While we are convinced that real acupuncture is superior to both sham and no-acupuncture control for various chronic pain conditions, as carefully reviewed in 29 randomized controlled trials (RCTs) (17 922 patients) by Vickers et al,1 the authors of that article also acknowledge that acupuncture, both real and sham, is likely to be associated with additional potent placebo and context effects, contributing to the total effects of acupuncture experienced by patients in routine practice.