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# Diabetic peripheral neuropathy, pain, and acupuncture

## Problem

A researcher is interested in studying diabetic peripheral neuropathy, a disorder where long-term high blood sugar leads to peripheral nerve damage. Peripheral neuropathy can affect motor, sensory, and autonomic nerves, and symptoms vary depending on the nerves that have been damaged. The researcher specifically looks at sensory nerve damage, and how it can cause hypersensitivity to stimuli that are not usually painful. This type of neuropathic pain is incredibly difficult for patients to endure - it affects their emotional well-being, sleep, and overall quality of life. The researcher develops a study to test the effects of acupuncture on neuropathic pain. She recruits $100$ patients who have been diagnosed with diabetic peripheral neuropathy, and randomly assigns them to the acupuncture group (n = $50$) or a wait-list control group (n = $50$). Individuals in the acupuncture group receive three $60$-minute acupuncture treatments per week; individuals in the control group do not receive the treatment. The researcher gives every participant an ecological momentary assessment device (EMA), which goes off at random intervals throughout the day and asks patients to report on their pain symptoms on a scale of $1$-$10$ (with $1$ indicating no pain and $10$ indicating extreme pain), as well as any other symptoms they are currently experiencing. Table $1$ outlines the average weekly ratings of pain for each group over a one month period of time.
Table $1$
TimepointAcupunctureControl
Baseline9.79.5
Week $1$8.48.8
Week $2$7.59.0
Week $3$7.08.6
Week $4$7.99.2
The researcher examines the data from the acupuncture group and finds that differences between baseline and week $4$ are statistically significant, but not clinically significant. What could this mean?