Brain Plasticity in Carpal Tunnel Syndrome and its Response to Acupuncture

腕管综合征的脑可塑性及其对针灸的反应

• 批准号: 7507560
• 负责人: VITALY NAPADOW
• 金额: $ 78.43万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7507560
• 关键词: Absenteeism at work; Acupressure; Acupuncture Points; Acupuncture Therapy; Acupuncture procedure; Address; Affect; Affective; Amygdaloid structure; Behavioral; Biological Markers; Blur; Brain; Brain region; Caring; Carpal Tunnel Syndrome; Chronic; Clinical; Contralateral; Control Groups; Diffuse; Digit structure; Dimensions; Distal; Electroacupuncture; Entrapment Neuropathies; Esthesia; Forearm; Functional Magnetic Resonance Imaging; Functional disorder; Grant; Health; Hyperactive behavior; Hypothalamic structure; Injury; Leg; Lesion; Location; Low Back Pain; Magnetic Resonance Imaging; Measures; Metric; Nerve; Neural Conduction; Neuraxis; Neuronal Plasticity; Outcome Measure; Pain; Paresthesia; Pathology; Patients; Peripheral; Peripheral Nerves; Pilot Projects; Placebos; Process; Protocols documentation; Psychomotor Performance; Public Health; Randomized; Rate; Regulation; Rehabilitation therapy; Reporting; Sensory Process; Severities; Signal Transduction; Somatosensory Cortex; Stimulus; Study models; Symptoms; Tactile; Testing; Therapeutic; Wrist; conditioning; disability; experience; improved; lost work time; median nerve; neuroimaging; neuromechanism; performance tests; response; somatosensory

DESCRIPTION (provided by applicant): Carpal tunnel syndrome (CTS), the most common entrapment neuropathy, is exceeded only by low back pain as a cause of employee absenteeism. Maladaptive neuroplasticity in the brain of CTS patients has been noted by several neuroimaging studies, and includes altered primary somatosensory cortex (SI) somatotopy and primary sensorimotor hyperactivation. We hypothesize that the disability and pain associated with CTS is not only a consequence of the peripheral nerve lesion but also relates to the observed, altered cortical sensory processing. Acupuncture has shown potential as a conservative treatment option for CTS, but its mechanisms of action are unknown. CTS is an excellent model for studying acupuncture mechanisms as clinical improvement can be evaluated by several objective outcome measures in addition to subjective symptom assessments. We propose that acupuncture, a somatosensory conditioning stimulus, can reverse CTS-associated maladaptive neuroplasticity via different mechanisms of neural modulation: focal and systemic. We will derive the contribution of these different mechanisms by randomizing CTS patients into three treatment groups local, distal, and placebo. We hypothesize that local acupuncture can affect brain biomarkers, pain sensation, peripheral nerve dysfunction, and functional deficits, whereas distal acupuncture will only address pain. In Aim 1, we will develop and optimize functional MRI (fMRI) neuroimaging biomarkers for CTS and correlate these biomarkers with more established peripheral clinical and functional deficit metrics. In Aim 2 we will evaluate brain response to acupuncture at both local and distal acupoints in CTS patients, and correlate activity in specific limbic brain regions and the primary sensorimotor cortex with peripheral clinical pathophysiology and SI digit somatotopy. In Aim 3 we will investigate the immediate and longitudinal response in central biomarkers to acupuncture therapy. Hence, we will utilize fMRI neuroimaging to better delineate the central mechanisms by which acupuncture ameliorates CTS pathology. We will derive the behavioral consequences of CTS patients' maladaptive cortical plasticity and the immediate brain and peripheral response to acupuncture stimulation. By understanding the neural mechanisms of different forms of acupuncture therapy, we hope to refine acupuncture utility for CTS and advance rehabilitation options in CTS care. PUBLIC HEALTH RELEVANCE. Carpal tunnel syndrome (CTS) is a very common ailment resulting from excessive compression of the median nerve in the wrist and consistently leads in lost work time among major disabling injuries. Acupuncture has shown potential as a conservative treatment option for CTS, but its mechanisms of action are not known. This grant will assess changes in brain activity that accompany the dysfunction in the wrist, as well as how different acupuncture protocols directed at different bodily locations might modify both local nerve health and brain function to help treat CTS patients.

描述（由申请人提供）：腕管综合症 (CTS) 是最常见的卡压性神经病，仅次于腰痛，是导致员工缺勤的原因之一。多项神经影像学研究已注意到 CTS 患者大脑中的适应不良神经可塑性，包括初级体感皮层 (SI) 体位改变和初级感觉运动过度激活。我们假设与 CTS 相关的残疾和疼痛不仅是周围神经损伤的结果，而且还与观察到的皮质感觉处理的改变有关。针灸已显示出作为 CTS 保守治疗选择的潜力，但其作用机制尚不清楚。 CTS 是研究针灸机制的绝佳模型，因为除了主观症状评估之外，还可以通过多种客观结果测量来评估临床改善。我们提出，针灸作为一种体感调节刺激，可以通过不同的神经调节机制（局灶性和全身性）逆转 CTS 相关的适应不良神经可塑性。我们将通过将 CTS 患者随机分为局部、远端和安慰剂三个治疗组来得出这些不同机制的贡献。我们假设局部针灸可以影响大脑生物标志物、疼痛感觉、周围神经功能障碍和功能缺陷，而远端针灸只能解决疼痛。在目标 1 中，我们将开发和优化 CTS 的功能 MRI (fMRI) 神经影像生物标志物，并将这些生物标志物与更成熟的外周临床和功能缺陷指标相关联。在目标 2 中，我们将评估 CTS 患者局部和远端穴位对针灸的大脑反应，并将特定边缘脑区域和初级感觉运动皮层的活动与外周临床病理生理学和 SI 数字体位相关联。在目标 3 中，我们将研究中心生物标志物对针灸治疗的即时和纵向反应。因此，我们将利用功能磁共振成像神经影像学来更好地描述针灸改善 CTS 病理的中心机制。我们将得出 CTS 患者适应不良的皮质可塑性以及对针灸刺激的直接大脑和外周反应的行为后果。通过了解不同形式针灸疗法的神经机制，我们希望完善针灸在 CTS 中的效用，并推进 CTS 护理中的康复选择。公共卫生相关性。腕管综合症（CTS）是一种非常常见的疾病，由手腕正中神经过度受压引起，在严重致残性损伤中一直会导致工作时间损失。针灸已显示出作为 CTS 保守治疗选择的潜力，但其作用机制尚不清楚。这笔赠款将评估伴随手腕功能障碍而来的大脑活动变化，以及针对不同身体部位的不同针灸方案如何改变局部神经健康和大脑功能，以帮助治疗 CTS 患者。