Many randomized clinical trials (RCTs) show acupuncture to be an effective treatment for diverse pain conditions. A closer look at this literature shows inconsistent findings: results lend to be confirmatory when RCTs compare acupuncture with ?not treatment? or ?standard care? controls;but inconclusive when RCTs compare genuine (verum) acupuncture with sham acupuncture suggesting that at least one healing component is mediated by something other than the acupuncture needles. A recent meta-analysis identified patient expectation of pain relief as the most robust predictor acupuncture treatment efficacy, regardless of verum or sham group assignment. Neuroimaging studies have begun identifying testable mechanistic hypotheses for both acupuncture and placebo analgesia. Our recent studies on healthy subjects demonstrate that in the context of positive expectation, both verum and sham acupuncture significantly relieve pain, however each functions via separable and distinct brain mechanisms. The current proposal will test whether these distinct brain activity patterns associated with pain relief following verum and sham acupuncture can be replicated in patients suffering from chronic knee pain due to osteoarthritis (OA). We propose two experiments in patients with knee OA that directly build upon recent research in our laboratory. In the first experiment we will systematically boost patients? positive expectation for pain relief following verum or sham acupuncture, then quantify the relation between expectation, behavioral , and brain imaging (BOLD fMRI) measures of treatment response. In the second experiment, a similar boost of positive expectation for treatment will be compared to standard treatment and to waitlist control in a 6-week longitudinal mechanistic treatment study of verum acupuncture. fMRI BOLD data obtained before the first and after the 6th treatment sessions will be examined with respect to individual expectation of treatment outcome to identify potential treatment responses predictors. The significance of his innovative approach is that it could provide clear scientific evidence for how expectation modulates the impact of an analgesic treatment. The results of these experiments will advance our understanding of not only acupuncture and placebo analgesia mechanisms, but also help refine future research methods, and inform clinical practice.

Public Health Relevance

The results of the proposed experiments will directly inform clinicians who treat patients with osteoarthritis of the knee about how to maximize the benefits of acupuncture treatments. And because the experiments specifically asks the question of what is the relation between a patient's expectation of how a treatment will relieve their pain and the outcome of the treatment, the results will potentially inform care givers about all treatments for osteoarthritis and other chronic pain disorders.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Research Project (R01)
Project #
5R01AT005280-05
Application #
8606408
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Huntley, Kristen V
Project Start
2010-02-01
Project End
2015-01-31
Budget Start
2014-02-01
Budget End
2015-01-31
Support Year
5
Fiscal Year
2014
Total Cost
$751,496
Indirect Cost
$253,874
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Long, Xiangyu; Huang, Wenjing; Napadow, Vitaly et al. (2016) Sustained Effects of Acupuncture Stimulation Investigated with Centrality Mapping Analysis. Front Hum Neurosci 10:510
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
Egorova, Natalia; Gollub, Randy L; Kong, Jian (2015) Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain. Neuroimage Clin 9:430-5
Curie, Aurore; Yang, Kathy; Kirsch, Irving et al. (2015) Placebo Responses in Genetically Determined Intellectual Disability: A Meta-Analysis. PLoS One 10:e0133316
Egorova, Natalia; Park, Joel; Orr, Scott P et al. (2015) Not seeing or feeling is still believing: conscious and non-conscious pain modulation after direct and observational learning. Sci Rep 5:16809
Egorova, Natalia; Yu, Rongjun; Kaur, Navneet et al. (2015) Neuromodulation of conditioned placebo/nocebo in heat pain: anodal vs cathodal transcranial direct current stimulation to the right dorsolateral prefrontal cortex. Pain 156:1342-7
Freeman, Sonya; Yu, Rongjun; Egorova, Natalia et al. (2015) Distinct neural representations of placebo and nocebo effects. Neuroimage 112:197-207
Chen, Xiaoyan; Spaeth, Rosa B; Freeman, Sonya G et al. (2015) The modulation effect of longitudinal acupuncture on resting state functional connectivity in knee osteoarthritis patients. Mol Pain 11:67
Hall, Kathryn T; Loscalzo, Joseph; Kaptchuk, Ted J (2015) Genetics and the placebo effect: the placebome. Trends Mol Med 21:285-94
Jensen, Karin B; Kaptchuk, Ted J; Chen, Xiaoyan et al. (2015) A Neural Mechanism for Nonconscious Activation of Conditioned Placebo and Nocebo Responses. Cereb Cortex 25:3903-10

Showing the most recent 10 out of 43 publications