The Neurophysiology Mechanisms of Acupuncture. How the heck does it work?
Over the past 50+ years, America has been progressively introduced to acupuncture. At first, it was viewed as fringe medicine with the word ‘medicine’ being a stretch. In the 1990s and early 2000s, it was beginning to be more accepted by the Western medical community. Back in 2007, a study was done and revealed that around 50% of medical doctors believe that acupuncture has benefits and yet, when I started around that time, I still ran across anecdotal stories from my patients in which their doctors laughed at them for trying acupuncture. The eye roll was a favorite among these close-minded doctors. And then the opioid epidemic hit and no longer could doctors laugh at fringe medicine. They had to start embracing it because they could no longer use medication to control pain.
In 2010, the FDA came out and stated that MDs had to start using acupuncture, chiropractic and other modalities for pain management. It forced MDs to look at the research that was already out there supporting acupuncture. Insurance companies, who were already offering acupuncture benefits on some employer plans, were encouraged to offer it to more plans. The VA (Veterans Affair) immediately embraced acupuncture and forced their MDs to ween their veterans off opioids and refer them out to acupuncturists. My business with the VA exploded. Being in-network with insurance companies, my business also exploded from that end. My patients found pain relief, they reported back to their MDs and the MDs started to embrace acupuncture more. It is very rare now that I hear back from patients that their MDs roll their eyes at them for trying acupuncture. Now, I hear from them that their MDs shrug their shoulders and say that they are unsure how acupuncture works, but it does and they should keep doing it.
Now, the unfortunate part about the acupuncture community, is that we do not do enough education to our patients and their MDs about how acupuncture ACTUALLY works. A large portion of that reason is due to the education structure of our Masters program. The majority of these programs still teach from a Chinese diagnosis system which works, but is based on observation, ancient Chinese language/theosophy and mistranslations of ancient texts that made acupuncture become an “energetic” medicine instead of what it is – a physical medicine based on neurophysiology. That’s on us Acupuncturists and we need to change that (like ASAP).
So this comes to my next point. How does acupuncture really work???
I will attempt to briefly explain the science in terms that can be understood by both MDs and their patients.
Acupuncture is a neurological-based medicine. That is to say, the Chinese literally recognized 2000+ years ago through deep extensive anatomy that there is a nervous system that runs through the body and when they ‘poke’ at neurovascular nodes (points in the nervous system where there are large bundles of nerves innervated by veins that nourish them), they can cause changes in the way that nerve communicates with the body. There are 5 different neurophysiological mechanisms that pain is reduced and all of them are employed by acupuncturists:
1. Local Effect – Simply breaking the skin with a needle will invoke a healing response because something broke a barrier that protects us from the outside world. The body responds by bringing fresh blood flow that nourishes/heals that area. For those with medical backgrounds, the axon reflex triggers CGRP to be released which, in turn, releases red blood cells, white blood cells, histamine, prostaglandins, serotonin, glutamate, substance P and nerve growth factor. If a patient is experiencing inflammation, doing local needling in that area can help heal that inflammation and fix the pain.
2. Spinal Segment – There are 31 pairs of spinal nerves that come off the spine where each disc is located. At the root within those spinal segments are three neurotransmitters that help to regulate the signals of nerves, especially in pain. They are enkephalins, serotonin, noradrenaline. When acupuncture stimulates a nerve bundle, that signal transmits to nerve roots at the corresponding spinal segment and triggers those three neurotransmitters to flood that area. In doing so, pain signals are down regulated at the spine and the transmission of pain slows to the brain. For those with medical backgrounds, please also consider Hilton’s Law – which states that nerve bundles of large muscles that innervate the same spinal segment as the joint will down regulate the pain signal at that segment. Acupuncturists will often stimulate those large muscle motor neurons to fire and interrupt dysfunctional signals at the spinal segment.
3. Endogenous Opioid Circult (EOC) – Through evolutionary biology, we have a built-in neuro-biological system that helps to reduce pain signals in our brain called the Endogenous Opioid Circuit. fMRIs have proven that acupuncture stimulates the EOC to dim pain signals in the brain. When electricity is employed to acupuncture at certain frequencies, different internal opioids (aka – primarily beta endorphins, enkephalins and dynorphins) can be targeted to release into the brain, spine and body to dim the pain response. Historically, the Chinese have used manual manipulation to release these internal opioids, but modern acupuncturists use tens units on the needles. Most of the research studies use electro-acupuncture (EA) and the results are positive.
4. Central Nervous System (CNS) – Our brain in general lights up in many different ways when there is pain. It can change our personality, our temperament, our ability to sleep and to perform tasks because pain impacts so many different central nervous system areas. Once again, acupuncture has been shown through research studies to dim or stimulate areas of the brain to promote better sleep, help anxiety/depression, disperse brain fog, promote better general brain health impacted by pain.
5. Myofascial Trigger Points – Ever heard of Dry Needling? This is what dry needling is. It’s a form of acupuncture (already documented 2000 years ago) that focuses on those “ouchy” points in our muscles. When our muscles become inflamed, the muscle fibers in the inflamed area form a kind of “glue” that causes the muscle fibers to bunch up like knots. Over time, those knots cement and become painful to the touch. They are trigger points. Inserting a needle into these points with manipulation can break up those knots and allow the muscle fibers to remodel correctly or, in essence, get rid of the knots. This is the 5th mechanism by which acupuncture has been employed for centuries to help billions of people feel better.
And so, there it is. The neurophysiological mechanisms by which acupuncture medically works. Ancient Chinese Secrets that are no longer secret or mysterious.
For those who are skeptical unless given actual studies to coincide, I present some of the multitude studies on the subject below.
Special Note: Because our medicine has done such a poor job of educating our profession as to medical ways by which acupuncture works in addition to learning Chinese diagnosis system used for centuries, Dr Heather Sullivan spent her time learning the above information under the tutelage of Dr Michael Corradino, inventor of Neuropuncture, which has advanced acupuncture into the 21st Century so that she may adequately educate the public as to the reasons why acupuncture works given modern understanding of medicine. Therefore, a special thanks needs to be given to him while writing this blog.
