Phantom Acupuncture Induces Placebo Credibility and Vicarious Sensations: A Parallel fMRI Study of Low Back Pain Patients

Makary, Meena M.; Lee, Jeungchan; Lee, Eun-Young; Eun, Seulgi; Kim, Jieun; Jahng, Geon‐Ho; Kim, Kiok; Youn, Yousuk; Lee, Jun-Hwan; Park, Kyungmo

doi:10.1038/s41598-017-18870-1

Cited by 33 publications

(56 citation statements)

References 118 publications

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“…Although sham acupuncture produced a minor benefit in reducing migraine attacks, the differences between manual acupuncture and sham acupuncture support the specific effects of manual acupuncture. On the basis of our results, clinical acupuncturists should pay careful attention to the specific components of acupuncture, including acupuncture points, needle manipulation, and acupuncture sensations, and the non-specific effects of acupuncture (acupuncture ritual or expectation for efficacy5152) should also not be neglected in clinical practice. In randomised controlled trials of acupuncture, the sham acupuncture group should not use penetrating needles.…”

Section: Discussionmentioning

confidence: 92%

Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial

Luo

et al. 2020

BMJ

146

123

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Objective To assess the efficacy of manual acupuncture as prophylactic treatment for acupuncture naive patients with episodic migraine without aura. Design Multicentre, randomised, controlled clinical trial with blinded participants, outcome assessment, and statistician. Setting Seven hospitals in China, 5 June 2016 to 15 November 2018. Participants 150 acupuncture naive patients with episodic migraine without aura. Interventions 20 sessions of manual acupuncture at true acupuncture points plus usual care, 20 sessions of non-penetrating sham acupuncture at heterosegmental non-acupuncture points plus usual care, or usual care alone over 8 weeks. Main outcome measures Change in migraine days and migraine attacks per four weeks during weeks 1-20 after randomisation compared with baseline (four weeks before randomisation). Results Among 150 randomised patients (mean age 36.5 (SD 11.4) years; 123 (82%) women), 147 were included in the full analysis set. Compared with sham acupuncture, manual acupuncture resulted in a significantly greater reduction in migraine days at weeks 13 to 20 and a significantly greater reduction in migraine attacks at weeks 17 to 20. The reduction in mean number of migraine days was 3.5 (SD 2.5) for manual versus 2.4 (3.4) for sham (adjusted difference −1.4, 95% confidence interval −2.4 to −0.3; P=0.005) at weeks 13 to 16 and 3.9 (3.0) for manual versus 2.2 (3.2) for sham (adjusted difference −2.1, −2.9 to −1.2; P<0.001) at weeks 17 to 20. At weeks 17 to 20, the reduction in mean number of attacks was 2.3 (1.7) for manual versus 1.6 (2.5) for sham (adjusted difference −1.0, −1.5 to −0.5; P<0.001). No severe adverse events were reported. No significant difference was seen in the proportion of patients perceiving needle penetration between manual acupuncture and sham acupuncture (79% v 75%; P=0.891). Conclusions Twenty sessions of manual acupuncture was superior to sham acupuncture and usual care for the prophylaxis of episodic migraine without aura. These results support the use of manual acupuncture in patients who are reluctant to use prophylactic drugs or when prophylactic drugs are ineffective, and it should be considered in future guidelines. Trial registration Clinicaltrials.gov NCT02765581 .

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Section: Discussionmentioning

confidence: 92%

Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial

Luo

et al. 2020

BMJ

146

123

View full text Add to dashboard Cite

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“…However, the mechanisms that mediate acupuncture and imagery efficacy remain poorly understood. Neuroimaging studies have found that acupuncture needle manipulation can produce wide-spread brain activations and deactivations [10][11][12][13][14]. Studies have also found that imagined experiences can produce brain responses similar to those that occur during actual experiences [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…Makary et al [13] investigated the effect of a specific form of sham acupuncture (phantom acupuncture (PHNT)) that reproduces the acupuncture needling procedure without somatosensory tactile stimulation. They found that PHNT can produce bilateral activation in the primary and secondary somatosensory cortex in patients with low back pain.…”

Section: Introductionmentioning

confidence: 99%

Imagined and Actual Acupuncture Effects on Chronic Low Back Pain: A Preliminary Study

et al. 2020

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Background. Research suggests that imagined experiences can produce brain responses similar to those produced by actual experiences. Shared brain responses that support both imagination and perception may underlie the functional nature of mental imagery. In a previous study, we combined acupuncture and imagery to develop a new treatment method, video-guided acupuncture imagery treatment (VGAIT). We found that VGAIT significantly increased pain thresholds in healthy subjects. The aim of this study is to extend our previous finding by investigating whether VGAIT can relieve symptoms in patients with chronic low back pain. Methods. We first performed a single-arm study in which we administered video-guided acupuncture imagery treatment (VGAIT) on patients with chronic low back pain (cLBP) (Study 1, n=18, 12 females). We then compared our findings to those from a recently published study in which real or sham acupuncture treatment was applied on patients with cLBP (Study 2, n=50, 31 females) using a similar protocol. All patients in Studies 1 and 2 received 6 treatments over 4 weeks. Results. All three treatments (VGAIT, real, and sham acupuncture) significantly reduced pain severity as measured by a low back pain bothersomeness score. VGAIT produced similar effects to real acupuncture (p=0.97) and nonsignificantly greater pain bothersomeness relief compared to sham acupuncture (p=0.14). Additional analysis showed that there was no significant difference on the sensations evoked by different treatment modalities. Conclusion. These findings support VGAIT as a promising method for pain management.

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“…However, not limited to this, the placebo effect also plays a role in treatment process. Research suggested that the sham acupuncture without somatosensory tactile stimulation could still improve the clinical symptoms [ 27 ]. The primary outcomes of our study suggested that clinical symptoms were improved in all groups after 5 weeks acupuncture treatment, including the N-Acu group (sham point).…”

Section: Discussionmentioning

confidence: 99%

“…Compared with the S-Acu group, the increased fALFF of the N-Acu group in anterior cingulate and insula were more obvious. Studies have shown that real acupuncture could exhibit greater activation in the anterior cingulate gyrus and insula regions than phantom acupuncture without somatosensory tactile stimulation [ 27 ]. However, sham acupuncture in our trial would produce pain stimulation, and MASS results showed that sharp pain scores were slightly higher than that in the S-Acu group, although there was no statistical difference between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and cerebral responses of multi-points acupuncture for primary insomnia: a preliminary randomized clinical trial and fMRI study

Wang

et al. 2020

BMC Complement Med Ther

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Background Primary insomnia (PI) is characterized by difficulties in initiating sleep or maintaining sleep, which lead to many serious diseases. Acupuncture for PI has drawn attention with its effectiveness and safety. However, the operation of choosing acupoints lacks scientific suggestion. Our trial aims to provide reference and scientific basis for the selection of acupoints and to explore its possible mechanism. Methods A patient-assessor-blinded, randomized and sham controlled trial was designed to compare the efficacy of 5-weeks acupuncture at a single acupoint, the combination of multi-acupoints, and a sham point. The Pittsburgh sleep quality index and Athens Insomnia Scale questionnaire were used for the primary clinical outcomes, while polysomnography was performed for the secondary clinical outcomes. The resting state functional MRI was employed to detect the cerebral responses to acupuncture. The brain activity in resting state was measured by calculating the fractional amplitude of low-frequency fluctuations (fALFF), which reflected the idiopathic activity level of neurons in the resting state. These results were analyzed by two factorial ANOVA test and post-hoc t-tests. Results The clinical outcomes suggest that acupuncture could improve clinical symptoms, and the combination of multi-acupoints might lead to a better clinical efficacy. The rs-fMRI results suggested that the brain activity of certain regions was related to the sleep experience, and acupuncture could regulate the activity of these regions. Furthermore, the combination of multi-acupoints could impact more regions which were influenced by the sleep experience. Conclusions Acupuncture has been proven to be beneficial for PI patients, and the combination of multi-acupoints might improve its efficacy. Trial registration This trial has been registered on the U.S. National Library of Medicine (https://clinicaltrials.gov) ClinicalTrials.gov Identifier: NCT02448602 . Registered date: 14/04/2015.

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Phantom Acupuncture Induces Placebo Credibility and Vicarious Sensations: A Parallel fMRI Study of Low Back Pain Patients

Cited by 33 publications

References 118 publications

Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial

Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial

Imagined and Actual Acupuncture Effects on Chronic Low Back Pain: A Preliminary Study

Effectiveness and cerebral responses of multi-points acupuncture for primary insomnia: a preliminary randomized clinical trial and fMRI study

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