White P, Lewith G
School of Health Profession and Rehabilitation Sciences, University of Southampton, Highfield, Southampton Hants SO17 1BJ, UK.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2006 Aug;49(8):743-8. doi: 10.1007/s00103-006-0004-x.
One of the problems in assessing acupuncture efficacy has been the lack of a standardised placebo/control. Despite the lack of 'proof', acupuncture is widely used; hence it would seem that a large proportion of the public are not too concerned with the question of efficacy. Patients and researchers approach the issue of whether acupuncture "works" in an entirely different way. It may be that the management of chronic pain as a whole is largely context driven and non-specific. Therefore, research should focus on areas such as pragmatic/comparative trials and the non-specific effects of treatment. Improving our understanding of the neural mechanisms and substrates of acupuncture, placebo and non-specific effects might enable us to better define a "true placebo" and improve trial design. Imaging studies, however, need to be much more pragmatic. Because of the large overlap in areas of brain activated through acupuncture, pain, placebo and non-specific factors, separating these out in an attempt to pinpoint the mechanisms behind acupuncture will be difficult. Ultimately we need a balance between efficacy, comparative and mechanistic trials using imaging work to inform the whole picture. A broader view of research is therefore necessary to yield meaningful answers and we need to look at the whole package that acupuncture delivers.
评估针灸疗效存在的问题之一是缺乏标准化的安慰剂/对照。尽管缺乏“证据”，针灸仍被广泛使用；因此，似乎很大一部分公众并不太关心疗效问题。患者和研究人员看待针灸是否“有效”的问题方式截然不同。可能整个慢性疼痛的管理很大程度上是由背景驱动且非特异性的。因此，研究应聚焦于实用/比较试验以及治疗的非特异性效应等领域。增进我们对针灸、安慰剂和非特异性效应的神经机制及基础的理解，或许能使我们更好地定义“真正的安慰剂”并改进试验设计。然而，影像学研究需要更加注重实际应用。由于通过针灸、疼痛、安慰剂和非特异性因素激活的脑区有很大重叠，试图区分这些以确定针灸背后的机制将很困难。最终，我们需要在疗效试验、比较试验和机制试验之间取得平衡，利用影像学研究来全面了解情况。因此，需要更广泛的研究视角才能得出有意义的答案，我们需要审视针灸所带来的整体效果。
