Minimal acupuncture is not a valid placebo control in randomised controlled trials of acupuncture: a physiologist's perspective
25/05/09 14:39 | Acupuncture research
Abstract
Placebo-control of acupuncture is used to evaluate and distinguish between the specific effects and
the non-specific ones. During 'true' acupuncture treatment in general, the needles are inserted into
acupoints and stimulated until deqi is evoked. In contrast, during placebo acupuncture, the needles
are inserted into non-acupoints and/or superficially (so-called minimal acupuncture). A sham
acupuncture needle with a blunt tip may be used in placebo acupuncture. Both minimal acupuncture
and the placebo acupuncture with the sham acupuncture needle touching the skin would evoke
activity in cutaneous afferent nerves. This afferent nerve activity has pronounced effects on the
functional connectivity in the brain resulting in a 'limbic touch response'. Clinical studies showed
that both acupuncture and minimal acupuncture procedures induced significant alleviation of
migraine and that both procedures were equally effective. In other conditions such as low back pain
and knee osteoarthritis, acupuncture was found to be more potent than minimal acupuncture and
conventional non-acupuncture treatment. It is probable that the responses to 'true' acupuncture
and minimal acupuncture are dependent on the aetiology of the pain. Furthermore, patients and
healthy individuals may have different responses. In this paper, we argue that minimal acupuncture
is not valid as an inert placebo-control despite its conceptual brilliance.
Full article is available from: http://www.cmjournal.org/content/4/1/1
Placebo-control of acupuncture is used to evaluate and distinguish between the specific effects and
the non-specific ones. During 'true' acupuncture treatment in general, the needles are inserted into
acupoints and stimulated until deqi is evoked. In contrast, during placebo acupuncture, the needles
are inserted into non-acupoints and/or superficially (so-called minimal acupuncture). A sham
acupuncture needle with a blunt tip may be used in placebo acupuncture. Both minimal acupuncture
and the placebo acupuncture with the sham acupuncture needle touching the skin would evoke
activity in cutaneous afferent nerves. This afferent nerve activity has pronounced effects on the
functional connectivity in the brain resulting in a 'limbic touch response'. Clinical studies showed
that both acupuncture and minimal acupuncture procedures induced significant alleviation of
migraine and that both procedures were equally effective. In other conditions such as low back pain
and knee osteoarthritis, acupuncture was found to be more potent than minimal acupuncture and
conventional non-acupuncture treatment. It is probable that the responses to 'true' acupuncture
and minimal acupuncture are dependent on the aetiology of the pain. Furthermore, patients and
healthy individuals may have different responses. In this paper, we argue that minimal acupuncture
is not valid as an inert placebo-control despite its conceptual brilliance.
Full article is available from: http://www.cmjournal.org/content/4/1/1