Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture

Napadow, Vitaly; Liu, Jing; Li, Ming; Kettner, Norman W.; Ryan, Angela; Kwong, Kenneth K.; Hui, Kathleen K.S.; Audette, Joseph

doi:10.1002/hbm.20261

Cited by 129 publications

(76 citation statements)

References 74 publications

(83 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This includes endogenous antinociceptive limbic networks (cingulate cortex, insula, and hypothalamus) as well as higher-order cognitive and affective control centers within the prefrontal cortex and medial temporal lobe (amygdala and hippocampus) [11][12][13][14][15][16][17][18][19][20][21]. Wu et al found that stimulation at LI4 (located at the first dorsal intermetacarpal space with a depth of approximately 1 cm) and ST36 (located four finger breadths below the lower margin of the patella and one finger breadth laterally from the anterior crest of the tibia) resulted in increases in signal intensity of the hypothalamus and nucleus accumbens, as well as decreases in the rostral part of the anterior cingulated cortex, amygdala, and hippocampus.…”

Section: Neuroimaging Results Of Acupuncture In Humanmentioning

confidence: 99%

Spatiotemporal Modulation of Central Neural Pathway Underlying Acupuncture Action: A Systematic Review

Bai¹,

Qin²,

Liang³

et al. 2009

CMIR

View full text Add to dashboard Cite

Acupuncture, an ancient therapeutic technique, is currently gaining popularity as an important modality of alternative and complementary medicine in the West world. Concurrently, scientific interests in exploring whether acupuncture is therapeutically effective are raised alongside those about the means by which it may operate. Modern neuroimaging techniques such as functional magnetic resonance imaging, positron emission tomography, electroencephalography, and magnetoencephalography provide a means to safely monitor brain activity in humans. In this review, we have summarized evidence derived from the neuroimaging studies and tried to elucidate the neurophysiological correlates of acupuncture. Previous investigations on the neural responses to acupuncture mainly focus on its acute effects and explore the correlation between the specific acupoints and cortical activations only in the spatial domain. However, abundant clinical reports and psychophysical analysis suggest the kinetics of acupuncture is longer acting as a function of time. Consequentially, an accurate interpretation of acupuncture actions depends on how effectively we can characterize the nature of temporal variations underlying neural activities, rather than simply detect the occurrence of such changes. This emerging picture indicates that both designing paradigms and statistical models involved in acupuncture studies should be applied with great care.

show abstract

Section: Neuroimaging Results Of Acupuncture In Humanmentioning

confidence: 99%

Spatiotemporal Modulation of Central Neural Pathway Underlying Acupuncture Action: A Systematic Review

Bai¹,

Qin²,

Liang³

et al. 2009

CMIR

View full text Add to dashboard Cite

show abstract

“…Following up on our pilot acupuncture neuroimaging study for CTS (Napadow et al, 2007b), this study is the first sham controlled neuroimaging acupuncture study for CTS. Other acupuncture clinical trials for CTS (Yao et al, 2012), similar to our study, found no difference between verum and sham acupuncture for symptom reduction-a subjective/psychological outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Acupuncture was delivered to subjects in supine position by one of four trained, licensed acupuncturists with at least 3 years of clinical experience. For the local acupuncture group, based on the protocol used in our pilot study (Napadow et al, 2007b), a hybrid design balanced standardized acupuncture therapy with more ecologically valid individualized acupoint selection. For all subjects, acupuncture needles were placed at acupoints TW5 and PC7 ( Fig.…”

Section: Acupuncture Treatmentmentioning

confidence: 99%

Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture

Maeda

Kim

Kettner

et al. 2017

Brain

Self Cite

122

View full text Add to dashboard Cite

Ã These authors contributed equally to this work.Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist. Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. Eligible patients (n = 80, 65 female, age: 49.3 AE 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture 'local' to the more affected hand; (ii) verum electro-acupuncture at 'distal' body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using non-penetrating placebo needles. Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up. Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5). While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance). Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor imaging of white matter microstructure adjacent to the primary somatosensory cortex. Compared to healthy adults (n = 34, 28 female, 49.7 AE 9.9 years old), patients with carpal tunnel syndrome demonstrated increased fractional anisotropy in several regions and, for these regions we found that improvement in median nerve latency was associated with reduction of fractional anisotropy near (i) contralesional hand area following verum, but not sham, acupuncture; (ii) ipsilesional hand area following local, but not distal or sham, acupuncture; and (iii) ipsilesional leg area following distal, but not local or sham, acupuncture. As these primary somatosensory cortex subregions are distinctly targeted by local versus distal acupuncture electrostimulation, acupuncture at local versus distal sites may improve median nerve function at the wrist by somatotopically distinct neuroplasticity in the primary somatosensory cortex following therapy. Our study further suggests that improvements in primary somatosensory cortex ...

show abstract

“…Despite its relatively recent arrival in Western countries, acupuncture has been increasingly accepted as an alternative or complementary method, [1][2][3] and research into its effects is gaining popularity. 4,5 The development of neuroimaging techniques, such as positron emission tomography and functional magnetic resonance imaging (fMRI), made it easier to investigate the neural responses to acupuncture stimulations in humans.…”

Section: Introductionmentioning

confidence: 99%

Consecutive Acupuncture Stimulations Lead to Significantly Decreased Neural Responses

Choe

Noort²,

Bosch³

et al. 2010

The Journal of Alternative and Complementary Medicine

View full text Add to dashboard Cite

Objective: Functional magnetic resonance imaging (fMRI), in combination with block design paradigms with consecutive acupuncture stimulations, has often been used to investigate the neural responses to acupuncture. In this study, we investigated whether previous acupuncture stimulations can affect brain activations of later acupuncture stimulations. Design: All subjects were measured twice in the same scanning session and a block design was used. Setting: The study was conducted at Kyung Hee University, Seoul, Republic of Korea. Subjects: Fifteen (15) healthy right-handed male volunteers participated in the study. Intervention: The subjects received two acupuncture stimulations on BL62 (Shenmai) on the right foot with a time interval of 5 minutes. In addition, sham stimulations were tested with the same paradigm. Outcome measures: One-sample t tests were conducted in order to map the brain activations induced by the acupuncture and sham stimulations. Moreover, paired-sample t tests were conducted to investigate the signal changes between the first and second acupuncture stimulation. Results: During the first acupuncture stimulation, in the left hemisphere, significant foci of activation were found in the hypothalamus, thalamus, claustrum, cerebellum, inferior frontal gyrus, and the superior temporal gyrus. In the right hemisphere, a significant focus of activation was found in the middle frontal gyrus. In addition, in both hemispheres, a significant focus of activation was found in the inferior parietal lobule. Interestingly, however, during the second acupuncture stimulation, the only areas that were also significantly activated were the cerebellum in the left hemisphere and the inferior parietal lobule in the right hemisphere. Conclusions: We found that consecutive acupuncture stimulations on BL62 affected the neural responses in a significant way, resulting in decreased activations during the second acupuncture stimulation. This is an important finding, suggesting that in future fMRI studies on acupuncture, researchers should take this methodological issue more seriously.

show abstract

Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture

Cited by 129 publications

References 74 publications

Spatiotemporal Modulation of Central Neural Pathway Underlying Acupuncture Action: A Systematic Review

Spatiotemporal Modulation of Central Neural Pathway Underlying Acupuncture Action: A Systematic Review

Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture

Consecutive Acupuncture Stimulations Lead to Significantly Decreased Neural Responses

Contact Info

Product

Resources

About