If you have been looking into the different types and practices of acupuncture, you will have undoubtedly come across mention of a practice called ‘sham acupuncture’. This is an interesting modern variant which we will discuss in this article.
What is sham acupuncture?
Sham acupuncture is essentially fake acupuncture, and is used as a control in scientific studies to determine whether or not the effects of a treatment are actually due to acupuncture treatment (discu,ssed in the next section in more detail). Sham acupuncture should not be a service offered at a cost from an acupuncturist, instead it is a tool used to discover more about the effectiveness of acupuncture.
Why is sham acupuncture used?
As mentioned above, sham acupuncture is used to discover whether or not the effects a person receiving acupuncture is experiencing are genuine. This kind of tool is called an experimental control, and is used to determine whether or not the results reported by patients is due to something called the placebo effect or the actual therapy being used.
The placebo effect refers to the phenomenon that occurs when patients experience positive effects after a treatment purely because they think they should rather than due to any change caused by the therapy. A placebo is basically an imitation treatment used as a control, and sham acupuncture is essentially a placebo.
Placebos achieve two important ends, the first is illustrating how important the brain is in recovery and healing, and the second is giving experiments a comparison point. Usually patients enrolled in a trial will not know which treatment is the placebo and which is the real deal, and because of that the results reported should reflect a genuine difference between treatment and therapy if there is one to be found.
The placebo effect is a fairly broad idea, and there are a number of factors which fit in under this general theme, all of which are elements which can influence a patient into perceiving benefits from sham acupuncture/placebos:
- Any suggestions by the practitioner that promote the idea of a treatment working can influence the outcome.
- How the practitioner behaves can also influence results, with more caring, knowledgeable, and affectionate acupuncturists influencing a positive outcome.
- What the client his/herself believes they can achieve through treatment.
- What the client believes about the effectiveness of acupuncture and the competence of their acupuncturist.
Sham acupuncture can also be used to compare the placebo effect of acupuncture to other treatments. Aspirin for example, can be used in a trial alongside sham acupuncture, and if the latter proves to achieve better results then the interpretation would be that the belief in acupuncture’s effectiveness based on personal beliefs and experience contribute to its effectiveness.
In order for acupuncture to prove itself as a viable therapy in such a test, it needs to prove significantly different in its results when compared to the sham control. In some extremely well designed investigations, both sham and real acupuncture are compared to a third, medical treatment, providing a more in-depth view of acupuncture’s effectiveness.
How is sham acupuncture performed?
In an ideal world, sham acupuncture would be performed as a double-blind, which is the gold standard for how placebos are used in medical trials and tests. In a double-blind test neither the patient or the acupuncturist would know whether a treatment was real or sham. This eliminates many confounding factors and would lead to a far more reliable study. In practice however, this does not seem possible as an acupuncturist would need to practice his or her therapy without knowing whether or not the needle has been placed into the target acupoint.
In reality there are several different kinds of sham acupuncture. One method involves preventing the actual penetration of a needle into the body. Acupuncture needles are extremely fine stainless steel needles that can, in the hands of a skilled and experienced practitioner, pass into the skin with virtually no pain or sensation at all. In a Swedish application of this method needles that retracted into their handles rather than penetrated the skin were used, stimulating some level of contact that can effectively trick the patient into thinking they are receiving genuine acupuncture.
Another version of sham acupuncture involves inserting needles into random points on the body rather than the acupoints usually targeted. It is important that a patient receiving this type of sham acupuncture is not familiar with acupoints or how acupuncture is performed. If the patient is knowledgeable enough about the practice of acupuncture to notice that the needles are not being placed in the right spots then the sham has effectively failed and the results reported would have to be discounted.
Sham acupuncture is an important practice in a world where many investigations are being performed to ascertain the validity of acupuncture as a treatment for so many different conditions. The key point to remember when performing sham acupuncture is that it is absolutely critical that the patient be unaware of whether or not they are receiving sham or true acupuncture. If the patient determines the nature of the treatment they are receiving, then the treatment would have to be discounted on the grounds that it is a compromised result for the purposes of a scientific investigation.
In more recent years sham acupuncture has been used to great effect and higher quality studies have been reported. With further work, we should be able to reach more solid conclusions about the efficacy of acupuncture as an alternative therapy.
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