Soft Tissue Biomechanical Behavior During Acupuncture in Low Back Pain

描述（由申请人提供）：本提案的目的是验证慢性或复发性腰痛（LBP）受试者对针刺有异常软组织反应的总体假设，并且这种改变的反应与肌肉周围结缔组织结构和生物力学异常有关。我们还将测试LBP针刺反应的改变是普遍的，还是像传统针灸理论预测的那样局限于特定部位。80名LBP和80名无LBP受试者将接受计算机机器人针刺和超声弹性成像的一次测试。将比较腰痛与无腰痛的经络与非经络、背部和腿部的穴位与非穴位的针刺扭矩、力和组织位移模式（目的1）。我们还将通过测量肌周结缔组织厚度、超声信噪比、结构连续性和生物力学参数（刚度和阻尼）来评估下背部的软组织结构和生物力学特征（目标2）。完成本研究的目的将：(1)促进我们对针灸机制的理解；(2)为研究结合结缔组织和神经可塑性的LBP新的动态病理生理模型提供第一步；(3)提供结缔组织结构和生物力学的客观结果测量，可用于未来针灸和其他治疗LBP的临床试验。相关性：尽管针灸广泛用于治疗腰痛（LBP），但其促进腰痛愈合的机制在很大程度上仍不清楚。这种认识的缺乏限制了改进治疗方法的发展，并阻碍了针灸纳入腰痛的主流治疗。此外，LBP本身的机制尚不清楚，这进一步损害了研究治疗机制的努力。这项研究将为针灸和腰痛的基本现象提供新的、客观的测量。证明针刺反应在腰痛中是异常的，并理解为什么这些反应是异常的，将使我们更接近于理解1)为什么腰痛发生，2)针灸如何促进这种常见和致残的疾病的愈合。

DESCRIPTION (provided by applicant): The goal of this proposal is to test the overall hypothesis that subjects with chronic or recurrent low back pain (LBP) have an abnormal soft tissue response to acupuncture needling, and that this altered response is associated with abnormal perimuscular connective tissue structure and biomechanics. We will also test whether or not altered needling responses in LBP are generalized, or localized to specific locations as predicted by traditional acupuncture theory. 80 LBP and 80 No-LBP subjects will undergo one testing session using computerized robotic acupuncture needling and ultrasound elastography. Needle torque, force and tissue displacement patterns will be compared in LBP vs. No-LBP at Meridians vs. Non-Meridians and Acupuncture Points vs. Non-Acupuncture Points in the back and leg (Aim 1). We also will evaluate soft tissue structural and biomechanical characteristics in the low back by measuring perimuscular connective tissue thickness, ultrasound signal to noise ratio, structural continuity and biomechanical parameters (stiffness and damping) (Aim 2). Accomplishing the Aims of this study will 1) advance our understanding of acupuncture mechanisms 2) provide a first step toward investigating a new dynamic pathophysiological model for LBP incorporating connective tissue and neuroplasticity and 3) provide objective outcome measures of connective tissue structure and biomechanics that can be used in future clinical trials of acupuncture and other therapies for LBP. Relevance: Despite its widespread use for the treatment low back pain (LBP), the mechanism by which acupuncture may promote healing in this condition remains largerly unknown. This lack of understanding constrains the development of improved treatments and is an obstacle to the integration of acupuncture into the mainstream management of LBP. Moreover, the mechanism of LBP itself is poorly understood, further impairing efforts to investigate treatment mechanisms. This study will provide new, objective measurements of phenomena fundamental to both acupuncture and LBP. Demonstrating that acupuncture needling responses are abnormal in LBP, and understanding why these responses are abnormal will bring us one step closer to understanding 1) why LBP occurs and 2) how acupuncture can promote healing in this common and disabling condition.