Neuroradiology

Central Nervous Pathway for Acupuncture Stimulation: Localization of Processing with Functional MR Imaging of the Brain—Preliminary Experience

Abstract

PURPOSE: To characterize the central nervous system (CNS) pathway for acupuncture stimulation in the human brain by using functional magnetic resonance (MR) imaging.

MATERIALS AND METHODS: Functional MR imaging of the whole brain was performed in two groups of nine healthy subjects during four stimulation paradigms: real acupuncture at acupoints ST.36 (on the leg) and LI.4 (on the hand) and control stimulations (minimal acupuncture and superficial pricking on the leg). Stimulations were performed in semirandomized, balanced order nested within two experiments. Psychophysical responses (pain, De-Qi effect [characteristic acupuncture effect of needle-manipulation sensation], anxiety, and unpleasantness) and autonomic responses were assessed. Talairach coordinates–transformed imaging data were averaged for a group analysis.

RESULTS: Acupuncture at LI.4 and ST.36 resulted in significantly higher scores for De-Qi and in substantial bradycardia. Acupuncture at both acupoints resulted in activation of the hypothalamus and nucleus accumbens and deactivation of the rostral part of the anterior cingulate cortex, amygdala formation, and hippocampal complex; control stimulations did not result in such activations and deactivations.

CONCLUSION: Functional MR imaging can demonstrate the CNS pathway for acupuncture stimulation. Acupuncture at ST.36 and LI.4 activates structures of descending antinociceptive pathway and deactivates multiple limbic areas subserving pain association. These findings may shed light on the CNS mechanism of acupuncture analgesia and form a basis for future investigations of endogenous pain modulation circuits in the human brain.

References

1 Nathan PW. . Acupuncture analgesia. Trends Neurosci 1978; :21-23. Google Scholar
2 Han JS. Neurochemical basis of acupuncture. Annu Rev Pharmacol Toxicol 1982; 22:193-220. Crossref, Medline, Google Scholar
3 Melzack R. Folk medicine and the sensory modulation of pain. In: Wall PD, Melzack R, eds. The textbook of pain. 3rd ed. London, England: Churchill Livingstone, 1994; 1209-1218. Google Scholar
4 Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Basics of acupuncture. 3rd ed. New York, NY: Springer-Verlag, 1995; 4-60. Google Scholar
5 Filshie J, White A. Medical acupuncture: a Western scientific approach London, England: Churchill Livingstone, 1998. Google Scholar
6 Eisenberg DM, Kesseler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs and patterns of use. N Engl J Med 1993; 328:246-252. Crossref, Medline, Google Scholar
7 Fisher P, Ward A. Complementary medicine in Europe. Br Med J 1994; 309:107-111. Crossref, Medline, Google Scholar
8 . 1993 exploratory grants for alternative medicine: National Institutes of Health guide Bethesda, Md: National Institutes of Health, 1993. Google Scholar
9 Bowsher D. Mechanisms of acupuncture. In: Filshie J, White A, eds. Medical acupuncture: a Western scientific approach. London, England: Churchill Livingstone, 1998; 69-82. Google Scholar
10 Peets JM, Pomeranz B. CXBK mice deficient in opiate receptors show poor electroacupuncture analgesia. Nature 1978; 273:675-676. Crossref, Medline, Google Scholar
11 Clement-Jones V, McLoughlin L, Tomlin S, Besser GM, Rees LH, Wen HL. Increased beta-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. Lancet 1980; 2:946-949. Medline, Google Scholar
12 Kiser RS, Khatami MJ, Gatchel RJ, Huang XY, Bhatia K, Altshuler KZ. Acupuncture relief of chronic pain syndrome correlates with increased plasma met-enkephalin concentrations. Lancet 1983; 2:1394-1396. Medline, Google Scholar
13 Ng LKY, Katims JJ, Lee MHM. Acupuncture, a neuromodulation technique for pain control In: Aronoff GM, ed. Evaluation and treatment of chronic pain. 2nd ed. Baltimore, Md: Williams & Wilkins, 1992. Google Scholar
14 Jin WQ, Zhou ZF, Han JS. Electroacupuncture and morphine analgesia potentiated by bestatin and thiorphan administered to the nucleus accumbens of the rabbit. Brain Res 1986; 380:317-324. Crossref, Medline, Google Scholar
15 Yu LC, Han JS. Involvement of arcuate nucleus of hypothalamus in the descending pathway from nucleus accumbens to periaqueductal gray subserving an antinociceptive effect. Int J Neurosci 1989; 48:71-78. Crossref, Medline, Google Scholar
16 Wang Q, Mao L, Han JS. The arcuate nucleus of hypothalamus mediates low but not high frequency electroacupuncture in rats. Brain Res 1990; 513:60-66. Crossref, Medline, Google Scholar
17 Takeshige C. The acupuncture point and its connecting central pathway for producing acupuncture analgesia. Brain Res Bull 1993; 30:53-67. Crossref, Medline, Google Scholar
18 Zhou Z, Du M, Wu W, Jiang Y, Han J. Effect of intracerebral microinjection of naloxone on acupuncture- and morphine-analgesia in the rabbit. Sci Sin 1981; 24:1166-1177. Medline, Google Scholar
19 Melzack R, Casey KL. Sensory, motivational and central control determinants of pain In: Kenshalo DR Jr, ed. The skin senses. Springfield, Ill: Thomas, 1968. Google Scholar
20 Bonica JJ. Basic considerations of pain In: The management of pain. 2nd ed. Philadelphia, Pa: Lea & Febiger, 1990; 2-208. Google Scholar
21 Hsieh JC, Belfrage M, Stone-Elander S, Hansson P, Ingvar M. Central representation of chronic ongoing neuropathic pain studied by positron emission tomography. Pain 1995; 63:225-236. Crossref, Medline, Google Scholar
22 Devinsky O, Morrell MJ, Vogt BA. Contributions of anterior cingulate cortex to behavior. Brain 1995; 118:279-306. Crossref, Medline, Google Scholar
23 Rainville P, Duncan GH, Price DD, Carrier B, Bushnell C. Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science 1997; 277:968-971. Crossref, Medline, Google Scholar
24 Beijing College of Traditional Chinese Medicine. Shanghai College of Traditional Chinese Medicine. Nanjing College of Traditional Chinese Medicine. Acupuncture Institute of the Academy of Traditional Chinese Medicine. Essentials of Chinese acupuncture Beijing, People's Republic of China: Foreign Language Press, 1980. Google Scholar
25 Vincent CA, Richardson PH, Black JJ, Pither CE. The significance of needle placement site in acupuncture. J Psychosom Res 1989; 33:489-496. Crossref, Medline, Google Scholar
26 Cho ZH, Chung SC, Jones JP, et al. New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci USA 1998; 95:2670-2673. Crossref, Medline, Google Scholar
27 Kwong KK, Belliveau JW, Chesler DA, et al. Dynamic magnetic resonance imaging of human brain activity during primary sensory stimulation. Proc Natl Acad Sci USA 1992; 89:5675-5679. Crossref, Medline, Google Scholar
28 Cohen MS, Bookheimer SY. Localization of brain function using magnetic resonance imaging. Trends Neurosci 1994; 17:268-277. Crossref, Medline, Google Scholar
29 Wu MT, Xian J, Kwong KK, Yang P, Rosen BR. Central processes of acupuncture assessed by functional MR imaging (abstr). Radiology 1997; 202(2):56A. Google Scholar
30 State Administration of Traditional Chinese Medicine. The location of acupoint: state standard of the People's Republic of China Beijing, People's Republic of China: Foreign Language Press, 1995. Google Scholar
31 Vincent CA, Lewith G. Placebo controls for acupuncture studies. J R Soc Med 1995; 88:199-202. Medline, Google Scholar
32 Lewith GT, Vincent CA. The clinical evaluation of acupuncture. In: Filshie J, White A, eds. Medical acupuncture: a Western scientific approach. London, England: Churchill Livingstone, 1998; 205-224. Google Scholar
33 Reese TG, Davis TL, Weisskoff RM. Automated shimming at 1.5 T using echo planar image frequency maps. JMRI 1995; 5:739-745. Crossref, Google Scholar
34 Jiang A, Kennedy DN, Baker JR, et al. Motion detection and correction in functional MR imaging. Hum Brain Mapp 1995; 3:1-12. Google Scholar
35 Woods RP, Cherry SR, Mazziotta JC. Rapid automated algorithm for aligning and reslicing PET imaging. J Comput Assist Tomogr 1992; 16:620-633. Crossref, Medline, Google Scholar
36 Talairach J, Tournoux P. Co-planar stereotaxic atlas of the human brain New York, NY: Thieme Medical, 1988. Google Scholar
37 Stuart A, Ord JK, eds. Kendall's advanced theory of statistics New York, NY: Oxford University Press, 1991. Google Scholar
38 Baker JR, Weisskoff RM, Stern CE, et al. Statistical assessment of functional MRI signal change (abstr) In: Book of abstracts: Society of Magnetic Resonance in Medicine 1992. Berkeley, Calif: Society of Magnetic Resonance in Medicine, 1992; 626. Google Scholar
39 Breiter HC, Etcoff NL, Whalen PJ, et al. Response and habituation of the human amygdala during visual processing of facial expression. Neuron 1996; 17:875-887. Crossref, Medline, Google Scholar
40 Nishijo K, Mori H, Yosikawa K, Yazawa K. Decreased heart rate by acupuncture stimulation in humans via facilitation of cardiac vagal activity and suppression of cardiac sympathetic nerve. Neurosci Lett 1997; 227:165-168. Crossref, Medline, Google Scholar
41 Angevine JB, Cotman CW. The limbic system and hypothalamus In: Principles of neuroanatomy. New York, NY: Oxford University Press, 1981; 253-293. Google Scholar
42 Lewith GT, Machin D. On the evaluation of the clinical effects of acupuncture. Pain 1983; 16:111-127. Crossref, Medline, Google Scholar
43 Le Bihan D, Dohi M. Can fMRI detect decreased neuronal activity? (abstr) In: Proceedings of the Society of Magnetic Resonance in Medicine and the European Society of Magnetic Resonance in Medicine. Berkeley, Calif: Society of Magnetic Resonance in Medicine, 1995; 452. Google Scholar
44 Manning BH, Mayer DJ. The central nucleus of the amygdala contributes to the production of morphine antinociception in the rat tail-flick test. J Neurosci 1995; 15:8199-8213. Crossref, Medline, Google Scholar
45 Khanna S, Sinclair JG. Responses of the CA1 region of the rat hippocampus to a noxious stimulus. Exp Neurol 1992; 117:28-35. Crossref, Medline, Google Scholar
46 Posner MI, Rothbart MK. Attentional mechanisms and conscious experience. In: Milner AD, Rugg MD, eds. The neuropsychology of consciousness. London, England: Academic Press, 1991; 91-111. Google Scholar
47 Derbyshire SW, Jones AK, Gyulai F, Clark S, Townsend D, Firestone LL. Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain 1997; 73:431-445. Crossref, Medline, Google Scholar
48 Coghill RC, Talbot JD, Evans AC, et al. Distributed processing of pain and vibration by the human brain. J Neurosci 1994; 14:4095-4108. Crossref, Medline, Google Scholar
49 Hsieh JC, Stahle-Backdahl M, Hagermark O, Stone-Elander S, Rosenquist G, Ingvar M. Traumatic nociceptive pain activates the hypothalamus and the periaqueductal gray: a positron emission tomography study. Pain 1995; 64:303-314. Google Scholar
50 Hsieh JC, Hannerz J, Ingvar M. Right-lateralized central processing for pain of nitro-glycerine–induced cluster headache. Pain 1996; 67:59-68. Crossref, Medline, Google Scholar
51 Derbyshire SWG, Jones AKP, Devani PFKJ, et al. Cerebral responses to pain in patients with atypical facial pain measured by positron emission tomography. J Neurol Neurosurg Psychiatry 1994; 57:1166-1172. Crossref, Medline, Google Scholar
52 Clement-Jones V, McLoughlin L, Lowry PJ, Besser GM, Rees LH, Wen HL. Acupuncture in heroin addicts: changes in met-enkephalin and beta-endorphin in blood and cerebrospinal fluid. Lancet 1979; 2:380-383. Medline, Google Scholar
53 Jobst K, Chen JH, McPherson K, et al. Controlled trial of acupuncture for disabling breathlessness. Lancet 1986; 2:1416-1419. Medline, Google Scholar

Article History

Published in print: July 1999

Vol. 212, No. 1

Metrics

Downloaded 2,744 times

Altmetric Score