We have carefully reviewed the recent study “Effect of Acupuncture Intervention on Chronic Musculoskeletal Pain in Hemodialysis-Dependent Kidney Failure Patients: Study Protocol for a Randomized Controlled Clinical Trial”.1 The aim of this article is to investigate the effect of acupuncture treatment in relieving chronic musculoskeletal pain in hemodialysis-dependent kidney failure(HDKF) patients and construct a relatively complete research framework on this basis. However, the study has some limitations that may affect the reliability and generalizability of its findings.

First, the lack of sample representativeness limits the applicability of the results; based on previous studies, larger sample sizes and inclusion of different races typically yield more accurate and representative results, highlighting the limited reliability and generalizability of results from smaller studies. The participants in this study were from a single center and were ethnically homogeneous, which may have weakened the extrapolation of the findings.

Second, although the study used randomization and was screened to reduce bias through strict inclusion and exclusion criteria, potential confounding factors may still affect the reliability of the findings.

Thirdly, based on the available methods for optimizing sham acupuncture and blinding,2 we note that the article did not mention whether the enrolled patients had received acupuncture treatment before? This would have had a great impact on the validity of applying blinding. In addition, due to the fact that only a few trials have confirmed their success in blinding patients, to test the effectiveness of blinding, we wonder if it is possible to recruit healthy volunteers before the start of the study to assess the feasibility of this blinding method, as was done in this study?3

Therefore, consideration of these elements in future studies might improve the research to provide more comprehensive and reliable conclusions and, in doing so, provide new perspectives and treatment strategies for pain management in HDKF patients.

The authors report no conflicts of interest in this communication.

1. Yan C, Liu HR, Kong Q, et al. Effect of acupuncture intervention on chronic musculoskeletal pain in hemodialysis-dependent kidney failure patients: study protocol for a randomized controlled clinical trial. Pain Res. 2024;17:4289–4300. doi:10.2147/JPR.S492158

2. Hu H, Hu T, Han D, Gao H. Establishment of appropriate sham acupuncture and successful patient blinding. Acupunct Med. 2021;39(2):159–160. doi:10.1177/0964528420924035

3. Fan JQ, Lu WJ, Tan WQ, et al. Effectiveness of acupuncture for anxiety among patients with Parkinson disease: a randomized clinical trial. JAMA Netw Open. 2022;5(9):e2232133. doi:10.1001/jamanetworkopen.2022.32133