The Modulation Effect of Longitudinal Acupuncture on Resting State Functional Connectivity in Knee Osteoarthritis Patients

Abstract

Recent advances in brain imaging have contributed to our understanding of the neural activity associated with acupuncture treatment. In this study, we investigated functional connectivity across longitudinal acupuncture treatments in older patients with knee osteoarthritis (OA). Over a period of 4 weeks (six treatments), we collected resting state functional magnetic resonance imaging (fMRI) scans from 30 patients before and after their first, third and sixth treatments. Clinical outcome showed a significantly greater pain subscore on the Knee Injury and Osteoarthritis Outcome Score (KOOS) (indicative of improvement) with verum acupuncture than with sham acupuncture. Independent component analysis (ICA) of the resting state fMRI data showed that the right frontoparietal network (rFPN) and the executive control network (ECN) showed enhanced functional connectivity (FC) with the rostral anterior cingulate cortex/medial prefrontal cortex, a key region in the descending pain modulatory system, in the verum groups as compared to the sham group after treatments. We also found that the rFPN connectivity with the left insula is (1) significantly associated with changes in KOOS pain score after treatments, and (2) significantly enhanced after verum acupuncture treatments as compared to sham treatment. Analysis of the acupuncture needle stimulation scan showed that compared with sham treatment, verum acupuncture activated the left operculum/insula, which also overlaps with findings observed in resting state analysis. Our results suggest that acupuncture may achieve its therapeutic effect on knee OA pain by modulating functional connectivity between the rFPN, ECN and the descending pain modulatory pathway.Clinical trial number: NCT01079390Electronic supplementary materialThe online version of this article (doi:10.1186/s12990-015-0071-9) contains supplementary material, which is available to authorized users.

Acupuncture treatment modulates the corticostriatal reward circuitry in major depressive disorder

“…Recently, rsFC has been used to investigate the underlying mechanism of acupuncture in healthy subjects (Bai, Qin, Tian, Dai, & Yang, 2009; Dhond, Yeh, Park, Kettner, & Napadow, 2008; Hui et al, 2009; Liu et al, 2009; Qin et al, 2008; Zhong et al, 2012), and patient populations, such as patients with MDD (Deng et al, 2016; Yi et al, 2012), knee osteoarthritis (Chen et al, 2015; Egorova, Gollub, & Kong, 2015), migraines (Li et al, 2016) and Alzheimer’s disease (Wang et al, 2014). For instance, investigators found that peripheral nerve stimulation and acupuncture can significantly modulate the rsFC of the default mode network (Deng et al, 2016; Fang et al, 2016), amygdala (Liu et al, 2016), and anterior cingulate cortex (Yi et al, 2012) in MDD patients.…”

Management of chronic pain using complementary and integrative medicine

“…35 More recently, functional magnetic resonance imaging (MRI) has shown that the improvement in pain by verum (traditional) acupuncture (compared with sham) is accompanied by restoration of the balance in the connectivity of several brain regions implicated in executive control and descending pain modulation, prevention of cortical thinning, and/or altered pain related attention and memory. [36][37][38] Clinical evidence for acupuncture Systemic reviews and meta-analyses have examined the effect of acupuncture on a variety of pain conditions. Most suggest that acupuncture is significantly better than both sham acupuncture and standard care for some but not all types of chronic pain.…”

Repeated acupuncture treatments modulate amygdala resting state functional connectivity of depressive patients

“…Previous studies suggested that acupuncture can significantly modulate rsFC in healthy subjects (Bai et al, 2009, Dhond et al, 2008, Hui et al, 2009; P. Liu et al, 2009, Qin et al, 2008, Zhong et al, 2012) and patient populations, such as patients with knee osteoarthritis (X. Chen et al, 2015, Egorova et al, 2015), migraine (Li et al, 2016a, Li et al, 2016b, Li et al, 2016a, Li et al, 2016b, Zhao et al, 2014) and Alzheimer's disease (Z. Wang et al, 2014).…”