Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture. Neuroimage, 25, 1161-1167

Wellcome Department of Imaging Neuroscience, 12 Queen Square, WC1N 3BG London, UK.
NeuroImage (Impact Factor: 6.36). 06/2005; 25(4):1161-7. DOI: 10.1016/j.neuroimage.2005.01.016
Source: PubMed

ABSTRACT Both specific and non-specific factors may play a role in acupuncture therapy for pain. We explored the cerebral consequences of needling and expectation with real acupuncture, placebo acupuncture and skin-prick, using a single-blind, randomized crossover design with 14 patients suffering from painful osteoarthritis, who were scanned with positron emission tomography (PET). The three interventions, all of which were sub-optimal acupuncture treatment, did not modify the patient's pain. The insula ipsilateral to the site of needling was activated to a greater extent during real acupuncture than during the placebo intervention. Real acupuncture and placebo (with the same expectation of effect as real acupuncture) caused greater activation than skin prick (no expectation of a therapeutic effect) in the right dorsolateral prefrontal cortex, anterior cingulate cortex, and midbrain. These results suggest that real acupuncture has a specific physiological effect and that patients' expectation and belief regarding a potentially beneficial treatment modulate activity in component areas of the reward system.

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Available from: Peter White, Aug 19, 2015
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    • "Furthermore, the reduced rsFC from both MHb and LHb to the aMCC and pACC may link chronic pain states to changes in negative affect, pain, and cognitive control (Vogt 2005; Geha et al. 2008; Shackman et al. 2011). Another interesting finding relates to the reduced rsFC to the pgACC previously implicated in pain inhibition systems (Petrovic et al. 2002; Wager et al. 2004; Bingel et al. 2006) and to the dlPFC repeatedly associated with pain modulation (Lorenz et al. 2003; Brighina et al. 2004; Fierro et al. 2010), perceived control over pain (Pariente et al. 2005; Wiech et al. 2006), and pain catastrophizing (Seminowicz and Davis 2006). "
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    ABSTRACT: The habenula (Hb) is a small brain structure located in the posterior end of the medial dorsal thalamus and through medial (MHb) and lateral (LHb) Hb connections, it acts as a conduit of information between forebrain and brainstem structures. The role of the Hb in pain processing is well documented in animals and recently also in acute experimental pain in humans. However, its function remains unknown in chronic pain disorders. Here, we investigated Hb resting-state functional connectivity (rsFC) in patients with complex regional pain syndrome (CRPS) compared to healthy controls. Twelve pediatric patients with unilateral lower-extremity CRPS (9 females; 10 - 17 years) and 12 age- and sex-matched healthy controls provided informed consent to participate in the study. In healthy controls, Hb functional connections largely overlapped with previously described anatomical connections in cortical, subcortical, and brainstem structures. Compared to controls, patients exhibited an overall Hb rsFC reduction with the rest of the brain; and specifically with the anterior midcingulate cortex, dorsolateral prefrontal cortex, supplementary motor cortex, primary motor cortex, and premotor cortex. Our results suggest that Hb rsFC parallels anatomical Hb connections in the healthy state and that overall Hb rsFC is reduced in patients, particularly connections with forebrain areas. Patients' decreased Hb rsFC to brain regions implicated in motor, affective, cognitive, and pain inhibitory/modulatory processes may contribute to their symptomatology.
    Journal of Neurophysiology 10/2013; 111(2). DOI:10.1152/jn.00405.2013 · 3.04 Impact Factor
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    • "During the verum acupuncture, needles create the specific needle sensation called " deqi " ( " aching, " " dull, " " heavy, " " numb, " " radiating, " " spreading " and " tingling " ) at specific acupuncture points [19]. Deqi is suggested to be the main mechanisms producing effects from acupuncture [20], by generating a release of spinal and supraspinal beta-endorphins, proinflammatory neuropeptides and an increase in peripheral circulation [21]. However, there is lack of adequate experimental data to indicate the relationship between deqi sensation and modulation effect of acupuncture on ANS [22]. "
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    ABSTRACT: Background. Recent reports suggest that a proportion of tinnitus patients suffer from mental illness. Autonomic nervous system plays a useful role in tinnitus therapy since electrical vagal nerve stimulation (VNS) has been frequently used to alleviate tinnitus-induced depression in clinic. heart rate variability (HRV), which is reflective of autonomic nervous system function, has been proved to be modulated by acupuncture. In the present study, we aim to compare the effect of deqi sensation on heart rate variability in adult tinnitus patients. Methods. Thirty participants are randomly assigned to verum acupuncture (creating deqi) or shallow acupuncture (not creating deqi) at Baihui (Du-20), Shenting (Du-24), Tinghui (GB-2), Waiguan (SJ-5), and Zulinqi (GB-41) for 3 weeks. The primary outcome measure is heart rate variability, which is measured at the first acupuncture, as well as the last acupuncture. Discussion. Completion of this trial will help to identify the role of deqi sensation in acupuncture effect for tinnitus and reveal an autonomic modulation mechanism for acupuncture effect. Trial Registration. This trial is registered with International Standard Randomised Controlled Trial Number ISRCTN58013563.
    Evidence-based Complementary and Alternative Medicine 07/2013; 2013:756012. DOI:10.1155/2013/756012 · 1.88 Impact Factor
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    • "Converging evidence from fMRI studies on acupuncture at commonly used acupoints have revealed significant modulatory effects at widespread cerebrocerebellar brain regions. These regions process information in circuits that can broadly be assumed to engage endogenous antinociceptive limbic networks as well as higher-order cognitive and affective control centers within the prefrontal cortex and medial temporal lobe [13] [14] [15] [16] [17] [18] [19] [20]. Researches from Wu et al. indicated that stimulation at LI4 and ST36 resulted in increases in signal intensity of the hypothalamus and nucleus accumbens, as well as decreases in the rostral part of the anterior cingulated cortex, amygdala, and hippocampus [18]. "
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    ABSTRACT: Acupuncture is currently gaining popularity as an important modality of alternative and complementary medicine in the western world. Modern neuroimaging techniques such as functional magnetic resonance imaging, positron emission tomography, and magnetoencephalography open a window into the neurobiological foundations of acupuncture. In this review, we have summarized evidence derived from neuroimaging studies and tried to elucidate both neurophysiological correlates and key experimental factors involving acupuncture. Converging evidence focusing on acute effects of acupuncture has revealed significant modulatory activities at widespread cerebrocerebellar brain regions. Given the delayed effect of acupuncture, block-designed analysis may produce bias, and acupuncture shared a common feature that identified voxels that coded the temporal dimension for which multiple levels of their dynamic activities in concert cause the processing of acupuncture. Expectation in acupuncture treatment has a physiological effect on the brain network, which may be heterogeneous from acupuncture mechanism. "Deqi" response, bearing clinical relevance and association with distinct nerve fibers, has the specific neurophysiology foundation reflected by neural responses to acupuncture stimuli. The type of sham treatment chosen is dependent on the research question asked and the type of acupuncture treatment to be tested. Due to the complexities of the therapeutic mechanisms of acupuncture, using multiple controls is an optimal choice.
    Evidence-based Complementary and Alternative Medicine 05/2013; 2013(17):812568. DOI:10.1155/2013/812568 · 1.88 Impact Factor
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