藥比較容易做“隨機雙盲”，針灸是操作（procedure），操作很難做“隨機雙盲”，手術也難做“隨機雙盲”， 假手術怎麽做啊？多貴啊，而且誰願意白切一刀啊。至少要有個疤吧。 所以手術的效果常常是事後兩組不同手術方法比較的， 或手術效果與保守治療比較。 好像很少聽見真假手術比較的。 針灸止痛的問題是其效用不是長久的，事後比較就難了。
wikipedia 就簡單談了非藥物治療隨機雙盲的困難：
藥物我是100%for金標準的。 另外，我並不認為針灸可以治百病。 不過，2012年那篇paper把針灸止痛說的很正麵啊。。。
http://en.wikipedia.org/wiki/Placebo-controlled_study
In research experimental studies, the method of establishing a proper control group to eliminate the placebo effect has also been difficult, particularly for surgical and therapy interventions that are not pharmaceutical in nature. Notably, there has been much debate of whether to use a placebo pill or conduct a sham procedure as a control.
2012年的paper
[1] Vickers, A. J. et al. Acupuncture for Chronic Pain Individual Patient Data Meta-analysis. Arch Intern Med 172, 1444-1453 (2012).
http://www.ncbi.nlm.nih.gov/pubmed/22965186
RESULTS:
In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.
CONCLUSIONS:
Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.
wikipedia 就簡單談了非藥物治療隨機雙盲的困難：
藥物我是100%for金標準的。 另外，我並不認為針灸可以治百病。 不過，2012年那篇paper把針灸止痛說的很正麵啊。。。
http://en.wikipedia.org/wiki/Placebo-controlled_study
In research experimental studies, the method of establishing a proper control group to eliminate the placebo effect has also been difficult, particularly for surgical and therapy interventions that are not pharmaceutical in nature. Notably, there has been much debate of whether to use a placebo pill or conduct a sham procedure as a control.
2012年的paper
[1] Vickers, A. J. et al. Acupuncture for Chronic Pain Individual Patient Data Meta-analysis. Arch Intern Med 172, 1444-1453 (2012).
http://www.ncbi.nlm.nih.gov/pubmed/22965186
RESULTS:
In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.
CONCLUSIONS:
Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.
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