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

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


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, Sep 29, 2015
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    • "In the field of pain, both additive effects and interactions have been found. Kong et al. (2009) combined verbal instruction (positive instruction vs neutral instruction) with acupuncture treatment (real vs sham). Pain ratings were significantly lower in the positive instruction groups compared with the neutral instruction groups, with no evidence of an interaction between instructions and treatment. "
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    ABSTRACT: Despite its initial treatment as a nuisance variable, the placebo effect is now recognized as a powerful determinant of health across many different diseases and encounters. This is in light of some remarkable findings ranging from demonstrations that the placebo effect significantly modulates the response to active treatments in conditions such as pain, anxiety, Parkinson's disease, and some surgical procedures. Here, we review pioneering studies and recent advances in behavioral, neurobiological, and genetic influences on the placebo effect. Based on a previous developed conceptual framework, the placebo effect is presented as the product of a general expectancy learning mechanism in which verbal, conditioned and social cues are centrally integrated to change behaviors and outcomes. Examples of the integration of verbal and conditioned cues, such as instructed reversal of placebo effects are also incorporated into this model. We discuss neuroimaging studies that using well-established behavioral paradigms have identified key brain regions and modulatory mechanisms underlying placebo effects. Finally, we present a synthesis of recent genetics studies on the placebo effect, highlighting a promising link between genetic variants in the dopamine, opioid, serotonin, and endocannabinoid pathways and placebo responsiveness. Greater understanding of the behavioral, neurobiological, and genetic influences on the placebo effect is critical for evaluating medical interventions and may allow health professionals to tailor and personalize interventions in order to maximize treatment outcomes in clinical settings. Copyright © 2015. Published by Elsevier Ltd.
    Neuroscience 08/2015; 307. DOI:10.1016/j.neuroscience.2015.08.017 · 3.36 Impact Factor
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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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    • "While clinical trials are meant to inform care delivery for future patients, it is not surprising that individuals who are interested in participating in a clinical trial do so in part with the hope that their specific conditions will be improved by trial participation. Given that previous research also found that higher expectancy of acupuncture outcomes may impact response to acupuncture, future clinical trials should include validated expectancy measures to help understand how expectancy may explain the variability observed in different studies [35,38-41]. "
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    ABSTRACT: As breast cancer patients increasingly use complementary and alternative medicine (CAM), clinical trials are needed to guide appropriate clinical use. We sought to identify socio-demographic, clinical and psychological factors related to willingness to participate (WTP) and to determine barriers to participation in an acupuncture clinical trial among breast cancer patients. We conducted a cross-sectional survey study among post-menopausal women with stage I-III breast cancer on aromatase inhibitors at an urban academic cancer center. Of the 300 participants (92% response rate), 148 (49.8%) reported WTP in an acupuncture clinical trial. Higher education (p = 0.001), increased acupuncture expectancy (p < 0.001), and previous radiation therapy (p = 0.004) were significantly associated with WTP. Travel difficulty (p = 0.002), concern with experimentation (p = 0.013), and lack of interest in acupuncture (p < 0.001) were significant barriers to WTP. Barriers differed significantly by socio-demographic factors with white people more likely to endorse travel difficulty (p = 0.018) and non-white people more likely to concern with experimentation (p = 0.024). Older patients and those with lower education were more likely to report concern with experimentation and lack of interest in acupuncture (p < 0.05). Although nearly half of the respondents reported WTP, significant barriers to participation exist and differ among subgroups. Research addressing these barriers is needed to ensure effective accrual and improve the representation of individuals from diverse backgrounds.
    BMC Complementary and Alternative Medicine 01/2014; 14(1):7. DOI:10.1186/1472-6882-14-7 · 2.02 Impact Factor
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