Acupuncture: Beer Goggles or Over Priced Wine?

Acupuncture: Beer Goggles or Over Priced Wine?

Painting with a broad brush, I would say that acupuncture doesn’t work. By ‘work’ I would say that it has no effect to change the underlying physiology or anatomy of the person receiving the acupuncture.

'Works" is different from having an effect, even a beneficial effect. Positive interactions between a patient and a health care provider, even when offering a pseudo-medicine, will make some patients feel better about their disease. I compare these pseudo-medicines, like acupuncture, as beer goggles. They change perception but not reality.

While changing the perception of disease for the better is of benefit, it is just not ethical to base treatment on a lie.  

 What happens with a process like acupuncture to alter patients perception? It doesn’t matter where the needles are placed or even if needles are used; twirled tooth picks are just as effective. What matters most for efficacy is if the patient thinks they are getting acupuncture and if they believe acupuncture is effective. Then acupuncture will have an effect. That’s it. So what is going on?

Another hint on the mechanism of acupuncture is in When pain is not only pain: Inserting needles into the body evokes distinct reward-related brain responses in the context of a treatment.

In this study 24 people received three identical stimuli: tactile, acupuncture, and pain stimuli. There were two groups to receive the three stimuli, an acupuncture treatment (AT) group and an acupuncture stimulation (AS) group. What differed is what they were told before the stimuli

participants in the AS group were primed to consider the acupuncture as a painful stimulus, whereas the participants in the AT group were told that the acupuncture was part of therapeutic treatment. 

They had fMRI (who doesn’t) and a questionnaire about their subjective experience.

Behavioral results generally revealed no differences between the AT and AS groups. The questionnaire results confirmed that there were no significant differences in expectancies, fear, or anticipation and subjective pain ratings related to needles being inserted into the body between patients in the AT and AS groups.

They found no analgesic effect in the acupuncture group. But there was a difference in the fMRI (for what that is worth):

We found that reward-related regions (specifically, the ventral striatum) of the brain were activated by acupuncture stimulation and that in response to painful simulation, activity in pain-processing regions(the SII and DLPFC) was decreased only when participants were told that acupuncture needles were a therapeutic tool.

and

As greater activation of the ventral striatum is generally correlated with more expectations of pleasure and rewards, our results could be interpreted to suggest that acupuncture stimulation was associated with the expectation of a reward – possibly an analgesic effect – for patients experiencing acupuncture in the context of a treatment (AT group).

So depending on the context,  people process the same stimulus differently. A needle for therapeutic acupuncture is different than the exact same needle used for stimulation.

Maybe. It is a small study and fMRI’s have issues as we know from dead salmon. But taken in the context of the literature pointing to the predominantly positive subjective effects of pseudo-medicines it is curious finding.  Maybe not beer goggles; probably more like making wine taste better by giving it a higher price.

Points of Interest 12/24/2014
Points of Interest 11/22/2014