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Placebo effect seen in acupuncture studies
Wed Jun 27, 2007
NEW YORK (Reuters Health)
Acupuncture can bring some relief to people with knee arthritis, but
the benefits may be at least partly from a placebo effect, a new
research review suggests.
In an analysis of nine clinical trials from the past 15 years,
researchers found that acupuncture generally seemed to improve knee
arthritis sufferers' pain and stiffness in the short term. The patients
had osteoarthritis, a degenerative joint disease associated with age,
as opposed to arthritis associated with an autoimmune disorder.
However, a closer look showed that the benefits were limited to
trials that compared acupuncture with doing nothing or with "usual
care," such as anti-inflammatory medication.
In trials that compared acupuncture with "sham" acupuncture, on
the other hand, there was no clear evidence that the real therapy was
more effective.
Sham acupuncture is accomplished by using non-penetrating
needles, or inserting needles only into the superficial layer of skin,
at random sites rather than the specific points used in real
acupuncture. In studies that evaluated electro-acupuncture, the sham
version involved phony electrodes and "mock" electrical stimulation of
acupuncture points.
The point is to keep study participants from knowing whether
they were receiving the real or the placebo treatment. This helps
separate the specific effects of a therapy from any placebo effects --
where people feel better simply because they believe they've been
treated.
The new findings suggest that the benefits of acupuncture for
knee arthritis are at least partly due to patients' expectations, the
study authors report in the Annals of Internal Medicine.
However, that doesn't mean acupuncture is not worthwhile,
according to the researchers, led by Eric Manheimer of the University
of Maryland School of Medicine in Baltimore.
Research does suggest that acupuncture has a "genuine
biological effect," and there was evidence in some studies that the
real therapy resulted in somewhat better short-term effects than sham
acupuncture, the researchers note.
For their study, Manheimer and his
colleagues combined the results of nine clinical trials conducted in
Europe, the U.S. and Thailand. The trials included a total of more than
3,500 subjects.
Each trial included a patient group that received
acupuncture for knee arthritis, as well as a "control" group. In some
studies, control patients were placed on a waiting list for
acupuncture, while in others they received some standard therapy that
acupuncture patients did not. Control patients in other studies
received sham acupuncture.
In general, the Manheimer's team found, only studies
that pitted acupuncture against doing nothing, or against standard
care, showed clear benefits. The results of the sham-controlled trials
were too mixed to show any benefits, according to the researchers.
The investigators do not, however, dismiss the
potential benefits of acupuncture for knee arthritis. Indeed, they
note, a possible explanation for the mixed results is that sham
acupuncture had some actual biological effects.
Given the overall safety of acupuncture, the
researchers conclude, patients can still consider it as one option in a
"multidisciplinary approach" to treating knee arthritis.
SOURCE: Annals of Internal Medicine, June 19, 2007.
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