In the largest experiment of its kind to date, 1162 patients aged 18 to 86 years (mean ± SD age, 50 ± 15 years) with a history of chronic low back pain for a mean of 8 years were randomly assigned to receive acupuncture, sham acupuncture, or conventional therapy (a combination of drugs, physical therapy, and exercise) for their chronic back pain. Patients underwent ten 30-minute sessions, generally 2 sessions per week.

After six months, patients answered questions from the Von Korff Chronic Pain Grade Scale questionnaire and the back-specific portions of the Hanover Functional Ability Questionnaire to determine their chronic level of pain after treatment.

In the real acupuncture group, 47 percent of patients improved (defined as 33% improvement or better on the Von Korff Scale or 12% better on the Hanover Questionnaire). In the sham acupuncture group, 44 percent improved. In the conventional care group, 27 percent got relief.

Study Conclusion: Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either real or sham, was almost twice that of conventional therapy.

Study Authors: Michael Haake, PhD, MD of the Orthopedic Department, University of Regensburg, Bad Abbach, Germany; Hans-Helge Müller, PhD; Carmen Schade-Brittinger; Heinz D. Basler, PhD; Helmut Schäfer, PhD; Christoph Maier, PhD, MD, of the Institutes for Medical Biometry and Epidemiology (Drs Müller and Schäfer) and Medical Psychology (Dr Basler) and Centre for Clinical Trials, Philipps-University Marburg, Marburg, Germany; Heinz G. Endres, MD; Hans J. Trampisch, PhD, of the Departments of Pain Management, BG-Kliniken Bergmannsheil (Dr Maier) and Medical Informatics, Statistics and Epidemiology, Ruhr-University Bochum, Bochum, Germany; Albrecht Molsberger, PhD, MD, of the Centre for Clinical Acupuncture and Research, Düsseldorf, Germany.

See the actual abstract at the Archives of Internal Medicine web site.

The Placebo Effect 

The study above demonstrates the power of the placebo effect – which must never be underestimated. What the client/patient believes is every bit as or possibly more important than the treatment itself. Health care providers – including alternative practitioners like Hypnotherapists, Rapid Eye Technicians, and others – must be mindful to steer the client's beliefs in the direction of cure or at least better health and successful outcome – by using the placebo effect.

Both of the following examples use the placebo effect because they are both uttered by a trusted professional to a client seeking assistance. One response, however, is more effective than the other. Which do you think might produce a more successful outcome:

1. "You'll continue to do great as long as you perform your daily exercise."
2. "The reason you feel great is because you did your daily exercise."

In the first example, there is an expectancy NOT fully realized and a built-in failure (what happens if I don't do the daily exercises). "As long as" is another form of "if" – and "if" connotes a possibility of more than one outcome.

In the second example, there is an expectancy ALREADY realized – and which is reinforced by a logical conclusion – while the treatment and outcome are strengthened by authoritative affirmation.

The Nocebo Effect 

Similar to the placebo effect is the "nocebo" effect in which a trusted authority instills a negative outcome frame in a client or patient. The famous example is the cancer death sentence, "You have just 6 months to live." Because the trusted authority believes this, the patient tends to believe it, too – and will tend to make the authority correct by dying on time.

This is not to say that we must lie to clients – but telling a client they will be ill, or will fail, or will in some way fall short of a therapeutic goal for whatever reason, is usually unnecessary and often untrue – because you, the practitioner, cannot possibly know ALL the possible outcomes. Spontaneous remission is more common than most people realize. So why not emphasize the positive outcome that COULD and likely WILL occur as the client/patient follows the treatment regimen. To even suggest the possibility of failure can be enough for some patients to "buy in" and carry out the prophecy.

What the client/patient BELIEVES can make all the difference in the outcome of treatment or process.