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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    • "In contrast, maintained high PAG–Hpc connectivity level in the sham group could indicate that no prediction or pain behavior update took place, as subjects did not experience pain relief from session to session, apart from the non-specific treatment effects — expectation and 'placebo' (Kong et al., 2009a) that decreased over the course of treatment. This speculation is further corroborated by the decrease in the PAG–MFC connectivity in the sham group, possibly reflecting a reduction in relief expec- tation. "
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    ABSTRACT: Acupuncture, an ancient East Asian therapy, is aimed at rectifying the imbalance within the body caused by disease. Studies evaluating the efficacy of acupuncture with neuroimaging tend to concentrate on brain regions within the pain matrix, associated with acute pain. We, however, focused on the effect of repeated acupuncture treatment specifically on brain regions known to support functions dysregulated in chronic pain disorders. Transition to chronic pain is associated with increased attention to pain, emotional rumination, nociceptive memory and avoidance learning, resulting in brain connectivity changes, specifically affecting the periaqueductal gray (PAG), medial frontal cortex (MFC) and bilateral hippocampus (Hpc). We demonstrate that the PAG-MFC and PAG-Hpc connectivity in patients with chronic pain due to knee osteoarthritis indeed correlates with clinical severity scores and further show that verum acupuncture-induced improvement in pain scores (compared to sham) is related to the modulation of PAG-MFC and PAG-Hpc connectivity in the predicted direction. This study shows that repeated verum acupuncture might act by restoring the balance in the connectivity of the key pain brain regions, altering pain-related attention and memory.
    Clinical neuroimaging 09/2015; DOI:10.1016/j.nicl.2015.09.012 · 2.53 Impact Factor
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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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