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Li et al correctly note that sham acupuncture is not a placebo. Nevertheless, the 2 forms of acupuncture differ in the location of acupuncture points, depth of needling, and intensity of nerve stimulation. The manual needle stimulation to elicit de qi sensation in verum acupuncture (but not sham) is considered a sign of sufficient stimulation of afferent nerve fibers.
Despite these differences, treatment success of sham and verum acupuncture did not differ significantly 6 months after baseline, and both forms were superior to conventional therapy. Consequently, there must be commonalities between the 2 forms of acupuncture, as discussed in our article,1 since the success of the conventional therapy cannot be attributed solely to a placebo effect and the success of acupuncture cannot be attributed solely to the conditions of a randomized trial (comparable success rates were measured under conditions of everyday practice in a related observational study2).
Endres HG, Molsberger A, Haake M. Sham Acupuncture Is Not a Placebo—Reply. Arch Intern Med. 2008;168(9):1012. doi:10.1001/archinte.168.9.1012