The modulation effect of longitudinal acupuncture on resting state functional connectivity in knee osteoarthritis patients.
Recent advances in brain imaging have contributed to our understanding of the neural activity associated with acupuncture treatment. In this study, we investigated functional connectivity across longitudinal acupuncture treatments in older patients with knee osteoarthritis (OA). Over a period of 4 weeks (six treatments), we collected resting state functional magnetic resonance imaging (fMRI) scans from 30 patients before and after their first, third and sixth treatments. Clinical outcome showed a significantly greater pain subscore on the Knee Injury and Osteoarthritis Outcome Score (KOOS) (indicative of improvement) with verum acupuncture than with sham acupuncture. Independent component analysis (ICA) of the resting state fMRI data showed that the right frontoparietal network (rFPN) and the executive control network (ECN) showed enhanced functional connectivity (FC) with the rostral anterior cingulate cortex/medial prefrontal cortex, a key region in the descending pain modulatory system, in the verum groups as compared to the sham group after treatments. We also found that the rFPN connectivity with the left insula is (1) significantly associated with changes in KOOS pain score after treatments, and (2) significantly enhanced after verum acupuncture treatments as compared to sham treatment. Analysis of the acupuncture needle stimulation scan showed that compared with sham treatment, verum acupuncture activated the left operculum/insula, which also overlaps with findings observed in resting state analysis. Our results suggest that acupuncture may achieve its therapeutic effect on knee OA pain by modulating functional connectivity between the rFPN, ECN and the descending pain modulatory pathway.


BACKGROUND
NCT01079390.
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. peaceinheavenhelen@gmail.com.
Xiaoyan
X
Chen
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. rosa.babbitt.spaeth@gmail.com.
Rosa B
RB
Spaeth
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. sgfreeman@gmail.com.
Sonya G
SG
Freeman
Mass General Orthopaedics Sports Performance Center, Massachusetts General Hospital, Foxborough, MA, USA. DSCARBOROUGH@mgh.harvard.edu.
Donna Moxley
DM
Scarborough
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. Javeria.Hashmi@dal.ca.
Javeria A
JA
Hashmi
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. wey@nmr.mgh.harvard.edu.
Hsiao-Ying
HY
Wey
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. NEGOROVA2@mgh.harvard.edu.
Natalia
N
Egorova
MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, 120, 2nd Ave. Suite 101, Charlestown, MA, 02129, USA. vangel@nmr.mgh.harvard.edu.|Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA. vangel@nmr.mgh.harvard.edu.
Mark
M
Vangel
Departments of Anesthesiology, Massachusetts General Hospital, Charlestown, MA, USA. JMAO@mgh.harvard.edu.
Jianren
J
Mao
Departments of Anesthesiology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. AWASAN@partners.org.
Ajay D
AD
Wasan
Departments of Anesthesiology, Perioperative, and Pain Medicine, and Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. RREDWARDS@partners.org.
Robert R
RR
Edwards
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. RGOLLUB@partners.org.|MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, 120, 2nd Ave. Suite 101, Charlestown, MA, 02129, USA. RGOLLUB@partners.org.
Randy L
RL
Gollub
Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. kongj@nmr.mgh.harvard.edu.|MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, 120, 2nd Ave. Suite 101, Charlestown, MA, 02129, USA. kongj@nmr.mgh.harvard.edu.
Jian
J
Kong
D015670:Acupuncture Therapy / Q000592:standards*; D000328:Adult; D000368:Aged; D002540:Cerebral Cortex / Q000502:physiology; D005260:Female; D006179:Gyrus Cinguli / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000628:therapy*; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D010296:Parietal Lobe / Q000502:physiology; D016896:Treatment Outcome