment option for this condition.
This study seems well-designed and is clearly documented. I have read it thoroughly and did not find major flaws. Why, then do I have doubts?
- I have never heard of a homeopathy advocating homeopathy for calcaneal spur.
- I don’t see why homeopathy could alleviate pain.
- The paper reads a little bit as being “too good to be true”.
- The study was conducted at the Calcutta Homoeopathic Medical College & Hospital, West Bengal, (India’s retraction rate has recently climbed to third place worldwide (5,412 total), rate 2.0002 per 1,000).
In any case, before we can accept homeopathy as a treatment of pain caused by calcaneal spur, we need an independent confirmation, preferably not from ardent supporters of homeopathy.
This study compared the analgesic efficacy of acupressure and magnetic therapy (AMT) versus diclofenac sodium (DFS) in acute renal colic. A total of 138 patients with acute renal colic (visual analog scale [VAS] score ≥ 7) were randomized to AMT or DFS treatment. Primary endpoints included changes in VAS scores at baseline, 1-, 10-, 30-, and 120-min post-intervention, along with analgesic duration. Multiple linear regression evaluated the influence of treatment modality, gender, white blood cell (WBC) count, and other covariates on VAS scores at 10 min. Interaction effect analysis was additionally used to assess how these factors modified treatment efficacy.
The AMT group demonstrated rapid onset, achieving an 86 % VAS reduction at 1-min post-intervention (vs. baseline, P < 0.001), though pain rebound occurred after 30 min. The DFS group exhibited slower onset but significantly prolonged analgesic duration compared to AMT (23.6 ± 2.2 h vs. 2.4 ± 1.0 h, P < 0.001). Multiple linear regression revealed that AMT had the best analgesic effect (B = -6.22, P < 0.001). Male gender (B = 0.78, P = 0.026) and lower baseline WBC counts (B = -0.16, P = 0.026) were associated with higher VAS scores. Interaction analysis indicated enhanced AMT efficacy in male patients and those with lower WBC counts.
The authors concluded that AMT and DFS exhibit complementary “rapid-sustained” analgesic profiles in renal colic management, with gender and WBC levels significantly modulating treatment efficacy. A stratified analgesia protocol based on these factors may optimize patient outcomes.
Apart from the fact that, as an equivalence trial, the study is hopelessly underpowered and its results therefore less than reliable, I have a further reason for not trusting its findings.
A renal colic is an acute and severe loin pain caused by a urinary stone moving from the kidney downwards into the ureter. The pain is often resistant to DFS or other conventional pain-killers and might require opioids. The pain usually peaks sharply, lasts for 20 to 60 minutes, and then subsides into a dull ache before the next “wave” begins. These waves are caused by the ureter’s peristalsis—the tube’s rhythmic muscular contractions—as it tries to squeeze the stone toward the bladder.
So, all I need to do to fake the effectivenesss of a so-called alternative medicine (SCAM) like AMT is to start treating patients when a wave is subsiding. This can easily appear as though AMT had a remarkable effect of 86%. Subsequently, the pain will recur. And this is probably what happened in this study! What I am trying to convey is that I am not convinced that AMT did much at all.
Moreover, I find it daft to conduct a trial where two SCAMs are tested together in one single treatment arm. Even if one would be convinced of the value of AMT – which I am not! – one would need to ask: was it the acupressure or the magnetic therapy that did the trick?
My conclusion is therefore yet again: if you design a silly study, you get a silly result.
Non-specific low back pain is a common condition with substantial socioeconomic implications. Pulsed electromagnetic field (PEMF) therapy is said to generate benefits in pain reduction and improvement of physical function in patients with pain-associated disorders like osteoarthritis. However, studies had heterogeneous settings. The aim of this systematic review was to assess the effects of PEMF on pain and function on patients with non-specific low back pain.
A systematic literature search of randomized controlled trials in PubMed, MEDLINE, EMBASE, Cochrane Library, and PEDro was performed (from inception until 15/5/2023). Outcome measures assessed pain and function.
Nine randomized controlled trials with 420 participants (n = 420) were included. The studies compared PEMF vs. placebo-PEMF, PEMF and conventional physical therapy vs. conventional physical therapy alone, PEMF and conventional physical therapy vs. placebo-PEMF and conventional physical therapy, PEMF vs. high-intensity laser therapy (HILT) vs. conventional physical therapy, and osteopathic manipulative treatment (OMT) and PEMF vs. PEMF alone vs. placebo-PEMF vs. OMT alone. Five of the nine included studies showed statistically significant pain reduction and improvement in physical function in comparison to their control groups (p < 0.05). There was substantial heterogeneity among the groups of the study, with a wide range of duration (10-30 min), treatments per week (2-7/week), applied frequencies (3-50 Hz), and intensities (2mT-150mT). No serious adverse event had been reported in any study. The included studies showed solid methodological quality, with an overall score of 7.2 points according to the PEDro scale.
The authors concluded that the results of the present systematic review suggest that the use of PEMF for patients with non-specific low back pain is beneficial in terms of pain reduction and enhancement of physical function, particularly if used as an addition to conventional physical therapy modalities. It has also been shown that PEMF is a safe therapy for the treatment of non-specific low back pain. Further high-quality studies with larger sample sizes and standardized protocols are necessary. The studies should also focus on determining the optimal parameters of frequency and intensity to advance PEMF application for all pain disorders.
PEMF therapy is a non-invasive treatment widely used by physiotherapist and some practitioners of so-called alternative medicine (SCAM). It applies low-frequency electromagnetic waves to the body. PEMF therapy acts like a wireless charger for your body, sending pulses of energy that penetrate deep into your tissues to jumpstart cellular recovery. Because your body contains conductive fluids (like blood) and charged ions (like calcium and potassium), the PEMF device is said to induce very small electrical currents within your tissues. In turn, the induced current is claimed to stimulate the mitochondria. This, according to proponents, boosts the production of ATP. The pulses are also said to influence the movement of ions across cell membranes, particularly calcium which triggers a cascade of beneficial biochemical reactions, such as the release of nitric oxide, which dilates blood vessels to improve circulation. Lastly, PEMF are claimed to help “calm” the chemical signals that cause chronic inflammation, switching the cellular environment from a state of stress to a state of healing.
While these assumptions look like wild extrapolations, the more crucial question is whether PEMF is clinically effective. The present review seems to tell us that it works for back pain. Yet, I am not convinced.
Most of the RCTs are not of good quality. Many did not blind patients or therapists. Only 2 made a direct comparison against a placebo, and those did not blind patients or check the success of blinding them. As the authors noted, there is plenty of heterogeneity in the included RCTs. All this adds up to a high level of uncertainty about the effectiveness of PEMF.
In summary, I fear that the authors of this review are too optimistic and lack critical thinking in evaluating the existing evidence. My conclusion therefore differs from theirs:
Many RCTs suggest that PEMF is effective for non-specific low back pain. Yet, due to serious limitations of the primary studies, no firm conclusion can be drawn.
