by WIlliam N. Loeliger, MD
Pain- all human beings have experienced it at some time or another. It can range from very mild to a severity so intense that it causes loss of consciousness. Pain is a signal to the brain of ongoing or imminent tissue damage. Therefore it is an important warning signal, but when pain becomes chronic it can be debilitating in and of itself.
Pain also takes a huge toll in terms of medical costs and lost income. Low back pain affects five million Americans annually; headaches 40 million and arthritis affects 66 million annually. Over four billion dollars a year are spent on pain medications. The Department of Health and Human Services estimate that chronic pain costs the national economy between 80 and 90 billion dollars a year.
Modern science and medicine has learned a great deal about the anatomy and physiology of pain transmission and has developed many drugs to treat pain including narcotics (e.g. morphine), NSAID drugs (e.g. ibuprofen) and steroids (e.g. cortisone). And yet, pain is still a major health problem today.
Of course, the ancient Chinese also experienced pain, but they did not have the drugs we do today. Instead they often used acupuncture. Acupuncture is just one component of Traditional Chinese Medicine, a four to five thousand year old system of healing that includes, in addition to acupuncture, Chinese herbal medicine, manual techniques such as cupping and massage, and nutritional regimens.
Scientists in the West did not pay much attention to acupuncture until President Nixon's first trip to China in 1971. At that time James Reston, a reporter accompanying Nixon, suffered an acute appendicitis and underwent surgery in Beijing. He received acupuncture post-operatively to treat his pain and slowly returning bowel function. Reston was so impressed that, on his return, he wrote about his experience in the New York Times. This unleashed a torrent of public and scientific interest. Soon groups of physicians were returning from China with tales if patients remaining awake and comfortable during surgery in which acupuncture had been used for anesthesia. This was not something that scientists could easily dismiss as the "placebo effect".
The Chinese belief is that acupuncture is based on the circulation of Qi or vital energy, through channels in the body called meridians. Meridians are associated with specific organs and along these meridians are discrete points called acupoints that can be used to balance the vital energy. If pain exists, then the free flow of Qi is felt to be blocked or stagnated.
Western scientists have never acknowledged the existence of vital life force energy, but during the 1970's and 1980's they began to seriously examine acupuncture's effects on the body. In the early 1980's the discovery was made that acupuncture stimulated the release of naturally occurring morphine-like substances in the body called endorphins. Subsequently, many other related substances affected by acupuncture were discovered. With this discovery within a short period of time, acupuncture became a respected treatment modality. Many physicians began to study acupuncture leading to greater than three thousand physicians in the U.S. today that incorporate acupuncture into their practices.
Research has continued and more information continues to be learned. For example, it has been documented that electrical stimulation of acupuncture needles creates pain relief in two ways. Low frequency, high intensity stimulation releases endorphins and creates relatively long duration pain relief. Whereas pain relief induced by high frequency, low intensity electrical stimulation is mediated by another group of neurotransmitters called biogenic amines and is of short duration. Bruce Pomeranz, a Canadian neurophysiologist, has documented acupuncture's modulating effects on pain transmission at various levels of the central nervous system.
Many techniques of acupuncture, some based in traditional knowledge and some based in modern neuroanatomy, are currently used to reduce pain. Superficial needling techniques known as surface energetics are employed to relieve subcutaneous nodules of stagnated energy. This method has been popularized by Japanese acupuncturists.
Another acupuncture technique uses needles to release "trigger points" that are knotty bands of muscle and fibrous tissue. They frequently arise in areas of chronic muscle tension or repeated strain injury.
Of course acupuncture can be used in a traditional way to stimulate stagnated Qi by needling conventional acupuncture points on the meridians. Other physical modalities are frequently used to compliment the needles such as electrical stimulation, heating with moxibustion (an herb which is burned), cupping, scraping the skin or massage techniques. Two more modern acupuncture techniques based on current knowledge of neuroanatomy include PENS (Percutaneous Electrical Nerve Stimulation) and osteopuncture (where acupuncture needles are used to stimulate the surface of bone). These have been developed by Western physicians to treat more severe chronic pain problems.
A modern technique which does not require needles is the use of a special type of electrical stimulation called Alpha-stim, a version of TENS (Transcutaneous Electrical Nerve Stimulation).
As our knowledge of acupuncture and how it works evolves, it is clear that more effective acupuncture techniques for pain treatment will be developed. Of course, pain is a very complex problem and no one modality can be expected to cure all pain. The best pain treatment centers employ many different strategies including diagnostic and therapeutic nerve blocks, medications, physical therapy, massage, counseling, mind- body techniques, as well as acupuncture. Acupuncture is rapidly finding its place as a valuable tool in the ongoing effort to control pain.
