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Open AccessArticle

Acupuncture Treatment Modulates the Connectivity of Key Regions of the Descending Pain Modulation and Reward Systems in Patients with Chronic Low Back Pain

1
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
2
Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
3
Department of Anesthesiology, Center for Pain Research, University of Pittsburgh, Pittsburgh, PA 15206, USA
4
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02467, USA
5
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 1719; https://doi.org/10.3390/jcm9061719
Received: 1 May 2020 / Revised: 22 May 2020 / Accepted: 22 May 2020 / Published: 3 June 2020
(This article belongs to the Special Issue State-of-the-Art Research on Acupuncture Treatment)
Chronic low back pain (cLBP) is a common disorder with unsatisfactory treatment options. Acupuncture has emerged as a promising method for treating cLBP. However, the mechanism underlying acupuncture remains unclear. In this study, we investigated the modulation effects of acupuncture on resting state functional connectivity (rsFC) of the periaqueductal gray (PAG) and ventral tegmental area (VTA) in patients with cLBP. Seventy-nine cLBP patients were recruited and assigned to four weeks of real or sham acupuncture. Resting state functional magnetic resonance imaging data were collected before the first and after the last treatment. Fifty patients completed the study. We found remission of pain bothersomeness in all treatment groups after four weeks, with greater pain relief after real acupuncture compared to sham acupuncture. We also found that real acupuncture can increase VTA/PAG rsFC with the amygdala, and the increased rsFC was associated with decreased pain bothersomeness scores. Baseline PAG-amygdala rsFC could predict four-week treatment response. Our results suggest that acupuncture may simultaneously modulate the rsFC of key regions in the descending pain modulation (PAG) and reward systems (VTA), and the amygdala may be a key node linking the two systems to produce antinociceptive effects. Our findings highlight the potential of acupuncture for chronic low back pain management. View Full-Text
Keywords: acupuncture; chronic low back pain; descending pain modulation system; reward network; functional connectivity; PAG; VTA acupuncture; chronic low back pain; descending pain modulation system; reward network; functional connectivity; PAG; VTA
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Yu, S.; Ortiz, A.; Gollub, R.L.; Wilson, G.; Gerber, J.; Park, J.; Huang, Y.; Shen, W.; Chan, S.-T.; Wasan, A.D.; Edwards, R.R.; Napadow, V.; Kaptchuk, T.J.; Rosen, B.; Kong, J. Acupuncture Treatment Modulates the Connectivity of Key Regions of the Descending Pain Modulation and Reward Systems in Patients with Chronic Low Back Pain. J. Clin. Med. 2020, 9, 1719.

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