Advertisement

Inserting Needles Into the Body: A Meta-Analysis of Brain Activity Associated With Acupuncture Needle Stimulation

Published:February 07, 2013DOI:https://doi.org/10.1016/j.jpain.2012.11.011

      Abstract

      Acupuncture is a therapeutic treatment that is defined as the insertion of needles into the body at specific points (ie, acupoints). Advances in functional neuroimaging have made it possible to study brain responses to acupuncture; however, previous studies have mainly concentrated on acupoint specificity. We wanted to focus on the functional brain responses that occur because of needle insertion into the body. An activation likelihood estimation meta-analysis was carried out to investigate common characteristics of brain responses to acupuncture needle stimulation compared to tactile stimulation. A total of 28 functional magnetic resonance imaging studies, which consisted of 51 acupuncture and 10 tactile stimulation experiments, were selected for the meta-analysis. Following acupuncture needle stimulation, activation in the sensorimotor cortical network, including the insula, thalamus, anterior cingulate cortex, and primary and secondary somatosensory cortices, and deactivation in the limbic-paralimbic neocortical network, including the medial prefrontal cortex, caudate, amygdala, posterior cingulate cortex, and parahippocampus, were detected and assessed. Following control tactile stimulation, weaker patterns of brain responses were detected in areas similar to those stated above. The activation and deactivation patterns following acupuncture stimulation suggest that the hemodynamic responses in the brain simultaneously reflect the sensory, cognitive, and affective dimensions of pain.

      Perspective

      This article facilitates a better understanding of acupuncture needle stimulation and its effects on specific activity changes in different brain regions as well as its relationship to the multiple dimensions of pain. Future studies can build on this meta-analysis and will help to elucidate the clinically relevant therapeutic effects of acupuncture.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Amanzio M.
        • Benedetti F.
        • Porro C.A.
        • Palermo S.
        • Cauda F.
        Activation likelihood estimation meta-analysis of brain correlates of placebo analgesia in human experimental pain.
        Hum Brain Mapp. 2012; https://doi.org/10.1002/hbm.21471
        • Apkarian A.V.
        • Bushnell M.C.
        • Treede R.D.
        • Zubieta J.K.
        Human brain mechanisms of pain perception and regulation in health and disease.
        Eur J Pain. 2005; 9: 463-484
        • Astin J.A.
        Why patients use alternative medicine: Results of a national study.
        JAMA. 1998; 279: 1548-1553
        • Becerra L.R.
        • Breiter H.C.
        • Stojanovic M.
        • Fishman S.
        • Edwards A.
        • Comite A.R.
        • Gonzalez R.G.
        • Borsook D.
        Human brain activation under controlled thermal stimulation and habituation to noxious heat: An fMRI study.
        Magn Reson Med. 1999; 41: 1044-1057
        • Beissner F.
        • Deichmann R.
        • Henke C.
        • Bar K.J.
        Acupuncture–deep pain with an autonomic dimension?.
        Neuroimage. 2012; 60: 653-660
        • Beissner F.
        • Henke C.
        Methodological problems in FMRI studies on acupuncture: A critical review with special emphasis on visual and auditory cortex activations.
        Evid Based Complement Alternat Med. 2011; https://doi.org/10.1093/ecam/nep154
        • Berman B.M.
        • Langevin H.M.
        • Witt C.M.
        • Dubner R.
        Acupuncture for chronic low back pain.
        N Engl J Med. 2010; 363: 454-461
        • Bingel U.
        • Quante M.
        • Knab R.
        • Bromm B.
        • Weiller C.
        • Buchel C.
        Subcortical structures involved in pain processing: Evidence from single-trial fMRI.
        Pain. 2002; 99: 313-321
        • Buckner R.L.
        • Andrews-Hanna J.R.
        • Schacter D.L.
        The brain's default network: Anatomy, function, and relevance to disease.
        Ann N Y Acad Sci. 2008; 1124: 1-38
        • Campbell A.
        Point specificity of acupuncture in the light of recent clinical and imaging studies.
        Acupunct Med. 2006; 24: 118-122
        • Carlsson C.
        Acupuncture mechanisms for clinically relevant long-term effects–reconsideration and a hypothesis.
        Acupunct Med. 2002; 20: 82-99
        • Cesaro P.
        • Mann M.W.
        • Moretti J.L.
        • Defer G.
        • Roualdes B.
        • Nguyen J.P.
        • Degos J.D.
        Central pain and thalamic hyperactivity: A single photon emission computerized tomographic study.
        Pain. 1991; 47: 329-336
        • Chae Y.
        • Park H.J.
        • Hahm D.H.
        • Hong M.
        • Ha E.
        • Park H.K.
        • Lee H.
        fMRI review on brain responses to acupuncture: The limitations and possibilities in traditional Korean acupuncture.
        Neurol Res. 2007; 29: S42-S48
        • Cho Z.H.
        • Chung S.C.
        • Jones J.P.
        • Park J.B.
        • Park H.J.
        • Lee H.J.
        • Wong E.K.
        • Min B.I.
        New findings of the correlation between acupoints and corresponding brain cortices using functional MRI.
        Proc Natl Acad Sci U S A. 1998; 95: 2670-2673
        • Choi E.M.
        • Jiang F.
        • Longhurst J.C.
        Point specificity in acupuncture.
        Chin Med. 2012; 7: 4
        • Deng G.
        • Hou B.L.
        • Holodny A.I.
        • Cassileth B.R.
        Functional magnetic resonance imaging (fMRI) changes and saliva production associated with acupuncture at LI-2 acupuncture point: A randomized controlled study.
        BMC Complement Altern Med. 2008; 8: 37
        • Dhond R.P.
        • Kettner N.
        • Napadow V.
        Neuroimaging acupuncture effects in the human brain.
        J Altern Complement Med. 2007; 13: 603-616
        • Duerden E.G.
        • Albanese M.C.
        Localization of pain-related brain activation: A meta-analysis of neuroimaging data.
        Hum Brain Mapp. 2013; 34: 109-149
        • Eickhoff S.B.
        • Laird A.R.
        • Grefkes C.
        • Wang L.E.
        • Zilles K.
        • Fox P.T.
        Coordinate-based activation likelihood estimation meta-analysis of neuroimaging data: A random-effects approach based on empirical estimates of spatial uncertainty.
        Hum Brain Mapp. 2009; 30: 2907-2926
        • Eickhoff S.B.
        • Stephan K.E.
        • Mohlberg H.
        • Grefkes C.
        • Fink G.R.
        • Amunts K.
        • Zilles K.
        A new SPM toolbox for combining probabilistic cytoarchitectonic maps and functional imaging data.
        Neuroimage. 2005; 25: 1325-1335
        • Eisenberg D.M.
        • Davis R.B.
        • Ettner S.L.
        • Appel S.
        • Wilkey S.
        • Van Rompay M.
        • Kessler R.C.
        Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey.
        JAMA. 1998; 280: 1569-1575
        • Engelmann J.M.
        • Versace F.
        • Robinson J.D.
        • Minnix J.A.
        • Lam C.Y.
        • Cui Y.
        • Brown V.L.
        • Cinciripini P.M.
        Neural substrates of smoking cue reactivity: A meta-analysis of fMRI studies.
        Neuroimage. 2012; 60: 252-262
        • Fang J.
        • Jin Z.
        • Wang Y.
        • Li K.
        • Kong J.
        • Nixon E.E.
        • Zeng Y.
        • Ren Y.
        • Tong H.
        • Wang P.
        • Hui K.K.
        The salient characteristics of the central effects of acupuncture needling: Limbic-paralimbic-neocortical network modulation.
        Hum Brain Mapp. 2009; 30: 1196-1206
        • Fox P.T.
        • Lancaster J.L.
        Opinion: Mapping context and content: The BrainMap model.
        Nat Rev Neurosci. 2002; 3: 319-321
        • Gareus I.K.
        • Lacour M.
        • Schulte A.C.
        • Hennig J.
        Is there a BOLD response of the visual cortex on stimulation of the vision-related acupoint GB 37?.
        J Magn Reson Imaging. 2002; 15: 227-232
        • Han J.S.
        • Ho Y.S.
        Global trends and performances of acupuncture research.
        Neurosci Biobehav Rev. 2011; 35: 680-687
        • Hui K.K.
        • Liu J.
        • Makris N.
        • Gollub R.L.
        • Chen A.J.
        • Moore C.I.
        • Kennedy D.N.
        • Rosen B.R.
        • Kwong K.K.
        Acupuncture modulates the limbic system and subcortical gray structures of the human brain: Evidence from fMRI studies in normal subjects.
        Hum Brain Mapp. 2000; 9: 13-25
        • Hui K.K.
        • Liu J.
        • Marina O.
        • Napadow V.
        • Haselgrove C.
        • Kwong K.K.
        • Kennedy D.N.
        • Makris N.
        The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI.
        Neuroimage. 2005; 27: 479-496
        • Hui K.K.
        • Marina O.
        • Claunch J.D.
        • Nixon E.E.
        • Fang J.
        • Liu J.
        • Li M.
        • Napadow V.
        • Vangel M.
        • Makris N.
        • Chan S.T.
        • Kwong K.K.
        • Rosen B.R.
        Acupuncture mobilizes the brain's default mode and its anti-correlated network in healthy subjects.
        Brain Res. 2009; 1287: 84-103
        • Ingvar M.
        Pain and functional imaging.
        Philos Trans R Soc Lond B Biol Sci. 1999; 354: 1347-1358
        • Kong J.
        • Gollub R.L.
        • Webb J.M.
        • Kong J.T.
        • Vangel M.G.
        • Kwong K.
        Test-retest study of fMRI signal change evoked by electroacupuncture stimulation.
        Neuroimage. 2007; 34: 1171-1181
        • Kong J.
        • Kaptchuk T.J.
        • Webb J.M.
        • Kong J.T.
        • Sasaki Y.
        • Polich G.R.
        • Vangel M.G.
        • Kwong K.
        • Rosen B.
        • Gollub R.L.
        Functional neuroanatomical investigation of vision-related acupuncture point specificity–a multisession fMRI study.
        Hum Brain Mapp. 2009; 30: 38-46
        • Kong J.
        • Loggia M.L.
        • Zyloney C.
        • Tu P.
        • Laviolette P.
        • Gollub R.L.
        Exploring the brain in pain: Activations, deactivations and their relation.
        Pain. 2010; 148: 257-267
        • Kong J.
        • Ma L.
        • Gollub R.L.
        • Wei J.
        • Yang X.
        • Li D.
        • Weng X.
        • Jia F.
        • Wang C.
        • Li F.
        • Li R.
        • Zhuang D.
        A pilot study of functional magnetic resonance imaging of the brain during manual and electroacupuncture stimulation of acupuncture point (LI-4 Hegu) in normal subjects reveals differential brain activation between methods.
        J Altern Complement Med. 2002; 8: 411-419
        • Laird A.R.
        • Lancaster J.L.
        • Fox P.T.
        BrainMap: The social evolution of a human brain mapping database.
        Neuroinformatics. 2005; 3: 65-78
        • Lancaster J.L.
        • Tordesillas-Gutierrez D.
        • Martinez M.
        • Salinas F.
        • Evans A.
        • Zilles K.
        • Mazziotta J.C.
        • Fox P.T.
        Bias between MNI and Talairach coordinates analyzed using the ICBM-152 brain template.
        Hum Brain Mapp. 2007; 28: 1194-1205
        • Langevin H.M.
        • Wayne P.M.
        • Macpherson H.
        • Schnyer R.
        • Milley R.M.
        • Napadow V.
        • Lao L.
        • Park J.
        • Harris R.E.
        • Cohen M.
        • Sherman K.J.
        • Haramati A.
        • Hammerschlag R.
        Paradoxes in acupuncture research: Strategies for moving forward.
        Evid Based Complement Alternat Med. 2011; https://doi.org/10.1155/2011/180805
        • Lewith G.T.
        • White P.J.
        • Pariente J.
        Investigating acupuncture using brain imaging techniques: The current state of play.
        Evid Based Complement Alternat Med. 2005; 2: 315-319
        • Li G.
        • Cheung R.T.
        • Ma Q.Y.
        • Yang E.S.
        Visual cortical activations on fMRI upon stimulation of the vision-implicated acupoints.
        Neuroreport. 2003; 14: 669-673
        • Li G.
        • Huang L.
        • Cheung R.T.
        • Liu S.R.
        • Ma Q.Y.
        • Yang E.S.
        Cortical activations upon stimulation of the sensorimotor-implicated acupoints.
        Magn Reson Imaging. 2004; 22: 639-644
        • Li G.
        • Liu H.L.
        • Cheung R.T.
        • Hung Y.C.
        • Wong K.K.
        • Shen G.G.
        • Ma Q.Y.
        • Yang E.S.
        An fMRI study comparing brain activation between word generation and electrical stimulation of language-implicated acupoints.
        Hum Brain Mapp. 2003; 18: 233-238
        • Lui F.
        • Duzzi D.
        • Corradini M.
        • Serafini M.
        • Baraldi P.
        • Porro C.A.
        Touch or pain? Spatio-temporal patterns of cortical fMRI activity following brief mechanical stimuli.
        Pain. 2008; 138: 362-374
        • Lund I.
        • Lundeberg T.
        Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls?.
        Acupunct Med. 2006; 24: 13-15
        • Mantini D.
        • Caulo M.
        • Ferretti A.
        • Romani G.L.
        • Tartaro A.
        Noxious somatosensory stimulation affects the default mode of brain function: Evidence from functional MR imaging.
        Radiology. 2009; 253: 797-804
        • Melzack R.
        • Wall P.D.
        Pain mechanisms: A new theory.
        Science. 1965; 150: 971-979
        • Na B.J.
        • Jahng G.H.
        • Park S.U.
        • Jung W.S.
        • Moon S.K.
        • Park J.M.
        • Bae H.S.
        An fMRI study of neuronal specificity of an acupoint: Electroacupuncture stimulation of Yanglingquan (GB34) and its sham point.
        Neurosci Lett. 2009; 464: 1-5
        • Nakagoshi A.
        • Fukunaga M.
        • Umeda M.
        • Mori Y.
        • Higuchi T.
        • Tanaka C.
        Somatotopic representation of acupoints in human primary somatosensory cortex: An FMRI study.
        Magn Reson Med Sci. 2005; 4: 187-189
        • Napadow V.
        • Makris N.
        • Liu J.
        • Kettner N.W.
        • Kwong K.K.
        • Hui K.K.
        Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI.
        Hum Brain Mapp. 2005; 24: 193-205
        • Napadow V.
        • Dhond R.P.
        • Kim J.
        • LaCount L.
        • Vangel M.
        • Harris R.E.
        • Kettner N.
        • Park K.
        Brain encoding of acupuncture sensation-coupling on-line rating with fMRI.
        Neuroimage. 2009; 47: 1055-1065
        • Peyron R.
        • Laurent B.
        • Garcia-Larrea L.
        Functional imaging of brain responses to pain. A review and meta-analysis.
        Neurophysiol Clin. 2000; 30: 263-288
        • Raichle M.E.
        • MacLeod A.M.
        • Snyder A.Z.
        • Powers W.J.
        • Gusnard D.A.
        • Shulman G.L.
        A default mode of brain function.
        Proc Natl Acad Sci U S A. 2001; 98: 676-682
        • Schliessbach J.
        • van der Klift E.
        • Siegenthaler A.
        • Arendt-Nielsen L.
        • Curatolo M.
        • Streitberger K.
        Does acupuncture needling induce analgesic effects comparable to diffuse noxious inhibitory controls?.
        Evid Based Complement Alternat Med. 2012; https://doi.org/10.1155/2012/785613
        • Siedentopf C.M.
        • Golaszewski S.M.
        • Mottaghy F.M.
        • Ruff C.C.
        • Felber S.
        • Schlager A.
        Functional magnetic resonance imaging detects activation of the visual association cortex during laser acupuncture of the foot in humans.
        Neurosci Lett. 2002; 327: 53-56
        • Tjen A.L.S.C.
        • Li P.
        • Longhurst J.C.
        Medullary substrate and differential cardiovascular responses during stimulation of specific acupoints.
        Am J Physiol Regul Integr Comp Physiol. 2004; 287: R852-R862
        • Treede R.D.
        • Kenshalo D.R.
        • Gracely R.H.
        • Jones A.K.
        The cortical representation of pain.
        Pain. 1999; 79: 105-111
        • Ulett G.A.
        • Han S.
        • Han J.S.
        Electroacupuncture: Mechanisms and clinical application.
        Biol Psychiatry. 1998; 44: 129-138
        • Vas J.
        • Ortega C.
        • Olmo V.
        • Perez-Fernandez F.
        • Hernandez L.
        • Medina I.
        • Seminario J.M.
        • Herrera A.
        • Luna F.
        • Perea-Milla E.
        • Mendez C.
        • Madrazo F.
        • Jimenez C.
        • Ruiz M.A.
        • Aguilar I.
        Single-point acupuncture and physiotherapy for the treatment of painful shoulder: A multicentre randomized controlled trial.
        Rheumatology (Oxford). 2008; 47: 887-893
        • Wesolowski T.
        • Lotze M.
        • Domin M.
        • Langner S.
        • Lehmann C.
        • Wendt M.
        • Usichenko T.I.
        Acupuncture reveals no specific effect on primary auditory cortex: A functional magnetic resonance imaging study.
        Neuroreport. 2009; 20: 116-120
        • White A.
        • Foster N.E.
        • Cummings M.
        • Barlas P.
        Acupuncture treatment for chronic knee pain: A systematic review.
        Rheumatology (Oxford). 2007; 46: 384-390
        • WHO
        Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials.
        World Health Organization, 2002
        • Wu M.T.
        • Hsieh J.C.
        • Xiong J.
        • Yang C.F.
        • Pan H.B.
        • Chen Y.C.
        • Tsai G.
        • Rosen B.R.
        • Kwong K.K.
        Central nervous pathway for acupuncture stimulation: Localization of processing with functional MR imaging of the brain–preliminary experience.
        Radiology. 1999; 212: 133-141
        • Wu M.T.
        • Sheen J.M.
        • Chuang K.H.
        • Yang P.
        • Chin S.L.
        • Tsai C.Y.
        • Chen C.J.
        • Liao J.R.
        • Lai P.H.
        • Chu K.A.
        • Pan H.B.
        • Yang C.F.
        Neuronal specificity of acupuncture response: A fMRI study with electroacupuncture.
        Neuroimage. 2002; 16: 1028-1037
        • Yoo S.S.
        • Teh E.K.
        • Blinder R.A.
        • Jolesz F.A.
        Modulation of cerebellar activities by acupuncture stimulation: Evidence from fMRI study.
        Neuroimage. 2004; 22: 932-940
        • Zhang W.T.
        • Jin Z.
        • Luo F.
        • Zhang L.
        • Zeng Y.W.
        • Han J.S.
        Evidence from brain imaging with fMRI supporting functional specificity of acupoints in humans.
        Neurosci Lett. 2004; 354: 50-53