24/06/2025
Interesting article on the two important issues:
1) placebo treatment for osteoarthritis and musculoskeletal (MSK) pain in general. Good placebo responses are certainly not unique to acupuncture and are frequently seen with MSK surgeries: “The more invasive the placebo, the higher the placebo response: The sham surgeries and the joint injections, or if there must be an injection to the bottom versus a tablet”.
2) overly mechanical diagnostic criteria for osteoarthritis and MSK issues. “You’ve got people who are running around with just self-described bone-on-bone knees, and they’re still managing to be out and about and active, and there are people with less severe structural changes who are less active and in more pain,” said rheumatologist Anita Wluka, MBBS, PhD, a consultant rheumatologist at The Alfred Hospital and professor of rheumatology at the University of Melbourne, both in Melbourne, Australia. “There are other factors that contribute to the pain that are not necessarily related to the structural damage...”
Increasingly research is pointing to neurogenic inflammation & sensitised nociceptors as the primary pain mechanism for a wide range of MSK pain.
Some take aways for acupuncturists and researchers:
1) diagnosis (i.e. of osteoarthritis) based solely on imagining/scans and mechanical structural elements can be unreliable and are not the sole reason most people are in pain.
2) addressing a broad range of contextual aspects is more useful including: reducing local neurogenic inflammation (of which acupuncture is likely a useful therapy), associated muscular imbalances and a fostering good therapeutic relationship.
3) patients with diagnostic labels of osteoarthritis or other MSK issues such as shoulder impingement syndrome display a wide range of differences in terms of pain, physical function, structural damage and muscular function. It may be defining more specific sub-groups are essential in regards to determining more effective treatments and better identifying placebo responders.
For decades, researchers and clinicians have struggled with high placebo responses in osteoarthritis, and now they are working to understand what’s behind them.
