A Western Medical Approach: Acupuncture and Neuroscience
Acupuncture is an age-old therapy rooted in traditional Chinese medical practices. At Movement Mechanics Osteopathy Auckland, we take a modern Western neuroscience-focused approach to acupuncture to ensure precise and effective pain management and integration into our clinic.
In this comprehensive exploration, we delve deep into the mechanisms behind acupuncture's therapeutic potential whilst respecting the synergy between tradition and modern medical innovation.
Local Pain Modulation: Specific and Targeted
The Local Effects on the Body
Local acupuncture primarily involves activating local pain gate mechanisms, providing analgesic effects, reducing inflammation, promoting tissue healing and the enhancement of local blood flow.
Acupuncture can influence pain signals from tissues at the site of injury by modulating the transmission of pain signals to the brain in a phenomenon known as the gate control theory (Melzack & Wall, 1965). Acupuncture stimulates the release of adenosine and other analgesic substances, blocking pain signals in the nerves at the local level (Goldman et al., 2010).
Another local effect of acupuncture is the axon reflex mechanism, where acupuncture needles stimulate peripheral nerves to modulate blood flow and neurotransmitter release. This reflex arc helps with healing and inflammation control by encouraging increased blood flow to the local area, setting the stage for a series of beneficial cellular reactions and making it a valuable tool in managing both localised pain and various pain-related conditions (Takahashi, 2011; Vickers et al., 2018).
When is local acupuncture used
This technique is used mainly for specific, localised areas of pain or pathology, such as muscle knots or trigger points, and aims to provide immediate relief at the site. The intensity of needling in acupuncture, often described through the sensation of 'de qi', is a significant aspect that contributes to the effectiveness of the treatment.
A more intense 'de qi' sensation, achieved through the manipulation of the acupuncture needle, tends to be associated with better therapeutic outcomes. This is likely due to the stronger activation of local pain pathways and tissue responses, creating a more immediate and potent impact on the targeted areas (Kong et al., 2007).
Segmental Acupuncture: Regional and Reflective
Underlying Mechanisms and Pathways
Segmental acupuncture works through the nervous system, targeting spinal segments and nerve roots corresponding to the affected area. This method influences the spinal reflex pathways and dorsal horn, moderating the pain signals transmitted to the brain (Srbely, 2010).
When is segmental acupuncture used
Used mainly for conditions with radiating or referred pain patterns, it reflects a neurological segmental distribution, such as sciatica or cervical radiculopathy. A moderate 'de qi' sensation is sought, with a needle retention period of about 20-30 minutes, allowing the modulation of the neural pathways.
Extra-segmental Acupuncture: Systemic and Holistic
Underlying Mechanisms and Pathways:
Extra-segmental acupuncture influences the pain modulation pathways at the spinal cord level and above, leading to widespread and systemic effects. It is believed to modulate the descending pain inhibitory pathways, incorporating various neurotransmitters and hormones, such as endorphins (Zhao, 2008).
When is extra-segmental acupuncture used
This approach is used for more diffuse, chronic, and complex pain patterns or systemic conditions, aiming for overall modulation of the pain perception. A subtle 'de qi' sensation and longer needle retention times, often up to 40 minutes, are used to facilitate a broader influence on the central nervous system.
Supra-spinal Acupuncture: Central Modulation
Underlying Mechanisms and Pathways:
Supra-spinal acupuncture targets the brain's pain modulation processes, influencing areas like the thalamus and cortex. This technique aims to modify the central processes of pain perception and processing (Hui et al., 2009).
When is supra-spinal acupuncture used
It is used to modulate central sensitisation and is particularly beneficial in conditions like fibromyalgia or other central sensitivity syndromes. A gentle stimulation strategy, aiming for a mild 'de qi' sensation, with varied needle retention times based on the individual and condition, focusing on central neural modulation.
Descending Pain Pathways: Serotonergic Pathways and Opioid Release
Understanding the Pathways: A Neuroscientific Approach
The Descending Pain Pathways constitute a complex network within the central nervous system, primarily involved in the modulation and suppression of pain signals. Acupuncture, a therapeutic intervention rooted in ancient practices, has shown significant efficacy in stimulating these pathways. The activation of DPP through acupuncture involves various neurotransmitters, such as serotonin and norepinephrine, which play crucial roles in pain modulation. This stimulation essentially inhibits the transmission of pain signals to the brain, thereby alleviating the perception of pain (Zhao, 2008).
Descending pain pathways plays a pivotal role in pain modulation. Acupuncture, through strategic needle placements, influences the serotonergic pathways, promoting the release of serotonin, a neurotransmitter instrumental in pain perception (Zhao, 2008). Additionally, acupuncture is a maestro in the orchestra of opioid peptides. The strategic stimulation of neural pathways encourages the release of endogenous opioids, orchestrating a natural and potent relief from pain (Han, 2004).
Intensity and Methodology of Needling
The activation of the descending pain pathways typically requires a deeper, more intense needling technique to stimulate the relevant neural pathways effectively. The elicitation of a strong ‘de qi’ sensation, often described as a radiating or dull aching feeling, is usually pursued during the application. This intensity facilitates the engagement of the descending pain pathways and the subsequent release of neurotransmitters that are integral for pain modulation.
Comparative Duration of Effects
When compared to local needling, the activation of descending pain pathways through acupuncture often results in more prolonged and sustainable pain relief. While local needling offers immediate but relatively short-term alleviation, stimulating the descending pain pathways fosters a more extended, systematic modulation of pain signals. The duration of these benefits varies significantly depending on the individual and the specific pathology but often presents a more durable solution in managing chronic pain conditions (Lee et al., 2013).
Autonomic Nervous System Stimulation and Reducing Central Sensitisation
Understanding the ANS Stimulation through Acupuncture
Acupuncture’s role in activating the Autonomic Nervous System (ANS) is pivotal in its efficacy in pain management and various other therapeutic applications. The ANS regulates the body's unconscious actions, and it’s composed of the sympathetic and parasympathetic nervous systems. By stimulating specific acupuncture points, there's a modulation of the ANS, which can lead to various physiological responses such as heart rate adjustment, blood pressure modulation, and changes in respiratory rate. The acupuncture points selected and the technique used are tailored based on the therapeutic goals, whether it is to amplify the sympathetic (fight or flight) or parasympathetic (rest and digest) responses (Takahashi, 2011).
The acupuncture needle serves as a conduit, interfacing with the autonomic nervous system (ANS). By modulating ANS activity, acupuncture fosters a balance between sympathetic and parasympathetic tones, promoting a harmonious physiological state conducive to healing and recovery (Tindle & Petzke, 2020).
Acupuncture also wields influence over central sensitisation processes. Through specific acupoint stimulation it can mitigate the heightened responsiveness of the central nervous system, attenuating exaggerated pain responses and fostering a more tolerable sensory experience (Chen et al., 2018).
Intensity of Needling in ANS Activation
In the context of ANS activation, the intensity of the acupuncture needling can vary. For modulating the ANS it might not necessarily require a strong 'de qi' sensation. The choice between superficial and deep needling, as well as the manipulation technique, is decided based on specific objectives, such as whether the treatment aims to calm or stimulate the patient.
Complementary Harmony: Western Acupuncture Meets Osteopathy
A harmonious confluence is witnessed when Western acupuncture principles intertwine with osteopathic treatments. This integrative approach facilitates a multifaceted strategy towards pain management, where acupuncture enhances the flow of Qi, and osteopathy ensures structural and functional integrity (Yuan et al., 2018).
Studies reveal that such integrative strategies usher enhanced outcomes in pain reduction and functional improvement, marking a triumph in holistic therapeutic approaches. This collaborative dance between acupuncture and osteopathy unfurls a canvas of enhanced therapeutic potential, promising improved patient outcomes (Coyle et al., 2005).
Jonathan Hall M.Ost, GradDipHeal, BAppSci (HB)
Jonathan Hall is the founder and principle Osteopath at Movement Mechanics Osteopathy, and specialises in Shockwave Therapy. A fully qualified Osteopath currently studying Western Medical Acupuncture out of AUT New Zealand, Jonathan founded Auckland Shockwave Therapy to help bring evidence-based Shockwave treatment to New Zealand using the industry-leading EMS Radial Shock Wave device.
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