Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing 100010, China.
School of Electronic and Information Engineering, Beijing Jiaotong University, Beijing 100044, China.
Neuroimage Clin. 2022;36:103168. doi: 10.1016/j.nicl.2022.103168. Epub 2022 Aug 24.
Migraine without aura (MWoA) is a major neurological disorder with unsatisfactory adherence to current medications. Acupuncture has emerged as a promising method for treating MWoA. However, the brain mechanism underlying acupuncture is yet unclear. The present study aimed to examine the effects of acupuncture in regulating brain connectivity of the key regions in pain modulation. In this study, MWoA patients were recruited and randomly assigned to 4 weeks of real or sham acupuncture. Resting-state functional magnetic resonance imaging (fMRI) data were collected before and after the treatment. A modern neuroimaging literature meta-analysis of 515 fMRI studies was conducted to identify pain modulation-related key regions as regions of interest (ROIs). Seed-to-voxel resting state-functional connectivity (rsFC) method and repeated-measures two-way analysis of variance were conducted to determine the interaction effects between the two groups and time (baseline and post-treatment). The changes in rsFC were evaluated between baseline and post-treatment in real and sham acupuncture groups, respectively. Clinical data at baseline and post-treatment were also recorded in order to determine between-group differences in clinical outcomes as well as correlations between rsFC changes and clinical effects. 40 subjects were involved in the final analysis. The current study demonstrated significant improvement in real acupuncture vs sham acupuncture on headache severity (monthly migraine days), headache impact (6-item Headache Impact Test), and health-related quality of life (Migraine-Specific Quality of Life Questionnaire). Five pain modulation-related key regions, including the right amygdala (AMYG), left insula (INS), left medial orbital superior frontal gyrus (PFCventmed), left middle occipital gyrus (MOG), and right middle cingulate cortex (MCC), were selected based on the meta-analysis on brain imaging studies. This study found that 1) after acupuncture treatment, migraine patients of the real acupuncture group showed significantly enhanced connectivity in the right AMYG/MCC-left MTG and the right MCC-right superior temporal gyrus (STG) compared to that of the sham acupuncture group; 2) negative correlations were established between clinical effects and increased rsFC in the right AMYG/MCC-left MTG; 3) baseline right AMYG-left MTG rsFC predicts monthly migraine days reduction after treatment. The current results suggested that acupuncture may concurrently regulate the rsFC of two pain modulation regions in the AMYG and MCC. MTG and STG may be the key nodes linked to multisensory processing of pain modulation in migraine with acupuncture treatment. These findings highlighted the potential of acupuncture for migraine management and the mechanisms underlying the modulation effects.
偏头痛无先兆（MWoA）是一种主要的神经障碍，目前的药物治疗效果并不理想。针灸作为一种治疗 MWoA 的有前途的方法已经出现。然而，针灸的大脑机制尚不清楚。本研究旨在探讨针灸对调节疼痛调节关键区域脑连接的影响。本研究招募了 MWoA 患者，并随机分为 4 周的真针或假针治疗。在治疗前后采集静息态功能磁共振成像（fMRI）数据。对 515 项 fMRI 研究的现代神经影像学文献进行荟萃分析，以确定与疼痛调节相关的关键区域作为感兴趣区域（ROI）。采用种子点与体素静息态功能连接（rsFC）方法和重复测量双向方差分析，以确定两组间和时间（基线和治疗后）的交互作用。分别评估真针和假针组治疗前后 rsFC 的变化。还记录了基线和治疗后的临床数据，以确定组间临床结果的差异以及 rsFC 变化与临床效果的相关性。最终有 40 名受试者参与了分析。本研究表明，与假针相比，真针在头痛严重程度（每月偏头痛天数）、头痛影响（6 项头痛影响测试）和健康相关生活质量（偏头痛特异性生活质量问卷）方面有显著改善。基于对大脑成像研究的荟萃分析，选择了 5 个与疼痛调节相关的关键区域，包括右侧杏仁核（AMYG）、左侧岛叶（INS）、左侧额中回眶内侧（PFCventmed）、左侧中枕叶（MOG）和右侧中央扣带皮层（MCC）。这项研究发现，1）针灸治疗后，与假针组相比，真针组偏头痛患者的右侧 AMYG/MCC-左侧 MTG 和右侧 MCC-右侧颞上回（STG）的连接明显增强；2）临床效果与右侧 AMYG/MCC-左侧 MTG 的 rsFC 增加呈负相关；3）基线右侧 AMYG-左侧 MTG rsFC 预测治疗后每月偏头痛天数的减少。目前的结果表明，针灸可能同时调节杏仁核和 MCC 中两个疼痛调节区域的 rsFC。MTG 和 STG 可能是与针刺治疗偏头痛时疼痛调节的多感觉处理相关的关键节点。这些发现强调了针灸在偏头痛管理中的潜力和调制效应的潜在机制。
