Can Classical Acupuncture Points and Trigger Points Be Compared in the Treatment of Pain Disorders? Birch's Analysis Revisited (original) (raw)
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Mechanisms of Acupuncture in Pain: A Physiological Perspective in a Clinical Context
Theories and Evidence, 2013
Acupuncture is part of Traditional Chinese Medicine, a medical system with an empirical basis. A lack of scientific studies to prove the claimed effects of acupuncture has led to its rejection by many of the Western scientific community. Now that the mechanisms can be partly explained in terms of endogenous mechanisms, and the reported effects are similar or sometimes even superior to established treatments, the integration of acupuncture with conventional medicine may be possible. The effects of acupuncture are likely to devolve from physiological and/or psychological mechanisms with biological foundations, and the needle stimulation could represent the artificial activation of systems obtained by natural biological effects in functional situations. Acupuncture and some other forms of sensory stimulation trigger similar effects in man and other mammals, suggesting that they bring about fundamental physiological changes. Acupuncture stimulation, eliciting 'de qi', excites receptors and or nerve fibers in the stimulated tissue, which are also similarly physiologically activated by strong muscle contractions. The effects on certain organ functions are also similar to those obtained by protracted exercise. On the other hand light superficial needling, as often used during 'sham' acupuncture, excites cutaneous touch receptors resulting in a limbic 'touch response' with a suggested role in wellbeing and social bonding. The effects of acupuncture in pain
Is there a physiological basis for the use of acupuncture in pain 2002.pdf
Acupuncture is part of Traditional Chinese Medicine (TCM), a system with an empirical basis that has been used in the treatment of pain for centuries. Its use for pain relief is supported by clinical trials and this has facilitated its acceptance in pain clinics in most countries. Acupuncture effects on pain must devolve from physiological and/or psychological mechanisms with biological foundations. Acupuncture and some other forms of sensory stimulation elicit similar effects in man and other mammals, suggesting that they bring about fundamental physiological changes. Acupuncture excites receptors or nerve fibres in the stimulated tissue which are also physiologically activated by strong muscle contractions, and the effects on certain organ functions are similar to those obtained by protracted exercise. Both exercise and acupuncture produce rhythmic discharges in nerve fibres, and cause the release of endogenous neurotransmitters including opioids, monoamines, oxytocin and other neuropeptides (SP, CGRP, GAL, CRF, NPY), important in the control of both sensory, affective and cognitive elements of pain. Over the past 10 years, there has been a growing awareness that pain is due not simply to the activation of peripheral nociceptors, as in nociceptive pain, but to multiple factors, and is therefore susceptible to various modes of acupuncture treatments. Depending on the etiology, pain may be classified into several categories, such as nociceptive, neurogenic, chronic pain syndrome and psychogenic pain. Musculoskeletal and visceral pain states, both nociceptive, are characterized by hyperalgesia. However, despite belonging to a similar category, the pain is triggered by different mechanisms. Neurogenic pain is caused by injury or dysfunction in the nervous system and is often severe and intractable and may not respond to even powerful opiates. Recent studies suggest that there is a third pain category, distinct from the neurogenic and nociceptive, where pain is related to a sickness response that occurs with exposure to chemical compounds and infectious agents and the associated central changes produce heightened pain sensitivity (''hurting all over''), termed chronic pain syndrome. In clinical trials, acupuncture or low-frequency electroacupuncture 0531-5131/02 D 2002 Elsevier Science B.V. All rights reserved. PII: S 0 5 3 1 -5 1 3 1 ( 0 2 ) 0 0 4 1 6 -8
Rising Popularity of Acupuncture Treatment: Justifications, Clinical Research, and Difficulties
Medical Acupuncture, 2011
Acupuncture has become a routine practice in some hospitals. The main indications include control of chronic pain that is resistant to conventional therapy, neuromuscular deficiencies of various causes and other odd situations in which conventional treatment fails to provide satisfactory results. The theories given to explain acupuncture's effects need to be assessed carefully before a wider endorsement of this treatment option should be given. Positive theories include the pain-control ''gate theory'' and the neurohumoral theory, both of which have objective proofs to support them. The negative theories of ''placebo effects,'' suggestion, and stress-related reactions do not have sufficient rational support. Clinical trials on acupuncture should follow the same approach used in the clinical testing of pharmaceuticals. However, the use of placebo acupuncture is difficult. Fortunately, adverse events are not serious. In spite of the difficulties encountered in attempting placebo acupuncture standardization and lack of objective assessment tools, the practical side of acupuncture is fully justified, and more-serious research to reveal the physiological events initiated by acupunctures, is indicated.
The Status and Future of Acupuncture Clinical Research
The Journal of Alternative and Complementary Medicine, 2008
On November 8-9, 2007, the Society for Acupuncture Research (SAR) hosted an international conference to mark the tenth anniversary of the landmark NIH [National Institutes of Health] Consensus Development Conference on Acupuncture. More than 300 acupuncture researchers, practitioners, students, funding agency personnel, and health policy analysts from 20 countries attended the SAR meeting held at the University of Maryland School of Medicine, Baltimore, MD. This paper summarizes important invited lectures in the area of basic and translational acupuncture research. Specific areas include the scientific assessment of acupuncture points and meridians, the neural mechanisms of cardiovascular regulation by acupuncture, mechanisms for electroacupuncture applied to persistent inflammation and pain, basic and translational research on acupuncture in gynecologic applications, the application of functional neuroimaging to acupuncture research with specific application to carpal-tunnel syndrome and fibromyalgia, and the association of the connective tissue system to acupuncture research. In summary, mechanistic models for acupuncture effects that have been investigated experimentally have focused on the effects of acupuncture needle stimulation on the nervous system, muscles, and connective tissue. These mechanistic models are not mutually exclusive. Iterative testing, expanding, and perhaps merging of such models will potentially lead to an incremental understanding of the effects of manual and electrical stimulation of acupuncture needles that is solidly rooted in physiology.
Longhua Chinese Medicine, 2019
The biological mechanisms which mediate the effectiveness of acupuncture for pain management have been debated by neuroscientists and acupuncture researchers for decades. There are already so many publications (1-17) in this area that I hesitate to add another to the total, but pain is such a basic and universal fact of human existence that new findings and updated research in this field are always worth discussing. Classical acupuncture principle states that acupuncture produces a combination of local effect, distal effect and whole-body effect. Can modern science validate this combination-of-effect principle? This brief article includes a summary of established understandings of acupuncture management for pain, as well as an outline of newly-discovered knowledge in acupuncture analgesia. Science has provided us with solid groundwork and breakthrough concepts regarding the neurological structures and mechanisms by which we feel and process the pain response. We now have a detailed understanding of nociceptive pain response, particularly for acute pain. Unfortunately, the mechanisms involved in chronic pain present a more complex scientific challenge, and are still not well-understood. Since clinic practitioners are much more likely to confront chronic pain, rather than acute pain, in the majority of their patients, the sooner we can understand chronic pain mechanisms the better. Following are three sections which discuss updated material on local, segmental, and general mechanisms of pain relief; and a fourth section which presents a new functional magnetic resonance imaging (fMRI)-based research on the neurobiological localizing of pain. From a neurobiological perspective, the effectiveness of acupuncture results from its local effect, segmental effect and general effect. These evidence-based conclusions coincide with the classical traditional Chinese medicine (TCM) principle of local effect, distal effect and wholebody effect of acupuncture. Local mechanisms of pain relief Many local mechanisms have been proposed as the effectors of pain relief, such as an increase in blood circulation and tension relief of trigger points. At this point, release
Longhua Chinese Medicine
Chronic musculoskeletal pain conditions are among the most common presenting complaints of patients seeking health care treatments. These chronic pain conditions result in disability, reduced quality of life, and significant health system economic burdens. Myofascial pain syndrome (MPS) is the most common chronic musculoskeletal pain condition, and its prevalence increases with age. Given the average age of individuals globally is increasing as is the average human lifespan, socioeconomic and healthcare burdens related to MPS will rise in the coming decades. The allopathic medicine standard for treating MPS is outlined in the Trigger Point Manual, which illustrates >200 of the "most common" myofascial trigger point (mTrP) locations, their clinical (pain and non-pain) indications, and their myofascial referred-pain patterns. Though early MPS practitioners typically administered local anesthetic and/or corticosteroid injections to deactivate mTrPs, the Trigger Point Manual documents dry needling of mTrPs is similarly effective. Over the past 2-3 decades In the United States, there has been significant growth of dry needling skill certification of physical and occupational therapists, who utilize acupuncture needles to deactivate mTrPs. There has been controversy since the 1970's regarding whether any anatomic and/or physiologic relationship exists between these "most common" mTrPs and their referred-pain patterns described by allopathic researchers, and the classical acupuncture points and primary channels described by Traditional Chinese Medicine some 2,000 years previously. If these "most common" mTrPs and classical acupoints can be shown to be similar anatomically, clinically, and physiologically, this would not only allow integration of ancient and contemporary clinical and research databases to optimally treat MPS, but also would have potential importance in elucidating acupuncture's mechanisms. This review summarizes prior literature findings regarding the anatomic, clinical, and physiologic correspondences of the "most common" mTrPs and classical acupoints, and the clinical and research implications of these relationships.
Mechanisms of acupuncture analgesia: Effective therapy for musculoskeletal pain?
Current Rheumatology Reports, 2007
Acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting and for postoperative dental pain. Several recent randomized trials have provided strong evidence for beneficial AP effects on chronic low-back pain and pain from knee osteoarthritis. For many other chronic pain conditions, including headaches, neck pain, and fibromyalgia, the evidence supporting AP's efficacy is less convincing. AP's effects on experimental pain appear to be mediated by analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes considerable time to develop and to resolve. Thus, some of the long-term effects of AP analgesia cannot be explained by placebo mechanisms. Furthermore, it appears that some forms of AP are more effective for providing analgesia than others. Particularly, electro-AP seems best to activate powerful opioid and non-opioid analgesic mechanisms.
Understanding of Myofascial Trigger Points (2): Acupuncture vs Dry Needling
The use of acupuncture and dry needling has been widely debated, and the main point of contention is whether dry needling has been derived from acupuncture. This paper comprehensively discusses the two aspects of basic theory, diagnosis and treatment of traditional acupuncture, meridian, acupoints, and myofascial trigger points (MTrPs). Except the difference between two theories, many aspects are related in terms of clinical practice and basic laboratory studies. Nevertheless, two aspects are highly similar in terms of treatment action, applicable disease, and physiological experiments. Therefore, MTrP theory is considered a basis for modern acupuncture, which is different from traditional acupuncture theory. MTrP is also easily accepted and learned by individuals with a background in modern medicine and those with knowledge in traditional acupuncture. Hence, MTrPs may be the precise acupoints in traditional Chinese medicine under modern scientific research, and meridian involves the synthesis of referred pain, nerves, vessels, and fascia mechanics. The scientific basis of Chinese and Western medicines should be coherent, although the origin of these two theories varies because of the distinctiveness of the identity between ancient and modern knowledge. The final goals of the two theories are the same, and their results are highly similar. Therefore, one theory should not belong to the other one. Meanwhile, as human behavior or thinking is essential for acupuncture development, a person often attempts either to experience nostalgia based on ancient knowledge or to develop new appropriate theory along with modern experiment technology.