Neuroimaging Approaches to Deconstructing Acupuncuture for Chronic Pain

神经影像学方法解构针灸治疗慢性疼痛

基本信息

批准号：
8651430
负责人：
RICHARD E HARRIS
金额：
$ 64.32万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-05-01 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8651430
关键词：
Absence of pain sensation Acupuncture Analgesia Acupuncture Therapy Acupuncture procedure Aminobutyric Acids Biological Assay Blinded Brain Clinical Devices Electroacupuncture Family Fibromyalgia Functional Magnetic Resonance Imaging Glutamates Glutamine Goals Heterogeneity Insula of Reil Intervention Lasers Magnetic Resonance Spectroscopy Manuals Measures Meta-Analysis Methods Needles Nervous system structure Neuraxis Neurobiology Neurotransmitters Nociception Outcome Outcome Measure Pain Pain Disorder Patients Perception Peripheral Physiological Physiology Placebos Play Predictive Value Procedures Process Protons Psychophysics Randomized Rest Role Sensory Signal Transduction Somatosensory Cortex Stimulus Testing Therapeutic Intervention Time chronic pain cohort desensitization gamma-Aminobutyric Acid neuroimaging pressure response somatosensory

项目摘要

Several recent meta-analyses of acupuncture for chronic pain have shown that verum acupuncture is not superior to sham/placebo acupuncture. However, these same meta-analyses have also noted significant heterogeneity in acupuncture methods across trials, which complicates combining results. For example, while electro-acupuncture (EA) was superior to sham acupuncture in relieving pain for fibromyalgia (FM), manual acupuncture (MA) was not. In terms of physiologic action, EA and MA are very different procedures. They effect different peripheral targets and induce different psychophysical perceptions, manifest in different brain response. In fact, somatosensory afference may be a key variable in acupuncture analgesia, and the use of some sham needling devices (e.g. Streitberger Needle (SN)) has been criticized since they also produce somatosensation. Moreover, somatosensation may be a particularly important variable for FM, as this chronic pain disorder is known to display altered sensory and nociceptive amplification. Thus, we hypothesize that EA has been more effective for FM because it functions as a desensitization therapy, which when applied repeatedly over multiple treatment sessions, gradually habituates the nervous system to continuing endogenous pain and somatosensory signaling. Our overall goal is to evaluate the impact of acupuncture-induced somatosensory afference on altered neurobiology and analgesia in FM. To test our hypotheses, we will incorporate neuroimaging into a randomized, blinded, longitudinal trial in FM using acupuncture interventions with significantly different amounts of somatosensory afference: (1) EA and (2) mock laser (ML) acupuncture - a relatively new form of sham acupuncture that does not induce any somatosensory afference. Our first Aim will characterize, at baseline, the altered somatosensory-related neurocircuitry underlying chronic pain in FM. Aim 2 will evaluate longitudinal desensitization effects of electro- and mock laser acupuncture on the neurocircuitry underlying chronic pain in FM. Aim 3 will then evaluate the ability of altered neurocircuitry at baseline to predict clinical response to both electro- and mock laser acupuncture. These analyses will provide much needed information about which patients might benefit most from which acupuncture interventions.

慢性疼痛的针灸最近的一些荟萃分析表明，Verum针灸不优于假/安慰剂针灸。但是，这些相同的荟萃分析还指出了整个试验的针灸方法中的显着异质性，这使得结合结果复杂化。例如，虽然电针（EA）在缓解纤维肌痛（FM）的疼痛方面优于假针灸，但手动针灸（MA）却没有。在生理行动方面，EA和MA是非常不同的程序。它们会影响不同的外围靶标，并引起不同的心理物理感知，体现在不同的大脑反应中。实际上，体感传播可能是针灸镇痛中的关键变量，并且由于它们也产生了体感应，因此对某些假针装置（例如Streitberger针（SN））的使用（例如Streitberger针（SN））受到批评。此外，对于FM而言，体质可能是一个特别重要的变量，因为已知这种慢性疼痛障碍会显示出改变的感觉和伤害性扩增。因此，我们假设EA对FM更有效，因为它可以用作脱敏疗法，当在多次治疗课程上反复应用该疗法时，逐渐将神经系统习惯于继续内源性内源性疼痛和体验信号传导。我们的总体目标是评估针灸诱导的体感对FM神经生物学和镇痛改变的影响。 To test our hypotheses, we will incorporate neuroimaging into a randomized, blinded, longitudinal trial in FM using acupuncture interventions with significantly different amounts of somatosensory afference: (1) EA and (2) mock laser (ML) acupuncture - a relatively new form of sham acupuncture that does not induce any somatosensory afference.我们的第一个目标将在基线上表征FM中慢性疼痛的与体感相关的神经相关性改变的变化。 AIM 2将评估电和模拟激光针灸对FM中慢性疼痛的神经记录的纵向脱敏作用。然后，AIM 3将评估基线上神经通路改变的能力，以预测对电和模拟激光针灸的临床反应。这些分析将提供急需的信息，以了解哪些患者可能受益于哪些针灸干预措施。