While acupuncture has been shown to be effective for chronic low back pain (cLBP) in many clinical trials, there is a current state of uncertainty as to why acupuncture is effective. In multiple trials, acupuncture does not demonstrate significant improvement over placebo controls based on sham needling, which can involve insertive or non-insertive """"""""needling"""""""" with a device that presses against the skin. However, the use of sham needling as placebo control has been criticized since it may be an active therapy akin to acupressure. Ultimately, this state of uncertainty arising from acupuncture clinical trials exists because we lack understanding about the mechanisms of action underlying real versus various forms of sham acupuncture. Specifically, we do not know just how important needle insertion and somatosensory afference are to the mechanisms underlying acupuncture analgesia in cLBP. There is reason to believe that real acupuncture may have different mechanisms from sham acupuncture, and we propose that neuroimaging can inform a testable neurobiological model that identifies diverse mechanisms of action for acupuncture therapy with versus without somatosensory afference. These hypotheses will be tested on a specific chronic pain population, idiopathic cLBP, which has a significant """"""""central"""""""" pain component characterized by aberrant somatotopy and augmented brain response to experimental pain (hyperalgesia). The brain correlates of clinical pain in cLBP have been less well characterized, but our own data suggests that clinical pain is associated with increased intrinsic functional connectivity between pain processing brain regions (e.g insula) and specific intrinsic connectivity networks. These networks include the executive attention network (EAN) and """"""""default mode network"""""""" (DMN), a network thought to underlie self-referential cognition and modulated by acupuncture. We propose that real and different forms of sham acupuncture differentially modulate these networks, and alter somatotopy. Our overall goal is to evaluate whether the brain neurocircuitry subserving cLBP responds differentially to real versus """"""""sham"""""""" acupuncture with and without somatosensory afference. To test our specific hypotheses, we will employ functional magnetic resonance imaging (fMRI) to assess brain networks subserving both clinical and experimental pain, acupuncture stimulation, and somatotopy in cLBP patients. These measures will be performed at baseline and following 7 weeks of (a.) acupuncture, ACUP;(b.) sham acupuncture with somatosensation, SHAM-sn;(c.) sham acupuncture without somatosensation, SHAM-ml or (d.) wait list, WL.
Aim 1 will characterize the pain neurocircuitry in cLBP, as well as low back SI somatotopy, and brain response to acupuncture stimuli.
Aim 2 will evaluate longitudinal effects of ACUP vs. SHAM-sn on brain networks and SI somatotopy in cLBP, while Aim 3 will evaluate the longitudinal effects of SHAM-sn vs. SHAM-ml on these same neuroimaging markers. Understanding the neural influence of somatosensation on acupuncture placebo effects will significantly impact our understanding of acupuncture and allow for development of more inert acupuncture placebos.

Public Health Relevance

The morbidity and resultant financial costs associated with chronic low back pain (cLBP) are incredibly high. Unfortunately, conventional treatment options for cLBP have yielded only limited relief for patients. Acupuncture has been a popular option for treating cLBP but the mechanisms behind this therapy are not well understood. This proposal will differentiate the components of acupuncture for the treatment of cLBP using fMRI methodologies well suited for evaluating brain network plasticity in longitudinal studies.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Research Program Projects (P01)
Project #
5P01AT006663-04
Application #
8703017
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
Gollub, Randy L; Kirsch, Irving; Maleki, Nasim et al. (2018) A Functional Neuroimaging Study of Expectancy Effects on Pain Response in Patients With Knee Osteoarthritis. J Pain 19:515-527
Sclocco, Roberta; Beissner, Florian; Bianciardi, Marta et al. (2018) Challenges and opportunities for brainstem neuroimaging with ultrahigh field MRI. Neuroimage 168:412-426
Kong, Jian; Wang, Zengjian; Leiser, Jaclyn et al. (2018) Enhancing treatment of osteoarthritis knee pain by boosting expectancy: A functional neuroimaging study. Neuroimage Clin 18:325-334
Wang, Yuming; Fang, Ji-Liang; Cui, Bingnan et al. (2018) The functional and structural alterations of the striatum in chronic spontaneous urticaria. Sci Rep 8:1725
Lee, Jeungchan; Mawla, Ishtiaq; Kim, Jieun et al. (2018) Machine learning-based prediction of clinical pain using multimodal neuroimaging and autonomic metrics. Pain :
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
Tu, Yiheng; Fang, Jiliang; Cao, Jin et al. (2018) A distinct biomarker of continuous transcutaneous vagus nerve stimulation treatment in major depressive disorder. Brain Stimul 11:501-508
Fang, Jiliang; Egorova, Natalia; Rong, Peijing et al. (2017) Early cortical biomarkers of longitudinal transcutaneous vagus nerve stimulation treatment success in depression. Neuroimage Clin 14:105-111
Song, Wenwen; Cao, Zhijian; Lang, Courtney et al. (2017) Disrupted functional connectivity of striatal sub-regions in Bell's palsy patients. Neuroimage Clin 14:122-129
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

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