Acupuncture and the Placebo Effect

[lavinia]

TL;DR Summary

What is the biological mechanism of the analgesic effect of acupuncture.?

Dr. Paul Offit in his book "Do You Believe in Magic?" mentions that acupuncture was tested against wrongly placed needles and retractible needles and all three had the same effect. He mentions this to illustrate the placebo effect which he attributes to the activation of endorphins which block the transmission of pain signals in nerves.

This review paper https://www.bmj.com/content/bmj/338/bmj.a3115.full.pdf?maxto-= finds some statistical differences between acupuncture, faux acupuncture, and placebo but does not see them as significant enough not to be explained by subtle bias in application. It also argues that the analgesic effect is small.

My question is: What is known about the biological mechanism of acupuncture, if any, and is there any real difference between it and the placebo effect?

Just as a confusing example: A friend insisted that acupuncture would "cure" my migraines which would seem to imply that it has some effect on the carotid arteries. So there should be some mechanism other than endorphin induced relief.

 

[Simon Bridge]

Since there is no verifiable medical effect beyond placebo, therefore there is no need to look further for a mechanism.

An acupuncture session could have va positive effect on your migranes.

What the session does is distract you from the migraine while you have a quiet lie down in a darkened room devoid of (other) stimulation. You know this helps with migraines anyway.

Note:
There is no single "placebo effect". The term groups a range of effects ... if you want to know the kinds of things that happen biologically in these effects, you can look them up.

 

[phinds]

Since there is no verifiable medical effect beyond placebo

John's Hopkins Medicine, citing the National Institute of Health, disagrees w/ you and they are both very reputable organizations, I assume you would agree.

https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture

National Institutes of Health (NIH) studies have shown that acupuncture is an effective treatment alone or in combination with conventional therapies to treat the following:

 

[Tom.G]

Interesting article, although inconclusive.
(Bold added.)

Acupuncture points are believed to stimulate the central nervous system.

Conditions that may benefit from acupuncture include...

Because scientific studies have not fully explained how acupuncture works within the framework of Western medicine, acupuncture remains a source of controversy.

 

[Simon Bridge]

What Tom said... also the John Hopkins article cited is out of date using poor studies.

There are also BMJ papers about acupuncture as a complimentary treatment, and UK NHS used to fund it. BMJ is a mainstream peer reviewed journal. This is a low bar. BMJ papers can be wrongnir misleading, so can John Hopkins articles.

Have you also looked through the lit for the many many studies that disagree?

I am familiar with the lit.
There is nothing there to contradict what I wrote.

Not long ago acupunctire was in a grey area of "maybe something there but not proved otherwise", now it is not contraversial to say it is not as advertised.

The mechanism is inside the usual range of normal placebo effects... as are the results.

ie.

The perported analgesic effect (summary to question) is just that patients have a higher pain threshold when they think something is done.

It has been very difficult to do good studies on acupuncture due to the difficulty of getting a control.

But if it worked as practitioners advertise, it wouldn't matter... results would be conclusively in favor. There wouldn't be this hair splitting.

 

[lavinia]

Interesting article, although inconclusive.
(Bold added.)

The placebo effect is a stimulation of the central nervous system. Endorphins are released in the brain - and also in the peripheral nervous system - and bind to the same receptors as morphine. This blocks the transmission of pain signals in nerves. Additionally Dopamine is activated and this confers a feeling of well being and a desire to repeat the experience. Dopamine apparently makes you want something that is experienced as a reward or as pleasurable. It has a role in Evolution to motivate an organism to repeat rewarding/pleasurable experiences. This is also why it is involved in addiction.

Dopamine is a powerful drug and has many physiological effects.

 

[Buzz Bloom]

My question is: What is known about the biological mechanism of acupuncture, if any, and is there any real difference between it and the placebo effect?

Hi Lavinia:

This is from direct personal knowledge. A friend whose dog had some serious organ related issues was treated with acupuncture. Lab tests showed subsequent major significant improvement. Another friend's dog had pain issues, and after the first acupuncture treatment the dog, without any encouragement, would jump up on to the table to receive more treatments.

To the best of my knowledge, it is generally assumed that the placebo effect does not work on dogs, but I am not aware of any specific tests about this.

Regards,
Buzz

 

[Rive]

The placebo effect is a stimulation of the central nervous system.

Placebo, as understood right now is a self induced stimulation of the central nervous system, only triggered by external means. The needles has no direct mechanism of effect.

Worth noting that a good, reliable placebo is still priceless, as long as it's not used instead a necessary (real) cure.

 

[phinds]

I am familiar with the lit.
There is nothing there to contradict what I wrote.

Fair enough