Neuroimaging Acupuncture Effects Brain Activity in Chronic low Back Pain

神经影像学针灸对慢性腰痛的大脑活动的影响

基本信息

批准号：
9404135
负责人：
RANDY Lyanne GOLLUB
金额：
$ 64.39万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-01 至 2017-06-30
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：虽然在许多临床试验中针灸已被证明对慢性腰痛（cLBP）有效，但目前对于针灸为何有效仍存在不确定性。在多项试验中，针灸并未表现出比基于假针刺的安慰剂对照有显着改善，假针刺可能涉及用压在皮肤上的装置进行插入式或非插入式“针刺”。然而，使用假针刺作为安慰剂对照受到了批评，因为它可能是一种类似于指压按摩的主动疗法。最终，针灸临床试验产生的这种不确定性状态的存在是因为我们对真实针灸与各种形式的假针灸的作用机制缺乏了解。具体来说，我们不知道针刺和体感传入对于 cLBP 针刺镇痛的机制有多重要。有理由相信，真正的针灸可能与假针灸有不同的机制，我们建议神经影像学可以为可测试的神经生物学模型提供信息，该模型可以识别有体感传入和无体感传入的针灸治疗的不同作用机制。这些假设将在特定的慢性疼痛人群（特发性 cLBP）上进行测试，该人群具有显着的“中枢”疼痛成分，其特征是异常的躯体形态和对实验性疼痛（痛觉过敏）的大脑反应增强。 cLBP 中临床疼痛的大脑相关性尚未得到很好的表征，但我们自己的数据表明，临床疼痛与疼痛处理大脑区域（例如岛叶）和特定内在连接网络之间内在功能连接的增加有关。这些网络包括执行注意力网络（EAN）和“默认模式网络”（DMN），这是一种被认为是自我参照认知的基础并通过针灸调节的网络。我们提出，真实的和不同形式的假针灸会差异性地调节这些网络，并改变体格。我们的总体目标是评估支持 cLBP 的大脑神经回路对有或没有体感传入的真实针灸与“假”针灸的反应是否存在差异。为了检验我们的具体假设，我们将采用功能磁共振成像 (fMRI) 来评估支持 cLBP 患者临床和实验疼痛、针灸刺激和躯体解剖的大脑网络。这些措施将在基线和 7 周后进行 (a.) 针灸、ACUP； (b.) 带有体感的假针灸，SHAM-sn； (c.) 没有体感的假针灸，SHAM-ml\ 或 (d.) 等待名单，WL。目标 1 将描述 cLBP 中的疼痛神经回路、腰部 SI 体位特征以及大脑对针灸刺激的反应。目标 2 将评估 ACUP 与 SHAM-sn 对 cLBP 中大脑网络和 SI 体位的纵向影响，而目标 3 将评估 SHAM-sn 与 SHAM-ml 对这些相同神经影像标记物的纵向影响。了解体感对针灸安慰剂效应的神经影响将显着影响我们对针灸的理解，并有助于开发更惰性的针灸安慰剂。