Effectiveness of a placebo intervention on visually induced nausea in women - A randomized controlled pilot study.

OBJECTIVE: Improvement of nausea by placebo interventions has recently been demonstrated in clinical trials and experimental settings. However, many questions regarding placebo effects on nausea remain unanswered. For example, nausea reduction in women could only be achieved when the placebo intervention was "enhanced" by conditioning, while men responded primarily to verbally suggested improvement. It is unclear whether these findings are generalizable or were due to situational variables. In this pilot study, we investigated the effects of sham acupuncture point stimulation and verbal suggestions on visually-induced nausea in a female population. METHODS: In a within-subjects design, 21 healthy female volunteers underwent both a placebo condition and a natural history condition (control condition) in a randomized order on two separate days. On both days, nausea was induced through optokinetic stimulation. On the placebo day, participants received sham acupuncture point stimulation together with positive verbal suggestions of nausea improvement. Expected and perceived nausea severity as well as symptoms of motion sickness were repeatedly assessed. RESULTS: Twenty participants completed both testing days. Participants developed significantly less nausea on the placebo day compared to the control day (p<0.001), and the effect size of placebo-induced nausea reduction was large (partial η2=0.71). Symptoms of motion sickness were also reduced (p=0.003). Expectation of nausea decreased following the placebo intervention as compared to no treatment (p=0.030), indicating successful expectancy manipulation. CONCLUSION: Sham acupuncture point stimulation combined with verbal suggestions induced a significant placebo effect on visually-induced nausea in women.

Pain and sensory detection threshold response to acupuncture is modulated by coping strategy and acupuncture sensation.

BACKGROUND: Acupuncture has been shown to reduce pain, and acupuncture-induced sensation may be important for this analgesia. In addition, cognitive coping strategies can influence sensory perception. However, the role of coping strategy on acupuncture modulation of pain and sensory thresholds, and the association between acupuncture sensation and these modulatory effects, is currently unknown. METHODS: Electroacupuncture (EA) was applied at acupoints ST36 and GB39 of 61 healthy adults. Different coping conditions were experimentally designed to form an active coping strategy group (AC group), who thought they could control EA stimulation intensity, and a passive coping strategy group (PC group), who did not think they had such control. Importantly, neither group was actually able to control EA stimulus intensity. Quantitative sensory testing was performed before and after EA, and consisted of vibration (VDT), mechanical (MDT), warm (WDT), and cold (CDT) detection thresholds, and pressure (PPT), mechanical (MPT), heat (HPT) and cold (CPT) pain thresholds. Autonomic measures (e.g. skin conductance response, SCR) were also acquired to quantify physiological response to EA under different coping conditions. Subjects also reported the intensity of any acupuncture-induced sensations. RESULTS: Coping strategy was induced with successful blinding in 58% of AC subjects. Compared to PC, AC showed greater SCR to EA. Under AC, EA reduced PPT and CPT. In the AC group, improved pain and sensory thresholds were correlated with acupuncture sensation (VDTchange vs. MI: r=0.58, CDTchange vs. tingling: r=0.53, CPTchange vs. tingling; r=0.55, CPTchange vs. dull; r=0.55). However, in the PC group, improved sensory thresholds were negatively correlated with acupuncture sensation (CDTchange vs. intensity sensitization: r=-0.52, WDTchange vs. fullness: r=-0.57). CONCLUSIONS: Our novel approach was able to successfully induce AC and PC strategies to EA stimulation. The interaction between psychological coping strategy and acupuncture sensation intensity can differentially modulate pain and sensory detection threshold response to EA. In a clinical context, our findings suggest that instructions given to the patient can significantly affect therapeutic outcomes and the relationship between acupuncture intensity and clinical response. Specifically, acupuncture analgesia can be enhanced by matching physical stimulation intensity with psychological coping strategy to acupuncture contexts. TRIAL REGISTRATION: KCT0000905.

Expectancy in real and sham electroacupuncture: does believing make it so?

BACKGROUND: The large placebo effect observed in prior acupuncture trials presents a substantial challenge for interpretation of the efficacy of acupuncture. We sought to evaluate the relationship between response expectancy, a key component of the placebo effect over time, and treatment outcome in real and sham electroacupuncture (EA). METHODS: We analyzed data from a randomized controlled trial of EA and sham acupuncture (SA) for joint pain attributable to aromatase inhibitors among women with breast cancer. Responders were identified using the Patient Global Impression of Change instrument at Week 8 (end of intervention). The Acupuncture Expectancy Scale (AES) was used to measure expectancy four times during the trial. Linear mixed-effects models were used to evaluate the association between expectancy and treatment response. RESULTS: In the wait list control group, AES remained unchanged over treatment. In the SA group, Baseline AES was significantly higher in responders than nonresponders (15.5 vs 12.1, P = .005) and AES did not change over time. In the EA group, Baseline AES scores did not differ between responders and nonresponders (14.8 vs 15.3, P = .64); however, AES increased in responders compared with nonresponders over time (P = .004 for responder and time interaction term) with significant difference at the end of trial for responders versus nonresponders (16.2 vs 11.7, P = .004). CONCLUSIONS: Baseline higher response expectancy predicts treatment response in SA, but not in EA. Divergent mechanisms may exist for how SA and EA influence pain outcomes, and patients with low expectancy may do better with EA than SA.

Acupuncture with manual and low frequency electrical stimulation as experienced by women with polycystic ovary syndrome: a qualitative study.

BACKGROUND: Polycystic ovary syndrome (PCOS) affects 5-10 percent of all fertile women and is associated with anovulation/oligoovulation, hyperandrogenism, and polycystic ovaries. Pharmacological treatment is often effective but associated with unwanted side effects. Acupuncture treatments have been shown to improve menstrual bleeding patterns and ovulation as well as hyperandrogenism, without side effects. The purpose of the present study was to describe the experience of acupuncture for women diagnosed with PCOS. METHODS: Eight women with PCOS living in western Sweden, were interviewed following repeated acupuncture treatments. Data was analyzed using systematic text condensation as described by Malterud. RESULTS: The experience of acupuncture for women diagnosed with PCOS can be described in five categories; the experience of hope, getting results, feelings of responsibility, skepticism and proof of effect, and feeling normal. CONCLUSION: Since acupuncture is a promising treatment for the symptoms of the common syndrome PCOS, the present study adds to the knowledge base by providing the important experiences of patients receiving the treatment. Acupuncture provides a possibility for patients to gain hope as the treatment shows results. The results show that acupuncture empowers the patients to take responsibility for their future well-being, although they may have been initially skeptical to the treatment. Because the syndrome had affected them for some time, even small changes offered a chance for them to feel that their bodies were capable of normal function.

Stereotactic core biopsy of an impalpable screen-detected breast lesion using acupuncture-analgesia.

Chinese acupuncture-analgesia is used for pain management during various surgical procedures. Over the past 40 years this approach has been introduced in many countries and has been particularly helpful in the investigation and treatment of patients who are unable to tolerate conventional analgesia. We report here the case of a woman with a 17-year history of myalgic encephalitis who underwent a stereotactic core biopsy of the breast under acupuncture-analgesia. A planning session was needed to assess the patient's existing condition and her response to acupuncture. During this session, a range of frequencies for electrical stimulation of the acupuncture needles using electro-acupuncture apparatus was determined. We describe the combined acupuncture and biopsy procedures and the patient's impressions and outcomes are recorded.

A randomized controlled trial of acupuncture for osteoarthritis of the knee: effects of patient-provider communication.

OBJECTIVE: There is conflicting evidence on the efficacy of traditional Chinese acupuncture (TCA), and the role of placebo effects elicited by acupuncturists' behavior has not been elucidated. We conducted a 3-month randomized clinical trial in patients with knee osteoarthritis to compare the efficacy of TCA with sham acupuncture and to examine the effects of acupuncturists' communication styles. METHODS: Acupuncturists were trained to interact in 1 of 2 communication styles: high or neutral expectations. Patients were randomized to 1 of 3 style groups, waiting list, high, or neutral, and nested within style, TCA or sham acupuncture twice a week over 6 weeks. Sham acupuncture was performed in nonmeridian points with shallow needles and minimal stimulation. Primary outcome measures were Joint-Specific Multidimensional Assessment of Pain (J-MAP), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction scores. RESULTS: Patients (n = 455) received treatment (TCA or sham) and 72 controls were included. No statistically significant differences were observed between TCA or sham acupuncture, but both groups had significant reductions in J-MAP (-1.1, -1.0, and -0.1, respectively; P < 0.001) and WOMAC pain (-13.7, -14, and -1.7, respectively; P < 0.001) compared with the waiting group. Statistically significant differences were observed in J-MAP pain reduction and satisfaction, favoring the high expectations group. In the TCA and sham groups, 52% and 43%, respectively, thought they had received TCA (κ = 0.05), suggesting successful blinding. CONCLUSION: TCA was not superior to sham acupuncture. However, acupuncturists' styles had significant effects on pain reduction and satisfaction, suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist's behavior.

Psychophysical outcomes from a randomized pilot study of manual, electro, and sham acupuncture treatment on experimentally induced thermal pain.

UNLABELLED: In this pilot study comparing the analgesic effects of three acupuncture modes--manual, electro, and placebo (with Streitberger placebo needles)--in a cohort of healthy subjects, we found that verum acupuncture treatment, but not placebo, lowered pain ratings in response to calibrated noxious thermal stimuli. This finding was mainly the result of highly significant analgesia in 5 of the 11 subjects who completed the 5-session study. Of the 5 responders, 2 responded only to electroacupuncture and 3 only to manual acupuncture, suggesting that acupuncture's analgesic effects on experimental pain may be dependent on both subject and mode. We developed a simple quantitative assessment tool, the Subjective Acupuncture Sensation Scale (SASS), comprised of 9 descriptors and an anxiety measure to study the relationship between the deqi sensation induced by acupuncture and the putative therapeutic effects of acupuncture. The SASS results confirm that the deqi sensation is complex, with all subjects rating multiple descriptors during each mode. We found significant correlations of analgesia with SASS ratings of numbness and soreness, but not with ratings of stabbing, throbbing, tingling, burning, heaviness, fullness, or aching. This suggests that attributes of the deqi sensation may be useful clinical indicators of effective treatment. PERSPECTIVE: The results of this study indicate the existence of both individual subject and acupuncture mode variability in the analgesic effects of acupuncture. This suggests that switching acupuncture mode may be a treatment option for unresponsive patients.