INTRODUCTION
synovitis, osteoarthritis, pain, KOA, KOA pain, overweight, skin irritation, KOA knee pain, Knee osteoarthritis, knee pain
DEGENERATION, MUSCLE ATROPHY, SYNOVITIS, OSTEOARTHRITIS, MUSCULOSKELETAL DISEASE, PATHOPHYSIOLOGY, KNEE OSTEOARTHRITIS
Knee osteoarthritis (KOA), the most prevalent type of musculoskeletal disease, is characterized by the degeneration of knee cartilage, bone remodeling, and synovitis.The pathophysiology of KOA knee pain is complex. Therefore, understanding the source and mechanism of pain is essential for treatment development. Local indicators of the knee joint and changes in the central nervous system (CNS) play a role in the development of knee pain. Biomechanical variables (including muscle atrophy, overweight, and joint laxity)The first line recommended medication for treating knee pain caused by KOA in medical practice is NSAIDs medications.Assessing the physical functioning of DPMS in a non‐invasive manner continues to be difficult. The resting‐state functional magnetic resonance imaging (fMRI) technique allows for the identification of correlations between remote brain regions (resting‐state functional connectivity, rs‐FC) through their highly correlated low‐frequency spontaneous fluctuations non‐invasively.Furthermore, prior research demonstrated that central sensitization and increased vlPAG activity in osteoarthritis patients are associated with skin irritation in pain areas.In this current work, a comparison of the vlPAG rs‐FC was made between individuals who experienced KOA knee pain and the healthy controls (HCs) matched with them. Furthermore, the mechanism by which the vlPAG rs‐FC could be modulated by different longitudinal interventions, including verum acupuncture, sham acupuncture, celecoxib, placebo medication, and a waiting list, was investigated. Additionally, the possible different vlPAG rs‐FC modulation effects between verum acupuncture and sham acupuncture/celecoxib treatment/placebo medication/waiting list control were compared. We hypothesized that different interventions have different modulation effects on vlPAG DPMS in KOA knee pain patients, and acupuncture could modulate the pain perception by DPMS, allowing psychological factors such as cognitive control, attention, and reappraisal to influence the pain experiences. It is hoped that this study could enhance the understanding of the mechanical characteristics of acupuncture for KOA pain relief compared with NSAIDs and placebo medication.