Full Length Article A randomized controlled trial of real versus sham acupuncture for basal thumb joint arthritis Anna Barnard 1,2 , Victoria Jansen 1 , Mark G. Swindells 1,3 , Melanie Arundell 1 and Frank D. Burke 1 Abstract We report a single-blinded randomized controlled trial comparing acupuncture to sham (non-penetrating) needling for relief of symptoms of basal thumb joint arthritis. Seventy acupuncture naive patients with basal thumb joint arthritis were randomized to receive true acupuncture or sham needling with 35 patients in each arm. Blinded baseline and post-treatment assessments included visual analogue pain scores for different grips and movement. Function was assessed using the Nelson questionnaire. Both groups showed statistically and clinically significant improvements in pain at week one post-treatment compared with baseline, but there was no difference between the treatment groups. The pain relief was comparable with published data for some standard treatments. Acupuncture did not perform better than sham needling in this study, indicating that pain relief may have been achieved through non-specific mechanisms. Level of evidence: I Keywords Acupuncture, carpometacarpal osteoarthritis, basal thumb joint, pain relief Date received: 7th May 2019; revised: 4th February 2020; accepted: 7th February 2020 Introduction Osteoarthritis (OA) of the basal joint of the thumb is a common, painful condition associated with older age (Haugen et al., 2011). With life expectancy rising, the burden it poses to society is anticipated to rise. Referrals to The Pulvertaft Hand Centre for OA almost trebled between the departmental audits in 1990 and 2000, emphasizing the workload involved in treating this condition and the importance of find- ing effective treatments to manage pain (Wildin et al., 2006). Acupuncture is used for pain relief, but it remains a controversial subject in Western medicine. There is ongoing debate surrounding its efficacy in relieving pain for a variety of conditions (Colquhoun and Novella, 2013; Manheimer et al., 2010; Vickers et al., 2012). Acupuncture is thought to relieve pain through peripheral and central mechanisms. For example, stimulating small Ad and c fibres in the peripheral nervous system leads to an analgesic effect through a central ‘pain gating mechanism’ mediated by neurotransmitters and endorphins (Wang et al., 2013). Currently the National Institute for Health and Care Excellence (NICE) recommends that acupunc- ture may be considered for tension headache and migraine (NICE, 2012), but should not be routinely used for OA as there is insufficient evidence of clin- ical efficacy (NICE, 2014). The evidence for acupunc- ture is predominantly related to OA of the knee, with no adequately powered studies for thumb joint OA. The primary objective of this study was to assess whether there is any difference in pain relief achieved 1 Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK 2 James Cook University Hospital, Middlesbrough, UK 3 The Drayton Surgery, Portsmouth, UK Corresponding Author: Victoria Jansen, Pulvertaft Hand Centre, Kings Treatment Centre, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK. Email: victoria.jansen@nhs.net Twitter: @VictoriaJanse11 Journal of Hand Surgery (European Volume) 0(0) 1–7 ! The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1753193420911326 journals.sagepub.com/home/jhs