East meets West, new meets old in study of pain Thursday, November 25, 2004 BY Anne Rueter
Rick Harris is about to launch a University of Michigan study in which brain-scanning machines, the pride of modern medicine, will peer inside the brains of people with fibromyalgia to gauge the pain-relieving effects of acupuncture. It's East meets West in more ways than one. Harris, 32, a molecular biologist, is also a trained practitioner of the ancient Chinese healing art. Acupuncture is one of the top 10 alternative medicine therapies Americans use, says Sara Warber, who co-directs Michigan Integrative Medicine, a center for the study and practice of complementary and alternative therapies at the U-M.
Patients in substantial numbers – 70 percent or more, Harris says, in his own clinic experience – report significant pain relief after receiving acupuncture treatments. Yet it's unknown just why that's so. Harris and other U-M scientists at the U-M Chronic Pain and Fatigue Research Center want to find out: What's the anatomy of this relief? What happens inside the brain when subjects with fibromyalgia's chronic pain have acupuncture therapy at key points along identified pathways of energy called meridians? And what happens when subjects in a control group think they are receiving acupuncture, but aren't? The new study takes up where an earlier study Harris coordinated left off. Its surprising results caused a buzz among his colleagues in a Georgetown University research group specializing in chronic pain and fatigue.
Two trains of thought, early on When Harris was growing up in Indiana, he took lots of science classes in high school. At Purdue University, he focused on molecular biology. He also read the works of existentialist philosophers. Looking back, he says, that was a "little flag" that he wanted to explore different ways of looking at the world, as he does now. For years he's studied the Asian physical arts of t'ai chi and qigong. He's schooled himself in Taoism and Buddhism and practiced meditation. He's married to Ashini Wijesinghe, a native of Sri Lanka. The couple have a newborn son, Kiran. In doing the research on acupuncture, "I wanted to meld my private life with my scientific world," Harris says. "I want to try to bridge the two – and it's not easy. … I think ultimately, any path you choose, there should be some heart in it."
After graduate school, Harris put his interest in Eastern culture aside and went to the National Institutes of Health to do post-doctoral work. Two years into his post-doc, he had an epiphany. His boss had left for a job out West. He decided he wanted to learn, as a scientist, about how Chinese medicine practices help patients. He trained as an acupuncturist at an institute of Chinese medicine, taking night classes for three years. Then came a serendipitous job opening at Georgetown University, to coordinate a study of acupuncture's effects on fibromyalgia patients being conducted in a chronic pain research program headed by Dan Clauw.
Clauw, a rheumatologist and a leading researcher on the underlying causes of chronic pain, moved his research team, including Harris, to the U-M to start the chronic pain and fatigue center here several years ago. The study produced intriguing results. One group of subjects got traditional Chinese acupuncture, with needles placed and manipulated according to standard practice. More than a third of them reported feeling less pain after the treatment. A second group had needles placed in the correct spots, but received no stimulation. A third group had needles placed in other locations and received stimulation. Subjects in the fourth group got the furthest deviation from standard practice: needles in the wrong spots and no stimulation. To researchers' surprise, more than one-third of subjects in these last three groups also reported improvement in pain. For Clauw, the results suggested a powerful role for the "placebo effect," one that, with more research, medicine could harness for the good of patients.
The results were unsettling to Harris. "When I got the results, I was kind of frustrated, kind of in disbelief – but that's the way science goes," he says. With acupuncture, "I fluctuate between being a believer and a non-believer. I tend to be more of a believer." He reasons that with a therapy known for thousands of years, for which patients continue to pay, "something has to be going on." Harris feels that the first study didn't prove that acupuncture produces no results aside from the placebo effect. To throw out acupuncture because of one study would be wrong, he believes. The study does raise new questions about acupuncture for subsequent studies, like the one he is about to launch. He says he has designed it to tackle "the mechanistic question of how it may be working." The study will draw subjects from a registry the U-M Chronic Pain and Fatigue Research Center has created to help with numerous studies of chronic pain and fatigue. Harris hopes to start sessions in January and finish the study within two years.
Watching the brain deal with pain The new study will measure the body's response to pain more objectively than simply asking subjects if they feel better. Researchers will use two powerful tools to image what parts of the brain are active when a subject experiences pain and how treatments with real and fake acupuncture affect the pain response. In 32 subjects in one part of the study, they will use positron emission tomography (PET) scans to look at nerve cells in the brain called mu opioid receptors, which may become active among the people who respond to acupuncture or a placebo. In another 32 subjects, they'll use functional magnetic resonance imaging (fMRI) to see how subjects' response to a painful stimulus may change after nine acupuncture or placebo treatments. Warber says she is pleased to have Harris conducting acupuncture research at the U-M. "I think it's an important thing to understand," says Warber, who recently attended a conference in Europe where research results on acupuncture, including its effects on the brain, were presented.
Studying placebo effect Harris is excited no matter what the upcoming study reveals. "I see this as a no-lose situation. Either acupuncture has specific effects, and we will find them, or acupuncture is a placebo effect," he says. That result would intrigue him, too. Like Clauw, he believes understanding the placebo effect could lead to powerful tools for healing. The placebo effect is annoying to drug researchers. It's common for a percentage of subjects in control groups to improve, even when they get a sham treatment. Drug researchers have to prove the real treatment gets results in subjects over and above those numbers. But the placebo effect intrigues others. In addition to Clauw's group, others at the U-M include psychiatrist Jon-Kar Zubieta and neurologist Kenneth Casey, who was part of a team that earlier this year published results using functional MRI to image pain relief mechanisms in the brain. Something akin to a placebo effect happens in real-life medicine, when a doctor talks to a patient, prescribes a drug or recommends surgery.
Harris says there is evidence the placebo effect is very powerful, especially for people in pain. "If we can identify a pathway, find a mechanism to tap that pathway … I don't think we should think of (the placebo effect) as something to eliminate. I think we should think of it as something to enhance." He doesn't foresee the results of one study laying any questions to rest definitively. "I don't think western science has a monopoly on truth. … No matter what happens (in the study) I just don't think we can throw out that whole field … (of acupuncture)." Maybe we don't have the right measures, he says. He acknowledges that depending on the results, his career will probably take different directions. He may end up doing further studies of acupuncture – or the placebo effect. © 2004 Ann Arbor News.