Neurocircuitry Subserving Acupuncture and Placebo Controls for Back/V.Napadow

Back/V.Napadow 的神经回路支持针灸和安慰剂对照

• 批准号: 8496731
• 负责人: BRUCE R ROSEN
• 金额: $ 41.72万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8496731
• 关键词: Acupressure; Acupuncture Analgesia; Acupuncture Therapy; Acupuncture procedure; Attention; Back; Brain; Brain region; Chronic idiopathic low back pain; Chronic low back pain; Clinical; Clinical Trials; Cognition; Data; Development; Devices; Financial cost; Functional Magnetic Resonance Imaging; Goals; Hyperalgesia; Instruction; Insula of Reil; Longitudinal Studies; Measures; Methodology; Modeling; Morbidity - disease rate; Needles; Neurobiology; Pain; Patients; Placebo Control; Placebo Effect; Placebos; Population; Process; Skin; Stimulus; Testing; Uncertainty; Waiting Lists; base; central pain; chronic pain; clinically significant; conventional therapy; neuroimaging; relating to nervous system; response; somatosensory

While acupuncture has been shown to be effective for chronic low back pain (cLBP) in many clinical trials, there is a current state of uncertainty as to why acupuncture is effective. In multiple trials, acupuncture does not demonstrate significant improvement over placebo controls based on sham needling, which can involve insertive or non-insertive "needling" with a device that presses against the skin. However, the use of sham needling as placebo control has been criticized since it may be an active therapy akin to acupressure. Ultimately, this state of uncertainty arising from acupuncture clinical trials exists because we lack understanding about the mechanisms of action underlying real versus various forms of sham acupuncture. Specifically, we do not know just how important needle insertion and somatosensory afference are to the mechanisms underlying acupuncture analgesia in cLBP. There is reason to believe that real acupuncture may have different mechanisms from sham acupuncture, and we propose that neuroimaging can inform a testable neurobiological model that identifies diverse mechanisms of action for acupuncture therapy with versus without somatosensory afference. These hypotheses will be tested on a specific chronic pain population, idiopathic cLBP, which has a significant "central" pain component characterized by aberrant somatotopy and augmented brain response to experimental pain (hyperalgesia). The brain correlates of clinical pain in cLBP have been less well characterized, but our own data suggests that clinical pain is associated with increased intrinsic functional connectivity between pain processing brain regions (e.g insula) and specific intrinsic connectivity networks. These networks include the executive attention network (EAN) and "default mode network" (DMN), a network thought to underlie self-referential cognition and modulated by acupuncture. We propose that real and different forms of sham acupuncture differentially modulate these networks, and alter somatotopy. Our overall goal is to evaluate whether the brain neurocircuitry subserving cLBP responds differentially to real versus "sham" acupuncture with and without somatosensory afference. To test our specific hypotheses, we will employ functional magnetic resonance imaging (fMRI) to assess brain networks subserving both clinical and experimental pain, acupuncture stimulation, and somatotopy in cLBP patients. These measures will be performed at baseline and following 7 weeks of (a.) acupuncture, ACUP; (b.) sham acupuncture with somatosensation, SHAM-sn; (c.) sham acupuncture without somatosensation, SHAM-ml\ or (d.) wait list, WL. Aim 1 will characterize the pain neurocircuitry in cLBP, as well as low back SI somatotopy, and brain response to acupuncture stimuli. Aim 2 will evaluate longitudinal effects of ACUP vs. SHAM-sn on brain networks and SI somatotopy in cLBP, while Aim 3 will evaluate the longitudinal effects of SHAM-sn vs. SHAM-ml on these same neuroimaging markers. Understanding the neural influence of somatosensation on acupuncture placebo effects will significantly impact our understanding of acupuncture and allow for development of more inert acupuncture placebos.

在许多临床试验中，针灸已被证明对慢性下腰痛（CLBP）有效，但针灸为何有效存在不确定性。在多个试验中，针灸并未证明基于假针的安慰剂控制，这可能涉及插入性或非插入性的“针刺”，以压在皮肤上的设备。但是，使用 假针作为安慰剂控制，因此受到了批评，因为它可能是类似于腔的积极疗法。 最终，存在针灸临床试验引起的这种不确定性状态，因为我们对实际和各种形式的假针刺的作用机制缺乏了解。 具体而言，我们不知道针头插入和体感的重要性对CLBP中针灸镇痛的机制有多重要。有理由相信，真正的针灸可能与假针刺具有不同的机制，我们建议神经想象力可以为可测试的神经生物学模型提供信息，该模型可以识别出具有各种作用机制，可用于针灸治疗。 而不是没有体感的传感。这些假设将在特定的慢性疼痛人群（特发性CLBP）上进行测试，特发性CLBP具有显着的“中心”疼痛成分，其特征是异常的体育疗法和对实验性疼痛的大脑反应增强（Hyperalgesia）。 CLBP临床疼痛的大脑相关性的特征较不那么良好，但是我们自己的数据表明，临床疼痛与疼痛处理大脑区域（例如sinula）和特定的内在连通性网络之间的内在功能连通性增加有关。这些网络包括执行注意力网络（EAN）和“默认模式网络”（DMN），该网络被认为是自我参照认知和针灸调节的基础的网络。我们提出，真实和不同形式的假针灸会差异地调节这些网络，并改变了体育。我们的总体目标是评估大脑神经记录的clbp是否对具有和没有体感感应的实际“假”针灸的反应差异。为了检验我们的特定假设，我们将采用功能磁共振成像（fMRI）来评估CLBP患者中临床和实验性疼痛，针灸刺激和体育型的大脑网络。这些措施将在基线和（a。）针灸（ACUP）的7周后进行； （b。）带有体敏的假针刺，sham-sn； （c。）无体感应的假针灸，sham-ml \或（d。）等待列表，wl。 AIM 1将表征痛苦 CLBP中的神经路，以及下背部SI体育局，以及对针灸刺激的大脑反应。 AIM 2将评估ACUP与SHAM-SN对CLBP中脑网络和SI体型的纵向影响，而AIM 3将评估Sham-SN与Sham-ML对这些相同神经成像标记的纵向效应。 了解体质对针灸安慰剂作用的神经影响会极大地影响我们对针灸的理解，并允许发展更多惰性针灸longos。