ObjectivesExpectation can significantly modulate pain and treatment effects. This study aims to investigate if boosting patients' expectancy can enhance the treatment of knee osteoarthritis (KOA), and its underlying brain mechanism.MethodsSeventy-four KOA patients were recruited and randomized to three groups: boosted acupuncture (with a manipulation to enhance expectation), standard acupuncture, or treatment as usual (TAU). Each patient underwent six treatments before being debriefed, and four additional treatments after being debriefed. The fMRI scans were applied during the first and sixth treatment sessions.ResultsWe found significantly decreased knee pain in the boosted acupuncture group compared to the standard acupuncture or TAU groups after both six and ten treatments. Resting state functional connectivity (rsFC) analyses using the nucleus accumbens (NAc) as the seed showed rsFC increases between the NAc and the medial prefrontal cortex (MPFC)/rostral anterior cingulate cortex (rACC) and dorsolateral prefrontal cortex in the boosted group as compared to the standard acupuncture group after multiple treatments. Expectancy scores after the first treatment were significantly associated with increased NAc-rACC/MPFC rsFC and decreased knee pain following treatment.ConclusionsOur study provides a novel method and mechanism for boosting the treatment of pain in patients with KOA. Our findings may shed light on enhancing outcomes of pharmacological and integrative medicines in clinical settings.

There are multiple ways in which working memory can influence selective attention. Aside from the content-specific effects of working memory on selective attention, whereby attention is more likely to be directed towards information that matches the contents of working memory, the mere level of load on working memory has also been shown to have an effect on selective attention. Specifically, high load on working memory is associated with increased processing of irrelevant information. In most demonstrations of the effect to-date, this has led to impaired target performance, leaving open the possibility that the effect partly reflects an increase in general task difficulty under high load. Here we show that working memory load can result in a performance gain when processing of distracting information aids target performance. The facilitation in the detection of a low-contrast Gabor stimulus in the presence of collinear flanking Gabors was greater when load on a concurrent working memory task was high, compared to low. This finding suggests that working memory can interact with selective attention at an early stage in visual processing.

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