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


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
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    • "The scores are as follows: high, >75%; moderate, 50e74%; low, 50%; N [ 0; UD [ 0; Y [ 1. N [ no; NA [ not applicable; RCT [ randomized controlled trial; NRCT [ nonrandomized trial; UD [ unable to determine; Y [ yes. Y Y Y Y Y Y Y Y Y NM Y Y NA NA NM Y Y Maeda et al [26] Y Y Y Y Y NM Y Y NM Y Y NA NA NA P Y P Harris et al [27] Y Y Y Y Y NM Y Y NM NM Y NM NA NA NM Y P Non-RCT Li et al [28] Y Y Y Y Y Y Y Y Y Y Y Y NA NA Y Y Y Napadow et al [30] Y Y Y Y Y NM Y Y NM NM Y Y NA NA P Y Y Napadow et al [29] Y Y Y Y Y NM Y Y NM NM Y Y NA NA P Y Y Pariente et al [31] NM Y Y Y Y NM Y Y Y Y Y NA NA NA NM Y P N [ no; NA [ not applicable; NM [ not mentioned; NRCT [ nonrandomized trial; P [ partially; RCT [ randomized controlled trial; Y [ yes. "
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    ABSTRACT: Acupuncture has been studied for several decades to establish evidence-based clinical practice. This systematic review aims to evaluate evidence for the effectiveness of acupuncture in influencing the functional connectivity of the central nervous system in patients with musculoskeletal pain. A systematic search of the literature was conducted to identify studies in which the central response of acupuncture in patients with musculoskeletal pain was evaluated by neuroimaging techniques. Databases searched were AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Pubmed, SCOPUS, SPORTDiscuss, and Web of Science. Included studies were assessed by two independent reviewers for their methodological quality by using the Downs and Black questionnaire and for their levels of completeness and transparency in reporting acupuncture interventions by using Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) criteria. Seven studies met the inclusion criteria. Three studies were randomized controlled trials (RCTs) and four studies were nonrandomized controlled trials (NRCTs). The neuroimaging techniques used were functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). Positive effects on the functional connectivity of the central nervous system more consistently occurred during long-term acupuncture treatment. The results were heterogeneous from a descriptive perspective; however, the key findings support acupuncture's ability to alter pain-related functional connectivity in the central nervous system in patients with musculoskeletal pain.
    Full-text · Article · Dec 2015 · Journal of Acupuncture and Meridian Studies
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    • "It is interconnected to a group of structures deep within the brain; these include the amygdale, hippocampus, parahippocampus, anterior cingulated cortex, prefrontal cortex, septum, nucleus accumbens, hypothalamus, insula and caudate (White et al., 2008). There is now considerable evidence that acupuncture has a considerable effect on the limbic system (Hui et al., 2000; Hui et al., 2005; Pariente et al., 2005). This general effect of acupuncture almost certainly does not depend on the needle site and has an emotional component (White et al., 2008). "

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    • "Acupuncture analgesia is modulated by various transmitters, notably endogenous opioids, serotonin and noradrenaline [22,23]. Acupuncture activates the ‘pain matrix’ - areas of the brain that have been shown to be consistently activated by noxious stimuli [24] - which includes the insula, an area that may be involved in the hot flush mechanism [25,26]. "
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    ABSTRACT: Background Hot flushes and night sweats (vasomotor symptoms) are common menopausal symptoms, often causing distress, sleep deprivation and reduced quality of life. Although hormone replacement therapy is an effective treatment, there are concerns about serious adverse events. Non-hormonal pharmacological therapies are less effective and can also cause adverse effects. Complementary therapies, including acupuncture, are commonly used for menopausal vasomotor symptoms. While the evidence for the effectiveness of acupuncture in treating vasomotor symptoms is inconclusive, acupuncture has a low risk of adverse effects, and two small studies suggest it may be more effective than non-insertive sham acupuncture. Our objective is to assess the efficacy of needle acupuncture in improving hot flush severity and frequency in menopausal women. Our current study design is informed by methods tested in a pilot study. Methods/design This is a stratified, parallel, randomised sham-controlled trial with equal allocation of participants to two trial groups. We are recruiting 360 menopausal women experiencing a minimum average of seven moderate hot flushes a day over a seven-day period and who meet diagnostic criteria for the Traditional Chinese Medicine diagnosis of Kidney Yin deficiency. Exclusion criteria include breast cancer, surgical menopause, and current hormone replacement therapy use. Eligible women are randomised to receive either true needle acupuncture or sham acupuncture with non-insertive (blunt) needles for ten treatments over eight weeks. Participants are blinded to treatment allocation. Interventions are provided by Chinese medicine acupuncturists who have received specific training on trial procedures. The primary outcome measure is hot flush score, assessed using the validated Hot Flush Diary. Secondary outcome measures include health-related quality of life, anxiety and depression symptoms, credibility of the sham treatment, expectancy and beliefs about acupuncture, and adverse events. Participants will be analysed in the groups in which they were randomised using an intention-to-treat analysis strategy. Discussion Results from this trial will significantly add to the current body of evidence on the role of acupuncture for vasomotor symptoms. If found to be effective and safe, acupuncture will be a valuable additional treatment option for women who experience menopausal vasomotor symptoms. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12611000393954 11/02/2009.
    Full-text · Article · Jun 2014 · Trials
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