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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

Study flow.Among twenty healthy subjects, ten received real acupuncture (REAL) first, while the rest received phantom acupuncture (PHNT) first, and they were re-classified into phantom credible (PHNTc) and phantom non-credible (PHNTnc) according to the needling credibility in phantom acupuncture (PHNT).
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pone-0104582-g002: Study flow.Among twenty healthy subjects, ten received real acupuncture (REAL) first, while the rest received phantom acupuncture (PHNT) first, and they were re-classified into phantom credible (PHNTc) and phantom non-credible (PHNTnc) according to the needling credibility in phantom acupuncture (PHNT).

Mentions: After finishing both REAL and PHNT sessions, subjects were retrospectively separated into phantom credible (PHNTc, high needling credibility, n = 11) and phantom non-credible (PHNTnc, low needling credibility, n = 9) groups using a questionnaire and interview that evaluate the credibility of the procedure – e.g., whether or not they were able to differentiate the difference between real and phantom acupuncture, and if they believed they received real needle acupuncture in both sessions. Four subjects in the PHNTnc subgroup recognized the procedure as placebo when they noticed that the video clip of acupuncture needling was not synchronized with their hand’s spontaneous movement. Five subjects in the PHNTnc subgroup had low credibility because they did not have any acupuncture sensation at the acupoint or surrounding region (Figure 2).


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)

Study flow.Among twenty healthy subjects, ten received real acupuncture (REAL) first, while the rest received phantom acupuncture (PHNT) first, and they were re-classified into phantom credible (PHNTc) and phantom non-credible (PHNTnc) according to the needling credibility in phantom acupuncture (PHNT).
© Copyright Policy
Related In: Results  -  Collection

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

pone-0104582-g002: Study flow.Among twenty healthy subjects, ten received real acupuncture (REAL) first, while the rest received phantom acupuncture (PHNT) first, and they were re-classified into phantom credible (PHNTc) and phantom non-credible (PHNTnc) according to the needling credibility in phantom acupuncture (PHNT).
Mentions: After finishing both REAL and PHNT sessions, subjects were retrospectively separated into phantom credible (PHNTc, high needling credibility, n = 11) and phantom non-credible (PHNTnc, low needling credibility, n = 9) groups using a questionnaire and interview that evaluate the credibility of the procedure – e.g., whether or not they were able to differentiate the difference between real and phantom acupuncture, and if they believed they received real needle acupuncture in both sessions. Four subjects in the PHNTnc subgroup recognized the procedure as placebo when they noticed that the video clip of acupuncture needling was not synchronized with their hand’s spontaneous movement. Five subjects in the PHNTnc subgroup had low credibility because they did not have any acupuncture sensation at the acupoint or surrounding region (Figure 2).

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