Acupuncture Analgesia: Therapy or Sham?

Acupuncture has been used for centuries to treat pain; however, multiple recent randomized controlled trials of acupuncture in chronic pain disorders have largely shown mixed findings. In most of these studies acupuncture is no better than sham/placebo. Moreover, many basic as well as clinical studies have indicated that analgesia following acupuncture treatment involves the body's own endogenous opioid system, which is also known to be a key factor in placebo analgesia. This raises the question: Is acupuncture simply a sham/placebo? During this presentation we will examine evidence from the animal basic science literature indicating that there may be some specific effects of acupuncture needling that differ from placebo analgesia. Also we will explore how translational approaches using quantitative sensory testing as well as functional and neurochemical imaging in humans have been used to suggest that acupuncture may specifically work by upregulating receptor activity and neurotransmitter release, both hallmarks of synaptic plasticity. These results indicate a disconnect between acupuncture clinical trials and basic/translational research. New approaches are clearly needed to bridge this gap. We will end by stepping back and entertaining the question of how relevant this information is for the treatment of chronic pain patients. (Recorded at PAINWeek 2016)