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Honarpishe R, Naghdi S, Ansari NN, Dommerholt J, Hassanabadi M. The Effect of Ankle Muscles Dry Needling on Brain Activity Map Based on fMRI: a Study Protocol for Randomized Controlled Trial. J Acupunct Meridian Stud 2024; 17:94-99. [PMID: 38898646 DOI: 10.51507/j.jams.2024.17.3.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/15/2024] [Accepted: 04/03/2024] [Indexed: 06/21/2024] Open
Abstract
Importance Neuromodulation may be one of the underlying mechanisms of dry needling (DN); however, the mechanism has not yet been fully clarified. Objective This randomized controlled trial is designed to evaluate DN stimulation of the tibialis anterior and peroneus longus muscles in chronic ankle instability (CAI) and healthy subjects, employing functional magnetic resonance imaging (fMRI). Design Clinical study protocol, SPIRIT compliant. Setting Brain Mapping Laboratory. Population A total of thirty participants aged between 18 and 40 years old will be included in this study. Twenty healthy participants will be randomized into 2 groups (real DN and sham DN). Ten patients with CAI will also be recruited to the third group and receive only real DN for comparison. Exposures Real and sham DN. Main Outcomes and Measures The voxel count, coordinates of peak activation, and peak intensity will be obtained as primary outcomes to report brain map activation. Measurements will be taken before, during, and after DN treatment. The strength of the ankle dorsiflexors, active dorsiflexion range of motion, and McGill pain questionnaire short-form will be used as secondary outcome measures. Results The results from this study will be published in peer-reviewed journals and disseminated as presentations at national and international congresses. Conclusion This trial will explore brain responses to real and sham DN in healthy participants and to real DN in CAI patients. Overall, our results will provide preliminary evidence of the neural mechanism of DN.
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Affiliation(s)
- Roshanak Honarpishe
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Jan Dommerholt
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Marzieh Hassanabadi
- Department of Physiotherapy, Rehabilitation Faculty, Semnan University of Medical Sciences, Semnan, Iran
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Chen Z, Li Q, Lu Y, Huang G, Huang Y, Pei X, Gong Y, Zhang B, Tang X, Liu Z, Guo T, Liang F. Contralateral acupuncture for migraine without aura: a randomized trial protocol with multimodal MRI. Front Neurosci 2024; 18:1344235. [PMID: 38560045 PMCID: PMC10979701 DOI: 10.3389/fnins.2024.1344235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Migraine is a common clinical disorder, ranks as the second most disabling disease worldwide, and often manifests with unilateral onset. Contralateral acupuncture (CAT), as a classical acupuncture method, has been proven to be effective in the treatment of migraine without aura (MWoA). However, its neural mechanisms have not been investigated using multimodal magnetic resonance imaging (MRI). Methods and analysis In this multimodal neuroimaging randomized trial, a total of 96 female MWoA participants and 30 female healthy controls (HCs) will be recruited. The 96 female MWoA participants will be randomized into three groups: Group A (CAT group), Group B [ipsilateral acupuncture (IAT) group], and Group C (sham CAT group) in a 1:1:1 allocation ratio. Each group will receive 30 min of treatment every other day, three times a week, for 8 weeks, followed by an 8-week follow-up period. The primary outcome is the intensity of the migraine attack. Data will be collected at baseline (week 0), at the end of the 8-week treatment period (weeks 1-8), and during the 8-week follow-up (weeks 9-16). Adverse events will be recorded. Multimodal MRI scans will be conducted at baseline and after 8-week treatment. Discussion This study hypothesized that CAT may treat MWoA by restoring pathological alterations in brain neural activity, particularly by restoring cross-integrated functional connectivity with periaqueductal gray (PAG) as the core pathological brain region. The findings will provide scientific evidence for CAT in the treatment of MWoA. Ethics and dissemination The Medical Ethics Committee of the Second Affiliated Hospital of Yunnan University of Chinese Medicine has given study approval (approval no. 2022-006). This trial has been registered with the Chinese Clinical Trials Registry (registration no. ChiCTR2300069456). Peer-reviewed papers will be used to publicize the trial's findings. Clinical trial registration https://clinicaltrials.gov/, identifier ChiCTR2300069456.
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Affiliation(s)
- Ziwen Chen
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qifu Li
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, China
| | - Yi Lu
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Gaoyangzi Huang
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, China
| | - Ya Huang
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, China
| | - Xianmei Pei
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, China
| | - Yi Gong
- Kunming Psychiatry Hospital/Yunnan University of Chinese Medicine Teaching Hospital, Kunming, China
| | - Bingkui Zhang
- Kunming Psychiatry Hospital/Yunnan University of Chinese Medicine Teaching Hospital, Kunming, China
| | - Xin Tang
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, China
| | - Zili Liu
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, China
| | - Taipin Guo
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, China
| | - Fanrong Liang
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Manuel J, Halbe E, Ewald AC, Hoff A, Jordan J, Tank J, Heusser K, Gerlach DA. Glucose-sensitive hypothalamic nuclei traced through functional magnetic resonance imaging. Front Neurosci 2023; 17:1297197. [PMID: 38146542 PMCID: PMC10749345 DOI: 10.3389/fnins.2023.1297197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction Hypothalamic glucose-sensitive neural circuits, which regulate energy metabolism and can contribute to diseases such as obesity and type 2 diabetes, have been difficult to study in humans. We developed an approach to assess hypothalamic functional connectivity changes during glucose loading using functional magnetic resonance imaging (fMRI). Methods To do so, we conducted oral glucose tolerance tests while acquiring functional images before, and 10 and 45 min after glucose ingestion in a healthy male and cross-sectionally in 20 healthy participants on two different diets. Results At group level, 39 fMRI sessions were not sufficient to detect glucose-mediated connectivity changes. However, 10 repeated sessions in a single subject revealed significant intrinsic functional connectivity increases 45 min after glucose intake in the arcuate, paraventricular, and dorsomedial nuclei, as well as in the posterior hypothalamic area, median eminence, and mammillary bodies. Discussion Our methodology allowed to outline glucose-sensitive hypothalamic pathways in a single human being and holds promise in delineating individual pathophysiology mechanisms in patients with dysglycemia.
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Affiliation(s)
- Jorge Manuel
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Institute for Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Eva Halbe
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Ann Charlotte Ewald
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Alex Hoff
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Karsten Heusser
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Darius A. Gerlach
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
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4
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Yang Y, Rao C, Yin T, Wang S, Shi H, Yan X, Zhang L, Meng X, Gu W, Du Y, Hong F. Application and underlying mechanism of acupuncture for the nerve repair after peripheral nerve injury: remodeling of nerve system. Front Cell Neurosci 2023; 17:1253438. [PMID: 37941605 PMCID: PMC10627933 DOI: 10.3389/fncel.2023.1253438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Peripheral nerve injury (PNI) is a structural event with harmful consequences worldwide. Due to the limited intrinsic regenerative capacity of the peripheral nerve in adults, neural restoration after PNI is difficult. Neurological remodeling has a crucial effect on the repair of the form and function during the regeneration of the peripheral nerve after the peripheral nerve is injured. Several studies have demonstrated that acupuncture is effective for PNI-induced neurologic deficits, and the potential mechanisms responsible for its effects involve the nervous system remodeling in the process of nerve repair. Moreover, acupuncture promotes neural regeneration and axon sprouting by activating related neurotrophins retrograde transport, such as nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial cell-derived neurotrophic factor (GDNF), N-cadherin, and MicroRNAs. Peripheral nerve injury enhances the perceptual response of the central nervous system to pain, causing central sensitization and accelerating neuronal cell apoptosis. Together with this, the remodeling of synaptic transmission function would worsen pain discomfort. Neuroimaging studies have shown remodeling changes in both gray and white matter after peripheral nerve injury. Acupuncture not only reverses the poor remodeling of the nervous system but also stimulates the release of neurotrophic substances such as nerve growth factors in the nervous system to ameliorate pain and promote the regeneration and repair of nerve fibers. In conclusion, the neurological remodeling at the peripheral and central levels in the process of acupuncture treatment accelerates nerve regeneration and repair. These findings provide novel insights enabling the clinical application of acupuncture in the treatment of PNI.
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Affiliation(s)
- Yongke Yang
- Beilun District People’s Hospital, Ningbo, China
| | - Chang Rao
- Tianjin Union Medical Center, Tianjin, China
| | - Tianlong Yin
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shaokang Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Huiyan Shi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xin Yan
- National Anti-Drug Laboratory Beijing Regional Center, Beijing, China
| | - Lili Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xianggang Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wenlong Gu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuzheng Du
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Feng Hong
- Beilun District People’s Hospital, Ningbo, China
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5
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Bonemazzi I, Nosadini M, Pelizza MF, Paolin C, Cavaliere E, Sartori S, Toldo I. Treatment of Frequent or Chronic Primary Headaches in Children and Adolescents: Focus on Acupuncture. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1626. [PMID: 37892289 PMCID: PMC10605007 DOI: 10.3390/children10101626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Acupuncture is a spreading and promising intervention, which has proven to be very useful in the treatment and prevention of chronic pain, in particular chronic headaches, in adults; the literature about the treatment of pediatric chronic headaches is scarce. In addition, few guidelines advise its use in children. The aim of this review is to collect all relevant studies with available data about the use, effect, and tolerability of acupuncture as a treatment for pediatric primary headaches. METHODS This is a narrative review based on eight studies selected from 135 papers including pediatric cases treated with acupuncture for headache. RESULTS Despite the differences in tools, procedures, and application sites, acupuncture demonstrated a positive effect on both the frequency and intensity of headaches and was well tolerated. There are no studies considering the long-term efficacy of acupuncture. CONCLUSION Further additional studies are needed on acupuncture in children and adolescents, with larger series and standardized procedures, in order to better assess efficacy, tolerability, and long-term prognosis and to define guidelines for the use of this promising and safe treatment. It is particularly relevant to identify safe and well-tolerated treatment options in pediatric patients affected by recurrent and debilitating headaches.
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Affiliation(s)
| | | | | | | | | | | | - Irene Toldo
- Juvenile Headache Center, Department of Woman’s and Child’s Health, University Hospital of Padua, 35128 Padua, Italy; (I.B.); (M.N.); (M.F.P.); (C.P.); (E.C.); (S.S.)
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Ma Y, Li B, Cui Y, Zhang Z, Jiang S, Yan X, He J, Du Y. The Top 100 Cited Articles on Acupuncture in the Last 20 Years: A Bibliometric Analysis. Complement Med Res 2023; 30:393-407. [PMID: 37263232 DOI: 10.1159/000530778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/14/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Acupuncture has gained increasing international attention in recent decades. The act of incorporating acupuncture treatment into the routine treatment of COVID-19 in China drove us to review the 100 most influential articles of the last 20 years to learn about the current status and trends of acupuncture. METHOD Articles related to acupuncture from January 1, 2001, to July 4, 2022, were searched in the Clarivate Analytics Web of Science Core Collection database. The top 100 most cited publications were selected, and information was extracted. Software such as VOSviewer, GraphPad Prism, Scimago Graphica, and CiteSpace were used to visualize and analyze the extracted data. RESULT The 100 most cited articles were identified, with an average of 218 citations (range: 131-625). The majority of the top 100 articles were from the USA (n = 53). The institution that published the most highly cited papers was Harvard University (n = 16). The most influential team was Klaus Linde's group. Pain was the top-ranked journal in terms of the number of publications. The largest clusters for co-occurrence keyword analysis focused on acupuncture and electroacupuncture analgesia and brain imaging responses to acupuncture stimulation via functional MRI. The two highest strength burst keywords were "randomized controlled trials" and "osteoarthritis," with "randomized controlled trials" being a consistent burst keyword from 2011 to the present. CONCLUSION This study provides insight into articles of historical significance in the field of acupuncture through bibliometric analysis. These data should provide clinicians and researchers with insight into future directions related to acupuncture. Hintergrund Die Akupunktur hat in den vergangenen Jahrzehnten zunehmend die internationale Aufmerksamkeit auf sich gezogen. Die Einbeziehung der Akupunktur in die Routinebehandlung von COVID-19 in China hat uns dazu veranlasst, die 100 einflussreichsten Artikel der letzten 20 Jahre zu überprüfen, um etwas über den aktuellen Stand und die Trends in der Akupunktur zu erfahren. Methode Artikel mit Bezug zu Akupunktur vom 1. Januar 2001 bis 4. Juli 2022 wurden in der Clarivate Analytics Web of Science Core Collection Datenbank gesucht. Die 100 am häufigsten zitierten Veröffentlichungen wurden ausgewählt und die Informationen wurden extrahiert. Visualisierung und Analyse der extrahierten Daten erfolgten mithilfe der Software VOSviewer, GraphPad Prism, Scimago Graphica und CiteSpace. Ergebnis Es wurden die 100 am häufigsten zitierten Artikel ermittelt mit durchschnittlich 218 Zitierungen (Spanne: 131 bis 625). Der Großteil der 100 meistzitierten Artikel stammte aus den Vereinigten Staaten ( n = 53). Die Institution, die die meisten zitierten Artikel veröffentlichte, war die Harvard-Universität ( n = 16). Das einflussreichste Team war die Gruppe von Klaus Linde. Was die Zahl der Veröffentlichungen betrifft, war Pain die am häufigsten zitierte Zeitschrift. Bei der Analyse der Koinzidenz von Schlüsselwörtern lag der Fokus der größten Cluster auf Akupunktur-und Elektroakupunktur-Analgesie sowie auf den Reaktionen auf Akupunkturstimulation in den bildgebenden Untersuchungen des Gehirns mittels funktioneller MRT. Die beiden stärksten Burst-Schlüsselwörter waren “randomisierte kontrollierte Studien” und “Osteoarthritis,” wobei “randomisierte kontrollierte Studien” von 2011 bis heute durchgängig ein Burst-Schlüsselwort ist. Schlussfolgerung Diese Studie bietet einen Einblick in historisch bedeutsame Artikel auf dem Gebiet der Akupunktur mittels bibliometrischer analyse. Diese Daten sollen Klinikern und Forschern einen Einblick in zukünftige Richtungen im Zusammenhang mit Akupunktur geben.
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Affiliation(s)
- Yuping Ma
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China,
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China,
| | - Bo Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Ying Cui
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zixing Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shiyi Jiang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xiong Yan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Junpeng He
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuzheng Du
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Wong KKL, Xu J, Chen C, Ghista D, Zhao H. Functional magnetic resonance imaging providing the brain effect mechanism of acupuncture and moxibustion treatment for depression. Front Neurol 2023; 14:1151421. [PMID: 37025199 PMCID: PMC10070747 DOI: 10.3389/fneur.2023.1151421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/22/2023] [Indexed: 04/08/2023] Open
Abstract
The efficacy of acupuncture and moxibustion in the treatment of depression has been fully recognized internationally. However, its central mechanism is still not developed into a unified standard, and it is generally believed that the central mechanism is regulation of the cortical striatum thalamic neural pathway of the limbic system. In recent years, some scholars have applied functional magnetic resonance imaging (fMRI) to study the central mechanism and the associated brain effects of acupuncture and moxibustion treatment for depression. This study reviews the acupuncture and moxibustion treatment of depression from two aspects: (1) fMRI study of the brain function related to the acupuncture treatment of depression: different acupuncture and moxibustion methods are summarized, the fMRI technique is elaborately explained, and the results of fMRI study of the effects of acupuncture are analyzed in detail, and (2) fMRI associated "brain functional network" effects of acupuncture and moxibustion on depression, including the effects on the hippocampus, the amygdala, the cingulate gyrus, the frontal lobe, the temporal lobe, and other brain regions. The study of the effects of acupuncture on brain imaging is not adequately developed and still needs further improvement and development. The brain function networks associated with the acupuncture treatment of depression have not yet been adequately developed to provide a scientific and standardized mechanism of the effects of acupuncture. For this purpose, this study analyzes in-depth the clinical studies on the treatment of anxiety and depression by acupuncture and moxibustion, by depicting how the employment of fMRI technology provides significant imaging changes in the brain regions. Therefore, the study also provides a reference for future clinical research on the treatment of anxiety and depression.
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Affiliation(s)
- Kelvin K. L. Wong
- The Research Center for Medical AI, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jinping Xu
- The Research Center for Medical AI, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Cang Chen
- The Research Center for Medical AI, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Dhanjoo Ghista
- The Research Center for Medical AI, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hong Zhao
- Acupuncture and Moxibustion Department, Luohu District Hospital of Traditional Chinese Medicine, Shenzhen, China
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Zhao TT, Pei LX, Guo J, Liu YK, Wang YH, Song YF, Zhou JL, Chen H, Chen L, Sun JH. Acupuncture-Neuroimaging Research Trends over Past Two Decades: A Bibliometric Analysis. Chin J Integr Med 2023; 29:258-267. [PMID: 35508861 DOI: 10.1007/s11655-022-3672-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify topics attracting growing research attention as well as frontier trends of acupuncture-neuroimaging research over the past two decades. METHODS This paper reviewed data in the published literature on acupuncture neuroimaging from 2000 to 2020, which was retrieved from the Web of Science database. CiteSpace was used to analyze the publication years, countries, institutions, authors, keywords, co-citation of authors, journals, and references. RESULTS A total of 981 publications were included in the final review. The number of publications has increased in the recent 20 years accompanied by some fluctuations. Notably, the most productive country was China, while Harvard University ranked first among institutions in this field. The most productive author was Tian J with the highest number of articles (50), whereas the most co-cited author was Hui KKS (325). Evidence-Based Complementary and Alternative Medicine (92) was the most prolific journal, while Neuroimage was the most co-cited journal (538). An article written by Hui KKS (2005) exhibited the highest co-citation number (112). The keywords "acupuncture" (475) and "electroacupuncture" (0.10) had the highest frequency and centrality, respectively. Functional magnetic resonance imaging (fMRI) ranked first with the highest citation burst (6.76). CONCLUSION The most active research topics in the field of acupuncture-neuroimaging over the past two decades included research type, acupoint specificity, neuroimaging methods, brain regions, acupuncture modality, acupoint specificity, diseases and symptoms treated, and research type. Whilst research frontier topics were "nerve regeneration", "functional connectivity", "neural regeneration", "brain network", "fMRI" and "manual acupuncture".
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Affiliation(s)
- Ting-Ting Zhao
- Department of Acupuncture Rehabilitation, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Li-Xia Pei
- Department of Acupuncture Rehabilitation, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.,Acupuncture and Moxibustion Disease Project Group of China Evidence-Based Medicine Center of Traditional Chinese Medicine, Nanjing, 210029, China
| | - Jing Guo
- Department of Acupuncture Rehabilitation, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Yong-Kang Liu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Yu-Hang Wang
- Department of Acupuncture Rehabilitation, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Ya-Fang Song
- Acupuncture and Massage College, Health and Rehabilitation College, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Jun-Ling Zhou
- Department of Acupuncture Rehabilitation, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Hao Chen
- Acupuncture and Massage College, Health and Rehabilitation College, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Lu Chen
- Acupuncture and Moxibustion Disease Project Group of China Evidence-Based Medicine Center of Traditional Chinese Medicine, Nanjing, 210029, China
| | - Jian-Hua Sun
- Department of Acupuncture Rehabilitation, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China. .,Acupuncture and Moxibustion Disease Project Group of China Evidence-Based Medicine Center of Traditional Chinese Medicine, Nanjing, 210029, China.
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9
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Feng Z, Cui S, Yang H, Wang Y, Zhou X, Wong J, Lai L, Yang Z, Huang B, Zheng H, Xu M. Acupuncture for neuropathic pain: A meta-analysis of randomized control trials. Front Neurol 2023; 13:1076993. [PMID: 36698895 PMCID: PMC9868276 DOI: 10.3389/fneur.2022.1076993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/09/2022] [Indexed: 01/10/2023] Open
Abstract
Background Neuropathic pain (NP) is expected to increase due to the high risk of global population aging. Acupuncture has a definite clinical effect on NP. Therefore, a systematic review and meta-analysis were conducted to evaluate the effect on pain intensity and safety of acupuncture in patients with NP. Methods An encompassing search of specific authoritative databases in English, from their inception to 2022, was performed. The databases were as follows: Scopus, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Ovid Cochrane Central Register of Controlled Trials, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, and Daily. All the randomized controlled trials regarding the acupuncture treatment of NP will be included. Methodological quality assessment of the included trials was assessed based on the risk of bias from the Cochrane handbook. A meta-analysis was performed for the main outcomes. In addition, sensitivity analysis, subgroup analysis, and funnel plot were also carried out. Results A total of 16 studies with 1,021 patients with NP were evaluated in a systematic review. According to the results of the overall meta-analysis in eight RCTs with 338 participants, the acupuncture group was better than the control group in improving changes in pain intensity (SMD -0.59, 95% CI: -0.95 to -0.23, P = 0.001). In subgroup analysis, five trials indicated that acupuncture was more effective in improving changes in pain intensity than sham acupuncture (SMD -0.54, 95% CI: -0.95 to -0.13, P = 0.01), two trials evaluated the effect on changes in pain intensity in the comparison of acupuncture and conventional treatments, no significant difference existed (SMD -0.61, 95% CI: -1.83 to 0.61, P = 0.33), and one trial compared acupuncture with blank control evaluating the effect of changes in pain intensity with a significant difference. Eleven studies mentioned the safety conditions and acupuncture-induced AEs were mild and reversible. Both the sensitivity analysis and funnel plot analysis showed that the meta-analysis was stable and irreversible without publication bias. The GRADE was rated as "very low." Conclusion The acupuncture group had higher effectiveness than sham intervention or blank control for changes in pain intensity, but there is no significant difference between acupuncture and conventional treatments in treating NP. The acupuncture-induced adverse events were mild and reversible. However, the interpretation of our results should be performed cautiously due to the low methodological quality of selected publications. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022306461.
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Affiliation(s)
- Zitong Feng
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaoyang Cui
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China,Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Huijun Yang
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yixiao Wang
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xuan Zhou
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - John Wong
- School of Nursing, MGH Institute of Health Professions, Boston, MA, United States,Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, United States
| | - Liting Lai
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zeyu Yang
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Bingjing Huang
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Huiyan Zheng
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingzhu Xu
- Shenzhen Hospital, Southern Medical University, Shenzhen, China,*Correspondence: Mingzhu Xu ✉
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10
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Gao Z, Cui M, Zhang J, Ji L. Activation likelihood estimation identifies brain regions activated during puncturing at Hegu in healthy volunteers: A meta-analysis. Front Neurosci 2022; 16:1084362. [PMID: 36620460 PMCID: PMC9813741 DOI: 10.3389/fnins.2022.1084362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background Hegu is the most commonly used acupoints for pain relief. Recently, several functional neuroimaging studies have been performed on acupuncture at Hegu in healthy volunteers, but these studies have yielded diverse findings. Therefore, there is an urgent need to understand the brain response characteristics of acupuncture at Hegu. Methods Neuroimaging studies on acupuncture at Hegu published before October 2022 were collected from PubMed, Web of Science, Google Scholar, Embase, and CNKI (China National Knowledge Infrastructure) databases, and were screened by strict inclusion and exclusion criteria. The extraction of brain coordinates was performed by two independent researchers, and the results were analyzed using activation likelihood estimation (ALE) analysis based on quantitative coordinates. Results In total, 338 studies were searched, of which 19 studies were included in the final analysis after a rigorous double-blind screening review. Activation likelihood estimation showed that postcentral gyrus in the left brain were activated, whereas the anterior cingulate in the left brain and superior temporal gyrus in the right brain were deactivated. Conclusion Acupuncture at Hegu in healthy volunteers did not reveal specific brain regions. This finding implies that organismal status of the study subjects may have an important impact on the effect of acupoints. Systematic review registration [https://www.crd.york.ac.uk], identifier [CRD42020197296].
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Affiliation(s)
- Zhen Gao
- Experimental Management Center, Shanxi University of Traditional Chinese Medicine, Jinzhong, Shanxi, China
| | - Mengjie Cui
- Experimental Management Center, Shanxi University of Traditional Chinese Medicine, Jinzhong, Shanxi, China
| | - Jing Zhang
- Affiliated Hospital of Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Laixi Ji
- Experimental Management Center, Shanxi University of Traditional Chinese Medicine, Jinzhong, Shanxi, China,*Correspondence: Laixi Ji,
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11
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Church D, Stapleton P, Vasudevan A, O'Keefe T. Clinical EFT as an evidence-based practice for the treatment of psychological and physiological conditions: A systematic review. Front Psychol 2022; 13:951451. [PMID: 36438382 PMCID: PMC9692186 DOI: 10.3389/fpsyg.2022.951451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Since the turn of the century, Emotional Freedom Techniques (EFT) has come into widespread use in medical and psychological treatment settings. It is also used as self-help by tens of millions of people each year. Clinical EFT, the manualized form of the method, has been validated as an "evidence-based" practice using criteria published by the American Psychological Association (APA) Division 12 Task Force on Empirically Validated Therapies. Its three essential ingredients are exposure, cognitive framing, and acupressure. Objectives In 2013 we published a paper defining Clinical EFT and reviewing published research. It has been viewed or downloaded over 36,000 times, indicating widespread interest in this treatment modality. Here we update our findings based on subsequently published literature and propose directions for future research. Method We performed a systematic review of the literature to identify randomized controlled trials (RCTs) and meta-analyses. Retrieval of 4,167 results resulted in the identification of 56 RCTs (n = 2,013), 41 of which were published subsequent to our earlier review, as well as eight meta-analyses. Results RCTs have found EFT treatment to be effective for (a) psychological conditions such as anxiety, depression, phobias, and posttraumatic stress disorder (PTSD); (b) physiological issues such as pain, insomnia, and autoimmune conditions; (c) professional and sports performance; and (d) biological markers of stress. Meta-analyses evaluating the effect of EFT treatment have found it to be "moderate" to "large." Successful independent replication studies have been carried out for anxiety, depression, PTSD, phobias, sports performance, and cortisol levels. We outline the next steps in EFT research. These include determining its impact on cancer, heart disease, diabetes, and cognitive impairment; analysis of the large-scale datasets made possible by mobile apps; and delivery through channels such as virtual practitioner sessions, artificial intelligence agents, online courses, apps, virtual reality platforms, and standardized group therapy. Conclusions Subsequent research has confirmed the conclusions of earlier studies. These find Clinical EFT to be efficacious for a range of psychological and physiological conditions. Comparatively few treatment sessions are required, treatment is effective whether delivered in person or virtually, and symptom improvements persist over time. Treatment is associated with measurable biological effects in the dimensions of gene expression, brain synchrony, hormonal synthesis, and a wide range of biomarkers. Clinical EFT is a stable and mature method with an extensive evidence base. Its use in primary care settings as a safe, rapid, reliable, and effective treatment for both psychological and medical diagnoses continues to grow.
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Affiliation(s)
- Dawson Church
- National Institute for Integrative Healthcare, Petaluma, CA, United States
| | - Peta Stapleton
- Department of Society and Design, Bond University, Gold Coast, QLD, Australia
| | - Anitha Vasudevan
- National Institute for Integrative Healthcare, Petaluma, CA, United States
| | - Tom O'Keefe
- Department of Society and Design, Bond University, Gold Coast, QLD, Australia
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12
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Ma X, Chen W, Yang NN, Wang L, Hao XW, Tan CX, Li HP, Liu CZ. Potential mechanisms of acupuncture for neuropathic pain based on somatosensory system. Front Neurosci 2022; 16:940343. [PMID: 36203799 PMCID: PMC9530146 DOI: 10.3389/fnins.2022.940343] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Neuropathic pain, caused by a lesion or disease of the somatosensory system, is common and distressing. In view of the high human and economic burden, more effective treatment strategies were urgently needed. Acupuncture has been increasingly used as an adjuvant or complementary therapy for neuropathic pain. Although the therapeutic effects of acupuncture have been demonstrated in various high-quality randomized controlled trials, there is significant heterogeneity in the underlying mechanisms. This review aimed to summarize the potential mechanisms of acupuncture on neuropathic pain based on the somatosensory system, and guided for future both foundational and clinical studies. Here, we argued that acupuncture may have the potential to inhibit neuronal activity caused by neuropathic pain, through reducing the activation of pain-related ion channels and suppressing glial cells (including microglia and astrocytes) to release inflammatory cytokines, chemokines, amongst others. Meanwhile, acupuncture as a non-pharmacologic treatment, may have potential to activate descending pain control system via increasing the level of spinal or brain 5-hydroxytryptamine (5-HT), norepinephrine (NE), and opioid peptides. And the types of endogenously opioid peptides was influenced by electroacupuncture-frequency. The cumulative evidence demonstrated that acupuncture provided an alternative or adjunctive therapy for neuropathic pain.
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Affiliation(s)
- Xin Ma
- School of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China
- School of Acupuncture-Moxibustion and Tuina, International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
| | - Wen Chen
- School of Acupuncture-Moxibustion and Tuina, International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
| | - Na-Na Yang
- School of Acupuncture-Moxibustion and Tuina, International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
| | - Lu Wang
- School of Acupuncture-Moxibustion and Tuina, International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Wan Hao
- School of Acupuncture-Moxibustion and Tuina, International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
| | - Chun-Xia Tan
- School of Acupuncture-Moxibustion and Tuina, International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-Ping Li
- School of Acupuncture-Moxibustion and Tuina, International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- Hong-Ping Li,
| | - Cun-Zhi Liu
- School of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China
- School of Acupuncture-Moxibustion and Tuina, International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Cun-Zhi Liu,
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13
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Kato Y, Yachi K, Hoshi H, Okada T, Shigihara Y. Two Distinct Neural Mechanisms Underlying Acupuncture Analgesia. FRONTIERS IN PAIN RESEARCH 2022; 3:869884. [PMID: 35663250 PMCID: PMC9159800 DOI: 10.3389/fpain.2022.869884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Acupuncture analgesia is a traditional treatment with a long history, although it lacks scientific evidence. It is reportedly associated with the central nervous system, including various brain regions, from the cortices to the brain stem. However, it remains unclear whether the distributed regions behave as a single unit or consist of multiple sub-units playing different roles. Magnetoencephalography is a neuroimaging technique that can measure the oscillatory frequency of neural signals and brain regions. The frequency band of neural signals allows further understanding of the characteristics of the acupuncture-related neural systems. This study measured resting-state brain activity using magnetoencephalography in 21 individuals with chronic pain before and after acupuncture treatment. The subjective level of pain was assessed using a visual analog scale, and brain activity was compared to identify the brain regions and the frequencies associated with acupuncture analgesia. Here, we categorized the changes in resting-state brain activity into two groups: low-frequency oscillatory activity (<3 Hz) in the left middle occipital and right superior partial lobule and high-frequency oscillatory activity (81–120 Hz) on both sides of the prefrontal, primary sensory, and right fusiform gyri. These findings suggest that acupuncture analgesia influences two or more sub-units of the neural systems, which helps us understand the neural mechanisms underlying acupuncture analgesia.
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Affiliation(s)
- Yasutaka Kato
- Department of Pathology and Genetics, Hokuto Hospital, Obihiro, Japan
- Acupuncture Centre, Hokuto Hospital, Obihiro, Japan
| | - Kazuhiro Yachi
- Acupuncture Centre, Hokuto Hospital, Obihiro, Japan
- Acupuncture Clinic Kaikido, Sapporo, Japan
| | - Hideyuki Hoshi
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan
| | - Toyoji Okada
- Clinical Laboratory, Hokuto Hospital, Obihiro, Japan
| | - Yoshihito Shigihara
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan
- *Correspondence: Yoshihito Shigihara
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14
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Assouline A, Mendelsohn A, Reshef A. Memory-directed acupuncture as a neuromodulatory treatment for PTSD: Theory, clinical model and case studies. Transl Psychiatry 2022; 12:110. [PMID: 35296636 PMCID: PMC8927413 DOI: 10.1038/s41398-022-01876-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) poses an ongoing challenge to society, to health systems, and to the trauma victims themselves. Today PTSD is often considered an incurable chronic problem that lacks effective treatment. While PTSD is closely related to memory, it also affects many physiological systems. PTSD is usually treated with medications and psychotherapy with moderate success, leaving a substantial proportion of patients with enduring distress and disability. Therefore, a search for better treatment options is vital. In this paper, we propose a model in which a conversation-based technique is integrated with bodily manipulation through acupuncture. This approach first emerged in clinical experience showing intriguing results from treating PTSD patients using acupuncture as a main strategy. Its theoretical foundations derive from the clinic and rely on contemporary neuroscience's understanding of memory consolidation and reconsolidation processes. Research shows that acupuncture can have potentially positive effects at three levels: (a) achieving a balance between sympathetic and parasympathetic neural activity; (b) reducing activation in the limbic system, hence inducing a calming effect; (c) reshaping the functional connectivity map within important and relevant cortical regions that encompass the default-mode network. We suggest that coupling traumatic memory retrieval leading to reconsolidation, combined with acupuncture, offers considerable potential for positive clinical improvement in patients with PTSD. This may explain the positive results of the described case studies and can pave the path for future advances in research and treatment in this field.
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Affiliation(s)
- Amir Assouline
- Sagol Department of Neurobiology, University of Haifa, Haifa, Israel.
- Institute for Information Processing and Decision Making, University of Haifa, Haifa, Israel.
| | - Avi Mendelsohn
- Sagol Department of Neurobiology, University of Haifa, Haifa, Israel
- Institute for Information Processing and Decision Making, University of Haifa, Haifa, Israel
| | - Alon Reshef
- Ha'Emek Medical Center, Department of Psychiatry, Afula, Israel
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15
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Schmid AB, Fundaun J, Tampin B. [Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management : German version]. Schmerz 2021; 35:419-433. [PMID: 34505948 DOI: 10.1007/s00482-021-00584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
Entrapment neuropathies such as carpal tunnel syndrome, radiculopathies, or radicular pain are the most common peripheral neuropathies and also the most common cause for neuropathic pain. Despite their high prevalence, they often remain challenging to diagnose and manage in a clinical setting. Summarising the evidence from both preclinical and clinical studies, this review provides an update on the aetiology and pathophysiology of entrapment neuropathies. Potenzial mechanisms are put in perspective with clinical findings. The contemporary assessment is discussed and diagnostic pitfalls highlighted. The evidence for the noninvasive and surgical management of common entrapment neuropathies is summarised and future areas of research are identified.
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Affiliation(s)
- Annina B Schmid
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University, West Wing Level 6, OX3 9DU, Oxford, Großbritannien.
| | - Joel Fundaun
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University, West Wing Level 6, OX3 9DU, Oxford, Großbritannien.,High Country Physical Therapy, Laramie, WY, USA
| | - Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Westaustralien, Australien.,School of Physiotherapy and Exercise Science, Curtin University, Westaustralien, Australien.,Fakultät Wirtschafts- und Sozialwissenschaften, Hochschule Osnabrück, Osnabrück, Deutschland
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16
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Zhang J, Li Z, Li Z, Li J, Hu Q, Xu J, Yu H. Progress of Acupuncture Therapy in Diseases Based on Magnetic Resonance Image Studies: A Literature Review. Front Hum Neurosci 2021; 15:694919. [PMID: 34489662 PMCID: PMC8417610 DOI: 10.3389/fnhum.2021.694919] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/21/2021] [Indexed: 01/18/2023] Open
Abstract
The neural mechanisms of acupuncture are not well-understood. Over the past decades, an increasing number of studies have used MRI to investigate the response of the brain to acupuncture. The current review aims to provide an update on acupuncture therapy in disease. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched from inception to January 31, 2021. Article selection and data extraction were conducted by two review authors. A total of 107 publications about MRI in acupuncture were included, the collective findings of which were as follows: (1) stroke and GB34 (Yanglingquan) are the most studied disease and acupoint. Related studies suggested that the mechanism of acupuncture treatment for stroke may associate with structural and functional plasticity, left and right hemispheres balance, and activation of brain areas related to movement and cognition. GB34 is mainly used in stroke and Parkinson's disease, which mainly activates brain response in the premotor cortex, the supplementary motor area, and the supramarginal gyrus; (2) resting-state functional MRI (rs-fMRI) and functional connectivity (FC) analysis are the most frequently used approaches; (3) estimates of efficacy and brain response to acupuncture depend on the type of sham acupuncture (SA) used for comparison. Brain processing after acupuncture differs between patients and health controls (HC) and occurs mainly in disorder-related areas. Factors that influence the effect of acupuncture include depth of needling, number and locations of acupoints, and deqi and expectation effect, each contributing to the brain response. While studies using MRI have increased understanding of the mechanism underlying the effects of acupuncture, there is scope for development in this field. Due to the small sample sizes, heterogeneous study designs, and analytical methods, the results were inconsistent. Further studies with larger sample sizes, careful experimental design, multimodal neuroimaging techniques, and standardized methods should be conducted to better explain the efficacy and specificity of acupuncture, and to prepare for accurate efficacy prediction in the future.
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Affiliation(s)
- Jinhuan Zhang
- Department of Acupuncture, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zihan Li
- Department of Acupuncture, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Zhixian Li
- Department of Acupuncture, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jiaying Li
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Chinese Academy of Sciences (CAS) Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Haibo Yu
- Department of Acupuncture, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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17
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Kim D, Chae Y, Park HJ, Lee IS. Effects of Chronic Pain Treatment on Altered Functional and Metabolic Activities in the Brain: A Systematic Review and Meta-Analysis of Functional Neuroimaging Studies. Front Neurosci 2021; 15:684926. [PMID: 34290582 PMCID: PMC8287208 DOI: 10.3389/fnins.2021.684926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
Previous studies have identified altered brain changes in chronic pain patients, however, it remains unclear whether these changes are reversible. We summarized the neural and molecular changes in patients with chronic pain and employed a meta-analysis approach to quantify the changes. We included 75 studies and 11 of these 75 studies were included in the activation likelihood estimation (ALE) analysis. In the 62 functional magnetic resonance imaging (fMRI) studies, the primary somatosensory and motor cortex (SI and MI), thalamus, insula, and anterior cingulate cortex (ACC) showed significantly decreased activity after the treatments compared to baseline. In the 13 positron emission tomography (PET) studies, the SI, MI, thalamus, and insula showed significantly increased glucose uptake, blood flow, and opioid-receptor binding potentials after the treatments compared to baseline. A meta-analysis of fMRI studies in patients with chronic pain, during pain-related tasks, showed a significant deactivation likelihood cluster in the left medial posterior thalamus. Further studies are warranted to understand brain reorganization in patients with chronic pain compared to the normal state, in terms of its relationship with symptom reduction and baseline conditions.
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Affiliation(s)
- Dongwon Kim
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Younbyoung Chae
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hi-Joon Park
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - In-Seon Lee
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
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18
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Structural white matter alterations in carpal tunnel syndrome: A modified TBSS study. Brain Res 2021; 1767:147558. [PMID: 34116054 DOI: 10.1016/j.brainres.2021.147558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022]
Abstract
Functional and structural brain alterations have been noted in carpal tunnel syndrome (CTS), the most common entrapment peripheral neuropathy. Previous studies were mainly focused on somatosensory cortices. However, the changes of white matter diffusion properties in nonsensorimotor cortices remain uninvestigated. We utilized a modified tract-based spatial statistics (TBSS) pipeline to explore CTS-related white matter plasticity, omitting the skeletonization step and registering diffusion tensor imaging (DTI) data to a study-specific, high resolution T1 template by an optimized registration method. The modified TBSS was demonstrated to be more sensitive to detect changes in white matter integrity than the standard TBSS approach. In this study, 25 moderate/severe CTS patients and 17 age- and sex-matched healthy controls (HC) were evaluated with DTI. Fractional anisotropy (FA) and radial diffusivity (RD) were calculated for group comparison. And the relationship between diffusion parameters and clinical assessments was also analyzed. Comparing with the healthy controls, CTS patients showed significantly increased FA and decreased RD in areas of multisensory integration and motor control involving the central opercular cortex and supplementary motor area (SMA) of the dominant hemisphere. Moreover, altered diffusion parameters in the central opercular cortex of the dominant hemisphere were significantly correlated with Boston Carpal Tunnel Questionnaire (BCTQ) scores. It is considered to be a form of maladaptive neuroplastic response to CTS-associated afference and motor control deficits. Such insight may be helpful in developing new strategies for the treatment of CTS.
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19
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Sun R, He Z, Ma P, Yin S, Yin T, Liu X, Lu J, Qu Y, Zhang T, Huang L, Suo X, Lei D, Gong Q, Liang F, Zeng F. The participation of basolateral amygdala in the efficacy of acupuncture with deqi treating for functional dyspepsia. Brain Imaging Behav 2021; 15:216-230. [PMID: 32125619 DOI: 10.1007/s11682-019-00249-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Deqi is taken as an indispensable requirement to achieve acupuncture efficacy. This study aimed to explore the central influence of deqi on the efficacy of acupuncture for functional dyspepsia (FD). 70 FD patients were randomized to receive 20 sessions' acupuncture treatment with (n = 35) and without deqi (n = 35). In each group, 25 FD patients randomly selected underwent functional magnetic resonance imaging (fMRI) scans before and after treatment. After group re-division according to deqi response, changes of amygdala subregions-based resting-state functional connectivity (rsFC) were compared between the acupuncture with and without obvious deqi group. The clinical changes of the Nepean Dyspepsia Symptom Index (NDSI) measuring FD symptoms were also used to further assess the correlation with amygdala subregions rsFC in FD patients. The decrease in the NDSI scores (pre-pos) in the obvious deqi group was significantly greater than that in the acupuncture without obvious deqi group (p < 0.05). Compared to the without obvious deqi group, the obvious deqi group showed significantly decreased the left basolateral amygdala (BLA) rsFC with bilateral insular (INS), putamen and middle/posterior cingulate cortex (MCC/PCC), right pallidum and hippocampus (HIPP) after treatment. The changed NDSI scores(pre-post) of all 41 FD patients was significantly positively correlated with their Fisher's transformed z value of the left BLA rsFC with left INS (r = 0.376, FDR corrected p = 0.015), and rsFC with right HIPP (r = 0.394, FDR corrected p = 0.015). The changed NDSI scores(pre-post) of the obvious deqi group was significantly negatively correlated with their Fisher's transformed z value of the right centromedial amygdala (CMA) rsFC with left medial prefrontal cortex (mPFC) (r = -0.463, p = 0.035). The results tested the hypothesis that the advantage of deqi on efficacy is related to affecting the BLA and CMA rsFC. It suggested that deqi might influence the abnormal rsFC within the salience network (SN), and participate in the adaptive modulation of disrupted relationship between the SN and default mode network (DMN).
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Affiliation(s)
- Ruirui Sun
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhaoxuan He
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Peihong Ma
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shuai Yin
- First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China
| | - Tao Yin
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaoyan Liu
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jin Lu
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuzhu Qu
- First Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tingting Zhang
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Liuyang Huang
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xueling Suo
- Departments of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Du Lei
- Departments of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiyong Gong
- Departments of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Fanrong Liang
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China. .,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
| | - Fang Zeng
- Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China. .,Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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20
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Pang Y, Liao H, Duan G, Feng Z, Liu H, Zou Z, Tao J, Li J, He H, Gao C, Liu P, Deng D. Regulated aberrant amygdala functional connectivity in premenstrual syndrome via electro-acupuncture stimulation at sanyinjiao acupoint(SP6). Gynecol Endocrinol 2021; 37:315-319. [PMID: 33307896 DOI: 10.1080/09513590.2020.1855633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Acupuncture is an effective therapy for premenstrual syndrome (PMS). However, the mechanisms behind this method are still unclear. Our previous study found that aberrant amygdala resting-state functional networks were involved in PMS. Thereby, a deep investigation on the alterations of amygdala resting-state functional networks induced by acupuncture stimulation might contribute to a better understanding of the intricate mechanisms of acupuncture treatment on PMS. Methods: Twenty three PMS patients were recruited in this study. All patients received a 6-minute electro-acupuncture stimulation (EAS) at Sanyinjiao acupoint (SP6) and underwent two 6-minute resting-state fMRI scannings before and after EAS. With amygdala as the seed region, functional connectivity (FC) method was adopted to examine EAS-related modulation of intrinsic connectivity in PMS patients by comparing pre-EAS. Results: The results showed that EAS at SP6 induced increased FC between the left amygdala and brainstem, right hippocampus, and decreased FC between the left amygdala and left thalamus, bilateral supplementary motor area (SMA). Moreover, the results also showed that EAS at SP6 induced increased FC between the right amygdala and brainstem, right hippocampus, right orbitofrontal cortex, bilateral anterior cingulate cortex (ACC), and decreased FC between the right amygdala and right SMA. Conclusions: Based on the results of our previous study, our findings might improve our understanding of neural mechanisms behind acupuncture effects on PMS.
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Affiliation(s)
- Yong Pang
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Hai Liao
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Gaoxiong Duan
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Zhuo Feng
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Huimei Liu
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Zhuocheng Zou
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Jien Tao
- Department of Acupuncture, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Jiayan Li
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Hengzhen He
- Department of Gynaecology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Chunping Gao
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Peng Liu
- Life Science Research Center, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Demao Deng
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
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21
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Lin LL, Li HP, Yang JW, Hao XW, Yan SY, Wang LQ, Yu FT, Shi GX, Liu CZ. Acupuncture for Psychological Disorders Caused by Chronic Pain: A Review and Future Directions. Front Neurosci 2021; 14:626497. [PMID: 33584181 PMCID: PMC7873369 DOI: 10.3389/fnins.2020.626497] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022] Open
Abstract
Accumulating evidence supports an association between chronic pain and psychological disorders, a connection that seems to be bidirectional. Treating both the pain and psychological conditions together is essential for effective treatment outcomes. Acupuncture is a somatosensory-guided mind-body therapy that can tackle the multidimensional nature of pain with fewer or no serious adverse effects. In this review, we discuss the use of acupuncture in some conditions with a high incidence of psychological disorders caused by chronic pain: headache, musculoskeletal pain, low back pain, and cancer pain, focusing on the effect and potential mechanisms of acupuncture. Overall clinical studies indicated that acupuncture might effectively contribute to management of psychological disorders caused by chronic pain. Mechanistic studies showed that acupuncture significantly alleviated such psychological disorders by regulating the activity of amygdala and insula, and regulating functional connectivity of insular and limbic regions/medial prefrontal cortex in humans and the corresponding animal models. In addition, 5-HT in the dorsal raphe nucleus, opioid receptors in the cingulate cortex, and plasma met-enkephalin are involved in acupuncture relief of pain and psychological symptoms. Substantial evidences from animal and human research support a beneficial effect of acupuncture in psychological disorders caused by chronic pain.
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Affiliation(s)
- Lu-Lu Lin
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-Ping Li
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Wen Yang
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Wan Hao
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shi-Yan Yan
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Qiong Wang
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Fang-Ting Yu
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Guang-Xia Shi
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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22
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Zhang J, Zhang Y, Hu L, Huang X, Liu Y, Li J, Hu Q, Xu J, Yu H. Global Trends and Performances of Magnetic Resonance Imaging Studies on Acupuncture: A Bibliometric Analysis. Front Neurosci 2021; 14:620555. [PMID: 33551731 PMCID: PMC7854454 DOI: 10.3389/fnins.2020.620555] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/14/2020] [Indexed: 01/17/2023] Open
Abstract
Objectives: To summarize development processes and research hotspots of MRI research on acupuncture and to provide new insights for researchers in future studies. Methods: Publications regarding MRI on acupuncture from inception to 2020 were downloaded from the Web of Science Core Collection. VOSviewer 1.6.15 and CiteSpace V software were used for bibliometric analyses. The main analyses include collaboration analyses between countries/institutions/authors, co-occurrence analysis between keywords, as well as analyses on keyword bursts, citation references, and clusters of references. Results: A total of 829 papers were obtained with a continually increased trend over time. The most productive country and institution in this field were the People's Republic of China (475) and KyungHee University (70), respectively. Evidence-based Complementary and Alternative Medicine (83) was the most productive journal, and Neuroimage (454) was the most co-cited journal. Dhond's et al. (2008) article (co-citation counts: 58) and Napadow's et al. (2005) article (centrality: 0.21) were the most representative and symbolic references, with the highest co-citation number and centrality, respectively. Jie Tian had the highest number of publications (35) and Kathleen K S Hui was the most influential author (280 co-citations). The four hot topics in MRI on acupuncture were acupuncture, fMRI, pain, and stimulation. The three frontier topics were connectivity, modulation, and fMRI. Based on the clustering of co-cited documents, chronic low back pain, sham electro-acupuncture treatment, and clinical research were the main research directions. Conclusion: This study provides an in-depth perspective for MRI research on acupuncture and provides researchers with valuable information to determine the current status, hot spots, and frontier trends of MRI research on acupuncture.
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Affiliation(s)
- Jinhuan Zhang
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China.,Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yangxin Zhang
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Liyu Hu
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xingxian Huang
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yongfeng Liu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jiaying Li
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Haibo Yu
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China.,Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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23
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Tu Y, Cao J, Bi Y, Hu L. Magnetic resonance imaging for chronic pain: diagnosis, manipulation, and biomarkers. SCIENCE CHINA-LIFE SCIENCES 2020; 64:879-896. [PMID: 33247802 DOI: 10.1007/s11427-020-1822-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022]
Abstract
Pain is a multidimensional subjective experience with biological, psychological, and social factors. Whereas acute pain can be a warning signal for the body to avoid excessive injury, long-term and ongoing pain may be developed as chronic pain. There are more than 100 million people in China living with chronic pain, which has raised a huge socioeconomic burden. Studying the mechanisms of pain and developing effective analgesia approaches are important for basic and clinical research. Recently, with the development of brain imaging and data analytical approaches, the neural mechanisms of chronic pain have been widely studied. In the first part of this review, we briefly introduced the magnetic resonance imaging and conventional analytical approaches for brain imaging data. Then, we reviewed brain alterations caused by several chronic pain disorders, including localized and widespread primary pain, primary headaches and orofacial pain, musculoskeletal pain, and neuropathic pain, and present meta-analytical results to show brain regions associated with the pathophysiology of chronic pain. Next, we reviewed brain changes induced by pain interventions, such as pharmacotherapy, neuromodulation, and acupuncture. Lastly, we reviewed emerging studies that combined advanced machine learning and neuroimaging techniques to identify diagnostic, prognostic, and predictive biomarkers in chronic pain patients.
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Affiliation(s)
- Yiheng Tu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Jin Cao
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, 02129, USA
| | - Yanzhi Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China. .,Department of Pain Management, The State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China.
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24
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25
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Blackmon AM, Elson L. Dry Needling and Acupuncture in Treatment of Dance-Related Injuries, MD, and PT Perspectives. Phys Med Rehabil Clin N Am 2020; 32:169-183. [PMID: 33198894 DOI: 10.1016/j.pmr.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dancers frequently present to health care professionals with musculoskeletal impairments. The role of the health care practitioner, whether physician, physical therapist, or acupuncturist, is to decrease pain and restore function in the short term and to restore adaptive potential and neural connectivity in the long term. When dysfunction is treated, pain improves. Acupuncture and dry needling improve tissue perfusion by improving vasomotor control and can improve strength by removing motor inhibition. Acupuncture and dry needling are safe, complementary modalities aimed at improving the function of the dancer.
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Affiliation(s)
- Amanda M Blackmon
- Department of Physical Therapy, College of Health Professions, Mercer University, Atlanta, GA, USA; Myopain Seminars, Atlanta Ballet; Atlanta Dance Medicine, Atlanta, GA, USA; MandyDancePT, LLC, Atlanta, GA, USA.
| | - Lauren Elson
- Spaulding Rehabilitation, Boston, MA, USA; Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA. https://twitter.com/laurenelsonMD
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26
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Lu YC, Wu JJ, Ma H, Hua XY, Xu JG. Functional Organization of Brain Network in Peripheral Neural Anastomosis Rats after Electroacupuncture: An ICA and Connectome Analysis. Neuroscience 2020; 442:216-227. [PMID: 32629154 DOI: 10.1016/j.neuroscience.2020.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022]
Abstract
Acupuncture is a mild therapy in rehabilitation practice of peripheral nerve injury. Previous studies confirmed the deep participation of brain plasticity in the process of functional restoration. The therapeutic effect of acupuncture is also believed to be closely associated with brain plasticity, especially in the hypothalamus and limbic system. But the fuzzy neural mechanism somehow limits the application or improvement of this therapy. There is little information about the effect of acupuncture on topological properties of brain networks. Instead of functional segregation approach, we utilized graph theory method to analyze the large-scale and distributed properties of information processing. We first established rat model of sciatic nerve injury and performed rehabilitation therapy of electroacupuncture for 120 days. Meanwhile, we used independent component analysis to extract seven sub-networks from the whole brain. Then measurements of graph theory were calculated in each sub-network as well as the whole brain network. We found no significant difference of any measurement in whole brain network among intervention group, model group and normal group. But the assortativity, hierarchy, small-world properties of sub-network displayed significant differences among three groups. It induces changes of neural plasticity in several sub-networks instead of whole brain network. We attributed the changes to the enhancement of the short-term compensatory adaptation and the reduction of the long-term overacting regional information transmission. The present study may shed light on the vague distinction of large-scale property of brain networks after electroacupuncture, which leads to a better understanding of this ancient traditional Chinese therapy.
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Affiliation(s)
- Ye-Chen Lu
- School of Rehabilitation Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai China
| | - Jia-Jia Wu
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai China
| | - Hao Ma
- Department of Trauma and Orthopedics, First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai China
| | - Xu-Yun Hua
- Department of Trauma and Orthopedics, Yueyang Hospital of Intergrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai China.
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27
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Electroacupuncture at Zusanli and at Neiguan characterized point specificity in the brain by metabolomic analysis. Sci Rep 2020; 10:10717. [PMID: 32612281 PMCID: PMC7329888 DOI: 10.1038/s41598-020-67766-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
Different point stimulations can induce brain activity in specific regions, and however whether these stimulations affect unique neurotransmitter transmission remains unknown. Therefore, we aimed to investigate the effect of point specificity to the brain by resolving the metabolite profiles. Eighteen Sprague–Dawley rats were randomly divided into three groups: (1) the sham group: sham acupuncture at Zusanli (ST36) without electric stimulation; (2) the Zusanli (ST36) group: electroacupuncture (EA) at ST36; and (3) the Neiguan (PC6) group: EA at PC6. Then, the metabolites from rat brain samples were measured by LC–ESI–MS. The results of a partial least squares discriminant analysis revealed the differences among the sham, ST36, and PC6 groups regarding the relative content of metabolites in the cerebral cortex, hippocampus, and hypothalamus. EA at PC6 resulted in downregulation of adenosine, adrenaline, γ-aminobutyric acid, glycine, and glutamate majorly in hippocampus, and then in cerebral cortex. Otherwise, EA at ST6 resulted in upregulation of adrenaline and arginine in hippocampus, and all stimulations showed barely change of identified neurotransmitters in hypothalamus. These differential metabolite and neurotransmitter profiles prove that brain areas can be modulated by point specificity and may provide a maneuver to understand more details of meridian.
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28
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Schmid AB, Fundaun J, Tampin B. Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management. Pain Rep 2020; 5:e829. [PMID: 32766466 PMCID: PMC7382548 DOI: 10.1097/pr9.0000000000000829] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 05/04/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022] Open
Abstract
Entrapment neuropathies such as carpal tunnel syndrome, radiculopathies, or radicular pain are the most common peripheral neuropathies and also the most common cause for neuropathic pain. Despite their high prevalence, they often remain challenging to diagnose and manage in a clinical setting. Summarising the evidence from both preclinical and clinical studies, this review provides an update on the aetiology and pathophysiology of entrapment neuropathies. Potential mechanisms are put in perspective with clinical findings. The contemporary assessment is discussed and diagnostic pitfalls highlighted. The evidence for the noninvasive and surgical management of common entrapment neuropathies is summarised and future areas of research are identified.
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Affiliation(s)
- Annina B. Schmid
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Joel Fundaun
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
- High Country Physical Therapy, Laramie, WY, USA
| | - Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia
- Faculty of Business Management and Social Sciences, Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
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29
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Yu S, Ortiz A, Gollub RL, Wilson G, Gerber J, Park J, Huang Y, Shen W, Chan ST, Wasan AD, Edwards RR, Napadow V, Kaptchuk TJ, Rosen B, Kong J. Acupuncture Treatment Modulates the Connectivity of Key Regions of the Descending Pain Modulation and Reward Systems in Patients with Chronic Low Back Pain. J Clin Med 2020; 9:E1719. [PMID: 32503194 PMCID: PMC7356178 DOI: 10.3390/jcm9061719] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
Chronic low back pain (cLBP) is a common disorder with unsatisfactory treatment options. Acupuncture has emerged as a promising method for treating cLBP. However, the mechanism underlying acupuncture remains unclear. In this study, we investigated the modulation effects of acupuncture on resting state functional connectivity (rsFC) of the periaqueductal gray (PAG) and ventral tegmental area (VTA) in patients with cLBP. Seventy-nine cLBP patients were recruited and assigned to four weeks of real or sham acupuncture. Resting state functional magnetic resonance imaging data were collected before the first and after the last treatment. Fifty patients completed the study. We found remission of pain bothersomeness in all treatment groups after four weeks, with greater pain relief after real acupuncture compared to sham acupuncture. We also found that real acupuncture can increase VTA/PAG rsFC with the amygdala, and the increased rsFC was associated with decreased pain bothersomeness scores. Baseline PAG-amygdala rsFC could predict four-week treatment response. Our results suggest that acupuncture may simultaneously modulate the rsFC of key regions in the descending pain modulation (PAG) and reward systems (VTA), and the amygdala may be a key node linking the two systems to produce antinociceptive effects. Our findings highlight the potential of acupuncture for chronic low back pain management.
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Affiliation(s)
- Siyi Yu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (S.Y.); (A.O.); (R.L.G.); (G.W.); (J.P.); (Y.H.); (W.S.)
| | - Ana Ortiz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (S.Y.); (A.O.); (R.L.G.); (G.W.); (J.P.); (Y.H.); (W.S.)
| | - Randy L. Gollub
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (S.Y.); (A.O.); (R.L.G.); (G.W.); (J.P.); (Y.H.); (W.S.)
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (S.Y.); (A.O.); (R.L.G.); (G.W.); (J.P.); (Y.H.); (W.S.)
| | - Jessica Gerber
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (J.G.); (S.-T.C.); (V.N.); (B.R.)
| | - Joel Park
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (S.Y.); (A.O.); (R.L.G.); (G.W.); (J.P.); (Y.H.); (W.S.)
| | - Yiting Huang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (S.Y.); (A.O.); (R.L.G.); (G.W.); (J.P.); (Y.H.); (W.S.)
| | - Wei Shen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (S.Y.); (A.O.); (R.L.G.); (G.W.); (J.P.); (Y.H.); (W.S.)
| | - Suk-Tak Chan
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (J.G.); (S.-T.C.); (V.N.); (B.R.)
| | - Ajay D. Wasan
- Department of Anesthesiology, Center for Pain Research, University of Pittsburgh, Pittsburgh, PA 15206, USA;
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02467, USA;
| | - Vitaly Napadow
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (J.G.); (S.-T.C.); (V.N.); (B.R.)
| | - Ted J. Kaptchuk
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Bruce Rosen
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (J.G.); (S.-T.C.); (V.N.); (B.R.)
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (S.Y.); (A.O.); (R.L.G.); (G.W.); (J.P.); (Y.H.); (W.S.)
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (J.G.); (S.-T.C.); (V.N.); (B.R.)
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30
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Zhang Q, Liu A, Abouelfetouh MM, Ma N, Li M, Chen S, Ding M, Ding Y. Let-7b-5p promotes electroacupuncture tolerance by downregulating Penk1 gene in CFA-induced inflammatory nociception rats. Gene 2020; 742:144583. [PMID: 32184167 DOI: 10.1016/j.gene.2020.144583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies showed that increased let-7b-5p microRNA during repeated electroacupuncture (EA) treatment was associated the formation of EA tolerance, which manifested as gradually decreased nociceptive threshold. Proenkephalin (PENK) is the precursor of enkephalin which is a pivot neuropeptide responsible for the decreased nociceptive threshold in EA. The aim of this study was to evaluate the relationship between let-7b-5p and PENK in EA tolerance. METHODS The target gene of let-7b-5p microRNA was determined through the dual-luciferase reporter assay in cortical neurons. Seventy-two Sprague Dawley rats received a combination of EA and intracerebroventricular injection of microRNA (let-7b-5p agomir, antagomir or their controls). The nociceptive thresholds were assessed with radiant heat tail-flick method. PENK and let-7b-5p were measured with Western Blot and qPCR, respectively, after administration of let-7b-5p agomir, antagomir, and their controls at day 1, 4 and 7. RESULTS Let-7b-5p targeted the 3' untranslated region of Penk1. The nociceptive thresholds in Let-7b-5p agomir + EA group were decreased (p < 0.05) compared with those in Let-7b-5p antagomir + EA group at day 1 to 7. Compared with Let-7b-5p agomir + EA group, the expression level of PENK in Let-7b-5p antagomir + EA group was increased at days 1, 4, and 7 (p < 0.05) CONCLUSION: Let-7b-5p may be a new potential target for decreasing the EA tolerance effect and facilitating the application of EA in treating chronic nociception of patients.
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Affiliation(s)
- Qiulin Zhang
- College of Veterinary Medicine, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei 430070, PR China.
| | - Ai Liu
- College of Veterinary Medicine, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei 430070, PR China.
| | - Mahmoud M Abouelfetouh
- College of Veterinary Medicine, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei 430070, PR China.
| | - Ning Ma
- College of Veterinary Medicine, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei 430070, PR China
| | - Meng Li
- College of Veterinary Medicine, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei 430070, PR China
| | - Shuhuai Chen
- College of Veterinary Medicine, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei 430070, PR China
| | - Mingxing Ding
- College of Veterinary Medicine, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei 430070, PR China.
| | - Yi Ding
- College of Veterinary Medicine, Huazhong Agricultural University, No.1, Shizishan Street, Hongshan District, Wuhan, Hubei 430070, PR China.
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Acupuncture Induces Reduction in Limbic-Cortical Feedback of a Neuralgia Rat Model: A Dynamic Causal Modeling Study. Neural Plast 2020; 2020:5052840. [PMID: 32148473 PMCID: PMC7023796 DOI: 10.1155/2020/5052840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/02/2020] [Accepted: 01/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background Neuropathic pain after brachial plexus avulsion remained prevalent and intractable currently. However, the neuroimaging study about neural mechanisms or etiology was limited and blurred. Objective This study is aimed at investigating the effect of electroacupuncture on effective connectivity and neural response in corticolimbic circuitries during implicit processing of nociceptive stimulus in rats with brachial plexus pain. Methods An fMRI scan was performed in a total of 16 rats with brachial plexus pain, which was equally distributed into the model group and the electroacupuncture group. The analysis of task-dependent data determined pain-related activation in each group. Based on those results, several regions including AMY, S1, and h were recruited as ROI in dynamic causal modeling (DCM) analysis comparing evidence for different neuronal hypotheses describing the propagation of noxious stimuli in regions of interest and horizontal comparison of effective connections between the model and electroacupuncture groups. Results In both groups, DCM revealed that noxious stimuli were most likely driven by the somatosensory cortex, with bidirectional propagation with the hypothalamus and amygdala and the interactions in them. Also, the 3-month intervention of acupuncture reduced effective connections of h-S1 and AMY-S1. Conclusions We showed an evidence that a full connection model within the brain network of brachial plexus pain and electroacupuncture intervention reduces effective connectivity from h and AMY to S1. Our study for the first time explored the relationship of involved brain regions with dynamic causal modeling. It provided novel evidence for the feature of the organization of the cortical-limbic network and the alteration caused by acupuncture.
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32
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Iwatsuki K, Hoshiyama M, Yoshida A, Shinohara T, Hirata H. A magnetoencephalographic study of longitudinal brain function alterations following carpal tunnel release. Sci Rep 2019; 9:19776. [PMID: 31874978 PMCID: PMC6930280 DOI: 10.1038/s41598-019-56190-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022] Open
Abstract
We investigate changes in brain function before and after carpal tunnel release. Magnetoencephalography (MEG), during which we recorded somatosensory evoked cortical magnetic fields (SEFs), and a clinical evaluation were performed before surgery and 6 months after. The distance on the vertical axis between the equivalent current dipoles (ECDs) for the first and third digits before surgery was significantly less than after surgery. There were no significant differences in values between the control participant and patients after surgery. In terms of distal motor latency, there was a negative correlation with the distance. The recovery function of the root mean square (RMS) before surgery for the N20m was less suppressed at 10 ms of ISI in patients, compared to controls. There were no significant differences in the RMS values for patients before and after surgery. Our results indicate that treating peripheral nerve lesions, such as in carpal tunnel release, positively modifies brain function.
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Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
| | - Minoru Hoshiyama
- Department of Health Sciences, Faculty of Medicine, Nagoya University, Nagoya, Japan.,Brain and Mind Research Center, Nagoya University, Nagoya, Japan
| | - Akihito Yoshida
- Department of Health Sciences, Faculty of Medicine, Nagoya University, Nagoya, Japan.,Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | | | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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33
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Acupuncture Augmentation of Lidocaine for Provoked, Localized Vulvodynia: A Feasibility and Acceptability Study. J Low Genit Tract Dis 2019; 23:279-286. [PMID: 31592976 DOI: 10.1097/lgt.0000000000000489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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34
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Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. CHILDREN-BASEL 2019; 6:children6020033. [PMID: 30795645 PMCID: PMC6406753 DOI: 10.3390/children6020033] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 12/13/2022]
Abstract
Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.
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35
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Abstract
Acupuncture is an ancient therapy with a variety of different explanatory models. A cascade of physiological effects has been reported, both in the peripheral and the central nervous system, following the insertion of a needle or light tapping of the skin. Clinical trials testing the specific claims of acupuncture have generally tried to focus on testing the efficacy of applying specific techniques and/or specified points. However, different conditions may respond differently to different modes of stimulation. Recently, it was demonstrated that both superficial and deep needling (with de qi/Hibiki) resulted in amelioration of patellofemoral pain and unpleasantness. The pleasurable aspect of the acupuncture experience has largely been ignored as it has been considered secondary to its pain alleviating effects. This aspect of acupuncture treatment is likely to be related to activation of self-appraisal and the reward system. When a patient seeks a therapist there are expectations of a specific effect. These expectations are partly based on self-relevant phenomena and self-referentia introspection and constitute the preference. Also, when asked about the effect of the treatment, processes that orientate pre-attentive anticipatory or mnemonic information and processes that mediate self-reflection and recollection are integrated together with sensory detection to enable a decision about the patient's perception of the effect of acupuncture treatment. These ‘self-appraisal’ processes are dependent on two integrated networks: a ventral medial prefrontal cortex paralimbic limbic ‘affective’ pathway and a dorsal medial prefrontal cortex cortical hippocampal ‘cognitive’ pathway. The limbic structures are implicated in the reward system and play a key role in most diseases and illness responses including chronic pain and depression, regulating mood and neuromodulatory responses (eg sensory, autonomic, and endocrine). The pleasurable and neuromodulatory aspects of acupuncture as well as ‘placebo needling’ may partly be explained by the activation or deactivation of limbic structures including the hippocampus, amygdala, and their connections with the hypothalamus. In patients with patellofemoral pain, the effects of superficial and deep needling remained for six months. These long term pain-alleviating effects have been attributed to activation of pain inhibiting systems in cortical and subcortical pathways. When considering long term effects the cortical cerebellar system needs to be taken into account. The cortical cerebellar system is probably central to the development of neural models that learn and eventually stimulate routinely executed (eg motor skills) and long term (eg pain alleviation) cognitive processes. These higher order cognitive processes are initially mediated in prefrontal cortical loci but later shift control iteratively to internal cerebellar representations of these processes. Possibly part of the long term healing effects of acupuncture may be attributed to changes in the cerebellar system thereby sparing processing load in cortical and subcortical areas. As cortical and subcortical structures are activated and/or de-activated following stimulation of receptors in the skin, disregarding site, ‘placebo or sham needling’ does not exist and conclusions drawn on the basis that it is an inert control are invalid. ‘Self’ may be seen as a shifting illusion, ceaselessly constructed and deconstructed, and the effect of acupuncture may reflect its status (as well as that of the therapist).
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Affiliation(s)
- Thomas Lundeberg
- Rehabilitation Medicine, UniversityClinic, Danderyds Hospital, Stockholm, Sweden.
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36
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Beissner F, Preibisch C, Schweizer-Arau A, Popovici RM, Meissner K. Psychotherapy With Somatosensory Stimulation for Endometriosis-Associated Pain: The Role of the Anterior Hippocampus. Biol Psychiatry 2018; 84:734-742. [PMID: 28258747 DOI: 10.1016/j.biopsych.2017.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/09/2016] [Accepted: 01/09/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endometriosis is a gynecological disorder affecting 6%-10% of all women in their reproductive age. There is an emerging view in the literature that psychological trauma plays a central role in the pathogenesis of pelvic pain, one of the core symptoms of endometriosis. Here we report central nervous system mechanisms of a novel combination of psychotherapy and somatosensory stimulation that has recently shown remarkable effects in reducing pain, anxiety, and depressive symptoms in these patients. METHODS We conducted a randomized controlled trial; 67 patients with severe endometriosis-associated pain (maximum pain: 7.6 ± 2.0, average pain: 4.5 ± 2.0 on a 10-point numeric rating scale) were included in the study and randomly allocated to intervention (35 patients) or waitlist control (32 patients) groups. Resting-state functional magnetic resonance imaging was used to assess brain connectivity of these patients at baseline, after 3 months of therapy, and after 6 months. The analysis focused on the hippocampus. RESULTS We identified a cortical network comprising the right anterolateral hippocampus-a region modulating the hypothalamic-pituitary-adrenal axis-and somatosensory, viscerosensory, and interoceptive brain regions. Regression analysis showed that reduction in connectivity predicted therapy-induced improvement in patients׳ anxiety. CONCLUSIONS We have identified a putative neurobiological mechanism underlying the potent combination of psychotherapy and somatic stimulation in treating symptoms of endometriosis.
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Affiliation(s)
- Florian Beissner
- Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover.
| | - Christine Preibisch
- Clinic for Neurology, Technische Universität München, Munich; Department of Neuroradiology, Technische Universität München, Munich
| | | | - Roxana M Popovici
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg
| | - Karin Meissner
- Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Munich; Division Integrative Health Promotion, University of Applied Sciences, Coburg, Germany
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37
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Is Tapping on Acupuncture Points an Active Ingredient in Emotional Freedom Techniques? A Systematic Review and Meta-analysis of Comparative Studies. J Nerv Ment Dis 2018; 206:783-793. [PMID: 30273275 DOI: 10.1097/nmd.0000000000000878] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emotional Freedom Techniques (EFTs) combine elements of cognitive restructuring and exposure techniques with acupoint stimulation. Meta-analyses indicate large effect sizes for posttraumatic stress disorder, depression, and anxiety; however, treatment effects may be due to components EFT shares with other therapies. This analysis reviewed whether EFTs acupressure component was an active ingredient. Six studies of adults with diagnosed or self-identified psychological or physical symptoms were compared (n = 403), and three (n = 102) were identified. Pretest vs. posttest EFT treatment showed a large effect size, Cohen's d = 1.28 (95% confidence interval [CI], 0.56 to 2.00) and Hedges' g = 1.25 (95% CI, 0.54 to 1.96). Acupressure groups demonstrated moderately stronger outcomes than controls, with weighted posttreatment effect sizes of d = -0.47 (95% CI, -0.94 to 0.0) and g = -0.45 (95% CI, -0.91 to 0.0). Meta-analysis indicated that the acupressure component was an active ingredient and outcomes were not due solely to placebo, nonspecific effects of any therapy, or nonacupressure components.
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Abstract
ABSTRACT As acupuncture is growing in popularity in Brazil and worldwide, it is necessary to study the benefits and possibilities of this type of treatment more in depth, especially as it is believed to produce fast results with few side effects and does not involve substances banned in sports. Thus, it seems like a good option to be considered as main or adjuvant therapy in sports-related injuries. In order to gain more knowledge about this subject, this article is an integrative review analyzing the publications of the period between January 2012 and January 2017 on the Cochrane and Pubmed platforms that analyzed acupuncture in the treatment of sports injuries. We found 49 articles, 11 of which fulfilled the inclusion criteria: two case reports, three clinical trials and six literature reviews. Although all the articles analyzed produced favorable results with the use of the therapeutic technique in question, flaws in the designs of the studies and the difficulty of creating a placebo control group in acupuncture hinder the qualification of the articles on evidence rating scales. Therefore, it is suggested to the researchers that further studies be published with experimental animal models and observational studies, and that STRICTA recommendations be followed to improve the level of evidence of acupuncture research. Level of Evidence II; Systematic review of level II studies.
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39
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Keszthelyi D, Aziz Q, Ruffle JK, O'Daly O, Sanders D, Krause K, Williams SCR, Howard MA. Delineation between different components of chronic pain using dimension reduction - an ASL fMRI study in hand osteoarthritis. Eur J Pain 2018. [PMID: 29520913 PMCID: PMC6055802 DOI: 10.1002/ejp.1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Traditional psychometric measures aimed at characterizing the pain experience often show considerable overlap, due to interlinked affective and modulatory processes under central nervous system control. Neuroimaging studies have been employed to investigate this complexity of pain processing, in an attempt to provide a quantifiable, adjunctive description of pain perception. In this exploratory study, we examine psychometric and neuroimaging data from 38 patients with painful osteoarthritis of the carpometacarpal joint. We had two aims: first, to utilize principal component analysis (PCA) as a dimension reduction strategy across multiple self‐reported endpoints of pain, cognitive and affective functioning; second, to investigate the relationship between identified dimensions and regional cerebral blood flow (rCBF) as an indirect measure of brain activity underpinning their ongoing pain experiences. Methods Psychometric data were collected using validated questionnaires. Quantitative estimates of rCBF were acquired using pseudo‐continuous arterial spin‐labelled functional magnetic resonance imaging. Results Two principal components were identified that accounted for 73% of data variance; one related to pain scores and a second to psychological traits. Voxel‐wise multiple regression analysis revealed a significant negative association between the ‘pain score’ component and rCBF to a right temporal lobe cluster, including the amygdala and the parahippocampal cortex. Conclusion We suggest this association may represent a coping mechanism that aims to reduce fear‐related pain‐anxiety. Further investigation of central brain processing mechanisms in osteoarthritis‐related pain may offer insights into more effective therapeutic strategies. Significance This study demonstrates that dimension reduction using PCA allows insight into pain perception and its affective components in relation to brain activation patterns in patients with painful hand osteoarthritis.
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Affiliation(s)
- D Keszthelyi
- Division of Gastroenterology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Q Aziz
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - J K Ruffle
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - O O'Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - D Sanders
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK.,Pain Management Research Institute, The University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia
| | - K Krause
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK.,Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - S C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - M A Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
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A Longitudinal Mapping Study on Cortical Plasticity of Peripheral Nerve Injury Treated by Direct Anastomosis and Electroacupuncture in Rats. World Neurosurg 2018. [PMID: 29524702 DOI: 10.1016/j.wneu.2018.02.173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We used functional magnetic resonance imaging to provide a longitudinal description of cortical plasticity caused by electroacupuncture (EA) of sciatic nerve transection and direct anastomosis in rats. METHODS Sixteen rats in a sciatic nerve transection and direct anastomosis model were randomly divided into intervention and control groups. EA intervention in the position of ST-36, GB-30 was conducted continuously for 4 months in the intervention group. Functional magnetic resonance imaging and gait assessment were performed every month after intervention. RESULTS The somatosensory area was more activated in the first 2 months and then deactivated in the rest 2 months when EA was applied. The pain-related areas had the same activation pattern as the somatosensory area. The limbic/paralimbic areas fluctuated more during the EA intervention, which was not constantly activated or deactivated as previous studies reported. We attributed such changes in somatosensory and pain-related areas to the gradual reduction of sensory afferentation. The alterations in limbic/paralimbic system might be associated with the confrontation between the upregulating effect of paresthesia or pain and the downregulating effect of EA intervention through the autonomic nerve system. The gait analysis showed significantly higher maximum contact mean intensity in the intervention group. CONCLUSIONS The alterations in the brain brought about by the long-term therapeutic effect of EA could be described as a synchronized activation pattern in the somatosensory and pain-related areas and a fluctuating pattern in the limbic/paralimbic system.
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A Longitudinal fMRI Research on Neural Plasticity and Sensory Outcome of Carpal Tunnel Syndrome. Neural Plast 2018; 2017:5101925. [PMID: 29348944 PMCID: PMC5733863 DOI: 10.1155/2017/5101925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/07/2017] [Accepted: 09/10/2017] [Indexed: 11/29/2022] Open
Abstract
Peripheral nerve compression is reported to induce cortical plasticity, which was well pictured by former researches. However, the longitudinal changes brought by surgical treatment are not clear. In this research, 18 subjects who suffered from bilateral carpal tunnel syndrome were evaluated using task-dependent fMRI and electromyography assessment before and after surgery. The third digit was tactually simulated by von Frey filaments. The results demonstrated that the pattern of activation was similar but a decreased extent of activation in the postcentral gyrus, inferior frontal lobe, superior frontal lobe, and parahippocampal gyrus after surgery was found. The correlation analysis showed a significant correlation between the decreased number of activated voxels and the improvement of EMG performance. This result implied a potential connection between fMRI measurement and clinical improvement.
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42
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Bao BB, Qu DQ, Zhu HY, Gao T, Zheng XY. Brain remodeling after chronic median nerve compression in a rat model. Neural Regen Res 2018; 13:704-708. [PMID: 29722324 PMCID: PMC5950682 DOI: 10.4103/1673-5374.230298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Carpal tunnel syndrome is the most common compressive neuropathy, presenting with sensorimotor dysfunction. In carpal tunnel syndrome patients, irregular afferent signals on functional magnetic resonance imaging are associated with changes in neural plasticity during peripheral nerve injury. However, it is difficult to obtain multi-point neuroimaging data of the brain in the clinic. In the present study, a rat model of median nerve compression was established by median nerve ligation, i.e., carpal tunnel syndrome model. Sensory cortex remodeling was determined by functional magnetic resonance imaging between normal rats and carpal tunnel syndrome models at 2 weeks and 2 months after operation. Stimulation of bilateral paws by electricity for 30 seconds, alternating with 30 seconds of rest period (repeatedly 3 times), resulted in activation of the contralateral sensorimotor cortex in normal rats. When carpal tunnel syndrome rats received this stimulation, the contralateral cerebral hemisphere was markedly activated at 2 weeks after operation, including the primary motor cortex, cerebellum, and thalamus. Moreover, this activation was not visible at 2 months after operation. These findings suggest that significant remodeling of the cerebral cortex appears at 2 weeks and 2 months after median nerve compression.
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Affiliation(s)
- Bing-Bo Bao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Dan-Qian Qu
- Yueyang Hospital of Intergrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong-Yi Zhu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Xian-You Zheng
- Department of Orthopedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
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Hu ML, Zhu HM, Zhang QL, Liu JJ, Ding Y, Zhong JM, Vodyanoy V, Ding MX. Exploring the Mechanisms of Electroacupuncture-Induced Analgesia through RNA Sequencing of the Periaqueductal Gray. Int J Mol Sci 2017; 19:ijms19010002. [PMID: 29295561 PMCID: PMC5795954 DOI: 10.3390/ijms19010002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/15/2017] [Accepted: 12/17/2017] [Indexed: 12/19/2022] Open
Abstract
Electroacupuncture (EA) can relieve various pains. However, its mechanism in terms of the transcriptome is still not well-known. To explore the full profile of EA-induced molecular modification in the central nerve system, three twins of goats were selected for a match-paired experiment: EA stimulation (60 Hz, 30 min) and none-EA (control). Goats in the EA group showed an increased (p < 0.05) nociceptive threshold compared with the control goats. Experimental goats were sacrificed at 4 h of the experiment, and the periaqueductal grays were harvested for RNA sequencing. As a result, 2651 differentially expressed genes (1803 up-regulated and 848 down-regulated genes) were found and enriched in 30 Kyoto Encyclopedia of Genes and Genomes pathways and 149 gene ontology terms. EA-regulated five neuropeptide genes (proenkephalin, proopiomelanocortin, preprodynorphin, diazepam-binding inhibitor and proprotein convertase 1 inhibitor) were validated with quantitative PCR. Furthermore, up-regulated glutamate receptors, glutamate transporters, γ-aminobutyric acid (GABA) receptors, GABA transporters, synaptotagmins or mitogen-activated protein kinase (MAPK) genes might contribute to EA-induced analgesia through regulating the glutamatergic synapse, GABAergic synapse, MAPKs, ribosome or ubiquitin-proteasome pathways. Our findings reveal a full profile of molecular modification in response to EA and provide a solid experimental framework for exploring the mechanisms underlying EA-induced analgesia.
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Affiliation(s)
- Man-Li Hu
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China.
| | - Hong-Mei Zhu
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China.
| | - Qiu-Lin Zhang
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China.
| | - Jing-Jing Liu
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China.
| | - Yi Ding
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China.
| | - Ju-Ming Zhong
- College of Physiology and Pharmacology, Auburn University, Auburn, AL 36849, USA.
| | - Vitaly Vodyanoy
- College of Physiology and Pharmacology, Auburn University, Auburn, AL 36849, USA.
| | - Ming-Xing Ding
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China.
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Cai RL, Shen GM, Wang H, Guan YY. Brain functional connectivity network studies of acupuncture: a systematic review on resting-state fMRI. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2017; 16:26-33. [PMID: 29397089 DOI: 10.1016/j.joim.2017.12.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/23/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) is a novel method for studying the changes of brain networks due to acupuncture treatment. In recent years, more and more studies have focused on the brain functional connectivity network of acupuncture stimulation. OBJECTIVE To offer an overview of the different influences of acupuncture on the brain functional connectivity network from studies using resting-state fMRI. SEARCH STRATEGY The authors performed a systematic search according to PRISMA guidelines. The database PubMed was searched from January 1, 2006 to December 31, 2016 with restriction to human studies in English language. INCLUSION CRITERIA Electronic searches were conducted in PubMed using the keywords "acupuncture" and "neuroimaging" or "resting-state fMRI" or "functional connectivity". DATA EXTRACTION AND ANALYSIS Selection of included articles, data extraction and methodological quality assessments were respectively conducted by two review authors. RESULTS Forty-four resting-state fMRI studies were included in this systematic review according to inclusion criteria. Thirteen studies applied manual acupuncture vs. sham, four studies applied electro-acupuncture vs. sham, two studies also compared transcutaneous electrical acupoint stimulation vs. sham, and nine applied sham acupoint as control. Nineteen studies with a total number of 574 healthy subjects selected to perform fMRI only considered healthy adult volunteers. The brain functional connectivity of the patients had varying degrees of change. Compared with sham acupuncture, verum acupuncture could increase default mode network and sensorimotor network connectivity with pain-, affective- and memory-related brain areas. It has significantly greater connectivity of genuine acupuncture between the periaqueductal gray, anterior cingulate cortex, left posterior cingulate cortex, right anterior insula, limbic/paralimbic and precuneus compared with sham acupuncture. Some research had also shown that acupuncture could adjust the limbic-paralimbic-neocortical network, brainstem, cerebellum, subcortical and hippocampus brain areas. CONCLUSION It can be presumed that the functional connectivity network is closely related to the mechanism of acupuncture, and central integration plays a critical role in the acupuncture mechanism.
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Affiliation(s)
- Rong-Lin Cai
- Graduate School of Anhui University of Chinese Medicine, Hefei 230012, Anhui Province, China
| | - Guo-Ming Shen
- Graduate School of Anhui University of Chinese Medicine, Hefei 230012, Anhui Province, China.
| | - Hao Wang
- School of Integrated Traditional Chinese & Western Medicine, Anhui University of Chinese Medicine, Hefei 230012, Anhui Province, China
| | - Yuan-Yuan Guan
- Graduate School of Anhui University of Chinese Medicine, Hefei 230012, Anhui Province, China
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de Oliveira RF, Goldman RS, Mendes FM, de Freitas PM. Influence of Electroacupuncture and Laser-Acupuncture on Treating Paresthesia in Patients Submitted to Combined Orthognathic Surgery and Genioplasty. Med Acupunct 2017; 29:290-299. [PMID: 29067139 DOI: 10.1089/acu.2017.1228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective: The goal of this research was to observe the influence of electroacupuncture (EA) and laser-acupuncture on the return of tactile/pain sensitivity in patients who underwent orthognathic surgery. Materials and Methods: Thirty volunteers subjected to orthognathic surgery were evaluated and randomly divided into 2 groups, in which 3 treatments were evaluated: control (n = 30) (G0, medication + placebo laser treatment) and 2 experimental treatments (n = 15) (G1, medication + EA) or G2 (medication + laser-acupuncture). The control group had n = 30 because for each experimental treatment conducted on a volunteer's hemi-face, there was a control treatment on the other hemi-face. In G1, medication was given with EA, with needles placed at predetermined points (ST 4 [Dicang], M-HN-18 [Jiachengjiang], CV 24 [Chengjiang], ST 5 [Daying], ST 6 [Jiache], and point A1 [YNSA]). For electrostimulation, the device used delivered transcutaneous electrical nerve stimulation of a burst type, with intensity and frequency variations of T = 220 ms and F = 4 Hz (30 minutes, 2 × /week). In G2, in addition to the medication, laser irradiation (at 780 nm) was applied on acupuncture points (at 0.04 cm2, 70 mW, 6 s/point, 0.42 J/point, 10 J/cm2, 2 × /week). All volunteers were evaluated before and during the 4 months following the surgery. Tactile sensitivity was assessed by mechanical brushing (brush #s 2 and 12) and by a 2-point discrimination test, using a bow compass. A pain test was performed with a pulp electrical test that stimulates intact nerves of the dentin-pulp complex. A Kaplan-Meier test was performed, and survival curves were plotted for comparison between groups. Cox regression analysis was also conducted (α = 0.05). Results: There were no statistically significant differences among the groups for the 2-point discrimination test (brushes #2 and #12) on the buccal mucosa region and for the pulp test on all evaluated regions. However, the tactile test using brush #12 revealed significant differences between G1 and the other groups when considering the lower lip (P = 0.024) and chin (P = 0.028) areas. Conclusions: Only EA was able to influence-using the brushing test (brush #12)-the return of tactile sensitivity on the chin and lower lip positively after combined orthognathic surgery and genioplasty.
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Affiliation(s)
- Renata F de Oliveira
- Special Laboratory of Lasers in Dentistry, Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Ricardo S Goldman
- Clínica de Cirurgia e Traumatologia Buco-Maxilo-Faciais, São Paulo, SP, Brazil
| | - Fausto Medeiros Mendes
- Department of Orthodontics and Pediatrics Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Patricia Moreira de Freitas
- Special Laboratory of Lasers in Dentistry, Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Lu YC, Zhang H, Zheng MX, Hua XY, Qiu YQ, Shen YD, Jiang S, Xu JG, Gu YD, Xu WD. Local and Extensive Neuroplasticity in Carpal Tunnel Syndrome: A Resting-State fMRI Study. Neurorehabil Neural Repair 2017; 31:898-909. [PMID: 28845734 DOI: 10.1177/1545968317723749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Carpal tunnel syndrome (CTS) is a most common peripheral nerve entrapment neuropathy characterized by sensorimotor deficits in median nerve innervated digits. Block-design task-related functional magnetic resonance imaging (fMRI) studies have been used to investigate CTS-related neuroplasticity in the primary somatosensory cortices. However, considering the persistence of digital paresthesia syndrome caused by median nerve entrapment, spontaneous neuronal activity might provide a better understanding of CTS-related neuroplasticity, which remains unexplored. The present study aimed to investigate both local and extensive spontaneous neuronal activities with resting-state fMRI. A total of 28 bilateral CTS patients and 24 normal controls were recruited, and metrics, including amplitude of low-frequency fluctuation (ALFF) and voxel-wise functional connectivity (FC), were used to explore synaptic activity at different spatial scales. Correlations with clinical measures were further investigated by linear regression. Decreased amplitudes of low-frequency fluctuation were observed in the bilateral primary sensory cortex (SI) and secondary sensory cortex (SII) in CTS patients (AlphaSim corrected P < .05). This was found to be negatively related to the sensory thresholds of corresponding median nerve innervated fingers. In the voxel-wise FC analysis, with predefined seed regions of interest in the bilateral SI and primary motor cortex, we observed decreased interhemispheric and increased intrahemispheric FC. Additionally, both interhemispheric and intrahemispheric FC were found to be significantly correlated with the mean ALFF.
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Affiliation(s)
- Ye-Chen Lu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Han Zhang
- 4 Hangzhou Normal University, Zhejiang Province, China
| | - Mou-Xiong Zheng
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xu-Yun Hua
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yan-Qun Qiu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.,5 Jing'an District Central Hospital, Shanghai, China
| | - Yun-Dong Shen
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Su Jiang
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Jian-Guang Xu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yu-Dong Gu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Wen-Dong Xu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.,5 Jing'an District Central Hospital, Shanghai, China
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The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:7420648. [PMID: 28676832 PMCID: PMC5476875 DOI: 10.1155/2017/7420648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
Abstract
Introduction The aim of this study was to explore the acupuncture effect on the cross-sectional area (CSA) of the median nerve at the wrist in patients with carpal tunnel syndrome (CTS) and, additionally, to identify whether clinical, electrophysiological, and ultrasonographic changes show any association. Methods Forty-five limbs of 27 female patients were randomly divided into two groups (acupuncture and control). All patients used night wrist splint. The patients in the acupuncture group received additional acupuncture therapy. Visual analog scale (VAS), Duruöz Hand Index (DHI), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, electrophysiologic measurements, and median nerve CSAs were noted before and after the treatment in both groups. Results VAS, DHI, Quick DASH scores, and electrophysiological measurements were improved in both groups. The median nerve CSA significantly decreased in the acupuncture group, whereas there was no change in the control group. Conclusion After acupuncture therapy, the patients with CTS might have both clinical and morphological improvement.
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Brown ML, Rojas E, Gouda S. A Mind-Body Approach to Pediatric Pain Management. CHILDREN (BASEL, SWITZERLAND) 2017; 4:E50. [PMID: 28632194 PMCID: PMC5483625 DOI: 10.3390/children4060050] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/11/2017] [Accepted: 06/13/2017] [Indexed: 12/19/2022]
Abstract
Pain is a significant public health problem that affects all populations and has significant financial, physical and psychological impact. Opioid medications, once the mainstay of pain therapy across the spectrum, can be associated with significant morbidity and mortality. Centers for Disease and Control (CDC) guidelines recommend that non-opioid pain medications are preferred for chronic pain outside of certain indications (cancer, palliative and end of life care). Mindfulness, hypnosis, acupuncture and yoga are four examples of mind-body techniques that are often used in the adult population for pain and symptom management. In addition to providing significant pain relief, several studies have reported reduced use of opioid medications when mind-body therapies are implemented. Mind-body medicine is another approach that can be used in children with both acute and chronic pain to improve pain management and quality of life.
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Affiliation(s)
- Melanie L Brown
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA (E.R.).
- Department of Pain, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Enrique Rojas
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA (E.R.).
| | - Suzanne Gouda
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA (E.R.).
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Maeda Y, Kim H, Kettner N, Kim J, Cina S, Malatesta C, Gerber J, McManus C, Ong-Sutherland R, Mezzacappa P, Libby A, Mawla I, Morse LR, Kaptchuk TJ, Audette J, Napadow V. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain 2017; 140:914-927. [PMID: 28334999 PMCID: PMC5837382 DOI: 10.1093/brain/awx015] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/08/2016] [Accepted: 12/17/2016] [Indexed: 12/31/2022] Open
Abstract
Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist. Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. Eligible patients (n = 80, 65 female, age: 49.3 ± 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture 'local' to the more affected hand; (ii) verum electro-acupuncture at 'distal' body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using non-penetrating placebo needles. Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up. Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5). While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance). Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor imaging of white matter microstructure adjacent to the primary somatosensory cortex. Compared to healthy adults (n = 34, 28 female, 49.7 ± 9.9 years old), patients with carpal tunnel syndrome demonstrated increased fractional anisotropy in several regions and, for these regions we found that improvement in median nerve latency was associated with reduction of fractional anisotropy near (i) contralesional hand area following verum, but not sham, acupuncture; (ii) ipsilesional hand area following local, but not distal or sham, acupuncture; and (iii) ipsilesional leg area following distal, but not local or sham, acupuncture. As these primary somatosensory cortex subregions are distinctly targeted by local versus distal acupuncture electrostimulation, acupuncture at local versus distal sites may improve median nerve function at the wrist by somatotopically distinct neuroplasticity in the primary somatosensory cortex following therapy. Our study further suggests that improvements in primary somatosensory cortex somatotopy can predict long-term clinical outcomes for carpal tunnel syndrome.
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Affiliation(s)
- Yumi Maeda
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Department of Radiology, Logan University, Chesterfield, MO, 63017, USA
| | - Hyungjun Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Clinical Research Division, Korean Institute of Oriental Medicine, Daejeon, 34054, South Korea
| | - Norman Kettner
- Department of Radiology, Logan University, Chesterfield, MO, 63017, USA
| | - Jieun Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Clinical Research Division, Korean Institute of Oriental Medicine, Daejeon, 34054, South Korea
| | - Stephen Cina
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Cristina Malatesta
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Medford, MA, 02155, USA
| | - Jessica Gerber
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Claire McManus
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Medford, MA, 02155, USA
| | - Rebecca Ong-Sutherland
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Medford, MA, 02155, USA
| | - Pia Mezzacappa
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Alexandra Libby
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Ishtiaq Mawla
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Leslie R. Morse
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, 02114, USA
| | - Ted J. Kaptchuk
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Joseph Audette
- Department of Pain Medicine, Harvard Vanguard Medical Associates, Atrium Health, Boston, MA, 02215, USA
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Department of Radiology, Logan University, Chesterfield, MO, 63017, USA
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50
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Karst M, Fink M. Acupuncture—A Biomedical Information Therapy: A Translational Analysis. Med Acupunct 2016. [DOI: 10.1089/acu.2016.1196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Matthias Karst
- Pain Clinic, Department of Anesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Matthias Fink
- Department of Physical Medicine and Rehabilitation, Hannover Medical School, Hannover, Germany
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