8/4/2019 Acupuncture and placebo act differently in the human
brain
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NOTAS DE LITERATURA /LITERATURE NOTES
ACUPUNCTURE AND PLACEBO ACT DIFFERENTLY IN THE HUMAN
BRAINACUPUNTURA E PLACEBO AGEM DE FORMA DIFERENTE NO CREBRO
HUMANO
David Gonalves Nordon*
33
Rev. Fac. Cinc.Md.Sorocaba,v.13,n.3,p. 33,
2011*Acadmicodocursode Medicina- FCMS/PUC-SP,acupunturista
peloColgioBrasileirodeAcupuntura.Recebidoem22/9/2010.Aceitopara
publicaoem16/11/2010.Contato: [email protected]
Much has been said lately concerning acupuncture
anditsmechanismofaction. Infact,aswelook intothe subject,veryfew
conclusions can be drawn without a certain doubt.Clinical trials
are usually unfavorable to acupuncture; theirdrawbacks concerning
the acupuncture technique,
however,makeitimpossibletodecidewhatisrightandwhatiswrong.
One form of looking beyond the clinical effect and seeexactly
what acupuncture makes inside us is using functionalscreening
methods, such as fMRI (functional magneticresonance imaging),
during acupuncture sessions. Severalstudies have used this method
to determine which areas of the
brain are stimulated or depressed by acupuncture and
whatneurotransmitters and hormones are activated by this type
oftreatment, incomparisonornotto placebo.
Arecentarticle byHarrisetal., publishedinNeuroimage,2009,
however, goes beyond the looking glass; instead
ofneurotransmitters, what about their receptors? The main idea
ofthis article is to compare the effects of verum acupuncture
andplacebo acupuncture in -opioid receptors (MORs) in the brain.And
insteadofchoosingonlyone ora fewacupointsandonlyonesession, the
authors chose to perform a complete treatment forfibromyalgia.
Twenty patients were scanned using C-carfenanil(CFN - a -opioid
selective radiotracer) positron emissiontomography (PET) in the
first session of treatment, before and
aftertheintroductionofneedles,andinthelast(9 )session.
Thetreatment protocol (Du20,earShenmen,LI4,LI11,Sp6, Liv3, GB
34, bilateral St36) was not perfect since theChinese syndrome was
not evaluated, rather a commonly usedprotocol aiming at lowering
the pain for this type of occidentaldisease was chosen. However,
there was special concerntowards obtaining and avoiding any
physiological effectof the control procedure, what apparently
achieved success, byusing a previously validated placebo needle
that does notpenetrate skin. All the placebo points chosen were in
similarareas to the original points, but were no known acupoints
andneither were in any meridian track. Blinding was successful
uptotheendofthestudy.
Both groups showed similar clinical response to
acupuncture,what isprobablyduetoexpectation,ratherthan
anyphysiological effect of theplacebo procedure. Nevertheless,
theiraction mechanisms were significantly different; whereas at
long
andshort term theverum acupuncture elicited increases in
MORbinding potential(BP) throughout thebrain,placebo
acupuncturedecreased it or resulted in no changes after the
session. Verumacupuncture affected mainly the thalamus, the
cingulated, theinsula, the caudate, the putamen and the temporal
pole; placeboacupuncture affected the dorsolateral prefrontal
cortex, rightamygdalaandleftinsula.
It is expected that the immediate effects of verumacupuncture
result of neuron stimulation and its modulation ofreceptor
expression at the plasma membrane. A
long-termdepression-typemodulationwouldexplainthelonglastingeffects
ofacupunctureobservedinthisandinothertrials.By evaluating such a
unique mechanism of action, I
amledtobelievethatacupuncture,thathasbeenregardedsofarasnobetter
than placebo in certain trials, is being misused
andunderestimated.Perhaps,ifacupuncturewereusedforothertypesofpain
inwhichtheexpectationeffectsanditsinherentunspecificanalgesia
effect were not enough to completely subdue pain, wewould finally
find a clinically and statistically significantdifference between
acupuncture and placebo, as we can see
insomerecentmeta-analysis.
th
De Qi
BIBLIOGRAPHY
1. HarrisRE,ZubietaJ-K,ScottDJ,NapadowV,GracelyR, Clauw
DJ. Traditional Chinese acupuncture and placebo
(sham)acupuncture are differentiated by their effect on
-opiodreceptors(MORs).Neuroimage.2009;47:1077-85.
2. Stener-Victorin E. The pain-relieving effect of
electro-acupuncture and conventional medical analgesic
methodsduring oocyte retrieval: a systematic review of
randomizedcontrolledtrials.HumReprod.2005;20(2):339-49.
3. Madsen MV, Goetzsche PC, Hrbjartsson A. Acupuncturetreatment
for pain: systematic review of randomised clinicaltrials with
acupuncture, placebo acupuncture, and
noacupuncturegroups.BMJ.2009;338:a3115.
Correa PC, Correa EJ. Toxoplasmose ocular adquirida. Rev Fac
Cinc Md Sorocaba. 2011; 13(2):28-29.Pgina Linha Coluna Onde se l
Leia-se:
28 2 1 retinocoidite retinocoroidite
Errata
