Abstract
ObjectivesExpectation can significantly modulate pain and treatment effects. This study aims to investigate if boosting patients' expectancy can enhance the treatment of knee osteoarthritis (KOA), and its underlying brain mechanism.MethodsSeventy-four KOA patients were recruited and randomized to three groups: boosted acupuncture (with a manipulation to enhance expectation), standard acupuncture, or treatment as usual (TAU). Each patient underwent six treatments before being debriefed, and four additional treatments after being debriefed. The fMRI scans were applied during the first and sixth treatment sessions.ResultsWe found significantly decreased knee pain in the boosted acupuncture group compared to the standard acupuncture or TAU groups after both six and ten treatments. Resting state functional connectivity (rsFC) analyses using the nucleus accumbens (NAc) as the seed showed rsFC increases between the NAc and the medial prefrontal cortex (MPFC)/rostral anterior cingulate cortex (rACC) and dorsolateral prefrontal cortex in the boosted group as compared to the standard acupuncture group after multiple treatments. Expectancy scores after the first treatment were significantly associated with increased NAc-rACC/MPFC rsFC and decreased knee pain following treatment.ConclusionsOur study provides a novel method and mechanism for boosting the treatment of pain in patients with KOA. Our findings may shed light on enhancing outcomes of pharmacological and integrative medicines in clinical settings.
Highlights
Non-specific effects, such as the placebo effect, play an important role in medical practice (Finniss et al, 2010; Price et al, 2008)
We explored the feasibility of enhancing acupuncture treatment on knee OA using a well-tested expectancy manipulation model
We found that boosted acupuncture with enhanced expectation of pain relief can significantly increase acupuncture's therapeutic effect on knee pain compared to standard acupuncture which received identical acupuncture treatment as boosted acupuncture group
Summary
Non-specific effects, such as the placebo effect, play an important role in medical practice (Finniss et al, 2010; Price et al, 2008). Investigators have found a well-accepted expectancy manipulation model (Eippert et al, 2009; Hashmi et al, 2014; Kong et al, 2006, 2009a; Wager et al, 2004), in which they surreptitiously reduce stimulus intensity after placebo treatment to make subjects believe the treatment is effective, that can produce greater placebo effects compared to verbal suggestion alone (Colloca et al, 2008; Kong et al, 2013b; Voudouris et al, 1990). We first applied an expectancy model using experimental heat pain to enhance subjects' expectation of acupuncture analgesia, and tested whether this enhanced expectation improved the treatment effect of acupuncture on chronic pain caused by knee osteoarthritis (OA)
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