Central Mechanisms of Acupuncture in the Treatment of Chronic /R.Manber/J.Kong

针灸越来越多地被美国公众用来治疗慢性疼痛。最近的两个 开创性的临床试验证实了其治疗慢性下腰痛的优越性。 (CLBP)。然而，有一个关键问题仍然存在：真针疗法与传统针灸疗法之间的临床差异很小。 (VA)和安慰剂针灸(PA)。与此同时，对动物和健康人体模型的研究揭示了 VA和PA的中枢机制。然而，几乎没有做什么工作来将这些发现转化为 健康的人体模型对慢性疼痛条件，如CLBP。我们的目标是致力于澄清 针灸在安慰剂作用之外发挥其治疗作用的机制。 中枢疼痛和情绪处理的失调越来越被认为是导致 慢性阻塞性肺疾病的发病机制。其他人和我们小组的研究表明，针灸具有治疗作用 在与CLBP发病机制相关的中枢过程中产生影响。这些过程 包括中枢痛觉调节和情绪调节。此外，对收益的预期也一直在 被证明是针灸反应的重要中介。我们希望勾勒出共同的和 VA和PA在CLBP中的不同作用机制 生物和心理因素。在一系列到两个创新设计中，我们计划a)分离和阐明 PA无反应者中VA的独特机制；b)比较 通过随机选择对VA或PA有反应的人来治疗VA和PA。具体的机制是 我们将研究疼痛促进和抑制的机制，以及涉及情绪调节的机制 它们是已知的调节疼痛体验和预期作用的物质。

Acupuncture is increasingly used by the American Public for the treatment of chronic pain. Two recent seminal clinical trials have established its superiority to usual care for the treatment of chronic low back pain (CLBP). However, one key issue remains: minimal clinical difference is found between verum acupuncture (VA) and placebo acupuncture (PA). Meanwhile studies in animals and healthy human models reveal distinct central mechanisms for VA and PA. However, little work has been done to translate the findings from healthy human models to chronic pain conditions such as CLBP. Our aim is to focus on elucidating mechanisms by which acupuncture exerts its therapeutic effects above and beyond the placebo effect. Dysregulation in central pain and emotional processing is increasingly recognized as a key contributor to the pathogenesis of CLBP. Works from others and our group show that acupuncture exerts therapeutic influence in the same central processes as those involved in the pathogenesis on CLBP. These processes include central pain modulation and emotional regulation. In addition, expectations of benefit has also been shown to be an important mediator of response to acupuncture. We hope to delineate the common and differential mechanisms of VA and PA in the CLBP by characterize their effect on the aforementioned biological and psychological factors. In a series to two innovative designs, we plan to a) isolate and elucidate the unique mechanism of VA among those who have NOT responded to PA; b) compare the mechanisms of VA and PA by randomizing those who HAVE responded to either VA or PA. The specific mechanisms that we will study are mechanisms of pain facilitation and inhibition, mechanisms involved in emotion regulation that are known to modulate the pain experience, and the role of expectancy.