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Archive for December, 2014

15
Dec

Many people who experience relief from acupuncture or other modalities wonder if it was the treatment, or the placebo effect.  My typical response is that I don’t care, so long as they feel better.

Much has been written about the Placebo Effect, and the article by Todd Hargrove which I’m attaching here has what I feel is a great explanation of it. Some text from the conclusion is below, and the full article may be read here.

The science of placebo is very interesting and informative. It is not unreasonable to suppose that a good degree of the success seen in movement-based therapies is through placebo-like effects, or through getting rid of nocebos. But I think the word placebo can be confusing. It refers to a wide variety of different phenomena that have different effects through different mechanisms.

Some placebo effects work through anxiety reduction, others through activation of the reward system, and others through descending inhibition of nociception. The common thread is they are all created by cognitive inputs – information that changes what the patient expects or believes about their health.

And this relates to another problem with the word placebo – it suggests that treatments which work through changes in client expectation are somehow inert, or ineffective, or not meaningful, or unethical, or even a scam. Of course this may very well be the case when the treatment is a sugar pill, or based on pseudoscience or quackery. In these instances, the clients’ expectations and beliefs are changed because they are deceived, and this is in most cases unethical.

But what if a treatment works primarily through changes in belief and expectation,but in a way that changes those beliefs to be more accurate? Consider the following scenarios, all of which might be described as involving placebo effects, but none of which involve deception:

  • a client is given accurate information about the poor correlation between back pain and objective MRI findings. This lowers his anxiety and pain.
  • a client is shown through passive and active movement that it is possible for her to bend forward without pain if she does so in a different manner. This reduces her anxiety, makes her expect benefit from therapy, and this reduces her pain.
  • a client receives compassionate and empathetic treatment from a caring therapist. This lowers his anxiety, makes him expect benefit, and thereby reduces his pain.
  • a client has had many past experiences with massage causing pain relief, and this learned association contributes to further pain relief from massage.

Are these all placebo effects? It is true that they all work in large part by changing the client’s beliefs. But that was the whole point of the treatment in the first place! So there should be no suggestion that the treatments are inert, ineffective or deceptive. Using the word placebo in these cases can be stigmatizing and confusing.

I prefer to look at it this way: pain results from perception of threat, and it can be treated by providing the client as much good news as possible about the threat in question.

Does this present an ethical issue? Only when that good news is built from lies and not the truth. Fortunately, I think there are many optimistic truths that clients can learn from therapists through touch, movement, and conversation.

01
Dec

Supermodel Elle Macpherson, recently said in an interview with UK tabloid, News of the World, “I have acupuncture regularly and I see a Chinese doctor who treats most common ailments with herbs.” 

When asked how she maintained her health and well being, Elle answered, “I do choose to look after my body from a Chinese medicine perspective, which promotes and maintains wellness rather than treats illness.”

Elle is not the only celebrity that seems to have become “star-struck” with this traditional form of health care that is touted as being able to treat everything from anxiety to a torn rotator cuff.  Gwyneth Paltrow, a longtime advocate of the benefits of acupuncture and Oriental medicine, once said that having acupuncture had guided her to a “new level” in life, helping her to find love with her husband and giving her the strength to cope with the death of her father. In an interview with Oprah Winfrey, Gwyneth Paltrow said, “I have been a big fan of Chinese medicine for a long time because it works.”

So what other celebrities are up for being a voluntary pin-cushion?  Dr. Maoshing Ni, an acupuncturist in Santa Monica lists Jim Carrey and Helen Hunt as two of his many famous clients.  In a testimonial, Jim Carrey said “undergoing [acupuncture] treatments with Dr. Mao at and following his nutritional advice has led to a marked change in my physical vitality and my general state of well-being.”

Celebrities have embraced acupuncture so whole-heartedly that they even schedule regular acupuncture treatments for their pets.  Sarah Michelle Gellar of Buffy the Vampire Slayer fame, has been spotted in Los Angeles taking her pampered pooch, Tyson, in for his acupuncture treatment.

Acupuncture is becoming more and more respected by conventional medicine, so much so that there were acupuncturists on-site for the athletes at both the Summer and Winter Olympics.

How it works
 
Is there any evidence to back up this rapid growth in the popularity of acupuncture?  Besides the 2000 years of clinical evidence, there are a multitude of studies to substantiate that acupuncture has a measurable affect on the body.  One study on how acupuncture works to relieve pain, published in the Journal of NeuroImage, used brain imaging technology to prove that acupuncture affects the brain’s long-term ability to regulate pain.  In the study, researchers were able to show that acupuncture increased the binding availability to opioid receptors in the brain in much the same way that opioid painkillers, such as morphine, codeine and other medications, are thought to work 

The U.S. National Institutes of Health (NIH) and the World Health Organization (WHO) have declared acupuncture effective for more than 200 other conditions including, respiratory, eye and mouth, gastro-intestinal, neurological and muscular disorders. Because of acupuncture’s ability to speed the healing process, bring down swelling and inflammation, relieve pain, and help to restore normal range of motion, it is especially effective at treating musculo-skeletal disorders.  

“When someone comes in for treatment, we take all of their symptoms into account and aim at balancing the energy within the body to optimize health.  Treatments are tailored for the individual.  That is why it is important to talk with an acupuncturist to see how acupuncture will be able to help your specific and unique case.”

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