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Sci Rep. 2018 Jan 17;8(1):930. doi: 10.1038/s41598-017-18870-1.

Phantom Acupuncture Induces Placebo Credibility and Vicarious Sensations: A Parallel fMRI Study of Low Back Pain Patients.

Author information

1
Systems and Biomedical Engineering Department, Faculty of Engineering, Cairo University, Giza, 12613, Egypt.
2
Department of Biomedical Engineering, Kyung Hee University, Yongin, 17104, Republic of Korea.
3
Department of Psychiatry, Yale University School of Medicine, New Haven, 06511, CT, USA.
4
The John B. Pierce Laboratory, New Haven, 06519, CT, USA.
5
Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, 02129, MA, USA.
6
Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea.
7
Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, 05278, Republic of Korea.
8
Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, 06272, Republic of Korea.
9
Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea.
10
Department of Biomedical Engineering, Kyung Hee University, Yongin, 17104, Republic of Korea. saenim@khu.ac.kr.

Abstract

Although acupuncture is an effective therapeutic intervention for pain reduction, the exact difference between real and sham acupuncture has not been clearly understood because a somatosensory tactile component is commonly included in the existing sham acupuncture protocols. In an event-related fMRI experiment, we implemented a novel form of sham acupuncture, phantom acupuncture, that reproduces the acupuncture needling procedure without somatosensory tactile stimulation while maintaining the credibility of the acupuncture treatment context. Fifty-six non-specific low back pain patients received either real (REAL) or phantom (PHNT) acupuncture stimulation in a parallel group study. The REAL group exhibited greater activation in the posterior insula and anterior cingulate cortex, reflecting the needling-specific components of acupuncture. We demonstrated that PHNT could be delivered credibly. Interestingly, the PHNT-credible group exhibited bilateral activation in SI/SII and also reported vicarious acupuncture sensations without needling stimulation. The PHNT group showed greater activation in the bilateral dorsolateral/ventrolateral prefrontal cortex (dlPFC/vlPFC). Moreover, the PHNT group exhibited significant pain reduction, with a significant correlation between the subjective fMRI signal in the right dlPFC/vlPFC and a score assessing belief in acupuncture effectiveness. These results support an expectation-related placebo analgesic effect on subjective pain intensity ratings, possibly mediated by right prefrontal cortex activity.

PMID:
29343693
PMCID:
PMC5772373
DOI:
10.1038/s41598-017-18870-1
[Indexed for MEDLINE]
Free PMC Article

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