Brain Mechanisms of Psychosocial Aspects of Acupuncture Therapy

Study Purpose

The overall aim of the present proposal is to investigate how patients' and clinicians' (Licensed acupuncturists, LAc) neural and autonomic processes during treatment interaction correlate to patient outcomes. Male and female healthy clinicians and fibromyalgia patients will be recruited for the study.

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

Yes
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 21 Years - 65 Years
Gender All
More Inclusion & Exclusion Criteria

Phase 1: Inclusion Criteria (Healthy Clinicians):

  • - Male and Female healthy clinicians.
  • - 25-60 years of age.
  • - Ability to read and understand English; English can be a second language provided that the participant feels that he/she understand all the questions used in the assessment measures.
Inclusion Criteria (Fibromyalgia Patients):
  • - Have a clinical diagnosis of fibromyalgia and meet the Wolfe et al 2011 research criteria for fibromyalgia for at least one year.
  • - Are on stable doses of medication for 30 days prior to entering the study and agree not to change medications or dosages during the trial.
  • - 21 to 60 years of age.
  • - Right-handed.
  • - Ability to read and understand English; English can be a second language provided that the participant feels that he/she understand all the questions used in the assessment measures.
Exclusion Criteria (All participants):
  • - Any longer period of work experience involving pain treatment, pain rehabilitation etc. This is in order to exclude participants with biased expectations regarding different methods of analgesia.
  • - Presence of any illness or medication use that is judged to interfere with the trial.
For example: psychiatric disorder according to the DSM-IV manual, medication that can influence cognition or emotional processing, i.e. sleep medication, antidepressants, anti-convulsants or opioids.
  • - Presence of any contraindications to fMRI scanning.
For example: cardiac pacemaker, metal implants, fear of closed spaces, pregnancy.
  • - Inability to respond accurately to the pain-relieving intervention in the behavioral part of the experiment, indicating a lack of response to the expectancy manipulation.
If the healthy volunteer or clinician is not a responder to the behavioral expectancy induction he or she will be excluded.
  • - Unwillingness to receive brief experimental pain.
  • - Leg pain or health issues that may interfere with the study procedures.
Exclusion Criteria (Specific to Fibromyalgia Patients):
  • - Comorbid acute pain condition.
  • - Comorbid chronic pain condition that is rated by the subject as more painful than fibromyalgia.
  • - Current use of opioid analgesics or stimulant medications or the fatigue associated with sleep apnea or shift work (e.g., modafinil) - Documented peripheral neuropathy.
  • - Any psychiatric disorder involving a history of psychosis (e.
g schizophrenia, bipolar disorder, severe personality disorders)
  • - History of anxiety disorders or significant anxiety symptoms interfering with fMRI procedures (e.g., panic) - Psychiatric hospitalization in the past 6 months.
  • - Any impairment, activity or situation that in the judgment of the Study Coordinator or Principal Investigator would prevent satisfactory completion of the study protocol.
  • - Is an actual clinical patient of the clinician subject.
Phase 2: Inclusion Criteria (healthy individuals): 1. Male and female healthy clinicians. 2. 25-65 years of age (clinicians) 3. Ability to read and understand English; English can be a second language provided that the participant feels that he/she understand all the questions used in the assessment measures. Inclusion Criteria (FM patients): 1. Have a clinical diagnosis of fibromyalgia and meet the Wolfe et al 2011 research criteria for fibromyalgia for at least one year. 2. Are on stable doses of medication for 30 days prior to entering the study and agree not to change medications or dosages during the trial. 3. 21-65 years of age. 4. Ability to read and understand English; English can be a second language provided that the participant feels that he/she understand all the questions used in the assessment measures. Exclusion Criteria (all participants): 1. Any longer period of work experience involving pain treatment, pain rehabilitation etc. This is in order to exclude participants with biased expectations regarding different methods of analgesia. 2. Presence of any illness that is judged to interfere with the trial. For example: psychiatric disorder according to the DSM-IV manual. 3. Presence of any contraindications to fMRI scanning. For example: cardiac pacemaker, metal implants, fear of closed spaces, pregnancy. 4. Inability to respond accurately to the pain-relieving intervention in the behavioral part of the experiment, indicating a lack of response to the expectancy manipulation. If the healthy volunteer or clinician is not a responder to the behavioral expectancy in-duction he or she will be excluded. 5. Unwillingness to receive brief experimental pain. 6. Leg pain or health issues that may interfere with the study procedures. Exclusion Criteria (specific to FM patients): 1. Comorbid acute pain condition. 2. Comorbid chronic pain condition that is rated by the subject as more painful than fibromyalgia. 3. Documented peripheral neuropathy. 4. Any psychiatric disorder involving a history of psychosis (e. g schizophrenia, bipolar disorder, severe personality disorders) 5. History of anxiety disorders or significant anxiety symptoms interfering with fMRI procedures (e.g., panic) 6. Psychiatric hospitalization in the past 6 months. 7. Marijuana use greater than once daily and unwillingness to withhold from consumption 12 hours prior to scans or lab visits. 8. Unwillingness to withhold from consuming nicotine 4 hours prior to scans. 9. Any impairment, activity or situation that in the judgment of the Study Coordinator or Principal Investigator would prevent satisfactory completion of the study protocol. 10. Is an actual clinical patient of the clinician subject

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT02908022
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

N/A
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

Massachusetts General Hospital
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

Vitaly Napadow, PhD, LicAc
Principal Investigator Affiliation Spaulding Rehabilitation Hospital
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Other, NIH
Overall Status Recruiting
Countries United States
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Physician-patient Relationship, Fibromyalgia, Acupuncture Therapy
Additional Details

First phase: At the training sessions, both clinician and patient will fill out a set of questionnaires and go through standardized psychophysical tests for assessing visual displays of affect. They will also be informed of the efficacy of the electroacupuncture in relieving pain during the experiment. During the clinical examination, the clinician will follow clinical exam protocol and do an intake of the fibromyalgia (FM) patient, including a physical exam and pain assessment. While in the scanner, the clinician will receive painful stimulations with a pressure cuff on the leg over an 8-minute paradigm in order to get cerebral representation. The patient will then be placed in a different scanner running simultaneously and will experience painful stimulations with a pressure cuff while interacting via live camera with the clinician in the other scanner. When visually prompted via cues on a screen, the clinician will activate analgesia for the patient, through a response device (response box) in clinician's one hand. After each trial of pain with/without treatment, the clinicians will be asked "how did you feel about the outcome (extremely positive

  • - extremely negative)", and how satisfied are you (Not at all satisfied - Very satisfied) on Numerical Rating Scales (NRS).
The patient will also give ratings after each trial of pain with/without treatment. They will be asked "how did you feel about the outcome (extremely positive
  • - extremely negative)?", and "how painful was the cuff (Not painful - Extremely painful)?" on NRS.
After the scan, both clinician and patient will be asked to rate anxiety during the presence of visual stimulus preceding cuff activation (not at all anxious
  • - extremely anxious).
After the final MRI session, the clinician and the patient will both be given the chance to report their responses to the treatment and then debriefed. Second phase: At training session both clinician and patient will fill out a set of questionnaires. During the first MRI session the clinician will receive painful stimulations with a pressure cuff on the leg over a 6-minute paradigm in order to get cerebral representation. The patient will then be placed in a different scanner running simultaneously and will experience pain stimulation with the pressure cuff while interacting via live camera with the clinician in the other scanner. When visually prompted via cues on a screen, the clinician will activate analgesia for the patient, through a response device (response box) in clinician's hand. Both patient and acupuncturist will be asked to give ratings of pain and other parameters during the scan. Following the first MRI session, the patient will attend biweekly acupuncture treatment sessions with the clinician (6 treatments total). During the first session the clinician will be introduced to the patient and do a general intake in addition to the acupuncture treatment. The final MRI session will be identical to the first.

Arms & Interventions

Arms

Experimental: Interaction

Phase 1: Prior to the MRI sessions, the clinician will be introduced to the patient and do a general intake of physical examination. During the MRI sessions, the patient will receive experimental pressure pain via the Hokanson Rapid Cuff Inflator and electroacupuncture analgesia to the leg for pain relief.

Experimental: No Interaction

Phase 1: The clinician and the patient will first be introduced at the MRI sessions. During the MRI sessions, the patient will receive experimental pressure pain via the Hokanson Rapid Cuff Inflator and electroacupuncture analgesia to the leg for pain relief.

Experimental: Longitudinal

Phase 2: Prior to first MRI session, both clinician and patient will go through a training visit. During the first MRI session, the patient will receive experimental pressure pain to the left leg via Hokanson Rapid Cuff Inflator and electroacupuncture to the same leg for pain relief. Following the first MRI session, the patient will attend biweekly acupuncture treatment sessions with the clinician (6 treatments total). During the first session the clinician will be introduced to the patient and do a general intake in addition to the acupuncture treatment. The final MRI session will be identical to the first. The patient will receive experimental pressure pain via Hokanson Rapid Cuff Inflator and electroacupuncture to the same leg for pain relief.

Interventions

Device: - Electroacupuncture Analgesia

For the MRI sessions, acupuncture needles will be inserted next to the cuff placed on the left leg and will be connected to electrodes. Low-amplitude electrical current will be activated when a button is pressed via a handheld device, controlled by the acupuncturist, in order to reduce pain, acting as an analgesic. Additionally, electroacupuncture-induced analgesia will be used for the treatments. During the treatment sessions the acupuncturist will insert needles in several locations aimed to reduce the patient's fibromyalgia pain. Low-amplitude electrical current will be activated by the acupuncturist using the same electroacupuncture device as in the MRI machine.

Device: - Hokanson Rapid Cuff Inflator

The Hokanson Rapid Cuff Inflator will be placed on the lower right leg of the subject and utilized for pain testing purposes according to the protocol. Ascending pressures will be administered using the cuff to elicit different pain intensities.

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

Martinos Center for Biomedical Imaging, Charlestown, Massachusetts

Status

Recruiting

Address

Martinos Center for Biomedical Imaging

Charlestown, Massachusetts, 02129

Site Contact

Seneca Ellis

[email protected]

617-952-6484

Spaulding Rehabilitation Hospital, Charlestown, Massachusetts

Status

Recruiting

Address

Spaulding Rehabilitation Hospital

Charlestown, Massachusetts, 02129

Site Contact

SenecA Ellis

[email protected]

617-952-6484