Abstract
AimsTo investigate the functional connectivity (FC) in nonacute sciatica and the neuronal correlation of acupuncture analgesia.MethodsA prospective study employing resting‐state functional magnetic resonance imaging was conducted. Twelve sciatica patients were enrolled to receive six or 18 acupoints of acupuncture treatment twice a week for 4 weeks. Regional homogeneity (ReHo) and seed‐based FC were performed.ResultsRegional homogeneity analysis demonstrated a greater alteration in the right posterior cingulate cortex (PCC) during the pre‐acupuncture phase than during the postacupuncture phase. Compared to that of healthy controls, the PCC‐seeded FC (default mode network, DMN) of sciatica patients exhibited hyperconnectivity of PCC‐FC with the PCC‐bilateral insula, cerebellum, inferior parietal lobule, right medial prefrontal cortex, and dorsal anterior cingulate cortex during the pre‐acupuncture phase as well as hypoconnectivity of PCC‐FC with the right cerebellum, left precuneus, and left dorsal medial prefrontal cortex during the postacupuncture phase. Correlation analysis between PCC‐seeded FC and behavior measurements revealed a positive association with the duration of sciatica in the right inferior parietal lobule prior to acupuncture treatment.ConclusionsAcupuncture in chronic sciatica patients is associated with normalized DMN activity and modulation of descending pain processing. The changes in the subclinical endophenotype of brain FC after acupuncture treatment may provide clues for understanding the mechanism of acupuncture‐mediated analgesia in chronic pain.
Highlights
Sciatica is a common chronic pain disorder, typically presenting as low back or gluteal pain that may radiate to one leg, with motor or sensory complaints (Peul et al, 2007; Valat, Genevay, Genevay, Marty, Rozenberg, & Koes, 2010)
We demonstrated that posterior cingulate cortex (PCC)/PCu was a pivotal hub in sciatica treatment with acupuncture
The present findings demonstrate that the nonacute/chronic sciatica group had greater PCC regional homogeneity (ReHo) values than did the healthy control and postacupuncture groups
Summary
Sciatica is a common chronic pain disorder, typically presenting as low back or gluteal pain that may radiate to one leg, with motor or sensory complaints (Peul et al, 2007; Valat, Genevay, Genevay, Marty, Rozenberg, & Koes, 2010). A measurement of the global burden of disease revealed that low back pain is the leading cause of daily disability, and sciatica is one of the most common variations of low back pain (Andersson, Pope, Frymoyer, & Snook, 1991; Murray & Lopez, 2013). Network meta-analyses comparing the clinical effectiveness of management strategies for sciatica demonstrate that for overall outcomes, there is a statistically significant improvement following disk surgery, epidural injections, nonopioid analgesia, manipulation, and acupuncture (Lewis et al, 2015). Chronic pain is a complex negative experience that engages multiple regions of the brain (Apkarian, Baliki, Baliki, & Geha, 2009). Many functional magnetic resonance imaging (fMRI) studies have identified that chronic pain may cause changes in the brain (May, 2008)
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