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

Abstract

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.

Applying the Power of the Mind in Acupuncture Treatment of Pain

“…The researchers did not detect significant differences in clinical outcomes or expectancy scores between the high-and low-context groups. 11,12 Taken together, these results suggest that boosting nonspecific effects (by applying the power of the mind) might shed light on enhancing treatment effects. 13 Nevertheless, enhancing expectancy and gaining patients' trust is a complicated process, and while warmth and empathy may be two of several factors that can influence patients' expectancy/ belief, they do not guarantee increased expectancy/belief on their own.…”

“…37 A comparison between this study 37 and a previous acupuncture study from the current author's laboratory using the same treatment paradigm showed that VGAIT produced similar effects to real acupuncture, and marginally greater low back-pain relief, compared to sham acupuncture. 11,12 These findings indicate a new way to apply the power of the mind in pain management. VGAIT may be a promising supplementary treatment for cLBP and other pain conditions, particularly during the COVID 19 pandemic, as VGAIT may be applied remotely.…”

“…However, it was suggested that verum acupuncture might simultaneously modulate the resting state functional connectivities (rsFC) of key regions in the descending painmodulation (e.g., PAG) and reward systems (e.g., ventral tegmental area), compared to sham acupuncture. 12 In another analysis based on the same data set, machine-learning approaches were used to test if pretreatment rsFC could predict responses to both verum and sham acupuncture treatments in patients with cLBP. Pretreatment rsFC predicted symptom changes with up to 34% and 29% variances for real and sham treatments, respectively.…”

“…39 Taken together, these results suggested that acupuncture is more than a placebo. Acupuncture can modulate sophisticated systems, including the descending pain-modulation system and reward networks, 12 as well as pain-related brain regions 10,40 /connectome-based markers. 39…”

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“…Yu S.Y. used acupuncture as a treatment for low back pain, thereby reducing the pain felt by the patient (18). Majid S. shows us in a review of the literature, conducted in 2020, that the effects of yoga practice has the potential to reduce pain and improve the quality of life in cases of low back pain (19).…”