Abstract
Placebo-control of acupuncture is used to evaluate and distinguish between the specific effects and the non-specific ones. During 'true' acupuncture treatment in general, the needles are inserted into acupoints and stimulated until deqi is evoked. In contrast, during placebo acupuncture, the needles are inserted into non-acupoints and/or superficially (so-called minimal acupuncture). A sham acupuncture needle with a blunt tip may be used in placebo acupuncture. Both minimal acupuncture and the placebo acupuncture with the sham acupuncture needle touching the skin would evoke activity in cutaneous afferent nerves. This afferent nerve activity has pronounced effects on the functional connectivity in the brain resulting in a 'limbic touch response'. Clinical studies showed that both acupuncture and minimal acupuncture procedures induced significant alleviation of migraine and that both procedures were equally effective. In other conditions such as low back pain and knee osteoarthritis, acupuncture was found to be more potent than minimal acupuncture and conventional non-acupuncture treatment. It is probable that the responses to 'true' acupuncture and minimal acupuncture are dependent on the aetiology of the pain. Furthermore, patients and healthy individuals may have different responses. In this paper, we argue that minimal acupuncture is not valid as an inert placebo-control despite its conceptual brilliance.
Highlights
Randomised placebo-controlled clinical trials are used to evaluate the efficacy of medical interventions
Repeated treatment can result in Pavlovian deconditioning/extinction of, for example, knee osteoarthritis pain [91,92]
Patients in acupuncture plus routine care showed marked clinical improvements compared to those with routine care only. These results showed that acupuncture may be demonstrated as a complement to routine care without using minimal acupuncture as a control
Summary
Randomised placebo-controlled clinical trials (placebocontrolled RCTs) are used to evaluate the efficacy of medical interventions. The effects of superficial needling at the points distant from acupoints may still induce a wide range of peripheral, segmental and central physiological responses and in this respect the minimal acupuncture technique is not inert and can not serve as a control for those using acupuncture in a physiological perspective (as a modality of sensory stimulation). Repeated treatment can result in Pavlovian deconditioning/extinction of, for example, knee osteoarthritis pain [91,92] In such a scenario, the construction of a placebo control is virtually impossible, as any kind of sensory stimulus may have a specific effect. The use of observational study with the data carefully collected over time as events occur, as in a longitudinal study, instead of conventional RCTs, may allow a trial design that suits the clinical situation better [99,100] and avoid inherent difficulties in patient information regarding the sham [101]
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