Thursday, January 10, 2013

How It Works: The SCIENCE on Acupuncture & Pain Management

People are increasingly looking for natural therapies to relieve painful conditions instead of relying on pharmaceutical medications. Acupuncture can effectively relieve pain anywhere in the body, regardless of its origin, without negative side-effects. Some studies show that the pain relief provided by acupuncture can last for several months.

Studies on Acupuncture & Pain Management:

Acupuncture has become readily accepted in mainstream modern medicine as a viable option for pain management. Studies support its therapeutic effects.

In a German study, published in the Archives of Internal Medicine, 1,162 adults with chronic, lower back pain were divided into groups treated with either the standard pharmaceutical and exercise therapy, commonly used in conventional medicine, or acupuncture. The researchers reported that acupuncture provided relief and lasting benefit to nearly twice as many lower back pain patients as drugs and exercise. Forty-eight percent of the acupuncture patients reported at least a one-third decrease in pain along with improvement in their ability to function, versus 27 percent of the patients treated with conventional methods reporting such benefits.

meta-study published in 2012 in the Archives of Internal Medicine analyzed 29 randomized controlled trials (RCTs) with a total of 17,922 chronic pain patients in five different countries. The study, heralded as "the most rigorous and detailed analysis of [acupuncture] to date," found acupuncture to be superior to placebo and standard biomedical care in the treatment of various types of chronic pain -- including neck pain, shoulder pain, osteoarthritis or chronic headache.

In another recent study published in the Annals of Internal Medicine, researchers from the University of Maryland School of Medicine analyzed 33 studies covering more than 2,100 patients from around the world on acupuncture for low back pain. They found acupuncture provided definite pain relief in the short-term (defined as relief sustained for three weeks after the end of the acupuncture sessions).

How Does Acupuncture Relieve Pain:

According to Chinese medicine theory, simply stated, pain represents obstruction to the flow of Qi in the body. Acupuncture moves Qi, thereby relieving pain.

A famous saying from the two thousand year old classic Chinese medical text Huangdi Neijing (or Yellow Emperor's Inner Canon) summarizes, "bu tong ze tong, tong bu ze tong," or "no free flow=pain; free flow=no pain."

In addition to reducing pain, acupuncture also hastens the healing process by increasing circulation and attracting white blood cells to an injured area.

Biomechanisms of Acupuncture & Pain Relief:

Biomedical research indicates that acupuncture has a number of physiological effects. Because of this, there is not a short, simple answer to the question of how acupuncture works. From a western point of view, acupuncture relieves pain through a variety of different mechanisms:
  • Promoting the secretion of naturally-occuring opioids in the body
  • Stimulating gate control and initiating diffuse noxious inhibitor pain suppression
  • Releasing local & systemic neurotransmitters
  • Signaling the brain and influencing autonomic regulatory processes
  • Increasing blood flow and relaxing muscles

The following section is a brief technical review of some of the modern scientific literature regarding the effects of acupuncture. Many are animal studies. (Links to related studies are embedded in text.)

Neurology & Brain Function:

  • Magnetic Resonance Imaging (MRI) of the human brain before and after acupuncture treatment of pain shows dramatic decreases in brain activity -- up to 70%. The decrease in brain activity associated with pain impulses diminishes painful sensations and increases a patient's tolerance for pain. Here's a link to this fascinating study.

Endocrine Involvement & Inter-cellular Communication:

  • In the realm of blood chemistry, acupuncture stimulates the secretion of naturally-occurring opiate subtances (endorphins, enkephalins, and dynorphins). These substances act on the central nervous system to block and modulate pain of both musculoskeletal and visceral (organ) origin. Here's a clinical review entitled "Acpuncture & Endorphins."
  • Acupuncture stimulates local and systemic secretion of neurotransmitters like serotonin and dopamine, which promote relaxation and a sense of well-being, thereby contributing to pain-relief.
  • Research shows that acupuncture can inhibit pro-inflammatory cytokines (molecular messengers between cells), reducing neuropathic pain. This study shows that acupuncture inhibits pro-inflammatory cytokines in patients with chronic headache. Here's another study on the cytokine-inhibiting, anti-inflammatory effect of acupuncture.
  • Studies also show that acupuncture influences leukocyte and lymphocyte levels, which, together with cytokine inhibition, can help fight infection and boost immune response.

Autonomic Nervous System Changes:

  • Acupuncture has been shown to enhance the generation of nitric oxide, which in turn, increases blood circulation, leading to decreased inflammation and increased healing. In one study, acupuncture was shown to increase blood flow in the sciatic nerve, relieving pain & improving the gait of horses suffering from lumbar spinal stenosis.
  • Acupuncture increases blood flow in muscles, leading to decreased inflammation and increased tissue repair.

Other Pain Relief Mechanisms:

  • The neurogate theory, tested on this study on rats, says that fibers that are stimulated by acupuncture could prevent pain input into the spinal cord. The diffuse noxious inhibitory control theory says that by providing a noxious stimulation (i.e. a non-painful stimulation by an acupuncture needle), the body responds by changing the signals it receives from the painful area being treated. You experience this when you bump your elbow, and it hurts less when you rub it.
  • Finally, Japanese researcher Kawakita proposes the polymodal receptor (PMR) theory. Polymodal receptors are nociceptors (pain receptors) which respond to mechanical, thermal and chemical stimuli. These release a variety of neuropeptides which serve as local neurotransmitters. Polymodal receptors are thought to be related to the qi sensation many patients feel with properly inserted acupuncture needles.

A growing body of scientific studies is showing that acupuncture is effective in the relief and management of all types of body pain -- often  more effective than conventional therapies. What is more, acupuncture has potential for preventing pain and promoting healing by:

  • relaxing tissues, 
  • increasing circulation,
  • attracting white blood cells to injury sites,
  • stimulating prostaglandins to reduce inflammation and prevent tissue damage,
  • increasing nerve conduction, 
  • restoring muscle tone,
  • quickening recovery from soft tissue injury, surgery and fracture -and-
  • restoring homeostasis and regulating physiological processes throughout all body systems.

Acupuncture is a supportive adjunct to other pain-management regimens, like physical therapy, bodywork, and exercise programs. It can be incorporated into any treatment or rehabilitation plan as a safe, simple strategy to support health and recover.

Acupuncture has no negative side effects.

If you or someone you care about suffers from acute and chronic pain, please call 510-495-5752, email, or follow this link to find out more about how acupuncture and Chinese medicine can help you.