Abstract
With growing use of acupuncture treatment in various clinical conditions, the question
has been posed whether the reported effects reflect specific mechanisms of acupuncture
or whether they represent placebo responses, as they often are similar in effect size
and resemble similarities to placebo analgesia and its mechanisms. We reviewed the
available literature for different placebos (sham procedures) used to control the
acupuncture effects, for moderators and potential biases in respective clinical trials,
and for central and peripheral mechanisms involved that would allow differentiation
of placebo effects from acupuncture and sham acupuncture effects. While the evidence
is still limited, it seems that biological differences exist between a placebo response,
e.g. in placebo analgesia, and analgesic response during acupunture that does not
occur with sham acupuncture. It seems advisable that clinical trials should include
potential biomarkers of acupuncture, e.g. measures of the autonomic nervous system
function to verify that acupuncture and sham acupuncture are different despite similar
clinical effects.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Autonomic Neuroscience: Basic and ClinicalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Methods of blinding in reports of randomized controlled trials assessing pharmacologic treatments: a systematic review.PLoS Med. 2006; 3: e425
- Moffet on the similarity of response to “active” and “sham” acupuncture.J. Altern. Complement. Med. 2009; 15: 209-210
- The neural substrates of verum acupuncture compared to non-penetrating placebo needle: an fMRI study.Neurosci. Lett. 2009; 450: 80-84
- A meta-analysis of the placebo response in complementary and alternative medicine trials of irritable bowel syndrome.Neurogastroenterol. Motil. 2007; 19: 630-637
- The placebo response in functional bowel disorders: perspectives and putative mechanisms.Neurogastroenterol. Motil. 2005; 17: 325-331
- New insights into the placebo and nocebo responses.Neuron. 2008; 59: 195-206
- German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups.Arch. Intern. Med. 2007; 167: 1892-1898
- Irritable bowel syndrome patients' ideal expectations and recent experiences with healthcare providers: a national survey.Dig. Dis. Sci. 2010; 55: 375-383
- Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs).Neuroimage. 2009; 47: 1077-1085
- Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment.N. Engl. J. Med. 2001; 344: 1594-1602
- Is the placebo powerless? Update of a systematic review with 52 new randomized trials comparing placebo with no treatment.J. Intern. Med. 2004; 256: 91-100
- Sham device v inert pill: randomised controlled trial of two placebo treatments.BMJ. 2006; 332: 391-397
- Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome.BMJ. 2008; 336: 999-1003
- Are drug and placebo effects in depression additive?.Biol. Psychiatry. 2000; 47: 733-735
- Brain activity associated with expectancy-enhanced placebo analgesia as measured by functional magnetic resonance imaging.J. Neurosci. 2006; 26: 381-388
- An fMRI study on the interaction and dissociation between expectation of pain relief and acupuncture treatment.Neuroimage. 2009; 47: 1066-1076
- Spontaneous improvement in randomised clinical trials: meta-analysis of three-armed trials comparing no treatment, placebo and active intervention.BMC Med. Res. Methodol. 2009; 9: 1
- Changes in brain function of depressed subjects during treatment with placebo.Am. J. Psychiatry. 2002; 159: 122-129
- Analgesic responses to morphine and placebo in individuals with postoperative pain.Pain. 1981; 10: 379-389
- Minimal acupuncture is not a valid placebo control in randomised controlled trials of acupuncture: a physiologist's perspective.Chin. Med. 2009; 4: 1
- The Emperors sham — wrong assumption that sham needling is sham.Acupunct. Med. 2008; 26: 239-242
Lundeberg T., Lund I., Sing A., Näslund J. Is placebo acupuncture what it is intended to be? Evid Based Complement Alternat Med (in press) doi:10.1093/ecam/nep049.
- Imperfect placebos are common in low back pain trials: a systematic review of the literature.Eur. Spine J. 2008; 17: 889-904
- Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups.BMJ. 2009; 338: a3115
- Sham acupuncture devices — practical advice for researchers.Acupunct. Med. 2007; 25: 36-40
- Traditional acupuncture theories yield null outcomes: a systematic review of clinical trials.J. Clin. Epidemiol. 2008; 61: 741-747
- Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials.J. Altern. Complement. Med. 2009; 15: 213-216
- Brain encoding of acupuncture sensation — coupling on-line rating with fMRI.Neuroimage. 2009; 47: 1055-1065
- Time-variant fMRI activity in the brainstem and higher structures in response to acupuncture.Neuroimage. 2009; 47: 289-301
- Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture.Neuroimage. 2005; 25: 1161-1167
- The placebo effect in irritable bowel syndrome trials: a meta-analysis.Neurogastroenterol. Motil. 2005; 17: 332-340
- Defining the predictors of the placebo response in irritable bowel syndrome.Clin. Gastroenterol. Hepatol. 2005; 3: 237-247
- Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain.BMC Neurol. 2009; 9:6
- Antidepressants for neuropathic pain.Cochrane Database Syst. Rev. 2007; : CD005454
- Acupuncture treatment in irritable bowel syndrome.Gut. 2006; 55: 649-654
- Acupuncture treatment in gastrointestinal diseases: a systematic review.World J. Gastroenterol. 2007; 13: 3417-3424
- Neuroendocrinological effects of acupuncture treatment in patients with irritable bowel syndrome.Complement. Ther. Med. 2007; 15: 255-263
- Individual differences in reward responding explain placebo-induced expectations and effects.Neuron. 2007; 55: 325-336
- Placebo and nocebo effects are defined by opposite opioid and dopaminergic responses.Arch. Gen. Psychiatry. 2008; 65: 220-231
- Introducing a placebo needle into acupuncture research.Lancet. 1998; 352: 364-365
- Acupuncture compared to placebo-acupuncture for postoeprative nausea and vomiting prophylaxis: a randomised placebo-controlled patient and observer blind trial.Anaethesia. 2004; 59: 142-149
- A double-blind placebo needle for acupuncture research.BMC Complement. Altern. Med. 2007; 7: 31
- A placebo acupuncture needle with potential for double blinding — a validation study.Acupunct. Med. 2008; 26: 224-230
- Developing and validating a sham acupuncture needle.Acupunct. Med. 2009; 27: 118-122
- The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomised, single-blind, cross-over pilot trial.Pain. 2003; 106: 401-409
- Neuronal specificity of acupuncture response: a fMRI study with electroacupuncture.Neuroimage. 2002; 16: 1028-1037
- Modulation of cerebellar activities by acupuncture stimulation: evidence from fMRI study.Neuroimage. 2004; 22: 932-940
- Placebo effects mediated by endogenous opioid activity on mu-opioid receptors.J. Neurosci. 2005; 25: 7754-7762
Article info
Publication history
Published online: August 27, 2010
Accepted:
March 8,
2010
Received:
November 23,
2009
Identification
Copyright
© 2010 Elsevier B.V. Published by Elsevier Inc. All rights reserved.