Soft Tissue Biomechanical Behavior During Acupuncture in Low Back Pain

描述(申请人提供)：这项建议的目标是测试总体假设，即患有慢性或复发性下腰痛(LBP)的受试者对针刺有异常的软组织反应，并且这种改变的反应与异常的肌周结缔组织结构和生物力学有关。我们还将测试LBP中变化的针刺反应是否如传统针灸理论所预测的那样是泛化的，还是局限于特定位置的。80名LBP和80名非LBP受试者将接受一次使用计算机化机器人针灸和超声弹性成像的测试。针的扭矩、力和组织移位模式将在经络与非经络、背部和腿部针灸穴位与非针灸穴位(目标1)的LBP与非LBP进行比较。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)来评估下背部软组织的结构和生物力学特性(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新的LBP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指标，可用于未来的针灸和其他治疗LBP的临床试验。相关性：尽管针灸被广泛用于治疗下腰痛，但在这种情况下，针灸促进愈合的机制仍然很大程度上尚不清楚。这种认识的缺乏制约了改进治疗的发展，也是将针灸融入LBP主流管理的障碍。此外，LBP本身的机制知之甚少，进一步损害了研究治疗机制的努力。这项研究将为针灸和LBP提供新的、客观的测量基础现象。证明LBP的针刺反应是异常的，了解这些反应异常的原因将使我们更进一步地了解1)为什么会发生LBP，以及2)在这种常见和致残的情况下，针灸如何促进愈合。

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.