INDICATIONS AND MECHANISMS

OF ACUPUNCTURE IN PAIN

Lecturer: M.K. Sastry

For over 3000 years Acupuncture

has been used to treat many diseases, as

infectious diseases

musculoskeletal diseases

internal diseases

metabolic diseases

hormonal imbalances

mental and nervous system diseases

Acupuncture has been

practiced for over fifty years

in Western countries,

achieving great success in

treating different diseases.

More than 10,500 scientific

publications are available on

Medline database,

demonstrating Acupuncture

effectiveness and safety.

Acute and chronic painful pathologies

are one of the more interesting fields of

application of Acupuncture, that often

can cure, alone or with other therapies,

many diseases difficultly treatable only by

the conventional resources.

Acupuncture in pain

variety of acupuncture effects, as follows:

anti-inflammatory

analgesic

decontracting-miorelaxing

vasoregulatory

sedative

neuroendocrine regulatory

So many diseases treated suggest a wide

Vasoregolatory-trophic effect

Documented from the thermography and

other fluxmetric methods, it restores the

correct blood flow in the affected area.

Painful diseases are often characterized by

local ischaemia or light inflammation,

frequently associated to edema.

This situation favors the

accumulation of waste and the

evolution towards fibrosis,

with functional failure.

The tissue distress

In the affected area we can see limited zones very painful

naturally

after pression

capable of causing pain locally and in a distant area.

These areas correspond to the traditional Ah Shi acupoints

and to the Trigger points (TP) described from Travell and

Simons as ischaemic zones with larger metabolic needs.

Each TP embodies a “warm” hyperexcitated area, that can

cause reflex phenomena locally and at some distance.

The ischaemic-irritative tissue condition

of TP zones, through the afferent

nerves, can maintain this distress.

Reflex nervous pathways are involved and

these mechanisms can play a role:

reflex constriction of Vasa Nervorum

nociceptive autonomic feedback

release of vasoactive peptides (SP, CGRP) from

afferent C fibres, that increases the stimulation of

nociceptive pathways

The “silent afferences”

In 1994 G.D. Schott (Brain, 117:397-413)

pointed out the role of autonomic nervous

fibres in the origin of chronic visceral

and musculoskeletal pain.

These afferent fibres represent over 50% of

the amielinic C fibres found in the different

tissues (skin, joints, muscles, viscera).

“Silent fibres” become sensitive and they are capable

of evoking a reaction only after longtime injuries,

as inflammatory and ischaemic processes.

The activation of these afferences can lead to a central

sensitisation, with an enlargement of receptive fields,

causing a more intense and continuing activity.

In this way chronic pain mantains itself.

Ischaemic-irritative condition of TP and

oedematose-phlogistic state of affected areas can

both activate C “silent” fibres and lead to a

chronic condition of the painful disease.

Through the convergence-facilitation and

-projection mechanisms, pain can get the chronic

condition also in the projection zones,

which sometimes are very far from its origin.

Deactivation of Trigger Points

Mechanic disorganization of TP area can resolve at the

same time local and projected symptoms, breaking at

the root the vicious circle mantaining the painful

disease.

The injection of anestetic drugs inside the TP does not

give better results than dry needle method.

Needle infixion must reach the center of TP and the

stimulation must be strong; it is also very important

to obtain the De Qi (needle sensation) and the

propagated sensation of the needle along the channels.

Thermal stimulation: the moxibustion

Failing visible phlogosis symptoms, the vasodilating effect

is increased from local application of heat.

So, it is possible to resolve ischaemic pathology forever.

The recovery of a correct blood flow in the affected areas

is the mean condition capable to ensure:

the elimination of waste

the restoration of tissue nourishment

Moxibustion: different methods1

65

4

3

2

Anti-inflammatory effect

The recovery of the tissue

nourishment and of the blood flow,

aid the intervention of cellular and

humoral components of the immune

system in the affected areas.

Many trials demonstrate the effect of

Acupuncture stimulation on different

components of immune function.

ACUPAINCARE, M.K. SASTRY

It is possible to get it through two ways:

Electroacupuncture (EA) applied for over 60 min.

due to the release of endogenous opiates by CNS

employed in surgical analgesia

the effect may last some hours

Manual stimulation for a brief time (few seconds)

segmental and suprasegmental reflex mechanisms are

involved, as gate-control system and descending anti-

nociceptive system

short lasting and low importance effect

Antalgic-analgesic effect

ACUPAINCARE, M.K. SASTRY

FRONTAL

CORTEX

DIFFUSE

CORTEXTHALAMUS

SENSITIVE

CORTEX

LYMBICO

SYSTEMHYPOTALAMUS

AND CNS LEVELS

RMN PGCN

HYPOPHYISIS

ACUPUNCTURE ANTALGIC EFFECT

F. NSTENDOPHINS

3TH level

PAG

DESCENDINGSYSTEMS 2th

level

ILN LVPN

F. PSRT

GATE CONTROL

1th level

Ser Nor

Inibition of nociceptive afferences

in the posterior medullar horn

(gate control system)

G

S E

AACAA

Dorsalcolumn

Paleospinothalamic Neospinothalamictract

G = gabaergic interneuron, E = enkefalinergic interneuron, S = efferent deutoneuron

tract

Acupuncture

electroanalgesia

and CNS

PAG

PGCN

nor

RMN

ser

G

S E

AAC

+ +

AA

Thalamus Thalamus

G = gabaergic interneuron

E = enkefalinergic interneuron

S = efferent deutoneuron

Nrm = rafe magnus nucleus

PGC = parvigigantocellularnucleus

PAG = periaqueductal grey

Acupuncture electroanalgesia (EA)

This method was conceived from Chinese

Acupuncturists in 1958 and later it spread accross the

world, favoured by its good degree of efficacy.

Athough limited to some operations and thanks to its

spectacularity, it was very appreciated by mass media.

Now EA is not very practised, but it had the

historical role of introducing Acupuncture scientific

research in Western Medicine, pointing out its

capacity to produce endorphins in CNS.

“Maoist” Acupuncture

Manual Acupuncture and EA

Over the millennia Acupunture has been

always executed by hand, to cure the

diseases and not only their painful symptoms.

EA, due to an increased production of

endorphines in CNS, only points out a single

effect and it can’t explain by any means the large

therapeutic value of Acupuncture.

Antalgic effect: therapeutic value

Although Acupuncture antalgic effect has

not a true therapeutic role, it can be

useful for treating musculoskeletal

diseases.

Some analgesia degree, even if for a short time, aids

joints mobilization after the treatment and favours

the functional recovery of the affected areas.

Decontracting-miorelaxing effect

Muscle contracture depends on segmentary distress and it

represents an attempt to protect the diseased area.

The quick decontracting effect of Acupuncture

involves reflex nervous mechanisms and affects

proprioceptive and nociceptive pathways.

Muscle decontraction and relaxation permit

the resolution of painful diseases and the

recovery of a suitable tissue nutrition.

Sedative effect

Patients suffering from painful and chronic

diseases are often afflicted with anxiety and

depression, caused by the sufference and

the fear thath they will not be cured.

The Acupuncture sedative-antidepressive effect

is very important to improve the patient’s

mental condition, including the quality of sleep.

Conclusions

We can say that Acupuncture has a main role in

painful diseases’ therapy, through its proven effects.

In Western countries Acupuncture technique is not

always the same and often its quality is not adequate.

Acupuncture and Reflextherapy are in addition often

confused, inside a big group of “alternative cares”.

This fact favours a big disorder and the diseased

people take all the consequences on themselves.

Elements for

a gold standard Acupuncture....

a complete acupoint prescription

(local, regional, distal and general points)

deep infixion in the local points(needle sensation radiated in the affected

area)

accurate stimulation of the distal points

(propagated sensation towards affected area)

accurate selection of the general points (based on the individual clinical picture)

Acupuncture in painful diseases:main clinical indications

Musculoskeletal diseases:

arthrosis, disk disorders, shoulder and hip periarthritis,

tendinitis, tennis elbow, carpal tunnel syndrome, joints

distortions, muscles contractures and cramps

Neurological diseases :

neuralgias, tensive and vascular headache

Gastrointestinal diseases:

gastritis and peptic ulcer, hiatal hernia and esophageal

spasm, hemorrhoids

Gynecological diseases:dismenorrhea, pain relief during delivery

Urological diseases :interstitial cystitis, renal colic

Hearth diseases :angina pectoris

Otorhinological diseases :sinusitis, otitis