Is Acupuncture a Placebo?

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People often assume that acupuncture is synonymous with Traditional Chinese Medicine and that anyone who uses acupuncture does so based on 'qi' or 'meridians'. This is a misconception. Many therapists practice needling in a biopsychosocial, evidence based model that is grounded in neurophysiology.

“The term ‘acupuncture’ is a translation of 针刺术 (zhen ci shu in Chinese pin yin) or in short 针 (zhen), and is literally equivalent to the term ‘needling’ or ‘needling technique’. Based on the traditional and official definition, the term acupuncture refers to the actual insertion of a needle (usually a solid needle) into the body, which describes a family of procedures involving the stimulation of points on the body using a variety of techniques”
— Fan et al. (2016). Dry needling is acupuncture. Acupunct Med.

Medical Acupuncture

The concept of medical acupuncture was pioneered by Felix Mann who began to view acupuncture as a form of peripheral nerve stimulation (Campbell 2015). In which acupuncture needles are inserted into anatomically defined sites, and stimulated manually or with electricity (White 2009).

Treatment targets are based on patient presentation, but preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia).

Is Acupuncture a Placebo

In any discussion on therapeutic effect it is important to acknowledge the placebo response. It is also a within the realm of possibility that patients have a complex biopsychosocial response that INCLUDES but is not LIMITED to placebo. Several plausible theories attempt to explain how acupuncture works, this includes but is not limited to:
• The gate control theory of pain (Melzack 1965)
• The release of endogenous opioids (Chen et al. 2017, Yin et al. 2017 )
• The release of endogenous cannabinoids (McPartland et al. 2014, Hu et al. 2017)
• Purinergic Signaling (Tang et al. 2016)
• Interactions between non-neuronal cells and neurons (Ji et al. 2016)
• The Inflammatory Reflex (Chavan et al. 2014, Lim et al. 2016, Pavlov et al. 2017)
• Neuroplasticity (Maeda et al. 2017)
• C Tactile Afferents (Chae et al. 2017)
• Mesenchymal Stem Cells (Salazar et al. 2017) 
• Local Changes in Microcirculation (Kaneko et al. 2016)

Thomas Lundeberg gives a brief description of the neurophysiology behind acupuncture - recorded at the British Medical Acupuncture Society Physiology Day in December 2013. http://www.medical-acupuncture.co.uk/

More to Explore (Mechanism of Action)

Textbooks and Historical Overview

Research

Bialosky, J.E., Bishop, M.D., Penza, C.W. (2017). Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing? J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28459190

Chae, Y. (2017). The dilemma of placebo needles in acupuncture research. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/28624770

Chae, Y., Olausson, H. (2017). The role of touch in acupuncture treatment. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/28151404

Chavan, S. S., & Tracey, K. J. (2014). Regulating innate immunity with dopamine and electroacupuncture. Nature Medicine.
https://www.ncbi.nlm.nih.gov/pubmed/24603793

Chavan, S.S., Pavlov, V.A., Tracey, K.J. (2017). Mechanisms and Therapeutic Relevance of Neuro-immune Communication. Immunity.
https://www.ncbi.nlm.nih.gov/pubmed/28636960

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

Hu, B., Bai, F., Xiong, L., Wang, Q. (2017). The endocannabinoid system, a novel and key participant in acupuncture's multiple beneficial effects. Neurosci Biobehav Rev.
https://www.ncbi.nlm.nih.gov/pubmed/28412017

Ji, R.R., Chamessian, A., Zhang, Y.Q. (2016). Pain regulation by non-neuronal cells and inflammation. Science.
https://www.ncbi.nlm.nih.gov/pubmed/27811267

Langevin, H. M. (2014). Acupuncture, Connective Tissue, and Peripheral Sensory Modulation. Critical Reviews in Eukaryotic Gene Expression.
https://www.ncbi.nlm.nih.gov/pubmed/25072149

Lim, H., Kim, M., Lee, C., & Namgung, U. (2016). Anti-Inflammatory Effects of Acupuncture Stimulation via the Vagus Nerve. PLoS ONE
http://www.ncbi.nlm.nih.gov/pubmed/26991319

Lund, I., & Lundeberg, T. (2015). Effects triggered in the periphery by acupuncture. Acupuncture and Related Therapies.
http://www.sciencedirect.com/science/article/pii/S2211766015000043

Maeda, Y., Kim, H., Kettner, N., Kim, J., Cina, S., .... Napadow, V. (2017). Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain.
https://www.ncbi.nlm.nih.gov/pubmed/28334999

Mcpartland, J. M., Guy, G. W., & Marzo, V. D. (2014). Care and Feeding of the Endocannabinoid System: A Systematic Review of Potential Clinical Interventions that Upregulate the Endocannabinoid System. PLoS ONE.
https://www.ncbi.nlm.nih.gov/pubmed/24622769

Melzack, R. & Wall, P.D. (1965). Pain mechanisms: a new theory. Science.
http://www.ncbi.nlm.nih.gov/pubmed/5320816

Pavlov, V.A., Tracey, K.J. (2017). Neural regulation of immunity: molecular mechanisms and clinical translation. Nat Neurosci.
https://www.ncbi.nlm.nih.gov/pubmed/28092663

Pelletier, R., Higgins, J., Bourbonnais, D. (2015). Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders. Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/25953594

Salazar, T.E., Richardson, M.R., Beli, E., ... Grant, M.B. (2017). Electroacupuncture Promotes CNS-Dependent Release of Mesenchymal Stem Cells. Stem Cells.
https://www.ncbi.nlm.nih.gov/pubmed/28299842

Tang, Y., Yin, H., Rubini, P., & Illes, P. (2016). Acupuncture-Induced Analgesia: A Neurobiological Basis in Purinergic Signaling. The Neuroscientist.
http://www.ncbi.nlm.nih.gov/pubmed/27343858

Torres-Rosas, R., Yehia, G., ... Ulloa, L. (2014). Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nat Med.
https://www.ncbi.nlm.nih.gov/pubmed/24562381

Yin, C., Buchheit, T.E., Park, J.J. (2017). Acupuncture for chronic pain: an update and critical overview. Curr Opin Anaesthesiol.
https://www.ncbi.nlm.nih.gov/pubmed/28719458

Zhang, R., Lao, L., Ren, K., & Berman, B. M. (2014). Mechanisms of Acupuncture–Electroacupuncture on Persistent Pain. Anesthesiology. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/24322588

More to Explore (Systematic Reviews and Clinical Practice Guidelines)

Acupuncture as a method of pain relief in the acute and chronic stage is based on a wide range of clinical trials published in reputable journals, done by researchers from reputable medical institutions.  

Busse, J.W., Craigie, S., Juurlink, D.N, ... Guyatt GH. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.
https://www.ncbi.nlm.nih.gov/pubmed/28483845

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., ... Brodt, E.D. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/28192793

Cox, J., Varatharajan, S., Côté, P., Optima Collaboration. (2016). Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/27117725

Jan, A.L., Aldridge, E.S., Rogers, I.R., Visser, E.J., Bulsara, M.K., Niemtzow, R.C. (2017). Review article: Does acupuncture have a role in providing analgesia in the emergency setting? A systematic review and meta-analysis. Emerg Med Australas.
https://www.ncbi.nlm.nih.gov/pubmed/28748654

Kjaer, P., Kongsted, A., Hartvigsen, J., ... Povlsen, T.M. (2017). National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J.
https://www.ncbi.nlm.nih.gov/pubmed/28523381

Lin, X., Huang, K., Zhu, G., Huang, Z., Qin, A., & Fan, S. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of Bone & Joint Surgery.
https://www.ncbi.nlm.nih.gov/pubmed/27655986

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Vertosick, E. A., . . . White, A. R. (2016). Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews.
https://www.ncbi.nlm.nih.gov/pubmed/27351677

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Shin, B., . . . White, A. R. (2016). Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews.
https://www.ncbi.nlm.nih.gov/pubmed/27092807

MacPherson, H., Vickers, A., Bland, M., Torgerson, D., Corbett, M., Spackman, E., ..., Watt, I. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.
https://www.ncbi.nlm.nih.gov/pubmed/28121095

Qaseem, A., Wilt, T.J., McLean, R.M., Forciea, M.A. (2017). Clinical Guidelines Committee of the American College of Physicians.. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/28192789

Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., Macpherson, H., Foster, N. E., . . . Collaboration, F. T. (2012). Acupuncture for Chronic Pain. Archives of Internal Medicine.
https://www.ncbi.nlm.nih.gov/pubmed/22965186 

Wong, J., Côté, P., Sutton, D., Randhawa, K., Yu, H., Varatharajan, S., . . . Taylor-Vaisey, A. (2017). Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/27712027

Yang, Y., Que, Q., Ye, X., Zheng, G.h. (2016). Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/26718001

Yin, C., Buchheit, T.E., Park, J.J. (2017). Acupuncture for chronic pain: an update and critical overview. Curr Opin Anaesthesiol.
https://www.ncbi.nlm.nih.gov/pubmed/28719458