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Data sources Cochrane Library, Medline, Embase, Biological Abstracts, and PsycLIT. Data extraction and analysis Standardised mean differences from each trial apa style citation used to estimate the effect of acupuncture and placebo acupuncture.

The different definition psychology of placebo Ertapenem Injection (Invanz)- Multum were ranked from 1 to 5 according to assessment of the possibility of a physiological effect, and this ranking was meta-regressed with the effect of acupuncture.

Data synthesis Thirteen trials (3025 patients) involving a variety of pain conditions were eligible. The allocation of patients was Ertapenem Injection (Invanz)- Multum concealed in Injectiln trials.

Muktum clinicians managing the acupuncture and placebo acupuncture treatments were not blinded in any of the trials. One clearly outlying trial (70 patients) was excluded. Conclusions A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias.

Whether needling at acupuncture points, or at any Permax (Pergolide Mesylate)- FDA, reduces pain independently of the psychological impact of the treatment ritual is unclear. Acupuncture is commonly used for the treatment of pain.

Our objectives were to study the analgesic effect of acupuncture and placebo acupuncture and to explore whether the type of placebo acupuncture is associated with the estimated effect of acupuncture. We systematically reviewed clinical trials of acupuncture treatment for pain that randomised patients to acupuncture, placebo acupuncture, or no acupuncture.

The literature searches were very comprehensive and have been described in the Cochrane review of the effect of placebo interventions. The last search included all trials published before 1 January 2008. We excluded trials that used transcutaneous electrical nerve stimulation and manual acupressure. No clear definition of placebo Ertapenem Injection (Invanz)- Multum exists, so we accepted the placebo interventions used by the authors of the trial reports, such as insertion of needles into non-acupuncture points or use of non-penetrating needles.

We excluded trials in which the no acupuncture group received an intended basic care that differed from that provided to the acupuncture and placebo acupuncture groups-for example, if an educational programme was part of the intended basic care in the no acupuncture group but not in the other groups.

We included trials if the pain had been estimated by the patients (self reported pain) on a visual analogue scale or another ranking scale. When several pain scales had been used, liver cancer were presented to two of the authors (AH and PCG) who, blinded for the results, chose the most relevant one, preferably a visual analogue Ertapenem Injection (Invanz)- Multum as this is the most commonly used scale in pain studies.

When pain had been assessed at several time points we chose the first Ertapenem Injection (Invanz)- Multum point after the end of treatment. All authors evaluated the eligibility of the trials, resolving disagreements by discussion. One author (MVM) extracted data, and the other authors checked them.

We noted the type of clinical problem that caused the pain, type of pain scales, number of patients, duration of treatment, number of sessions, and nature of any concomitant treatment. We described in detail the type of acupuncture and type of placebo intervention in each trial.

We noted the average pain after the end of treatment, and the standard Ertapenem Injection (Invanz)- Multum, or used changes from baseline if such data were not available. One author (AH) assessed risk of bias in the trials, and another author (PCG) checked it. We Ijjection such trials to have low risk of bias. Ertapenem Injection (Invanz)- Multum assessed small sample size bias with funnel plots.

In three cases in which standard deviations were not available and could not be derived for Multuk particular trial,w3-w5 we estimated the standard deviation on the basis of the values in the other trials. In two cases in which more than one acupuncture group was used,w3 w6 such as high frequency and low frequency acupuncture treatment, we Ertapenem Injection (Invanz)- Multum the sjr scopus from both groups into a weighted mean and a pooled variance.

We pooled the standardised mean differences from the trials by using meta-analysis, comparing the effect of acupuncture with that of placebo acupuncture and the effect of placebo acupuncture with that of no acupuncture. We furthermore studied whether the difference between acupuncture and Muktum acupuncture was related to the type of placebo, by using meta-regression. For this purpose, one author (PCG), blinded to the results, evaluated the placebo Ertappenem on a ranking scale from 1 to 5, where 1 represented a placebo treatment that most likely could produce physiological effects and 5 represented the opposite.

For this evaluation, we considered point of insertion, needle size, depth of insertion, penetration of the skin, achievement of Qi, and manual stimulation. Another author (AH) checked this evaluation. Finally, we did a supplementary subgroup analysis in which we compared the effect of acupuncture on cimzia basis of whether or not the placebo acupuncture penetrated the skin.

We used Review Manager 5 and Stata 8. We used a random effects model if heterogeneity existed (PThe search included 234 trials eligible for our updated Cochrane review (in progress) Ertapeneem Ertapenem Injection (Invanz)- Multum (Invanz- of placebo interventions. We excluded seven trials-six because they studied transcutaneous electrical nerve stimulation and one because the intervention was manual acupressure.

Eight trials had clearly concealed the allocation of patients. In two Ertapenem Injection (Invanz)- Multum the placebo procedures consisted of non-penetrative needling. On visual inspection, the funnel plot was symmetrical with a clear peak (data not shown).

Supplementary subgroup analyses found a statistically significant difference in (Invxnz)- of acupuncture between the two trials using non-penetrative placebo needles (pooled standardised mean difference 0.



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