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Acupuncture and the Placebo Effect

An interesting meta-analysis was recently published in the Annals of Internal Medicine.  It showed that acupuncture for knee arthritis can reduce pain, but its effects are likely due to the placebo effect.  The placebo effect is nicely described in Wikipedia:

A so-called placebo effect occurs when a patient’s symptoms are altered
in some way (i.e., alleviated or exacerbated) by an otherwise inert
treatment, due to the individual expecting or
that it will work. Some people consider this to be a remarkable aspect
of human physiology; others consider it to be an illusion arising from
the way medical experiments are conducted.

Because of the mind-body connection, we humans can actually alter our experience of pain if we will ourselves to do so.  We experience more intense pain when we’re depressed or particularly fixated upon it (via boredom for example).  And we experience less pain when we’re happy (take women immediately after giving birth – they barely even notice the Ob as she sews up their tears).

When it comes to pain management, there are many non-medical techniques that can improve the experience of pain, even if it doesn’t affect the physiology of it.  And so if we can find ways to put ourselves in a frame of mind that minimizes the pain sensations, that can be really valuable.

But as far as the physiology of acupuncture is concerned, we have not yet been able to explain exactly how it works.  I’ve often wondered if it may be due to the fact that the sharp pain fibers (stimulated by acupuncture needles in different locations) travel along slightly different nerve pathways than the fibers from the actual painful area for which one is getting the acupuncture.  The pain input might subconsciously distract the mind from the duller (or more chronic) pain input from the arthritic joint (or other pain generator).  This might explain why sham acupuncture works (meaning, putting the needles anywhere, rather than in certain specified meridians).

I’m sure some of you will disagree with this – and it’s only a theory.  But it does seem that inserting tiny sharp needles into the skin improves pain sensations in knee arthritis – no matter where the needles are put.  How do we explain this placebo effect?  I’m not sure – but if the treatment is quite harmless, and seems to decrease pain, how important is it to have an explanation?

And by the way, I was just about to post this when I found another interesting article about acupuncture in the journal Circulation.  In this study, they found that acupuncture (when performed 3-5 times a week for 30 minutes each time) was able to reduce blood pressure by about the same amount as a low dose ACE inhibitor pill.  Interestingly, though, in this case the needles placed according to Traditional Chinese Medicine (in certain meridians) rather than sham acupuncture (random placement) decreased blood pressure significantly more.  I wonder if the TCM placements are activating the autonomic nervous pathways in this case?

At this point the jury’s still out on how all this works.  But acupuncture does have measurable effects – even if they’re due to the placebo effect and/or stimulation of the autonomic nervous system.  The real question is: would you rather pop a pill each day or travel to and from an acupuncturist’s office 3-5 times a week for 30 minute treatment sessions?This post originally appeared on Dr. Val’s blog at

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2 Responses to “Acupuncture and the Placebo Effect”

  1. Amka says:

    The placebo effect really intrigues me. It is kind of hard to do studies on that effect specifically, but I think it would be very helpful to medicine.

    Hrmmm.. Here is an idea. What if we enrolled people in a study about a treatment for something, and give them some pills. It gets ‘leaked’ accidently to half of the people that they actually have a placebo some time into the treatment. They keep a daily log of symptoms before treatment and through the treatment.

    What would it tell us?

    Again, I think it is very cool just that it is there. If we can understand that, maybe we can make effective treatments even better as well as help those who have chronic pain issues with few options.

  2. Bradly Jacobs MD MPH says:

    This meta-analysis highlights how the selection of your control group can influence the study question and conclusions.  In acupuncture research, you can have a active or inactive control groups.  Active controls (like inserting needles in the wrong places on the body; known as insertion sham acupuncture) is like taking a low dose pain killer- they have healing effects.  Inactive controls (like taping a toothpick on the skin without penetrating the epidermis is like a ‘sugar pill’)-  the treatment has no healing effects and therefore any healing effect observed comes from expectancy and other self-healing (placebo) attributes.  This study tells me that acupuncture will help you (better than usual care/wait-list). As you correctly point out, location of needle placement may not be important for chronic pain conditions. The concept of ‘diffuse noxious inhibitory control’ is well-studied– every hurt your finger tip and find yourself shaking your hand to relieve the pain?   For a longer discussion, you can see my blog posting

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