title: Brain correlates of phasic autonomic response to acupuncture stimulation: an event-related fMRI study.
abstract: Autonomic nervous system (ANS) response to acupuncture has been investigated by multiple studies; however, the brain circuitry underlying this response is not well understood. We applied event-related fMRI (er-fMRI) in conjunction with ANS recording (heart rate, HR; skin conductance response, SCR). Brief manual acupuncture stimuli were delivered at acupoints ST36 and SP9, while sham stimuli were delivered at control location, SH1. Acupuncture produced activation in S2, insula, and mid-cingulate cortex, and deactivation in default mode network (DMN) areas. On average, HR deceleration (HR-) and SCR were noted following both real and sham acupuncture, though magnitude of response was greater following real acupuncture and inter-subject magnitude of response correlated with evoked sensation intensity. Acupuncture events with strong SCR also produced greater anterior insula activation than without SCR. Moreover, acupuncture at SP9, which produced greater SCR, also produced stronger sharp pain sensation, and greater anterior insula activation. Conversely, acupuncture-induced HR- was associated with greater DMN deactivation. Between-event correlation demonstrated that this association was strongest for ST36, which also produced more robust HR-. In fact, DMN deactivation was significantly more pronounced across acupuncture stimuli producing HR-, versus those events characterized by acceleration (HR+). Thus, differential brain response underlying acupuncture stimuli may be related to differential autonomic outflows and may result from heterogeneity in evoked sensations. Our er-fMRI approach suggests that ANS response to acupuncture, consistent with previously characterized orienting and startle/defense responses, arises from activity within distinct subregions of the more general brain circuitry responding to acupuncture stimuli.
authors.affiliation: Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts; Department of Radiology, Logan College of Chiropractic, Chesterfield, Missouri.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Napadow
authors.forename: Jeungchan
authors.initials: J
authors.lastname: Lee
authors.forename: Jieun
authors.initials: J
authors.lastname: Kim
authors.forename: Stephen
authors.initials: S
authors.lastname: Cina
authors.forename: Yumi
authors.initials: Y
authors.lastname: Maeda
authors.forename: Riccardo
authors.initials: R
authors.lastname: Barbieri
authors.forename: Richard E
authors.initials: RE
authors.lastname: Harris
authors.forename: Norman
authors.initials: N
authors.lastname: Kettner
authors.forename: Kyungmo
authors.initials: K
authors.lastname: Park
mesh_terms: D015669:Acupuncture Points; D015670:Acupuncture Therapy; D000328:Adult; D001341:Autonomic Nervous System / Q000502:physiology*; D001921:Brain / Q000502:physiology*; D001931:Brain Mapping; D017352:Echo-Planar Imaging; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D058748:Pain Perception; D011677:Punctures / Q000009:adverse effects; D055815:Young Adult