1. Needling of Tendons & Ligaments is NOT a Placebo: Puncture of Cell membrane With Inflammatory Lipid Release
In the treatment of low back pain there are four treatment comparison studies. The control group in all back studies involved needle contact with attachments of ligaments and tendons. By injecting ligaments and tendons, there is needle contact with cell membranes of connective tissue cells. Disrupting cell membranes releases lipids, which in turn cause signaling of fibroblasts.
Examples of Needling Effects:
2. Needling of Tendons is NOT a Placebo: Microbleeding with Platelet Effects
In addition, microbleeding from needle contact is expected, and Edwards and colleagues have demonstrated the potential healing effect of whole blood injection in patients with recalcitrant tennis elbow. (Edwards SG, Calandruccio JH: Autologous blood injections for refractory lateral epicondylitis J Hand Surg [Am] 28(2):272, 2003.)
The hope is that future studies on low back pain will include a near-placebo arm that avoids connective tissue contact or blood effects and that standard injection methods will be used. In the treatment of low back pain, standard treatment methods are now taught in cadaver courses offered by the American Academy of Orthopedic Medicine. An example of such a near-placebo would be needle insertion through skin without contacting bone or ligament.