This is a comment by Acupuncturist, Marie Hopkinson on Today's news reporting on a recent study for Acupuncture in the treatment of hot flushes.
Reported by ABC "Real and fake acupuncture both ease the symptoms of menopausal hot flushes: study"
and even in a very limited "article" in the West Australian today:
The current published report (1) is a conference abstract, so we can only see they used a placebo, but not exactly what it was. In this study, the placebo used was called "noninvasive sham acupuncture" - this can be a number of things as I will describe below.
In the sham (placebo) acupuncture, blinding is essential. This means the participant doesn’t know if they are getting the placebo or not. In Acupuncture studies, the patient lies down, having a curtain partioning their head and body, obstructing the participants ability to see their body. The acupuncturists starts the treatment process as if they were doing everything like the real acupuncture treatment, except when it comes to actually inserting the needle itself. A non-invasive sham acupuncture is usually a retractable needle so it feels like it's touching the skin but does not penetrate into the person.
Sometimes a non-invasive sham acupuncture is tapping the points with the outside of the guide tube, along with the practitioner pretending to do the acupuncture itself, gives the participants brain the understanding that they are having acupuncture when in fact they are just lying down.
Compared with a drug trial, It's much more difficult to simulate a proper placebo with Acupuncture, for obvious reasons. Often the process of the placebo is already doing similar things to the body that acupuncture would be doing. For instance - it can stimulate the skin in an acupressure-like way that gives off a therapeutic response. After all, there are many treatments in acupuncture where the needles are not retained at all, only stimulated for a moment and then removed. This can be just as effective as a treatment where needles are retained for 20 minutes.
In the Acupuncture for Hot Flushes trial report(1) the authors used a ‘non-invasive’ sham, which means the needles would not be inserted at all. However, there are other placebo type acupuncture treatments used like needling the body in random place that is not an acupuncture point, or needling points that are not supposed to treat the condition being studied. These can have a lot more therapeutic effects than the non-invasive sham acupuncture.
SO WHY DOES PLACEBO ACUPUNCTURE HAVE SUCH GREAT RESULTS?
In the study we are focusing on here, the results were on par in both groups, so much so that the authors concluded “An eight-week course of Chinese medicine acupuncture was not superior to non-invasive sham acupuncture for menopausal hot flushes”(1)
One major difference of placebo acupuncture compared with a placebo in a drug or herbs trial for instance, is that the person doesn’t just take the placebo and get on with their daily life, they actually do something different – usually lying down for the 20 or so minutes. So we could say that relaxing for the same time and thinking you are having acupuncture for this complaint – that’s visualising having acupuncture is just as effective to treat the symptoms.
Then we have to think what are the causes of the symptoms…from a Chinese Medicine perspective. Even thought the patients selected had a diagnosis of Kidney Yin Deficiency. So we have to think what is Kidney Yin and how would lying down help this if at all? In Chinese Medicine, lying down in the day (usually associated with a post-lunch afternoon nap) means more blood goes from your extremities (arms and legs) and circulates around your vital organs. In Chinese Medicine, 20 minutes of lying down flat is considered therapeutic exercise for your Liver Blood (Xue). This is directly linked to Kidney Yin, although not all Kidney yin deficiency patients will have Liver Blood deficiency, it is commonly seen affecting one another.
On an experiential level, as a practitioner over the past 14 years of practice I would say a common comment patients make is that they “never feel more relaxed” and I’ve even had a few patients that say “wow, this is the only time I can relax when I come here and have acupuncture” If you have had acupuncture yourself, you will likely be familiar with the side effect of relaxation that it brings. Part of this is the lying down part. Trust me, as a busy entrepreneur as well as a practitioner, if I get sick with a headache or some pain or symptom I’ll often put needles in my head, legs or wherever I can to fix it, and the symptoms might go away but I don’t feel relaxed walking around the house with needles in my head!
What is this high placebo effect telling us? Does it mean acupuncture isn’t effective and we should all just lie down for 20 minutes once a week? No, I still think there is value in the skill of a Chinese Medicine practitioner – but what I give to my patients is not just sticking in the needles. There is usually diet advice, herbs and home treatments like exercises or even non-Chinese medicine things like helping patients to make a plan for dealing with stress.
Not all studies of acupuncture using the same kind of placebo as this hot flushes study have such an equal placebo-treatment outcome. This is just one study on one kind of symptom – Hot Flushes in menopause.
Secondly, if people wanted to try healing themselves at home, this study adds evidence to the concept that visualising having acupuncture is just as powerful as having it. I encourage my patients to do that as much as possible, in between their acupuncture treatments. Your brain can be an amazing resource to heal your body.
- Ee C, Xue C, Chondros P, Myers S, French S, Teede H, et al. Acupuncture for menopausal hot flushes: A randomised sham-controlled trial. Advances in Integrative Medicine. 2015;2(2):115-6.
