Neuroimaging acupuncture effects in the human brain

Acupuncture is an ancient East Asian healing modality that has been in use for more than 2000 years. Unfortunately, its mechanisms of action are not well understood, and controversy regarding its clinical efficacy remains. Importantly, acupuncture needling often evokes complex somatosensory sensations and may modulate the cognitive/affective perception of pain, suggesting that many effects are supported by the brain and extending central nervous system (CNS) networks. Modern neuroimaging techniques such as functional magnetic resonance imaging, positron emission tomography, electroencephalography, and magnetoencephalography provide a means to safely monitor brain activity in humans and may be used to help map the neurophysiological correlates of acupuncture. In this review, we will summarize data from acupuncture neuroimaging research and discuss how these findings contribute to current hypotheses of acupuncture action.     

Use of acupuncture for chronic pain: optimizing clinical practice

Increasingly, individuals are turning to complementary therapies to reduce or cope with chronic pain. Acupuncture, one of the oldest complementary therapies, originated from China more than 2500 years ago. It has steadily gained popularity in the United States over the last few decades as a modality for pain relief among both practitioners and patients. A 1997 National Institutes of Health consensus conference concluded that acupuncture needling releases endorphins and other neurotransmitters in the brain and should be considered as an appropriate pain treatment option. This article will provide an overview about acupuncture principles, discuss current clinical evidence, and identify acupuncture resources to optimize practice for chronic pain management.     

Developments in acupuncture research: big-picture perspectives from the leading edge

On November 8-9, 2007, the Society for Acupuncture Research (SAR) hosted an international conference to mark the tenth anniversary of the landmark NIH [National Institutes of Health] Consensus Development Conference on Acupuncture. More than 300 acupuncture researchers, practitioners, students, funding agency personnel, and health policy analysts from 20 countries attended the SAR meeting held at the University of Maryland School of Medicine, Baltimore, MD. This paper summarizes important invited lectures in the area of how the field has developed in the past decade, along with a focus on appropriate strategies for advancing the field. Specific topics include: the impact of the 1997 NIH Acupuncture Consensus Conference on acupuncture research; whole-system strategies for developing the evidence without distorting the medicine; use of qualitative research methods to explore acupuncture as a complex intervention; use of qualitative research approaches to explore some "missing" topics in acupuncture research; and the impact of acupuncture research on clinical practice. A concluding section focuses on future directions in acupuncture research.     

The status and future of acupuncture mechanism research

On November 8-9, 2007, the Society for Acupuncture Research (SAR) hosted an international conference to mark the tenth anniversary of the landmark NIH [National Institutes of Health] Consensus Development Conference on Acupuncture. More than 300 acupuncture researchers, practitioners, students, funding agency personnel, and health policy analysts from 20 countries attended the SAR meeting held at the University of Maryland School of Medicine, Baltimore, MD. This paper summarizes important invited lectures in the area of basic and translational acupuncture research. Specific areas include the scientific assessment of acupuncture points and meridians, the neural mechanisms of cardiovascular regulation by acupuncture, mechanisms for electroacupuncture applied to persistent inflammation and pain, basic and translational research on acupuncture in gynecologic applications, the application of functional neuroimaging to acupuncture research with specific application to carpal-tunnel syndrome and fibromyalgia, and the association of the connective tissue system to acupuncture research. In summary, mechanistic models for acupuncture effects that have been investigated experimentally have focused on the effects of acupuncture needle stimulation on the nervous system, muscles, and connective tissue. These mechanistic models are not mutually exclusive. Iterative testing, expanding, and perhaps merging of such models will potentially lead to an incremental understanding of the effects of manual and electrical stimulation of acupuncture needles that is solidly rooted in physiology.     

Current status of neuroimaging research on the effects of acupuncture: a bibliometric and visual analyses

ObjectiveTo conduct an inductive analysis of neuroimaging studies following the global popularity surrounding the effects of acupuncture.MethodsThe relevant works of literature on acupuncture effects-related neuroimaging studies were retrieved from the web of science core collection database from the date of its establishment to 2022. Bibexcel software was used to extract information, such as article numbers, countries, journals, agencies, funding sources and keywords. The VOSviewer software’s co-occurrence and clustering module was used for the co-occurrence and cluster analysis of collaborative networks and high frequency keywords, such as authors, institutions and countries.ResultsNeuroimaging research on the effects of acupuncture began in the 1960 s and has since received the extensive attention of scholars. China, The United States and South Korea conduct more neuroimaging research on the effects of acupuncture than other countries. Academic journals such as Evidence-Based Complementary and Alternative Medicine, Journal of Alternative and Complementary Medicine, Neural Regeneration Research and Acupuncture in Medicine have published the highest number of acupuncture-related neuroimaging articles. Moreover, cluster analysis differentiates high-frequency keywords into six clusters. Furthermore, the use of the keyword ‘density atlas’ reveals that neuroimaging research on the effects of acupuncture surrounding pain and neurofunctional rehabilitation is currently the research focus.ConclusionsThis bibliometric study identifies six important research hot spots: Static brain functional connectivity analysis of acupuncture analgesic effects, key theories on the scientific problems of acupuncture, acupuncture analgesic effect of the placebo effect, the neuroimaging of acupoint ST-36, the value of acupuncture in regulating the autonomic nerves and acupuncture therapy as complementary medicine.     

Seminal studies in acupuncture research

Acupuncture, a component of the health care system of China that can be traced back at least 2500 years, describes a family of procedures involving stimulation of anatomical locations on the skin by a variety of techniques. In November 1997, the National Institutes of Health conducted a consensus conference during which a panel of experts convened to discuss the scientific evidence regarding acupuncture. The panel concluded that acupuncture is an effective treatment for several medical conditions and described biochemical and physiologic mechanisms that begin to explain these effects. This presentation summarizes the evidence of the clinical efficacy of acupuncture and is divided into three segments. The first segment presents an overview of evidence-based medicine, the second segment summarizes the current evidence from systematic reviews of acupuncture, and the third segment looks to the future by proposing a stepwise method for designing phase I, II, and III acupuncture clinical trials.     

Emerging frontiers in healthcare research and delivery.: the 16th Annual HMO Research Network Conference, March 21-24, 2010, Austin, Texas

The Health Maintenance Organization Research Network (HMORN), a consortium of 16 healthcare delivery systems with integrated research centers, held their 16(th) annual conference in Austin, Texas from March 21-24, 2010. The conference was hosted by Scott & White Healthcare. Its theme "Emerging Frontiers in Healthcare Research and Delivery" reflected the objective of the conference which was to build synergy among scientists and clinicians to influence the health of the nation; to demonstrate the network's commitment to reach beyond traditional collaborators; discuss tools and technologies; and to expand opportunities for public-private partnerships in cutting-edge healthcare research and delivery. More than 320 researchers and healthcare professionals, representing each of the member HMOs, participated in this conference. Representatives from the AHRQ, CDC, NCI and NIH met with researchers to advance the quality and breadth of public domain research in HMOs. The objective of this article is to provide information about the HMORN and its 16(th) annual conference.     

What is the guidelines challenge? The CauseHealth perspective

This paper is an introduction to the conference, The Guidelines Challenge, held in Oxford in October 2017. My aim is to explain our motivation for organising this conference, as part of the research project Causation, Complexity, and Evidence in Health Sciences (CauseHealth). Depending on the professional starting point, the guidelines challenge can be interpreted in a number of ways. Our idea with this conference was to discuss guidelines from 3 overarching perspectives: practice, policy, and philosophy. In particular, we wanted to discuss some of the challenges that face anyone developing and implementing clinical guidelines in the evidence‐based era of medicine. This introduction gives a brief overview of what CauseHealth sees as the guidelines challenge from these perspectives. More attention is given to the philosophical issues with which the CauseHealth project is particularly concerned, although a proper treatment or discussion of these issues naturally falls outside the scope of this introduction.     

The 2005 conference on the biology of manual therapies

A historic and critically important scientific workshop for all professions involved with manual therapies was held at the National Institutes of Health (NIH) on June 9 and 10, 2005. The conference was jointly sponsored and organized by the NIH and the Canadian Institutes of Health Research and was the first ever national or international research conference to focus on the biologic mechanisms that underlie a broad range of interventions, which can be described as "manual therapies." Leading scientific experts from North America and Europe presented their latest findings and theories related to 5 different areas of science relevant to manual therapies: neuroscience, biomechanics, endocrinology, imaging, and immunology. During the conference, breakout groups composed of scientists, physicians and therapists, and patient advocates were formed in the relevant disciplines. These groups developed consensus statements on key unanswered research questions, which were then submitted back to the conference for comment and approval. The outcomes of this workshop have subsequently been incorporated into a new initiative by the NIH and Canadian Institutes of Health Research for funding research on the biology of manual therapies. This editorial includes presentation summaries and 13 key consensus recommendations relating to mechanisms of action for manual therapies.     

Acupuncture

Worldwide, acupuncture is integral to everyday medical practice. In recent decades its practice has gained popularity in the United States. With increasing evidence of its clinical efficacy, acupuncture is now a widely practiced treatment modality in complementary and integrative medicine. According to the 2007 National Health Interview Survey, an estimated 3.1 million US adults and 150,000 children had acupuncture in the previous year. The National Health Interview Survey also estimated that between 2002 and 2007, acupuncture use among adults increased by approximately 1 million people. Patients want more information from their clinicians about the use of acupuncture and its safety and efficacy. Although many clinicians may recommend acupuncture, they often believe they are not sufficiently informed to discuss acupuncture with their patients. This article provides answers to the most frequently asked questions regarding acupuncture.     

Default mode network connectivity encodes clinical pain: An arterial spin labeling study

Neuroimaging studies have suggested the presence of alterations in the anatomo-functional properties of the brain of patients with chronic pain. However, investigation of the brain circuitry supporting the perception of clinical pain presents significant challenges, particularly when using traditional neuroimaging approaches. While potential neuroimaging markers for clinical pain have included resting brain connectivity, these cross-sectional studies have not examined sensitivity to within-subject exacerbation of pain. We used the dual regression probabilistic Independent Component Analysis approach to investigate resting-state connectivity on arterial spin labeling data. Brain connectivity was compared between patients with chronic low back pain (cLBP) and healthy controls, before and after the performance of maneuvers aimed at exacerbating clinical pain levels in the patients. Our analyses identified multiple resting state networks, including the default mode network (DMN). At baseline, patients demonstrated stronger DMN connectivity to the pregenual anterior cingulate cortex (pgACC), left inferior parietal lobule, and right insula (rINS). Patients’ baseline clinical pain correlated positively with connectivity strength between the DMN and right insula (DMN–rINS). The performance of calibrated physical maneuvers induced changes in pain, which were paralleled by changes in DMN–rINS connectivity. Maneuvers also disrupted the DMN–pgACC connectivity, which at baseline was anticorrelated with pain. Finally, baseline DMN connectivity predicted maneuver-induced changes in both pain and DMN–rINS connectivity. Our results support the use of arterial spin labeling to evaluate clinical pain, and the use of resting DMN connectivity as a potential neuroimaging biomarker for chronic pain perception.     

Inserting Needles Into the Body: A Meta-Analysis of Brain Activity Associated With Acupuncture Needle Stimulation

Acupuncture is a therapeutic treatment that is defined as the insertion of needles into the body at specific points (ie, acupoints). Advances in functional neuroimaging have made it possible to study brain responses to acupuncture; however, previous studies have mainly concentrated on acupoint specificity. We wanted to focus on the functional brain responses that occur because of needle insertion into the body. An activation likelihood estimation meta-analysis was carried out to investigate common characteristics of brain responses to acupuncture needle stimulation compared to tactile stimulation. A total of 28 functional magnetic resonance imaging studies, which consisted of 51 acupuncture and 10 tactile stimulation experiments, were selected for the meta-analysis. Following acupuncture needle stimulation, activation in the sensorimotor cortical network, including the insula, thalamus, anterior cingulate cortex, and primary and secondary somatosensory cortices, and deactivation in the limbic-paralimbic neocortical network, including the medial prefrontal cortex, caudate, amygdala, posterior cingulate cortex, and parahippocampus, were detected and assessed. Following control tactile stimulation, weaker patterns of brain responses were detected in areas similar to those stated above. The activation and deactivation patterns following acupuncture stimulation suggest that the hemodynamic responses in the brain simultaneously reflect the sensory, cognitive, and affective dimensions of pain.PerspectiveThis article facilitates a better understanding of acupuncture needle stimulation and its effects on specific activity changes in different brain regions as well as its relationship to the multiple dimensions of pain. Future studies can build on this meta-analysis and will help to elucidate the clinically relevant therapeutic effects of acupuncture.     

针刺临床研究中常用的Rs-fMRI分析方法:10年概况

Rs-fMRI是一种用于针刺临床中研究脑部活动的一种科学放法，Rs-fMRI分析方法可以辅助研究者得出研究结论，从而反馈于临床实践中。Rs-fMRI分析方法在近十年针刺临床研究中常用的有3种:局部一致性（ReHo）、低频振幅分析（ALFF）、功能连接性分析（FC）。ReHo在针刺研究中可用于研究某穴位激活或抑制，某个脑区或某几个脑区，从而得出该穴位的靶效应脑区，为研究“穴位-脑-疾病”打下基础；ALFF可直接反映局部神经元自发同步化神经活动的强度，在一定程度上反映各相关脑区间的相互作用和神经网络连接；FC可以得出脑区之间的功能连接，即脑区间的“高速路”，其简单易懂，结果直接。运用不同的分析方法可以显示针刺不同穴位的脑部活动，如局部神经活动的同步性、相邻脑区之间的连接性及大脑的自发波动及功能活动等。本文将阐述ReHo、ALFF、FC 3种分析方法在针刺研究中的适用研究方向。      

Facilitating Emergency Care Research Networks: Integration into the Clinical Translational and Science Award (CTSA) Infrastructure

Emergency care research (ECR) does not fit neatly into the traditional National Institutes of Health (NIH) funding model, because emergency research involves undifferentiated disease presentations involving multiple disciplines and time-sensitive interventions. A task force of emergency care researchers and other stakeholders was convened to discuss the present and future state of clinical research networks. Integration of ECR with the Clinical Translational and Science Award (CTSA) program through a multidisciplinary emergency care research network (ECRN) would obviate the duplication of research efforts by disease-specific or institute-specific multicenter networks and reduce startup and maintenance costs. Strategies to enhance integration must include the training of emergency physician investigators in biostatistical and epidemiologic methods, as well as educating collaborative investigators in emergency care–related methodologies. Thus, an ECRN would be of great benefit to CTSA awardees and applicants and should be considered a priority.     

The Programme for Global Paediatric Research

When it comes to global health, there is no 'them'... only 'us.'" - Global Health Council There is a major anomaly in child health research. The majority of pediatric research resources and expertise is located in the developed world, whereas the vast majority of childhood disease and mortality is in the developing world. This disequilibrium has been referred to as the "10/90 gap", suggesting that only 10% of global health research dollars are devoted to conditions that account for 90% of the global disease burden (Global Forum for Health Research). The Programme for Global Paediatric Research (PGPR) began as an effort to include, in a major pediatric research conference, topics dealing with diseases of children in the developing world in order to engage more interest and more research dollars. It has evolved into a program educating and linking professionals, and developing global networks of colleagues working collaboratively to solve major childhood health problems.     

Unique Characteristics of Emergency Care Research: Scope, Populations, and Infrastructure

The National Institutes of Health (NIH) Clinical and Translational Science Awards (CTSA) program and the 2006 Institute of Medicine (IOM) Report on the future of emergency care highlight the need for coordinated emergency care research (ECR) to improve the outcomes of acutely ill or injured patients. In response, the Society for Academic Emergency Medicine (SAEM) and the American College of Emergency Physicians (ACEP) sponsored the Emergency Care Research Network (ECRN) Conference in Washington, DC, on May 28, 2008. The conference objectives were to identify the unique nature of ECR and the infrastructure needed to support ECR networks and to understand the optimal role of emergency medicine (EM) and other acute care specialties in research networks. Prior to the conference, participants responded to questions addressing the relevant issues that would form the basis of breakout session discussions; two of these breakout questions are summarized in this report: 1) what makes EM research unique? and 2) what are the critical components needed to establish and maintain networked ECR? Emergency care research was defined as “the systematic examination of patient care that is expected to be continuously available to diverse populations presenting with undifferentiated symptoms of acute illness, or acutely decompensated chronic illness, and whose outcomes depend on timely diagnosis and treatment.” The chain of ECR may extend beyond the physical emergency department (ED) in both place and time and integrate prehospital care, as well as short‐ and long‐term outcome determination. ECR may extend beyond individual patients and have as the focus of investigation the actual system of emergency care delivery itself and its effects on the community with respect to access to care, use of resources, and cost. Infrastructure determinants of research network success identified by conference participants included multidisciplinary collaboration, accurate long‐term outcome determination, novel information technology, intellectual infrastructure, and wider network relationships that extend beyond the ED.     

近20年激光针灸脑效应研究进展

激光针灸作为社会科技进步的时代产物,是一种将低水平激光应用于经络系统的治疗方法,拓宽了传统针灸技术的应用及发展,其脑效应研究于近20年兴起,本文从当前应用较多的功能磁共振成像、脑电图和经颅多普勒超声3种技术层面对激光针灸脑效应的研究进展及未来展望加以论述。研究表明激光针灸在刺激不同穴位时产生的脑效应能够体现穴位的特异性且与其主治存在关联,同时有相似作用的穴位产生的脑效应存在一定的相关性。目前激光针灸作用机制仍未探查清楚,脑效应研究为探索其治疗以疼痛为代表的某些疾病的疗效机制提供了新的视角,虽然仍面临着许多挑战,但未来有着广阔的发展前景。     

Multimodal Functional Neuroimaging by Simultaneous BOLD fMRI and Fiber-Optic Calcium Recordings and Optogenetic Control

Recent developments of optogenetic tools and fluorescence-based calcium recording techniques enable the manipulation and monitoring of neural circuits on a cellular level. Non-invasive imaging of brain networks, however, requires the application of methods such as blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI), which is commonly used for functional neuroimaging. While BOLD fMRI provides brain-wide non-invasive reading of the hemodynamic response, it is only an indirect measure of neural activity. Direct observation of neural responses requires electrophysiological or optical methods. The latter can be combined with optogenetic control of neuronal circuits and are MRI compatible. Yet, simultaneous optical recordings are still limited to fiber-optic-based approaches. Here, we review the integration of optical recordings and optogenetic manipulation into fMRI experiments. As a practical example, we describe how BOLD fMRI in a 9.4-T small animal MR scanner can be combined with in vivo fiber-optic calcium recordings and optogenetic control in a multimodal setup. We present simultaneous BOLD fMRI and calcium recordings under optogenetic control in rat. We outline details about MR coil configuration, choice, and usage of opsins and chemically and genetically encoded calcium sensors, fiber implantation, appropriate light power for stimulation, and calcium signal detection, to provide a glimpse into challenges and opportunities of this multimodal molecular neuroimaging approach.