How does acupuncture work on pain?

Recently, the FDA recommended that doctors learn about acupuncture as a therapy to possibly help patients avoid using prescription opioids (Thielking, 2017). The most commonly seen indications for using acupuncture in managing pain includes headaches/ migraines, back pain, fibromyalgia, arthritis, and pain in the upper /lower extremities (Eshkevari, 2017, p.127).

First, we need to understand some basic science of pain. How do we feel pain? Pain impulses start from the peripheral primary afferent neurons in the affected tissues. They are forwarded to secondary neurons in the spinal cord, modulated and transmitted to the thalamus of the brain, where they synapse with third-order neurons and project to various parts of the cortex, eliciting pain responses (Hu, 2014, p.11442).

In the past decades, multidisciplinary scientists have found mounting evidence in support of the effectiveness of acupuncture in alleviating pain by both peripheral and central mechanisms. They suggest that acupuncture activates A-δ and C afferent fibers in muscle and triggers a sequence of events that modulate pain signals processed along the afferent nociceptive pathway(Wang, 2008, p.603).

In neurophysiologic research, acupuncture was found to increase the pain threshold. It has been shown that acupuncture and related techniques, activate peripheral sympathetic nerve fibers, as well as the cannabinoid system, which in turn trigger a sequence of events that include the release of neurotransmitters, endogenous opioid-like substances, and activation of c-fos (a marker of activation in the brain within the central nervous system (Wang, 2008, p.605).

Central nervous system imaging studies, which visualize the anatomic and functional effects of acupuncture stimulation in the human brain, demonstrate that acupuncture affects the limbic system, the area of our brains that control the basic emotions and play an important role in inducing analgesia (Wang, 2008, p.608). Research on functional magnetic resonance imaging (fMRI) data found that acupuncture increased activity at various areas of the brain. This activity negatively correlated with Visual Analog Scale (VAS) pain scores and positively correlated with data reflecting acupuncture’s ability to significantly reduce pain intensity (Eshkevari, 2017, p.124).

In addition, studies on chronic lower back pain suggest that chronic inflammation and fibrosis of connective tissues may also play a role in chronic musculoskeletal pain. Local acupuncture may help to stretch the connective tissues. This not only causes local adenosine-mediated analgesia but also encourages fibroblasts to expand, actively relaxing the tissue, and increasing shear plane motion. All of these actions are responsible for deeper, long- term healing of the sources of chronic pain (Langevin, 2014, p.251).

As we know, the perception of pain is produced by a complex mechanism in our bodies. Through studies in acupuncture, scientists have elucidated pathways by which this traditional medicine was shown to effectively manage pain. Furthemore, these studies also have traveled beyond the field of acupuncture to affect several aspects of biomedicine, helped scientists to understand chronic pain, connective tissues and placebo effects (MacPherson, 2016, p. 102). Treating the body holistically with in-depth understanding of the interdependence of each individual part/organ is exactly the core practice, theory, culture, and foundation of Traditional Chinese Medicine.

Reference

Eshkevari L.(2017)Acupuncture and Chronic Pain Management. Annu Rev Nurs Res, 35(1):117-

134.

Hu, L., Cai, M. M., Xiao, P., Luo, F., Iannetti, G. D. (2014). Human brain responses to

concomitant stimulation of Adelta and C nociceptors. Journal of Neuroscience,

34(34): 11439–11451.

Langevin HM. (2014). Acupuncture, connective tissue, and peripheral sensory modulation. Crit

Rev Eukaryot Gene Expr, 24(3):249-253.

MacPherson H, Hammerschlag R, Coeytaux RR, Davis RT, Harris RE, Kong JT,… Wayne PM

(2016). Unanticipated Insights into Biomedicine from the Study of Acupuncture.

J Altern Complement Med, 22(2):101-107.

Thielking,M. (2017). FDA proposes that doctors learn about acupuncture for pain management