PMID- 29868449 OWN - NLM STAT- MEDLINE DCOM- 20190204 LR - 20210109 IS - 2213-1582 (Electronic) IS - 2213-1582 (Linking) VI - 18 DP - 2018 TI - Enhancing treatment of osteoarthritis knee pain by boosting expectancy: A functional neuroimaging study. PG - 325-334 LID - S2213-1582(18)30021-4 [pii] LID - 10.1016/j.nicl.2018.01.021 [doi] AB - OBJECTIVES: Expectation can significantly modulate pain and treatment effects. This study aims to investigate if boosting patients' expectancy can enhance the treatment of knee osteoarthritis (KOA), and its underlying brain mechanism. METHODS: Seventy-four KOA patients were recruited and randomized to three groups: boosted acupuncture (with a manipulation to enhance expectation), standard acupuncture, or treatment as usual (TAU). Each patient underwent six treatments before being debriefed, and four additional treatments after being debriefed. The fMRI scans were applied during the first and sixth treatment sessions. RESULTS: We found significantly decreased knee pain in the boosted acupuncture group compared to the standard acupuncture or TAU groups after both six and ten treatments. Resting state functional connectivity (rsFC) analyses using the nucleus accumbens (NAc) as the seed showed rsFC increases between the NAc and the medial prefrontal cortex (MPFC)/rostral anterior cingulate cortex (rACC) and dorsolateral prefrontal cortex in the boosted group as compared to the standard acupuncture group after multiple treatments. Expectancy scores after the first treatment were significantly associated with increased NAc-rACC/MPFC rsFC and decreased knee pain following treatment. CONCLUSIONS: Our study provides a novel method and mechanism for boosting the treatment of pain in patients with KOA. Our findings may shed light on enhancing outcomes of pharmacological and integrative medicines in clinical settings. FAU - Kong, Jian AU - Kong J AD - Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA; MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA. Electronic address: kongj@nmr.mgh.harvard.edu. FAU - Wang, Zengjian AU - Wang Z AD - Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. FAU - Leiser, Jaclyn AU - Leiser J AD - Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. FAU - Minicucci, Domenic AU - Minicucci D AD - Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. FAU - Edwards, Robert AU - Edwards R AD - Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. FAU - Kirsch, Irving AU - Kirsch I AD - Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. FAU - Wasan, Ajay D AU - Wasan AD AD - Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. FAU - Lang, Courtney AU - Lang C AD - Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. FAU - Gerber, Jessica AU - Gerber J AD - MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA. FAU - Yu, Siyi AU - Yu S AD - Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA. FAU - Napadow, Vitaly AU - Napadow V AD - MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA. FAU - Kaptchuk, Ted J AU - Kaptchuk TJ AD - Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. FAU - Gollub, Randy L AU - Gollub RL AD - Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA; MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA; Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. LA - eng GR - R21 AT008707/AT/NCCIH NIH HHS/United States GR - R61 AT009310/AT/NCCIH NIH HHS/United States GR - R01 AT006364/AT/NCCIH NIH HHS/United States GR - R01 AT008563/AT/NCCIH NIH HHS/United States GR - K24 AT004095/AT/NCCIH NIH HHS/United States GR - P01 AT006663/AT/NCCIH NIH HHS/United States GR - R01 AT005280/AT/NCCIH NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20180228 PL - Netherlands TA - Neuroimage Clin JT - NeuroImage. Clinical JID - 101597070 RN - S88TT14065 (Oxygen) SB - IM MH - Acupuncture Therapy/*methods MH - Adult MH - Aged MH - Analysis of Variance MH - Brain/*diagnostic imaging MH - Female MH - Humans MH - Hyperalgesia/rehabilitation MH - Image Processing, Computer-Assisted MH - Magnetic Resonance Imaging/*methods MH - Male MH - Middle Aged MH - *Osteoarthritis, Knee/diagnostic imaging/psychology/therapy MH - Oxygen/blood MH - Pain/etiology/psychology MH - Pain Measurement MH - Pain Threshold/*psychology MH - Physical Stimulation/adverse effects MH - Severity of Illness Index MH - Time Factors MH - Treatment Outcome PMC - PMC5984593 OTO - NOTNLM OT - Acupuncture OT - Expectancy OT - Knee osteoarthritis OT - Resting state functional connectivity OT - Reward EDAT- 2018/06/06 06:00 MHDA- 2019/02/05 06:00 PMCR- 2018/02/28 CRDT- 2018/06/06 06:00 PHST- 2017/09/13 00:00 [received] PHST- 2017/12/08 00:00 [revised] PHST- 2018/01/18 00:00 [accepted] PHST- 2018/06/06 06:00 [entrez] PHST- 2018/06/06 06:00 [pubmed] PHST- 2019/02/05 06:00 [medline] PHST- 2018/02/28 00:00 [pmc-release] AID - S2213-1582(18)30021-4 [pii] AID - 10.1016/j.nicl.2018.01.021 [doi] PST - epublish SO - Neuroimage Clin. 2018 Feb 28;18:325-334. doi: 10.1016/j.nicl.2018.01.021. eCollection 2018.