More about acupuncture: press needles as a placebo


ResearchBlogging.org
Slightly tangential to my normal topics, I located this article today on a placebo procedure that may work for acupuncture.
Many people will be aware that in acupuncture, it’s really difficult to truly conduct a double-blind trial where both the person receiving and the person giving the treatment are unaware of which is the ‘active’ treatment. In fact ongoing criticism of many studies such as those reviewed in Cochrane reviews (and the recent post I made of Ernst’s review of 32 Cochrane reviews) is that in giving the ‘placebo’ treatment, the comparison is not really between acupuncture and placebo acupuncture, but it is instead of acupuncture with ‘something else’, and in doing this, much of the ‘active’ component of acupuncture is lost.

This paper, written by researchers from Kyushu University; and Fukuoka University, is in two parts: Part One ‘to evaluate the applicability and efficacy of the press needles, 90 participants who had never been treated using acupuncture were randomly assigned to receive either the press needle (n=45) or a placebo (n=45)’. This part of the study determined whether participants thought the needles penetrated their skin, and whether the intervention was in any way effective. The participants all had chronic low back pain, and the findings showed that there was no significant difference concerning the perception of penetration, and for patients with LBP, the press needles reduced the subjective evaluation of LBP compared with the placebo (P<0.05).
Just to clarify the two interventions: press needles are a device that look like this (see below), while the placebo has just the needle removed, so it looks exactly the same.
press needle

Part Two looked at ‘the mechanism for the analgesic effect of the press needles on LBP.‘ Before the press needle was inserted, an anesthetic patch (lidocaine) was applied for 30 min to block the peripheral nerve fibres around the acupoint site. The two groups were compared where one group was treated with the press needles after local anesthesia, and a second group who were treated with the press needles without anaesthetic. The findings from this study showed that LBP was reduced significantly more in the press needle group than in the local anesthesia group (P<0.05), suggesting that one potential action is via the peripheral nerve fibres around the acupoint site.

Of course, those who practice acupuncture suggest that it’s not simply the action of the acupuncture at the site of insertion but also the context of the treatment (the ch’i and balancing yin/yang and unblocking the flow of ch’i) – suggesting that unless you’re a ‘real’ acupuncturist you can’t replicate the ‘real’ action of acupuncture with all the nonspecific effects of the consultation and so on. Hmmm, if the practitioner is blind to whether or not the press needle has a needle, and carries out all the rest of the consultation as normal, perhaps these arguments will no longer hold.

I really do look forward to further studies using this device, so we can progress toward a methodologically sound way to establish whether acupuncture has any effect apart from those ‘nonspecific’ components of the consultation. If it does – then we can have the discussion about whether this intervention can be included as part of ongoing self management, or whether it should be something completed before self management is commenced.

One thing I’m always reminded of in being a scientist: I may need to revisit my opinion on whether an approach should be supported or not, depending on the cumulative evidence available. Dogmatic beliefs simply don’t belong in health practice.

Miyazaki S, Hagihara A, Kanda R, Mukaino Y, & Nobutomo K (2009). Applicability of press needles to a double-blind trial: a randomized, double-blind, placebo-controlled trial. The Clinical journal of pain, 25 (5), 438-44 PMID: 19454879

Ernst, E. (2009). Acupuncture: What Does the Most Reliable Evidence Tell Us? Journal of Pain and Symptom Management, 37 (4), 709-714 DOI: 10.1016/j.jpainsymman.2008.04.009

2 comments

  1. I immediately thought of you this morning when I sneak peeked at the first of next weeks integrated topic (Chronic pain:modulation and management ) lectures. Placebo response is going to be gone into (among other things) and this study involving acupuncture is mentioned! I so hope next week will be a bit more insightful than this weeks McKenzie and Mulligan “its a miracle” and “we dont really know how it works but it does” stuff.

    1. I hope you asked some ‘difficult’ questions!! If you want to look more into placebo you can’t go beyond reading Dan Moerman and also Benedetti and Colloca and colleagues. Some great food for thought. Just remember there are lots of reasons for people to find that their pain reduces after a treatment – even when the treatment has no active component. People ask for help when they’re most distressed, so distress reduces when they receive it; people who take action feel more control, so just seeking treatment reduces pain; chronic pain has a fluctuating course – so if it reduces after an inert treatment, people tend to attribute it to the treatment – and so on!
      Head to here for more detail.

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