INDICATIONS AND MECHANISMSINDICATIONS AND MECHANISMS

OF ACUPUNCTURE IN PAINOF ACUPUNCTURE IN PAIN

INDICATIONS AND MECHANISMSINDICATIONS AND MECHANISMS

OF ACUPUNCTURE IN PAINOF ACUPUNCTURE IN PAIN

Quirico Piero Ettore M.D.

Acupuncture School C.S.T.N.F. - Torino

F.I.S.A. - Italian Federation of Acupuncture Societies

infectious diseases

musculoskeletal diseases

internal diseases

metabolic diseases

hormonal imbalances

mental and nervous system diseases

For over 3000 years Acupuncture has been used to treat many diseases, as

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.

neurological and mental dis. 14,7musculoskeletal dis. 10,0antalgic therapy 9,3gastrointestinal dis. 7,8cardiovascular dis. 7,2surgical analgesia 6,4pediatric dis. 4,6dental dis. 3,8hormonal dis. 3,5urogenital dis. 3,5immunological and allergic dis. 3,5addiction/withdrawal 3,2otolaryngological dis. 2,5skin dis. 2,0palliative care 1,6ophtalmological dis. 1,6others 5,9

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 painAcupuncture in painAcupuncture in painAcupuncture in pain

anti-inflammatory

analgesic

decontracting-miorelaxing

vasoregulatory

sedative

neuroendocrine regulatory

So many diseases treated suggest a wide variety of acupuncture effects, as follows:

Vasoregolatory-trophic effectVasoregolatory-trophic effectVasoregolatory-trophic effectVasoregolatory-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.

Infrared thermography in AcupunctureInfrared thermography in AcupunctureInfrared thermography in AcupunctureInfrared thermography in Acupuncture

The tissue distressThe tissue distressThe tissue distressThe tissue distress

naturally

after pression

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.

In the affected area we can see limited zones very painful

capable of causing pain locally and in a distant area.

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 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:

The “silent afferences”The “silent afferences”The “silent afferences”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 PointsDeactivation of Trigger PointsDeactivation of Trigger PointsDeactivation 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 moxibustionThermal stimulation: the moxibustionThermal stimulation: the moxibustionThermal 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 methodsMoxibustion: different methodsMoxibustion: different methodsMoxibustion: different methods1

65

4

3

2

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.

Anti-inflammatory effectAnti-inflammatory effectAnti-inflammatory effectAnti-inflammatory effect

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 effectAntalgic-analgesic effectAntalgic-analgesic effectAntalgic-analgesic effect

FRONTAL CORTEX

DIFFUSE CORTEX

THALAMUSSENSITIVE CORTEX

LYMBICOSYSTEM

HYPOTALAMUS

HYPOPHYISIS

ACUPUNCTURE ANTALGIC EFFECT AND CNS LEVELS

ENDOPHINS3TH level

DESCENDINGSYSTEMS 2th level

ILN LVPN

PAG

RMN PGCN

F. NST

F. PSRT

GATE CONTROL 1th level

Ser Nor

Inibition of nociceptive afferencesInibition of nociceptive afferencesin the posterior medullar hornin the posterior medullar horn

(gate control system)(gate control system)

Inibition of nociceptive afferencesInibition of nociceptive afferencesin the posterior medullar hornin the posterior medullar horn

(gate control system)(gate control system)

G

S E

A CA

Dorsal column

Paleospinothalamic Neospinothalamictract

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

tract

Acupuncture Acupuncture electroanalgesiaelectroanalgesia

and CNSand CNS

Acupuncture Acupuncture electroanalgesiaelectroanalgesia

and CNSand CNS

PAG

PGCNnor

RMNser

G

S E

AC

++

A

Thalamus Thalamus

G = gabaergic interneuronE = enkefalinergic interneuronS = efferent deutoneuronNrm = rafe magnus nucleusPGC = parvigigantocellular nucleusPAG = periaqueductal grey

Acupuncture electroanalgesia (EA)Acupuncture electroanalgesia (EA)Acupuncture electroanalgesia (EA)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 Maoist” Acupuncture ““Maoist” Acupuncture Maoist” Acupuncture

Manual Acupuncture and EAManual Acupuncture and EAManual Acupuncture and EAManual 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 valueAntalgic effect: therapeutic valueAntalgic effect: therapeutic valueAntalgic 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 effectDecontracting-miorelaxing effectDecontracting-miorelaxing effectDecontracting-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 effectSedative effectSedative effectSedative 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.

ConclusionsConclusionsConclusionsConclusionsWe 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 Elements for a gold standard Acupuncture....a gold standard Acupuncture....Elements for Elements for a gold standard Acupuncture....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: Acupuncture in painful diseases: main clinical indicationsmain clinical indications

Acupuncture in painful diseases: Acupuncture in painful diseases: main clinical indicationsmain 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