An introduction into Acupuncture

As I practice acupuncture I thought that it was about time that I wrote a blog article on the subject. I know it’s a long time coming but Physiotherapy is such a broad subject! There is way too much to cover!

So for my first blog article on acupuncture I thought that it would be best to discuss acupuncture in general, to give you an understanding of what it is and how it works. In future articles I can discuss acupuncture relating to specific problems such as low back pain etc.

Acupuncture is commonly used within physiotherapy as part of the multimodal management of pain and injury. The purpose of acupuncture in physiotherapy is to enhance normal physiotherapy treatments such as exercise to promote recovery and improve quality of life.

Now Physiotherapists are bound by clinical evidence and so it is important that acupuncture stands up to the scrutiny of research. This article and future articles will try to guide us, as to whether acupuncture is evidence based.

So what is Acupuncture?

Acupuncture is part of Traditional Chinese medicine (TCM), which is an ancient system of medicine from 1000 years BC. Essentially acupuncture is the insertion of fine needles into the body, mainly along meridians that relate to organs of the body.

The Chinese believe that illness is the effect of imbalances in the body’s energy. They use acupuncture to correct these energy imbalances. The energy they describe is referred to as Qi, (pronounced chee), you may have heard of Yin and Yang? These are the different types of Qi that exist according to the Chinese.

Yin:

Quiet and calm

Yang:

Vigorous and exciting.

Essentially they are opposites and in good health they exist in a dynamic but balanced state. When you are ill or injured the belief is that there is an imbalance in these energies. It is believed that stimulating certain Acupuncture points can help to restore the balance between Yin and Yang to re balance them and restore normal health.

The problem with this theory is that it has no evidence behind it. Now this doesn’t mean that it doesn’t work, it just means that the reasons why it works are different, according to clinical research.

So what does the research say about how and why it works?

Basically acupuncture has been found to reduce pain by stimulating the nervous system. Generally this produces natural pain-relieving chemicals such as endorphins, melatonin, serotonin and more.

Here is a diagram detailing the nervous system below:

More specifically acupuncture produces cutaneous stimulations from the needle insertion, these are transmitted to the internal viscera (internal organs) through the somato-visceral neuronal synapses in the spinal cord. The visceral nerves are therefore stimulated, which seems to selectively stimulate either the sympathetic or the parasympathetic nervous system and in turn adjusts the function of the autonomic nervous system.

This was highlighted by Grashchenkov et al (1959). Now I know this paper is extremely old but they demonstrated that the blood content of adrenalin, noradrenaline, diamine oxidase, acetylcholine, acetylcholine esterase, and histamine in asthma and peptic ulcer patients returned to normal after acupuncture. I know this isn’t conclusive but it is a sign of acupunctures effects. More recently Paulson & Shay (2013) found that acupuncture appeared to activate the sympathetic nervous system, indicated by a bilateral increase in skin conductance and a bilateral decrease in distal skin temperature after needle insertion.

Acupuncture has also been found to stimulate an analgesic (pain relieving) biochemical chemokine called CXCL10, which reduces pain and inflammation by activating natural opioids (pain relieving chemicals) in the body (Wang et al 2014).

Serotonin (neurotransmitter) is released in response to acupuncture making the serotoninergic descending inhibitory pathway an important mechanism of pain relief through acupuncture. However to date no satisfactory consensus has been reached with regards exactly how this works (Lin & Chen 2008).

Proinflammatory mediators (chemicals that assist the inflammatory process), such as histamine, bradykinin, PGE2, 5-HT and ATP, are released from acupuncture and they excite nociceptors (pain detecting receptors) directly or indirectly (Boucher et al 2000) & (Meyer et al 2005). This is important due to the fact that inflammation is needed to heal and repair the body.

Low intensity needling techniques have been found to stimulate sensory neuropeptides such as substance P and calcitonin gene-related peptide (CGRP) to be released from primary afferent nerve endings and these substances cause local vasodilatation (increasing blood flow) and influence local immune responses (Lundeberg et al 1988).

Non painful and high-intensity needling may increase sympathetic outflow to tissues supplied by the segment needled in the short term, which can elicit strong analgesic effects (Sato et al 1997). For this effect you need to needle the site of injury or any tissue innervated by the same spinal segment as the injured tissue (Lundeberg 1998).

Acupuncture affects the descending inhibitory systems from the brain. These include diffuse noxious inhibitory controls, descending pain inhibitory pathways, neurohormonal responses and central control of the autonomic nervous system (Carlsson 2002). For these specific effects, longer periods of needling of up to 40 minutes are needed to initiate supraspinal effects (above the spine, meaning brain), since the brain systems are generalised and non-specific, and may require high-intensity stimulation over time to activate them.

Interestingly Lundeberg (1998), believes that central responses may not be dependent on the site of needle placement but is dependent on how strongly the points are needled. If a spinal segment is highly sensitised then the needles should be placed extrasegmentally (basically away from the painful area) to the injured part otherwise the pain will be stirred up too much.

An increase in the cerebral oxygen saturation could be registered with the help of microelectrodes in the cortex during acupuncture (Schwarz et al 1998). It is obvious that if the saturation is low then this will affect the body, however the link to anything clinically relevant has not been found.

How often should acupuncture be performed?

Treatments should be repeated regularly but the exact frequency will depends on the origin and nature of the problem (Lundeberg 1998).

In summary, acupuncture influences the peripheral nervous system with the release of neuropeptides from sensory nerve endings, which then affect the central nervous system by blocking pain signals in the dorsal horn in the spinal cord. This then changes the sympathetic outflow and motor output. In strong stimulation of the needles acupuncture may also activate nuclei in the brain for descending inhibition of pain and those controlling body processes, such as autonomic and endocrine responses.

So it’s all a bit complicated but overall acupuncture has been found to lower pain, affect inflammation, influence blood flow and therefore assist healing and return the body to a normal state.

Obviously it is one thing to say all this has been found to occur in the body but how effective is it for various conditions is another question entirely. For the answer to this and other questions stay tuned for the next article on acupuncture.

If you need any further information or would like to book an appointment then call Hawkes Physiotherapy on 01782 771861 or 07866195914

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