Acupuncture Beer Goggles

Acupuncture Beer Goggles

I have been writing a lot about acupuncture in the last few weeks. Perhaps it is because there are just more papers to evaluate about acupuncture, it being the pseudo-medicine with the most active presence on the Pubmeds.

Sham acupuncture is no better than real acupuncture for the relief of pain. The usual interpretation is that if an intervention is no different that a placebo, the intervention does not work. But there is always the issue that sham and real acupuncture (as if there is a difference) are better at relieving pain than doing nothing.

​I have always referred to pseudo-medical therapies as beer goggles: they do not change reality, they just change the perception of reality. Changing perception of disease is an important result in an interaction with the patient. I attempt it all the time, although unlike pseudo-medical practitioners, I do it truthfully.

Little did I realize there is medical term for beer goggles: tactile discrimination training. It is

stimulation of some form is applied to the painful area and the patient is asked to decide on the locality or type of stimulation, an approach that has been shown to be effective in the management of certain chronic pain problems.

In this study they decided to compare acupuncture to acupuncture used as tactile discrimination training in chronic low back pain. The protocol was

After locating the points, the 14 needles were inserted. We used 15 mm needles fully inserted to ensure that the depth of needling was the same across conditions. In the experimental condition, participants participated in a sensory discrimination training task similar to that described by Moseley et al.19 A picture of a back with the position of each needle numbered (see figure 1) was positioned so that it could be comfortably viewed by the participant. The clinician then rotated a single needle in accordance with a random number sequence and the participant was required to nominate which needle was being stimulated, if the participant committed an error, they were told which point had in fact been stimulated. Each needle was stimulated for 3 s with a 10-s interval between each stimulus. This task was performed with visualization of the back via a mirror in the first 10 min and progressed to no visualization in the last 10 min. In the control condition, participants were asked to lay comfortably and relaxed and to not attend to the needles. During the 20 min control condition the therapist manipulated needles at the same rate and using the same random sequence as they did in the experimental condition.

Both interventions were done my the same person, an acupuncturist, so any clever Hans effect would likely be in favor of acupuncture. The only difference between the acupuncture and the tactile discrimination was in the latter they patient was asked to tell which needle was being manipulated vrs lying there and ignoring the needles.

And the tactile discrimination acupuncture outperformed acupuncture for pain reduction.

This helps explain why sham and real acupuncture have the same effect and better than no therapy, why acupuncture does not depend upon where the needles are placed or even if needles are used. It is a form of tactile discrimination training, aka beer goggles. Perception is altered, not underlying pathology.  Now if there were just a way to use pseudo-medicines without being unethical.  

Rationalization

Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: a randomized cross-over experiment Br J Sports Med doi:10.1136/bjsports–2013–092949 http://bjsm.bmj.com/content/early/2013/09/10/bjsports–2013–092949

Pain. 2008 Jul 31;137(3):600–8. Epub 2007 Dec 3. Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain. http://www.ncbi.nlm.nih.gov/pubmed/18054437

Points of Interest: 1/28/2014
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