Is Placebo Acupuncture What It Is Intended to Be?

Abstract

Randomized, placebo-controlled clinical trials are recommended for evaluation of a treatment's efficacy with the goal of separating the specific effects (verum) from the non-specific ones (placebo). In order to be able to carry out placebo-controlled acupuncture trials, minimal/sham acupuncture procedures and a sham acupuncture needle has been used with the intention of being inert. However, clinical and experimental results suggest that sham/minimal acupuncture is not inert since it is reported that both verum acupuncture and sham/minimal acupuncture induce a significant alleviation of pain. This alleviation is as pronounced as the alleviation obtained with standard treatment and more obvious than the one obtained with placebo medication or by the use of waiting list controls. These results also suggest that sham acupuncture needles evoke a physiological response. In healthy individuals sham acupuncture results in activation of limbic structures, whereas a deactivation is seen in patients with pain, i.e. results from healthy individuals do not reflect what is seen in clinical conditions. Also, depending on the etiology of pain (or any under clinical condition under investigation), the response to sham acupuncture is varying. The acupuncture ritual may also be seen as an emotional focused therapy allowing for psychological re-orientation. Sham needling in such context may be as powerful as verum acupuncture. We recommend that the evaluated effects of acupuncture could be compared with those of standard treatment, also taking the individual response into consideration, before its use or non-use is established.

Efficacy of auriculotherapy for the reduction of stress in nursing students: a randomized clinical trial

“…Considering the seeds and semi-permanent needles, the group with needles, when compared to the control group without intervention, achieved statistically significant differences after Given the complexity of the subject, it is recommended that the effects evaluated of the sham acupuncture be compared with a standard treatment, also taking into account the possible individual responses (19) .…”

Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial

“…In the present study, we did not use placebo or sham needles or minimal acupuncture, because studies suggest that that these are not inert treatments (8,22,23,28). Instead, our research question aimed to elucidate whether acupuncture is superior to the time and attention of meeting with the therapist.…”

Electroacupuncture counteracts the development of thermal hyperalgesia and the alteration of nerve growth factor and sensory neuromodulators induced by streptozotocin in adult rats

“…with 20 mmol/l citrate, pH 4.5; 12 rats were injected with streptozotocin as described above (STZ group); and 12 rats were injected with streptozotocin and treated twice a week with lowfrequency electroacupuncture (described below) for three consecutive weeks starting 1 week after diabetes induction (STZ+EA group). Control of electroacupuncture by minimal or superficial sensory stimulation (sham electroacupuncture) in diabetic rats was omitted since it does not represent an inert intervention, often producing significant responses comparable to those elicited by acupuncture itself [32]. Electoacupuncture in control rats was also omitted because of its demonstrated different effects in healthy and diseased persons [32].…”

“…Control of electroacupuncture by minimal or superficial sensory stimulation (sham electroacupuncture) in diabetic rats was omitted since it does not represent an inert intervention, often producing significant responses comparable to those elicited by acupuncture itself [32]. Electoacupuncture in control rats was also omitted because of its demonstrated different effects in healthy and diseased persons [32].…”