Acupuncture and Osteoarthritis of the Knee
A new study recently reported in WebMD showed that treatment of osteoarthritis-related knee pain with acupuncture produced about the same results as treatment with "sham acupuncture." In this study, one group of patients received authentic acupuncture treatments, but in the other group, the physicians inserted the needles outside of the correct meridian points and too shallowly to make a difference.
The researchers compared the real and bogus acupuncture treatments in 455 sufferers of knee arthritis. Subjects' symptoms included pain, swelling of the knee, and stiffness in the knee joints. But the study wasn't simply about the effectiveness of acupuncture. It was also about the impact of the interaction with the physician on patient outcomes. The acupuncturists were trained to deliver the treatment in two styles: "high expectation" and "neutral expectation." High expectation involved telling patients that the physician has had a high degree of success reducing pain using the treatment. Neutral expectation involved telling patients that the treatment may or may not work.
In the end, the recipients of both the real and fake acupuncture reported greater improvement in their symptoms than those who received no treatment. But among patients who saw a high-expectation physician, 41.2 percent report a 50 percent improvement in symptoms, as compared to only 33.6 percent of those who saw a neutral expectation doctor. In a news release, study leader Dr. Maria Suarez-Almazor, a rheumatologist at the University of Texas Anderson Cancer Center in Houston, said, "We found a small but significant effect on pain and satisfaction with treatment, demonstrating a placebo effect related to the clinician's communications style. The improvement in pain and satisfaction suggests that the benefits of acupuncture may be partially mediated through placebo effects related to the behavior of the acupuncturist."
As the witch said in Monty Python and the Holy Grail, after being exposed in a scientific study, "It's a fair cop." I know most practitioners of acupuncture will be indignant, but let's be honest for a moment. Doesn't a patient's mental state have a great deal to do with the effectiveness of any treatment?
And that would apply to medical doctors and their cuttings and dosings too, would it not?
In other words, the old "bedside manner" may be as much of a healing tool as the pocket full of pills. When the physician helps the patient feel hope, the results are better than when the physician frightens the patient with stories of scary outcomes or leaves the patient's expectations in neutral. The study also underlines the fact that so much of healing occurs in the mind. According to WebMD, "Optimism is a resource for healing. Optimists are more likely to overcome pain and adversity in their efforts to improve their medical treatment outcomes. For example, optimistic coronary bypass patients generally recover more quickly and have fewer complications after surgery than do patients who are less hopeful."
And then there's the American Psychological Association list of facts demonstrating the mind/body connection in positive health outcomes. The list notes that higher levels of hostility are a better predictor of heart disease than cholesterol levels, cigarette smoking, or obesity; and that employees using mental health counseling reduced their use of medical insurance by 31 percent.
Clearly, positive health outcomes require, among other things, a positive attitude on the part of both patient and physician, appropriate treatment regimens, and good patient-physician communication. If any of these elements are off the mark, they can have a profound impact on the results.
In the meantime, don't give up on acupuncture. Remember, in the study, the treatment helped even those who believed it might not. Confidence in the physician merely improved the results. In addition, there have been numerous medical studies that have acupuncture's as effective as medical treatments for a number of conditions. For example, there's the 2008 study that shows that acupuncture works as well as myofascial pain therapy in treating chronic musculoskeletal pain. And of course, for all those people who used acupuncture as their analgesic of choice during major surgery, it would be a huge surprise to find out that the effect was all placebo.
In the end, there's no denying the influence of the mind when it comes to reducing pain…and even mortality. This is true regardless of the type of therapy used, alternative or medical. It is not for nothing that one of the most important chapters in Lessons from the Miracle Doctors is titled, "The Thought that Kills."