Bio

Bio


Dr. Jiang-Ti Kong specializes in the treatment of chronic pain syndromes with expertise in the clinical management and scientific investigation of low back pain and fibromyalgia. In addition to teaching and practicing conventional pain management, Dr. Kong also leads the acupuncture service at the Stanford Pain Management Center, offering effective treatment alternatives for patients suffering from back pain, neck pain, joint pain, headaches, and complex regional pain syndrome. Dr. Kong has developed a strong interest in the interdisciplinary study of chronic pain mechanisms and alternative treatment modalities such as acupuncture. She currently leads two NIH-funded projects investigating the mechanisms of electro-acupuncture for the treatment of chronic low back pain.

Clinical Focus


  • Anesthesia
  • Pain Management
  • Low Back Pain
  • Fibromyalgia
  • Interventional Pain Blocks
  • Acupuncture: for back pain, neck pain, arthritis, headaches, and complex regional pain syndrome (CRPS)

Academic Appointments


  • Instructor, Anesthesiology, Perioperative and Pain Medicine

Administrative Appointments


  • Instructor, Department of Anesthesiology, Perioperative and Pain Medicine (2014 - Present)

Boards, Advisory Committees, Professional Organizations


  • Member, International Association for the Study of Pain (IASP) (2014 - Present)
  • Associate Member, Association of University Anesthesiologists (2016 - Present)
  • Secretary and member of the executive board, Society for Acupuncture Research (2013 - Present)

Professional Education


  • Medical Education:Stanford University School of Medicine Registrar (2004) CA
  • Board Certification: Pain Medicine, American Board of Anesthesiology (2012)
  • Board Certification: Anesthesia, American Board of Anesthesiology (2009)
  • Fellowship:Stanford Pain Management (2009) CA
  • Residency:Stanford University (2008) CA
  • Internship:Massachusetts General Hospital (2005) MA

Publications

All Publications


  • H Acupuncture for Chronic Low Back Pain: Recommendations to Medicare/Medicaid from the Society for Acupuncture Research JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Mao, J. J., Davis, R. T., Coeytaux, R., Hullender-Rubin, L., Kong, J., MacPherson, H., Napadow, V., Schnyer, R., Wayne, P., Witt, C., Harris, R. 2019
  • Central mechanisms of real and sham electroacupuncture in the treatment of chronic low back pain: study protocol for a randomized, placebo-controlled clinical trial. Trials Kong, J., MacIsaac, B., Cogan, R., Ng, A., Law, C. S., Helms, J., Schnyer, R., Karayannis, N. V., Kao, M., Tian, L., Darnall, B. D., Gross, J. J., Mackey, S., Manber, R. 2018; 19 (1): 685

    Abstract

    BACKGROUND: Chronic low back pain (CLBP) is the most common chronic pain condition and is often resistant to conventional treatments. Acupuncture is a popular alternative for treating CLBP but its mechanisms of action remain poorly understood. Evidence suggests that pain regulatory mechanisms (particularly the ascending and secondarily the descending pain modulatory pathways) and psychological mechanisms (e.g., expectations, pain catastrophizing and self-efficacy) may be involved in the pathogenesis of CLBP and its response to treatments. We will examine these mechanisms in the treatment of CLBP by electroacupuncture (EA).METHODS: We present the aims and methods of a placebo-controlled, participant-blinded and assessor-blinded mechanistic study. Adult patients with CLBP will be randomized to receiving 16 sessions of real (active) or sham (placebo) EA over the course of 8weeks. The primary pain regulatory measure for which the study was powered is temporal summation (TS), which approximates ascending pain facilitation. Conditioned pain modulation (CPM), representing a descending pain modulatory pathway, will be our secondary pain regulatory measure. The primary psychological measure is expectations of benefit, and the secondary psychological measures are pain catastrophizing and self-efficacy in managing pain. Main clinical outcomes are back pain bothersomeness on a 0-100 visual analog scale (primary), Roland Morris Disability Questionnaire (secondary), and relevant items from the National Institutes of Health (NIH) Patient-Reported Outcome Measures Information System (secondary). We hypothesize that compared to sham, real EA will lead to greater reduction in TS after 8 treatment sessions (4weeks); and that reduction in TS (and secondarily, increase in CPM) after 8 treatment sessions will mediate reduction in back pain bothersomeness from baseline to week 10 (clinical response) to EA. We also hypothesize that the three psychological factors are moderators of clinical response. With 100 treatment completers, the study is designed to have 80% power to detect a medium-sized between-group effect (d=0.5) on temporal summation.DISCUSSION: To the best of our knowledge, this is the first appropriately powered, placebo-controlled clinical trial evaluating mechanisms of EA in the treatment of CLBP.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02503475 . Registered on 15 July 15 2015. Retrospectively registered.

    View details for DOI 10.1186/s13063-018-3044-2

    View details for PubMedID 30541586

  • Exploring the Multiple Roles of Acupuncture in Alleviating the Opioid Crisis JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Kong, J. 2018; 24 (4): 304–6

    View details for DOI 10.1089/acm.2018.0083

    View details for Web of Science ID 000429497200001

    View details for PubMedID 29624407

    View details for PubMedCentralID PMC5963592

  • Advancing Transcranial Magnetic Stimulation Methods for Complex Regional Pain Syndrome: An Open-Label Study of Paired Theta Burst and High-Frequency Stimulation Neuromodulation Gaertner, M., Kong, J., Scherrer, K., Foote, A., Mackey, S., Johnson, K. 2018

    View details for DOI 10.1111/ner.12760

  • Dynamic Quantitative Sensory Testing to Characterize Central Pain Processing JOVE-JOURNAL OF VISUALIZED EXPERIMENTS Mackey, I. G., Dixon, E. A., Johnson, K., Kong, J. 2017

    Abstract

    Central facilitation and modulation of incoming nociceptive signals play an important role in the perception of pain. Disruption in central pain processing is present in many chronic pain conditions and can influence responses to specific therapies. Thus, the ability to precisely describe the state of central pain processing has profound clinical significance in both prognosis and prediction. Because it is not practical to record neuronal firings directly in the human spinal cord, surrogate behavior tests become an important tool to assess the state of central pain processing. Dynamic QST is one such test, and can probe both the ascending facilitation and descending modulation of incoming nociceptive signals via TS and CPM, respectively. Due to the large between-individual variability in the sensitivity to noxious signals, standardized TS and CPM tests may not yield any meaningful data in up to 50% of the population due to floor or ceiling effects. We present methodologies to individualize TS and CPM so we can capture these measures in a broader range of individuals than previously possible. We have used these methods successfully in several studies at the lab, and data from one ongoing study will be presented to demonstrate feasibility and potential applications of the methods.

    View details for DOI 10.3791/54452

    View details for Web of Science ID 000397847700006

    View details for PubMedID 28287532

  • Unanticipated Insights into Biomedicine from the Study of Acupuncture. Journal of alternative and complementary medicine MacPherson, H., Hammerschlag, R., Coeytaux, R. R., Davis, R. T., Harris, R. E., Kong, J., Langevin, H. M., Lao, L., Milley, R. J., Napadow, V., Schnyer, R. N., Stener-Victorin, E., Witt, C. M., Wayne, P. M. 2016; 22 (2): 101-107

    Abstract

    Research into acupuncture has had ripple effects beyond the field of acupuncture. This paper identifies five exemplars to illustrate that there is tangible evidence of the way insights gleaned from acupuncture research have informed biomedical research, practice, or policy. The first exemplar documents how early research into acupuncture analgesia has expanded into neuroimaging research, broadening physiologic understanding and treatment of chronic pain. The second describes how the acupuncture needle has become a tool to enhance biomedical knowledge of connective tissue. The third exemplar, which illustrates use of a modified acupuncture needle as a sham device, focuses on emergent understanding of placebo effects and, in turn, on insights into therapeutic encounters in treatments unrelated to acupuncture. The fourth exemplar documents that two medical devices now in widespread use were inspired by acupuncture: transcutaneous electrical nerve stimulators for pain control and antinausea wrist bands. The final exemplar describes how pragmatic clinical trial designs applied in acupuncture research have informed current general interest in comparative effectiveness research. In conclusion, these exemplars of unanticipated outcomes of acupuncture research comprise an additional rationale for continued support of basic and clinical research evaluating acupuncture and other under-researched therapies.

    View details for DOI 10.1089/acm.2015.0184

    View details for PubMedID 26745452

    View details for PubMedCentralID PMC4761810

  • Acupuncture for Pediatric Conditions: A Narrative Review MEDICAL ACUPUNCTURE Milley, R. J., Davis, R., Kong, J., Schnyer, R. N. 2015; 27 (6): 420–31
  • Electroacupuncture in treating residual insomnia associated with depression: lessons learned. journal of clinical psychiatry Kong, J. 2015; 76 (6): e818-9

    View details for DOI 10.4088/JCP.15com09782

    View details for PubMedID 26132692

  • Manual and Electrical Needle Stimulation in Acupuncture Research: Pitfalls and Challenges of Heterogeneity JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Langevin, H. M., Schnyer, R., MacPherson, H., Davis, R., Harris, R. E., Napadow, V., Wayne, P. M., Milley, R. J., Lao, L., Stener-Victorin, E., Kong, J., Hammerschlag, R. 2015; 21 (3): 113-128

    Abstract

    In the field of acupuncture research there is an implicit yet unexplored assumption that the evidence on manual and electrical stimulation techniques, derived from basic science studies, clinical trials, systematic reviews, and meta-analyses, is generally interchangeable. Such interchangeability would justify a bidirectional approach to acupuncture research, where basic science studies and clinical trials each inform the other. This article examines the validity of this fundamental assumption by critically reviewing the literature and comparing manual to electrical acupuncture in basic science studies, clinical trials, and meta-analyses. The evidence from this study does not support the assumption that these techniques are interchangeable. This article also identifies endemic methodologic limitations that have impaired progress in the field. For example, basic science studies have not matched the frequency and duration of manual needle stimulation to the frequency and duration of electrical stimulation. Further, most clinical trials purporting to compare the two types of stimulation have instead tested electroacupuncture as an adjunct to manual acupuncture. The current findings reveal fundamental gaps in the understanding of the mechanisms and relative effectiveness of manual versus electrical acupuncture. Finally, future research directions are suggested to better differentiate electrical from manual simulation, and implications for clinical practice are discussed.

    View details for DOI 10.1089/acm.2014.0186

    View details for Web of Science ID 000350749200001

    View details for PubMedID 25710206

    View details for PubMedCentralID PMC4855731

  • Conditioned pain modulation is minimally influenced by cognitive evaluation or imagery of the conditioning stimulus JOURNAL OF PAIN RESEARCH Bernaba, M., Johnson, K. A., Kong, J., Mackey, S. 2014; 7: 689-697

    Abstract

    Conditioned pain modulation (CPM) is an experimental approach for probing endogenous analgesia by which one painful stimulus (the conditioning stimulus) may inhibit the perceived pain of a subsequent stimulus (the test stimulus). Animal studies suggest that CPM is mediated by a spino-bulbo-spinal loop using objective measures such as neuronal firing. In humans, pain ratings are often used as the end point. Because pain self-reports are subject to cognitive influences, we tested whether cognitive factors would impact on CPM results in healthy humans.We conducted a within-subject, crossover study of healthy adults to determine the extent to which CPM is affected by 1) threatening and reassuring evaluation and 2) imagery alone of a cold conditioning stimulus. We used a heat stimulus individualized to 5/10 on a visual analog scale as the testing stimulus and computed the magnitude of CPM by subtracting the postconditioning rating from the baseline pain rating of the heat stimulus.We found that although evaluation can increase the pain rating of the conditioning stimulus, it did not significantly alter the magnitude of CPM. We also found that imagery of cold pain alone did not result in statistically significant CPM effect.Our results suggest that CPM is primarily dependent on sensory input, and that the cortical processes of evaluation and imagery have little impact on CPM. These findings lend support for CPM as a useful tool for probing endogenous analgesia through subcortical mechanisms.

    View details for DOI 10.2147/JPR.S65607

    View details for Web of Science ID 000364591200001

    View details for PubMedID 25473310

    View details for PubMedCentralID PMC4251756

  • Perioperative interventions to reduce chronic postsurgical pain. Journal of reconstructive microsurgery Carroll, I., Hah, J., Mackey, S., Ottestad, E., Kong, J. T., Lahidji, S., Tawfik, V., Younger, J., Curtin, C. 2013; 29 (4): 213-222

    Abstract

    Approximately 10% of patients following a variety of surgeries develop chronic postsurgical pain. Reducing chronic postoperative pain is especially important to reconstructive surgeons because common operations such as breast and limb reconstruction have even higher risk for developing chronic postsurgical pain. Animal studies of posttraumatic nerve injury pain demonstrate that there is a critical time frame before and immediately after nerve injury in which specific interventions can reduce the incidence and intensity of chronic neuropathic pain behaviors-so called "preventative analgesia." In animal models, perineural local anesthetic, systemic intravenous local anesthetic, perineural clonidine, systemic gabapentin, systemic tricyclic antidepressants, and minocycline have each been shown to reduce pain behaviors days to weeks after treatment. The translation of this work to humans also suggests that brief perioperative interventions may protect patients from developing new chronic postsurgical pain. Recent clinical trial data show that there is an opportunity during the perioperative period to dramatically reduce the incidence and severity of chronic postsurgical pain. The surgeon, working with the anesthesiologist, has the ability to modify both early and chronic postoperative pain by implementing an evidence-based preventative analgesia plan.

    View details for DOI 10.1055/s-0032-1329921

    View details for PubMedID 23463498

  • Perioperative Interventions to Reduce Chronic Postsurgical Pain JOURNAL OF RECONSTRUCTIVE MICROSURGERY Carroll, I., Hah, J., Mackey, S., Ottestad, E., Kong, J. T., Lahidji, S., Tawfik, V., Younger, J., Curtin, C. 2013; 29 (4): 213-222

    Abstract

    Approximately 10% of patients following a variety of surgeries develop chronic postsurgical pain. Reducing chronic postoperative pain is especially important to reconstructive surgeons because common operations such as breast and limb reconstruction have even higher risk for developing chronic postsurgical pain. Animal studies of posttraumatic nerve injury pain demonstrate that there is a critical time frame before and immediately after nerve injury in which specific interventions can reduce the incidence and intensity of chronic neuropathic pain behaviors-so called "preventative analgesia." In animal models, perineural local anesthetic, systemic intravenous local anesthetic, perineural clonidine, systemic gabapentin, systemic tricyclic antidepressants, and minocycline have each been shown to reduce pain behaviors days to weeks after treatment. The translation of this work to humans also suggests that brief perioperative interventions may protect patients from developing new chronic postsurgical pain. Recent clinical trial data show that there is an opportunity during the perioperative period to dramatically reduce the incidence and severity of chronic postsurgical pain. The surgeon, working with the anesthesiologist, has the ability to modify both early and chronic postoperative pain by implementing an evidence-based preventative analgesia plan.

    View details for DOI 10.1055/s-0032-1329921

    View details for Web of Science ID 000317597000001

    View details for PubMedID 23463498

  • Test-Retest Reliability of Thermal Temporal Summation Using an Individualized Protocol JOURNAL OF PAIN Kong, J., Johnson, K. A., Balise, R. R., Mackey, S. 2013; 14 (1): 79-88

    Abstract

    Temporal summation (TS) refers to the increased perception of pain with repetitive noxious stimuli. It is a behavioral correlate of wind-up, the spinal facilitation of recurring C-fiber stimulation. In order to utilize TS in clinical pain research, it is important to characterize TS in a wide range of individuals and to establish its test-retest reliability. Building on a fixed-parameter protocol, we developed an individually adjusted protocol to broadly capture thermally generated TS. We then examined the test-retest reliability of TS within-day (intertrial intervals ranging from 2 to 30 minutes) and between-days (intersession interval of 7 days). We generated TS-like effects in 19 of the 21 participants. Strong correlations were observed across all trials over both days (intraclass correlation [ICC] [A, 10] = .97, 95% confidence level [CL] = .94-.99) and across the initial trials between days (ICC [A, 1] = .83, 95% CL = .58-.93). Repeated measures mixed-effects modeling demonstrated no significant within-day variation and only a small (5 out of 100 points) between-day variation. Finally, a Bland-Altman analysis suggested that TS is reliable across the range of observed scores. Without intervention, thermally-generated TS is generally stable within day and between days.Our study introduces a new strategy to generate thermal TS in a high proportion of individuals. This study confirms the test-retest reliability of thermal TS, supporting its use as a consistent behavioral correlate of central nociceptive facilitation.

    View details for DOI 10.1016/j.jpain.2012.10.010

    View details for Web of Science ID 000314081100009

    View details for PubMedID 23273835

    View details for PubMedCentralID PMC3541942

  • Understanding Central Mechanisms of Acupuncture Analgesia Using Dynamic Quantitative Sensory Testing: A Review EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE Kong, J., Schnyer, R. N., Johnson, K. A., Mackey, S. 2013

    Abstract

    We discuss the emerging translational tools for the study of acupuncture analgesia with a focus on psychophysical methods. The gap between animal mechanistic studies and human clinical trials of acupuncture analgesia calls for effective translational tools that bridge neurophysiological data with meaningful clinical outcomes. Temporal summation (TS) and conditioned pain modulation (CPM) are two promising tools yet to be widely utilized. These psychophysical measures capture the state of the ascending facilitation and the descending inhibition of nociceptive transmission, respectively. We review the basic concepts and current methodologies underlying these measures in clinical pain research, and illustrate their application to research on acupuncture analgesia. Finally, we highlight the strengths and limitations of these research methods and make recommendations on future directions. The appropriate addition of TS and CPM to our current research armamentarium will facilitate our efforts to elucidate the central analgesic mechanisms of acupuncture in clinical populations.

    View details for DOI 10.1155/2013/187182

    View details for Web of Science ID 000319569800001

    View details for PubMedID 23762107

    View details for PubMedCentralID PMC3666367

  • Concealed mothball abuse prior to anesthesia: mothballs, inhalants, and their management ACTA ANAESTHESIOLOGICA SCANDINAVICA Kong, J. T., Schmiesing, C. 2005; 49 (1): 113-116

    Abstract

    Mothballs are one of a number of volatile compounds including model airplane glue, spray paint, nail polish remover, room fresheners, and gasoline that are intentionally inhaled for the purpose of recreational self-intoxication. Their inhalation produces a rapid 'high' characterized by euphoria and generalized intoxication. Chronic abuse can be associated with significant organ impairment, and, in rare cases, cardiac dysrhythmias and deranged end-tidal gas monitoring. Mothballs contain the aromatic compound naphthalene and/or paradichlorobenzene. Prolonged exposure can cause hepatic failure and severe hemolytic anemia. We present a case of a young adult who initially concealed her chronic mothball inhalation. The literature regarding mothball abuse as well as inhalant abuse relevant to anesthesia is reviewed, and suggestions for the diagnosis and peri-operative management are offered.

    View details for DOI 10.1111/j.1399-6576.2004.00510.x

    View details for Web of Science ID 000226638800024

    View details for PubMedID 15675996

  • Serotyping of Toxoplasma gondii infections in humans using synthetic peptides JOURNAL OF INFECTIOUS DISEASES Kong, J. T., Grigg, M. E., Uyetake, L., Parmley, S., Boothroyd, J. C. 2003; 187 (9): 1484-1495

    Abstract

    To determine whether the characteristics of disease due to Toxoplasma gondii (toxoplasmosis) are dependent on the infecting strain, we have developed an enzyme-linked immunosorbent assay for typing strains that uses infection serum reacted against polymorphic peptides derived from Toxoplasma antigens SAG2A, GRA3, GRA6, and GRA7. Pilot studies with infected mice established the validity of the approach, which was then tested with human serum. In 8 patients who had Sabin-Feldman dye test titers >64 and for whom the infecting strain type was known, the peptides correctly distinguished type II from non-type II infections. ELISA analysis of a second group of 10 infected pregnant women from whom the parasite strain had not been isolated gave a clear prediction of the strain type causing infection. This method should allow statistically significant data to be obtained about whether different strain types cause disease with different characteristics.

    View details for Web of Science ID 000182273700017

    View details for PubMedID 12717631