针刺预防偏头痛远期疗效评价(续3)
We suspected that the slight improvement in the WL group was probably due to the Hawthorne effect or the effect of regression to the mean, a finding that is consistent with those of a previous report. Although inferior to TA, SA was still associated with clinical improvement and was possibly a result of the nonspecific physiological effect experienced during needling or a placebo effect orginating from frequent patient–acupuncture practitioner interactions. This could explain why a significant difference between SA control and WL control was observed only during the follow-up period instead of at the endof treatment.
These results are beneficial to patients with aura-free migraine who had at least 2 monthly attacks during the 4-week of pretreatment. Among such patients, TA was more efficacious for migraine prophylaxis than SA or no acupuncture, and the improvement induced by acupuncture persists for at least 24 weeks.
Limitations
Our study also has 3 limitations. First, our study used a semistandard prescription with fewer acupoints stimulated; because we focused on efficacy in the present study, we did not use personalized treatment planning that is based on the acupuncturists’ experiences, which might cause performance bias. Second, blinding was not possible for patients in the WL group. This means that we may have overestimated both the differences between TA and WL groups and that between SA and WL groups owing to nonspecific effects of needling. Finally, our study did not test the comparative effect of acupuncture and standard therapy on migraine prophylaxis. Further studies are warranted to investigate this important issue, particularly in a pragmatic environment.
ConclusionsCompared with SA and WL control groups, TA manifested persisting superiority and clinically relevant benefits for at least 24 weeks in migraine prophylaxis, including reducing the number of migraine frequency and days with migraine, as well as decreasing pain intensity.
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