In Reply As we noted in our Editorial, the German decision to support acupuncture for low back pain was based on the evidence for substantial benefit of sham and verum acupuncture compared with usual care. The decision was made, as Dr Marcus notes, despite the fact that verum acupuncture failed to show significant benefit compared with sham.1,2 However, results of a well-conducted meta-analysis3 have found significant differences between verum and sham acupuncture for some pain conditions. These differences, although modest, are similar to the effect size seen in some analyses of standard allopathic treatments for chronic pain, including nonsteroidal anti-inflammatory drugs.4 The safety profile of acupuncture is favorable, particularly when compared with nonsteroidal anti-inflammatory drugs and other drugs. The result is some uncertainty about the clinical significance of the modest specific benefits of acupuncture and an inevitable (and perhaps unresolvable) debate about the appropriateness of using the nonspecific benefits.
Briggs JP, Shurtleff D. Acupuncture and Sham Acupuncture for Pain Relief—Reply. JAMA. 2017;318(15):1503. doi:10.1001/jama.2017.13398
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