Elsevier

The Journal of Pain

Volume 11, Issue 6, June 2010, Pages 555-563
The Journal of Pain

Original Report
The Impact of Placebo, Psychopathology, and Expectations on the Response to Acupuncture Needling in Patients With Chronic Low Back Pain

https://doi.org/10.1016/j.jpain.2009.09.013Get rights and content
Under an Elsevier user license
open archive

Abstract

Comorbid psychopathology is a variable not explored in the acupuncture RCTs that could explain whether subgroups of patients with chronic low back pain have differential responses to acupuncture or placebo treatments. This was a controlled, blinded, crossover trial of verum acupuncture and validated sham acupuncture in 40 CLBP patients, with a Low or High level of psychiatric comorbidity. They completed a 0 to 10 rating scale for pain at the beginning and end of each treatment session, and rated their expectations for change in pain. Verum acupuncture was performed at Large Intestine 4 on the dorsal right hand for 30 minutes by a licensed acupuncturist. Data analysis used percent improvement in pain as the primary outcome for each of the treatment sessions. Both groups (21 Low and 19 High) reported significant analgesia with verum acupuncture needling, mean 33%, P = .9 for difference between groups; and with placebo, 26%, P = .09. In both groups, expectations were only a significant predictor of verum acupuncture response, P = .002, such that those with greater expectations had greater pain relief. Psychiatric comorbidity does not significantly impact acupuncture or placebo acupuncture analgesia in CLBP. It does not affect the positive impact of expectations on reported pain relief from real acupuncture.

Perspective

Psychiatric comorbidity may predict differences between acupuncture and placebo responses, not otherwise seen in the RCTs for low back pain. Using a blinded, crossover design, we report that it does not predict outcome, nor does it seem to modify the effect of expectancy (a known predictor) on acupuncture response.

Key words

Psychiatric comorbidity
acupuncture
chronic low back pain
placebo controlled
expectations

Cited by (0)

Supported by NIH grants# NIDA 1K23DA020681-01A1 and NCCAMP01 AT002048-01 (A.D.W.); NCAAMKO1AT003883 (J.K.); NCAAMK24AT004095 (T.K.).