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Definite Proof: Acupuncture More Than Placebo

Enough with answering back at mudslingers.  I get more than enough of that in the local media, with the Philippine elections just around the corner.  Let’s move on to being proactive instead of being defensive.

A common “debunking” technique of anti-acupuncture bigots is to come up with “evidence” that acupuncture is clinical similar to placebo and then “conclude” that acupuncture is therefore useless or irrelevant.  This plays the assumption that placebo = no effect, when in actuality placebo  = the doc does nothing but the patient feels an effect. (http://qi-spot.com/2010/04/28/the-smear-campaign-continues-acupuncture-does-not-relieve-childbirth-pain/)

Of course, even if both acupuncture and sham acupuncture have clinical effects that seem similar (and studies have shown that the real thing beats the fake stuff, even if not by much), the argument the skeptics pose is that if acupuncture is no different than placebo, then what’s the point of doing real acupuncture at all?

Well, a while back, I posted about a study I was looking forward to. (http://qi-spot.com/2010/04/04/a-study-to-look-forward-to-acupuncture-more-than-just-placebo/).  Thanks to Chris, I now have the whole article.   I would like to start by quoting thus:

As long as acupuncture and sham acupuncture treatments produce similar clinical improvements, the results of respective trials can only be taken as evidence against the efficacy of acupuncture. (I don’t think so… – Philip) Only when it can be shown that acupuncture and sham acupuncture effects are mediated differently, this can be taken as evidence that acupuncture effects are different from placebo effects, although both may still be equally effective.

I still can’t help but detect a bit of bias.  When something can be interpreted negatively, it “can only be taken as evidence against…” meaning there is no other way to interpret it, supposedly.

Coke can Definite Proof: Acupuncture More Than Placebo

Similar clinical effect, different mechanism of action

Still the point is valid.  If we can show that the real deal triggers physiologic reactions distinct from sham, then that should construe evidence that acupuncture is not only valid, but should be encouraged.

According to the article “Acupuncture, Psyche and the Placebo Response” (the article mentioned above) they HAVE found such physiologic differences.  Why does this matter?  It matters because a) skeptics can’t say it’s like placebo anymore and b) we now have an increased knowledge of acupuncture mechanism of action, which is more than what we can say for such western drugs as lithium.

533d8cf85e38b801ac15cad9c45dd896 Definite Proof: Acupuncture More Than Placebo

Take two of these and call me in the morning, even if we don't know how they work

So how does the real thing differ from the fake stuff?  Let’s count the ways as enumerated by Enck et al:

a) “Acupuncture but not sham acupuncture was found to induce both cerebellar as well as limbic cortex activation indicating both motor as well as affective component modulation of the pain matrix.  Acupuncture resp. electroacupuncture at non-acupuncture points and tactile stimulation alone served as controls in early fMRI studies (Wu et al., 2002; Yoo et al.m 2004)

b) Verum (true) acupuncture in contrast to non-penetrating placebo nedles activated cortical centers involved in affective pain modulation (Chae et al., 2009)

c) Greater activation of sensorimotor areas by sham procedure (superficial manipulation at acupuncture points) than by true acupuncture (Napadow et al 2009) – (note that stimulation of true acupuncture points by non-needling methods was considered sham by the authors, whereas in chinese medicine it is a valid method of stimulation)

d) Variances of time of central activation between verum and sham acupuncture, attributed to stronger peripheral actions of true acupuncture

e) PET scans on fibromyalgia patients show that needling at true points elicited significant activation of mu opoid receptor binding capacity in the cingulate, caudate, thalamus and amygdala both after one session and after four weeks, while with sham (insertion into non acupuncture points), small DEactivations were noted, an effect that is seen with placebo analgesia. (Zubieta et al., 2005)

There are more, but these should suffice to prove the point.

All in all I believe this evidence validates my personal belief that real acupuncture has longer lasting effects than sham acupuncture.  This is shown by the fact that real acupuncture has more central (meaning up in the brain, as opposed to just local pain mediation) effects.

Another thing worth noting is that different people have different definitions of sham.  For some, it’s using real points but not inserting.  For others, it’s inserting into non-acupoints.  Logic dictates that both have different effects.  Controls used in acupuncture studies should be standardized!

The crazy thing is that all this has been known by Stux, Berman and others since I was in grammar school in the early 80s!  Jeez!

_________________________
Enck, P., et al., Acupuncture, psyche and the placebo response.  Auton. Neurosci. (2010), http://www.ncbi.nlm.nih.gov/pubmed/20359961
Harris, Zubieta et al. ” Traditional Chinese Acupuncture and placebo (sham) acupuncture are differentiated by their effects on Mu-Opioid Receptors (MORS)” Neuroimage.  2009 Sep; 47(3):1077-85. Epub 2009 Jun 6. http://www.ncbi.nlm.nih.gov/pubmed/19501658

 

 

 

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  1. Calum thomson
    April 27th, 2011 at 17:02 | #1

    We might also add that the sham needling/needling into places that aren’t actual points control mechanism would constitute a treatment using the sinew meridians. Not widely practiced but there it is sitting in Deadman and the Ling Shu. I do use them in my practice and they involve needling areas of tension to release the fascia, the needling is very shallow and more or less involves agitating the uppermost layers of the fascia and skin. You don’t use points per se and you can do them using a cocktail stick or something similar that doesn’t break the skin. They apply to musculo-skeletal conditions but can be used to treat all sorts. I’ve controlled colitis using them, for instance. Is ‘sham needling’ sham needling then, in the context of the sinews the answer would be no.

  2. Kendra
    September 30th, 2011 at 18:07 | #2

    you dont actually prove anything, you just write a bunch of bull and try to make it look like science by using smart-looking words. in conclusion, you are an idiot.

  3. Philip
    October 6th, 2011 at 22:40 | #3

    Kendra, you are absolutely right in that I, personally, don’t prove anything.

    The scientists who published their data on peer reviewed, respected journals are the ones who conducted the experiments and validated the points (pun intended). They’re the ones who did the proving.

    I encourage you to look through Enck’s article, examine each and every article whose authors and study titles I quoted from Enck, and tell them your complaints and opinions. You know, those neuroscientists and doctors and all who probably don’t know diddly-squat about physiology and anatomy?

  4. Philip
    October 6th, 2011 at 22:44 | #4

    http://www.ncbi.nlm.nih.gov/pubmed/20359961 link to the article. above link is outdated

  5. March 27th, 2012 at 07:05 | #5

    Thanks for the interesting post, I’ve been looking for acupuncture research like that. Looking at those studies, it seems there are a few arguments going on. One is the metaphorical/mystical acupuncture theories vs. the scientific/neuroanatomical theories. Another is all fans of acupuncture vs. rudely dismissive people like Kendra. As an acupuncturist who is also skeptical of many things, I am very much wanting to know how much more effective my (mostly TCM based) acupuncture is than placebo or random acupuncture. I also want to know what conditions are more amenable to acupuncture. The best (Cochrane reviewed) research suggests real acupuncture is a little better than placebo for pain and nausea (especially musculo-skeletal and back pain). It also suggests that acupuncture has no good supportive research for some things like uterine fibroids or smoking cessation. It is probably more difficult for acupuncturists to deal with the idea that acupuncture isn’t effective for smoking or fibroids than it is for skeptics to accept the idea that acupuncture may be a reasonable treatment for low-back pain. With the wide variety of therapies in the Traditional Chinese Medical system, from diet and exercise to herbs and acupuncture, it is clear to me that Chinese doctors in the past didn’t feel acupuncture was the answer for every condition. The idea that with proper point selection, anything can be treated effectively with acupuncture seems unrealistic and is perhaps where some acupuncturists go too far. I’ve met some acupuncturists who believe this so much that they feel bad about themselves and their abilities when they can’t treat a particular patient or disease. It seems more realistic (and better for mental health) to start to narrow down a list of conditions which are more amenable to good responses to acupuncture, which should include many types of muscle and nerve pain. I’ve been impressed by the results some of my patients have had with my acupuncture for things I didn’t think would respond as well as they did (i.e. allergies, temporary improvement in advanced Alzheimer’s disease, some skin conditions…). It’s hard to know to what degree the ‘placebo’ of being treated well in a nice clinic has contributed to these effects, and what is caused by acupuncture causing a chemical or electrical response in the body. I’m very interested to find out, and will be following your blog and good quality acupuncture research to continue my quest.

    Thanks!

    Kevin O’Neil, L.Ac.

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