Stronger placebo effect

Like massage, acupuncture is difficult to study because it's hard to give a "fake" massage or "placebo" acupuncture. Says Clauw: "In 'sham' or placebo controlled trials in chronic pain, more studies have shown that acupuncture doesn't work. But that doesn't necessarily mean that it's not effective—it might be that there really is no such thing as sham acupuncture. Acupuncture might somehow be effective in engendering a placebo response." Whether that matters if someone feels significant pain relief is a question only the patient can answer. "The best evidence that it's effective is that a lot people will pay out of pocket to use it," he says.
Clauw himself conducted a fascinating imaging study of acupuncture, finding that while patients with fibromyalgia reported decreased pain with both fake and real acupuncture, fake acupuncture affected brain opioid receptors in a way that was more comparable to that seen with placebo. "Sham acupuncture may work via placebo effects and active acupuncture may work by more specific effects. That could help explain why trials don't show much difference," he says.
Some have claimed that electroacupuncture—which runs a small current through acupuncture needles—is more effective than needles alone, but Clauw says it's even harder to parse out placebo effects here. "It may give a stronger placebo effect," he says. For people in pain, however, that could be a good thing.

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