Acupuncture has been effectively used to treat chronic
pain conditions. However, the lack of understanding of underlying mechanisms of
acupuncture, and reported cases of failure to produce greater clinical
improvement, compared with sham acupuncture, have slowed down the incorporation
of this modality into the mainstream of healthcare practice.
Functional magnetic resonance image (fMRI) showed that
acupuncture stimulation caused changes in neuronal activity in many brain
areas, including medial frontal cortex (MFC), hippocampus and periaqueductal
gray (PAG). PAG is a pain-learning brain region as it is able to form long-term
pain behavioural and nociceptive memory. Brain regional connectivity of PAG-MFC
and PAG-hippocampus are believed to be associated with long-term pain learning
process and pain memory.
Recently Dr. Jian Kong and colleagues in Harvard Medical
School, the United States conducted a clinical study to assess the effect of
repeated acupuncture specifically on brain regions known to support functions
dysregulated in chronic pain conditions, such as knee osteoarthritis.
Forty-nine patients with knee osteoarthritis were recruited and randomly
divided into verum acupuncture and sham acupuncture groups. Patients in verum
group were given acupuncture at ST35 and Xiyan points for the low-dose verum
groups and additionally at GB34, SP9, GB39 and SP6 for the high-dose group, six
times within one month. Treatments 1, 3, and 6 were conducted with the patient
lying in a 3 Tesla MRI scanner. Treatments 2, 4 and 5 took place in a
behavioural testing room. Sham acupuncture was performed with non-penetrating
Streitberger needles at above acupoints.
It was shown at the end of study that verum acupuncture
produced a significant decrease in knee pain and improved function in sport,
and modulated connectivity of PAG-MFC and PAG-hippocampus, compared with sham
acupuncture group.
Results of study have showed that repeated verum
acupuncture might act by restoring the balance in the connectivity of the key
pain brain regions, altering pain-related attention and memory. It also has
implications for the assessment of the efficacy of acupuncture treatment with
regard to reversal of chronic pain disorders.
Reference:
N Egorova et al., Repeated
verum but not placebo acupuncture normalizes connectivity in brain regions
dysregulated in chronic pain. NeuroImage: Clinical 9 (2015) 430–435. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0067485
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