Acupuncture and Pain

Many people show interest in acupuncture, but have no idea what it really means. For some it's just a novel concept, a fun new activity they could talk about at a dinner party. However, for more and more people, acupuncture plays an important role in one's life to help maintain health, prevent disease, stop pain, and promote the healing process. One of the most studied aspects of acupuncture is its ability to stop pain. So how does this actually work? As I've stated before, acupuncture is the most studied manual therapy with an amazing assortment of research being done on this ancient technique---specifically regarding pain. PAIN, we all know it and we all want to avoid it...what's worse than constantly being reminded of your aches and constant pains. My brother once said to me, "Pain is just weakness leaving the body" and that made me want to smack him. Yea, I'll show him pain. But here's the thing--while it's necessary to life, it doesn't have to define you, and for many people acupuncture has helped relieve this pain.

So...how the hell does sticking a needle under the skin on your foot relieve your headache? And why are the small needles in the ear supposed to help with my back pain? Now, I could do a whole post on the theory of acupuncture channels and their pathways, and the years of studying it took to learn the theory behind this. I could also talk about the new and exciting research happening that seems to prove the existence of these so called 'channels'. But right now, lets stick to pain (pun intended).

Here are some of the many theories surrounding acupuncture's great success around pain relief.

1) Natural Opioid Substances: I know you've heard of opioids, you've listened to Janis Joplin right? Well, opioids are not just drugs that people took in the late 60s, but they are also naturally occurring substances found in the body. Needling seems to affect these substances--specifically the Cerebrospinal fluid (CSF) concentrations of the naturally occurring opiate substances: dynorphin (acting at a spinal level), endorphin (acting within the brain), and encephalin (acting both in the brain and at a spinal level). Okay, so why is this important? WELL, endorphins and enkephalins are potent blockers or modulators of pain arising from the musculoskeletal system. Dynorphin is a powerful modulator of visceral pain; it has a weaker effect on musculoskeletal pain modulation. So in other words...they help stop pain. Actually, they help reduce our perception of pain and act similarly to drugs such as morphine and codeine. However, in contrast to the opiate drugs, activation of the opiate receptors by the body's endorphins does not lead to addiction or dependence. So basically, acupuncture can stimulate the body's natural opiate receptors but it WON'T lead to an untimely death. Too soon?

In addition to decreased feelings of pain, secretion of endorphins leads to feelings of euphoria, modulation of appetite, release of sex hormones, and enhancement of the immune response. With high endorphin levels, we feel less pain and fewer negative effects of stress.

Here's a clinical review entitled "Acpuncture & Endorphins."

2) 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, or the "Honey! I hurt my knee! Can you please massage my back??"

3) Activating the Immune System: The presence of a foreign needle (sterilized single use needle) may act to stimulate vascular and immuno-modulatory factors, including those of local inflammation. Adrenocorticotrophic hormone has been shown to be elevated after acupuncture treatments, suggesting that adrenal activation and the release of endogenous corticosteroids may also result (yes, corticosteroids---the same ones your doctor prescribes). Again, what does this mean? It means that sticking needles in your body creates a micro-trauma which in turn stimulates the activity of immune cells that control inflammation. This is GOOD.

Chris Kresser further delves into the subject:

There are millions of immune cells called mast cells in the dermis of the skin. These cells are like water balloons full of fatty molecules called leukotrienes and prostaglandins A & B. When a needle is inserted into the skin, it pops the mast cells and releases the leukotrienes and prostaglandins. Prostaglandins cause the cutaneous nerve in the area to fire (which activates the process described in the previous paragraphs). Leukotrienes are the strongest anti-inflammatory substance the body can produce.

Leukotrienes cause local capillaries to vasodilate and become permeable. White blood cells called macrophages leak out through the capillaries and immediately begin to heal the damage caused by the needle stick.

However, the healing caused by the needle insertion isn’t limited to the damage caused by the needle. If there is other damage in the area from previous traumas or injuries, that will also be addressed by the immune chemicals released by the needle insertion.

What’s more, the micro-trauma caused by the needle starts a systemic immune response. This promotes healing of the soft tissue throughout the body – not just at the needling site. After the needles are removed, the needle-induced lesions continue to stimulate the body until the lesions heal. This means that the anti-inflammatory effect of acupuncture persists for 2-3 days (and sometimes as long as a week) after the needle is withdrawn.

 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.

4) Myofibrillary entanglement: Acupuncture may induce relaxation of ‘stuck’ myofibrils within tissue planes. Myofibrils are basic rod-like units of muscle. Myofibrils are composed of long proteins such as actin, myosin, and titian,and other proteins that hold them together. These proteins are organized into thin filaments and thick filaments, which repeat along the length of the myofibril in sections called sarcomeres. Muscles contract by sliding the thin (actin) and thick (myosin) filaments along each other. ENOUGH OF THE BORING STUFF. Why is this good? Well, it is thought that acupuncture may have a similar effect to the injection of painful trigger points (a common procedure undertaken in pain clinics). Needles may actually relax these myofibrils and reduce pain felt in the muscle.

5) Local blood flow: As I've stated before, acupuncture has been shown to increase blood flow (especially locally) which may initiate or catalyze the healing process. Also, 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.

6) PMR Theory: 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.

OH MY LORD, when will she stop? Have you had enough yet? The research doesn't stop there, but I will. In the next post I'll further discuss the many mechanisms of acupuncture and how it can help with chronic pain.

 http://chriskresser.com/chinese-medicine-demystified-part-v-a-closer-look-at-how-acupuncture-relieves-pain

http://acustef.blogspot.com/2013/01/scientific-research-on-acupuncture-pain.html

http://www.ncbi.nlm.nih.gov/pubmed/1754056

http://ceaccp.oxfordjournals.org/content/7/4/135.full#ref-3

http://www.medscape.com/viewarticle/501973_2

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Polk Acupuncture

3166 N Lincoln Ave

Chicago

,

Illinois

606578477693312