An fMRI study of expectancy on acupuncture treatment outcomes in knee OA

描述（由申请人提供）：许多随机临床试验（RCT）表明针灸是一种有效的治疗各种疼痛条件。仔细研究这些文献，发现不一致的结果：当RCT将针灸与“无治疗”或“标准护理”对照进行比较时，结果往往是确证性的;但当RCT将真正的（真实的）针灸与假针灸进行比较时，结果往往是不确定的，这表明至少有一种愈合成分是由针灸针以外的东西介导的。 最近的一项荟萃分析确定，患者对疼痛缓解的期望是针灸治疗疗效的最有力的预测因素，无论是真针组还是假针组。神经影像学研究已经开始确定针灸和安慰剂镇痛的可检验的机制假设。我们最近对健康受试者的研究表明，在积极期望的背景下，真针和假针都能显著缓解疼痛，但每种作用都是通过可分离和不同的大脑机制实现的。目前的提议将测试这些与verum和假针灸后疼痛缓解相关的不同大脑活动模式是否可以在患有骨关节炎（OA）所致慢性膝关节疼痛的患者中复制。 我们提出了两个实验，直接建立在我们实验室最近的研究膝关节骨性关节炎患者。在第一个实验中，我们将系统地提高患者对真针或假针后疼痛缓解的积极期望，然后量化治疗反应的期望、行为和脑成像（BOLD fMRI）测量之间的关系。在第二个实验中，一个为期5周的纵向机械治疗研究的verum和假针灸，fMRI BOLD反应的伤害性刺激之前和之后的第一次和最后一次治疗会议将检查个人期望的治疗结果，以确定潜在的治疗反应预测。 这种创新方法的意义在于，它可以为真针和假针治疗如何调节疼痛感知提供明确的科学证据。这些实验的结果不仅将促进我们对针灸和安慰剂镇痛机制的理解，还有助于完善未来的研究方法，并为临床实践提供信息。 公共卫生相关性：拟议实验的结果将直接告知治疗膝关节骨关节炎患者的临床医生如何最大限度地发挥针灸治疗的益处。而且，由于这些实验特别提出了这样一个问题：患者对治疗如何缓解疼痛的期望与治疗结果之间的关系是什么，因此这些结果可能会告知护理人员有关骨关节炎和其他慢性疼痛疾病的所有治疗方法。

DESCRIPTION (provided by applicant): Many randomized clinical trials (RCTs) show acupuncture to be an effective treatment for diverse pain conditions. A closer look at this literature shows inconsistent findings: results tend to be confirmatory when RCTs compare acupuncture with 'no treatment' or 'standard care' controls; but inconclusive when RCTs compare genuine (verum) acupuncture with sham acupuncture suggesting that at least one healing component is mediated by something other than the acupuncture needles. A recent meta-analysis identified patient expectation of pain relief as the most robust predictor of acupuncture treatment efficacy, regardless of verum or sham group assignment. Neuroimaging studies have begun identifying testable mechanistic hypotheses for both acupuncture and placebo analgesia. Our recent studies on healthy subjects demonstrate that in the context of positive expectation, both verum and sham acupuncture significantly relieve pain, however each functions via separable and distinct brain mechanisms. The current proposal will test whether these distinct brain activity patterns associated with pain relief following verum and sham acupuncture can be replicated in patients suffering from chronic knee pain due to osteoarthritis (OA). We propose two experiments in patients with knee OA that directly build upon recent research in our laboratory. In the first experiment we will systematically boost patients' positive expectation for pain relief following verum or sham acupuncture, then quantify the relation between expectation, behavioral, and brain imaging (BOLD fMRI) measures of treatment response. In the second experiment, a 5-week longitudinal mechanistic treatment study of verum and sham acupuncture, fMRI BOLD responses to noxious stimuli obtained before and after the first and final treatment sessions will be examined with respect to individual expectation of treatment outcome to identify potential treatment response predictors. This significance of this innovative approach is that it could provide clear scientific evidence for how verum and sham acupuncture treatments modulate pain perception. The results of these experiments will advance our understanding of not only acupuncture and placebo analgesia mechanisms, but also help refine future research methods, and inform clinical practice. PUBLIC HEALTH RELEVANCE: The results of the proposed experiments will directly inform clinicians who treat patients with osteoarthritis of the knee about how to maximize the benefits of acupuncture treatments. And because the experiments specifically asks the question of what is the relation between a patient's expectation of how a treatment will relieve their pain and the outcome of the treatment, the results will potentially inform care givers about all treatments for osteoarthritis and other chronic pain disorders.