Imaging Metabolic and Perfusion Changes in Acupuncture Therapy for Myofascial Pain Syndrome

Inclusion criteria

• Ability to understand the purposes and risks of the trial and willingness to sign an informed consent form
• Willingness and ability to comply with all protocol required procedures
• Willingness to be randomized to receive either true acupuncture or sham acupuncture
• Current self-report of chronic low back pain (cLBP) which has persisted for the past 3 months AND has resulted in pain on \> 50% of days in the past 6 months
• At least one palpable nodule or taut band in paraspinal, quadratus lumborum, or gluteal muscles
• Reproduction of the patient's dominant pain with palpation of a muscle nodule or taut band
• Predominantly paramedian pain (may be uni-lateral or bi-lateral)
• Willing and able to lay motionless in a supine position at least twice, preferably thrice: 70-minute TB-PET/CT scan
• Willing and able to fast for at least 6 hours before and for the duration of the TB-PET/CT scan
• Willing to avoid strenuous exercise for 24 hours before the TB-PET/CT scan visit
• Willingness to practice effective contraception during the study.

Exclusion criteria

• No Primary Care Physician
• History of spine infection (discitis or osteomyelitis) or spine tumor
• History of ankylosing spondylitis, rheumatoid arthritis, polymyalgia rheumatica, psoriatic arthritis, or lupus
• Confounding conditions that are known to be responsible for inducing pain
• Implants at or in the region of the sites of interest
• Diagnosis of any vertebral fracture in the last 6 months
• Cauda equina syndrome or lumbar radiculopathy with functional motor deficit (strength\<4/5 on manual motor testing)
• Spinal implants (including fixation hardware, spinal cord stimulator, intra-thecal pumps, that are present in the region of the sites of interest)
• Predominantly central pain
• Pain below the knee
• Positive straight leg raise test
• Symptomatic hip arthritis
• Uncontrolled claustrophobia
• Pregnant or lactating participants
• Body weight more than 225 kg (496 pounds) due to the weight limitation of the scanner bed
• Prisoners
• Inability to speak, read, and write in the English language
• Concurrent or prior enrollment in a separate research study involving a PET scan performed within the last 12 months for research purposes only.
• That is, PET scans are not performed as part of a patient's treatment plan (e.g. standard of care, therapeutic purposes, or clinical care) and the research study did not intend to provide therapeutic benefit to the patient.
• Any other criteria, which would make the participant unsuitable to participate in this study as determined by the Principal Investigator