Enhancing treatment of osteoarthritis knee pain by boosting expectancy: A functional neuroimaging study

Autor: Robert R. Edwards, Ted J. Kaptchuk, Vitaly Napadow, Courtney Lang, Domenic Minicucci, Jessica Gerber, Jian Kong, Randy L. Gollub, Irving Kirsch, Jaclyn Leiser, Zengjian Wang, Ajay D. Wasan, Siyi Yu
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
0301 basic medicine
Time Factors
Acupuncture Therapy
Osteoarthritis
Severity of Illness Index
lcsh:RC346-429
0302 clinical medicine
Image Processing
Computer-Assisted
Medicine
Prefrontal cortex
Pain Measurement
Brain
Regular Article
Middle Aged
Osteoarthritis
Knee
Magnetic Resonance Imaging
3. Good health
Treatment Outcome
medicine.anatomical_structure
Neurology
Hyperalgesia
lcsh:R858-859.7
Female
Knee osteoarthritis
medicine.symptom
Adult
Pain Threshold
medicine.medical_specialty
Cognitive Neuroscience
Pain
lcsh:Computer applications to medicine. Medical informatics
Expectancy
03 medical and health sciences
Physical medicine and rehabilitation
Reward
Functional neuroimaging
Physical Stimulation
Acupuncture
Humans
Radiology
Nuclear Medicine and imaging
Anterior cingulate cortex
lcsh:Neurology. Diseases of the nervous system
Aged
Analysis of Variance
Resting state fMRI
business.industry
medicine.disease
Oxygen
Dorsolateral prefrontal cortex
030104 developmental biology
Knee pain
Resting state functional connectivity
Neurology (clinical)
business
030217 neurology & neurosurgery
Zdroj: NeuroImage: Clinical, Vol 18, Iss, Pp 325-334 (2018)
NeuroImage : Clinical
ISSN: 2213-1582
Popis: Objectives Expectation 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. Methods Seventy-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. Results We 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. Conclusions Our 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.
Highlights • Acupuncture with enhanced expectancy produced greater pain relief in KOA patients. • NAc – ACC/MPFC rsFC increased after acupuncture with enhanced expectancy. • NAc – ACC/MPFC rsFC increases are associated with clinical improvements. • Our findings provide a novel method for boosting the treatment of chronic pain.
Databáze: OpenAIRE
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