The Brain Effects of Laser Acupuncture in Healthy Individuals: An fMRI Investigation

Background: As laser acupuncture is being increasingly used to treat mental disorders, we sought to determine whether it has a biologically plausible effect by using functional magnetic resonance imaging (fMRI) to investigate the cerebral activation patterns from laser stimulation of relevant acupoints. Methodology/Principal Findings: Ten healthy subjects were randomly stimulated with a fibreoptic infrared laser on 4 acupoints (LR14, CV14, LR8 and HT7) used for depression following the principles of Traditional Chinese Medicine (TCM), and 1 control non-acupoint (sham point) in a blocked design (alternating verum laser and placebo laser/rest blocks), while the blood oxygenation level-dependent (BOLD) fMRI response was recorded from the whole brain on a 3T scanner. Many of the acupoint laser stimulation conditions resulted in different patterns of neural activity. Regions with significantly increased activation included the limbic cortex (cingulate) and the frontal lobe (middle and superior frontal gyrus). Laser acupuncture tended to be associated with ipsilateral brain activation and contralateral deactivation that therefore cannot be simply attributed to somatosensory stimulation. Conclusions/Significance: We found that laser stimulation of acupoints lead to activation of frontal-limbic-striatal brain regions, with the pattern of neural activity somewhat different for each acupuncture point. This is the first study to investigate laser acupuncture on a group of acupoints useful in the management of depression. Differing activity patterns depending on the acupoint site were demonstrated, suggesting that neurological effects vary with the site of stimulation. The mechanisms of activation and deactivation and their effects on depression warrant further investigation.5 page(s

An experimental and clinical study on the effects of laser acupuncture in the alleviation of depressive symptoms

The World Health Organisation has recently declared depression as the number one cause of disability in the world. Treatment options include pharmacotherapy, cognitive behaviour therapy and supportive counselling. The adverse effects of pharmacotherapy (a major deterrent to patient compliance) and recent literature reporting only 6-7% of depressed patients remitting are of concern. Many patients suffering from depression turn to Complementary Medicine, including acupuncture, for answers. Acupuncture has been commonly used to treat depression, but due to the heterogeneity of acupuncture in depression studies, empirical data have been inconclusive. Acupuncture’s adverse effects profile is minimal and it is well tolerated. This thesis presents a comprehensive investigation of the use of low intensity laser acupuncture (LA) in the treatment of depression, prompted by a pilot study using the LR14, CV14, HT7, LR8 acupoints.The significant brain effects of LA on these acupoints in healthy and depressed subjects were investigated using functional MRI (fMRI). Default mode network (DMN) modulation by LA and its relevance to depression was explored. The fMRI studies showed that LA activated brain regions relevant to emotional regulation and modulated the DMN, supporting the plausibility of LA as an antidepressant treatment. While differential activation patterns were produced by stimulation of different acupoints, it was unclear which were likely to be most effective. Stimulation of sham acupoints also produced brain activation.The major component of this body of work was the conduct of a randomised placebo-controlled trial of LA for depression, which demonstrated its effectiveness, with the benefit being sustained at 3 months follow-up. Somatisation effects were significantly improved in the clinical study delivering a better quality of life. Transient fatigue was the only adverse effect reported. The final experiment was to test the differential brain activation between laser and needle acupuncture on the most significant acupoint within the treatment regime.The series of studies presented in this thesis go toward establishing a body of work to substantiate acupuncture, in particular LA, as a treatment modality for depression. The results clearly suggest that this field is worthy of further exploration and likely application in practice

Laser acupuncture for depression : a randomised double blind controlled trial using low intensity laser intervention

Introduction: Trials of acupuncture for the treatment of depression have produced mixed results. We examined the effectiveness of laser acupuncture compared with placebo acupuncture for the treatment of major depression. Methods: A randomised, double blinded, placebo controlled trial was conducted in Sydney, Australia. Participants aged 18–50 years with DSM-IV major depressive disorder were eligible to join the study. Forty-seven participants were randomised to receive laser acupuncture or placebo laser at acupoints LR14, CV14, LR8, HT7 and KI3. The intervention was administered twice a week for 4 weeks and once a week for another four weeks, for a total of 12 sessions. The primary outcome assessed the change in severity of depression using the Hamilton-Depression Rating Scale(HAM-D),and secondary outcomes assessed the change in severity of depression using the Quick Inventory for Depression-Self Reporting (QID-SR), the Quick Inventory for Depression-Clinician (QIDS-CL), with outcomes assessed at eight weeks. The treatment response (greater than 50%improvement in HAM-D) andremission (HAM-Do8) were analysed. Results: At eight weeks participants showed greater improvement in the active laser group on the primary and clinician-rated secondary outcome measures (HAM-D (mean 9.28(SD6.55)vs. mean 14.14 (SD 4.78 p<0.001); QIDS-CL (mean 8.12 (SD6.61 versus 12.68 (mean SD3.77)) p<0.001).The self-report QIDS-SR scores improved in both groups but did not differ significantly between the groups. In the active laser group, QIDS-SR scores remained significantly lower than base line at 3months follow-up. Response rates (active laser, placebo laser) on ITT (intention to treat)analyses were 72.0% and 18.2% (p<0.001), respectively. Remission rates on ITT analyses (active laser, placebo laser) were 56.0% and 4.5% (p<0.001). Transient fatigue was the only adverse effect reported. Limitations: There was no follow-up for the placebo group at one and 3months. Conclusion: Laser acupuncture showed a clinically and statistically significant benefit with reducing symptoms of depressionon objective measures

The Antidepressant effect of laser acupuncture : a comparison of the resting brain's default mode network in healthy and depressed subjects during functional magnetic resonance imaging

Background: It has been suggested that the antidepressant effect of laser acupuncture involves modulation of the default mode network (DMN) or resting state network (RSN). In this study, the authors investigated changes in the DMN during laser acupuncture in depressed and nondepressed participants. Objective: To aim of this study was to determine if the modulation of the DMN effects by laser acupuncture in depressed participants are different from those of nondepressed participants. Design: Randomized stimulation was performed with laser acupuncture on four putative antidepressant acupoints (LR 14, LR 8, CV 14, and HT 7) in a block on-off design, while the blood oxygenation level-dependent (BOLD) fMRI response was recorded from each subject's whole brain on a 3T scanner. DMN patterns of the participants were identified, using an independent component analysis. The identified DMN components from both the nondepressed group and the depressed group were then analytically compared using SPM5. Setting: This study took place at a research institute. Subjects: Ten nondepressed participants and 10 depressed participants (DS) as confirmed by the Hamilton Depression Rating Scale (HAM-D) participated in this study. Intervention: Low Intensity Laser Acupuncture. Main outcome measures: Significant DMN patterns in one group were greater than those in the other group. Results: The nondepressed participants had significant modulation of DMN in the frontal region at the medial frontal gyrus (verum laser>rest, prest, p<0.001). Conclusions: Laser acupuncture on LR 8, LR 14, and CV 14 stimulated both the anterior and posterior DMN in both the nondepressed and depressed participants. However, in the nondepressed participants, there was consistently outstanding modulation of the anterior DMN at the medial frontal gyrus across all three acupoints. In the depressed participants, there was wider posterior DMN modulation at the parieto-temporal-limbic cortices. This is part of the antidepressant effect of laser acupuncture.10 page(s

Differential brain effects of laser and needle acupuncture at LR8 using functional MRI

Objective While needle acupuncture is a well-accepted technique, laser acupuncture is being increasingly used in clinical practice. The differential effects of the two techniques are of interest. We examine this in relation to brain effects of activation of LR8, a putative acupuncture point for depression, using functional MRI (fMRI). Methods Sixteen healthy participants were randomised to receive low intensity laser acupuncture to LR8 on one side and needle acupuncture to the contralateral LR8. Stimulation was in an on-off block design and brain patterns were recorded under fMRI. Results Significant activation occurred in the left precuneus during laser acupuncture compared with needle acupuncture and significant activation occurred in the left precentral gyrus during needle acupuncture compared with laser acupuncture. Conclusions Laser and needle acupuncture at LR8 in healthy participants produced different brain patterns. Laser acupuncture activated the precuneus relevant to mood in the posterior default mode network while needle acupuncture activated the parietal cortical region associated with the primary motor cortex. Further investigations are warranted to evaluate the clinical relevance of these effects.8 page(s

The Brain effects of laser acupuncture in depressed individuals : an fMRI investigation

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A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants

Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods are ambiguous. The objective was to review the effectiveness and safety of non-pharmacological methods of pain relief in newborn infants and to identify those that are the most effective. PubMed and Google Scholar were searched using the terms: &ldquo;infant&rdquo;, &ldquo;premature&rdquo;, &ldquo;pain&rdquo;, &ldquo;acupuncture&rdquo;, &ldquo;skin-to-skin contact&rdquo;, &ldquo;sucrose&rdquo;, &ldquo;massage&rdquo;, &ldquo;musical therapy&rdquo; and &lsquo;breastfeeding&rsquo;. We included 24 studies assessing different methods of non-pharmacological analgesic techniques. Most resulted in some degree of analgesia but many were ineffective and some were even detrimental. Sucrose, for example, was often ineffective but was more effective than music therapy, massage, breast milk (for extremely premature infants) or non-invasive electrical stimulation acupuncture. There were also conflicting results for acupuncture, skin-to-skin care and musical therapy. Most non-pharmacological methods of analgesia provide a modicum of relief for preterm infants, but none are completely effective and there is no clearly superior method. Study is also required to assess potential long-term consequences of any of these methods