Several recent meta-analyses of acupuncture for chronic pain have shown that verum acupuncture is not superior to sham/placebo acupuncture. However, these same meta-analyses have also noted significant heterogeneity in acupuncture methods across trials, which complicates combining results. For example, while electro-acupuncture (EA) was superior to sham acupuncture in relieving pain for fibromyalgia (FM), manual acupuncture (MA) was not. In terms of physiologic action, EA and MA are very different procedures. They effect different peripheral targets and induce different psychophysical perceptions, manifest in different brain response. In fact, somatosensory afference may be a key variable in acupuncture analgesia, and the use of some sham needling devices (e.g. Streitberger Needle (SN)) has been criticized since they also produce somatosensation. Moreover, somatosensation may be a particularly important variable for FM, as this chronic pain disorder is known to display altered sensory and nociceptive amplification. Thus, we hypothesize that EA has been more effective for FM because it functions as a desensitization therapy, which when applied repeatedly over multiple treatment sessions, gradually habituates the nervous system to continuing endogenous pain and somatosensory signaling. Our overall goal is to evaluate the impact of acupuncture-induced somatosensory afference on altered neurobiology and analgesia in FM. To test our hypotheses, we will incorporate neuroimaging into a randomized, blinded, longitudinal trial in FM using acupuncture interventions with significantly different amounts of somatosensory afference: (1) EA and (2) mock laser (ML) acupuncture - a relatively new form of sham acupuncture that does not induce any somatosensory afference.
Our first Aim will characterize, at baseline, the altered somatosensory-related neurocircuitry underlying chronic pain in FM.
Aim 2 will evaluate longitudinal desensitization effects of electro- and mock laser acupuncture on the neurocircuitry underlying chronic pain in FM.
Aim 3 will then evaluate the ability of altered neurocircuitry at baseline to predict clinical response to both electro- and mock laser acupuncture. These analyses will provide much needed information about which patients might benefit most from which acupuncture interventions.

Public Health Relevance

Acupuncture is a heterogeneous family of therapeutic interventions, and one important variable that differs substantially across different forms of acupuncture is the somatosensory afference input to the central nervous system. Our study will incorporate different neuroimaging markers we have developed to assay clinical pain, as outcome measures in a longitudinal trial of different forms of real and sham acupuncture in the treatment of fibromyalgia, a functional chronic pain disorder. Understanding the role that somatosensation plays in acupuncture analgesia will allow us to optimize which acupuncture therapy will most benefit which fibromyalgia patients.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Research Project (R01)
Project #
1R01AT007550-01
Application #
8420814
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Huntley, Kristen V
Project Start
2013-05-01
Project End
2018-04-30
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
1
Fiscal Year
2013
Total Cost
$679,493
Indirect Cost
$191,937
Name
University of Michigan Ann Arbor
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Lee, Jeungchan; Mawla, Ishtiaq; Kim, Jieun et al. (2018) Machine learning-based prediction of clinical pain using multimodal neuroimaging and autonomic metrics. Pain :
Lee, Yvonne C; Napadow, Vitaly; Loggia, Marco L (2018) Editorial: Functional Connectivity: Dissecting the Relationship Between the Brain and ""Pain Centralization"" in Rheumatoid Arthritis. Arthritis Rheumatol 70:977-980
Lee, Jeungchan; Protsenko, Ekaterina; Lazaridou, Asimina et al. (2018) Encoding of Self-Referential Pain Catastrophizing in the Posterior Cingulate Cortex in Fibromyalgia. Arthritis Rheumatol 70:1308-1318
Sclocco, Roberta; Beissner, Florian; Bianciardi, Marta et al. (2018) Challenges and opportunities for brainstem neuroimaging with ultrahigh field MRI. Neuroimage 168:412-426
Lee, UnCheol; Kim, Minkyung; Lee, KyoungEun et al. (2018) Functional Brain Network Mechanism of Hypersensitivity in Chronic Pain. Sci Rep 8:243
Toschi, Nicola; Kim, Jieun; Sclocco, Roberta et al. (2017) Motion sickness increases functional connectivity between visual motion and nausea-associated brain regions. Auton Neurosci 202:108-113
Schreiber, Kristin L; Loggia, Marco L; Kim, Jieun et al. (2017) Painful After-Sensations in Fibromyalgia are Linked to Catastrophizing and Differences in Brain Response in the Medial Temporal Lobe. J Pain 18:855-867
Kutch, Jason J; Ichesco, Eric; Hampson, Johnson P et al. (2017) Brain signature and functional impact of centralized pain: a multidisciplinary approach to the study of chronic pelvic pain (MAPP) network study. Pain 158:1979-1991
Lazaridou, Asimina; Kim, Jieun; Cahalan, Christine M et al. (2017) Effects of Cognitive-Behavioral Therapy (CBT) on Brain Connectivity Supporting Catastrophizing in Fibromyalgia. Clin J Pain 33:215-221
Garcia, Ronald G; Lin, Richard L; Lee, Jeungchan et al. (2017) Modulation of brainstem activity and connectivity by respiratory-gated auricular vagal afferent nerve stimulation in migraine patients. Pain 158:1461-1472

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