Sham Acupuncture Is Not a Placebo

We read with great interest the German Acupuncture Trials (GERAC) for chronic low back pain by Haake et al.¹ Such a randomized and multicenter trial is always welcomed. The trials compared 3 different treatments and showed that almost half of the patients in the verum and sham acupuncture groups responded to treatment. This result was nearly twice the responders to multimodal conventional therapy. The sham acupuncture was described as “a form of acupuncture developed especially for this study,”^1(p1894) and it was used to differentiate the physiologic (specific) from the psychologic (nonspecific) effects of acupuncture. But the trials proved that sham acupuncture has not only psychologic or nonspecific effects because it works better than multimodal conventional therapy used in routine care. In addition, almost half of the enrolled subjects responded by showing some improvement on the pain scale or functional ability, although the trial did not demonstrate the range of improvement. So, once more, we believe that sham acupuncture should not be considered as a placebo because it is neither an inert nor innocuous procedure that could be used in controlled experiments.² Finally, for the patients with chronic low back pain, if the multimodal conventional therapy is accepted, then the acupuncture treatment should be recommended and should be included as an insured benefit, as in Brazil.