Abstract
BackgroundElectrical acupuncture (EA) has been utilized in acute pain management. However, the neuronal mechanisms that lead to the analgesic effect are still not well defined. The current study assessed the intensity [optimal EA (OI-EA) vs. minimal EA (MI-EA)] effect of non-noxious EA on supraspinal regions related to noxious heat pain (HP) stimulation utilizing an EA treatment protocol for acute pain and functional magnetic resonance imaging (fMRI) with correlation in behavioral changes. Subjects underwent five fMRI scanning paradigms: one with heat pain (HP), two with OI-EA and MI-EA, and two with OI-EA and HP, and MI-EA and HP.ResultsWhile HP resulted in activations (excitatory effect) in supraspinal areas known for pain processing and perception, EA paradigms primarily resulted in deactivations (suppressive effect) in most of these corresponding areas. In addition, OI-EA resulted in a more robust supraspinal sedative effect in comparison to MI-EA. As a result, OI-EA is more effective than MI-EA in suppressing the excitatory effect of HP in supraspinal areas related to both pain processing and perception.ConclusionIntensities of EA plays an important role in modulating central pain perception.
Highlights
Electrical acupuncture (EA) has been utilized in acute pain management
No statistically significant difference was observed between heat pain (HP) only and HP after minimal EA (MI-EA) VAS scores
It is known that collateral pain ascending pathways exist and individual afferent neurons often project in more than one of these pathways [16,17,18]. These pathways include a spinohypothalamic pathway, a spinopontoamygdaloid pathway, and a component of the spinothalamic pathway that projects to specific midline thalamic nuclei which further projects to limbic cortical areas such as the anterior cingulate cortex (ACC) and insular cortex (IC)
Summary
Electrical acupuncture (EA) has been utilized in acute pain management. the neuronal mechanisms that lead to the analgesic effect are still not well defined. The current study assessed the intensity [optimal EA (OI-EA) vs minimal EA (MI-EA)] effect of non-noxious EA on supraspinal regions related to noxious heat pain (HP) stimulation utilizing an EA treatment protocol for acute pain and functional magnetic resonance imaging (fMRI) with correlation in behavioral changes. We conducted the current study utilizing a published acute pain treatment acupuncture paradigm, thermal noxious stimulation and functional magnetic resonance imaging (fMRI), to: 1) assess the baseline supraspinal blood oxygen level dependent (BOLD) response related to HP stimulation and two (minimal and optimal) intensities of EA with behavioral correlation in pain and deqi (tingling sensation) VAS scores respectively; and 2) assess the direct effect of the different intensities of EA on supraspinal response to subsequent HP stimulation. The authors are aware of different sensations associated with deqi sensation and chose “tingling sensation” as the primary acupuncture intensity assessment based on a previous study which established this particular sensation as the most prominent sensation associated with EA [10]
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