Inserting Needles Into the Body: A Meta-Analysis of Brain Activity Associated With Acupuncture Needle Stimulation

Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Korea
The journal of pain: official journal of the American Pain Society (Impact Factor: 4.01). 02/2013; 14(3). DOI: 10.1016/j.jpain.2012.11.011
Source: PubMed


Acupuncture is a therapeutic treatment that is defined as the insertion of needles into the body at specific points (ie, acupoints). Advances in functional neuroimaging have made it possible to study brain responses to acupuncture; however, previous studies have mainly concentrated on acupoint specificity. We wanted to focus on the functional brain responses that occur because of needle insertion into the body. An activation likelihood estimation meta-analysis was carried out to investigate common characteristics of brain responses to acupuncture needle stimulation compared to tactile stimulation. A total of 28 functional magnetic resonance imaging studies, which consisted of 51 acupuncture and 10 tactile stimulation experiments, were selected for the meta-analysis. Following acupuncture needle stimulation, activation in the sensorimotor cortical network, including the insula, thalamus, anterior cingulate cortex, and primary and secondary somatosensory cortices, and deactivation in the limbic-paralimbic neocortical network, including the medial prefrontal cortex, caudate, amygdala, posterior cingulate cortex, and parahippocampus, were detected and assessed. Following control tactile stimulation, weaker patterns of brain responses were detected in areas similar to those stated above. The activation and deactivation patterns following acupuncture stimulation suggest that the hemodynamic responses in the brain simultaneously reflect the sensory, cognitive, and affective dimensions of pain.

This article facilitates a better understanding of acupuncture needle stimulation and its effects on specific activity changes in different brain regions as well as its relationship to the multiple dimensions of pain. Future studies can build on this meta-analysis and will help to elucidate the clinically relevant therapeutic effects of acupuncture.

Download full-text


Available from: Dong-Seon Chang
  • Source
    • "The lack of understanding of the underlying mechanisms of acupuncture and reported cases of a failure to elicit greater clinical improvement compared to sham acupuncture (Hinman et al., 2014; Kong et al., 2013; Langevin et al., 2011), however, have hampered incorporation of this treatment modality into mainstream medical practice. Functional neuroimaging investigation into the mechanisms of acupuncture shows that acupuncture needle stimulation is associated with fMRI signal increase in the insula, thalamus, and primary and secondary somatosensory cortices, signal decrease in the caudate, posterior cingulate cortex, thalamus and parahippocampus, as well as both signal increase and decrease in the medial prefrontal cortex (mPFC), anterior cingulate, amygdala and cerebellum (Chae et al., 2013). In addition, connectivity between these pain regions and the periaqueductal gray (PAG) is modulated during acupuncture (Zyloney et al., 2010) and differentiates verum (genuine) and sham treatments. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Sep 2015 · Clinical neuroimaging
  • Source
    • "This demonstrates not only that the context of a treatment is important but also that pain induced by therapeutic tools might be associated with reward values because patients would have no reason to undergo painful treatments unless they believed that the expected value of reward (relief from the initial suffering or pain) outweighs the additional pain induced by the treatment . From a physiological point of view, inserting needles into the body is generally considered a painful stimulus, but from a therapeutic point of view, inserting needles into the body during acupuncture is known to result in various clinical and therapeutic effects, such as acupuncture analgesia [11] [12]. If acupuncture needling is delivered outside of a therapeutic context, we imagine that it would be considered a painful 'stimulus' for the patient, which might cause different physiological responses than acupuncture 'treatment' given in a therapeutic context. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to compare behavioral and functional brain responses to the act of inserting needles into the body in two different contexts, treatment and stimulation, and to determine whether the behavioral and functional brain responses to a subsequent pain stimulus were also context dependent. Twenty-four participants were randomly divided into two groups: an acupuncture treatment (AT) group and an acupuncture stimulation (AS) group. Each participant received three different types of stimuli, consisting of tactile, acupuncture, and pain stimuli, and was given behavioral assessments during fMRI scanning. Although the applied stimuli were physically identical in both groups, the verbal instructions differed: participants in the AS group were primed to consider the acupuncture as a painful stimulus, whereas the participants in the AT group were told that the acupuncture was part of therapeutic treatment. Acupuncture yielded greater brain activation in reward-related brain areas (ventral striatum) of the brain in the AT group when compared to the AS group. Brain activation in response to pain stimuli was significantly attenuated in the bilateral secondary somatosensory cortex and the right dorsolateral prefrontal cortex after prior acupuncture needle stimulation in the AT group but not in the AS group. Inserting needles into the body in the context of treatment activated reward circuitries in the brain and modulated pain responses in the pain matrix. Our findings suggest that pain induced by therapeutic tools in the context of a treatment is modulated differently in the brain, demonstrating the power of context in medical practice. Copyright © 2014. Published by Elsevier Inc.
    Full-text · Article · Dec 2014 · Physiology & Behavior
  • Source
    • "As a unique treatment modality, studies have shown that acupuncture may produce an analgesic effect through the endogenous descending pain modulatory system141516. Brain imaging studies have also shown that acupuncture needle stimulation1718192021 can evoke widespread brain activity changes and modulate the functional connectivity (FC) of the pain processing network2223242526272829, which opens a new window to understand the central mechanism of acupuncture treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this study, we investigated cortical thickness and functional connectivity across longitudinal acupuncture treatments in patients with knee osteoarthritis (OA). Over a period of four weeks (six treatments), we collected resting state functional magnetic resonance imaging (fMRI) scans from 30 patients before their first, third and sixth treatments. Clinical outcome showed a significantly greater Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score (improvement) with verum acupuncture compared to the sham acupuncture. Longitudinal cortical thickness analysis showed that the cortical thickness at left posterior medial prefrontal cortex (pMPFC) decreased significantly in the sham group across treatment sessions as compared with verum group. Resting state functional connectivity (rsFC) analysis using the left pMPFC as a seed showed that after longitudinal treatments, the rsFC between the left pMPFC and the rostral anterior cingulate cortex (rACC), medial frontal pole (mFP) and periaquiduct grey (PAG) are significantly greater in the verum acupuncture group as compared with the sham group. Our results suggest that acupuncture may achieve its therapeutic effect on knee OA pain by preventing cortical thinning and decreases in functional connectivity in major pain related areas, therefore modulating pain in the descending pain modulatory pathway.
    Full-text · Article · Sep 2014 · Scientific Reports
Show more