Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs).
Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs).
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DOI：
10.1016/j.neuroimage.2009.05.083
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发表时间：
2009-09
期刊：
影响因子：
5.7
通讯作者：
Clauw, Daniel J.
中科院分区：
文献类型：
--
作者：
Harris, Richard E.;Zubieta, Jon-Kar;Scott, David J.;Napadow, Vitaly;Gracely, Richard H.;Clauw, Daniel J.
关于针刺止痛的作用机制，目前仍存在争议。一种流行的理论是，它涉及内源性阿片抗伤害感受系统和μ-阿片受体(MORS)的激活，但在人类中基本上没有得到证实。这也是一个神经递质系统，调节安慰剂诱导的止痛效果。这种潜在机制的重叠可能解释了在多个对照临床试验中，传统针灸与非传统针灸或假针灸之间缺乏区别的原因。我们比较了传统中医针灸(TA)和假针灸(SA)治疗对诊断为纤维肌痛(FM)的慢性疼痛患者体内MOR结合可用性的短期和长期效果。患者随机接受TA或SA治疗，疗程为四周。在第一次治疗期间用11C-卡芬太尼进行正电子发射断层扫描(PET)一次，一个月后在第八次治疗后重复。针刺疗法在多个疼痛和感觉处理区域，包括扣带回(背侧和膝下)、脑岛、尾状核、丘脑和杏仁核，引起短期内MOR结合电位的增加。针刺疗法也引起了包括扣带回(背侧和生殖周)、尾状核和杏仁核在内的一些相同结构的MOR结合电位的长期增加。在观察到小幅减少的假手术组中，这些短期和长期影响是不存在的，这一效果与之前的安慰剂PET研究更一致。TA后MOR BP的长期增加也与临床疼痛的更大程度的减轻有关。这些发现表明，不同的MOR过程可能介导了针刺和假针刺的临床相关镇痛效应。
Controversy remains regarding the mechanisms of acupuncture analgesia. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and μ-opioid receptors (MORs). This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. This overlap in potential mechanisms may explain the lack of differentiation between traditional acupuncture and either non-traditional or sham acupuncture in multiple controlled clinical trials. We compared both short- and long-term effects of traditional Chinese acupuncture (TA) versus sham acupuncture (SA) treatment on in vivo MOR binding availability in chronic pain patients diagnosed with fibromyalgia (FM). Patients were randomized to receive either TA or SA treatment over the course of four weeks. Positron emission tomography (PET) with 11C-carfentanil was performed once during the first treatment session and then repeated a month later following the eighth treatment. Acupuncture therapy evoked short-term increases in MOR binding potential, in multiple pain and sensory processing regions including the cingulate (dorsal and subgenual), insula, caudate, thalamus, and amygdala. Acupuncture therapy also evoked long-term increases in MOR binding potential in some of the same structures including the cingulate (dorsal and perigenual), caudate, and amygdala. These short- and long-term effects were absent in the sham group where small reductions were observed, an effect more consistent with previous placebo PET studies. Long-term increases in MOR BP following TA were also associated with greater reductions in clinical pain. These findings suggest that divergent MOR processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture.
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