title: Does acupuncture therapy alter activation of neural pathway for pain perception in irritable bowel syndrome?: a comparative study of true and sham acupuncture using functional magnetic resonance imaging.
abstract: OBJECTIVE
  Patients with irritable bowel syndrome (IBS) are characterized by abnormal central processing with altered brain activation in response to visceral nociceptive signals. The effect of electroacupuncture (EA) on IBS patients is unclear. The study is set to study the effect of EA on brain activation during noxious rectal distension in IBS patients using a randomized sham-controlled model.
  
  
  METHODS
  Thirty IBS-diarrhea patients were randomized to true electroacupuncture or sham acupuncture. Functional MRI was performed to evaluate cerebral activation at the following time points: (1) baseline when there was rectal distension only, (2) rectal distension during application of EA, (3) rectal distension after cessation of EA and (4) EA alone with no rectal distension. Group comparison was made under each condition using SPM5 program.
  
  
  RESULTS
  Rectal distension induced significant activation of the anterior cingulated cortex, prefrontal cortex, thalamus, temporal regions and cerebellum at baseline. During and immediately after EA, increased cerebral activation from baseline was observed in the anterior cingulated cortex, bilateral prefrontal cortex, thalamus, temporal regions and right insula in both groups. However, true electroacupuncture led to significantly higher activation at right insula, as well as pulvinar and medial nucleus of the thalamus when compared to sham acupuncture.
  
  
  CONCLUSIONS
  We postulate that acupuncture might have the potential effect of pain modulation in IBS by 2 actions: (1) modulation of serotonin pathway at insula and (2) modulation of mood and affection in higher cortical center via ascending pathway at the pulvinar and medial nucleus of the thalamus.
authors: Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
authors: Winnie Cw
authors: WC
authors: Chu
authors: Justin Cy
authors: JC
authors: Wu
authors: David Tw
authors: DT
authors: Yew
authors: Liang
authors: L
authors: Zhang
authors: Lin
authors: L
authors: Shi
authors: David Kw
authors: DK
authors: Yeung
authors: Defeng
authors: D
authors: Wang
authors: Raymond Ky
authors: RK
authors: Tong
authors: Yawen
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authors: Chan
authors: Lixing
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authors: Lao
authors: Ping C
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authors: Leung
authors: Brian M
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authors: Sung