Recent large randomized controlled trials (RCTs) for cLBP indicate that acupuncture is superior to both optimal guideline-based mainstream care and waitlist controls. Yet, the medical community's acceptance of acupuncture as a treatment option has been hampered by a failure to find significant clinical differences between verum and sham (placebo) acupuncture. Importantly, despite their similar clinical effect, studies from both our and other groups found that real and sham acupuncture treatments work through different brain mechanisms to produce treatment effect. In parallel, previous studies have demonstrated that context (i.e., the broad non-specific effects of treatment ncluding patient-practitioner relationship, expectation, warmth, support, attention, and elaborate ritual) can have significant and meaningful impact on many disorders. Recent RCT trials by our group using acupuncture as the method of treatment also demonstrated that, relative to treatment delivered with a limited provider engagement, treatment delivered with augmented context effect produces a significant increase in clinical benefit. The relative ease by which acupuncture efficacy can be systematically varied by context makes acupuncture an ideal choice for future context experiments. Notably, neural longitudinal mechanisms underlying the two context conditions (limited versus augmented) have yet to be studied. We propose to conduct a novel mechanistic longitudinal 2x2 factorial study on cLBP patients using the cutting edge neuroimaging technique of arterial spin labeling (ASL) and BOLD fMRI. Eighty patients with cLBP will be randomized to one of five arms: A)

Public Health Relevance

This experiment will help us understand the brain mechanisms underlying context effects, acupuncture, and their interaction. This will enable clinicians and chronic pain populations to make more informed decisions about treatment options and strategies.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Research Program Projects (P01)
Project #
5P01AT006663-04
Application #
8703018
Study Section
Special Emphasis Panel (ZAT1)
Project Start
Project End
Budget Start
2014-07-01
Budget End
2015-06-30
Support Year
4
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
City
Boston
State
MA
Country
United States
Zip Code
02199
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