Acupuncture needles are being tested against counselling and usual GP care in a full-scale trial for depression, while four separate meta-analyses pool patient data on acupuncture for low back pain, neck pain, headache, and knee osteoarthritis. This matters because chronic pain affects millions of NHS patients, and demand for acupuncture is rising despite uncertainty about whether it works better than sham needles or usual care. Previous trials have produced confusing results—real acupuncture often performs only marginally better than sham, partly because the sham needle’s role is poorly understood. The programme tackles this head-on by evaluating different sham controls and by using individual patient data to sharpen the comparisons. If successful, the research could give GPs and NHS commissioners clear evidence on whether to fund acupuncture for common painful conditions and for depression. The economic modelling will show whether acupuncture is cost-effective as an add-on to usual care, helping the NHS decide where to allocate limited resources. For patients, this could mean access to a non-drug treatment option that either works or is ruled out on solid evidence.
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Aims and objectives The overall aim of this programme is to establish rigorous evidence on the clinical and cost effectiveness of acupuncture for chronic pain and depression in primary care. Our objectives are: to conduct four meta-analyses of acupuncture using individual patient data (for low back pain, neck pain, headache and osteoarthritis of the knee); to conduct related economic evaluations with decision-analysis; to study ways to control for placebo effects, and to conduct a large randomised controlled trial to evaluate the effectiveness and cost-effectiveness of acupuncture for depression. Background Chronic pain represents a large burden to patients and the NHS. Patient demand for acupuncture is rising but there is uncertainty about the evidence. Evidence syntheses are needed where substantial recent evidence is now available. Comprehensive economic modelling is required for NHS decision-making. New robust RCTs are needed for chronic illnesses in primary care where the evidence from existing reviews and pilot RCTs is encouraging. Research Plans Project 1: Evidence synthesis: four individual patient data meta-analyses. A number of large, high quality trials of the clinical effectiveness of acupuncture for low back pain, neck pain, osteoarthritis of the knee, and headache have recently been published. We will incorporate these in individual patient meta-analyses comparing acupuncture to both usual care and to sham acupuncture. Project 2: Economic evaluation: modelling and decision analysis. We will conduct three economic evaluations with decision-analysis of acupuncture for low back pain, neck pain and headache when provided as an adjunct to usual care using data from Project 1. Then, as an exemplar, we will use a decision analytic modelling framework to synthesise the evidence for all common treatments, including acupuncture, for osteoarthritis of the knee. Project 3: Controlling for placebo effects in randomised controlled trials of acupuncture. Several recent trials of acupuncture have used a sham acupuncture intervention as a control. In these trials, acupuncture has been found to be equivalent to, or marginally better than real acupuncture. Because the mechanism of acupuncture is unknown, the role of the sham needle is unclear and therefore the results of these trials are difficult to interpret. In this project, we will explore a variety of sham interventions, and evaluate their adequacy. Project 4: Acupuncture for depression: an RCT. Systematic reviews suggest there is sufficient evidence on the effects of acupuncture to warrant further research. Building on our 40 patient pilot RCT of acupuncture vs. counselling vs. usual GP care alone, we will conduct a full scale RCT to determine clinical and cost effectiveness of acupuncture compared to usual care alone. We will also compare acupuncture to counselling, an intervention that will provide a control for equivalent time with an empathetic therapist. Research Team The research team will be led by Dr MacPherson, a holder of a NIHR Career Scientist Award to evaluate the effectiveness of acupuncture. There is NHS involvement from a Clinical Services Manager (Wheeler), York Hospital Pain Clinic (Hall), and GPs (Geddes, Watt). The team includes specialists in acupuncture (Hall, Geddes, MacPherson), chronic pain (Hall, Morley), and mental health (Geddes, Gilbody, Morley) as well as experts in systematic reviews (Gilbody, Stewart, Woolacott), individual patient data meta-analyses (Stewart, Sutton), trials in primary care (Bland, Gilbody, Morley, Torgerson, Watt), and economic evaluation, modelling and decision analysis (Sculpher, Torgerson). Research Environment The University of York has a strong research health services research and clinical evaluation environment with key academic centres supporting the proposed programme: Department of Health Sciences, Centre for Reviews & Dissemination, Centre for Health Economics and York Trials U
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