One Utah

I’ve blogged about suffering from migraines.  At the time I described a migraine as not unlike having a short term mental illness.  The pain of a migraine can be debilitating, pain so intense at times that I’ve rubbed my temples so hard I’ve bruised them.  Migraine pain interferes with your ability to see, to think, to function.  At times, I’ve had migraines so intense I’ve actually thought the only explanation for such pain could be some sort of horrific fast growing tumor.  Then the migraine ends and I feel transformed.

After years of putting medicine in my body I decided to try some different approaches to managing migraine pain ( fundamentally, I felt that the huge quantities of medicine required to manage migraine pain couldn’t be having a positive effect on my body).  I used heating pads, cold wash cloths, ice packs, massage, rest and so forth.  Basically, in terms of pain management, I saw little positive effect.

I’ve read articles suggesting acupuncture works for migraines.  So two months ago, suffering a migraine so intense I probably should not have been driving, I went to an acupuncturist.  The experience was, to say the least, interesting.  Unlike my MD, my acupuncturist spent 45 minutes talking with me before doing any treatment - she asked a series of questions concerning lifestyle, the nature of the pain and what actions seems to alleviate the pain before giving me a diagnosis.  Then, she said each treatment session would have two parts - acupressure massage (aka tuina), acupuncture and every so often, time spent on additional consultation.  An acupuncture treatment lasts about one hour - I arrive, take off my shoes and socks, loosen my belt and lie on an examination table in a darkened room.  Doctor Ming then comes in, covers me with soft, wool blankets, does the massage (acupressure massage is actually quite relaxing), then performs the acupuncture.  After the needles are in place, she turns a heat lamp on my feet so they don’t get cold then leave me in the darkened room for about 20 to 30 minutes or so, encouraging me to sleep.

After several visits, I developped the theory that the positive outcomes I experienced were the result of the acupuncturists attention and the quiet relaxation in the dark room - i.e. the placebo effect.  Research on the placebo effect has shown it works on a wide array of ailments, especially those that are related to the sufferer’s emotional state.

I see over at Respectful Insolence, that my theory was right.  A study was done with a control group that received no treatment, a second group that received only the sham acupuncture with minimal interaction and a third group that had an acupuncture experience like mine (receiving however, sham acupuncture):

. . . Every subject in every group underwent three weeks of therapy. After three weeks, subjects in groups 2 and 3 were re-randomized to either group 2 or 3 again without their knowledge, and the experiment continued for another three weeks. At three weeks and six weeks, scales measuring global improvement, adequate relief of symptoms, symptom severity, and quality of life were measured. The overall rationale for this experimental design, of course, is to test three postulated parts of the placebo effect, the response to treatment and assessment (Hawthorne effect), the patient’s response to a therapeutic ritual (placebo acupuncture), and the patient’s response to the patient-practitioner interaction.

. . . Global improvement scores were lowest in the observation group, increased in the limited group, and increased still more in the augmented group. The same was true of the symptom severity scores, only in reverse. This score decreased from observation to limited to augmented, indicating improvement of IBS symptoms, results that persisted to six weeks. This was also likely to be significant clinically, because a decrease in the symptom severity score of 50 reliably indicates improvement of symptoms and approximately 60% of patients reached this level of improvement. The results showed a statistically significant trend, and suggested that a ritualized treatment provided some placebo effect but that the practitioner-patient relationship was capable of producing the most powerful placebo effect. The investigators tested for successful blinding, and similar numbers of patients in groups 2 and 3 (around 80%) believed that they were getting effective acupuncture.

 . . . none of these patients received “real” acupuncture, only sham acupuncture. Basically, the main variables being studied and measured were the effects of ritualized treatment and the practitioner-patient relationship on patient perception of symptomatic relief. Strengths of the study included its design and the use of a validated sham acupuncture.

IOW, the primary effect of acupuncture come from the treatment ritual, not the actual treatment. 

Why does this matter? 

Well, people spend a lot of money on alternative therapies - many of which are useless but some of which are worse than useless.  Some of these therapies (I’m thinking of reiki as an example) involve a practitioner spending time and giving attention to a patient, along with some non-invasive touch.  It’s a long established fact that human beings are physically and emotionally healthier when we receive regular, consensual touch and contact with other human beings.  Generally, people who practice alternative medicine believe their treatments are beneficial.  That belief probably helps their patients be reinforcing the placebo effect.  But, we could probably save people a lot of money.

This entry was posted Wednesday, April 9th, 2008 at 10:56 am and is filed under Healthcare, Mental Illness, Mental health, Society, This Blog. You can leave a response, or trackback from your own site.