| Clinical research: |
| (i) There is mounting evidence from large-scale effectiveness trials that acupuncture treatments are superior to usual care |
| for some chronic pain conditions [39]. |
| (ii) However, overall, acupuncture treatments are, at most, only marginally more effective than sham acupuncture |
| [3, 41, 42]. |
| (iii) Sham acupuncture treatment, when compared to no treatment, is associated with larger effect sizes than |
| when conventional placebos are compared to no treatment [7–10]. |
| (iv) There is no conclusive evidence as to which individual components of acupuncture treatment are directly |
| associated with therapeutic benefit [3]. |
| Basic research: |
| (i) Basic science experiments, mostly in animals and healthy human subjects, show that acupuncture needling has |
| demonstrable physiological effects that are dependent on needling parameters, including needle insertion depth, type, |
| amplitude and frequency of needle stimulation [21, 40, 43–48]. |
| (ii) In animal models, needling parameters appear related to therapeutically relevant outcomes, for example, |
| analgesia, antihyperalgesia, decreased tissue inflammation, decreased elevated blood pressure, and altered gastrointestinal |
| motility [19, 49–51]. |
| (iii) The extent to which the precise needling location (e.g., acupuncture point versus nearby nonacupuncture point) |
| influences physiological responses remains unclear, although, in animal models, different effects have been demonstrated |
| when needles are inserted in different body regions (e.g., abdomen versus limb) [21, 52, 53]. |
| (Citations refer to SAR conference summary articles, as well as more recent systematic reviews) |
