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A look at acupuncture and how it works

A look at acupuncture and how it works

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  • To understand how the theories of acupuncture translate to pain relief, it is necessary to know a little about how pain is transmitted and experienced by the body. Pain is a double-edged sword. On one hand it protects us from damage by warning us of harmful situations, but in chronic conditions it is as debilitating as the disease process itself. Abnormal chronic pain states are thought to result from damage within the pain pathway itself, either in the peripheral nerves or the central nervous system. The normal protective pain mechanism, which warns of impending or actual damage, is activated by mechanical, heat or other noxious stimuli impinging on pain receptors that then transmit the pain impulse to the CNS through afferent nerve fibers.
  • Unlike other sensory input, pain recognition is subjective, and previous experiences can influence one's perception of it. This is true of dogs also; some breeds generally are more stoic than others. Pain perception also is a function of sex as females have shown a much higher pain threshold.
  • How is this possible? The body has its own pain-suppression mechanisms. This built-in analgesic system depends on the presence of endogenous opiates, which include endorphins. Most Western theories suggest acupuncture either instigates the production of these opiates or blocks pain transmission. Not unexpectedly, when East meets West and when philosophy meets science, confusion undoubtedly will occur. Similarly, when old meets new, questions of quackery from both sides will arise. Even in light of this, some Western theories have sought to explain the reported pain-relief benefits of acupuncture. One of those is the gate or inhibition theory, which proposes that pain is blocked by stimulating sensory neurons that travel faster than those that transmit pain (25).  
  • Several types of nerve fibers are involved in pain transmission. As mentioned before, there are three types of pain receptors. Stimuli received from the mechanical and thermal pain receptors are transmitted over large myelinated A-delta fibers at a speed close to 30 meters per second. Impulses received by the other type of receptors travel much more slowly on the C fibers at the rate of 12 meters per second. A-alpha fibers, which are necessary for the proper perception of where we are in three-dimensional space, i.e., where our feet are located, are found in muscles and joints. Alpha-beta neurones are involved in feeling light touch and the bending of hairs. A-alpha and A-beta fibers transmit nerve impulses many times faster than A-delta or C fibers. AP stimulation may induce non-painful sensory information that travels along A-beta fibers. When the information reaches something called the inhibitory interneurones, it shuts a nerve transmission "gate" that blocks the conduction of the slower traveling A-delta and C fibers.  
  • The gate theory may account for some part of the mechanism of acupuncture analgesia, but it does not explain the delayed effects of treatment or the results of cross-circulation studies (studies in which the blood circulation of two animals were connected, and the procedure performed on one produced results in both). These factors are much better explained by the competing humoral theory, which states that acupuncture instigates the release of endogenous (developed from within) opiates that produce a self-induced analgesia (26). In other words, acupuncture may work by stimulating specific afferent nerves, which in turn activate a spinal cord center, a mid-brain center and the hypothalamus/anterior pituitary unit. All three of these have been shown to block pain transmission by means of endorphins and/or other analgesic neurotransmitters. Some believe that acupuncture's pain relief derives from a combination of the neurological and humoral explanations (27).  
  • Another theory suggests acupuncture may have localized vasodilatation effects, which would explain the procedure's benefits specific to musculoskeletal disorders. Dilated blood vessels are better able to eliminate pain-producing substances such as bradykinin (a substance released from blood plasma by some snake venoms and certain other enzymes that lowers blood pressure and triggers pain), prostaglandins and other inflammatory products. Another explanation is the autonomic theory, which maintains that internal organs can be stimulated by external acupuncture points that selectively excite parasympathetic and sympathetic nerves regulating the autonomic nervous system (28).
  • Another explanation is the autonomic theory, which maintains that internal organs can be stimulated by external acupuncture points that selectively excite parasympathetic and sympathetic nerves regulating the autonomic nervous system (28).
  • The bioelectric theory tops off this confusing mix of theories. It suggests acupuncture meridians are like direct current pathways and acupuncture points function as amplifiers.

Powerpoint acupuncture works Powerpoint acupuncture works Presentation Transcript

  • ACUPUNCTUREAN ANCIENT SCIENCE WITH MODERN IMPLICATIONSDr. Linda Lucienne EhlersChiropractic Physician8700 West 95th StreetHickory Hills, Illinois 604571.708.598.9010  
  • IS THE WORLD FLAT?
  • Does Acupuncture Work? PAIN, International Association for the Study of Pain, November 1996, Volume IV, Issue 6 Perception of non-European medical practice as empiric or "folk" medicine ignores the history of science. During Europe’s "Dark Ages" of restricted scientific activity, the East witnessed intense scientific development. Written records of Traditional Chinese Medicine (TCM) on systems of acupuncture and moxibustion provide ample evidence for a science based on centuries of inductive logic, observation, and painstaking classification 1,2. TCM poses insights but not in biomedical terms. Both the self-contained logic of TCM and Western medical establishment attitudes about "alternative" or "complementary" medicine have insulated acupuncture from developments in biomedicine3. Recent biomedical research on the neural modulation of pain rekindled interest in acupuncture as a mode of peripheral sensory stimulation (PSS)4,5. The potential of TCM and the effectiveness of acupuncture are now being defined biomedically.
  • Traditional Chinese Explanation of How  Acupuncture Works     The human body has thousands of  nerve points or pressure points  that control different parts of the  body.    Points located along 14 major  meridians or power lines inside the  body.    These power lines carry energy or  Qi, Chi or …which is distributed  evenly in cases of a healthy body.    However in cases of sickness or  disease, an obstruction at a  particular point affects the rest of  the body.    Needles clean out the obstruction  and redirect energy into these  affected parts.  This will cure the  problem over a period of time.  
  • WHAT IS THE SCOPE OF ACUPUNCTURE? Acupuncture is a system which can influence three areas of  health care:  promotion of health and well-being,  prevention of illness,  treatment of various medical conditions.  Often associated with pain control it has much broader  applications.   Effective as the only treatment used, or as the support or  adjunct to other medial treatment forms in many medical and  surgical disorders.
  • THE WORLD HEALTH ORGANIZATIONRecognizes the use of acupuncture in the treatment of a  wide range of medical problems Digestive disorders:     Neurological and muscular gastritis & hyperacidity, disorders: headaches, facial  spastic colon,  tics, neck pain, rib neuritis,  constipation,  frozen shoulder, tennis elbow,  various forms of tendonitis,  diarrhea.  low back pain, sciatica,  osteoarthritis.  Respiratory disorders:  sinusitis,   Urinary, menstrual, and sore throat,  reproductive problems.  bronchitis,   Particularly useful in resolving  asthma,  physical problems related to  recurrent chest     tension, stress & emotional infections.  conditions. 
  • From: A Randomized, Placebo-Controlled Trial of Acupuncture in Patients With Chronic Obstructive Pulmonary Disease (COPD): Title and subTitle BreakThe COPD-Acupuncture Trial (CAT)Acupuncture in Patients With COPD Arch Intern Med. 2012;():1-9. doi:10.1001/archinternmed.2012.1233 Figure Legend : Figure 1. Acupuncture points used. The acupuncture points were selected according to traditional Chinese medicine theory: (1) LU1 (Zhongfu) and (2) LU9 (Taiyuan) in the lung meridian; (3) LI18 (Futu) in the large intestine meridian; (4) CV4 (Guanyuan) and (5) CV12 (Zhongwan) in the conception vessel; (6) ST36 (Zusanli) in the stomach meridian; (7) KI3 (Taixi) in the kidney meridian; (8) GB12 (Wangu) in the gallbladder meridian; and (9) BL13 (Feishu), (10) BL20 (Pishu), and (11) BL23 (Shenshu) in the bladder meridian. Copyright © 2012 American MedicalDate of download: 5/15/2012 Association. All rights reserved.
  • Pain = Protective Mechanismwarns of impending or actual damage, 3 types of pain receptors: -mechanical, -heat -other noxious stimuliSends the pain impulse to the CNS through afferent nerve fibers.Abn px states = damage w/in px pathway
  • Pain RecognitionUnlike other sensory input ◦ Subjective, ◦ Previous experiences can influence ones perception of px. ◦ True of dogs also; some breeds generally are more stoic than others. ◦ A function of sex as females have shown a much higher pain threshold
  • Pain Control & Acupuncture ATwo Possibilities ◦ instigates the production endogenous opiates (Ant. Pituitary)  Or ◦ blocks pain transmission.
  • SIGNAL TRANSMISSION Melzak-Wall Gate Control Theory of Pain Control  3 types of pain receptors. Stimuli received from the mechanical and thermal pain receptors & transmitted over large myelinated A-delta fibers -- close to 30 meters per second. Impulses received by the other type of receptors travel much more slowly on the C fibers at the rate of 12 meters per second. A-alpha fibers, necessary for the proper perception of where we are in three- dimensional space, found in muscles and joints. A-beta neurons are involved in feeling light touch and the bending of hairs. A-alpha and A-beta fibers transmit nerve impulses many times faster than A-delta or C fibers . Pressure/mechanical stimulation produces non-painful sensory information that travels along A-beta fibers. When the information reaches the inhibitory interneurons, it shuts a nerve transmission "gate" that blocks the conduction of the slower traveling A-delta and C fibers . Does not explain the delayed effects of treatment or the results of cross-circulation studies ( blood circulation of two animals were connected, and the procedure performed on one produced results in both).
  • SIGNAL TRANSMISSIONHumoral TheoryVasodilation TheoryAutonomic TheoryBioelectricTheoryNon-synaptic diffusion neurotransmission (NDN)
  • Humoral Theory Acupuncture instigates release of endogenous (developed from within) opiates that produce a self-induced analgesia. Stimulates specific afferent nerves, that in turn activate a spinal cord center, a mid-brain center and the hypothalamus/ anterior pituitary. All three of these have been shown to block pain transmission by means of endorphins and/or other analgesic neurotransmitters. Some believe that acupunctures pain relief derives from a combination of the neurological and humoral explanations. 
  • Vasodilatation EffectsLocalized vasodilatation effects,Dilated blood vessels are better able to eliminate pain-producing substances such as bradykinin, prostaglandins and other inflammatory products.Explains procedures benefits specific to musculoskeletal disorders.
  • Autonomic TheoryInternal organs can be stimulated by external acupuncture points.Selectively excite parasympathetic and sympathetic nerves regulating the autonomic nervous system.
  • Bioelectric TheoryAcupuncture meridians are like directcurrent pathwaysAcupuncture points function as amplifiers &rectifiers.
  • Dr. Paul Bach-y-Rita 1934 - 2006 American neuroscientist One of first to seriously study the idea of neuroplasticity Introduced sensory substitution as a tool to treat patients suffering from neurological disorders.
  • Non-synaptic diffusion neurotransmission (NDN)Discovered in 1962 by Bach-y-RitaA complementary mechanism of information transmissionMay play multiple roles in the brain, including in normal and abnormal activity, brain plasticity and drug actions
  • Non-synaptic diffusion neurotransmission (NDN) Diffusion of neurotransmitters and other neuroactive substances through the extracellular fluid to reach extrasynaptic receptors, & Diffusion of substances such as nitric oxide through both the extracellular fluid and cellular membranes to act w/in the cell. The possible roles of NDN in mass, sustained functions such as mood, sleep and brain “tone”, as well as in various other functions, e.g., in long term potentiation, at the retinal, lateral geniculate nucleus and visual cortex levels of the visual system, in recovery from brain damage and in neuropharmacology,
  • What these theories have in common is the stimulation ofacupuncture points insertion of small needles, application of pressure, cupping (suction) and application of heat through moxibustion (which can be used to raise the temperature of the needles), or infrared, laser or electrical stimulation
  • Myofascial Chains Alternative therapists disagree with the neurological explanation. According to them acu works by stimulating nerve points to send extra messages over the fascia to the covering tissue of muscle bundles. The messaged travel via specially made myofascial chains that are geared to carry messages. The exact message will vary according to the neurological point that is stimulated. ◦ For example, stimulating a point in the forehead may help to sooth sinus pains and encourage draining. These neurological or electrical points are said to have a lower electrical resistance and they work like switches to control pain and healing in different parts of the body.
  • Nerve Complex Explanation of How Does Acupuncture Work Some neurologists believe it is possible that acupuncture points contain deep seated nerve complexes. Pressing down on these nerve complexes does cause a dull ache in the affected area/body part. Inserting needles into these nerve points could result in a stimulation of the brain and the spinal cord encouraging the release of natural painkillers or endorphins. These chemicals can then block the sensation of pain and help the area heal itself.