An fMRI study on the interaction and dissociation between expectation of pain relief and acupuncture treatment

Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA 02129, USA.
NeuroImage (Impact Factor: 6.36). 07/2009; 47(3):1066-76. DOI: 10.1016/j.neuroimage.2009.05.087
Source: PubMed

ABSTRACT It is well established that expectation can significantly modulate pain perception. In this study, we combined an expectancy manipulation model and fMRI to investigate how expectation can modulate acupuncture treatment. Forty-eight subjects completed the study. The analysis on two verum acupuncture groups with different expectancy levels indicates that expectancy can significantly influence acupuncture analgesia for experimental pain. Conditioning positive expectation can amplify acupuncture analgesia as detected by subjective pain sensory rating changes and objective fMRI signal changes in response to calibrated noxious stimuli. Diminished positive expectation appeared to inhibit acupuncture analgesia. This modulation effect is spatially specific, inducing analgesia exclusively in regions of the body where expectation is focused. Thus, expectation should be used as an important covariate in future studies evaluating acupuncture efficacy. In addition, we also observed dissociation between subjective reported analgesia and objective fMRI signal changes to calibrated pain in the analysis across all four groups. We hypothesize that as a peripheral-central modulation, acupuncture needle stimulation may inhibit incoming noxious stimuli; while as a top-down modulation, expectancy (placebo) may work through the emotional circuit.

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Available from: Randy Lyanne Gollub, Jul 31, 2015
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    • "was revealed to be attenuated after 25–30 min TEAS or EA treatment in a cold pain research in humans (Zhang et al., 2003a, 2003b), a heat pain research in humans (Kong et al., 2009a, 2009b), and a radiant heat study in rats using multichannel recording technique (Wang et al., 2004). Thus, we speculated that inhibition of the pain-processing areas may be involved in mediating the analgesic effect induced by relatively long-period acupuncture-like stimulation. "
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    • "For the present study, the average intensity for each sensation was between .06 and 1.89, compared to our previous studies, where average intensity of each sensation was between 0 and 4 [26] and between 0.1 and 3.7 [39]. We believe that this may be due to the age of patients in the present study (58 ± 8.3) compared to studies conducted in healthy, young subjects (29 ± 7 [26] and 26.4 ± 4.9 [39]). We speculate that one difference between these populations is that the peripheral nervous system in these older patients may not be as sensitive as other younger populations. "
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