Specifying the nonspecific components of acupuncture analgesia

Lene Vase; Sara Baram; Nobuari Takakura; Hiroyoshi Yajima; Miho Takayama; Ted J Kaptchuk; Søren Schou; Troels Staehelin Jensen; Robert Zachariae; Peter Svensson

doi:10.1016/j.pain.2013.05.008

Specifying the nonspecific components of acupuncture analgesia

Lene Vase, Sara Baram, Nobuari Takakura, Hiroyoshi Yajima, Miho Takayama, Ted J Kaptchuk, Søren Schou, Troels Staehelin Jensen, Robert Zachariae, Peter Svensson

Section 01 - Prosthetics

48 Citations (Scopus)

Abstract

It is well known that acupuncture has pain-relieving effects, but the contribution of specific and especially nonspecific factors to acupuncture analgesia is less clear. One hundred one patients who developed pain of ≥ 3 on a visual analog scale (VAS, 0 to 10) after third molar surgery were randomized to receive active acupuncture, placebo acupuncture, or no treatment for 30 min with acupuncture needles with potential for double-blinding. Patients' perception of the treatment (active or placebo) and expected pain levels (VAS) were assessed before and halfway through the treatment. Looking at actual treatment allocation, there was no specific effect of active acupuncture (P=.240), but there was a large and significant nonspecific effect of placebo acupuncture (P<.001), which increased over time. Interestingly, however, looking at perceived treatment allocation, there was a significant effect of acupuncture (P<.001), indicating that patients who believed they received active acupuncture had significantly lower pain levels than those who believed they received placebo acupuncture. Expected pain levels accounted for significant and progressively larger amounts of the variance in pain ratings after both active and placebo acupuncture (up to 69.8%). This is the first study to show that under optimized blinding conditions, nonspecific factors such as patients' perception of and expectations toward treatment are central to the efficacy of acupuncture analgesia and that these factors may contribute to self-reinforcing effects in acupuncture treatment. To obtain an effect of acupuncture in clinical practice, it may therefore be important to incorporate and optimize these factors.

Original language	English
Journal	Pain
Volume	154
Issue number	9
Pages (from-to)	1659-67
Number of pages	9
ISSN	0304-3959
DOIs	https://doi.org/10.1016/j.pain.2013.05.008
Publication status	Published - Sept 2013

Keywords

Acupuncture Analgesia
Acupuncture Points
Analysis of Variance
Anesthetics, Local/therapeutic use
Double-Blind Method
Female
Humans
Lidocaine/therapeutic use
Male
Pain Management
Pain Measurement
Pain, Postoperative/therapy
Placebo Effect
Regression Analysis
Retrospective Studies
Tooth, Impacted/surgery

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10.1016/j.pain.2013.05.008

Cite this

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title = "Specifying the nonspecific components of acupuncture analgesia",

abstract = "It is well known that acupuncture has pain-relieving effects, but the contribution of specific and especially nonspecific factors to acupuncture analgesia is less clear. One hundred one patients who developed pain of ≥ 3 on a visual analog scale (VAS, 0 to 10) after third molar surgery were randomized to receive active acupuncture, placebo acupuncture, or no treatment for 30 min with acupuncture needles with potential for double-blinding. Patients' perception of the treatment (active or placebo) and expected pain levels (VAS) were assessed before and halfway through the treatment. Looking at actual treatment allocation, there was no specific effect of active acupuncture (P=.240), but there was a large and significant nonspecific effect of placebo acupuncture (P<.001), which increased over time. Interestingly, however, looking at perceived treatment allocation, there was a significant effect of acupuncture (P<.001), indicating that patients who believed they received active acupuncture had significantly lower pain levels than those who believed they received placebo acupuncture. Expected pain levels accounted for significant and progressively larger amounts of the variance in pain ratings after both active and placebo acupuncture (up to 69.8%). This is the first study to show that under optimized blinding conditions, nonspecific factors such as patients' perception of and expectations toward treatment are central to the efficacy of acupuncture analgesia and that these factors may contribute to self-reinforcing effects in acupuncture treatment. To obtain an effect of acupuncture in clinical practice, it may therefore be important to incorporate and optimize these factors.",

keywords = "Acupuncture Analgesia, Acupuncture Points, Analysis of Variance, Anesthetics, Local/therapeutic use, Double-Blind Method, Female, Humans, Lidocaine/therapeutic use, Male, Pain Management, Pain Measurement, Pain, Postoperative/therapy, Placebo Effect, Regression Analysis, Retrospective Studies, Tooth, Impacted/surgery",

author = "Lene Vase and Sara Baram and Nobuari Takakura and Hiroyoshi Yajima and Miho Takayama and Kaptchuk, {Ted J} and S{\o}ren Schou and Jensen, {Troels Staehelin} and Robert Zachariae and Peter Svensson",

year = "2013",

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doi = "10.1016/j.pain.2013.05.008",

language = "English",

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T1 - Specifying the nonspecific components of acupuncture analgesia

AU - Vase, Lene

AU - Baram, Sara

AU - Takakura, Nobuari

AU - Yajima, Hiroyoshi

AU - Takayama, Miho

AU - Kaptchuk, Ted J

AU - Schou, Søren

AU - Jensen, Troels Staehelin

AU - Zachariae, Robert

AU - Svensson, Peter

PY - 2013/9

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N2 - It is well known that acupuncture has pain-relieving effects, but the contribution of specific and especially nonspecific factors to acupuncture analgesia is less clear. One hundred one patients who developed pain of ≥ 3 on a visual analog scale (VAS, 0 to 10) after third molar surgery were randomized to receive active acupuncture, placebo acupuncture, or no treatment for 30 min with acupuncture needles with potential for double-blinding. Patients' perception of the treatment (active or placebo) and expected pain levels (VAS) were assessed before and halfway through the treatment. Looking at actual treatment allocation, there was no specific effect of active acupuncture (P=.240), but there was a large and significant nonspecific effect of placebo acupuncture (P<.001), which increased over time. Interestingly, however, looking at perceived treatment allocation, there was a significant effect of acupuncture (P<.001), indicating that patients who believed they received active acupuncture had significantly lower pain levels than those who believed they received placebo acupuncture. Expected pain levels accounted for significant and progressively larger amounts of the variance in pain ratings after both active and placebo acupuncture (up to 69.8%). This is the first study to show that under optimized blinding conditions, nonspecific factors such as patients' perception of and expectations toward treatment are central to the efficacy of acupuncture analgesia and that these factors may contribute to self-reinforcing effects in acupuncture treatment. To obtain an effect of acupuncture in clinical practice, it may therefore be important to incorporate and optimize these factors.

AB - It is well known that acupuncture has pain-relieving effects, but the contribution of specific and especially nonspecific factors to acupuncture analgesia is less clear. One hundred one patients who developed pain of ≥ 3 on a visual analog scale (VAS, 0 to 10) after third molar surgery were randomized to receive active acupuncture, placebo acupuncture, or no treatment for 30 min with acupuncture needles with potential for double-blinding. Patients' perception of the treatment (active or placebo) and expected pain levels (VAS) were assessed before and halfway through the treatment. Looking at actual treatment allocation, there was no specific effect of active acupuncture (P=.240), but there was a large and significant nonspecific effect of placebo acupuncture (P<.001), which increased over time. Interestingly, however, looking at perceived treatment allocation, there was a significant effect of acupuncture (P<.001), indicating that patients who believed they received active acupuncture had significantly lower pain levels than those who believed they received placebo acupuncture. Expected pain levels accounted for significant and progressively larger amounts of the variance in pain ratings after both active and placebo acupuncture (up to 69.8%). This is the first study to show that under optimized blinding conditions, nonspecific factors such as patients' perception of and expectations toward treatment are central to the efficacy of acupuncture analgesia and that these factors may contribute to self-reinforcing effects in acupuncture treatment. To obtain an effect of acupuncture in clinical practice, it may therefore be important to incorporate and optimize these factors.

KW - Acupuncture Analgesia

KW - Acupuncture Points

KW - Analysis of Variance

KW - Anesthetics, Local/therapeutic use

KW - Double-Blind Method

KW - Female

KW - Humans

KW - Lidocaine/therapeutic use

KW - Male

KW - Pain Management

KW - Pain Measurement

KW - Pain, Postoperative/therapy

KW - Placebo Effect

KW - Regression Analysis

KW - Retrospective Studies

KW - Tooth, Impacted/surgery

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DO - 10.1016/j.pain.2013.05.008

M3 - Journal article

C2 - 23707680

SN - 0304-3959

VL - 154

SP - 1659

EP - 1667

JO - Pain

JF - Pain

IS - 9

ER -

Specifying the nonspecific components of acupuncture analgesia

Abstract

Keywords

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