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Fatally flawed study of acupuncture for shoulder pain

PainSci » bibliography » Molsberger et al 2010
updated
Tags: treatment, acupuncture, controversy, manual therapy, modalities, passive, professions, debunkery, traditional Chinese medicine, vitalism

One page on PainSci cites Molsberger 2010: Does Acupuncture Work for Pain?

PainSci notes on Molsberger 2010:

In Germany, researchers tested acupuncture for chronic shoulder pain on 424 patients. One group of patients received Chinese acupuncture in the shoulder, another group received sham acupuncture in the leg, and a third group received convential but conservative orthopaedic treatment. Everyone received 15 treatments over a 6-week period.

The results seemed significant and positive, and the conclusion was glowing: “The trial indicates that Chinese acupuncture is an effective alternative to conventional orthopaedic treatment for CSP.”

Wait a second … sham acupuncture in the leg? For a shoulder pain study?

This experiment suffered from a glaring flaw that renders its results almost meaningless: a sham has to be convincing to bother comparing it to a treatment, and the sham used in this study clearly was not convincing, as the needles were placed in the leg. Patients might not know much about acupuncture, but they certainly would know that sticking needles in a leg probably isn’t a treatment for their shoulder! D’oh. The result is that patients could easily get a huge placebo effect from the “real” treatment, and none at all from the sham.

This criticism is discussed in detail in an article by Neil O’Connell, Location location location!.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

The German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) comprised 424 outpatients with chronic shoulder pain (CSP) > or =6 weeks and an average pain score of VAS > or =50 mm, who were randomly assigned to receive Chinese acupuncture (verum), sham acupuncture (sham) or conventional conservative orthopaedic treatment (COT). The patients were blinded to the type of acupuncture and treated by 31 office-based orthopaedists trained in acupuncture; all received 15 treatments over 6 weeks. The 50\% responder rate for pain was measured on a VAS 3 months after the end of treatment (primary endpoint) and directly after the end of the treatment (secondary endpoint).

RESULTS: In the ITT (n=424) analysis, percentages of responders for the primary endpoint were verum 65% (95% CI 56-74%) (n=100), sham 24% (95% CI 9-39%) (n=32), and COT 37% (95% CI 24-50%) (n=50); secondary endpoint: verum 68% (95% CI 58-77%) (n=92), sham 40% (95% CI 27-53%) (n=53), and COT 28% (95% CI 14-42%) (n=38). The results are significant for verum over sham and verum over COT (p<0.01) for both the primary and secondary endpoints. The PPP analysis of the primary (n=308) and secondary endpoints (n=360) yields similar responder results for verum over sham and verum over COT (p<0.01). Descriptive statistics showed greater improvement of shoulder mobility (abduction and arm-above-head test) for the verum group versus the control group immediately after treatment and after 3 months. The trial indicates that Chinese acupuncture is an effective alternative to conventional orthopaedic treatment for CSP.

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