Neuroimaging Somatosensory and Psychosocial Mechanisms Underlying Acupuncture

Acupuncture consists of several components, including 1) ritual with palpation, diagnosis, and 2) somatosensory stimulation. Our recent study of acupuncture in treating carpal tunnel syndrome found that while verum and sham acupuncture interventions reduced symptom severity, verum acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both locally to the wrist and in the brain. Specifically, acupuncture may improve median nerve function at the wrist due to neuroplasticity in primary somatosensory cortex following therapy. Additionally, the patient-clinician relationship and therapeutic alliance can significantly influence response to therapy. We completed fMRI hyperscanning in patient-clinician dyads who interacted via video transfer during clinician-initiated electroacupuncture treatment of evoked pain in fibromyalgia patients. Greater therapeutic alliance was noted for dyads following clinical interaction. Further, patients’ and clinicians’ brain response demonstrated consistent shared activation of social mirroring/theory-of-mind circuitry (e.g. Temporoparietal Junction, TPJ). Dyad-based analyses suggested that these nodes showed extensive dynamic coupling with the partners’ brain activity, but only in dyads who had established a clinical relationship prior to interaction. Patient-clinician mirroring in facial expressions was associated with greater therapeutic alliance and analgesia. Thus, patient-clinician coupling of brain activity in theory-of-mind/social mirroring circuitry supports therapeutic alliance and psychosocially-facilitated analgesia during clinical interaction.