Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Acupuncture & Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
CNS Neurosci Ther. 2023 Jul;29(7):1965-1980. doi: 10.1111/cns.14153. Epub 2023 Mar 8.
The analgesic effect of acupuncture is widely recognized, but the mechanical characteristics of acupuncture for pain relief, compared to non-steroidal anti-inflammatory (NSAIDs) and placebo medication, remain unknown.
To compare the modulation effects of acupuncture treatment with NSAIDs and placebo medication on descending pain modulation system (DPMS) in knee osteoarthritis (KOA) patients.
This study recruited 180 KOA patients with knee pain and 41 healthy controls (HCs). Individuals with KOA knee pain were divided randomly into groups of verum acupuncture (VA), sham acupuncture (SA), celecoxib (SC), placebo (PB), and waiting list (WT), with 36 patients in each group. VA and SA groups included ten sessions of puncturing acupoints or puncturing non-acupoints acupuncture treatment for two successive weeks. Celecoxib capsules were continuously given orally to patients in the SC group at a dosage of 200 mg daily for 2 weeks. In the PB group, patients received a placebo capsule once a day for 2 weeks at the same dosage as celecoxib capsules. In the WL group, patients did not receive any treatment. Patients underwent a resting-state BOLD-fMRI scan pre- and post-receiving the therapy, whereas HCs only underwent a baseline scan. Seed (ventrolateral periaqueductal gray, vlPAG, a key node in DPMS) based resting-state functional connectivity (rs-FC) was applied in the data analysis.
All groups demonstrated improved knee pain scores relative to the initial state. There was no statistical difference between the VA and SA groups in all clinical outcomes, and vlPAG rs-FC alterations. KOA knee pain individuals reported higher vlPAG rs-FC in the bilateral thalamus than HCs. KOA knee pain patients in the acupuncture group (verum + sham, AG) exhibited increased vlPAG rs-FC with the right dorsolateral prefrontal cortex (DLPFC) and the right angular, which is associated with knee pain improvement. In contrast with the SC and PB group, the AG exhibited significantly increased vlPAG rs-FC with the right DLPFC and angular. Contrary to the WT group, the AG showed greater vlPAG rs-FC with the right DLPFC and precuneus.
Acupuncture treatment, celecoxib, and placebo medication have different modulation effects on vlPAG DPMS in KOA knee pain patients. Acupuncture could modulate vlPAG rs-FC with brain regions associated with cognitive control, attention, and reappraisal for knee pain relief in KOA patients, compared with celecoxib and placebo medication.
针刺的镇痛效果已被广泛认可，但与非甾体抗炎药（NSAIDs）和安慰剂药物相比，针刺缓解疼痛的力学特性仍不清楚。
比较针刺治疗与 NSAIDs 和安慰剂药物对膝骨关节炎（KOA）患者下行疼痛调节系统（DPMS）的调节作用。
本研究共纳入 180 例膝痛 KOA 患者和 41 例健康对照者（HCs）。将 KOA 膝痛患者随机分为真针刺（VA）、假针刺（SA）、塞来昔布（SC）、安慰剂（PB）和候补名单（WT）组，每组 36 例。VA 和 SA 组进行十次针刺穴位或针刺非穴位针刺治疗，连续两周。SC 组连续口服塞来昔布胶囊，每日 200mg，连续两周。PB 组患者每日服用与塞来昔布胶囊相同剂量的安慰剂胶囊，连续两周。WL 组患者未接受任何治疗。患者在接受治疗前后进行静息状态 BOLD-fMRI 扫描，而 HCs 仅进行基线扫描。在数据分析中应用了基于种子（腹外侧导水管周围灰质，vlPAG，DPMS 的关键节点）的静息状态功能连接（rs-FC）。
与初始状态相比，所有组的膝关节疼痛评分均有所改善。VA 和 SA 组在所有临床结局和 vlPAG rs-FC 改变方面均无统计学差异。KOA 膝关节疼痛患者的双侧丘脑显示出高于 HCs 的 vlPAG rs-FC。针刺组（真+假，AG）的 KOA 膝关节疼痛患者表现出与膝关节疼痛改善相关的右侧背外侧前额叶皮层（DLPFC）和右侧角回的 vlPAG rs-FC 增加。与 SC 和 PB 组相比，AG 组表现出与右侧 DLPFC 和角回的显著增加的 vlPAG rs-FC。与 WT 组相比，AG 组显示出与右侧 DLPFC 和楔前叶更大的 vlPAG rs-FC。
针刺治疗、塞来昔布和安慰剂药物对 KOA 膝关节疼痛患者的 vlPAG DPMS 具有不同的调节作用。与塞来昔布和安慰剂药物相比，针刺治疗可能通过调节与认知控制、注意力和重新评价相关的大脑区域的 vlPAG rs-FC 来缓解 KOA 患者的膝关节疼痛。
