Brief Research Notes: Medical Acupuncture

Medical Acupuncture

Brief Research Notes

People often assume that acupuncture is synonymous with Traditional Chinese Medicine and that anyone who uses acupuncture does so based on 'qi' or 'meridians'. This is a misconception. Regardless of its theoretical basis, based on the traditional and official definition, the term acupuncture refers to the actual insertion of a needle into the body (Fan et al. 2016).

Acknowledging that traditional narratives outdated, medical acupuncture is an approach that is based upon a theory that is inline current scientific understanding of how the body works. Reframing acupuncture form of peripheral nerve stimulation technique in which acupuncture needles are inserted into anatomically defined sites, and stimulated manually or with electricity (White 2009).

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia). All of these areas are highly innervated and as a result there are a number of physiological responses that help modulate the experience of pain.

Is Acupuncture a Placebo?

The way we present ourselves and present our techniques is tied to clinical outcomes, the magnitude of a response may be influenced by mood, expectation, and conditioning. In any discussion on therapeutic effect it is important to acknowledge the placebo response (Kong et al. 2013).

It is also a within the realm of possibility that when acupuncture needles are inserted into anatomically defined sites, and stimulated manually or with electricity patients have a complex biopsychosocial response that INCLUDES but is not LIMITED to placebo. Several plausible theories attempt to explain how acupuncture works, this includes but is not limited to:
• The Gate Control Theory of Pain (Melzack & Wall 1984)
• The Release of Endogenous Opioids (Chen et al. 2017, Yin et al. 2017 )
• The Release of Endogenous Cannabinoids (Gao et al. 2017, McPartland et al. 2014, Hu et al. 2017)
• Purinergic Signaling (Sawynok 2016, Tang et al. 2016)
• Interactions Between Non-Neuronal Cells and Neurons (Ji et al. 2016, Zhang et al. 2014)
• The Inflammatory Reflex (Chavan et al. 2014, Lim et al. 2016, Pavlov et al. 2017)
• Neuroplastic Changes Across Different Areas of the Peripheral and Central Nervous System (Maeda et al. 2017)
• Sensory-Discriminative and Affective-Social Touch (Chae et al. 2017)
• Mesenchymal Stem Cells (Salazar et al. 2017) 
• Downregulation of Pronociceptive Mediators (Qiao et al. 2017)
• Polarisation of M2 Macrophages (da Silva et al. 2015, Zhao et al. 2017)
• Local Nitric Oxide Release (Ma et al. 2017)

More to Explore

Chae, Y., Olausson, H. (2017). The role of touch in acupuncture treatment. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/28151404

Chavan, S. S., & Tracey, K. J. (2014). Regulating innate immunity with dopamine and electroacupuncture. Nature Medicine.
https://www.ncbi.nlm.nih.gov/pubmed/24603793

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

da Silva, M.D., Bobinski, F., Sato, K.L., Kolker, S.J., Sluka, K.A., Santos, A.R. (2015). IL-10 cytokine released from M2 macrophages is crucial for analgesic and anti-inflammatory effects of acupuncture in a model of inflammatory muscle pain. Mol Neurobiol.
https://www.ncbi.nlm.nih.gov/pubmed/24961568/

Fan, A.Y., He, H. (2016). Dry needling is acupuncture. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/26672062

Gao, F., Xiang, H.C., ... Li, M. (2017). Electroacupuncture Inhibits NLRP3 Inflammasome Activation through CB2 Receptors in Inflammatory Pain. Brain Behav Immun.
https://www.ncbi.nlm.nih.gov/pubmed/28782714

Hu, B., Bai, F., Xiong, L., Wang, Q. (2017). The endocannabinoid system, a novel and key participant in acupuncture's multiple beneficial effects. Neurosci Biobehav Rev.
https://www.ncbi.nlm.nih.gov/pubmed/28412017

Ji, R.R., Chamessian, A., Zhang, Y.Q. (2016). Pain regulation by non-neuronal cells and inflammation. Science.
https://www.ncbi.nlm.nih.gov/pubmed/27811267

Kong, J., Spaeth, R., ... Kaptchuk, T.J. (2013). Are all placebo effects equal? Placebo pills, sham acupuncture, cue conditioning and their association. PLoS One.
https://www.ncbi.nlm.nih.gov/pubmed/23935833

Lim, H., Kim, M., Lee, C., & Namgung, U. (2016). Anti-Inflammatory Effects of Acupuncture Stimulation via the Vagus Nerve. PLoS ONE
http://www.ncbi.nlm.nih.gov/pubmed/26991319

Ma, S.X., Lee, P.C., Anderson, T.L., Li, X.Y., Jiang, I.Z. (2017). Response of Local Nitric Oxide Release to Manual Acupuncture and Electrical Heat in Humans: Effects of Reinforcement Methods. Evid Based Complement Alternat Med.
https://www.ncbi.nlm.nih.gov/pubmed/28717380

Maeda, Y., Kim, H., Kettner, N., Kim, J., Cina, S., .... Napadow, V. (2017). Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain.
https://www.ncbi.nlm.nih.gov/pubmed/28334999

Mcpartland, J. M., Guy, G. W., & Marzo, V. D. (2014). Care and Feeding of the Endocannabinoid System: A Systematic Review of Potential Clinical Interventions that Upregulate the Endocannabinoid System. PLoS ONE.
https://www.ncbi.nlm.nih.gov/pubmed/24622769

Melzack, R., Wall, P.D. (1984). Acupuncture and transcutaneous electrical nerve stimulation. Postgrad Med J.
https://www.ncbi.nlm.nih.gov/pubmed/6334851

Pavlov, V.A., Tracey, K.J. (2017). Neural regulation of immunity: molecular mechanisms and clinical translation. Nat Neurosci.
https://www.ncbi.nlm.nih.gov/pubmed/28092663

Qiao, L.N., Liu, J.L., Tan, L.H., Yang, H.L., Zhai, X., Yang, Y.S. (2017). Effect of electroacupuncture on thermal pain threshold and expression of calcitonin-gene related peptide, substance P and γ-aminobutyric acid in the cervical dorsal root  ganglion of rats with incisional neck pain. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/28600329

Salazar, T.E., Richardson, M.R., Beli, E., ... Grant, M.B. (2017). Electroacupuncture Promotes CNS-Dependent Release of Mesenchymal Stem Cells. Stem Cells.
https://www.ncbi.nlm.nih.gov/pubmed/28299842

Sawynok, J. (2016). Adenosine receptor targets for pain. Neuroscience.
https://www.ncbi.nlm.nih.gov/pubmed/26500181

Tang, Y., Yin, H., Rubini, P., & Illes, P. (2016). Acupuncture-Induced Analgesia: A Neurobiological Basis in Purinergic Signaling. The Neuroscientist.
http://www.ncbi.nlm.nih.gov/pubmed/27343858

White, A. (2009). Western medical acupuncture: a definition. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/19369193

Yin, C., Buchheit, T.E., Park, J.J. (2017). Acupuncture for chronic pain: an update and critical overview. Curr Opin Anaesthesiol.
https://www.ncbi.nlm.nih.gov/pubmed/28719458

Zhang, R., Lao, L., Ren, K., & Berman, B. M. (2014). Mechanisms of Acupuncture–Electroacupuncture on Persistent Pain. Anesthesiology. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/24322588 

Zhao, J., Wang, L., Li, Y. (2017). Electroacupuncture alleviates the inflammatory response via effects on M1 and M2 macrophages after spinal cord injury. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/28077367