Elsevier

NeuroImage: Clinical

Volume 9, 2015, Pages 430-435
NeuroImage: Clinical

Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain

https://doi.org/10.1016/j.nicl.2015.09.012Get rights and content
Under a Creative Commons license
open access

Highlights

  • Increased PAG–hippocampus connectivity correlates with worse pain in knee osteoarthritis.

  • Reduced PAG–medial frontal connectivity is associated with worse pain during sport.

  • Verum acupuncture decreases PAG–hippocampus connectivity improving pain scores.

  • Sham acupuncture decreases PAG–medial frontal connectivity with no pain improvement.

Abstract

Acupuncture, an ancient East Asian therapy, is aimed at rectifying the imbalance within the body caused by disease. Studies evaluating the efficacy of acupuncture with neuroimaging tend to concentrate on brain regions within the pain matrix, associated with acute pain. We, however, focused on the effect of repeated acupuncture treatment specifically on brain regions known to support functions dysregulated in chronic pain disorders. Transition to chronic pain is associated with increased attention to pain, emotional rumination, nociceptive memory and avoidance learning, resulting in brain connectivity changes, specifically affecting the periaqueductal gray (PAG), medial frontal cortex (MFC) and bilateral hippocampus (Hpc). We demonstrate that the PAG–MFC and PAG–Hpc connectivity in patients with chronic pain due to knee osteoarthritis indeed correlates with clinical severity scores and further show that verum acupuncture-induced improvement in pain scores (compared to sham) is related to the modulation of PAG–MFC and PAG–Hpc connectivity in the predicted direction. This study shows 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.

Keywords

Acupuncture
Resting state fMRI
Chronic pain
Osteoarthritis

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