Acupuncture "Rewires" the Brain … with Lasting Effects.
Acupuncture "Rewires" the Brain … with Lasting Effects.
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针灸“重新连接”大脑……具有持久的效果。
DOI：
10.1089/acm.2017.29027.reh
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Harris,RichardE
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文献类型：
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作者：
Harris,RichardE
感觉现象可以给周围和中枢神经系统留下持久的变化。例如，当周围神经被切断或损坏时，如在手术中，脊髓和大脑内突触可塑性的变化被认为是损伤的信号，导致随后的主观疼痛感觉，可能是急性的，持续时间较长，或慢性的。人们很少理解的是，以治疗方式形式出现的感觉现象是如何导致症状改善的？针灸的治疗仪式当然包括身体感觉，比如触诊穴位，用针插入皮肤，也包括手工操作针或其他方式，包括热和电刺激。事实上，德气的感觉长期以来一直被认为是针灸“好结果”的一个预测因素（尽管在很大程度上缺乏关于慢性疼痛的研究证据）。那么，如何将针灸针插入体内导致症状的持久变化呢？中枢神经系统是否参与其中？如果是，是如何参与的？Maeda等人发表在多学科期刊《Brain》上的有趣研究为该领域提供了新的数据，同时正面解决了这些问题。Maeda等人在大量腕管综合征（CTS）患者中研究了不同类型针灸对周围和中枢神经系统的影响。这项研究建立在越来越多的工作基础上，该团队已经表明，CTS患者在对手指刺激做出反应时，在感觉皮层内表现出增强的大脑活动。在之前的一项研究中，该团队发现，这种增强的大脑活动可以通过针灸来调节。具体来说，在CTS中，2号和3号手指的体位表征（大脑内的位置）更紧密地并列在一起，而在针灸治疗后，这种距离增加了，这种变化与临床结果的改善有关。这些结果来自一项动力不足的试点试验，也不是虚假控制，因此需要该小组进行更大更明确的研究。Maeda等人的研究比较了局部和远端针刺方案，并在大样本（n= 80）的CTS患者中，将这些效果与非皮肤穿透假干预进行了对比。在任何治疗前的基线，所有CTS患者都接受了包括功能性磁共振成像（fMRI）在内的脑神经成像，其中大脑对手指刺激的反应被激发，以及弥散张量成像（DTI），它评估水的扩散，是神经元完整性的标志。然后，患者被随机分为三组：局部针灸集中在受损的手腕，远端针灸在对侧脚踝，或非皮肤穿透假针灸干预涉及手腕和腿部。患者接受治疗8周，然后进行治疗后神经影像学检查，与基线相同。然后对参与者进行为期3个月的临床症状评估。重要的是，研究人员还评估了手腕的神经传导速度，这是疾病状态的客观标志，在基线和治疗后，并将这些与主观临床改善和大脑对治疗的反应联系起来。
Sensory phenomena can leave lasting changes on the peripheral and central nervous system. For example, when a peripheral nerve is cut or damaged, as in surgery, changes in synaptic plasticity within the spinal cord and brain are thought to signal the damage resulting in the subsequent subjective sensation of pain, which may be acute, longer lasting, or chronic. 1 What is far less understood is how sensory phenomena in the form of a healing modality can lead to symptom improvement? The healing ritual of acupuncture certainly involves physical sensations such as palpation of acupuncture points, skin penetration with needle insertion, and also needle manipulation manually or with other modalities, including thermal and electrical stimulation. Indeed, the de qi sensation has long been thought of as a predictor of a ‘‘good outcome’’for acupuncture (although the research evidence at least for chronic pain specifically, has largely been lacking). How then does the insertion of an acupuncture needle into the body result in lasting changes in symptoms? Is the central nervous system involved and if so, how? The interesting study by Maeda et al. 2 appearing in the multidisciplinary journal Brain provides new data for the field, while addressing these questions head on. Maeda et al. investigated the effects of different types of acupuncture on the peripheral and central nervous system in a large sample of carpal tunnel syndrome (CTS) patients. This study builds upon a growing body of work wherein this team has shown that CTS patients display augmented brain activity within the sensory cortex in response to finger stimulation. 3 In a previous investigation, this team found that this enhanced brain activity can be modulated by acupuncture. 4 Specifically, the somatotopic representation (location within the brain) of digits 2 and 3 were more closely juxtaposed in CTS, whereas following acupuncture treatment, this distance was increased and this change was associated with improved clinical outcomes. These results originated from an underpowered pilot trial, which was also not sham controlled, thus requiring the group to move to a larger more definitive study.The Maeda et al. study compared local and distal needling formulas, and these effects were contrasted with a nonskin penetrating sham intervention in a large sample (n= 80) of CTS patients. 2 At baseline before any treatment, all CTS patients underwent brain neuroimaging involving functional magnetic resonance imaging (fMRI), wherein brain responses to finger stimulation were elicited, as well as diffusion tensor imaging (DTI), which assesses water diffusion and is a marker for neuronal integrity. Patients were then randomized to one of three groups: local acupuncture focused on the lesioned wrist, distal acupuncture at the contralesional ankle, or a nonskin penetrating sham acupuncture intervention involving both the wrist and leg. Patients underwent treatment for 8 weeks and then had a post-treatment neuroimaging session, identical to baseline. Participants were then followed for 3 months to assess clinical symptoms. Importantly, the investigators also assessed nerve conduction velocities at the wrist, an objective marker of disease status, at baseline and following treatment, and related these to subjective clinical improvements and brain responses to treatment.