The Human Brain On Acupuncture: Chinese Traditional Medicine, Visualized

Acupuncture needles inserted in the body produce a rapid sedative effect that stimulates multiple regions of the brain. Photo courtesy of Shutterstock

Lying down on an exam table, spreading your arms and legs apart, and closing your eyes as fine needles are inserted into your skin sounds counterintuitive to pain relief. The ultra-thin stainless-steel acupuncture needles are strategically placed into your skin at acupuncture points to evoke "deqi" sensations that can lead to a relaxed and healthier you. The tiny sensations caused by the pricks on your skin actually activate the nervous system and the brain, but how does this all work?

The “qi” sensation that is widely discussed in acupuncture is produced when a needle is inserted. The aching, tingling sensation generates responses in different brain regions as acupoints are needled. In fact, specific acupuncture points have distinct deqi characteristics that have a consistent and unique ability to stimulate specific brain regions.

Stimulating acupuncture points leads to overlapping brain responses in a number of cortical and subcortical brain regions. This includes the insula, thalamus, anterior cingulate cortex and primary and secondary somatosensory cortices — all part of the sensorimotor cortical network, according to Medscape. At the same time, there is a deactivation in the limbic-paralimbic-neocortical network, which includes the medial prefrontal cortex, caudate, amygdala, posterior cingulate cortex, and parahippocampus. These brain areas are associated with a pain matrix that is responsible for modulating both the sensation of pain and affective pain perception.

In the YouTube video, “This Is Your Brain On Acupuncture,” user James Whittle, an acupuncturist in Asheville, N.C., shows the difference in brain activity during superficial needling and deep needling. Unlike superficial needling, deep needling has been shown to be more effective than the superficial one for the treatment of pain associated with myofascial (pressure) on trigger (sensitive) points. However, the superficial technique is more apt for treating areas with potential risk of significant adverse effects, such as lungs and large blood vessels.

A group of researchers in the video sought to delve deeper into the effects of both techniques on the brain. First, an MRI scan was taken of the brain at base line, meaning at rest, to observe the activity taking place. Then, the research team scanned the brain when the needles were inserted into the participant’s body using superficial and deep needling techniques, respectively.

In the superficial needling MRI, the researchers found there was an increase in blood flow in front of the brain. This is just the brain’s normal response to the needle being lightly inserted. The deqi sensation in deep needling was actually found to lead to a deactivation in areas of the brain further back. Scientific analysis has shown deqi can deactivate areas within the brain that are associated with the processing of pain. “That reinforces the idea that something quite special is happening, something unique to acupuncture, something physiological,” said Dr. George Lewith of the University of Southampton in the video.

MRI images of two acupuncture techniques.

MRI images of brain activity in superficial needling (L) and deep needling (R).

A 2005 study published in the journal NeuroImage found acupuncture increased activity in a different brain area called the insula, which is part of the cerebral cortex. Although the researchers admit they don’t know what this activity means, it indicates acupuncture does have some real effect on the brain. "What we have demonstrated is that acupuncture is partially modulated by expectation but is probably also modulated by a real treatment effect," Lewith said in the press release.

These studies add evidence that the already proven beneficial practice in Traditional Chinese Medicine does have a mysterious, unexplained effect on the brain. Acupuncture does cause an activation/deactivation of cerebral functional regions. However, there are those who believe much of the relief of acupuncture is simply due to a placebo effect.

In the U.S., there are more than 3,000 physicians who integrate acupuncture into their clinical practice, according to the Cleveland Clinic. Currently, chiropractors and acupuncturists are struggling to gain acceptance from the health insurance industry since acupuncture’s efficacy has yet to be confirmed in scientific studies. Traditional Chinese Medicine, such as acupuncture, still has a long way to go in the U.S. to be considered in the same caliber as other Western medical treatments.

Looking for relief from hot flashes or night sweats?

If you’re a woman in the throes of menopause who is experiencing any of the telltale symptoms — hot flashes, night sweats, irritability, insomnia, vaginal dryness, libido changes — you might have explored a variety of treatments for relief.

 

Some women try to get more phytoestrogens naturally in their diet, others try a combination of exercise and herbal formulas, and some find hormone replace therapy necessary. For others, acupuncture could be the answer.

 

Some studies show that acupuncture may provide relief from menopausal symptoms such as hot flashes. The National Center for Complementary and Alternative Medicine (NCCAM) from the National Institutes of Health agrees that there are likely some benefits to alternative therapies such as acupuncture to ease the symptoms of menopause. However, because studies are often small, NCCAM suggests that more research is necessary.

 

How much of this could be due to the placebo effect? In at least one study, women who were given a placebo needle had less relief than women who were given real acupuncture needles. In other studies, however, women felt no difference between real and fake needles. Another study surmised that acupuncture could be effective against hot flashes because it boosts the production of endorphins, which may stabilize the body's temperature controls.

 

Scientists may be undecided about the positive effects of acupuncture, but practitioners are convinced of its healing powers.

 

“The beautiful thing about acupuncture and Chinese medicine is people say, ‘Oh I have this. Does acupuncture treat that?’ Well, yes, it treats everything,” says Lauren Buckley, a licensed acupuncturist at South Philly Community Acupuncture in Philadelphia.

 

“What we are doing is treating a pattern imbalance in the body,” she says. “And the way we treat a pattern imbalance in the body is by gathering all the symptoms you have that should be comprehensive of all systems in your body — respiratory, gynecological, digestion, cardiology, skin, hair, nails, bowel movements — all the data from your body systems. And the data is then consolidated into imbalances in chi and blood, yin and yang, interior and exterior, and hot and cold — those are the eight principals in acupuncture.”

 

Buckley says that women come to here, wanting to know if acupuncture can treat insomnia, night sweats or vaginal dryness. She tells them it can, but what it’s really treating is the root imbalance in the body. “Once we get to the root imbalance in chi and blood flow, then we are able to fix the symptoms. So I tell people, yeah, I’m fixing their irregular cycle, but really I am fixing a liver/spleen/blood imbalance,” she says.

 

Sometimes women combine acupuncture treatments with Chinese medicine — herbal medicinal formulas that may be a combination of many herbs tailored specifically to that woman’s symptoms.

 

Not every woman who comes in for acupuncture is 100 percent relieved of her menopausal symptoms, but people rarely leave without some type of improvement, Buckley says. The remedy isn’t a one-time gig, either, but takes eight to 12 sessions — twice a week at first then tapering off, depending on how it goes. They may have to return occasionally if symptoms flare.

Baseball’s Oldest Player Reveals His Secret – Acupuncture

Jason Giambi says he got some teasing at first, but now even his younger teammates are giving this ancient healing art a try.

The team doctor for the Cleveland Indians says he can’t think of any other baseball team with an in-house acupuncturist. That may be because the Cleveland Indians also boast the oldest player currently in the major leagues.

Designated hitter Jason Giambi is 43. He started in the majors 20 years ago, when some of his teammates were still in diapers. He says he was looking for anything to help him keep up.

“I’m older and traveling a lot and not sleeping so much,” he says. “We got on this routine of doing acupuncture…and it’s really made a huge difference for me.”

Jamie Starkey is the lead acupuncturist at the Center for Integrative Medicine at the Cleveland Clinic. She is also the Cleveland Indians’ team acupuncturist.

“I can go in and actually release some of the muscles that may be tight and that would actually prevent injury down the road,” she says.

She also offers yoga and Reiki massage. “It’s wonderful in terms of supporting the immune system and to promote sleep and overall wellness and stress management,” she says. “All of those things in combination – both eastern and western medicines – will help prolong a player’s shelf life.”

Giambi says at first his teammates made fun of him, but not anymore. “Now they’re like, ‘Hey, he’s still playing. He’s 43. I might give that a shot,’" he says. "And before you know it, there’s five or six guys that do it now.”

Acupuncture Helps Boost Drugs Used to Treat Depression

Acupuncture enhances the therapeutic effects of paroxetine, a drug often given the trade name Paxil, Aropax or Seroxat. Patients receiving acupuncture plus paroxetine showed greater clinical improvements in obsessive-compulsive symptoms, depression and anxiety than patients receiving only paroxetine. Researchers discovered the synergistic effects of acupuncture combined with paroxetine plus another important advantage of adding acupuncture to paroxetine intake. Yin Tang and othe acupoints are needled here. Acupuncture sped up the effective action of therapeutic benefits. The researchers note, “acupuncture/electroacupuncture has a rapid onset of therapeutic effect and produces a noticeable improvement in obsessive-compulsive, depressive and anxiety symptoms.”

Acupuncture and electroacupuncture were found equally beneficial in overall therapeutic results. Scores in individual areas of improvement varied between acupuncture and electroacupuncture therapy when combined with paroxetine. Importantly, electroacupuncture showed significant improvements over manual acupuncture in reducing recurrent and multiple medical symptoms of no known organic cause. Electroacupuncture also demonstrated significant efficacy over manual acupuncture in reducing depression related hostility and phobic anxiety. Both manual acupuncture and electroacupuncture showed significant clinical benefits in reducing primary unipolar depression when combined with paroxetine with significant improvements over and above those of paroxetine only.

The researchers cite several important findings as the basis for the investigation. Roschke, et al. published in the Journal of Affective Disorders, “Acupuncture is more effective than oral antidepressants in improving depressive symptoms.” Yeung et al. document that acupuncture is effective for patients with “poor outcomes after antidepressant medications.” Zhang et al. confirm that acupuncture is both safe and effective for treating depression.

The study confirms three major findings. Acupuncture, electroacupuncture and paroxetine are effective in the treatment of primary unipolar depression. Acupuncture and electroacupuncture combined with paroxetine has a “rapid onset of therapeutic effect.” Additionally, acupuncture and electroacupuncture combined with paroxetine synergistically improves conditions of obsessive-compulsive behavior and anxiety in patients with depression. The results are better for patients combining acupuncture or electroacupuncture with paroxetine than those only taking paroxetine. The researchers also note that acupuncture and electroacupuncture combined with paroxetine “is a safe treatment for primary unipolar depression.”

The researchers used a standard set of acupuncture points with minor modifications for all patients in the study. This varies from customized clinical care wherein a licensed acupuncturist has more flexibility in the acupuncture point prescription based on differential diagnostics. Although the approach of using one set of acupuncture points for all patients is common in many research models, it is considered a variation from the norm according to Traditional Chinese Medicine (TCM) principles wherein each patient receives a custom acupuncture point prescription based on an exact presentation of conditions.

The research team cited several studies finding the governing, pericardium, spleen, liver and stomach meridians effective for the treatment of depression. These findings combined with a presentation of Chinese medicine principles for the treatment of depression were given as the reasoning for the acupuncture point choices. The primary acupuncture points used in the study were Baihui (DU20), Yintang (EX-HN3), Fengfu (DU16), Fengchi (GB20), Dazhui (DU14), Neiguan (PC6) and Sanyinjiao (SP6). Minor customizations based on some indications were added. Zusanli (ST36) was added for cases involving poor appetite or fatigue. Shenmen (HT7) was added for patients with sleep disturbances. Shuaigu (GB8) was added for patients with headaches. Zhigou (TB6) was added for patients with constipation.

Wang, et al. confirm that acupuncture combined with SSRIs (serotonin reuptake inhibitors) is more effective than using SSRI medications alone. The additional research also confirms that acupuncture potentially reduces the “delay before the onset of the therapeutic action of SSRIs.” Wang, et al. note, “Acupuncture combined with SSRIs shows a statistically significant benefit over a 6-week period compared with SSRI administration only.” The research team notes that acupuncture is safe and produces no adverse effects. Wang, et al. add that acupuncture may allow for “the reduction of the dose of antidepressants and their associated adverse clinical outcome.”

The researchers note, “We showed that acupuncture combined with SSRIs produces statistically significantly larger reductions of HDRS (Hamilton Depression Rating Scale) values than SSRIs alone. This additional benefit was evident from the first week and continued throughout 6 weeks of treatment.” The investigators note that these findings are consistent with another body of research including a 6 week controlled, randomized trial of acupuncture combined with paroxetine.

Psychiatrists prescribed SSRIs to each patient in this randomized, controlled study. The acupuncture group received SSRIs plus acupuncture therapy. The control group received SSRIs only. A differential diagnosis was made for each patient by a China Association of Acupuncture and Moxibustion certified acupuncturist with a minimum of 15 years of clinical experience. The standard of care was protocolized to a given set of primary and secondary acupuncture point prescriptions. Between 6 and 10 needles were applied to each patient at each office visit. The acupuncture needles were 0.25 × 40 mm and the depth of insertion was 10 – 30 mm. Needles were stimulated until deqi arrived. The dao qi acupuncture technique was applied to the primary acupuncture points. Dao qi is lifting, thrusting and rotating the acupuncture needle with gentle and smooth stimulation.

Several back points are inserted here.

GV14 and GV4 were needled in the seated position with a 5 minute retention time prior to removal of the needles. Next, patients were in the supine position for additional acupuncture care for 30 minutes. Treatment was applied once per day in the morning at a rate of 5 days per week for a total of 6 weeks.

The primary acupuncture points were GV24 (Shenting), GV20 (Baihui), GV14 (Dazhui) and GV4 (Mingmen). Secondary points were:

LR3 (Taichong), SP9 (Yinlingquan) for liver depression & spleen deficiency
LR3, LR14 (Qimen) for liver qi stagnation
HT7 (Shenmen), ST36 (Zusanli) for heart and spleen deficiency
KI3 (Taixi), LR3 for liver and kidney yin deficiency
CV4, CV6 for spleen and kidney yang deficiency
HT7 and Anmian for insomnia and forgetfulness
PC6 (Neiguan) for palpitations and chest tightness
ST25 (Tianshu), ST37 (Shangjuxu) for constipation
Mental illness is a serious individual and societal issue. Working towards more effective treatment protocols and greater access to care will help in the treatment of depression. Given the increasing body of evidence that acupuncture enhances the clinical benefits of paroxetine, an integrative medicine approach seems more rational than a medication only approach. Let’s look forward to acupuncture treatments becoming recommended and available to patients needing care in the treatment of depression.


References:
Chen, Junqi, Weirong Lin, Shengxu Wang, Chongqi Wang, Ganlong Li, Shanshan Qu, Yong Huang, Zhangjin Zhang, and Wei Xiao. "Acupuncture/electroacupuncture enhances anti-depressant effect of Seroxat: the Symptom Checklist-90 scores." Neural Regeneration Research 9, no. 2 (2014): 213.

Wang, Tianjun, Lingling Wang, Wenjian Tao, and Li Chen. "Acupuncture combined with an antidepressant for patients with depression in hospital: a pragmatic randomised controlled trial." Acupuncture in Medicine (2014): acupmed-2013.

Qu SS, Huang Y, Zhang ZJ, et al. A 6-week randomized controlled trial with 4-week follow-up of acupuncture combined with paroxetine in patients with major depressive disorder. J Psychiat Res 2013;47:726–32.

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1398-acupuncture-boosts-drugs-for-depression#sthash.6BUuSqHS.dpuf

When Beauty Sleep’s Elusive, Try Acupuncture

Sleep. It sounds so simple. But for the millions of Americans that suffer from sleep deprivation, it’s a very complex issue.

With a job, two kids and living a life at the breakneck pace that is New York City, I never thought I’d have trouble sleeping. And the truth is, I have no trouble falling asleep. But I can’t stay asleep. So I decided to give acupuncture a try.

“After acupuncture, there’s a change in the brain that’s visible on a MRI,” said Dr. Yemeng Chen, the president of the New York College of Traditional Chinese Medicine.

With campuses in New York City and Long Island, the school has graduated more than 500 acupuncturists. Chen said that even traditional medical doctors seek out acupuncture training to complement their expertise.

But won’t it hurt? Chen said that one of the acupuncture points related to sleep issues is in the ear. He proposes putting two needles in my ear. Inside my ear.

“For sure, no one likes needles," Chen said. "But this is thin and tiny. We insert in acupuncture points, those related to nerve endings. The patient won’t feel severe pain.”

So maybe a little pain.

The first thing Chen ordered me to do was stick out my tongue. He said I was dehydrated, which was a shock to me. I drink about 70 ounces of water every day. But interestingly, I do feel thirsty much of the time.

Chen then put about 20 needles on me, from my ears to my forehead to my wrists and ankles. The only one that made me truly uncomfortable was the one in my left ankle, which Chen said was indicative of some sort of blockage that is affecting my sleep, probably in my liver. When I told him I typically wake up every night 45 minutes after initially falling asleep, he was further convinced of circulatory system block.

Some find the road to sleep is immediate. One patient in Chen’s waiting room said, “When I’m here, I fall asleep very easily. It’s a nice nap, very refreshing.”

I didn’t fall asleep during my session, but was relaxed, though it was difficult to say whether that was because of the well-placed needles or being separated from my iPhone in a dimly-lit room for 20 minutes. Even if this is my only go at acupuncture, I learned a valuable lesson: Don't take my phone to bed.

Acupuncture Eases Pain For Children, Stanford University

A Stanford University study finds acupuncture safe and cost-effective for relieving pain in children. Dr. Golianu, MD (Department of Anesthesiology, Stanford University), et. al., note research confirming that acupuncture is “useful in chronic pain conditions” adding that it may be clinically valuable in an integrative medical setting. The research documents acupuncture’s ability to stimulate natural pain killers within the body, dynorphins and endorphins, along with several other important biological responses involved in pain management. The researchers cited multiple findings of acupuncture successfully relieving headaches, migraines, abdominal pain, fibromyalgia, pelvic pain, Complex Regional Pain Syndrome (CRPS), acute post-operative pain, and post-operative delirium.

Children Accept Acupuncture
The Stanford University research team cites findings that “53% of children were initially apprehensive of acupuncture needles, following their first needle 64% felt it did not hurt, and furthermore would recommend it to someone else.” In adolescents, 67% report acupuncture as “pleasant” and 70% report that acupuncture reduced pain levels. The receptivity to acupuncture may be due, in part, to acupuncture’s ability to induce deep relaxation in patients combined with lasting analgesic effects.

The researchers note that, “Acupuncture can be a useful adjuvant in the care of pediatric patients with painful conditions, both in the chronic and acute setting.” Citing Lin, et. al., young children and adolescents experienced significant pain relief from acupuncture treatments. The children also found acupuncture “highly acceptable.” On safety, the research confirms “that acupuncture is safe when performed by appropriately trained practitioners.” In the United States, acupuncturists are licensed medical professionals with medical board oversight in most states.

Headaches
The researchers note that acupuncture decreases headache frequency and severity across several controlled studies. In addition, acupuncture reduces the need for medications and is proven effective in treating migraines. The research team cites a randomized trial of children with migraines finding acupuncture effective in reducing the intensity and frequency of migraines. Another pediatric study meeting the review standards of the research team finds cold laser acupuncture effective for reducing the frequency of migraines and tension headaches.

Abdominal Pain
The researchers cited findings showing acupuncture in adults effective for treating IBS, irritable bowel syndrome, “a comparative effectiveness trial of acupuncture compared to two antispasmodics (pinaverium bromide and trimebutin maleate) showed acupuncture as more effective than these standard therapies for IBS.” A pediatric study found acupuncture effective for the treatment of intermittent abdominal pain. Given the prevalence of abdominal pain in children, the researchers recommend further studies investigating the “dose or frequency and duration of acupuncture treatment required.”

Fibromyalgia and Arthritis
The research team did not find randomized controlled pediatric studies on the treatment of fibromyalgia. However, adult studies find acupuncture “superior to standard care alone.” In addition, “Acupuncture was found to change cortical responses to painful stimuli in fibromyalgia patients, suggesting a complex inhibitory modulation may be active in the central nervous system in fibromyalgia patients.” The same scenario was found in the case of juvenile arthritis. No pediatric studies have been conducted but adult studies find acupuncture effective for the treatment of osteoarthritis. For fibromyalgia and arthritis, the research team recommends specific investigations on the effects of acupuncture on children. 

Pelvic PainPediatric studies have been conducted on the effectiveness of acupuncture. A study of adolescents with dysmenorrhea (menstrual cramping and pain) finds acupuncture equally as effective as NSAIDS, non-steroidal anti-inflammatory drugs. Another study of pelvic pain caused by endometriosis finds acupuncture effective in reducing pain with residual results documented at six months following the treatment regime. 

CRPS, Cancer and Acute Pain
Both adult studies and a pediatric study demonstrated acupuncture’s clinical efficacy for the treatment of Complex Regional Pain Syndrome (CRPS). Researchers found that 29% of young children and 36% of adolescents with cancer in Germany use acupuncture. The researchers found quality studies showing acupuncture effective for reducing nausea and vomiting related to cancer chemotherapy treatments along with a reduced need for anti-emetic medications. The researchers note that a study of children from ages 7 months to 18 years experienced significant and lasting post-operative pain relief from acupuncture. Other pediatric studies find acupuncture effective in reducing post-operative delirium, pain and agitation.

Cost-Effectiveness
The research team looked into a cost-benefit analysis of acupuncture. A study was conducted by Great Britain’s National Health Service (NHS) on patient’s with lower back pain. The randomized investigation revealed that “the addition of acupuncture to standard care led to improved pain both immediately after the treatments as well as at 24 months. Though the cost of delivering acupuncture in addition to standard care was an increase of expenditure, this cost was more than balanced by a reduction in lost days of work, and decreased medical spending in other areas including hospitalization, general practitioner or other outpatient visits.”

Based on the review of available quality research including large sample randomized-controlled studies, the researchers note that acupuncture “can be an important adjuvant in the care of the pediatric patient with chronic pain.” They add, “The evidence suggests that it is a safe and cost-effective treatment modality for pediatric pain.”

References:
Golianu, Brenda, Ann Ming Yeh, and Meredith Brooks. "Acupuncture for Pediatric Pain." Children 1, no. 2 (2014): 134-148. Author Affiliations:
Department of Anesthesiology and Pain Medicine, Pediatric Anesthesiology, Stanford University, Stanford, California.
Pediatric Gastroenterology, Stanford University, Palo Alto, California.

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1397-acupuncture-eases-pain-for-children-stanford-university#sthash.qBR3CjpK.dpuf

Acupuncture & Exercise Found to Ease Pain from Breast Cancer

Breast cancer patients who experience pain and swelling related to their treatment may find relief in acupuncture and exercise, new research suggests.

In one study, acupuncture helped reduce joint pain by up to 40 percent, said study author Dr. Jun Mao, director of the integrative oncology program at the Abramson Cancer Center at the University of Pennsylvania, in Philadelphia.

And it didn't matter if people thought it would work or not, he found.

While other studies have found acupuncture is effective for a variety of symptoms, including joint pain, fatigue and sleeping difficulties, Mao wanted to see the role a person's expectations of the treatment would have.

He studied 41 breast cancer survivors, assigning them to a sham acupuncture group or an electroacupuncture group, and compared them to a "control group" that got neither treatment. Electroacupuncture uses a small electrical current passed between two pairs of acupuncture needles to stimulate certain points on the body. The women did not know whether they were getting the real treatment or the sham one.

The women had stiffness or joint pain, which are common side effects when taking aromatase inhibitors, a hormonal therapy used to help treat breast cancer.

"What we found is in the real acupuncture, the response was not dependent on whether the patient believed acupuncture to work or not," Mao said. "However, in the sham group, the response seemed to be driven by the higher expectation of acupuncture to work."

Those in the real acupuncture group had a consistent level of pain reduction, Mao said. In the sham group, if there was a low expectation, no change in pain was reported. "For those [in the sham group] with extremely high expectations, their effect was as strong as 80 percent," he said.

Pain relief from real acupuncture is often dismissed as a "placebo effect," Mao explained. "Our results demonstrate the opposite," he said. In real acupuncture, expectation plays no role in pain reduction. "The real acupuncture group, regardless of expectation, everyone had about a 40 percent reduction in pain," he said. A decline of 30 percent or higher is viewed as meaningful, he added.

What this means, Mao said, is that "real acupuncture will work for anyone, whether you believe it or not."

The study is published in the November issue of the Journal of the National Cancer Institute Monographs.

In the same journal, University of Pennsylvania researchers looked at how a community-based exercise program could help women affected by lymphedema (a swelling of the limbs), muscle problems and decreased body image that can occur after breast cancer.

In a previous study, the researchers had found the program worked in a research setting. But, they wanted to test it in a community setting. The program is administered by physical therapists and included a group-based exercise class and a program for patients to continue at home or at the gym.

In all, 67 breast cancer patients completed measurements of the effects after a year. These participants had improvements in symptoms, body image and muscular strength. The results in the community setting were similar to those that were found in the research setting.

However, the researchers did note issues that were encountered in getting the program operational, including payments, the need for advocates and how to get patients referred so it would be covered by insurance.

The acupuncture study is a solid piece of research, said Leslie Bernstein, director of cancer etiology at the City of Hope Cancer Center, in Duarte, Calif.

However, she said, it's important to point out that acupuncture won't work for everyone. "But, on average, it will work," she said, based on the study results.

The exercise study showed the challenges that come with taking a program that's been tested and found effective in research settings and putting it into practice, Bernstein added. "It highlighted the issues that one would meet in what works as an intervention, and taking that into the community."

Among the common issues, she said, are finding someone to administer such programs, paying for them and getting insurance coverage and approvals.

By Kathleen Doheny

HealthDay Reporter

The Science of Acupuncture

Acupuncture has been used in traditional Chinese medicine for over 2,000 years. In the Western world, acupuncture has been a highly controversial therapy, mostly due to the lack of scientific explanations for its mechanisms of action. Nevertheless, acupuncture has become increasingly accepted, having spread worldwide and having become a frequently sought-after alternative therapy.

In 1997, the National Institutes of Health (NIH) Consensus Development Program recognized acupuncture as a therapeutic intervention of complementary medicine. The World Health Organization (WHO) now recommends the use of acupuncture for treatment of numerous diseases and symptoms associated with cardiovascular, neurological, musculoskeletal, respiratory, gastrointestinal, gynecological and psychological disorders.

It is estimated that 3 million adults in the USA receive acupuncture treatments each year, with chronic pain being the most common reason for seeking this therapy. In fact, the efficacy of acupuncture in diverse painful conditions is now widely recognized, having earned the denomination “acupuncture analgesia”. An estimate of 50% to 85% of chronic pain patients seem to benefit from acupuncture.

Although acupuncture analgesia may have an important psychological component, increasing evidence has been demonstrating that the analgesic effect of acupuncture may indeed be due to a physiological action. The increasingly generalized use of acupuncture has stimulated research on the physiological and biochemical mechanisms underlying acupuncture analgesia. In the last decades, there has been a rapid development of our knowledge of the neurological processes induced by acupuncture. Although a consensual theory is still lacking, many hypotheses have been proposed for the mechanisms of acupuncture analgesia.

Acupuncture points seem to be special sites with denser sensory innervation and connective tissue, and a richer content of TRPV1 receptors, which are important players in pain mechanisms. The insertion of a needle into these points acts as a mechanical stimulus that activates the mechanoreceptors and sends afferent signals to the central nervous system, to areas involved in pain processing. Neurochemical processes of pain modulation are consequently activated, inducing acupuncture analgesia.

Both clinical and laboratory data indicate that the endogenous opioid system participates in acupuncture analgesia. In fact, a reduced need for opioid-like-medication in patients with chronic pain after acupuncture treatment has been reported. The noradrenergic system has also been associated with acupuncture analgesia in experimental studies, where a decreased level of noradrenaline in the brain was observed after acupuncture-induced analgesia. Studies in animal models of inflammatory and neuropathic pain have also found evidence for a role of serotonin and glutamate in acupuncture analgesia. Other pain mediators that have been suggested to be modulated by acupuncture include somatostatin, cannabinoids, and neurotrophic factors. However, clinical studies supporting these theories are still lacking.

Experimental models of pain have also indicated that acupuncture may have an anti-inflammatory action by having a modulatory effect on the release of pro-inflammatory mediators. These results have been supported by clinical findings showing a reduction in the production of pro-inflammatory molecules after acupuncture in patients with osteoarthritic pain and chronic pelvic pain syndrome.

Despite these recent advances in the understanding of the mechanisms of acupuncture analgesia, there is still a lot of ground to break. What seems to be clear is that, regardless of how that happens, acupuncture works. And there’s no harm in trying it.

by Sara Adaes, PhD (c)

References

Leung L (2012). Neurophysiological basis of acupuncture-induced analgesia–an updated review. Journal of acupuncture and meridian studies, 5 (6), 261-70 PMID: 23265077

Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K, & Acupuncture Trialists’ Collaboration (2012). Acupuncture for chronic pain: individual patient data meta-analysis. Archives of internal medicine, 172 (19), 1444-53 PMID: 22965186

Vickers AJ, & Linde K (2014). Acupuncture for chronic pain. JAMA : the journal of the American Medical Association, 311 (9), 955-6 PMID: 24595780

Zhang R, Lao L, Ren K, & Berman BM (2014). Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology, 120 (2), 482-503 PMID: 24322588

Zhao ZQ (2008). Neural mechanism underlying acupuncture analgesia. Progress in neurobiology, 85 (4), 355-75 PMID: 18582529

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