In Traditional Chinese Medicine (TCM), pain is almost always understood as resulting from stagnation. Stagnation in this model means that something, usually qi and/or blood, is not circulating appropriately throughout the system. A blockage can be localized, like a traffic jam at a single intersection, or it can be systemic, like grid lock in NYC at rush hour on a Friday evening. In the human body stagnation might manifest acutely, as in a painful swollen knee from a sports injury, or chronically, as in the whole body pain and malaise typical of fibromyalgia. The basic concept in treating pain with acupuncture is to remove blockage and restore harmonious movement of qi and blood.
How does acupuncture work?
From the TCM standpoint, acupuncture works by accessing energy at key points along the meridian system in order to regulate that flow. Point selection, point combinations, and needle techniques allow the practitioner to tonify, disperse and harmonize energy. The meridian system, the map of energetic pathways in the body, can be accessed at different levels. When treating pain conditions, in addition to identifying the affected meridian or meridians, it is also important to figure out at what level the stagnation/blockage is occurring. Even in cases of longstanding pain with underlying structural change, I have found it effective to start by clearing the most superficial layer, and then work inward. A sinew channel treatment, which addresses the most superficial layer and helps to release fascial restrictions and restore fascial fluidity, often offers an excellent and lasting reduction in pain levels.
From the standpoint of science, the jury is still out on what exactly is happening when acupuncture is performed. The most popular theories are that acupuncture treatment produces a placebo effect, or that acupuncture causes the release of endorphins, the same group of hormones that contribute to a “runner’s high.” Recent studies looking at the effect of acupuncture on paw pain in mice (there is no reason to believe that mice benefit from a placebo effect) suggests that needling acupuncture points near the painful paws causes an increased release near the needled sites of adenosine – a neurotransmitter that acts like a local anesthetic. In other recent research, Dr. Niemtzow, in his work on auricular acupuncture for pain, has done PET scans that suggest that the auricular acupuncture is preventing the mapping of pain in the brain, thus altering pain perception. Research into acupuncture for fertility has shown that needling specific points on the lower back, in conjunction with electrical stimulation of those needles, produces dilation of the artery serving the uterus and ovaries and increases blood flow to that area.
I think that expecting to find a single mechanism to scientifically explain the effects of acupuncture is probably simplistic. I believe that eventually we will find that acupuncture works like an adaptogen, that it works differently depending on the needs of the system. In my experience, acupuncture seems to act simultaneously on several levels to reduce the fight or flight response (down regulate the sympathetic nervous system), support the rest and digest functions (up regulate the parasympathetic nervous system), improve blood circulation and tissue perfusion, and to remove fascial restrictions and allow appropriate movement of both internal and superficial structures. Philosophically, acupuncture is ultimately about restoring balance and maximizing the body’s ability to maintain the most favorable homeostasis; acupuncture at the most basic level is about keeping everything moving in an orderly fashion.
Do I need a Western medical diagnosis before I try acupuncture for my pain?
It is not essential to have a Western diagnosis to address pain with acupuncture, but it is helpful. It doesn’t really alter my treatment of your back pain to know if you have a disc herniation or spinal stenosis, but it does alter the prognosis and the understanding of what our treatment goals are. Undertaking a course of treatment expecting to emerge pain-free and “cured” is different then looking for a reduction in the need for pain medication and an increased ease in the activities of daily life. One key reason to get a Western diagnosis is so that we don’t delay appropriate medical treatment in the event of something catastrophic, like a tumor pressing on your spinal cord or a stomach ulcer masquerading as upper back pain. On the other hand, there is no reason not to come for acupuncture to manage the pain and increase function during those three weeks that you wait to see your doctor or wait for your MRI to be scheduled. Suffering needlessly is really not a virtue. While having acupuncture in addition to standard treatment for your breast cancer is probably not going to change the outcome, it will absolutely make getting through a year of chemo and radiation a lot easier.
What factors besides injury contribute to stagnation/pain?
In addition to external trauma, many factors can cause or contribute to pain conditions. The six climactic factors of Traditional Chinese Medicine – wind, cold, summer heat, dampness, dryness, and fire – can all be part of a pain presentation, and will contribute characteristic symptoms that help in diagnosis. Everyone will have a sensitivity or a tendency to one or more of these factors both as external conditions and as an internal environment. Many people with old injuries will feel impending rain as a deep dull ache in the affected part, the chronic stagnation around the injury has become sensitive to environmental dampness; others will feel crippled in a cold New England winter, but on a mid-winter trip to Florida they will move better and have much less pain, this is typical of injured joints that have developed osteoarthritis, the cold causes contraction of tissue around the damaged area which causes pain and further reduces mobility of the already compromised joint, The five emotions – joy, anger, worry, fear/shock, and sadness – also play a part in pain conditions. Any emotional state that we get stuck in is likely to cause trouble eventually. How many times have you seen intertwined depression and chronic pain conditions?
During our intake, even for a sports injury, we go through the body systems to determine what the underlying constitutional tendencies are and what climactic or emotional factors might affect your pain experience. We ask very specific questions about the quality of pain, location, duration, does it change or move throughout the day, does it keep you from sleeping or performing routine daily tasks, what self-care makes it better, what activities or motions make it worse? If there is a Western diagnosis of the problem this is also helpful. All of this information helps us to treat the pain more effectively and efficiently and allows us to give you a better idea of how much treatment you will need to see a useful change.
Is acupuncture curative or a palliative care?
Acupuncture excels at treating functional disorders. These are conditions where all the parts are intact and structurally sound, but for some reason they are not functioning very well. This could be something like sinus pain and pressure from seasonal allergies, back and neck pain from repetitive tasks combined with poor posture, headaches, menstrual cramps …. Any condition that is worse when you are physically or emotionally stressed is likely to be better with acupuncture. In many cases acupuncture combined with self-care techniques or lifestyle changes can actually banish functional issues. For conditions that are self-limiting, like round ligament pain during pregnancy, or where there is structural change like degenerative disc disease, hernias, or fibroid tumors, acupuncture can be part of a good pain management strategy.
Goldman, Nanna; Adenosine A1 Receptors Mediate Local Anti-nociceptive Effects of Acupuncture, Nature Neuroscience, Published online 5/30/10
Niemtzow, Richard; Class Lecture Notes – Battle Field Acupuncture, NESA 6/19/10