针刺治疗慢性疼痛的功能磁共振研究述评＊

目的基于针刺治疗慢性疼痛的功能磁共振(Functional magnetic resonance imaging,fMRI)文献进行述评,为针刺治疗慢性疼痛的机制研究提供思路和借鉴。方法对近10年针刺治疗慢性疼痛的fMRI研究进行回顾,依据病种选择、样本量计算、试验设计、研究结果四方面内容进行述评,分析并总结当前研究现状。结果偏头痛、膝骨关节炎和下腰痛是目前研究中涉及频次最高的3个病种。受试者的疾病亚型、年龄段、利手习惯及fMRI禁忌症在研究中基本都保证了一致性和规范性。但多数研究仍存在样本量计算方式不明确的问题。对照组设置主要包括标准对照、无效对照和安慰对照。针刺效应因素在各研究间存在较大差异。研究中结局指标包括疾病特异性量表、疼痛评分及心理、精神状态的评估。fMRI设计以静息态和单一任务态设计为主,多任务fMRI研究相对较少。研究证实针刺可调节疼痛处理网络的功能连接,有效建立心理物理疼痛稳态。结论运用fMRI探讨针刺治疗慢性疼痛作用机制的研究成果丰硕,未来可通过扩大病种的选择,完善质量控制,关注针刺效应影响因素,丰富数据处理手段,借鉴多学科任务设计方式等方式,促进针刺疗慢性疼痛机制研究的进一步发展。

A Narrative Review of fMRI Researches on Acupuncture Treatment of Chronic Pain

Objective To summarize and analyze the functional magnetic resonance imaging (fMRI) literature on acupuncture treatment of chronic pain and provide ideas and references for the mechanism research on acupuncture treatment of chronic pain.Methods The fMRI research on acupuncture treatment of chronic pain in recent 10 years was reviewed and the research status was analyzed and summarized from the following four aspects: disease selection, sample size, experimental design, and research results.Results Migraine, knee osteoarthritis, and low back pain were the three most frequently involved diseases. The patients'' disease subtype, age, handedness habit, and contraindications of fMRI were consistent and standardized in the study. However, there were still some problems in the calculation of sample size. The control group included standard control, invalid control, and placebo control. There were great differences in acupuncture effect factors among the studies. The outcome measures included a disease-specific scale, pain score, and evaluation of psychological and mental state. The fMRI design is mainly composed of resting state and single-task state, while multi-task fMRI research was relatively less. It was proved that acupuncture could regulate the functional connection of the pain treatment network and effectively establish psychophysical pain homeostasis.Conclusion The research on the mechanism of acupuncture in the treatment of chronic pain by fMRI is fruitful. In the future, we can expand the selection of diseases, improve the quality control, pay attention to the influencing factors of acupuncture effect, enrich the means of data processing, and learn from the design of multi-disciplinary tasks, so as to promote the further development of acupuncture in the treatment of chronic pain.