Sunday, September 13, 2009

Fibromyalgia: Traditional vs Sham Acupuncture Success

In the past year there have been several studies that confirm acupuncture is more effective for back pain than the typical lortab, physical therapy, epidural, and surgery regimen touted by western pain management specialists. The studies included a fake or "sham" acupuncture treatment group along with a real or "traditional" acupuncture treatment group. The problem with these designs was the lack of studies comparing traditional and sham acupuncture. When the results of the studies showed statistically insignificant difference in effectiveness, the conclusions make the reader think all you have to do is stick some needles randomly in your back, not necessarily by a qualified acupuncturist, and the placebo effect will take over from there. The following abstract was pulled from Pub Med and discusses the short and long term effects of traditional acupuncture on pain receptors in the brain for fibromyalgia.

Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs).

Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA.

Controversy remains regarding the mechanisms of acupuncture analgesia. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and mu-opioid receptors (MORs). This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. This overlap in potential mechanisms may explain the lack of differentiation between traditional acupuncture and either non-traditional or sham acupuncture in multiple controlled clinical trials. We compared both short- and long-term effects of traditional Chinese acupuncture (TA) versus sham acupuncture (SA) treatment on in vivo MOR binding availability in chronic pain patients diagnosed with fibromyalgia (FM). Patients were randomized to receive either TA or SA treatment over the course of 4 weeks. Positron emission tomography (PET) with (11)C-carfentanil was performed once during the first treatment session and then repeated a month later following the eighth treatment. Acupuncture therapy evoked short-term increases in MOR binding potential, in multiple pain and sensory processing regions including the cingulate (dorsal and subgenual), insula, caudate, thalamus, and amygdala. Acupuncture therapy also evoked long-term increases in MOR binding potential in some of the same structures including the cingulate (dorsal and perigenual), caudate, and amygdala. These short- and long-term effects were absent in the sham group where small reductions were observed, an effect more consistent with previous placebo PET studies. Long-term increases in MOR BP following TA were also associated with greater reductions in clinical pain. These findings suggest that divergent MOR processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture.

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