| Objection:In this study,patients with chronic neck pain were taken as the research object.On the basis of observing the clinical efficacy of acupuncture at the sensitized acupoints of treatment of patients with chronic neck pain,resting magnetic resonance imaging technology was used to study part of the neuroimaging mechanism of chronic neck pain,And focus on analyzing the influence of acupuncture at sensitized points on the brain function connection network features of patients with chronic neck pain,reveal the central imaging mechanism of acupuncture at sensitized points in the treatment of chronic neck pain,and enrich the scientific connotation of acupoints sensitization theory.Methods:A total of 73 patients with chronic neck pain and 30 healthy subjects who met the inclusion criteria were included in this study.All subjects were randomly assigned to the sensitized acupoints group(39 cases)and routine care group(34 cases).In the sensitized acupoints group,the 5 acupoints / sensitive points with the greatest change in the tenderness threshold measured by the WAGNER tenderness instrument were selected as acupuncture points.After 2 weeks of treatment,they were measured again,and the acupuncture points were adjusted according to the test results;the sensitized acupoints group was treated 3 times a week in the first two weeks and 2 times a week in the next two weeks.A total of 10 acupuncture treatments were performed for 4 weeks.The routine care group did not undergo acupuncture intervention,and the observation period was 4 weeks.Before and after treatment / observation,the frequency of neck pain episodes(average days of neck pain episodes per week for the past 4 weeks,the average daily duration of neck pain episodes for the past 4 weeks),the degree of neck pain(VAS score,Mc Gill score),and neck function(NDI score)clinical evaluation in three aspects.Patients in the sensitized acupoints group and routine care group were scanned at the time of enrollment and at the end of treatment / observation.Healthy subjects were scanned at the time of enrollment.Perform the following analysis separately:1.Compare the intra-group and inter-group differences of clinical indexes before and after treatment / observation in the sensitized acupoints group and routine care group.2.Using voxel-based morphological measurement method to analyze the brain structural characteristics of patients with chronic neck pain,Amplitude of low frequency fluctuation and functional connection method to analyze the brain function differences between the acupuncture-sensitized point group and the conventional care group To further analyze the brain function connection network characteristics of acupuncture at the sensitized acupoints for chronic neck pain and its correlation with clinical efficacy.Results:1.Evaluation of clinical curative effect of acupuncture at the sensitized acupoints on chronic neck pain(1)There was no statistically significant difference in the baseline condition between patients in the sensitized acupoints group and the routine care group,and the baseline was comparable(P> 0.05).(2)Comparison within the group: After 4 weeks of acupuncture treatment,the average number of days of neck pain attacks per week in the sensitized acupoints group in the past 4 weeks,the average daily duration of neck pain attacks in the past 4 weeks,VAS score,NDI score and Mc Gill The score was significantly different from that before treatment(P<0.05).There was no statistical difference in the conventional nursing group before and after observation.(3)Comparison between groups: After 4 weeks of acupuncture treatment / observation,the average number of days of neck pain attacks per week in t the sensitized acupoints group and the routine care group in the past 4 weeks,the average daily duration of neck pain attacks in the past 4 weeks,and NDI There was a significant difference between the score and the Mc Gill score(P<0.05).In terms of VAS score,the difference between the two groups was not statistically significant(P> 0.05).2.Analysis of sensitized acupoints characteristics in patients with chronic neck painSensitized acupuncture points in patients with chronic neck pain are mainly concentrated in acupoints such as Tianliao,Dazhu,Houxi,Jianzhongyu,Jianwaishu,and Zhongzhu,and the points of hand intestinal meridian and hand Shaoyang Sanjiao are most frequently sensitized.3.Brain structural characteristics of patients with chronic neck painBrain gray matter VBM analysis results: Compared with healthy people,the gray matter volume of the left anterior cingulate gyrus and the right apical gyrus was significantly reduced in patients with chronic neck pain(P<0.05,FDR corrected).The gray matter volume and age of the patients with chronic neck pain in the anterior cingulate gyrus on the left and the apical gyrus on the right,the course of disease,the average number of days of neck pain attacks per week in the past 4 weeks,the average length of daily neck pain attacks in the past 4 weeks,NDI score,Mc Gill No significant correlation was found in scores and VAS scores.4.Analysis of changes in brain function activity before and after treatment / observation of acupuncture at the sensitized acupoints(1)Comparison within the group: After treatment,patients with chronic neck pain in the sensitized acupoints group had significantly higher ALFF values in the central and posterior gyrus after treatment;patients in the conventional care group had significantly higher ALFF values in the middle temporal gyrus than before and after observation High(P<0.05,FDR corrected).(2)Comparison between groups: After treatment,the sensitized acupoints group had significantly higher ALFF values in the paracentral lobule,insula,superior temporal gyrus,and posterior central gyrus compared with the conventional care group(P<0.05,FDR corrected).5.Analysis of brain function connection network characteristics of acupuncture at the sensitized acupoints for chronic neck pain(1)FC results: FC analysis was performed using the left anterior cingulate gyrus and the right top apical gyrus as seed points.It was found that patients in t the sensitized acupoints group had left anterior cingulate gyrus and left anterior wedge after treatment.The functional connection between the medial superior frontal gyrus on the right side and the superior intraorbital frontal gyrus on the right side(P<0.05,FDR corrected),no brain area weakened with the functional connection of the anterior cingulate gyrus;Variety.There was no significant change in the functional connection of the routine care group.(2)Correlation analysis results: after treatment with acupuncture at the sensitized acupoints group,the change rate of the functional connection between the anterior cingulate gyrus and anterior wedge was positively correlated with the change rate of Mc Gill score(r = 0.460,P=0.014);other functional connections No correlation with changes in clinical indicators.Conclusions:1.This study initially confirmed that the frequency of acupuncture at the sensitized acupoints on chronic neck pain,the degree of pain and the improvement of neck function were significantly improved.2.Tianjiao,Dazhu,Houxi,Jianzhongshu and Jianwaishu are the key sensitized acupoints in patients with chronic neck pain,which may be the key to the effectiveness of acupuncture at the point of sensitization.3.The left anterior cingulate gyrus and the right top gyrus may be the key parts of abnormal brain structure in patients with chronic neck pain.4.Anterior cingulate gyrus-anterior wedge lobes,anterior cingulate gyrus-medial forehead gyrus,and anterior cingulate gyrus-intraorbital forehead are brain functional networks specifically affected by acupuncture sensitization points;Changes in the functional connection of the leaves may be the key central mechanism for acupuncture at the sensitized acupoints to improve the degree of neck pain. |
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