Peripheral mechanisms - Mechanisms of Acupuncture-Electroacupuncture on Persistent Pain

Soft tissue pain often starts to subside immediately after needling therapy and even completely disappears within a few days. After needling, the peripheral mechanisms of normalizing soft tissue dysfunction are operating. Without central command from the brain and spinal cord, however, peripheral organs cannot work without central coordination; therefore the role of the CNS is important. Even though this focuses on clinically observable and measurable physical parameters such as musculoskeletal balance, the basic background of the central mechanism of needling is indispensable for understanding peripheral mechanisms.

Neurochemical Mechanisms of Acupuncture Analgesia

The neurochemical mechanisms of acupuncture analgesia have been investigated extensively in many Chinese, Japanese, South Korean, and North American universities. Han's laboratory at Beijing Medical University and Pomeranz's, laboratory at the University of Toronto have contributed solid scientific data explaining the neurochemical processes of acupuncture analgesia.

The explanation of acupuncture analgesia is simplified for the purposes of this text. For example, after pain impulses reach the spinal cord, at least six neural pathways transmit those impulses from spinal cord to cerebral cortex, and numerous neurochemicals are released at different sites to modulate pain signals, including three different endorphins (enkephalin, β-endorphin, and dynorphin), acetylcholine, cholecystokinin, serotonin, adrenocorticotrophic hormone (ACTH), somatostatin, substance P, vasoactive intestinal peptide, neurotensin, CGRP, gamma-aminobutyric acid (GABA), epinephrine and norepinephrine, and cytokines. More substances will probably be discovered in addition to this long list. However, a detailed description of interactions among neurochemicals is beyond the scope of this book.

The purpose of needling treatment is the integration of physiologic systems. This integration is achieved by normalizing any dysfunction that is caused by local or systemic pathologic condition.

The neurochemical mechanisms of needling provide analgesia (pain relief); promote homeostasis and tissue healing; improve the immune system, digestive system, cardiovascular system, and endocrine system; and promote psychologic adjustment for systemic integration. The integrated nature of these mechanisms explains why problems as different as asthma, tinnitus, irritable bowel, and gastric ulcers are all improved in the course of needling treatment for pain management. Needling therapy restores the body's control system and promotes self-healing through a systemic integration that is suppressed during disease or injury.

The systemic integration of physiologic and even anatomic functions of the human body by ISDN therapy is understood to result from activating the reflex circuits at different levels of the nervous system: the spinal cord segments, the brainstem, the hypothalamus and thalamus, the upper part of the limbic system, and the cortex.

Learn more: Tools and Acupuncture Maps for Sciatica

Peripheral mechanisms - Acupuncture-Electroacupuncture on Persistent Pain 

Peripheral inflammatory cells-released opioids are involved in electroacupuncture inhibition of inflammatory pain. Studies in carrageenan-induced inflammatory pain rat models show that an intraplantar injection of naloxone or selective antagonists against μ (D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-ThrNH2), δ (naltrindole), or κ (nor-Binaltorphimine) opioid receptors 1 h before electroacupuncture treatment at Zusanli (ST36,) dosage-dependently blocked electroacupuncture-produced inhibition of mechanical hyperalgesia assessed through paw pressure threshold. Consistent with these results, intraplantar naloxone methiodide, a peripherally acting opioid receptor antagonist and an antibody against β-endorphin, eliminated electroacupuncture-produced inhibition of CFA-induced thermal hyperalgesia assessed with paw withdrawal latency (PWL) in response to radiant thermal stimuli.These data indicate that electroacupuncture induces release of endogenous opioids from lymphocytes, monocytes/macrophages, and granulocytes into inflamed skin. The opioids in turn activate receptors on peripheral nerve terminals to suppress nociception.

Rat and human maps of acupoints used in pain studies.

Electroacupuncture activates sympathetic nerve fibers to increase endogenous opioid in inflammatory site. Sympathetic nerve fiber activation enhances the expression of intracellular adhesion molecule-1 in the blood vessels of inflamed tissue to promote migration of β-endorphin- and met-enkephalin-containing polymorphonuclear leukocytes and mononuclear cells in rats with CFA-induced hind paw inflammation. Further, sympathetic neuron-derived norepinephrine stimulates adrenergic receptors on inflammatory cells to release β-endorphin, leading to inhibition of pain. Electroacupuncture activates sympathetic nerve fibers to inhibit pain, although the exact mechanism is not clear. For instance, pretreatment with either 6-hydroxydopamine, a neurotoxin for sympathetic nerve endings, or the β-adrenoceptor antagonist propranolol, significantly prevents electroacupuncture inhibition of carrageenan-induced thermal hyperalgesia.This electroacupuncture action on sympathetic nerves might enhance migration of opioid-containing cells to an inflammatory site, increasing the release of endogenous opioids.

Electroacupuncture also increases endogenous cannabinoid CB2 receptors (CB2R) to upregulate opioids in inflamed skin tissue. At Huantiao (GB30) and Yanglingquan (GB34), the modality significantly elevated proopiomelanocortin messenger RNA (mRNA) and β-endorphin levels in inflamed skin tissue as well as the percentage of β-endorphin-immunoreactive keratinocytes, macrophages, and T-lymphocytes. These effects were significantly attenuated by CB2R antagonist AM630 pretreatment. Interestingly, electroacupuncture also increased the levels of endogenous anandamide in inflamed tissue and the expression of CB2R on keratinocytes, macrophages, and T-lymphocytes in inflammation.

In a recent study in the CFA-induced inflammatory pain rat model, electroacupuncture significantly increased PWL and mechanical threshold assessed with von Frey filaments and significantly decreased tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6 expression in inflamed skin. Moreover, electroacupuncture’s inhibition of pain was significantly attenuated by the CB2R antagonist AM630, as was cytokine expression.17 Since proinflammatory cytokines facilitate nociception and morphine inhibits cytokine release from peripheral blood mononuclear cell cultures, electroacupuncture mitigates pain by upregulating endogenous anandamide, which activates CB2R to promote opioid production, consequently blocking cytokine release to inhibit pain.

Electroacupuncture inhibition of cyclooxygenase-2 (COX-2) might increase levels of endogenous anandamide. The modality activated the hypothalamus-pituitary-adrenal axis to significantly increase plasma corticosterone levels in a CFA-inflammatory pain rat model and significantly downregulated carrageenan-induced expression of COX-1, COX-2 mRNA, and their proteins. It is known that the endocannabinoids anandamide and 2-arachidonoyl glycerol are metabolized by fatty acid amide hydrolase, monoacylglycerol lipase, and COX-2. Thus electroacupuncture-induced corticosterone might inhibit COX-2 to interfere with endocannabinoid metabolism, resulting in their escalation at inflammatory sites and leading to an increase in opioids.

Corticotrophin-releasing factor (CRF) and prostaglandin E2 (PGE2) are also involved in electroacupuncture analgesia. For instance, an intraplantar CRF antagonist also prevented electroacupuncture inhibition of inflammatory pain. CRF is known to block pain by stimulating the release of opioids from immune cells. Thus electroacupuncture might induce skin fibroblasts to release CRF, which in turn stimulates opioid release to inhibit pain. Electroacupuncture decreased carrageenan-induced PGE2 in inflammatory paws; since PGE2 receptor activation of peripheral nociceptors contributes to pain, this ability to inhibit PGE2 might also be a factor in electroacupuncture’s effect on pain.

Manual acupuncture or a local injection of the adenosine A1 receptor agonist 2-chloro-N(6)-cyclopentyladenosine at acupoint ST36 significantly inhibits mechanical allodynia and thermal hyperalgesia in wild-type but not in adenosine A1 receptor knockout mice with inflammatory and neuropathic pain. Additionally, both interventions suppress high-intensity stimulation-evoked field excitatory postsynaptic potentials in the anterior cingulate cortex (ACC). Acupuncture also significantly increased extracellular adenosine near ST. The investigators concluded that acupuncture attenuated the pain by increasing local adenosine that acts on A1 receptors in sensory afferents of ascending nerve tracks.

Collectively, these studies demonstrate that peripheral opioids play a central role in electroacupuncture inhibition of inflammatory pain by blocking proinflammatory cytokine release from polymorphonuclear leukocytes and mononuclear cells and by acting on peripheral opioid receptors to desensitize peripheral sensory nerves

Mechanisms of electroacupuncture inhibition of inflammatory and neuropathic pain. Symbols + and − respectively represent enhancement and inhibition. 5-HT1AR = 5-hydroxytryptamine 1A receptors; ACC = anterior cingulated cortex; ATF-2 = activating transcription factor-2;CB2R = Cannabinoid 2 receptor; CORT = corticosterone; COX-2 = cyclooxygenase-2; EAA = excitatory amino acid; GABA = γ-aminobutyric acid; ICAM-1 = intracellular adhesion molecule-1; IL-6 = interleukin-6; IL-1β = interleukin-1beta; LC = locus coeruleus; N/OFQ = nociceptin/orphanin FQ; NE = norepinephrine; NMDAR = n-methyl-d-aspartate receptor; NRM = nucleus raphe magnus; PAG = periaqueductal grey; p-Akt = phosphorylated Akt; PGE2 = prostaglandin E2; pGluN1 = phosphorylated GluN1; SP = substance P; TNF-α = tumor necrosis factor-α.

Learn more: Types of Acupuncture Treatments: TCM and ElectroAcupuncture

Electroacupuncture increases opioids at inflammatory sites via two pathways. 
1) It activates sympathetic nerve fibers to enhance migration of opioid-containing cells to the site.
2) It triggers hypothalamus-pituitary-adrenal to decrease COX-2, which in turn interfere with endocannabinoid metabolism, leading to increased levels of opioids at the site.

Furthermore, electroacupuncture might decrease COX-2, thus lowering PGE2 levels and alleviating pain.

Electroacupuncture-upregulated endocannabinoid may directly inhibit pain because CB2 receptor activation inhibits sensory nerve activities in rat pain model.30 Although peripheral CRF and adenosine are involved in electroacupuncture action, how the modality modulates their synthesis warrants further investigation.

Overall, although the current studies show that opioid, cytokines, cannabinoids, CB2R, CRF, PGE2, and adenosine are involved in acupuncture/electroacupuncture analgesia, other peripheral bioactive chemicals and receptors such as serotonin, nerve growth factor, bradykinin, and transient receptor potential channels are implicated in inflammatory pain

Comprehensive health program of Energy Medicine

The Natural Synergy system treats strong pain and a multitude of common ailments at its root cause while accelerating the body’s healing response.

Eastern medicine states that the root of all health problems (physical, mental & emotional) can be traced back to energy blockages in our meridian system.

Energy blockages are a result of many external influences such as poor diet, un-natural irritants, chemicals and pollutants.

The meridian system is best described as a network of energy lines.  Each meridian line is dotted with energy points called ‘acupoints’.

Acupoints are like ‘natural reset buttons’ for blocked energy and can be stimulated in a number of ways.

Natural Synergy

Acupuncture uses needles, Acupressure uses finger pressure, Electro-Acupuncture uses electricity, and Acu-Acoustic treatment uses Bio-frequencies.

Natural Synergy employs a combination of two Acu-therapies: Acupressure and Acu-Acoustics to extinguish strong pain while accelerating the healing process; much like Electro-Acupuncture but without the pain and discomfort of electric needles.

It's a process called Acu-Frequency​TM.​

You can expect fantastic results with either of these acu-therapies; acupressure or acu-acoustics by itself…

But it turns into a holistic experience if you have some quiet time for deep

relaxation where you can apply both practices together.

And because you can do it by yourself at home you don’t need to spend countless hours (and thousands of dollars) on an acupuncturist.

Natural Synergy applies a simple non-invasive exercise that takes only 3 minutes a day…

Restoring the natural balance within your body; eliminating the root cause of your pain or ailment and maintaining a healthy free-flow of energy.

Natural Synergy