Feasibility of Auricular Field Stimulation in Fibromyalgia: Evaluation by Functional Magnetic Resonance Imaging, Randomized Trial

• Type of Material: Article
• Authors: Anna Woodbury, Emory University; Venkatagiri Krishnamurthy, Emory University; Melat Gebre, Emory University; Vitaly Napadow, Harvard Medical School; Corinne Bicknese, Emory University; Mofei Liu, Emory University; Joshua Lukemire, Emory University; Jerry Kalangara, Emory University; Xiangqin Cui, Emory University; Ying Guo, Emory University; Roman Sniecinski, Emory University; Bruce Crosson, Emory University
• Language: English
• Date: 2021-03-01
• Publisher: OXFORD UNIV PRESS
• Publication Version: Final Published Version
• Copyright Statement: Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2020.
• Final Published Version (URL): http://dx.doi.org/10.1093/pm/pnaa317
• Title of Journal or Parent Work: PAIN MEDICINE
• Volume: 22
• Issue: 3
• Start Page: 715
• End Page: 726
• Grant/Funding Information: This research was supported in part by Career Development Awards 1IK1RX002113-01A2, 1IK2RX003227-01 (Anna Woodbury), and 1IK2RX002934 (Venkatagiri Krishnamurthy); by Senior Research Career Scientist Award Grant B6364L (Bruce Crosson) and Center Grant 5I50RX002358 from the US Department of Veterans Affairs Rehabilitation Research and Development Service; and by the National Institute of Mental Health of the National Institutes of Health under Award No. R01MH105561 and R01MH118771 (Ying Guo).
• Keywords: Medicine, General & Internal; PAIN; Alternative Therapies; COST; US; Fibromyalgia; General & Internal Medicine; MATTER; SENSITIVITY; Science & Technology; Anesthesiology; NERVE-STIMULATION; PREGABALIN; Life Sciences & Biomedicine; Rehabilitation Medicine; Percutaneous Electrical Nerve Stimulation (PENS); HEALTH; INTRINSIC BRAIN CONNECTIVITY; Chronic Pain; Magnetic Resonance Imaging (MRI); NETWORK
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Objective: To evaluate the feasibility of recruitment, preliminary efficacy, and acceptability of auricular percutaneous electrical nerve field stimulation (PENFS) for the treatment of fibromyalgia in veterans, using neuroimaging as an outcome measure and a biomarker of treatment response. Design: Randomized, controlled, single-blind. Setting: Government hospital. Subjects: Twenty-one veterans with fibromyalgia were randomized to standard therapy (ST) control or ST with auricular PENFS treatment. Methods: Participants received weekly visits with a pain practitioner over 4 weeks. The PENFS group received reapplication of PENFS at each weekly visit. Resting-state functional connectivity magnetic resonance imaging (rs-fcMRI) data were collected within 2 weeks prior to initiating treatment and 2 weeks following the final treatment. Analysis of rs-fcMRI used a right posterior insula seed. Pain and function were assessed at baseline and at 2, 6, and 12 weeks post-treatment. Results: At 12 weeks post-treatment, there was a nonsignificant trend toward improved pain scores and significant improvements in pain interference with sleep among the PENFS treatment group as compared with the ST controls. Neuroimaging data displayed increased connectivity to areas of the cerebellum and executive control networks in the PENFS group as compared with the ST control group following treatment. Conclusions: There was a trend toward improved pain and function among veterans with fibromyalgia in the ST + PENFS group as compared with the ST control group. Pain and functional outcomes correlated with altered rs-fcMRI network connectivity. Neuroimaging results differed between groups, suggesting an alternative underlying mechanism for PENFS analgesia.