From Monash Medical Centre, Clayton VIC 3168, Australia.
The study by Berman and colleagues (1) is one of several that examines the possible role of acupuncture in the treatment of osteoarthritis. Although many aspects of Berman and colleagues' study are very impressive, there are a few points that should be discussed when evaluating it.
First, the sham acupuncture involved a combined insertion and noninsertion procedure using, among other things, insertion at 2 sham points in the abdominal area. We cannot exclude the possibility that skin-penetrating acupuncture at sham sites produces analgesic effects as the result of diffuse noxious inhibitory control; these effects may be greater than the analgesic effects produced by placebo. A non–needle-insertion control would have reduced the physiologic response to the stimulus (2).