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A study carried out in the USA has explored the central brain mechanisms by which expectation modulates the analgesic effects of verum and sham acupuncture treatment in chronic pain patients with knee osteoarthritis (OA). Investigators used an expectancy manipulation model and fMRI to study response to heat pain stimuli before and after verum or sham acupuncture treatment in 43 patients patients with chronic pain from knee OA. The results showed that although both interventions resulted in pain relief, each was associated with a distinct pattern of brain activation, suggesting that verum and sham analgesia may work through different pathways, and that their effects may also be different in chronic pain patients compared with healthy individuals.

A Functional Neuroimaging Study of Expectancy Effects on Pain Response in Patients With Knee Osteoarthritis. J Pain. 2018 May;19(5):515-527.


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