indications and mechanisms of acupuncture in pain
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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