Acupuncture: A 2,000-year tradition of placebo effect?

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Acupuncture has been — how shall we say? — one of the less ridiculed techniques of alternative medicine, at least in recent years. A body of evidence shows that it does indeed relieve pain, for many conditions. But a study released today suggests that acupuncture probably only works because patients believe that it will — and it’s the belief, not the procedure, that makes the difference.

In the new trial released today by the journal Arthritis Care & Research, 455 patients with osteoarthritis of the knee were randomly assigned either to receive traditional Chinese acupuncture or to receive a sham treatment — a kind of mock acupuncture with needles inserted away from traditional acupuncture meridians, and with shallow needles designed to give very little of the stimulation that acupuncture provides. After six weeks of therapy, the two treatment groups showed comparable results in terms of arthritis symptoms, pain, and overall satisfaction. Furthermore, both groups reported less pain and fewer symptoms than a smaller group of patients who were still on a wait list, having not received treatment at all. In the end, it would seem that acupuncture did make people feel better — but that it’s not the treatment itself that matters.

What did matter in the study, however, was how optimistic the acupuncture providers appeared when they spoke to their patients. Practitioners were asked either to express neutral opinions about whether acupuncture would work for the patient, or to be positive about the expected results. Irrespective of whether patients received the real, traditional acupuncture treatment, those who were told to expect improvements were more likely to feel better afterward.

This study is by no means the first to suggest that pain relief from acupuncture is largely one big placebo effect. A trial last year found that simply poking a patient’s back with toothpicks provided similar pain relief to acupuncture. But this new study adds valuable information about the role of providers’ counsel — and, in particular, about how malleable a patient’s pain perception might be. The study also raises interesting ethical questions. Patients feel better simply by believing that they’ve had effective treatment. But should a doctor be enthusiastic about treatment, knowing that enthusiasm itself improves results? We like to think it’s better for our doctors to be honest with us.

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