Brain Plasticity in Carpal Tunnel Syndrome and its Response to Acupuncture

腕管综合征的脑可塑性及其对针灸的反应

• 批准号: 7809795
• 负责人: VITALY NAPADOW
• 金额: $ 60.57万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-12-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7809795
• 关键词: Absenteeism at work; Acupressure; Acupuncture Points; Acupuncture Therapy; Acupuncture procedure; Ancillary Study; Autistic Disorder; Basal Ganglia; Biological Markers; Brain; Caring; Carpal Tunnel Syndrome; Clinical; Complement; Data; Digit structure; Discrimination; Disinhibition; Distal; Dystonia; Entrapment Neuropathies; Evaluation; Fibromyalgia; Forearm; Functional Magnetic Resonance Imaging; Functional disorder; Funding; Grant; Health; Injury; Judgment; Lesion; Low Back Pain; Metric; Modeling; N-Methylaspartate; Nerve; Neural Conduction; Neuraxis; Neuronal Plasticity; Neurons; Outcome Measure; Pain; Paresthesia; Pathology; Patients; Peripheral Nerves; Placebos; Process; Protocols documentation; Randomized; Rehabilitation therapy; Sensory Process; Severities; Site; Somatosensory Cortex; Stimulus; Study models; Symptoms; Tactile; Testing; Therapeutic; Validation; Wrist; biobehavior; conditioning; disability; lost work time; median nerve; neuroimaging; neuromechanism; public health relevance; response; somatosensory

DESCRIPTION (provided by applicant): Carpal tunnel syndrome (CTS), the most common entrapment neuropathy, is exceeded only by low back pain as a cause of employee absenteeism. Maladaptive neuroplasticity in the brain of CTS patients has been noted by several neuroimaging studies, and includes altered primary somatosensory cortex (SI) somatotopy and SI hyperactivation, which may be due to cortical disinhibition. We hypothesize that the disability and pain associated with CTS is not only a consequence of the peripheral nerve lesion but also relates to the observed, altered cortical sensory processing. Acupuncture has shown potential as a conservative treatment option for CTS, but its mechanisms of action are unknown. CTS is an excellent model for studying acupuncture mechanisms as clinical improvement can be evaluated by several objective outcome measures in addition to subjective symptom assessments. We propose that acupuncture, a somatosensory conditioning stimulus, can reverse CTS-associated maladaptive neuroplasticity including cortical disinhibition via use-dependent plasticity. Furthermore, it is known that repetitive stimulation - in the healthy brain - results in temporally defined changes of cortical activity, the most prominent of which is a reduction in cortical response with extended stimulus duration. This is referred to as adaptation. Cortical disinhibition is known to modulate adaptation metrics. We propose that a biobehavioral assessment of cortical disinhibition quantified by maladaptive change in adaptation metrics will be sensitive to brain abnormalities in CTS. Thus, these metrics complement our fMRI data, potentially providing important cross-validation via an independent testing protocol. CTS patients randomized to verum acupuncture (forearm acupoints) and placebo acupuncture groups will be evaluated with adaptation metrics. We hypothesize that verum, but not sham acupuncture will alleviate CTS pathology and increase cortical inhibition, leading to normalization in adaptation metrics. Improvement in adaptation metrics will correlate with fMRI biomarkers and median nerve dysfunction. Hence, we will combine biobehavioral testing with fMRI neuroimaging to better delineate the central mechanisms by which acupuncture ameliorates CTS pathology. By understanding the neural mechanisms of different forms of acupuncture therapy, we hope to refine acupuncture utility for CTS and advance rehabilitation options in CTS care. PUBLIC HEALTH RELEVANCE: Carpal tunnel syndrome (CTS) is a very common ailment resulting from excessive compression of the median nerve in the wrist and consistently leads in lost work time among major disabling injuries. Acupuncture has shown potential as a conservative treatment option for CTS, but its mechanisms of action are not known. This grant will assess changes in brain activity and cortical disinhibition that accompany the dysfunction in the wrist, as well as how acupuncture might modify both local nerve health and brain function to help treat CTS patients.

描述(申请人提供)：腕管综合征(CTS)，最常见的卡压性神经病，只有腰痛是员工旷工的原因之一。一些神经影像研究发现，CTS患者脑内存在适应性不良的神经可塑性，包括初级躯体感觉皮层(SI)躯体动作的改变和SI的过度激活，这可能是由于皮质去抑制所致。我们推测，与CTS相关的残疾和疼痛不仅是周围神经损伤的结果，还与观察到的皮质感觉加工改变有关。针灸已显示出作为一种保守治疗CTS的潜力，但其作用机制尚不清楚。CTS是研究针灸机制的一个很好的模型，因为除了主观症状评估外，临床改善可以通过几个客观结果指标来评估。我们认为，作为一种躯体感觉条件性刺激，针灸可以逆转CTS相关的适应不良神经可塑性，包括通过使用依赖性可塑性来解除皮质抑制。此外，众所周知，在健康的大脑中，重复刺激会导致皮质活动的时间性变化，其中最显著的是随着刺激持续时间的延长，皮质反应减弱。这被称为适应。众所周知，皮质去抑制可以调节适应指标。我们认为，通过适应指标的不良适应变化来量化皮质去抑制的生物行为评估将对CTS的脑异常敏感。因此，这些指标补充了我们的fMRI数据，有可能通过独立的测试协议提供重要的交叉验证。将CTS患者随机分为真性针灸(前臂穴位)组和安慰剂针刺组，将采用适应度量法进行评估。我们假设，真针，而不是假针灸，将缓解CTS的病理，增加皮质抑制，导致适应指标的正常化。适应指标的改善将与功能磁共振生物标记物和正中神经功能障碍相关。因此，我们将结合生物行为测试和功能磁共振神经成像来更好地描述针灸改善CTS病理的中枢机制。通过了解不同形式针灸疗法的神经机制，我们希望改进针灸治疗CTS的作用，并在CTS护理中提出康复选择。 公共卫生相关性：腕管综合征(CTS)是一种非常常见的疾病，由腕部正中神经过度压迫引起，在重大致残性损伤中一直导致工作时间损失。针灸已显示出作为一种保守治疗CTS的潜力，但其作用机制尚不清楚。这笔赠款将评估伴随手腕功能障碍而出现的大脑活动和皮质去抑制的变化，以及针灸如何改变局部神经健康和大脑功能，以帮助治疗CTS患者。