| ObjectsIn this study,patients with chronic neck pain were taken as the research object.Based on traditional Chinese theory of “pressure pain points”,observing the improvement of clinical symptoms of chronic neck pain patients by acupuncture.The Blood Oxygen Level Dependent-functional Magnetic Resonance Imaging(BOLD-f MRI)technology was used to observe the changes in Regional Homogeneity(Re Ho)of the brain regions in the resting state before and after the treatment of patients in the acupuncture group and the waiting list group,and to calculate their relevance of clinical efficacy changes.Analyzing the effect of “pressure pain points” acupuncture on the brain function of patients with chronic neck pain,exploring the central imaging mechanism,and providing an objective basis for guiding clinical scientific acupoint selection.MethodsA total of 73 patients with chronic neck pain were included in this study.They were randomly divided into the acupuncture group(39 cases)and the waiting list group(34 cases)by SAS software.1.Acupoints selection method: The electronic tenderness meter was used to measure the pressure pain thresholds of the proposed 15 acupoints and the prescribed detection area of the neck touched by hand three times respectively,and the change ranges(the average of the difference between the three tenderness thresholds and the other healthy people’s pressure pain thresholds)ranked from large to small,and the top five acupoints / sensitive points were used as the acupuncture points.The acupoints / sensitive points during the treatment period are measured once every 2 weeks,and the acupuncture points of the treatment group were adjusted according to the actual detection results to achieve individualized acupuncture treatment;2.Control method: Patients in the waiting list group did not receive acupuncture treatment,which is allowed to take prescribed analgesic drugs or the patient’s previous routine care for relief when the neck pain was severe.Patients were informed that they would receive free acupuncture treatments 10 times after 4 weeks of observation.3.Therapeutic method: The patients in “pressure pain points” acupuncture group received 10 sessions of acupuncture treatment for 4 weeks(3 times a week for the first 2 weeks,and twice a week for the next 2 weeks),each lasting 30 minutes.The trial periods were 8 weeks,of which the baseline periods were 4 weeks and the treatment or observe periods were 4 weeks.4.Evaluation method: Patients in the two groups underwent resting-state f MRI scans before and after treatment.The clinical efficacy evaluation index including the Northwick Park Neck Pain Questionnaire(NPQ),Visual Analogue Scale(VAS),and SF-12 quality of life score(Short-form 12-Item Health Survey,SF-12).The clinical efficacy evaluation of the case report form was completed before and after the treatment.At the end of the trial,the following analyses were completed:(1)SPSS software was used to statistically analyze the differences in the NPQ,VAS,and SF-12 efficacy indexes of patients with chronic neck pain before and after the treatment in both groups and the differences between the groups after treatment using T test(in accordance with normal distribution)(P<0.05),to explore the clinical effect and safety of acupuncture with “pressure pain points” in the treatment of chronic neck pain;(2)SPM software and the Regional Homogeneity(Re Ho)analysis method was used to observe and analyze the differences in Re Ho values between the acupuncture group and the waiting list group before and after treatment and the changes in Re Ho values between the groups after treatment(FDR corrected,P <0.05).Selecting significantly different brain areas to analyze their Re Ho changes and significantly changed clinical effect indicators with SPSS software and to further discover the central mechanism of acupuncture group with “pressure pain points” to relive pain in patients with chronic neck pain.Results1.The differences in baseline data and disease-related indicators between the “pressure pain points” acupuncture group and the waiting list group were statistically significant(P>0.05),and were comparable.2.Before and after the treatment,the differences of treatment group in the NPQ scores,VAS scores,and SF-12 scores were statistically significant(P <0.01),while there were no significant differences in control group(P>0.05).There was a statistically significant difference in NPQ scores between the two groups after the treatment(P<0.05),but there were no statistical differences in the VAS scores and SF-12 scores(P>0.05).3.After the treatment,the acupuncture group showed the Re Ho of the left Cingulate Gyrus,the right Precentral Gyrus,and the Insular increased;The Re Ho of the left Inferior Parietal Lobule and the right Postcentral Gyrus reduced.The Re Ho of the left posterior central gyrus and the middle temporal gyrus increased in the treatment group,but no Re Ho of brain regions reduced.After the treatment period,the Re Ho of the bilateral medial frontal gyrus and the right inferior frontal gyrus were increased,and the left medial occipital gyrus,inferior frontal gyrus,inferior semilunar lobule,and the right superior frontal gyrus,inferior parietal lobule,and anterior cingulate gyrus were decreased in the treatment group.4.Since the most significant differences of therapeutic indicators in the treatment group,the most significantly changed brain region of the right insula in the treatment group was selected for correlation analysis with its significantly changed therapeutic indicators of NPQ scores,VAS scores and SF-12 scores.The results showed that: the increase of Re Ho in the right insula was negatively correlated with the change of SF-12 scores(r=-0.413,p=0.029),but not correlated with the NPQ scores(r=0.231,p=0.236)and VAS scores(r=-0.203,p=0.300)Conclusions1.This study can initially prove that the treatment of CNP with “pressure pain points” acupuncture is safe and effective,especially in terms of the degree of neck pain.Patients in the waiting list group had no self-healing tendency without intervention.2.The regulation effect of the acupuncture group with “pressure pain points” on the brain is related to limbic system,parietal lobe,frontal lobe,occipital lobe and posterior cerebellar lobe;the regulation of the brain in the waiting list group is related to the temporal lobe and parietal lobe.The limbic system and the parietal lobe played a key role in the treatment group.3.Correlation analysis showed that the increase of Re Ho in the right insula was negatively correlated with the change of SF-12 scores in the treatment group. |
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