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Expectancy in real and sham electroacupuncture: does believing make it so?

Joshua Bauml1, Sharon X Xie1, John T Farrar1

  • 1Division of Hematology/Oncology (JB, AD), Center for Clinical Epidemiology and Biostatistics (SXX, JTF, AD, JJM), Department of Anesthesia and Critical Care (JTF), Department of Family Medicine and Community Health (SQL, JJM), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (JB, AD); Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA (JB, AD, JJM); Center for Clinical Epidemiology and Biostatistics (SXX, JTF, AD, JJM) and Department of Anesthesia and Critical Care (JTF), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Boonshoft School of Medicine, Wright State University, Dayton, OH (MAB); Nell Hodgson School of Nursing, Emory University, Atlanta, GA (DB).

Journal of the National Cancer Institute. Monographs
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Summary

Response expectancy influences acupuncture outcomes differently for real electroacupuncture (EA) versus sham acupuncture (SA). Higher baseline expectancy predicted response in SA, while EA response improved over time with increasing expectancy.

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Area of Science:

  • Integrative oncology
  • Pain management
  • Clinical research

Background:

  • The significant placebo effect in acupuncture trials complicates efficacy interpretation.
  • Response expectancy is a key factor influencing placebo effects and treatment outcomes.

Purpose of the Study:

  • To evaluate the relationship between response expectancy over time and treatment outcomes in real electroacupuncture (EA) versus sham acupuncture (SA).

Main Methods:

  • Analysis of data from a randomized controlled trial comparing EA and SA for joint pain in breast cancer patients.
  • Patient Global Impression of Change (PGIC) identified responders at Week 8.
  • Acupuncture Expectancy Scale (AES) measured expectancy across four time points.
  • Linear mixed-effects models assessed the association between expectancy and treatment response.

Main Results:

  • In sham acupuncture (SA), higher baseline expectancy correlated with better treatment response.
  • In real electroacupuncture (EA), baseline expectancy did not predict response, but expectancy increased over time in responders.
  • Responder expectancy significantly increased over time in the EA group compared to non-responders.

Conclusions:

  • Response expectancy predicts treatment success in SA but not in EA for joint pain.
  • Distinct mechanisms may underlie SA and EA efficacy in pain management.
  • EA may be more effective than SA for patients with lower response expectancies.