Placebo acupuncture as a form of ritual touch healing: a neurophenomenological model.

Catherine E Kerr,Ted J Kaptchuk,Jessica R Shaw,Eric Jacobson,John M Kelley,Lisa A Conboy

doi:10.1016/j.concog.2010.12.009

Catherine E Kerr, Ted J Kaptchuk + Show 4 more

Open Access

https://doi.org/10.1016/j.concog.2010.12.009

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Abstract

Evidence that placebo acupuncture is an effective treatment for chronic pain presents a puzzle: how do placebo needles appearing to patients to penetrate the body, but instead sitting on the skin's surface in the manner of a tactile stimulus, evoke a healing response? Previous accounts of ritual touch healing in which patients often described enhanced touch sensations (including warmth, tingling or flowing sensations) suggest an embodied healing mechanism. In this qualitative study, we asked a subset of patients in a singleblind randomized trial in irritable bowel syndrome to describe their treatment experiences while undergoing placebo treament. Analysis focused on patients' unprompted descriptions of any enhanced touch sensations (e.g., warmth, tingling) and any significance patients assigned to the sensations. We found in 5/6 cases, patients associated sensations including "warmth" and "tingling" with treatment efficacy. The conclusion offers a "neurophenomenological" account of the placebo effect by considering dynamic effects of attentional filtering on early sensory cortices, possibly underlying the phenomenology of placebo acupuncture.

Highlights

Placebo acupuncture is among the most studied forms of ritual to be explicitly evaluated in “gold-standard” randomized controlled trials (RCTs) (Madsen, Gotzsche, & Hrobjartsson, 2009; Moffet, 2009)
The scientific motivation for focusing on the placebo acupuncture ritual has increased with a recent extensive, systematic review(Madsen, et al, 2009) showing that while real acupuncture appears to have a modest genuine positive effect on chronic pain, placebo acupuncture ritual elicits stronger and more clinically relevant relief in chronic pain patients, as well as recent RCTs involving over a thousand patients comparing a placebo acupuncture ritual to a usual care condition or to a contrasting ritual have shown that the placebo acupuncture ritual is efficacious for a broad range of pain disorders including irritable bowel syndrome (IBS), arm pain and chronic low back pain. (Cherkin, et al, 2009; Foster, et al, 2007; Kaptchuk, et al, 2008; Kaptchuk, et al, 2006)
Of the six patients who received placebo acupuncture for all six weeks of the trial, five described notable enhanced touch sensations associated with placebo acupuncture needling

Summary

Introduction

Placebo acupuncture is among the most studied forms of ritual to be explicitly evaluated in “gold-standard” randomized controlled trials (RCTs) (Madsen, Gotzsche, & Hrobjartsson, 2009; Moffet, 2009). The trial found, as hypothesized, that patients receiving a ritual that included a warm, empathic, confident interaction did better than patients receiving the identical tactile needling procedure with a neutral interaction (both placebo acupuncture groups did better than the no-treatment control condition). Taken together, these studies suggest that the touch component and the motivational and emotional context surrounding touch both contribute to the efficacy of placebo acupuncture

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