A recent National Institutes of Health randomized, controlled study of 570 people with osteoarthritis of the knee, showed that real acupuncture, as opposed to
sham acupuncture and pain drugs used as a control, provided pain relief and improved function by 40 %.
The aim of this review was to give a systematic overview about the fMRI research on acupuncture regarding the following four aspects: 1) differences between verum and
sham acupuncture, 2) differences due to various methods of acupuncture manipulation, 3) differences between patients and healthy volunteers, 4) differences between different acupuncture points.
Nevertheless, we could see that brain regions such as SII, insula, cingulate gyrus, amygdala / hippocampal formation and prefrontal cortices might be important when differentiating the acupuncture specific effect from
sham acupuncture.
Whereas, on greater deactivation from verum than
sham acupuncture or greater activation for sham (2b, sham > verum, 21 subjects, 3 experiments and 27 foci) the result showed significant convergence in supramarginal gyrus, superior temporal gyrus and cuneus (Table 5, Figure 4B).
Qin et al. [150], [151] identified an amygdala - related network during the resting state both after verum and penetrating
sham acupuncture at a nearby point.
The controlled studies, including
sham acupuncture as a control, were mainly from China and the US: the Chinese studies mainly used penetrating sham at a nearby non-acupuncture point as a control while the US studies mainly applied the non-penetrating Streitberger needle or monofilament tapping at the same acupuncture points.
Of six studies, two studies [47], [48] showed no differences between verum and
sham acupuncture.
The ALE subtraction analysis for the comparison of verum versus
sham acupuncture should be interpreted with caution because the groups are disparate in total number of foci.
(D) Differences in brain response between verum and
sham acupuncture from subtraction analysis showed more activation in the sensorimotor affective / cognitive processing brain regions and more deactivation in the amygdala / hippocampal formation for verum acupuncture.
Five other studies [40]--[44] found no significant difference between verum and
sham acupuncture.
So this result suggested expectancy might involve distinct mechanisms between verum acupuncture and
sham acupuncture.
The meta - analyses on the specific effect of acupuncture that compared verum and
sham acupuncture came up with heterogeneous results.
In contrast, one study [39] found greater activation in the supplementary motor area in response to
sham acupuncture.
The Subtraction analysis for verum versus
sham acupuncture included in the first step analyses 3a — d for the pre-post contrast on verum or
sham acupuncture compared to baseline (Table 5, Figure 4C).
Comparing results on greater activation of
sham acupuncture points than baseline (3c, sham > rest) from 164 subjects, 15 experiments and 200 foci, showed significant convergence in cerebellum, supramarginal gyrus, superior temporal gyrus and thalamus.
In addition, Napadow et al. [51] found that both verum and
sham acupuncture showed linearly decreasing activation over repeated stimulus blocks in the sensorimotor areas, while verum acupuncture produced bimodal activity in a limbic midbrain region - activation in early blocks, but deactivation in later stimulus blocks.
From the studies which had both verum and
sham acupuncture groups: 3a) greater activation of verum acupuncture points than baseline (verum > rest), 3b) greater deactivation of verum acupuncture points than baseline (rest > verum), 3c) greater activation of
sham acupuncture points than baseline (sham > rest), 3d) greater deactivation of
sham acupuncture points than baseline (rest > sham), 3e) comparison ALE map of greater activation of verum than
sham acupuncture relative to rest («verum > rest» - «sham > rest»), 3f) comparison ALE map of greater deactivation of verum than
sham acupuncture relative to rest («rest > verum» - «rest > sham»).
In clinical studies large effects produced by
sham acupuncture were observed [4]--[6].
From the studies which provided direct contrasts between verum and
sham acupuncture: 2a) greater activation from verum than
sham acupuncture (or greater deactivation for sham, i.e. verum > sham), 2b) greater deactivation from verum than
sham acupuncture (or greater activation for sham, i.e. sham > verum).
The convergence of brain regions shown for these meta - analyses comparing verum and
sham acupuncture overlapped for middle cingulate gyrus.
However, for
the sham acupuncture group, more differences were observed in contralateral operculum, ipsilateral insula, inferior frontal gyrus, medial frontal gyrus and superior frontal gyrus.
Including data on greater deactivation of
sham acupuncture points compared to baseline (3d, rest > sham) from 50 subjects, 5 experiments and 52 foci, resulted in significant convergence in pregenual anterior cingulate, subgenual cortex and parahippocampal gyrus.
Studies also have found that traditional acupuncture works differently than
sham acupuncture in the brain.
«Importantly, the results of this trial show that even
sham acupuncture — which is effectively a placebo — is more effective than medications.
«Real acupuncture no better than
sham acupuncture for treating hot flushes: Study.»
Only one woman reported an episode of drowsiness from
the sham acupuncture, whereas the placebo pill recipients reported eight adverse events such as headache, fatigue, dizziness and constipation.
They were followed by the group that had received the «
sham acupuncture» treatment.
After all, wouldn't everyone want a treatment — be it sugar pill «drug» or
sham acupuncture — that made them feel better without producing the side effects associated with active medications?
Some of the best support for this contention came in 2012, when researchers at Memorial Sloan Kettering Cancer Center and their colleagues published a meta - analysis of 29 studies involving nearly 18,000 patients, which found that traditional acupuncture produced a somewhat greater reduction in pain than placebo or
sham acupuncture.
Not exact matches
For one thing, they point out,
acupuncture studies are extremely difficult to double - blind — a methodological approach in which neither the researchers nor patients know who is receiving the treatment under investigation and who is receiving the placebo or
sham.
Studies have found no meaningful difference between
acupuncture and a wide range of
sham treatments.
They also found some evidence supporting the use of techniques such as
acupuncture and spinal manipulation for acute and chronic pain — although it should be noted that several researchers have questioned whether these treatments are superior to placebo or
sham therapies.
A new study has revealed traditional Chinese
acupuncture treatments are no better than fake
acupuncture for treating menopause symptoms., But in a surprise finding, both the real and
sham treatments showed a 40 per cent improvement in the severity and frequency of hot flushes at the end of eight weeks of treatment.
To quantify the difference, a 2013 meta - analysis looked at placebo effects in 79 studies of migraine prevention: sugar pills reduced headache frequency for 22 percent of patients, fake
acupuncture helped 38 percent, and
sham surgery was a hit for a remarkable 58 percent.
Compared to
sham, verum
acupuncture increased the connectivity between the amygdala, the PAG (periaqueductal gray) and the insula, and decreased the connectivity between the amygdala with the middle frontal cortex, the postcentral gyrus and the posterior cingulate cortex (PCC).
From the descriptive view on the data it seems that compared to
sham, verum
acupuncture tended to be associated with more activation in the basal ganglia, brain stem, cerebellum, and insula and more deactivation was seen in the so - called «default mode network» and limbic brain areas, such as the amygdala and the hippocampus.
; b) needling at non-
acupuncture points in close proximity to
acupuncture points; c) needling at non-
acupuncture points distant to
acupuncture points; d) cutaneous stimulation at the same
acupuncture points or
sham point / area (Table S1).
The researchers did note that the differences between «true» and «
sham»
acupuncture were «relatively modest.»
In a well - documented 2008 study, 89 patients with CP / CPPS were divided into two groups, one treated with
acupuncture and the other with
sham (or placebo)
acupuncture.
The other half received «
sham» treatments, with shallow needles at points not considered therapeutic in
acupuncture (the «control» group).
Results showed that, on average, participants experienced less pain on the
acupuncture group in comparison to the
sham and treatment - free groups.
[64, 65] Although scientists do not understand how it works, several studies have shown that
acupuncture treats chronic pain more effectively than no treatment or «
sham»
acupuncture treatments (placing needles on non-meridian points).