Different Outcomes According to Needling Point Location Used in Sham Acupuncture for Cancer-Related Pain: A Systematic Review and Network Meta-Analysis

Simple Summary When sham acupuncture was set as a control in previous acupuncture clinical trials, the sham procedure was conducted either at the same points that were used for the verum acupuncture group or at nonindicated points. The network meta-analysis according to needling point location used in sham acupuncture for cancer-related pain revealed no significant difference in pain severity between verum acupuncture and sham acupuncture using the same points as verum acupuncture. However, verum acupuncture significantly improved the pain severity compared to sham acupuncture at sham points. Sham acupuncture needling at the same points as verum acupuncture is not a true placebo due to the lack of consideration for acupuncture point specificity.Abstract Numerous acupuncture studies have been conducted on cancer-related pain; however, its efficacy compared to sham acupuncture remains controversial. We confirmed whether the outcome of acupuncture differs according to the needling points of sham acupuncture for cancer-related pain. We searched 10 databases on 23 May 2023 to screen acupuncture trials using sham acupuncture or waiting list as controls for cancer-related pain. Sham acupuncture was classified into two types, depending on whether the needling was applied at the same locations as verum acupuncture (SATV) or not (SATS). A network meta-analysis (NMA) was performed on the basis of a frequentist approach to assess pain severity. Eight studies (n = 574 participants) were included in the review, seven of which (n = 527 participants) were included in the NMA. The pain severity was not significantly different between SATV and verum acupuncture, but verum acupuncture significantly improved pain severity compared to SATS. The risk of bias affecting the comparisons between the verum and sham acupuncture was generally low. Previous acupuncture trials for cancer-related pain showed differing outcomes of sham and verum acupuncture, depending on the needling points of sham acupuncture. The application of SATV cannot be considered a true placebo, which leads to an underestimation of the efficacy of verum acupuncture.