Hi

Happy New Year and Welcome to 2014

Interesting Lower Quadrant Research Article

Li J, Zhang J-H, Yi T, Tang W-J, Wang S-W, and Dong J-C. Acupuncture treatment of chronic low back pain reverses an abnormal brain default mode network in correlation with clinical pain relief. Acupuncture in Medicine 2013.

URL: http://aim.bmj.com/content/early/2013/12/02/acupmed-2013-010423.abstract

Abstract Summary

Background

Acupuncture is gaining in popularity as a treatment for chronic low back pain (cLBP); however, its therapeutic mechanisms remain controversial, partly because of a similar improvement in sham acupuncture control groups (but both sham and verum improve significantly more than 'usual care'). Resting-state functional MRI (rsfMRI) has demonstrated aberrant default mode network (DMN) connectivity in patients with chronic pain, and also shown that acupuncture increases DMN connectivity in pain-modulator and affective-emotional brain regions of healthy subjects.

Objective

This study sought to explore how cLBP influences the DMN and whether, and how, the altered DMN connectivity is reversed after acupuncture for clinical pain.

Methods

RsfMRI data from 20 patients with cLBP, before and after 4 weeks of treatment, and 10 age- and gender-matched healthy controls (without treatment) were analysed using independent components analyses to determine connectivity within the DMN, and combined with correlation analyses to compute covariance between changes in DMN connectivity and changes in clinical pain. Visual analogue scale data were assessed to rate clinical pain levels.

Results

Less connectivity within the DMN was found in patients with cLBP than in healthy controls, mainly in the dorsolateral prefrontal cortex, medial prefrontal cortex, anterior cingulate gyrus and precuneus. After acupuncture, patients’ connectivities were restored almost to the levels seen in healthy controls. Furthermore, reductions in clinical pain were correlated with increases in DMN connectivity.

Conclusions

This result suggests that modulation of the DMN by acupuncture is related to its therapeutic effects on cLBP. Imaging of the DMN provides an objective method for assessment of the effects of acupuncture-induced analgesia.

Summary

The treatment used here involved eight acupuncture points (commonly used in the treatment of acute and chronic lumbar pain) in the lumbar region and lower leg. They being BL23 (L2/3 bilateral), lower back ah shi point/tender point, GV3 (midline L45), BL40 (midpoint popliteal crease bilateral) and KI3 (midpoint achilles and medial malleolus bilateral). Patients received 30-minute acupuncture treatments three times a week for 4 weeks (12 treatments in total).

Chronic pain is associated with an altered default mode network (DMN) connectivity. The DMN connectivity was measured in normals (no treatment) and patients (chronic back pain) before and after a clinically realistic period of acupuncture. It was found the DMN was restored towards normal (see picture), in correlation with the degree of pain relief.

This type of approach and the associated clinical reasoning will be covered in the recently revised and upcoming Advanced Lower Quadrant Course and Master Needling Course in 2014. These courses provide an opportunity to update your anatomy, palpation and dry needling skills and include a free 2 hour Wet Lab Anatomy Workshop at UWA.

All the best,

Doug Cary FACP
Specialist Musculoskeletal Physiotherapist (awarded by Australian College of Physiotherapy, 2009)
PhD Candidate Curtin University
Clinical Director AAP Education

email: doug@aapeducation.com.au

ph/fx: 08 90715055

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