Introduction

Chronic pain affects millions globally, significantly diminishing their quality of life and daily functioning. Traditional treatments often rely on medications that can cause side effects and dependency. Acupuncture, an ancient practice from Traditional Chinese Medicine (TCM), offers a complementary approach to pain management. This blog explores acupuncture’s role in treating chronic pain, considering both TCM principles and biomedical evidence.

Acupuncture in Traditional Chinese Medicine

Acupuncture is a core practice within TCM, viewing the body as an interconnected system where health is the harmonious balance of Yin and Yang. Chronic pain and other ailments are often seen as disruptions or imbalances of Qi (vital energy) within the body’s meridians. These meridians are channels that facilitate Qi flow, and any disruption can lead to illness.

By inserting fine needles at specific acupoints along these meridians, acupuncture aims to unblock and regulate Qi flow, restoring balance and promoting the body’s natural healing processes. This technique addresses physical symptoms and seeks to harmonize the internal environment, enhancing overall well-being.

Additionally, acupuncture can be combined with other TCM treatments such as herbal medicine, cupping, and moxibustion to enhance therapeutic outcomes. The selection of acupoints and complementary treatments is often personalized, reflecting TCM’s holistic approach to health restoration and future imbalance prevention.

Mechanisms of Action: Biomedical Perspective

From a biomedical standpoint, acupuncture influences the body through several mechanisms, particularly in pain management and overall bodily function. Here are some key points:

Pain Management:

• Pain Perception and Neural Pathways: Acupuncture modulates pain perception through various mechanisms. Functional MRI (fMRI) studies have shown that acupuncture can alter brain activity in regions associated with pain processing, such as the thalamus, limbic system, and somatosensory cortex, reducing the subjective experience of pain

• Endorphin Release: One of the well-documented effects of acupuncture is the release of endorphins, the body’s natural painkillers. Endorphins bind to opioid receptors in the brain, reducing pain perception and inducing a sense of well-being. This endorphin release can provide significant relief for individuals suffering from chronic pain conditions such as osteoarthritis, back pain and fibromyalgia.

• Neurotransmitter Modulation: Acupuncture affects the level of neurotransmitters in the body. Neurotransmitters such as serotonin, dopamine, norepinephrine, GABA, glutamate, and endorphins, play a crucial role in pain modulation and mood regulation. Norepinephrine modulates pain through descending pain pathways, GABA reduces neuronal excitability and pain signals, glutamate is involved in pain signal transmission, and endorphins act as natural painkillers. This can help manage pain and improve mental health concurrently. By balancing these neurotransmitters, acupuncture can reduce symptoms of anxiety and depression, providing a holistic approach to mental well-being. Additionally, the modulation of neurotransmitters can lead to enhanced relaxation and stress relief, further supporting overall emotional health.

• Gate Control Theory: Acupuncture activates the spinal cord’s pain-inhibitory mechanism, effectively blocking pain transmission at the spinal level. Research indicates that acupuncture stimulates A-delta and C fibers, which in turn activate inhibitory interneurons in the spinal cord. These inhibitory interneurons release neurotransmitters such as endorphins and enkephalins, which can reduce the perception of pain.

• Anti-inflammatory Effects: Chronic pain is often associated with inflammation. Acupuncture has been shown to exert anti-inflammatory effects by modulating the activity of cytokines and other inflammatory mediators. This can help reduce swelling and pain in conditions like rheumatoid and osteoarthritis, tendonitis, bursitis and chronic low back pain.
• Blood Flow Improvement: Acupuncture enhances blood circulation, promoting healing in affected areas by increasing oxygen and nutrient delivery and removing metabolic waste products. Acupuncture influences the production and release of nitric oxide (NO), which plays several crucial roles:

Vasodilation: 

• Nitrous oxide: Relaxes blood vessels, improving blood flow and lowering blood pressure.

• Anti-inflammatory Effects: NO reduces inflammation and associated pain.

• Neurotransmission: NO modulates pain signaling pathways in the nervous system.
• Blood Flow and Nutrient Delivery: Increased NO production enhances circulation, promoting healing, waste removal, and tissue repair. Studies have shown that acupuncture can effectively increase microcirculation in both local and systemic areas, contributing to overall cardiovascular health. This mechanism is particularly beneficial for patients suffering from conditions such as chronic pain, muscle stiffness, and certain vascular disorders.

Physiological Processes:

• Autonomic Nervous System Regulation: Balancing the sympathetic and parasympathetic nervous systems, acupuncture can help reduce stress and improve functions like digestion, sleep, and heart rate. This balance is crucial for patients with chronic pain, as it can help mitigate the stress and anxiety that often accompany long-term pain conditions.

• Immune System Modulation: Acupuncture enhances immune response by influencing immune cell activity, reducing inflammation, and promoting a balanced immune response. Studies have shown that acupuncture can increase the activity of natural killer cells, T cells, and macrophages, and alter cytokine levels, contributing to a more balanced immune response.

• Hormonal Balance: By affecting cortisol and other hormones like serotonin, melatonin, and endorphins, acupuncture helps manage stress, improve sleep quality, and enhance overall well-being. Chronic pain often leads to elevated stress levels, and by regulating these hormones, acupuncture can provide a pathway to reduce stress, improve sleep quality, and enhance overall well-being.

• Muscle Relaxation: Acupuncture effectively alleviates muscle tension and spasms, promoting relaxation and reducing pain. By targeting specific acupoints, acupuncture enhances blood flow to muscles, relieving tightness. This approach is particularly beneficial for patients with chronic muscle-related pain. The treatment also affects the fascia, the connective tissue surrounding muscles, aiding in breaking up adhesions and improving flexibility and movement. Acupuncture-induced muscle relaxation can reduce the risk of further injury, decrease the likelihood of muscle spasms, and enhance recovery by promoting healthier muscle fiber alignment and improving nutrient delivery to affected tissues.
• Neuroplasticity: Evidence suggests acupuncture promotes neuroplasticity, helping the brain reorganize and adapt in response to pain and other stimuli. This capacity for adaptation can lead to long-term changes in how pain is processed and perceived, offering hope for more sustainable pain relief.

Clinical Evidence and Applications

Following are a few examples of where the application of acupuncture may be beneficial.

• Low Back Pain: Meta-analyses show acupuncture provides significant pain relief and functional improvement in chronic low back pain.
• Migraines and Headaches: Acupuncture reduces the frequency and intensity of migraines and tension-type headaches, with fewer side effects compared to prophylactic drug therapy.
• Osteoarthritis: Acupuncture reduces pain and improves joint function, particularly in knee osteoarthritis, by modulating inflammatory responses.
• Fibromyalgia: Acupuncture improves pain threshold and sleep quality in fibromyalgia patients, enhancing their overall quality of life.
• Carpal Tunnel Syndrome: Studies indicate that acupuncture can alleviate symptoms of carpal tunnel syndrome, including pain, numbness, and tingling. By targeting specific acupoints, acupuncture can reduce inflammation and improve nerve function, providing relief for this condition.
• Cancer Pain: Acupuncture has been shown to be effective in managing pain associated with cancer and its treatment. It can help reduce pain, nausea, and fatigue in cancer patients, improving their overall quality of life. This is particularly beneficial for those undergoing chemotherapy or radiation therapy, as acupuncture can help mitigate some of the side effects of these treatments.

Integrating Acupuncture into Pain Management

Acupuncture should be part of a multidisciplinary approach to chronic pain management, complementing conventional treatments, physical therapy, and lifestyle modifications. It is essential for healthcare providers to ensure patients receive acupuncture from licensed and trained practitioners to maximize benefits and minimize risks.

Conclusion

Acupuncture is a valuable tool in chronic pain management, capable of modulating pain perception, inducing endorphin release, enhancing nitric oxide production, and exerting anti-inflammatory effects. Its integration into mainstream medical practice can offer patients effective, holistic pain management options. Continued research and integration into mainstream medical practice can provide patients with effective, holistic pain management options.

References

• Lai, P., Cheng, S., Chen, X., Cheng, F., Cheng, J., Xin, M., et al. (2024). The Emotion Regulation of Acupuncture in Chronic Low Back Pain: A Clinical Neuroimaging Protocol. Journal of Pain Research, 17, 817-825.
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• Turkistani, A., Shah, A., Jose, A. M., Melo, J. P., Luenam, K., Ananias, P., et al. (2021). Effectiveness of manual therapy and acupuncture in tension-type headache: a systematic review. Cureus, 13, e17601. doi: 10.7759/cureus.17601.
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