The Clinical Effect Of Acupuncture On CPPS And The Mechanism Of Central Analgesia Based On FMRI

Objective:In this study,the patients with chronic pelvic pain syndrome(CPPS)were taken as the research object to observe the clinical effect of cooling blood and removing blood stasis acupuncture based on the theory of blood stasis and heat;and functional MRI was used to observe the effect of acupuncture on the brain function of CPPS patients,so as to explain the central regulatory mechanism of acupuncture treatment of CPPS and provide central imaging basis for acupuncture treatment of CPPSMethods:In this study,31 CPPS patients were included,19 of them were in the observation group,12 of them were in the treatment group and 32 healthy subjects were in the control group.One MRI scan was performed between the observation group and the healthy subjects to observe the difference of the topological structure of the white matter network between the CPPS patients and the healthy subjects.12 patients in the treatment group were treated with "cooling blood and removing blood stasis" acupuncture five times a week,and the acupoints were selected as Zhongji,Sanyinjiao(bilateral),yinlingquan(bilateral),Shenshu(bilateral),Geshu(bilateral),and the course of treatment was four weeks;the patients in the treatment group were evaluated with NIH-CPSI before and after treatment,with TCM stasis heat symptom score table and MRI scanning;the NIH-CPSI of patients before and after treatment were observed And the changes of TCM syndrome score of blood stasis and heat and the differences of brain white matter network topology before and after treatment.Results:1.After the correlation analysis of the course of CPPS with the total score of NIH-CPSI and the total score of TCM stasis heat symptom score,it was found that the course of disease was positively correlated with the total score of NIH-CPSI by 0.01,and positively correlated with the total score of TCM stasis heat symptom score by 0.05;2.After 4 weeks of acupuncture,the pain score,symptom score and urinary symptoms in NIH-CPSI were significantly improved compared with those before treatment(P<0.05);3.After acupuncture for 4 weeks,the main symptoms,secondary symptoms and tongue pulse in the score of TCM stasis and heat symptoms were significantly improved compared with those before treatment(P<0.05);4.Compared with healthy subjects,the brain areas with lower global efficiency attribute in CPPS patients were right middle frontal gyrus,while the ascending brain areas were left supplementary activity area,middle cingulate gyrus,central posterior gyrus and paracentral lobule;the brain areas with lower local efficiency attribute were right middle frontal gyrus,while the ascending brain areas were left central anterior gyrus,central posterior gyrus,bilateral supplementary activity area and bilateral cingulate band Middle and left cingulate gyrus,right hippocampus,left superior parietal gyrus,right superior marginal gyrus,left anterior cuneiform lobe,left paracentral lobule,right superior temporal gyrus.5.After acupuncture,the global efficiency of the white matter network increased in the right middle frontal gyrus,superior frontal gyrus of left medial orbit,the front of the left cingulate gyrus and the right parahippocampal gyrus,and decreased in the left olfactory cortex;the local efficiency of the white matter network increased in the left middle frontal gyrus,the left supplementary activity area,the right supplementary activity area,the left parahippocampal gyrus and the left cuneiform leaf,and decreased in the right brain area Rectus,middle part of right cingulate gyrus,left anygdala,left lingual gyrus.Conclusion:1.Through the observation of the clinical effect of acupuncture on CPPS patients,the total score and each score of NIH-CPSI before and after the treatment were statistically different(P<0.05),so it can be considered that acupuncture is effective on CPPS;2.In the treatment of CPPS,there were statistical differences in the total score and each score before and after the treatment(P<0.05),suggesting that the method of cooling blood and removing blood stasis can effectively treat the symptoms of blood stasis and heat;3.The abnormal areas of white matter network in CPPS patients are mainly distributed in frontal lobe,cingulate gyrus,paracentral lobule and other areas,which lead to the increase of pain and discomfort in pelvic area.4.Acupuncture can not only improve the function of prefrontal lobe,but also activate the limbic system,including hippocampus,cingulate gyrus and amygdala,which are closely related to pain cognition and emotion processing.Therefore,we speculate that acupuncture treatment of stasis heat syndrome of CPPS may achieve analgesic effect by regulating sensory,cognitive and emotional processing.