International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
Pain. 2023 Jul 1;164(7):1578-1592. doi: 10.1097/j.pain.0000000000002859. Epub 2023 Jan 5.
Chronic pain has been one of the leading causes of disability. Acupuncture is globally used in chronic pain management. However, the efficacy of acupuncture treatment varies across patients. Identifying individual factors and developing approaches that predict medical benefits may promise important scientific and clinical applications. Here, we investigated the psychological and neurological factors collected before treatment that would determine acupuncture efficacy in knee osteoarthritis. In this neuroimaging-based randomized controlled trial, 52 patients completed a baseline assessment, 4-week acupuncture or sham-acupuncture treatment, and an assessment after treatment. The patients, magnetic resonance imaging operators, and outcome evaluators were blinded to treatment group assignment. First, we found that patients receiving acupuncture treatment showed larger pain intensity improvements compared with patients in the sham-acupuncture arm. Second, positive expectation, extraversion, and emotional attention were correlated with the magnitude of clinical improvements in the acupuncture group. Third, the identified neurological metrics encompassed striatal volumes, posterior cingulate cortex (PCC) cortical thickness, PCC/precuneus fractional amplitude of low-frequency fluctuation (fALFF), striatal fALFF, and graph-based small-worldness of the default mode network and striatum. Specifically, functional metrics predisposing patients to acupuncture improvement changed as a consequence of acupuncture treatment, whereas structural metrics remained stable. Furthermore, support vector machine models applied to the questionnaire and brain features could jointly predict acupuncture improvement with an accuracy of 81.48%. Besides, the correlations and models were not significant in the sham-acupuncture group. These results demonstrate the specific psychological, brain functional, and structural predictors of acupuncture improvement and may offer opportunities to aid clinical practices.
慢性疼痛是导致残疾的主要原因之一。针灸在全球范围内被用于慢性疼痛管理。然而，针灸治疗的疗效因人而异。确定个体因素并开发预测医疗效益的方法可能具有重要的科学和临床应用价值。在这里，我们研究了治疗前收集的心理和神经因素，这些因素将决定膝骨关节炎的针灸疗效。在这项基于神经影像学的随机对照试验中，52 名患者完成了基线评估、4 周的针灸或假针灸治疗以及治疗后的评估。患者、磁共振成像操作人员和结果评估者对治疗组分配均不知情。首先，我们发现接受针灸治疗的患者的疼痛强度改善明显大于接受假针灸治疗的患者。其次，积极的期望、外向性和情绪注意力与针灸组临床改善的幅度相关。第三，确定的神经学指标包括纹状体体积、后扣带回皮层（PCC）皮质厚度、PCC/楔前叶低频振幅（fALFF）、纹状体 fALFF 以及默认模式网络和纹状体的基于图的小世界网络。具体而言，使患者对针灸改善产生倾向的功能指标随着针灸治疗而改变，而结构指标则保持稳定。此外，应用于问卷和大脑特征的支持向量机模型可以以 81.48%的准确率共同预测针灸的改善。此外，在假针灸组中，相关性和模型不显著。这些结果表明了针灸改善的特定心理、大脑功能和结构预测因子，并可能为辅助临床实践提供机会。
