Simulated acupuncture – sometimes referred to as placebo – is just as beneficial as real acupuncture for treating nausea in cancer patients undergoing radiotherapy, according to a study from Karolinska Institutet and Linköping University in Sweden. Patients, who received only standard care including medications for nausea, felt significant more nausea than patients in both the acupuncture groups. The results of the study were published in the open access journal, PLoS One. Check the end of this report for a link to download the full-text study.
“The beneficial effects seem not to come from the traditional acupuncture method, but probably from the patients’ positive expectations and the extra care that the treatment entails,” says Anna Enblom, physiotherapist and researcher at the Osher Centre for Integrative Medicine at Karolinska Institutet. “The patients communicated with the physiotherapists administering the acupuncture, received tactile stimulation, and were given extra time for rest and relaxation.”
The study included 277 patients at Linköping and Lund university hospitals and Karolinska University Hospital in Solna, all of whom were undergoing radiotherapy of the abdomen or pelvic region for cancer. A selection of 215 patients from this group were blindly assigned traditional or simulated acupuncture. The former group (109 patients) had needles inserted into their skin to stimulate certain points, and the latter (106 patients) had blunt telescopic placebo needles merely pressed against the skin. The acupuncture patients were then compared with 62 patients who had only received the standard care regime with medications for nausea and no acupuncture.
The results show that the patients who had received genuine or simulated acupuncture felt much less nauseous than those who had received standard care only. Of the patients who had had some form of acupuncture, only 37 felt nausea and seven per cent vomited, compared with 63 per cent and 15 per cent of the standard care group. However, no differences were observed between the two acupuncture groups, despite the fact that the placebo needle was applied to the skin for a total of only two minutes during the entire five-week treatment period.
The patients’ expectations seemed to be important for the effect: 81 per cent of those who expected to feel ill did so, in contrast to only 50 per cent of those who did not.
“It’s important to remember that the effects of the treatment are valuable to the patients, even if they can be said to have been caused by unspecific factors, such as the manner in which the patients were taken care of and their positive expectations,” says Dr. Enblom. “So our next step is to study which part of the acupuncture procedure actually are of importance, to make possible the use of those components to further increase quality of care.”
The published study also formed a part of Dr. Enblom’s previously published doctoral thesis from Linköping University.
Material adapted from Karolinska Institutet.
Reference
Anna Enblom, Mats Lekander, Mats Hammar, Anna Johnsson, Erik Onelöv, Martin Ingvar, Gunnar Steineck and Sussanne Börjeson. ”Getting the Grip on Nonspecific Treatment Effects: Emesis in Patients Randomized to Acupuncture or Sham Compared to Patients Receiving Standard Care.” PLoS ONE on 23 March 2011.
Remarkably similar results to “sham” knee surgery as reported in NEJM 7/11/02 (http://bit.ly/hjyG3X) where placebo “surgery” results were equivalent to real surgical interventions. No one argues that placebo is a bad thing, except pharmaceutical companies attempting to show medication benefit exceeding placebo. The question may be, “how much are we willing to pay for placebo?”
I was surprised by the new wave research posted today that calls into question the efficacy of acupuncture (i.e., people instead improve due to non-specific treatment effects).
Research had previously shown positive improvements following acupuncture, some of which was reported at BMED Report; for example: http://wp.me/pprXN-2NO and http://wp.me/pprXN-3qN
This highlights the importance of placebo controlled trials, as well as the power to self-heal when one believes he or she will get better.
There is also another ethical dilemma here that you started to touch on. The idea of placebo medicine and whether healthcare professionals are justified (ethically) to knowingly give their patient’s a placebo without telling them. For example, a patient demands an anti-depressant and the physician instead prescribes a sugar pill without the patient’s knowledge because the physician does not think the patient needs one. But then again, this could destroy the healthcare professional/patient relationship which should be built on trust. I do not think there are any clear or easy answers at this point.