People with back pain who have low expectations of acupuncture before they start a course of treatment will get less relief than those people who believe it will work, a new study shows.
Conversely, people who have a positive view of back pain and who feel in control of their condition experience less back-related disability over the course of acupuncture treatment.
Says Felicity Bishop of the University of Southampton, who is an Arthritis Research UK career development fellow:
“The analysis showed that psychological factors were consistently associated with back-related disability. People who started out with very low expectations of acupuncture— who thought it probably would not help them— were more likely to report less benefit as treatment went on.
When individual patients came to see their back pain more positively they went on to experience less back-related disability.
In particular, they experienced less disability over the course of treatment when they came to see their back pain as more controllable, when they felt they had better understanding of their back pain, when they felt better able to cope with it, were less emotional about it, and when they felt their back pain was going to have less of an impact on their lives.”
Acupuncture is one of the most established forms of complementary therapy and there is evidence from clinical trials to show that it can help to reduce pain.
Previous research has established that factors—other than the insertion of needles—play a part in the effectiveness of acupuncture, such as the relationship that the patient develops with the acupuncturist and the patient’s belief about acupuncture.
For the study, 485 people who were being treated by acupuncturists completed questionnaires before they started treatment, then two weeks, three months, and six months later. The questionnaires measured psychological factors, clinical and demographic characteristics, and back-related disability.
To improve the effectiveness of treatment, acupuncturists should consider helping patients to think more positively about their back pain as part of their consultations, Bishop says. Future studies are needed to test whether this could significantly improve patients’ treatment outcomes.
“This study emphasizes the influence of the placebo effect on pain,” says Stephen Simpson, director of research at Arthritis Research UK. “The process whereby the brain’s processing of different emotions in relation to their treatment can influence outcome is a really important area for research.
Factors such as the relationship between practitioner and the patient can inform this and we should be able to understand the biological pathways by which this happens.
This understanding could lead in the future to better targeting of acupuncture and related therapies in order to maximize patient benefit.”
Bishop, Felicity L. PhD, et al. Psychological Covariates of Longitudinal Changes in Back-related Disability in Patients Undergoing Acupuncture Clinical Journal of Pain: Volume 31 - Issue 3 - p 254–264 doi: 10.1097/AJP.0000000000000108
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