Acucebo

Question - presumeably if you are aware that acupuncture has no more effect that placebo acupuncture then you would not experience a placebo effect?

Second Question - has anyone figured out what CAUSES the placebo effect? Because if it can be understood, harnessed, and turned to the light side of the force...

(not holding my breathe... :-)

If the goal is symptom improvement - which in the case of something like back pain is really what you're looking for - the benefit to the patient is the same if the improvement is due to a placebo effect brought on by acupuncture, or through pain medication, for instance, assuming the alternative treatment does no harm. Especially when the pain medication would likely have side effects that the acupuncture doesn't.

Saying the treatment is no better than placebo really doesn't tell us much - placebo can be very effective medicine. What percentage of patients experienced an improvement in symptoms following treatment? And how does that compare to other therapies, such as pain medications or surgery?

Obviously you don't want to use CAMs such as acupuncture for treatment of a serious illness that requires actual medical treatment. But for something like back pain that there is little medicine can do (short of surgery or ongoing medication, both of which have mixed results), why limit the patients options, if the patient feels they benefit from it?

I think complementary/alternative therapies have a place, and I'm not sure why it is such an issue where the benefit comes from, as long as the patient feels better.

As for your back pain - I swear by yoga. I don't know if there is science to support it,but it has proved extremely effective for me in reducing my pain (as long as I am consistent - like any treatment).

In a previous post, i pointed out the danger of this approach.

Placebo "effect" is an artifact of the patient's interaction with the health care system. There is no such thing as placebo "treatment", in that it isn't in any way predictable. If you prescribe an inert treatment (like acupuncture or homeopathy), certain patients in certain situations may improve, which will have nothing to do with the intervention, on the fact of the intervention. It is an important distinction.

In this case, the placebo effect might be from endorphins released from the needles puncturing the skin. As I understand this study was a meta analysis and "placebo" acupuncture can be defined as acupuncture with needles that puncture in the "wrong" place, or acupuncture with "sham" needles that merely press the skin without puncture. In either case, the meta analysis may not have made the distinction between the two, or it is possible that even the "sham" needles create endorphin release. Endorphins would explain why the effect is short lived, and why there is a difference between acupuncture/placebo acupuncture vs. no acupuncture.
Sorry about your back PAL. Not that you need any more advice, but I have found Earth shoes to be a great relief, as wearing them shifts the weight of the back and creates just enough of a difference in your posture to fool the nerve endings.

I remember that article, and agree. But what I was really pondering was what was causing this effect. Is it simply a lowering of stress/anxiety that makes the patient "feel" better?

"placebo can be very effective medicine"

What I'm about to say in response only addresses one aspect of the placebo effect: when you aren't sick but you think you are.

Not everyone has an actual physical malady causing their symptoms. They have some emotional stress and need the hour of care and empathy provided by their 'practitioner' to feel better. And so what if he told them he manipulated some magical energy fields and sold them some cherry seed extract?

The danger is twofold (or twentyfold; I'm simplifying):

1) There is no inherent distinction between a person who feels sick and a person who is sick. If you go to a practitioner for treatment when you feel sick, and he does make you feel better, you will tend to think what he does actually works the way he says. But it won't work when you go to him with salmonellosis.

A practitioner is not qualified to diagnose whether your problem can be treated by lending a hearing ear, and probably doesn't realize that's what he's doing when it works.

2) The way us laymen understand our health problems is overly simplified. You and I may both have "high blood pressure", but in actuality you have stress-related essential hypertension and I have secondary hypertension caused by my congenital aortic coarctation. You may think cherry seed extract lowers your blood pressure, but it doesn't. Talking to the practitioner about your problems lowered your stress level. That won't work for me.

We may both understand our problems to be the same thing, and think the same sham treatment will work for both of us, but they aren't and it won't. And our practitioner is unlikely to understand the subject any better than we do, and is unqualified to diagnose us or prescribe treatment.

If we set up a system that allows and encourages placebos as treatments, people with legitimate health problems will unwittingly use them too, and it will not work for them.

Sorry to add more so soon. In case it wasn't clear...

By saying practitioners are unqualified, I mean to say that without the training to be able to diagnose the problem properly, they are not qualified to choose who would benefit from their services and who should go to a real doctor.

A kinesiologist won't know you have cancer, and will therefore not realize he should send you to a doctor. Of course, even if he were qualified he'd have to recognize his treatment as a placebo before he would.

I hope that answers your question, Colin :)