Do the neural correlates of acupuncture and placebo effects differ?

MGH/MIT/HMS Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA. <>
Pain (Impact Factor: 5.21). 04/2007; 128(1-2):8-12. DOI: 10.1016/j.pain.2007.01.001
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Available from: Vitaly Napadow,
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    • "The selection and compatibility of acupoints are considered to have direct impact on the therapeutic effect. Data from neuroimaging studies in humans suggest that modulation of the limbic system may differentiate between specific and non-specific components of acupuncture [39]. "
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    ABSTRACT: Acupuncture treatment has been widely used for many conditions, while results of the increasing numbers of randomized trials and systematic reviews remain controversial. Acupuncture is a complex intervention of both specific and non-specific factors associated with therapeutic benefit. Apart from needle insertion, issues such as needling sensation, psychological factors, acupoint specificity, acupuncture manipulation, and needle duration also have relevant influences on the therapeutic effects of acupuncture. Taking these factors into consideration would have considerable implications for the design and interpretation of clinical trials.
    Trials 04/2012; 13(42):42. DOI:10.1186/1745-6215-13-42 · 1.73 Impact Factor
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    • "Despite emerging neuroimaging evidence demonstrating that acupuncture can modulate and decrease neuronal activity at several CNS structures (Hui et al., 2005; Dhond et al., 2007; Napadow et al., 2007), clinical benefits seem to be of small magnitude and of short duration (Mathew and Ernst, 2007). Acupuncture recruits a wide network of brain regions including the primary somatosensory (SI), second somatosensory (SII), anterior cingulated (ACC), prefrontal (PFC) and insular cortices, amygdala, hippocampus, hypothalamus, periaquedutal gray and the cerebellum (Hui et al., 2005; Dhond et al., 2007; Napadow et al., 2007), which are similar to the structures usually involved in chronic pain states. Acupuncture may be valuable in reducing the number of tender points lower than 4kg/cm 2 and the mean pressure pain threshold over the 18 classic tender points when added to usual treatment (Targino et al., 2008). "
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    ABSTRACT: Fibromyalgia is a clinical syndrome of chronic widespread pain and reduced pain thresholds to palpation. The pathophysiology remains unknown, but there is increasing evidence that peripheral and central sensitization cause an amplification of sensory impulses that may alter pain perception in fibromyalgia patients. Interventions to treat fibromyalgia should aim at different targets simultaneously in order to reduce peripheral and central sensitization. There are both pharmacologic and non-pharmacologic approaches with evidence for effectiveness in the treatment of fibromyalgia and its associated symptoms. Evidence from randomized trials and meta-analyses shows that partial and short-term improvements in fibromyalgia symptoms can be achieved with low doses of antidepressants and with physical activity such as aerobic and strengthening exercises. A multidimensional approach which emphasizes education and integration of exercise and cognitive behavior therapy improves quality of life and reduces pain, fatigue and depressive symptoms when measured on a short term basis. More recently, trials have shown the neuromodulators gabapentin and pregabalin to be effective in reducing pain and improving quality of sleep in fibromyalgia. In addition, small trials of noninvasive brain stimulation have also shown benefits in reducing pain in fibromyalgia. It is essential to keep in mind that some important clinical conditions can mimic and overlap with fibromyalgia and should always be ruled out by a complete history, physical examination and appropriate laboratory testing.
    European journal of pain (London, England) 11/2009; 3(2):117-122. DOI:10.1016/j.eujps.2009.08.011 · 2.93 Impact Factor
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    • "A part of the specific effects of minimal acupuncture may be attributed to the deactivation of limbic structures and modulation of default mode [17,68-78]. If it is the case, needle depth or site of stimulation is not essential for eliciting some of the specific effects of acupuncture [79-84]. "
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    ABSTRACT: Placebo-control of acupuncture is used to evaluate and distinguish between the specific effects and the non-specific ones. During 'true' acupuncture treatment in general, the needles are inserted into acupoints and stimulated until deqi is evoked. In contrast, during placebo acupuncture, the needles are inserted into non-acupoints and/or superficially (so-called minimal acupuncture). A sham acupuncture needle with a blunt tip may be used in placebo acupuncture. Both minimal acupuncture and the placebo acupuncture with the sham acupuncture needle touching the skin would evoke activity in cutaneous afferent nerves. This afferent nerve activity has pronounced effects on the functional connectivity in the brain resulting in a 'limbic touch response'. Clinical studies showed that both acupuncture and minimal acupuncture procedures induced significant alleviation of migraine and that both procedures were equally effective. In other conditions such as low back pain and knee osteoarthritis, acupuncture was found to be more potent than minimal acupuncture and conventional non-acupuncture treatment. It is probable that the responses to 'true' acupuncture and minimal acupuncture are dependent on the aetiology of the pain. Furthermore, patients and healthy individuals may have different responses. In this paper, we argue that minimal acupuncture is not valid as an inert placebo-control despite its conceptual brilliance.
    Chinese Medicine 02/2009; 4(2):1. DOI:10.1186/1749-8546-4-1 · 1.49 Impact Factor
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