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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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Influence of credibility on acupuncture sensations to phantom acupuncture.PHNTc reported significantly greater sensation intensity for numbness and dull pain (i.e. deqi sensations). n.b. *<0.05, **<0.01, ***<0.001. Error bars represent standard error of the mean.
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pone-0104582-g004: Influence of credibility on acupuncture sensations to phantom acupuncture.PHNTc reported significantly greater sensation intensity for numbness and dull pain (i.e. deqi sensations). n.b. *<0.05, **<0.01, ***<0.001. Error bars represent standard error of the mean.

Mentions: Interestingly, following PHNTc, subjects reported many different acupuncture sensations (e.g. aching = 1.7±0.6, P<0.05; soreness = 1.1±0.5, P<0.05; deep pressure = 2.2±0.6, P<0.01; heaviness = 2.3±0.7, P<0.001; fullness = 2.4±0.7, P<0.01; warmth = 2.0±0.8, P<0.05; coolness = 1.1±0.4, P<0.05; numbness = 3.0±0.9, P<0.01; dull pain = 2.8±0.9, P<0.05; throbbing = 2.1±0.6, P<0.01; sharp pain = 1.2±0.5, P<0.05; spreading = 2.4±0.7, P<0.01). For PHNTnc, reported sensations were more mild and fewer in number (i.e. aching = 1.0±0.3, P<0.01; dull pain = 0.8±0.3, P<0.05; sharp pain = 1.2±0.5, P<0.05; and spreading = 2.0±0.6, P<0.05). Significant differences between credible versus non-credible PHNT subgroups were noted for deep pressure (PHNTc = 2.2±0.6, PHNTnc = 0.6±0.2, P<0.05), heaviness (PHNTc = 2.3±0.7, PHNTnc = 0.6±0.3, P<0.05), fullness (PHNTc = 2.4±0.7, PHNTnc = 0.4±0.2, P<0.05), and numbness (PHNTc = 3.0±0.9, PHNTnc = 0.3±0.2, P<0.05) – all classic deqi sensations. Trending differences were noted for dull pain (PHNTc = 2.8±0.9, PHNTnc = 0.8±0.3, P = 0.06) and MI (PHNTc = 2.7±0.8, PHNTnc = 1.0±0.4, P = 0.08) (Figure 4).


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)

Influence of credibility on acupuncture sensations to phantom acupuncture.PHNTc reported significantly greater sensation intensity for numbness and dull pain (i.e. deqi sensations). n.b. *<0.05, **<0.01, ***<0.001. Error bars represent standard error of the mean.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0104582-g004: Influence of credibility on acupuncture sensations to phantom acupuncture.PHNTc reported significantly greater sensation intensity for numbness and dull pain (i.e. deqi sensations). n.b. *<0.05, **<0.01, ***<0.001. Error bars represent standard error of the mean.
Mentions: Interestingly, following PHNTc, subjects reported many different acupuncture sensations (e.g. aching = 1.7±0.6, P<0.05; soreness = 1.1±0.5, P<0.05; deep pressure = 2.2±0.6, P<0.01; heaviness = 2.3±0.7, P<0.001; fullness = 2.4±0.7, P<0.01; warmth = 2.0±0.8, P<0.05; coolness = 1.1±0.4, P<0.05; numbness = 3.0±0.9, P<0.01; dull pain = 2.8±0.9, P<0.05; throbbing = 2.1±0.6, P<0.01; sharp pain = 1.2±0.5, P<0.05; spreading = 2.4±0.7, P<0.01). For PHNTnc, reported sensations were more mild and fewer in number (i.e. aching = 1.0±0.3, P<0.01; dull pain = 0.8±0.3, P<0.05; sharp pain = 1.2±0.5, P<0.05; and spreading = 2.0±0.6, P<0.05). Significant differences between credible versus non-credible PHNT subgroups were noted for deep pressure (PHNTc = 2.2±0.6, PHNTnc = 0.6±0.2, P<0.05), heaviness (PHNTc = 2.3±0.7, PHNTnc = 0.6±0.3, P<0.05), fullness (PHNTc = 2.4±0.7, PHNTnc = 0.4±0.2, P<0.05), and numbness (PHNTc = 3.0±0.9, PHNTnc = 0.3±0.2, P<0.05) – all classic deqi sensations. Trending differences were noted for dull pain (PHNTc = 2.8±0.9, PHNTnc = 0.8±0.3, P = 0.06) and MI (PHNTc = 2.7±0.8, PHNTnc = 1.0±0.4, P = 0.08) (Figure 4).

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