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Zhang C, Zhang Z, Li Y, Yin Y, Feng C, Zhan W, Fu R, Yu Q, Jiang G, Wang C. Alterations in functional connectivity in patients with non-specific chronic low back pain after motor control exercise: a randomized trial. Eur J Phys Rehabil Med 2024; 60:319-330. [PMID: 38358464 PMCID: PMC11112508 DOI: 10.23736/s1973-9087.24.08087-0] [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: 06/14/2023] [Revised: 11/03/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Motor control exercise (MCE) is effective in alleviating non-specific chronic low back pain (NCLBP). Neuro-imaging research is warranted to explore the underlying neural mechanisms of MCE. AIM We used resting-state functional magnetic resonance imaging (rs-fMRI) to explore the central mechanism underpinning the effects of MCE in patients with NCLBP. DESIGN A randomized, single-blinded, controlled trial. SETTING The setting was out-patient and community. POPULATION Fifty-eight patients with NCLBP. METHODS Patients were randomized into the MCE or manual therapy (MT) group. All the participants completed pain-related clinical assessments and rs-fMRI scans before and after intervention. We performed exploratory whole-brain analyses in regional homogeneity (ReHo) and resting-state functional connectivity (rsFC) with significant post-pre differences in ReHo before and after intervention, and investigated associations between imaging and pain-related clinical assessments. RESULTS Compared with the MT group, a greater alleviation in pain intensity and disability was observed in the MCE group after intervention, and was sustained at the 6-month follow-up (P<0.001). Only the MCE group showed increased ReHo values in the right pre-central gyrus and decreased ReHo values in the bilateral posterior cerebellum (voxel level P<0.001, cluster-level FWE corrected P<0.05). Decreased rsFC of the right posterior cerebellum-left superior parietal gyrus and left insula were significantly positively associated with pain-related disability (voxel level P<0.001, cluster-level FWE corrected P<0.05). CONCLUSIONS These findings demonstrated that MCE had superior effects in relieving pain and pain-related disability, which might be associated with its modulation of rsFC between the cerebellum and areas involved in sensory-discriminative processing of noxious and somato-sensory stimuli, affection, and cognition. CLINICAL REHABILITATION IMPACT This study provided preliminary evidence that MCE might alleviate NCLBP through its modulation of the function of brain areas related to chronic pain and postural control. Those results support MCE's clinical application and help physiotherapists to provide better multidisciplinary interventions with the combination of MCE and other first-line treatments.
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Affiliation(s)
- Chanjuan Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhou Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuelong Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yi Yin
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Chenyang Feng
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Wenfeng Zhan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ruochen Fu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China -
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Chen Y, Yang Y, Gong Z, Kang Y, Zhang Y, Chen H, Zeng K, Men X, Wang J, Huang Y, Wang H, Zhan S, Tan W, Wang W. Altered effective connectivity from cerebellum to motor cortex in chronic low back pain: A multivariate pattern analysis and spectral dynamic causal modeling study. Brain Res Bull 2023; 204:110794. [PMID: 37871687 DOI: 10.1016/j.brainresbull.2023.110794] [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: 04/03/2023] [Revised: 08/01/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
To explore the central processing mechanism of pain perception in chronic low back pain (cLBP) using multi-voxel pattern analysis (MVPA) based on the static and dynamic fractional amplitude of low-frequency fluctuations (fALFF) analysis, and spectral dynamic causal modeling (spDCM). Thirty-two patients with cLBP and 29 matched healthy controls (HCs) for the first cohort and 24 patients with cLBP and 22 HCs for the validation cohort underwent resting-state fMRI scan. The alterations in static and dynamic fALFF were as classification features to distinguish patients with cLBP from HCs. The brain regions gotten from the MVPA results were used for further spDCM analysis. We found that the most discriminative brain regions that contributed to the classification were the right supplementary motor area (SMA.R), left paracentral lobule (PCL.L), and bilateral cerebellar Crus II. The spDCM results displayed decreased excitatory influence from the bilateral cerebellar Crus II to PCL.L in patients with cLBP compared with HCs. Moreover, the conversion of effective connectivity from the bilateral cerebellar Crus II to SMA.R from excitatory influence to inhibitive influence, and the effective connectivity strength exhibited partially mediated effects on Chinese Short Form Oswestry Disability Index Questionnaire (C-SFODI) scores. Our findings suggest that the cerebellum and its weakened or inhibited connections to the motor cortex may be one of the underlying feedback pathways for pain perception in cLBP, and partially mediate the degree of dysfunction.
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Affiliation(s)
- Yilei Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuchan Yang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhigang Gong
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yingjie Kang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Zeng
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiubo Men
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianwei Wang
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanwen Huang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Songhua Zhan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenli Tan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Wei Wang
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Multidimensional Pain Modulation by Acupuncture Analgesia: The Reward Effect of Acupuncture on Pain Relief. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3759181. [PMID: 36408345 PMCID: PMC9671730 DOI: 10.1155/2022/3759181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/30/2022] [Accepted: 11/05/2022] [Indexed: 11/12/2022]
Abstract
Pain is an intrinsically unpleasant experience with features that protect an organism by promoting motivation and learning. Pain relief, a negative reinforcement of pain, is considered a reward and activates the brain's reward system. The reward circuit in the brain involves reward and pain. Acupuncture has a multidimensional and comprehensive regulating effect on chronic pain. However, the reward effect of acupuncture in relieving chronic pain and the mechanism of the brain reward circuit involved in acupuncture analgesia are not thoroughly studied. In this article, we have reviewed the definition of pain abnormalities and negative emotions in patients with chronic pain, the conceptual characteristics of analgesic reward, and the new progress in studying brain reward circuits and functions. Moreover, we have expounded on the critical clinical and scientific significance of studying the reward effect of acupuncture analgesia and related brain reward circuits, the pain mechanism obtained from human neuroimaging studies, and the survey results on the effects of acupuncture on reward/motivation circuits. Some viewpoints and suggestions on the reward effect of acupuncture analgesia and related reward circuits have been put forward to clarify the multidimensional characteristics and benign regulation of acupuncture analgesia. Studies on the reward effect of acupuncture in relieving chronic pain and the regulating effect of the brain reward loop on acupuncture analgesia help to deepen the clinical understanding of acupuncture analgesia, innovate the research concept of acupuncture analgesia, and provide help for further studies on the central mechanism of acupuncture in improving chronic pain in the future.
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Masoumbeigi M, Alam NR, Kordi R, Rostami M, Afzali M, Yadollahi M, Rahimiforoushani A, Jafari AH, Hashemi H, Kavousi M. rTMS Pain Reduction Effectiveness in Non-specific Chronic Low Back Pain Patients using rs-fMRI Functional Connectivity. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Ha G, Tian Z, Chen J, Wang S, Luo A, Liu Y, Tang J, Lai N, Zeng F, Lan L. Coordinate-based (ALE) meta-analysis of acupuncture for musculoskeletal pain. Front Neurosci 2022; 16:906875. [PMID: 35937886 PMCID: PMC9354890 DOI: 10.3389/fnins.2022.906875] [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: 03/29/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Neuroimaging studies have been widely used to investigate brain regions' alterations in musculoskeletal pain patients. However, inconsistent results have hindered our understanding of the central modulatory effects of acupuncture for musculoskeletal pain. The main objective of our investigation has been to obtain comprehensive evidence of acupuncture for musculoskeletal pain diseases. Methods The PubMed, Web of Science, Google Scholar, Embase, China National Knowledge Infrastructure (CNKI), VIP Database, China Biology Medicine disc Database, Clinical Trial Registration Platform, and Wanfang Database were searched for neuroimaging studies on musculoskeletal pain diseases published from inception up to November 2021. Then, the relevant literature was screened to extract the coordinates that meet the criteria. Finally, the coordinate-based meta-analysis was performed using the activation likelihood estimation algorithm. Results A total of 15 neuroimaging studies with 183 foci of activation were included in this study. The ALE meta-analysis revealed activated clusters in multiple cortical and sub-cortical brain structures in response to acupuncture across studies, including the thalamus, insula, caudate, claustrum, and lentiform nucleus. Conclusions The studies showed that acupuncture could modulate different brain regions, including the thalamus, insula, caudate, claustrum, and lentiform nucleus. The findings offer several insights into the potential mechanisms of acupuncture for musculoskeletal pain and provide a possible explanation for the observed clinical benefit of this therapy. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227850, identifier: CRD42021227850.
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Affiliation(s)
- Guodong Ha
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zilei Tian
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiyao Chen
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuo Wang
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Aga Luo
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yunyu Liu
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Juan Tang
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ningyuan Lai
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zeng
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Key Laboratory of Sichuan Province for Acupuncture and Chronobiology, Chengdu, China
| | - Lei Lan
- Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Revealing the Neuroimaging Mechanism of Acupuncture for Poststroke Aphasia: A Systematic Review. Neural Plast 2022; 2022:5635596. [PMID: 35494482 PMCID: PMC9050322 DOI: 10.1155/2022/5635596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Aphasia is a common symptom in stroke patients, presenting with the impairment of spontaneous speech, repetition, naming, auditory comprehension, reading, and writing function. Multiple rehabilitation methods have been suggested for the recovery of poststroke aphasia, including medication treatment, behavioral therapy, and stimulation approach. Acupuncture has been proven to have a beneficial effect on improving speech functions in repetition, oral speech, reading, comprehension, and writing ability. Neuroimaging technology provides a visualized way to explore cerebral neural activity, which helps reveal the therapeutic effect of acupuncture therapy. In this systematic review, we aim to reveal and summarize the neuroimaging mechanism of acupuncture therapy on poststroke aphasia to provide the foundation for further study. Methods Seven electronic databases were searched including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, the Wanfang databases, and the Chinese Scientific Journal Database. After screening the studies according to the inclusion and exclusion criteria, we summarized the neuroimaging mechanism of acupuncture on poststroke aphasia, as well as the utilization of acupuncture therapy and the methodological characteristics. Result After searching, 885 articles were retrieved. After removing the literature studies, animal studies, and case reports, 16 studies were included in the final analysis. For the acupuncture type, 10 studies used manual acupuncture and 5 studies used electroacupuncture, while body acupuncture (10 studies), scalp acupuncture (7 studies), and tongue acupuncture (8 studies) were applied for poststroke aphasia patients. Based on blood oxygen level-dependent (BOLD) and diffusion tensor imaging (DTI) technologies, 4 neuroimaging analysis methods were used including amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), seed-based analysis, and independent component analysis (ICA). Two studies reported the instant acupuncture effect, and 14 studies reported the constant acupuncture's effect on poststroke aphasia patients. 5 studies analyzed the correlation between the neuroimaging outcomes and the clinical language scales. Conclusion In this systematic review, we found that the mechanism of acupuncture's effect might be associated with the activation and functional connectivity of language-related brain areas, such as brain areas around Broca's area and Wernicke's area in the left inferior temporal gyrus, supramarginal gyrus, middle frontal gyrus, and inferior frontal gyrus. However, these studies were still in the preliminary stage. Multicenter randomized controlled trials (RCT) with large sample sizes were needed to verify current evidence, as well as to explore deeply the neuroimaging mechanisms of acupuncture's effects.
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Xiang A, Chen M, Qin C, Rong J, Wang C, Shen X, Liu S. Frequency-Specific Blood Oxygen Level Dependent Oscillations Associated With Pain Relief From Ankle Acupuncture in Patients With Chronic Low Back Pain. Front Neurosci 2021; 15:786490. [PMID: 34949986 PMCID: PMC8688988 DOI: 10.3389/fnins.2021.786490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Recent advances in brain imaging have deepened our knowledge of the neural activity in distinct brain areas associated with acupuncture analgesia. However, there has not been conclusive research into the frequency-specific resting-state functional changes associated with acupuncture analgesia in patients with chronic pain. Here, we aimed to characterize changes across multiple frequencies of resting-state cortical activity associated with ankle acupuncture stimulation (AAS) in patients with chronic low back pain (CLBP) and healthy controls. Methods: Twenty seven patients with CLBP and Twenty five age- and gender-matched healthy volunteers were enrolled in the study. Participants received tactile sham acupuncture (TSA) and AAS, respectively. The whole-brain amplitude of low-frequency fluctuation (ALFF) in the range 0.01–0.25 Hz was assessed for changes associated with each intervention. Further, a visual analog scale (VAS) was used to collect subjective measures of pain intensity in patients. Linear mixed-effect modeling (LME) was used to examine the mean ALFF values of AAS and TSA between patients and healthy controls. Results: The ALFF was modulated in the default mode network (an increase in the medial prefrontal cortex, and a decrease in the cerebellum/posterior ingulate/parahippocampus, P < 0.01, corrected) in both patients and controls. Decreased ALFF in the bilateral insular was frequency-dependent. Modulations in the cerebellum and right insular were significantly correlated with VAS pain score after AAS (P < 0.01). Conclusion: Hence, frequency-specific resting-state activity in the cerebellum and insular was correlated to AAS analgesia. Our frequency-specific analysis of ALFF may provide novel insights related to pain relief from acupuncture.
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Affiliation(s)
- Anfeng Xiang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,The First Rehabilitation Hospital of Shanghai, School of Medicine, Tongji University, Shanghai, China
| | - Meiyu Chen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chuan Qin
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Rong
- Department of Sports Rehabilitation, Zhejiang Integrated Traditional and Western Medicine Hospital, Zhejiang, China
| | - Can Wang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xueyong Shen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sheng Liu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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8
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Wen Q, Ma P, Dong X, Sun R, Lan L, Yin T, Qu Y, Liu Y, Xiao Q, Zeng F. Neuroimaging Studies of Acupuncture on Low Back Pain: A Systematic Review. Front Neurosci 2021; 15:730322. [PMID: 34616275 PMCID: PMC8488100 DOI: 10.3389/fnins.2021.730322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study was conducted in order to investigate the study design and main outcomes of acupuncture neuroimaging studies on low back pain (LBP). Methods: Neuroimaging studies of acupuncture on LBP were collected from three English databases such as PubMed and four Chinese databases such as China National Knowledge Infrastructure (CNKI) from inception to December 31, 2020. Study selection, data extraction, and assessment of risk of bias were performed independently by two investigators. The quality of studies was appraised with the Cochrane's risk of bias tools. Information on basic information, methodology, and brain imaging data were extracted. Results: The literature search returned 310 potentially eligible studies and 19 articles met inclusion criteria; 78.9% of studies chose manual acupuncture as the intervention, 89.5% of studies evaluated functional changes elicited by acupuncture, and 68.4% of studies used resting-state fMRI as imaging condition. The most frequently reported acupuncture-induced brain alterations of LBP patients were in the prefrontal cortex, insula, cerebellum, primary somatosensory cortex, and anterior cingulate cortex. There was a significant correlation between improved clinical outcomes and changes in the brain. Conclusions: The results suggested that improving abnormal structure and functional activities in the brain of the LBP patient is an important mechanism of acupuncture treatment for LBP. The brain regions involved in acupuncture analgesia for LBP were mainly located in the pain matrix, default mode network (DMN), salience network (SN), and descending pain modulatory system (DPMS). However, it was difficult to draw a generalized conclusion due to the heterogeneity of study designs. Further well-designed multimodal neuroimaging studies investigating the mechanism of acupuncture on LBP are warranted.
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Affiliation(s)
- Qiao Wen
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Peihong Ma
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaohui Dong
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ruirui Sun
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lei Lan
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Yin
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuzhu Qu
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yalan Liu
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qingqing Xiao
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zeng
- Acupuncture and Tuina School, Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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The Instant Effects of Continuous Transcutaneous Auricular Vagus Nerve Stimulation at Acupoints on the Functional Connectivity of Amygdala in Migraine without Aura: A Preliminary Study. Neural Plast 2020; 2020:8870589. [PMID: 33381165 PMCID: PMC7759401 DOI: 10.1155/2020/8870589] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background A growing body of evidence suggests that both auricular acupuncture and transcutaneous auricular vagus nerve stimulation (taVNS) can induce antinociception and relieve symptoms of migraine. However, their instant effects and central treatment mechanism remain unclear. Many studies proved that the amygdalae play a vital role not only in emotion modulation but also in pain processing. In this study, we investigated the modulation effects of continuous taVNS at acupoints on the FC of the bilateral amygdalae in MwoA. Methods Thirty episodic migraineurs were recruited for the single-blind, crossover functional magnetic resonance imaging (fMRI) study. Each participant attended two kinds of eight-minute stimulations, taVNS and sham-taVNS (staVNS), separated by seven days in random order. Finally, 27 of them were included in the analysis of seed-to-voxel FC with the left/right amygdala as seeds. Results Compared with staVNS, the FC decreased during taVNS between the left amygdala and left middle frontal gyrus (MFG), left dorsolateral superior frontal gyrus, right supplementary motor area (SMA), bilateral paracentral lobules, bilateral postcingulum gyrus, and right frontal superior medial gyrus, so did the FC of the right amygdala and left MFG. A significant positive correlation was observed between the FC of the left amygdala and right SMA and the frequency/total time of migraine attacks during the preceding four weeks. Conclusion Continuous taVNS at acupoints can modulate the FC between the bilateral amygdalae and pain-related brain regions in MwoA, involving the limbic system, default mode network, and pain matrix, with obvious differences between the left amygdala and the right amygdala. The taVNS may produce treatment effects by modulating the abnormal FC of the amygdala and pain networks, possibly having the same central mechanism as auricular acupuncture.
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Pei Y, Zhang Y, Zhu Y, Zhao Y, Zhou F, Huang M, Wu L, Gong H. Hyperconnectivity and High Temporal Variability of the Primary Somatosensory Cortex in Low-Back-Related Leg Pain: An fMRI Study of Static and Dynamic Functional Connectivity. J Pain Res 2020; 13:1665-1675. [PMID: 32753942 PMCID: PMC7351631 DOI: 10.2147/jpr.s242807] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/23/2020] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate the functional connectivity (FC) and its variability in the primary somatosensory cortex (S1) of patients with low-back-related leg pain (LBLP) in the context of the persistent stimuli of pain and numbness. Patients and Methods We performed functional magnetic resonance imaging on LBLP patients (n = 26) and healthy controls (HCs; n = 34) at rest. We quantified and compared static FC (sFC) using a seed-based analysis strategy, with 6 predefined bilateral paired spherical regions of interest (ROIs) in the S1 cortex. Then, we captured the dynamic FC using sliding window correlation of ROIs in both the LBLP patients and HCs. Furthermore, we performed a correlational analysis between altered static and dynamic FC and clinical measures in LBLP patients. Results Compared with controls, the LBLP patients had 1) significantly increased static FC between the left S1back (the representation of the back in the S1) and right superior and middle frontal gyrus (SFG/MFG), between the left S1chest and right SFG/MFG, between right S1chest and right SFG/MFG, between the left S1face and right MFG, and between the right S1face and right inferior parietal lobule (P < 0.001, Gaussian random field theory correction); 2) increased dynamic FC only between the right S1finger and the left precentral and postcentral gyrus and between the right S1hand and the right precentral and postcentral gyrus (P < 0.01, Gaussian random field theory correction); and 3) a negative correlation between the Barthel index and the increased static FC between the left S1face and right inferior parietal lobule (P = 0.048). Conclusion The present study demonstrated the hyperconnectivity of the S1 cortex to the default mode and executive control network in a spatial pattern and an increase in the tendency for signal variability in the internal network connections of the S1 cortex in patients with LBLP.
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Affiliation(s)
- Yixiu Pei
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Yong Zhang
- Department of Pain Clinic, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province 330006, People's Republic of China
| | - Yanyan Zhu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Yanlin Zhao
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Muhua Huang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Lin Wu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, People's Republic of China.,Neuroradiology Laboratory, Jiangxi Province Medical Imaging Research Institute, Nanchang 330006, People's Republic of China
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Influence of the Intensity, Components, and Spreading of the Deqi Sensation on the Analgesic Effect of SP6 Needling in Primary Dysmenorrhea Patients: A Secondary Analysis of a Randomised Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:6462576. [PMID: 31223331 PMCID: PMC6541943 DOI: 10.1155/2019/6462576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/18/2019] [Accepted: 04/11/2019] [Indexed: 12/15/2022]
Abstract
Although deqi, the phenomenon whereby excitation of Qi in the meridians occurs with needling, is critical to the practice of acupuncture and its efficacy, it is poorly understood. So we investigate the influence of the deqi sensation on the analgesic effects of acupuncture in patients who were enrolled in a randomised controlled trial for the treatment of patients with primary dysmenorrhea, a painful and common condition, and cold and dampness stagnation. Two groups were assessed: a deqi group (undergoing deep needling with thick needles and manipulation, n=17) and a non-deqi group (undergoing shallow needling with thin needles and no manipulation, n=51). The Sanyinjiao (SP6) was needled for 30 min in both groups. Pain scores at baseline, upon needle removal, and at 10, 20, and 30 min after needle removal were evaluated by the Visual Analogue Scale for pain. The deqi sensation was evaluated by the Acupuncture Deqi Clinical Assessment Scale. Patients who experienced a genuine deqi sensation (n=39) were selected for further analysis. Compared with patients in the non-deqi group who experienced deqi (n=25), patients who self-reported deqi in the deqi group (n=14) felt a stronger deqi sensation, experienced soreness and fullness more frequently, felt a greater intensity of soreness, fullness, electric sensation, spreading, and radiating, and experienced larger spreading distances. In those who experienced the deqi sensation in the deqi group, the intensity of the sensation, as well as their degree of soreness and fullness, was negatively correlated with pain reduction. In patients who experienced the deqi sensation in the non-deqi group, deqi intensity was positively correlated with pain reduction, while soreness was negatively correlated with pain reduction. The distance of spreading was not correlated with pain reduction in either group. We found, in SP6 needling of patients with primary dysmenorrhea with cold and dampness stagnation, that a moderate deqi response predicted a prolonged analgesic effect better than a strong deqi response.
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