Acupuncture for Back Pain
Back pain is no fun!
There are many reasons people have back pain and there are as many therapies to treat it. How does acupuncture work to relieve back pain? Here is an excerpt from one of Dr. Dayhoff's articles where she explains some of the mechanisms behind acupuncture therapy.
Acupuncture Analgesia (Pain relief)
Acupuncture analgesia (pain relief) has been a quandary as to what mechanisms produce pain relieving effects and has ignited several research studies that explore acupuncture’s mechanism of action. However, it is not well understood and proves to be difficult to explain, often due to poor study designs (9). However, in the study, Connective Tissue Fibroblast Response to Acupuncture: Dose-Dependent Effect of Bidirectional Needle Rotation, it is established that there is, in fact, a physiological response at the cellular level from acupuncture needling with manual manipulation (10). This study shows an increase in fibroblast activity found in connective tissue that secret collagen proteins creating the elasticity essential to tissue repair and structural framework (10). This may help explain one of the many facets of acupuncture efficacy. Research also shows that endomorphins, dynophins and substance P are released during acupuncture, offering an effective analgesic therapy. In the randomized control trial, Hegu Acupuncture for Chronic Low-Back Pain: A Randomized Controlled Trial, the analgesic effects of acupuncture are shown to increase levels of endorphins as an effective analgesic therapy and decreases the inflammatory responses (11).
Studies starting in the 1970s explored the effects of electro-acupuncture (EA) on the release of the pain relieving endogenous opioids (12). Studies showed that high and low frequency EA stimulated the release of endorphins and dynorphins to mitigate pain signals by activating pain relieving opioid receptors (12). The inflammation reflex is modulated by endorphins released by the hypothalamus, the pivot point for both hormonal and neurotransmitter systems. Researchers found endorphins in the form of neurotransmitters in the central nervous system (CNS) and in the peripheral nervous system endorphins were found in the form of hormones (12). High frequency EA stimulates the release of neurotransmitters and has been found to have a strong and long acting effect on the anti-inflammatory reflex (12). While low frequency EA stimulates the release of hormones and has a slow effect on the inflammation reflex (12). This is because the nervous system is faster acting than the hormonal system. However, in one study they found that mixed frequency used in tandem has an overall analgesic effect that was greater than with one frequency alone (11). Therefore, mixed frequency EA can down regulate the inflammation reflex. In addition to anti-inflammation, EA is thought to also decrease pain via the gate control theory. There are two types of nerve fibers involved in Gate Theory; nociceptive afferent pain fibers and nonnociceptive non pain fibers. Nociceptive afferent pain fibers are stimulated by tissue damage and sends pain signals to the brain. Nonnociceptive (no pain) are stimulated by touch, pressure and vibration. These fibers interfere with the nociceptive pain signals being sent to the brain and CNS as if turning off a light switch. When nonnociceptive fibers (touch, pressure, vibration) are stimulated they can block signals from the nociceptive pain signaling fibers. Therefore, when acupuncture, massage or tuina is applied to the site of an injury - like a sprained ankle, the process of applying pressure to the injured area can interrupt pain signals being sent to the brain and reduce pain. In theory, pressing, rubbing, and/or touching an acupuncture point before placing a needle can stimulate nonnociceptive fibers.
9. Yun Hyung Koog, Jin Su Lee, & Hyungsun Wi. Clinically meaningful nocebo effect occurs in acupuncture treatment: a systematic review. Journal of Clinical Epidemiology. 2014,67(8),858–869.
10. Langevin, H. M., Bouffard, N. A., Churchill, D. L., & Badger, G. J. (2007). Connective Tissue Fibroblast Response to Acupuncture: Dose-Dependent Effect of Bidirectional Needle Rotation. The Journal of Alternative and Complementary Medicine. 2007,13(3),355–360.
11. Yun, M., Shao, Y., Zhang, Y., He, S., Xiong, N., Zhang, J., … Yan, J. (2012). Hegu Acupuncture for Chronic Low-Back Pain: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine, 18(2), 130–136. doi:10.1089/acm.2010.0779
12. Lin, J.-G., & Chen, W.-L. (2008). Acupuncture analgesia: a review of its mechanisms of actions. The American Journal of Chinese Medicine, 36(4), 635–645. doi:10.1142/S0192415X08006107
There are many reasons people have back pain and there are as many therapies to treat it. How does acupuncture work to relieve back pain? Here is an excerpt from one of Dr. Dayhoff's articles where she explains some of the mechanisms behind acupuncture therapy.
Acupuncture Analgesia (Pain relief)
Acupuncture analgesia (pain relief) has been a quandary as to what mechanisms produce pain relieving effects and has ignited several research studies that explore acupuncture’s mechanism of action. However, it is not well understood and proves to be difficult to explain, often due to poor study designs (9). However, in the study, Connective Tissue Fibroblast Response to Acupuncture: Dose-Dependent Effect of Bidirectional Needle Rotation, it is established that there is, in fact, a physiological response at the cellular level from acupuncture needling with manual manipulation (10). This study shows an increase in fibroblast activity found in connective tissue that secret collagen proteins creating the elasticity essential to tissue repair and structural framework (10). This may help explain one of the many facets of acupuncture efficacy. Research also shows that endomorphins, dynophins and substance P are released during acupuncture, offering an effective analgesic therapy. In the randomized control trial, Hegu Acupuncture for Chronic Low-Back Pain: A Randomized Controlled Trial, the analgesic effects of acupuncture are shown to increase levels of endorphins as an effective analgesic therapy and decreases the inflammatory responses (11).
Studies starting in the 1970s explored the effects of electro-acupuncture (EA) on the release of the pain relieving endogenous opioids (12). Studies showed that high and low frequency EA stimulated the release of endorphins and dynorphins to mitigate pain signals by activating pain relieving opioid receptors (12). The inflammation reflex is modulated by endorphins released by the hypothalamus, the pivot point for both hormonal and neurotransmitter systems. Researchers found endorphins in the form of neurotransmitters in the central nervous system (CNS) and in the peripheral nervous system endorphins were found in the form of hormones (12). High frequency EA stimulates the release of neurotransmitters and has been found to have a strong and long acting effect on the anti-inflammatory reflex (12). While low frequency EA stimulates the release of hormones and has a slow effect on the inflammation reflex (12). This is because the nervous system is faster acting than the hormonal system. However, in one study they found that mixed frequency used in tandem has an overall analgesic effect that was greater than with one frequency alone (11). Therefore, mixed frequency EA can down regulate the inflammation reflex. In addition to anti-inflammation, EA is thought to also decrease pain via the gate control theory. There are two types of nerve fibers involved in Gate Theory; nociceptive afferent pain fibers and nonnociceptive non pain fibers. Nociceptive afferent pain fibers are stimulated by tissue damage and sends pain signals to the brain. Nonnociceptive (no pain) are stimulated by touch, pressure and vibration. These fibers interfere with the nociceptive pain signals being sent to the brain and CNS as if turning off a light switch. When nonnociceptive fibers (touch, pressure, vibration) are stimulated they can block signals from the nociceptive pain signaling fibers. Therefore, when acupuncture, massage or tuina is applied to the site of an injury - like a sprained ankle, the process of applying pressure to the injured area can interrupt pain signals being sent to the brain and reduce pain. In theory, pressing, rubbing, and/or touching an acupuncture point before placing a needle can stimulate nonnociceptive fibers.
9. Yun Hyung Koog, Jin Su Lee, & Hyungsun Wi. Clinically meaningful nocebo effect occurs in acupuncture treatment: a systematic review. Journal of Clinical Epidemiology. 2014,67(8),858–869.
10. Langevin, H. M., Bouffard, N. A., Churchill, D. L., & Badger, G. J. (2007). Connective Tissue Fibroblast Response to Acupuncture: Dose-Dependent Effect of Bidirectional Needle Rotation. The Journal of Alternative and Complementary Medicine. 2007,13(3),355–360.
11. Yun, M., Shao, Y., Zhang, Y., He, S., Xiong, N., Zhang, J., … Yan, J. (2012). Hegu Acupuncture for Chronic Low-Back Pain: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine, 18(2), 130–136. doi:10.1089/acm.2010.0779
12. Lin, J.-G., & Chen, W.-L. (2008). Acupuncture analgesia: a review of its mechanisms of actions. The American Journal of Chinese Medicine, 36(4), 635–645. doi:10.1142/S0192415X08006107