title: Phantom acupuncture: dissociating somatosensory and cognitive/affective components of acupuncture stimulation with a novel form of placebo acupuncture.
abstract: In a clinical setting, acupuncture treatment consists of multiple components including somatosensory stimulation, treatment context, and attention to needle-based procedures. In order to dissociate somatosensory versus contextual and attentional aspects of acupuncture, we devised a novel form of placebo acupuncture, a visual manipulation dubbed phantom acupuncture, which reproduces the acupuncture needling ritual without somatosensory tactile stimulation. Subjects (N = 20) received both real (REAL) and phantom (PHNT) acupuncture. Subjects were retrospectively classified into two groups based on PHNT credibility (PHNTc, who found phantom acupuncture credible; and PHNTnc, who did not). Autonomic and psychophysical responses were monitored. We found that PHNT can be delivered in a credible manner. Acupuncture needling, a complex, ritualistic somatosensory intervention, induces sympathetic activation (phasic skin conductance [SC] response), which may be specific to the somatosensory component of acupuncture. In contrast, contextual effects, such as needling credibility, are instead associated with a shift toward relative cardiovagal activation (decreased heart rate) during needling and sympathetic inhibition (decreased SC) and parasympathetic activation (decreased pupil size) following acupuncture needling. Visual stimulation characterizing the needling ritual is an important factor for phasic autonomic responses to acupuncture and may undelie the needling orienting response. Our study suggests that phantom acupuncture can be a viable sham control for acupuncture as it completely excludes the somatosensory component of real needling while maintaining the credibility of the acupuncture treatment context in many subjects.
authors.affiliation: Department of Biomedical Engineering, Kyung Hee University, Yongin, Gyeonggi, South Korea.
authors.forename: Jeungchan
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Biomedical Engineering, Kyung Hee University, Yongin, Gyeonggi, South Korea; Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Napadow
authors.affiliation: Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America.
authors.forename: Jieun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Neuropsychiatry, College of Korean Medicine, Sangji University, Wonju, Gangwon, South Korea.
authors.forename: Seunggi
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Neuropsychiatry, College of Korean Medicine, Sangji University, Wonju, Gangwon, South Korea.
authors.forename: Woojin
authors.initials: W
authors.lastname: Choi
authors.affiliation: Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Ted J
authors.initials: TJ
authors.lastname: Kaptchuk
authors.affiliation: Department of Biomedical Engineering, Kyung Hee University, Yongin, Gyeonggi, South Korea.
authors.forename: Kyungmo
authors.initials: K
authors.lastname: Park
mesh_terms: D026881:Acupuncture / Q000193:education* / Q000379:methods*; D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D003071:Cognition; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D010775:Photic Stimulation
references.citation: Learn Mem. 2006 Nov-Dec;13(6):711-8
references.pmid: 17101871
references.citation: Neurosci Biobehav Rev. 2010 Feb;34(2):148-59
references.pmid: 19712693
references.citation: J Altern Complement Med. 2007 Dec;13(10):1059-70
references.pmid: 18166116
references.citation: Neuroimage. 2012 Mar;60(1):653-60
references.pmid: 22227140
references.citation: PM R. 2012 May;4(5):367-73
references.pmid: 22405683
references.citation: Pain. 1998 Mar;75(1):19-25
references.pmid: 9539670
references.citation: Acupunct Electrother Res. 1983;8(1):25-35
references.pmid: 6135301
references.citation: Biol Psychol. 2010 Jul;84(3):437-50
references.pmid: 19879918
references.citation: Nature. 1998 Feb 19;391(6669):756
references.pmid: 9486643
references.citation: Pain. 2003 Mar;102(1-2):125-33
references.pmid: 12620603
references.citation: Hum Brain Mapp. 2013 Oct;34(10):2592-606
references.pmid: 22504841
references.citation: Brain Res. 2004 Mar 12;1000(1-2):40-56
references.pmid: 15053950
references.citation: Lancet. 1998 Aug 1;352(9125):364-5
references.pmid: 9717924
references.citation: Proc Natl Acad Sci U S A. 2012 Sep 25;109(39):15959-64
references.pmid: 23019380
references.citation: J Auton Nerv Syst. 2000 Feb 14;79(1):52-9
references.pmid: 10683506
references.citation: J Neurosci. 2013 Jun 19;33(25):10503-11
references.pmid: 23785162
references.citation: J Altern Complement Med. 2002 Aug;8(4):421-5
references.pmid: 12230902
references.citation: Neurosci Lett. 2002 Mar 1;320(1-2):21-4
references.pmid: 11849754
references.citation: BMJ. 2009 Jan 27;338:a3115
references.pmid: 19174438
references.citation: Conf Proc IEEE Eng Med Biol Soc. 2004;2004:1451-4
references.pmid: 17271968
references.citation: J Clin Epidemiol. 2000 Aug;53(8):786-92
references.pmid: 10942860
references.citation: Evid Based Complement Alternat Med. 2012;2012:591304
references.pmid: 23243458
references.citation: Neurobiol Learn Mem. 2008 Nov;90(4):644-50
references.pmid: 18755284
references.citation: Lancet. 2010 Feb 20;375(9715):686-95
references.pmid: 20171404
references.citation: Arch Gen Psychiatry. 1998 Jun;55(6):553-9
references.pmid: 9633675
references.citation: Philos Trans R Soc Lond B Biol Sci. 2011 Jun 27;366(1572):1808-17
references.pmid: 21576138
references.citation: Brain Behav Immun. 2005 Nov;19(6):500-9
references.pmid: 16055306
references.citation: Brain Res. 1982 May 20;240(1):77-85
references.pmid: 7201339
references.citation: Auton Neurosci. 2010 Jun 24;155(1-2):5-13
references.pmid: 20304708
references.citation: Pain. 2010 Jun;149(3):453-462
references.pmid: 20417032
references.citation: Neuropsychologia. 1971 Mar;9(1):97-113
references.pmid: 5146491
references.citation: Ann N Y Acad Sci. 2009 Mar;1156:198-210
references.pmid: 19338509
references.citation: JAMA. 2005 May 4;293(17):2118-25
references.pmid: 15870415
references.citation: Evid Based Complement Alternat Med. 2011;2011:180805
references.pmid: 20976074
references.citation: Pain. 2003 Dec;106(3):401-409
references.pmid: 14659523
references.citation: BMJ. 2006 Feb 18;332(7538):391-7
references.pmid: 16452103
references.citation: Psychophysiology. 2009 Jan;46(1):1-11
references.pmid: 18778317
references.citation: Brain. 2003 Oct;126(Pt 10):2139-52
references.pmid: 12821513