Table 1

Advantages and disadvantages of various sham methods

Sham methodAdvantagesDisadvantages
Placebo needlingSimilar sensation to needling with no skin penetrationTechnique is time consuming, increasing patient–practitioner contact
Same psychological impact as actual needlingProblematic in hairy areas
Effective form of acupressure
Needle manipulation is difficult
Manipulation to achieve needling effect (de qi)Manipulation provides greater effectsHigher risk of adverse effects especially with moxibustion
Difficulty in blinding patients
Varying depth of needlingSame psychological impact as true acupunctureJapanese acupuncture considers superficial needling effective
Minimal specific effect of acupuncture
Needling at incorrect sitesSame psychological impact as true acupunctureCannot be considered physiologically inert
Offers information on effective sites for needlingSuggestion that 100 extra points off normal points at meridian
Homoeopathy/other treatmentsStudy acupuncture versus physiologically inert techniqueDifficulty in blinding patients
Easily performed