Sham Acupuncture Isn’t So Sham: What the Latest Evidence Tells Us

Phoebus Tian
Sep 17
3 min read

For years, clinical trials on acupuncture have used “sham acupuncture” as the placebo control. The logic was straightforward: if real acupuncture didn’t outperform sham, then perhaps acupuncture was no more than a placebo.

But new research published in the Journal of Integrative Medicine shows that sham acupuncture is not a neutral control at all. In fact, it can produce a measurable therapeutic effect of its own. That means many past studies may have underestimated how effective acupuncture really is.

Why Sham Acupuncture Is Tricky？

In drug research, a placebo is usually a sugar pill. It contains nothing active, so any improvement seen can be put down to expectation or psychology.

Acupuncture doesn’t work that way. Even when the needles are placed at non-acupuncture points or only just under the skin, the act of inserting a needle stimulates nerves, skin and muscle receptors, and even areas of the brain. Sham acupuncture is not just a ritual — it creates a real physical response.

So when trials compare acupuncture to “sham,” the two groups are closer than they should be. The control isn’t inactive, and that hides some of acupuncture’s true effect.

What is the purpose of the new study?

Researchers from West China Hospital at Sichuan University reviewed 32 high-quality trials involving more than 5,400 patients. Each study had three groups:

True acupuncture
Sham acupuncture
No treatment

This design allowed the researchers to break down the benefit of acupuncture into three elements:

Natural recovery – the improvement that happens anyway as a condition fluctuates or heals.
Placebo/ritual effect – the benefit that comes from taking part in treatment, being cared for, and expecting to improve.
Specific acupuncture effect – the genuine therapeutic benefit that belongs to acupuncture itself.

They also separated sham into two kinds:

Non-penetrating sham – no skin penetration, often using blunt needles or a device that simulates pressure.
Penetrating sham – needles actually inserted into the skin, but not at recognised points.

The key question: Does penetrating sham create its own therapeutic effect?

What They Found

Penetrating sham gave a real boost. It accounted for around 19% of the total benefit seen in acupuncture. If acupuncture’s full effect was 10 points, penetrating sham alone produced nearly 2 of those.
True acupuncture’s impact has been underestimated. Earlier trials suggested acupuncture’s specific effect was about 36%. Once the extra effect of the penetrating sham was taken out, the figure jumped to roughly 50%.
Some “negative” studies would flip. Among trials that originally found no difference between real and sham acupuncture, almost half would change to a positive result once the sham effect was adjusted for.
Needle penetration matters. Background effects were far higher in penetrating sham (70%) compared with non-penetrating sham (55%). The simple act of breaking the skin makes a difference.

Why This Matters？

For patients:

If you’ve read that acupuncture is “no better than a placebo,” it may be because the placebo wasn’t inert. Sham acupuncture is active in its own right.
The genuine effect of acupuncture is likely stronger than many headlines suggest.

For practitioners:

This research supports what many already observe in the clinic — acupuncture offers more than ritual and expectation.
It also highlights why trial design matters. Using a penetrating sham as a control underestimates the true value of acupuncture.

So, Is Acupuncture “Just a Placebo”?

Not at all. Acupuncture works through a combination of natural recovery, the therapeutic encounter, and direct physiological stimulation. Sham acupuncture clouds the picture because it is never fully inactive — especially when needles penetrate the skin.

This new evidence shows that acupuncture’s specific benefit is larger than once believed, and that sham acupuncture is not so sham after all.

Luo, X. C., Liu, J. L., Yao, M. H., Chen, Y. M., Fan, A. Y., Liang, F. R., Zhao, J. P., Zhao, L., Zhou, X., Zhong, X. Y., Yang, J. H., Li, B., Zhang, Y., Sun, X., & Li, L. (2025). Specific effect of inserted sham acupuncture and its impact on the estimation of acupuncture treatment effect in randomized controlled trials: A systematic survey. Journal of integrative medicine, S2095-4964(25)00113-X. Advance online publication. https://doi.org/10.1016/j.joim.2025.07.011