When most people think of acupuncture as a treatment option it is for pain management, and they're not wrong. Acupuncture has been a primary treatment for pain throughout Asia for several thousands of years. But acupuncture was not just used for pain, it has historically been a complete system of medicine and in the hands of a skilled practitioner can address a wide variety of concerns. It is because of the wide variety of conditions which acupuncture can treat and what has historically seems like an illusive mechanism of action that acupuncture has become one of the most widely studied health modalities with over 13,000 published peer review articles.
The Australian Department of Veteran's Affairs (2010), US Department of Veteran's Affairs (2014), and the Acupuncture Evidence Project (2017) have all conducted large scale meta-analyses of those publication and build upon each other's work to provide a summarized list of the condition for which acupuncture has been proven effect for a total of 117 conditions. To save you from reading all of the reports, I have included some highlights of conditions that can be effectively treated and what the research is telling us about how acupuncture works below (and yes, a lot of them are for pain).
Chronic Low Back Pain
Acute Low Back Pain
Chronic Pelvic Pain
Plantar Heel Pain
Shoulder Pain & Impingement
Obstetrics and GynecologY
Back & Pelvic Pain in Pregnancy
Irritable Bowel Syndrome
Restless Leg Syndrome
Modulating Sensory Perception Thresholds
Post Traumatic Stress Disorder
Chemotherapy Induced Nausea/ Vomiting
Menopausal Hot Flashes
Perimenopausal & Postmenopausal Insomnia
Hypothalamus, Pituitary, Adrenal Axis Regulation
Some of the areas in which acupuncture preformed particularly well were oesteoarthiritis of the knee where it showed the largest effect compared to usual treatment. In the treatment of shoulder impingement acupuncture also out performed 17 other interventions including steroid injections, NSAIDs, and ultrasound therapy. In the treatment of sciatica, acupuncture was only bested by biological agents and out performed manipulations (massage and chiropractic), opiods, exercise, and surgery. Last, but certainly not least, acupuncture was more effective for treating chronic constipation than drugs and had fewer side effects.
So, How is Acupuncture able to treat such a wide vareity of conditions?
The use of acupuncture for pain has a pretty clear mechanism of action and there are several aspect of it. A large part of acupuncture's pain reducing effects can be attributed to a variety of naturally produced chemicals (known as opioid neuropeptides) including enkephalins, endorphins, dynorphins, endomorphins, and nociceptin. These powerful chemicals are responsible for keeping our pain response in check on a day to day basis. Some other important substances include substance P (SP), vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP) which have demonstrated systemic anti-inflammatory effects.
Acupuncture also plays an important role in the bodies neurological mapping. In order for the body to be able to heal the brain needs to know where the injury/ dysfunction is. FMRI (a type of diagnostic imaging used measure activity in different areas of the brain) studies have shown that persistent pain, even when there is no longer a physical obstruction, may be due to a poorly flushed out image of that region of the body in the neurological map. With a fuzzy picture, the brain cannot appropriately direct the bodies healing response. Through stimulation of specific points and nerve pathways, acupuncture can better establish the connection between the brain and that area to create a clearer picture.
The more diverse effects of acupuncture can be largely explain by a process known as purinergic signaling. Purinergic signaling is a primitive system which uses adenosine and ATP (the molecules which are our body's energy source) for signaling and regulating the body's tissues and organs. Purinergic signaling has been directly linked to clinical areas such as improving migraines and headaches, immune dysfunction and inflammation, cancer, autism, Alzheimer's, cardiovascular disease, endocrine function, and embryological development. The ability of this system to effect the amount of energy and therein the function of the organs explains the many other effects which still need further study.
Acupuncture has also demonstrated direct effects on the central nervous system including spinal reflexes. The spine and brain are responsible for a top-down regulation of all the stimi that our body receives from the outside world and must decide which stimi are important and what can be ignored so that the body doesn't get overwhelmed. The regulation of spinal reflexes through acupuncture relaxes muscles and stimulates change in the visceral organs. In the brain these effects include increasing functional connectivity, decreasing activity of the structures associated with stress and illness, and regulating various hormonal axes. The parasympathetic system, responsible for rest, relaxation, digestion, and tissue healing, can also be modulated by acupuncture.
I hope this post has been able to provide some insight into the use of acupuncture and how it may be an effective treatment option for your health. I would like to thank the Acupuncture Evidence Project for taking the time to put together some amazing research and making it readily available for the public and practitioners to help everyone better understand acupuncture.
Dr. Kevin Ianson is a register acupuncturists, herbalist, and doctor of traditional Chinese medicine in Duncan, BC. He developed a special interest in treating neurological conditions while completing a residency in the acupuncture neurology department at the Beijing University of Chinese Medicine.