Arch Phys Med Rehabil. 2004 Sep;85(9):E42-E43. Wei Huang, MD, PhD (Univ North Carolina, Chapel Hill, NC); Weili Lin, PhD; Michael Y. Lee, MD; John Oh, MD; Vickie Kowlowitz, PhD; Bremer Jonathan, e-mail: firstname.lastname@example.org. [No authors listed] DISCLOSURE: W. Huang, None; W. Lin, None; M.Y. Lee, None; J. Oh, None; V. Kowlowitz, None; B. Jonathan, None.
OBJECTIVES: To test whether sensory processing of cold stimulation differs in fibromyalgia patients versus normal subjects, and whether acupuncture can modify central nervous system (CNS) responses in both groups.
Design: Functional magnetic resonance imaging (fMRI) was performed on all subjects using 3-T magnet with BOLD method during a 30-s cold pack application to the right lateral elbow region and a 3-min warming-up period with warm pack application. The process was repeated 3 times both before and after the acupuncture treatment. Images were analyzed using Statistical Parametric Mapping and pain ratings were analyzed with nonparametric tests. Setting: fMRI laboratory at university hospitals. Participants: 4 healthy subjects and 2 fibromyalgia patients diagnosed using the American College of Rheumatology criteria. Intervention: 20-min acupuncture to meridian points (right LI-4, TH-5; bilateral SP-6, KI-3, BL-60). Main Outcome Measures: fMRI images and pain ratings.
Results: In response to cold stimulation, fibromyalgia patients showed significantly higher activation in the prefrontal and insular cortexes (P<.001), corresponding to significantly higher pain ratings (4.0 vs 1.5, P<.01). Healthy subjects showed increased activation in the postcentral gyrus (Brodmann area 7) and caudate nuclear (P<.01). Despite no immediate change of pain ratings after acupuncture (healthy: 1 vs 1.5, fibromyalgia: 4 vs 4), there was significant deactivation in bilateral insular and cingulate cortexes in the healthy subjects (P<.001), and in the prefrontal, insular, anterior cingulate, inferior temporal, and premotor cortexes in the fibromyalgia patients (P<.01). Interestingly, activation was seen in the postcentral gyrus (Brodmann area 7) after acupuncture in the fibromyalgia patients but not in the healthy subjects (P<.01).
Conclusions: This pilot study confirms that CNS pain pathway activation, in response to cold stimulation in the fibromyalgia patients, suggests an analgesic role of acupuncture with immediate modification of central pain processing, and elucidates the possible benefits of acupuncture in the fibromyalgia population by "correcting" the CNS response to cold stimulation by facilitating sensory pathway. Key Words: Acupuncture; Fibromyalgia; Magnetic resonance imaging; Rehabilitation. PMID: 15376097 [PubMed – as supplied by publisher]