In my last blog, I touched on the topic of the Placebo Effect in acupuncture (click here if you missed it). To briefly review, one of the most powerful influences on patient healing is the patient’s belief about the treatment received. If the patient believes s/he is getting effective treatment, healing is much more likely. Controlled studies of the placebo effect have shown it to improve chest pain, warts, asthma, arthritis, cancer, and many other medical conditions.
I also posed the question whether acupuncture is merely an elaborate placebo treatment, which, as you might imagine, elicited a number of responses. Thanks to everyone who commented.
I’ll tell you what I think: Yes, there’s a placebo dimension to acupuncture. There undoubtedly must be, just as there’s a placebo dimension to every other treatment, medication, procedure or interaction with a healthcare provider. Each of these does something to influence patient belief, which in turn influences healing. Just as the presence of a doctor in a white coat has been shown to increase blood pressure, the presence of a caring acupuncturist may bring feelings of well being. This is no surprise to anyone.
Of course, there are real problems designing good studies of “sham” acupuncture, because it’s hard to “fake” inserting a needle into the skin. The sham studies I’ve seen basically take two forms.
- Studies that use real acupuncture, but in non-acupuncture point areas. This approach is problematic because any needle insertion is going to communicate with the body’s fascial network and affect the main meridians through collateral branches. There is no place in the body where you can insert a needle and not affect the body’s electrical system. Sham locations are not the same as sham acupuncture.
- Studies that use “fake” acupuncture with elaborate, non-piercing fake needles, designed to deceive the patient into believing the needle has actually pierced the skin. In this case, there is a piercing sensation as the sharpened point presses on the skin without penetrating. The problem with this approach is that you are still stimulating the point with acupressure and nociceptive input. Should we be surprised if such stimulation produces the same results as needle penetration? No.
Not surprisingly, recent studies employing sham acupuncture have wrongly asserted that it is just as effective as real acupuncture. Let’s take a look at a couple of cases:
A 2009 study by Daniel C. Cherkin, PhD., treated 638 adults with chronic low back pain, using one of the following approaches:
- Individualized acupuncture
- Standardized acupuncture
- Simulated acupuncture
- Usual (medical) care
All three of the acupuncture approaches, including sham, produced similar results. The study’s authors asserted, “Collectively, these recent trials provide strong and consistent evidence that real acupuncture needling using the Chinese meridian system is no more effective for chronic back pain than various purported forms of sham acupuncture.” In other words, since real and sham got the same results, it’s a placebo.
But the very next sentence, the one that wasn’t reported in the popular press, said, “However, both real and sham acupuncture appear superior to usual care.” Translation: even “fake” acupuncture gets better results than the medical approach to back pain. Take a look for yourself:
So why aren’t more doctors prescribing “fake” acupuncture for low back pain? Why do they continue to prescribe drugs, physical therapy, and surgery and get demonstrably inferior results? Is this malpractice?
The fact that we don’t fully understand WHY something works doesn’t mean we shouldn’t use it–particularly when it is so obviously superior to another approach.
Here’s another study to consider:
Klaus Linde undertook two studies of headache treatment for acupuncture. Here are the reported results:
Overall, following a course of at least eight weeks, patients treated with acupuncture suffered fewer headaches compared to those who were given only pain killers. In the migraine study, acupuncture was superior to proven prophylactic drug treatments, but faked treatments were no less effective. In the tension headache study, true acupuncture was actually slightly more effective than faked treatments.”
So what do you think the popular press headlines said? Yep–you guessed it. Acupuncture is just a placebo. Many didn’t bother honestly reporting the fact that even “fake” acupuncture is better than pain killers.
So, does placebo account for the totality of acupuncture’s positive effects? Certainly not.
In my next post, I’ll discuss some of the objective evidence of acupuncture’s effectiveness beyond placebo. Meanwhile, you can feel good knowing even “fake” acupuncture is better than real drugs.