In Reply

We thank Dr. Silva for his comments on the relative effects of electroacupuncture and manual acupuncture.¹  We agree that, while there is no conclusive evidence to show that electroacupuncture is superior to manual in pain management, scattered evidence suggests that the former might be superior to the latter. In a study²  with 20 patients, electroacupuncture was superior to manual acupuncture in relieving pain in patients with tennis elbow. In Dr. Manheimer’s³  meta-analysis of 16 trials of acupuncture for osteoarthritis, sensitivity analysis suggested that electroacupuncture might be associated with better outcomes. Furthermore, indirect comparison between electroacupuncture and manual acupuncture also indicates the same tendency. For example, in a study by Dr. Berman et al.,⁴  both electroacupuncture and manual acupuncture significantly relieved knee osteoarthritis pain between weeks 14 and 26 compared to needle insertion at sham points and nonpenetrating mock electrical stimulation, whereas in a study by Dr. Witt et al.⁵  manual acupuncture significantly improved pain at 8 weeks but not 26 weeks compared to superficial needling at nonacupuncture points. Although these data are preliminary, they suggest that electroacupuncture might be more effective than manual acupuncture for managing pain. However, more studies that directly compare the effects of these types of acupuncture on pain, and take into consideration pain severity, acupuncture point location (local vs. distant), treatment “dosage,” and follow-up period, are necessary.