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Transcranial magnetic stimulation (TMS) determined a reduction or the remission of pain in 69%% of migraine with aura patients versus 48%% in the group treated with sham technique (level of recommendation II) [406].
The sham technique appeared very similar to the SNAG but the application of the optimum direction and the appropriate amount of force were absent.
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This is a serious problem when investigators are attempting to evaluate the effects of TMS by using traditional sham techniques because of unintended systematic differences between real and sham TMS groups (ie, confounds).
We feel that until better sham techniques are available, it is prudent to design a study that does not employ a placebo control.
But George Lewith, a clinical researcher at the University of Southampton, U.K. says the sham acupuncture technique may not be sufficiently fake.
In a rare trial pitting two fake treatments against each other, researchers have found that a sham acupuncture technique provided more pain relief than a dummy pill.
Here detailed information was given to the trial protocol, the case report forms and the verum and sham acupuncture technique.
Most sham TMS techniques produce identical sounds to active TMS, but they do not cause much, if any, scalp or facial sensation or discomfort.
These sham acupuncture techniques are therefore inappropriate.
Control procedures involving invasive or non-invasive sham needling techniques may be therapeutically active, evoking neurophysiological and/or localised immune and circulatory responses.
Sham group (SHAM).
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