by Lindsey Sisson
Often in clinic patients want to know how acupuncture can take their pain away, immediately and long term. How does this work? Why does it work? Why would you put a needle way over there if my pain is right here!? There are two ways we can answer these questions, the first is from a Traditional Chinese Medicine (TCM) perspective, where we talk about meridians and imbalances in the body. The second explanation is based on research of the scientific explanation of how and why acupuncture is effective for pain relief. Both explanations are important, and often we touch a little on both when explaining how our medicine works. In this article we will talk more in detail about how current scientific research explains how this ancient healing art works.
For people who have had acupuncture one of the most mystifying aspects is that acupuncture points (acupoints) are not always located in or near the pain site. What has been shown is that about 95% of all acupoints are located very close, within 1cm, of nerve trunks (Shaozong, C.). These nerve trunks are large nerve branches that span large areas over the body. By stimulating areas where the nerve branch is superficial we are able to affect that nerve branch deep within the body at different sites. This is why for pain on the trunk, such as back pain, we may be stimulating points on the hands and feet. The points on the periphery send signals that travel along the nerve branch directly through the area in pain, stimulating the body to send pain relief to that nerve branch.
When patients are getting substantial pain relief from treatments they start to wonder how this can be so effective. We are asked frequently if there is any type of pain medication in/on the needles we insert. The answer is No. Acupuncture releases the natural pain killers that are present in our bodies. This is no small thing, and to understand the how acupuncture can be so effective on pain we can look at what pain reliving substances do when released within the body. The three substances we will discuss are enkephalin, endorphins and norepinephrine. All of these have been shown to be released in response to acupuncture.
When there is an injury to body tissue a signal is sent that travels through the spinal cord into the brain. The brain in turn releases Enkephalins and Endorphins in response to pain. Enkephalins block pain signals within the spinal cord. Endorphins are not completely understood, but are thought to block pain mostly within the brain stem. When inserting needles into the body we are causing micro traumas at highly sensitive areas (think back to the nerve branch) and stimulating this feedback loop without causing a large amount of trauma to the body that is typically needed to release Enkephalins and Endorphins.
Enkephalins and Endorphins are morphine like substances. When they are released in response to the micro traumas caused by needle insertion they provide pain relief in a similar manner to opium-based pharmacuticals. Together these “natural painkillers” have a pain reliving potential up to 200 times more than morphine. So, when we say in explanation that acupuncture is allowing your body to release its own pain-killers, this is no small thing!
Norepinephrine is a third substance thats released during acupuncture treatments. This is a stress hormone which, along with epinephrine regulates our fight or flight response. When this response is triggered one of the things that happens is that our body releases blood into skeletal muscle. With this blood comes oxygen, nutrients and analgesics (pain relievers). So while we are getting pain relief from the others, this response decreases pain but also enables our body to start repairing. Additionally, Norepinepherine can suppress neuroinflammation which is inflammation of the nervous tissue due to infection, traumatic brain injury, toxicity, or autoimmunity. Acute inflammation is needed and is a repairing mechanism of the body. However, chronic inflammation not only causes pain but can lead to cancer, rheumatoid arthritis, hay fever and atherosclerosis (hardening and narrowing of the arteries). Suppressing and eliminating chronic inflammation is an important part not only of pain relief, but disease prevention.
These mechanisms are only part of the complicated system that is responsible for pain relief. Research that shows how acupuncture initiates these responses provides insight into the substantial and lasting pain relief we see in our clinical practice daily. Modern research is still exploring how pain is eliminated in our bodies. This is true not only within acupuncture research but within the pharmaceutical realm as well. The way some of our most commonly used pain relievers work are still not completely understood.
We welcome the curiosity of our patients and want to give as much information as possible regarding how acupuncture is able to help relieve symptoms. We are so happy to be able to share how this medicine works from a TCM (Traditional Chinese Medicine) perspective as well as a biomedical perspective. There is exciting research being done currently to further explain the physiological effects of acupuncture. We look forward to gaining even more understanding of how these little tiny needles make such a big impact on pain.
Shaozong, C. Modern acupuncture theory and its clinical application. (Chapter 5 The Morphologic Relationship between Points and Nerves). International Journal of Clinical Acupuncture. 2001;121(2):149-158