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Phantom acupuncture: dissociating somatosensory and cognitive/affective components of acupuncture stimulation with a novel form of placebo acupuncture.

Lee J, Napadow V, Kim J, Lee S, Choi W, Kaptchuk TJ, Park K - PLoS ONE (2014)

Bottom Line: Autonomic and psychophysical responses were monitored.We found that PHNT can be delivered in a credible manner.In contrast, contextual effects, such as needling credibility, are instead associated with a shift toward relative cardiovagal activation (decreased heart rate) during needling and sympathetic inhibition (decreased SC) and parasympathetic activation (decreased pupil size) following acupuncture needling.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Engineering, Kyung Hee University, Yongin, Gyeonggi, South Korea.

ABSTRACT
In a clinical setting, acupuncture treatment consists of multiple components including somatosensory stimulation, treatment context, and attention to needle-based procedures. In order to dissociate somatosensory versus contextual and attentional aspects of acupuncture, we devised a novel form of placebo acupuncture, a visual manipulation dubbed phantom acupuncture, which reproduces the acupuncture needling ritual without somatosensory tactile stimulation. Subjects (N = 20) received both real (REAL) and phantom (PHNT) acupuncture. Subjects were retrospectively classified into two groups based on PHNT credibility (PHNTc, who found phantom acupuncture credible; and PHNTnc, who did not). Autonomic and psychophysical responses were monitored. We found that PHNT can be delivered in a credible manner. Acupuncture needling, a complex, ritualistic somatosensory intervention, induces sympathetic activation (phasic skin conductance [SC] response), which may be specific to the somatosensory component of acupuncture. In contrast, contextual effects, such as needling credibility, are instead associated with a shift toward relative cardiovagal activation (decreased heart rate) during needling and sympathetic inhibition (decreased SC) and parasympathetic activation (decreased pupil size) following acupuncture needling. Visual stimulation characterizing the needling ritual is an important factor for phasic autonomic responses to acupuncture and may undelie the needling orienting response. Our study suggests that phantom acupuncture can be a viable sham control for acupuncture as it completely excludes the somatosensory component of real needling while maintaining the credibility of the acupuncture treatment context in many subjects.

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Related in: MedlinePlus

Experimental protocol.A. The paradigm consisted of 3-minute event-related stimulation (STIM, 3-second stimulation, ISI mean = 19.5 sec) surrounded by two 2-minute rest sessions (BASE and POST). B. Acupuncture stimulation location (PC6). C. Experimental setup for REAL and PHNT sessions. n.b. Figure in B. was modified from an image in ‘WHO Regional Office for the Western Pacific, 2008, WHO Standard Acupuncture Point Locations in the Western Pacific Region, Manila’.
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pone-0104582-g001: Experimental protocol.A. The paradigm consisted of 3-minute event-related stimulation (STIM, 3-second stimulation, ISI mean = 19.5 sec) surrounded by two 2-minute rest sessions (BASE and POST). B. Acupuncture stimulation location (PC6). C. Experimental setup for REAL and PHNT sessions. n.b. Figure in B. was modified from an image in ‘WHO Regional Office for the Western Pacific, 2008, WHO Standard Acupuncture Point Locations in the Western Pacific Region, Manila’.

Mentions: Real acupuncture (REAL) and phantom acupuncture (PHNT) sessions, separated by at least 40 min, were performed with pseudo-randomized order. For REAL, a 2-minute duration resting baseline (BASE) was followed by needle insertion (completed within 30 seconds, Figure 1B). The needle (0.3 mm*30 mm stainless steel needle, Dongbang Co., Korea) was inserted at left acupoint PC6 on the medial side of the right forearm and rotated manually at a rate of ∼2 Hz. This acupoint is 2 cun (approximately 5 cm) proximal to the transverse wrist crease, between the tendons of the palmaris longus and flexor carpi radialis muscles, and is innervated by the median and antebrachial cutaneous nerves. This point is thought to be useful for cardiac conditions, as well as to control nausea and vomiting. It was chosen for this study because clinically, stimulation at this point has been used to modulate autonomic function and is known to induce robust acupuncture sensation [26].


Phantom acupuncture: dissociating somatosensory and cognitive/affective components of acupuncture stimulation with a novel form of placebo acupuncture.

Lee J, Napadow V, Kim J, Lee S, Choi W, Kaptchuk TJ, Park K - PLoS ONE (2014)

Experimental protocol.A. The paradigm consisted of 3-minute event-related stimulation (STIM, 3-second stimulation, ISI mean = 19.5 sec) surrounded by two 2-minute rest sessions (BASE and POST). B. Acupuncture stimulation location (PC6). C. Experimental setup for REAL and PHNT sessions. n.b. Figure in B. was modified from an image in ‘WHO Regional Office for the Western Pacific, 2008, WHO Standard Acupuncture Point Locations in the Western Pacific Region, Manila’.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4125217&req=5

pone-0104582-g001: Experimental protocol.A. The paradigm consisted of 3-minute event-related stimulation (STIM, 3-second stimulation, ISI mean = 19.5 sec) surrounded by two 2-minute rest sessions (BASE and POST). B. Acupuncture stimulation location (PC6). C. Experimental setup for REAL and PHNT sessions. n.b. Figure in B. was modified from an image in ‘WHO Regional Office for the Western Pacific, 2008, WHO Standard Acupuncture Point Locations in the Western Pacific Region, Manila’.
Mentions: Real acupuncture (REAL) and phantom acupuncture (PHNT) sessions, separated by at least 40 min, were performed with pseudo-randomized order. For REAL, a 2-minute duration resting baseline (BASE) was followed by needle insertion (completed within 30 seconds, Figure 1B). The needle (0.3 mm*30 mm stainless steel needle, Dongbang Co., Korea) was inserted at left acupoint PC6 on the medial side of the right forearm and rotated manually at a rate of ∼2 Hz. This acupoint is 2 cun (approximately 5 cm) proximal to the transverse wrist crease, between the tendons of the palmaris longus and flexor carpi radialis muscles, and is innervated by the median and antebrachial cutaneous nerves. This point is thought to be useful for cardiac conditions, as well as to control nausea and vomiting. It was chosen for this study because clinically, stimulation at this point has been used to modulate autonomic function and is known to induce robust acupuncture sensation [26].

Bottom Line: Autonomic and psychophysical responses were monitored.We found that PHNT can be delivered in a credible manner.In contrast, contextual effects, such as needling credibility, are instead associated with a shift toward relative cardiovagal activation (decreased heart rate) during needling and sympathetic inhibition (decreased SC) and parasympathetic activation (decreased pupil size) following acupuncture needling.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Engineering, Kyung Hee University, Yongin, Gyeonggi, South Korea.

ABSTRACT
In a clinical setting, acupuncture treatment consists of multiple components including somatosensory stimulation, treatment context, and attention to needle-based procedures. In order to dissociate somatosensory versus contextual and attentional aspects of acupuncture, we devised a novel form of placebo acupuncture, a visual manipulation dubbed phantom acupuncture, which reproduces the acupuncture needling ritual without somatosensory tactile stimulation. Subjects (N = 20) received both real (REAL) and phantom (PHNT) acupuncture. Subjects were retrospectively classified into two groups based on PHNT credibility (PHNTc, who found phantom acupuncture credible; and PHNTnc, who did not). Autonomic and psychophysical responses were monitored. We found that PHNT can be delivered in a credible manner. Acupuncture needling, a complex, ritualistic somatosensory intervention, induces sympathetic activation (phasic skin conductance [SC] response), which may be specific to the somatosensory component of acupuncture. In contrast, contextual effects, such as needling credibility, are instead associated with a shift toward relative cardiovagal activation (decreased heart rate) during needling and sympathetic inhibition (decreased SC) and parasympathetic activation (decreased pupil size) following acupuncture needling. Visual stimulation characterizing the needling ritual is an important factor for phasic autonomic responses to acupuncture and may undelie the needling orienting response. Our study suggests that phantom acupuncture can be a viable sham control for acupuncture as it completely excludes the somatosensory component of real needling while maintaining the credibility of the acupuncture treatment context in many subjects.

Show MeSH
Related in: MedlinePlus