Acupuncture is increasingly used by the American Public for the treatment of chronic pain. Two recent seminal clinical trials have established its superiority to usual care for the treatment of chronic low back pain (CLBP). However, one key issue remains: minimal clinical difference is found between verum acupuncture (VA) and placebo acupuncture (PA). Meanwhile studies in animals and healthy human models reveal distinct central mechanisms for VA and PA. However, little work has been done to translate the findings from healthy human models to chronic pain conditions such as CLBP.
Our aim i s to focus on elucidating mechanisms by which acupuncture exerts its therapeutic effects above and beyond the placebo effect. Dysregulation in central pain and emotional processing is increasingly recognized as a key contributor to the pathogenesis of CLBP. Works from others and our group show that acupuncture exerts therapeutic influence in the same central processes as those involved in the pathogenesis on CLBP. These processes include central pain modulation and emotional regulation. In addition, expectations of benefit has also been shown to be an important mediator of response to acupuncture. We hope to delineate the common and differential mechanisms of VA and PA in the CLBP by characterize their effect on the aforementioned biological and psychological factors. In a series to two innovative designs, we plan to a) isolate and elucidate the unique mechanism of VA among those who have NOT responded to PA;b) compare the mechanisms of VA and PA by randomizing those who HAVE responded to either VA or PA. The specific mechanisms that we will study are mechanisms of pain facilitation and inhibition, mechanisms involved in emotion regulation that are known to modulate the pain experience, and the role of expectancy.

Public Health Relevance

With an innovative design this project aims to characterize biological and psychological mechanisms of acupuncture for CLBP. It will investigate the effects of acupuncture on normalizing dysregulation in central pain and emotional processing that are present in CLBP and how these effects are related to overall improvement in CLBP severity.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Research Program Projects (P01)
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Special Emphasis Panel (ZAT1-SM)
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Stanford University
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Sturgeon, John A; Carriere, Junie S; Kao, Ming-Chih J et al. (2016) Social Disruption Mediates the Relationship Between Perceived Injustice and Anger in Chronic Pain: a Collaborative Health Outcomes Information Registry Study. Ann Behav Med 50:802-812
Darnall, Beth D (2016) Pain Psychology and Pain Catastrophizing in the Perioperative Setting: A Review of Impacts, Interventions, and Unmet Needs. Hand Clin 32:33-9
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Darnall, Beth D; Schatman, Michael E (2015) The Relationship Between Industry and Pain Societies, Part 1: Demystification and Legitimization of Continuing Medical Education. Pain Med 16:1251
Darnall, Beth D; Schatman, Michael E (2015) Opioid use and lactation: protecting the child in the context of maternal pain care. Pain Med 16:628
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Darnall, Beth D (2015) ""Compassion Cultivation in Chronic Pain May Reduce Anger, Pain, and Increase Acceptance: Study Review and Brief Commentary"". Health Care Curr Rev 3:
Chapin, Heather L; Darnall, Beth D; Seppala, Emma M et al. (2014) Pilot study of a compassion meditation intervention in chronic pain. J Compassionate Health Care 1:
Darnall, Beth D (2014) Minimize opioids by optimizing pain psychology. Pain Manag 4:251-3
Darnall, Beth D; Sturgeon, John A; Kao, Ming-Chih et al. (2014) From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing. J Pain Res 7:219-26

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