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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

Temporal evolution of autonomic response to real (REAL) and phantom (credible, PHNTc; non-credible, PHNTnc) acupuncture.Needle insertion, whether real or phantom, produced significantly greater (A) HR decrease, (B) SC increase and (C) PS increase, compared to needle manipulation. ANS response to needle manipulation was relatively stable over all 8 manipulations for REAL (n = 20), PHNTc (n = 11), and PHNTnc (n = 9). SC increase was greater for REAL compared to PHNTc and especially PHNTnc, consistently over all stimuli. Error bars represent standard error of the mean.
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pone-0104582-g007: Temporal evolution of autonomic response to real (REAL) and phantom (credible, PHNTc; non-credible, PHNTnc) acupuncture.Needle insertion, whether real or phantom, produced significantly greater (A) HR decrease, (B) SC increase and (C) PS increase, compared to needle manipulation. ANS response to needle manipulation was relatively stable over all 8 manipulations for REAL (n = 20), PHNTc (n = 11), and PHNTnc (n = 9). SC increase was greater for REAL compared to PHNTc and especially PHNTnc, consistently over all stimuli. Error bars represent standard error of the mean.

Mentions: During the needle insertion, before the needle manipulation (1st –8th stim.), significant HR deceleration was observed in the three groups (REAL = −8.25±3.85 BPM, P<0.0001; PHNTc = −9.67±4.02, P<0.0001; PHNTnc = −9.25±4.59, P<0.0001). The amplitude of HR decrease, in subsequent needle manipulation, was then reduced but still significant compared to the baseline (P<0.05 for all events, Figure 7A for individual response, Figure 3A for average response of eight stimuli). No significant difference was found between groups at each event.


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)

Temporal evolution of autonomic response to real (REAL) and phantom (credible, PHNTc; non-credible, PHNTnc) acupuncture.Needle insertion, whether real or phantom, produced significantly greater (A) HR decrease, (B) SC increase and (C) PS increase, compared to needle manipulation. ANS response to needle manipulation was relatively stable over all 8 manipulations for REAL (n = 20), PHNTc (n = 11), and PHNTnc (n = 9). SC increase was greater for REAL compared to PHNTc and especially PHNTnc, consistently over all stimuli. 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-g007: Temporal evolution of autonomic response to real (REAL) and phantom (credible, PHNTc; non-credible, PHNTnc) acupuncture.Needle insertion, whether real or phantom, produced significantly greater (A) HR decrease, (B) SC increase and (C) PS increase, compared to needle manipulation. ANS response to needle manipulation was relatively stable over all 8 manipulations for REAL (n = 20), PHNTc (n = 11), and PHNTnc (n = 9). SC increase was greater for REAL compared to PHNTc and especially PHNTnc, consistently over all stimuli. Error bars represent standard error of the mean.
Mentions: During the needle insertion, before the needle manipulation (1st –8th stim.), significant HR deceleration was observed in the three groups (REAL = −8.25±3.85 BPM, P<0.0001; PHNTc = −9.67±4.02, P<0.0001; PHNTnc = −9.25±4.59, P<0.0001). The amplitude of HR decrease, in subsequent needle manipulation, was then reduced but still significant compared to the baseline (P<0.05 for all events, Figure 7A for individual response, Figure 3A for average response of eight stimuli). No significant difference was found between groups at each event.

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