A growing body of evidence substantiates that acupuncture treatment significantly improves clinical outcomes for patients with chronic pain disorders, and specifically for patients with chronic Low Back Pain (cLBP). Major stakeholders recommend acupuncture as one possible treatment option, despite the fact that in most cases, especially in large trials, sham (placebo) treatment is equally efficacious to real acupuncture, because both treatments are superior to optimal mainstream care or no-treatment. To more fully understand acupuncture treatment and how to best incorporate it into clinical practice, understanding placebo effects is urgent. Further, extensive research from our own group suggests that sham acupuncture has enhanced placebo effects compared to placebos for conventional treatments (e.g. pills or creams). Mechanistic work using a conditioning expectancy manipulation in healthy subjects to investigate the neural basis for analgesia after treatment with real acupuncture or placebo acupuncture suggests that this difference is not because of differential expectations. A critical question is, do different routes of administration configure unique neural mechanisms of placebo analgesia? Published fMRI data from our team demonstrates distinctly different mechanisms for real and placebo acupuncture, despite comparable levels of pain relief. Comparing our fMRI data with published studies from other laboratories suggests different mechanisms between sham acupuncture and placebo creams. Importantly, levels of expectation of pain relief were experimentally enhanced by the same conditioning mechanism. Notably, very little work has been done to investigate the neural mechanism underlying placebo effects in chronic pain patients. In this study, we will directly compare cohorts of cLBP patients and matched healthy control subjects to investigate the impact that living with significant, chronic pain has on the neural mechanisms underlying the expectation component of analgesic response to real acupuncture and placebo acupuncture. This study will expand our understanding of acupuncture's potential role in the management of cLBP and clarify the nature of placebo responses.

Public Health Relevance

The information gained from this experiment will enable scientists and the community to better interpret the results of a substantial body of literature investigating the mechanisms of acupuncture and placebo analgesia most of which has been done in healthy subjects. Most importantly, it will enable the translation of the results from healthy people to those suffering from a chronic pain disorder.

Agency
National Institute of Health (NIH)
Type
Research Program Projects (P01)
Project #
5P01AT006663-04
Application #
8703019
Study Section
Special Emphasis Panel (ZAT1)
Project Start
Project End
Budget Start
Budget End
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
Rong, Peijing; Liu, Jun; Wang, Liping et al. (2016) Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder: A nonrandomized controlled pilot study. J Affect Disord 195:172-9
Fang, Jiliang; Rong, Peijing; Hong, Yang et al. (2016) Transcutaneous Vagus Nerve Stimulation Modulates Default Mode Network in Major Depressive Disorder. Biol Psychiatry 79:266-73
Long, Xiangyu; Huang, Wenjing; Napadow, Vitaly et al. (2016) Sustained Effects of Acupuncture Stimulation Investigated with Centrality Mapping Analysis. Front Hum Neurosci 10:510
Ellingsen, D-M; Garcia, R G; Lee, J et al. (2016) Cyclic Vomiting Syndrome is characterized by altered functional brain connectivity of the insular cortex: a cross-comparison with migraine and healthy adults. Neurogastroenterol Motil :
Wang, Xiaoyun; Wang, Zengjian; Liu, Jian et al. (2016) Repeated acupuncture treatments modulate amygdala resting state functional connectivity of depressive patients. Neuroimage Clin 12:746-752
Sclocco, Roberta; Kim, Jieun; Garcia, Ronald G et al. (2016) Brain Circuitry Supporting Multi-Organ Autonomic Outflow in Response to Nausea. Cereb Cortex 26:485-97
Tao, Jing; Liu, Jiao; Egorova, Natalia et al. (2016) Increased Hippocampus-Medial Prefrontal Cortex Resting-State Functional Connectivity and Memory Function after Tai Chi Chuan Practice in Elder Adults. Front Aging Neurosci 8:25
As-Sanie, Sawsan; Kim, Jieun; Schmidt-Wilcke, Tobias et al. (2016) Functional Connectivity is Associated With Altered Brain Chemistry in Women With Endometriosis-Associated Chronic Pelvic Pain. J Pain 17:1-13
Li, Zhengjie; Liu, Mailan; Lan, Lei et al. (2016) Altered periaqueductal gray resting state functional connectivity in migraine and the modulation effect of treatment. Sci Rep 6:20298
Hwang, J W; Xin, S C; Ou, Y M et al. (2016) Enhanced default mode network connectivity with ventral striatum in subthreshold depression individuals. J Psychiatr Res 76:111-20

Showing the most recent 10 out of 61 publications