How Acupuncture Works: Eastern and Western Medicine Perspectives
Acupuncture has been around for thousands of years, originating in China and used successfully to treat a variety of conditions. In North America, it’s starting to gain popularity as more people are beginning to seek natural healthcare for treatment options. This article provides an overview of how acupuncture relieves pain, from the traditional Eastern medicine view, as well as the neuroscience-based explanation from Western medical research.
Acupuncture is based on Traditional Chinese Medicine (TCM) theory, where the purpose is to restore balance and to ensure the smooth flow of qi (pronounced chee) and blood throughout the body. Consider qi as your life force, inner light, or mojo - however you see it. In health, qi and blood freely circulate, but factors like stress, poor diet or sleep, injuries, genetics, etc. can all interfere and block the flow in certain areas, which can result in pain.
In TCM, the body is a map of meridians (click here to view) made up of different acupuncture points that each have specific actions. The selection of points is a true art, and is completely individualized based on the presenting illness in order to restore balance.
*Notes: 1. This is an over-simplified version of TCM theory. 2. Naturopathic doctors apply TCM theory when choosing acupuncture protocols, as well as using local points along affected muscles for pain relief. This contrasts with physiotherapists and/or chiropractors, who needle affected musculature and don’t typically apply TCM theory.
The following is a summary of my research on the physiological effects of acupuncture. The science nerd in me really found this interesting, I hope you do too!
Point Location: Acupuncture points are located along large nerve bundles or nerve endings. It turns out that 80% of acupuncture points correspond with perforations in the superficial fascia, ie. gaps where the nerves pass through connective tissue to muscle. Also, 70% of acupuncture points are associated with trigger points, which are constricted bands of muscle causing a specific distribution of pain (view here).
Central Nervous System Modulation: When a peripheral nerve is stimulated via acupuncture, imaging studies have discovered that the spinal cord and the following areas in the brain have altered neural and metabolic activity: reticular formation, thalamus, hypothalamus, nucleus accumbens, cingulate cortex, amygdala, and hippocampus. It’s been proposed that the altered activity of these regions causes decreased pain pathway signalling from the body —> brain and from the brain —>body. Also, the actual processing of pain (specifically, within the limbic system) is blunted, which decreases the sensation, awareness and/or emotional experience of the pain.
Release of Analgesic Mediators: Acupuncture induces opioid production in the spinal cord and in the central nervous system. Opioids are the body’s morphine-like chemicals that inhibit the release of Substance P (which activates pain signals) from nerve endings, thus they create a natural, analgesic effect. The synthesis of certain opioids like endorphins and enkaphalins are thought to be up-regulated by acupuncture, and the break-down of opioids is prolonged, allowing them to work their analgesic magic for longer. Adenosine is another neuromodulator released during acupuncture, which also has analgesic actions in the brain. If you’ve had acupuncture before, perhaps you can relate to the dream-like feeling following a treatment - I know I can!
Hormonal Effects: Acupuncture also influences hormone levels throughout the brain. Specifically: serotonin, dopamine, somatostatin, GABA, acetylcholine, and noradraneline. Like opioids, somatostatin inhibits the release of substance P, decreasing pain signalling. However, given the various actions of these hormones in different areas across the brain, the exact role they play in pain modulation is still unknown.
Local Effects: Needling causes an increase in blood flow to both the skin and underlying musculature. Blood carries nutrients, peripheral opioids, and other anti-inflammatory mediators to the area, providing analgesic relief to affected muscles and joints.
Note: The majority of these studies (see references below) used electro-stimulation of TCM-based acupuncture points. Many naturopathic doctors use electro-acupuncture in practice, and we can too at the RSNC!
Regardless of how acupuncture works, it can be a great treatment modality for those suffering with pain. Since there’s no risk of interactions with medications, it is safe to use alongside conventional treatment.
Curious to try acupuncture? Click here, to search for a licensed naturopathic doctor near you!
Sims J. The mechanism of acupuncture analgesia: a review. Complementary Therapies in Medicine. 1997 Jun 1;5(2):102-11.
Lily C, Peng L, Cheng W. The Mechanism Of Acupuncture Therapy And Clinical Case Studie.
Wu MT, Hsieh JC, Xiong J, Yang CF, Pan HB, Chen YC, Tsai G, Rosen BR, Kwong KK. Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain—preliminary experience 1. Radiology. 1999 Jul;212(1):133-41.
Sicuteri F, Rainò L, Geppetti P. Substance P and endogenous opioids: how and where they could play a role in cluster headache. Cephalalgia. 1983 Aug;3(1_suppl):143-5.
Sandberg M, Lindberg LG, Gerdle B. Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia. European Journal of Pain. 2004 Apr 1;8(2):163-71.
Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain. 1977 Feb 1;3(1):3-23.
Goldman N, Chen M, Fujita T, Xu Q, Peng W, Liu W, Jensen TK, Pei Y, Wang F, Han X, Chen JF. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature neuroscience. 2010 Jul 1;13(7):883-8.
Carlsson C. Acupuncture mechanisms for clinically relevant long-term effects–reconsideration and a hypothesis. Acupuncture in Medicine. 2002 Aug 1;20(2-3):82-99.