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Kong Q, Sacca V, Walker K, Hodges S, Kong J. Thalamocortical Mechanisms Underlying Real and Imagined Acupuncture. Biomedicines 2023; 11:1830. [PMID: 37509469 PMCID: PMC10377130 DOI: 10.3390/biomedicines11071830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/30/2023] Open
Abstract
Both acupuncture and imagery have shown potential for chronic pain management. However, the mechanisms underlying their analgesic effects remain unclear. This study aims to explore the thalamocortical mechanisms underlying acupuncture and video-guided acupuncture imagery treatment (VGAIT), a combination of acupuncture and guided imagery, using the resting-state functional connectivity (rsFC) of three thalamic subdivisions-the ventral posterolateral thalamus (VPL), mediodorsal thalamus (MD), and motor thalamus subregion (Mthal)-associated with somatosensory, limbic, and motor circuity. Twenty-seven healthy individuals participated in a within-subject randomized crossover design study. Results showed that compared to sham acupuncture, real acupuncture altered the rsFC between the thalamus and default mode network (DMN) (i.e., mPFC, PCC, and precuneus), as well as the prefrontal and somatosensory cortex (SI/SII). Compared to the VGAIT control, VGAIT demonstrated greater rsFC between the thalamus and key nodes within the interoceptive network (i.e., anterior insula, ACC, PFC, and SI/SII), as well as the motor and sensory cortices (i.e., M1, SMA, and temporal/occipital cortices). Furthermore, compared to real acupuncture, VGAIT demonstrated increased rsFC between the thalamus (VPL/MD/Mthal) and task-positive network (TPN). Further correlations between differences in rsFC and changes in the heat or pressure pain threshold were also observed. These findings suggest that both acupuncture- and VGAIT-induced analgesia are associated with thalamocortical networks. Elucidating the underlying mechanism of VGAIT and acupuncture may facilitate their development, particularly VGAIT, which may be used as a potential remote-delivered pain management approach.
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Affiliation(s)
| | | | | | | | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
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Zhou J, Zeng F, Cheng S, Dong X, Jiang N, Zhang X, Tang C, He W, Chen Y, Sun N, Zhou Y, Li X, Hu S, Sun R, Wintermark M, Yang W, Liang F, Li Z. Modulation effects of different treatments on periaqueductal gray resting state functional connectivity in knee osteoarthritis knee pain patients. CNS Neurosci Ther 2023. [PMID: 36890655 DOI: 10.1111/cns.14153] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The analgesic effect of acupuncture is widely recognized, but the mechanical characteristics of acupuncture for pain relief, compared to non-steroidal anti-inflammatory (NSAIDs) and placebo medication, remain unknown. AIMS To compare the modulation effects of acupuncture treatment with NSAIDs and placebo medication on descending pain modulation system (DPMS) in knee osteoarthritis (KOA) patients. METHODS This study recruited 180 KOA patients with knee pain and 41 healthy controls (HCs). Individuals with KOA knee pain were divided randomly into groups of verum acupuncture (VA), sham acupuncture (SA), celecoxib (SC), placebo (PB), and waiting list (WT), with 36 patients in each group. VA and SA groups included ten sessions of puncturing acupoints or puncturing non-acupoints acupuncture treatment for two successive weeks. Celecoxib capsules were continuously given orally to patients in the SC group at a dosage of 200 mg daily for 2 weeks. In the PB group, patients received a placebo capsule once a day for 2 weeks at the same dosage as celecoxib capsules. In the WL group, patients did not receive any treatment. Patients underwent a resting-state BOLD-fMRI scan pre- and post-receiving the therapy, whereas HCs only underwent a baseline scan. Seed (ventrolateral periaqueductal gray, vlPAG, a key node in DPMS) based resting-state functional connectivity (rs-FC) was applied in the data analysis. RESULTS All groups demonstrated improved knee pain scores relative to the initial state. There was no statistical difference between the VA and SA groups in all clinical outcomes, and vlPAG rs-FC alterations. KOA knee pain individuals reported higher vlPAG rs-FC in the bilateral thalamus than HCs. KOA knee pain patients in the acupuncture group (verum + sham, AG) exhibited increased vlPAG rs-FC with the right dorsolateral prefrontal cortex (DLPFC) and the right angular, which is associated with knee pain improvement. In contrast with the SC and PB group, the AG exhibited significantly increased vlPAG rs-FC with the right DLPFC and angular. Contrary to the WT group, the AG showed greater vlPAG rs-FC with the right DLPFC and precuneus. CONCLUSIONS Acupuncture treatment, celecoxib, and placebo medication have different modulation effects on vlPAG DPMS in KOA knee pain patients. Acupuncture could modulate vlPAG rs-FC with brain regions associated with cognitive control, attention, and reappraisal for knee pain relief in KOA patients, compared with celecoxib and placebo medication.
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Affiliation(s)
- Jun Zhou
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zeng
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shirui Cheng
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaohui Dong
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Nannan Jiang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinyue Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chenjian Tang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenhua He
- The Second Affiliated Hospital of Shanxi, University of Traditional Chinese Medicine, Taiyuan, China
| | - Yang Chen
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ning Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, China
| | - Yuanfang Zhou
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinling Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shengjie Hu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ruirui Sun
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Max Wintermark
- Radiology Department, Stanford University, Stanford, California, USA
| | - Weihua Yang
- Dali Bai Autonomous Prefecture Chinese Medicine Hospital, Dali, China
| | - Fanrong Liang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhengjie Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Multidimensional Pain Modulation by Acupuncture Analgesia: The Reward Effect of Acupuncture on Pain Relief. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3759181. [PMID: 36408345 PMCID: PMC9671730 DOI: 10.1155/2022/3759181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/30/2022] [Accepted: 11/05/2022] [Indexed: 11/12/2022]
Abstract
Pain is an intrinsically unpleasant experience with features that protect an organism by promoting motivation and learning. Pain relief, a negative reinforcement of pain, is considered a reward and activates the brain's reward system. The reward circuit in the brain involves reward and pain. Acupuncture has a multidimensional and comprehensive regulating effect on chronic pain. However, the reward effect of acupuncture in relieving chronic pain and the mechanism of the brain reward circuit involved in acupuncture analgesia are not thoroughly studied. In this article, we have reviewed the definition of pain abnormalities and negative emotions in patients with chronic pain, the conceptual characteristics of analgesic reward, and the new progress in studying brain reward circuits and functions. Moreover, we have expounded on the critical clinical and scientific significance of studying the reward effect of acupuncture analgesia and related brain reward circuits, the pain mechanism obtained from human neuroimaging studies, and the survey results on the effects of acupuncture on reward/motivation circuits. Some viewpoints and suggestions on the reward effect of acupuncture analgesia and related reward circuits have been put forward to clarify the multidimensional characteristics and benign regulation of acupuncture analgesia. Studies on the reward effect of acupuncture in relieving chronic pain and the regulating effect of the brain reward loop on acupuncture analgesia help to deepen the clinical understanding of acupuncture analgesia, innovate the research concept of acupuncture analgesia, and provide help for further studies on the central mechanism of acupuncture in improving chronic pain in the future.
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