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eCAM Advance Access published online on June 12, 2009
eCAM, doi:10.1093/ecam/nep049
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Is Placebo Acupuncture What It is Intended to Be?

Thomas Lundeberg1, Irene Lund2, Audrey Sing3 and Jan Näslund4

1Foundation for Acupuncture and Alternative Biological Treatment Methods, Sabbatsbergs Hospital,2Department of Physiology and Pharmacology, Karolinska Institutet,3Foundation for Acupuncture and Alternative Biological Treatment Methods, Sabbatsbergs Hospital and 4Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

Randomized, placebo-controlled clinical trials are recommended for evaluation of a treatment's efficacy with the goal of separating the specific effects (verum) from the non-specific ones (placebo). In order to be able to carry out placebo-controlled acupuncture trials, minimal/sham acupuncture procedures and a sham acupuncture needle has been used with the intention of being inert. However, clinical and experimental results suggest that sham/minimal acupuncture is not inert since it is reported that both verum acupuncture and sham/minimal acupuncture induce a significant alleviation of pain. This alleviation is as pronounced as the alleviation obtained with standard treatment and more obvious than the one obtained with placebo medication or by the use of waiting list controls. These results also suggest that sham acupuncture needles evoke a physiological response. In healthy individuals sham acupuncture results in activation of limbic structures, whereas a deactivation is seen in patients with pain, i.e. results from healthy individuals do not reflect what is seen in clinical conditions. Also, depending on the etiology of pain (or any under clinical condition under investigation), the response to sham acupuncture is varying. The acupuncture ritual may also be seen as an emotional focused therapy allowing for psychological re-orientation. Sham needling in such context may be as powerful as verum acupuncture. We recommend that the evaluated effects of acupuncture could be compared with those of standard treatment, also taking the individual response into consideration, before its use or non-use is established.

Keywords: inert – minimal – pain etiology – randomized controlled trials – sham

For reprints and all correspondence: Jan Näslund, RPT, PhD, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. Tel: +46 8 52487261; Fax: +46 8 332047; E-mail: jan.e.naslund{at}ki.se

Received October 19, 2008; accepted May 7, 2009


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