Soft Tissue Biomechanical Behavior During Acupuncture in Low Back Pain

描述（由申请人提供）：本提案的目的是检验以下总体假设：慢性或复发性腰痛（LBP）受试者对针灸具有异常软组织反应，并且这种改变的反应与异常肌周结缔组织结构和生物力学相关。我们还将测试是否改变针刺反应在腰痛是普遍的，或本地化的特定位置，如传统针灸理论预测。80名LBP和80名无LBP受试者将使用计算机化机器人针灸和超声弹性成像进行一次测试。将在背部和腿部的经络与非经络以及穴位与非穴位（目标1）处比较LBP与无LBP的针扭矩、力和组织位移模式。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（目的2）。完成这项研究的目的将1）促进我们对针灸机制的理解2）为研究新的LBP动态病理生理模型提供第一步，包括结缔组织和神经可塑性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LBP疗法的临床试验。相关性：尽管针灸被广泛用于治疗腰痛，但针灸促进腰痛愈合的机制仍不清楚。这种缺乏了解限制了改进治疗的发展，也是将针灸纳入LBP主流治疗的障碍。此外，LBP本身的机制知之甚少，进一步削弱了研究治疗机制的努力。这项研究将提供新的，客观的测量现象的基本针灸和腰痛。证明针灸针刺反应在LBP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理解1）为什么LBP发生和2）针灸如何促进这种常见和禁用条件的愈合。

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.