Expectancy in Real and Sham Electroacupuncture: Does Believing Make It So?
Expectancy in Real and Sham Electroacupuncture: Does Believing Make It So?
复制标题
DOI：
10.1093/jncimonographs/lgu029
复制
发表时间：
2014-11-01
期刊：
影响因子：
--
通讯作者：
Mao, Jun J.
中科院分区：
文献类型：
--
作者：
Bauml, Joshua;Xie, Sharon X.;Mao, Jun J.
背景先前的针灸试验中观察到的大量的安慰剂效应对解释针灸的疗效提出了很大的挑战。我们试图评估随着时间推移安慰剂效应的关键组成部分-反应预期与真实和假电针(EA)治疗结果之间的关系。方法我们分析了电针和假电针(SA)治疗乳腺癌女性患者因芳香酶抑制剂引起的关节疼痛的随机对照试验的数据。在第8周(干预结束)，使用患者全球变化印象工具确定应答者。在试验期间，四次使用了针灸预期量表(AES)来衡量预期。采用线性混合效应模型评估预期与治疗反应之间的关系。结果在等待名单对照组中，在治疗过程中AES保持不变。在SA组中，有反应者的基线AES显著高于无反应者(15.5vs12.1，P=0.005)，且AES不随时间变化。在EA组，有效和无应答的基线AES评分没有差异(14.8vs15.3，P=.64)；然而，随着时间的推移，应答者的AES比无应答者增加(应答者和时间相互作用期的P=.004)，试验结束时应答者和无应答者的差异显著(16.2vs11.7，P=.004)。结论基线更高的预期应答预示着SA的治疗反应，但在EA中不是。关于SA和EA如何影响疼痛结果，可能存在不同的机制，而预期值较低的患者使用EA可能比SA更好。
Background The large placebo effect observed in prior acupuncture trials presents a substantial challenge for interpretation of the efficacy of acupuncture. We sought to evaluate the relationship between response expectancy, a key component of the placebo effect over time, and treatment outcome in real and sham electroacupuncture (EA).Methods We analyzed data from a randomized controlled trial of EA and sham acupuncture (SA) for joint pain attributable to aromatase inhibitors among women with breast cancer. Responders were identified using the Patient Global Impression of Change instrument at Week 8 (end of intervention). The Acupuncture Expectancy Scale (AES) was used to measure expectancy four times during the trial. Linear mixed-effects models were used to evaluate the association between expectancy and treatment response.Results In the wait list control group, AES remained unchanged over treatment. In the SA group, Baseline AES was significantly higher in responders than nonresponders (15.5 vs 12.1, P = .005) and AES did not change over time. In the EA group, Baseline AES scores did not differ between responders and nonresponders (14.8 vs 15.3, P = .64); however, AES increased in responders compared with nonresponders over time (P = .004 for responder and time interaction term) with significant difference at the end of trial for responders versus nonresponders (16.2 vs 11.7, P = .004).Conclusions Baseline higher response expectancy predicts treatment response in SA, but not in EA. Divergent mechanisms may exist for how SA and EA influence pain outcomes, and patients with low expectancy may do better with EA than SA.