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Acupuncture May Ease Pain

Critics question if the benefit is simply a placebo effect.

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Acupuncture has gained acceptance by many physicians in the United States, yet the research on its pain-fighting benefits is murky. Some studies suggest that it confers superior relief when compared to common treatments such as pain relievers, while other scientific trials have found that acupuncture offers little or no benefit. 

In 2012, a team of researchers conducted a meta-analysis of 29 studies involving nearly 18,000 patients on acupuncture for the treatment of neck and back pain, chronic headache and osteoarthritis (OA). Unlike meta-analyses of acupuncture for pain conducted previously, this one – published in the Archives of Internal Medicine – didn’t lump all study results together; instead, it assessed each individual patient’s outcome.

Results showed that people in pain who had acupuncture felt significantly better than those who weren’t treated or who only received “usual care,” such as recommendations to take pain medications or general advice about managing symptoms. The researchers also found that real acupuncture is more effective than placebo, or sham acupuncture – but only slightly so; 50 percent of acupuncture patients said their pain improved by half or more, compared to 42.5 percent of patients receiving placebo treatments. These may be performed several ways, such as using special telescoping needles that don’t penetrate the skin or by randomly inserting real needles.

Lead study author Andrew J. Vickers, PhD, attending research methodologist at Memorial Sloan-Kettering Cancer Center in New York City, believes the study confirms the value of acupuncture for treating chronic pain, even though the analysis showed only a modest difference between real and sham needle therapy. He notes that sham acupuncture may actually trigger production of pain-blocking chemicals. “Just putting an acupuncture needle in the body, even if it is not at a true acupuncture point, likely has some physiologic effect,” he explains.

Other researchers aren’t so sure. A 2010 review of 12 studies by scientists at the University of Maryland found that six months of real acupuncture produced “clinically irrelevant improvements in osteoarthritis pain” when compared to sham acupuncture.

Practitioners of traditional Chinese medicine (TCM) say that precisely placed needles heal disease by influencing the flow of energy – known as chi or qiin the body, but few Western-trained physicians embrace that belief, and there remains no accepted scientific explanation for how acupuncture might work.

Questions about acupuncture’s mechanism and whether it really eases pain leave many doctors reluctant to recommend the treatment to patients. “In my opinion, it’s a placebo,” says rheumatologist Donald M. Marcus, MD, of the Baylor College of Medicine. Dr. Marcus was coauthor of a study (included in Vickers’ meta-analysis) that found no difference between real and sham acupuncture; it was published in Arthritis Care & Research in 2010. Some people may feel better after receiving acupuncture, Dr. Marcus concedes. “But it’s expensive and the effects are transient,” he says. “The relief may last a while, then you’re back to square one.”

Other doctors agree that acupuncture’s benefits may be due largely to the placebo effect – yet still feel it could be worth trying. Growing research suggests that placebos – whether fake needles or sugar pills – may prevent pain signals from reaching the brain and promote other biological changes that could relieve symptoms of osteoarthritis and other conditions.

“If I’m suffering chronic pain and someone offers me an intervention that will improve my symptoms, I’d be thinking, ‘Of course I want that,’” says Andrew L. Avins, MD, a clinical professor of medicine who studies pain and other health issues at the University of California, San Francisco. “As a patient, I just want to feel better.… If our ultimate goal is to help patients achieve their goals, the mechanism is not all that relevant.”

Intriguingly, recent studies suggest that some patients may respond well to placebos even if they know they’re receiving an inert treatment, notes Dr. Avins.

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