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Evidence for specific effects of acupuncture that are clinically relevant remains contentious. When compared with no treatment, acupuncture is effective.1 However, in comparison to sham or placebo acupuncture, there is a greatly reduced treatment effect.2 Thus, the benefit of the treatment may be due to incidental (and unknown) elements of the intervention. These factors have been called ‘non-specific’ effects; the mechanism is unknown but may be mediated by such factors as patient–practitioner communication, the therapeutic ritual and patient expectations about the treatment. Historically, the term ‘placebo effect’ has been applied to account for these non-specific effects of treatment. However, despite general acceptance of the term, there remains considerable controversy regarding the definition of ‘placebo’. Further, by choosing not to use the term, we favour attempts to move beyond the idea of a placebo as a sort of black box towards elucidation of the elements responsible for its effect. Understanding non-specific treatment effects and integrating these attributes in to practice (eg, enhancing treatment expectations) may help optimise treatment effectiveness.
The primary aim was to investigate the size of the non-specific effects of acupuncture. The secondary aim was to investigate factors that influence the size of non-specific effects such as the type of sham intervention, the condition for which the treatment was applied and study quality.
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