Does Acupuncture Work by Re-Mapping The Brain?

Acupuncture is a form of traditional medical therapy that originated in China several thousand years ago. It was developed at a time bereft of tools such as genetic testing or even a modern understanding of anatomy, so medical philosophers did the best they could with what was available – herbs, animal products and rudimentary needles. In the process, perhaps, they stumbled on an effective medical approach.

In the past century, some modernisation has taken place. For instance, acupuncture has been paired with electrical currents, allowing for stimulation to be more continuous and to penetrate deeper into the body. This approach was termed electro-acupuncture and represents a convergence between the ancient practice of acupuncture therapy and modern forays into targeted electrostimulation delivered to the skin or nerves. Such approaches have attracted the attention of the pharmaceutical industry and are part of a growing class of neuromodulatory therapies.

So why all the rancour against acupuncture from some corners of the internet (and academia)? Shouldn’t we apply our modern research methods to see which classical acupuncture techniques have solid physiological backing?

It’s not as easy as it seems. Let’s look at the clinical research. A recent landmark meta-analysis threw together data from thousands of chronic-pain patients enrolled in prior clinical trials, finding that acupuncture might be just marginally better than sham acupuncture (in which non-inserted needles are used as a placebo control). The differences were statistically significant, but lack of a larger difference could be due to the clinical outcome measure that the researchers studied. Symptoms such as pain (along with fatigue, nausea and itch) are notoriously difficult for different people to rate in a consistent manner. Conventional wisdom says that these kinds of symptoms are improved by placebo, but what about improvements in the body’s physiology? For instance, in a recent study that assigned an albuterol inhaler for asthma to some patients and sham acupuncture to others, patients reported both as effective. But objective physiological measures demonstrated significant improvement only for albuterol. It’s clear that in evaluations of acupuncture, research should explicitly hunt for potential physiological improvements, in addition to patient reports.

While most chronic-pain disorders lack such established, objective outcomes of disease, this is not true for carpal tunnel syndrome (CTS), a neuropathic pain disorder that can be validated by measuring electrical conduction across the median nerve, which passes through the wrist. Interestingly, the slowing of nerve conduction at the wrist does not occur in isolation – it’s not just the nerve in the wrist that’s affected in CTS. My own department’s research and others’ has clearly demonstrated that the brain, and particularly a part of the brain called the primary somatosensory cortex (S1), is re-mapped by CTS. Specifically, in functional magnetic resonance imaging (fMRI) brain scans, the representation of fingers innervated by the median nerve are blurred in S1. We then showed that both real and placebo acupuncture improved CTS symptoms. Does this mean that acupuncture is a placebo? Maybe not. While symptom relief was the same immediately following therapy, real acupuncture was linked to long-term improvement while sham acupuncture was not. And better S1 re-mapping immediately following therapy was linked with better long-term symptom reduction. Thus, sham acupuncture might work through an alternative route, by modulating known placebo circuitry in the brain, while real acupuncture rewires brain regions such as S1, along with modulating local blood flow to the median nerve in the wrist.

Where you stick the needle might matter as well. While site-specificity is one of the key features of acupuncture therapy, it has been controversial. Interestingly, in the S1 region of the brain, different body areas are represented in different spatial areas – this is how we localise the mosquito that’s biting us, and swat it. Different S1 areas might also pass along information to a diverse set of other areas that affect different bodily systems such as the immune, autonomic and other internal motor systems. As far as acupuncture is concerned, the body-specific map in S1 could serve as the basis for a crude form of point specificity. In our study, we compared patients receiving real acupuncture locally to the wrist with patients receiving real acupuncture far from the wrist, in the opposite ankle. Our results suggested that both local and distal acupuncture improved median nerve function at the wrist. This suggests that the brain changes resulting from acupuncture might not just be a reflection of changes at the wrist, but could also drive the improved median nerve function directly by linking to autonomic brain regions that control blood vessel diameter and blood flow to the median nerve.

This new research clearly demonstrates that bodily response is not the only means by which acupuncture works; response within the brain might be the most critical part. Once we better understand how acupuncture works to relieve pain, we can optimise this therapy to provide effective, non-pharmacological care for many more chronic-pain patients.

This article originally appeared on Aeon & written by Vitaly Napadow.

Acupuncture and Seasonal Allergies

Symptoms of running nose, sneezing, and watery itchy eyes that recur during specific parts of the year (especially Spring and Fall) are a cause of much suffering of a large segment of the U.S. population. Millions of dollars are spent on medications and the allergy shots for the treatment of seasonal allergies.

Western medicine views seasonal allergies as a form of immediate hypersensitivity reaction which occurs when anti-bodies produced by lymphocytes interact with airborne particles such as pollen. Western medicine describes the locations of lymphocytes in addition to being in the blood stream as also in Peyer's patches in the gastrointestinal tract, spleen, lymph nodes, and bone marrow. Interestingly in my practice of acupuncture the Spleen, Stomach, and Large Intestine meridians are utilized a great deal. One sees an interesting overlap of Western and Chinese medical thought. Also, Chinese medical thought sees sweets as being harmful to the Spleen (Chinese sense of the Spleen) function. In my practice sweets are often a major factor in the persistence and intensity of seasonal allergy symptoms.

I find it gratifying to treat seasonal allergies with acupuncture. There is often a quick response. Often patients get some relief during the first visit while lying on the exam table with their acupuncture needles in place. Patients are asked to score their nose stuffiness on a zero to ten scale. Zero meaning no stuffiness at all and 10 being the worst possible stuffiness for the patient. A score may be determined before and after the acupuncture treatment. Patients can also determine the effectiveness of acupuncture treatment by tracking the number of sneezes per day and the number of itching episodes around their eyes. After an initial series of treatments, patients come in for further treatments on an as needed basis. Some patients come back in once or twice a year for a booster while others may come more often. In general, patients do better if they avoid sugar and milk in their diets. They have better and longer lasting responses. I have seen many patients who failed medication and allergy shots respond to acupuncture. Patients continue with whatever standard treatments they are currently undergoing while getting acupuncture treatments. Most patients end up significantly reducing or eliminating their dependence on allergy medications.

There are many different ways of performing acupuncture, for example TCM (Traditional Chinese Medicine), Japanese, Korean, French Energetics, Worsley 5 Elements, ear, hand, etc. In choosing an acupuncturist the specific style a practitioner uses is not so important as the success rate a practitioner obtains with whatever style they use. Prospective patients should speak with the acupuncturist and inquire about past experience in treating seasonal allergies and their success rate.

In conclusion, it is my opinion that acupuncture is an excellent treatment option for seasonal allergies.

this article originally appeared on medicalacupuncture.org and was written by  Patrick J. LaRiccia, M.D.