Acupuncture and Chronic Low Back Pain. Part 3
Acupuncture is a therapeutic intervention characterized by the insertion of fine, solid metallic needles into or through the skin at specific sites. The technique is believed to have originated in China, where it has remained a fundamental component of a system of medical theory and practice that is often termed “traditional Chinese medicine.” Although a number of different techniques or schools of acupuncture practice have arisen, the approach used in traditional Chinese medicine appears to be the most widely practiced in the United States.
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Traditional Chinese medicine espouses an ancient physiological system (not based on Western scientific empiricism) in which health is seen as the result of harmony among bodily functions and between body and nature. Internal disharmony is believed to cause blockage of the body’s vital.
Acupuncture Meridians.
energy, known as qi, which flows along 12 primary and 8 secondary meridians. Blockage
of qi is thought to be manifested as tenderness on palpation. The insertion of acupuncture needles at specific points along the meridians is supposed to restore the proper flow of qi.
Efforts have been made to characterize the effects of acupuncture in terms of the established principles of medical physiology on which Western medicine is based. These efforts remain inconclusive, for several reasons. First, the majority of studies have been conducted in animals, and it is difficult to relate findings from such studies to effects in humans. Second, acupuncture has been shown to activate peripheral-nerve fibers of all sizes, rendering a systematic study of responses complex. Third, the acupuncture experience is dominated by a strong psychosocial context, including expectations, beliefs, and the therapeutic milieu.
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Despite these limitations, some physiological phenomena associated with acupuncture have been identified. Local anesthesia at needle-insertion sites completely blocks the immediate analgesic effects of acupuncture, indicating that these effects are dependent on neural innervation.35 Acupuncture has been shown to induce the release of endogenous opioids in brain-stem, subcortical, and limbic structures. In the rat, electroacupuncture has been shown to induce pituitary secretion of adrenocorticotropic hormone and cortisol, leading to systemic antiinflammatory effects.38 Functional MRI studies in humans have shown immediate effects of prolonged acupuncture stimulation in limbic and basal forebrain areas related to somatosensory and affective functions that are known to be involved in pain processing. Results on positron-emission tomography have shown that acupuncture increases μ-opioid–binding potential for several days in some of the same brain areas. Acupuncture also has effects on local tissues, including mechanical stimulation of connective tissue, release of adenosine at the site of needle stimulation, and increases in local blood flow. However, the various observations that have been made are not sufficient to permit a unified theory regarding the effect of acupuncture on mechanisms of chronic pain.