Acupuncture and Pain Relief
by Thisarana Wijayaratne

Acupuncture is an alternative form of medicine. This means that it is mostly based on cultural and historical evidence rather than on scientific evidence which can be seen in conventional medicine. Acupuncture originated in China and its main underlying feature is the insertion of a needle into the skin and underlying tissues in special sites known as points, for therapeutic or preventive purposes1. It relieves musculoskeletal pain including headaches. It is one of the oldest healing practices in the world and has a vast history which runs as far back as the 2nd century BC. There are many forms of acupuncture and they are practiced in many western countries but the main difference is that they do not use Chinese herbal medicine like the form of acupuncture practiced in China. In western countries, acupuncture is mainly used by people who suffer from arthritis or with chronic muscular pain when conventional medicine fails to make any difference to the condition. It is also used to treat ear, nose and throat conditions, infertility, menstrual problems and stress1. In Chinese medicine it is believed that health is a balance of two opposites, Yin and Yang1. According to this, the solid organs such as the heart and liver are considered as Yin and hollow organs such as the stomach are considered as Yang. Yin represents the cold, slow, or passive principle, while Yang represents the hot, excited, or active principle2.

I have used my artwork to show this by shading the human body in black and white to depict these two components. According to traditional Chinese medicine, health is acquired and maintained by having the body in a “balanced state”. Imbalances of the Yin and Yang components cause disease. Yin and Yang depend on each other for existence. This is quite similar to the interaction of the mind and body; they depend on each other and both are necessary for existence. This is shown by the positions of the two arms of the human body. The 1st picture depicts a perfect balance between yin and yang hence the person is maintaining a perfect level of health, whereas the second picture shows the opposite when a person is suffering from a disease. The inflamed brain and the ankle which is under pain depicts that when this balance between Yin and Yang is disrupted, disease is caused. If either of the hands tilt, the balance is disrupted, and acupuncture can restore the balance and the patient would be in a balanced state again as he/she was previously.

The underlying feature of Chinese medicine is ‘qi’ which means energy. It is believed that qi is inherited at birth and maintained during life by the intake of food and air1. It is understood that qi is circulated throughout the body via 12 meridians and forms channels through most parts of the body. There are many acupuncture points (also known as acupoints) identified in traditional Chinese acupuncture. Most are found along ‘meridians’ or ‘channels’ that are believed to be the pathways by which energy or Qi flows through the body (about 350 acupoints)3. There are some points found outside the meridians and they are called “extraordinary points”. Diseases are associated with disturbances, disharmony or imbalance of energy1. This leads to the malfunction of tissues and organs. When qi cannot flow freely throughout the body disease is caused. There can be many reasons for this; emotional and physical stress, poor nutrition, infection or injuries are among the most common. By inserting ultra-fine sterile needles into specific acupuncture points, a traditional acupuncturist seeks to re-establish the free flow of qi to restore balance and trigger the body's natural healing response4. Even healthy individuals can benefit from acupuncture because the disturbances in qi can be detected before they become complicated. The physiology behind acupuncture is fairly well understood but there’s a lack of hard evidence for the presence of qi and meridians. When a map of acupoints is superimposed on a picture of the human body in an anatomy book, the acupoints run closer to the major nerves and blood vessels. Some acupuncture points are sites at which nerves can be stimulated. Acupuncture could thus be a method of affecting the nervous and muscular systems1.

There are many ways in which traditional Chinese acupuncture works when looked at from a Western medicine point of view. Such mechanisms include the release of neurotransmitters, release of opioid peptides which relieves pain, signalling the brain and regulating the autonomic nervous system and increasing the blood flow. When an acupuncture needle is inserted into the body, nerve fibres surrounding the area send impulses to the brain and the spinal cord. Here, endorphogenic cells are stimulated to release endorphins such as enkephalin and dynorphin. These substances provide local inhibition (blocking) of the incoming pain signal5. When enkephalin is released from the gray area of the brain, it stimulates the release of noradrenaline and serotonin which are neurotransmitters. This causes in the suppression of the pain. Another effect is the release of adrenocorticotropic hormone (ACTH) which is released into the blood and the cerebrospinal fluid by the pituitary gland and additionally it activates the adrenal gland to release cortisol and brings out a system wide pain relief by relieving pain and inflammation. This helps the patient to alleviate pain. Acupuncture is carried out by a traditional Chinese acupuncturist and the diagnosing techniques used in acupuncture are different from that used in conventional medicine. According to traditional Chinese medicine, the surface of the tongue has a map of the whole body and the teeth markings on the tongue correspond to problems in various parts of the body. According to the traditional diagnosis, an acupuncturist will examine the tongue, palpate various parts of the body, focus on the seven inquiries (chills, fever, menses, appetite, thirst etc.), the body odour and body sounds. Furthermore an examination of the pulse is carried out and thereby the volume, strength and the rhythm of the pulse is observed. The acupuncturist will ask the patient about the general health condition and the medical history. If the patient has any condition, then the symptoms and the treatment will be noted. These subtle diagnosing techniques have been developed and refined over many centuries. The focus is on the individual, not his or her illness narrowly, and all the symptoms are seen in relation to each other. Each patient is unique; thus two people with the same western diagnosis may well receive different acupuncture treatments4. This shows that acupuncture has a holistic approach. That is, the patient is considered as a whole and the diagnosis and treatment is carried out, rather than considering only the symptoms of the patient in isolation and providing treatment based on the narrow diagnosis of the particular condition rather than the person as a whole.

The holistic approach in acupuncture is depicted in my artwork by the red circle which surrounds the person. This holistic approach does not ignore the mind or the spiritual aspect of the patient and uses them in conjunction with the physical aspect. This is because the human body has both the mind and the body components interacting with each other, and there is a balance between these two. This is shown in my first artwork by the picture of a brain (to symbolize the mind) and a synapse (to symbolize the body) on two sides which show that there’s a balance between these two and hence the person is maintaining a perfect level of health. The second picture attempts to show that disease is caused when the balance between the mind and the body disrupted. Thus, for a person to overcome disease it would be important to treat both these aspects. Illness and its remedies lie at many levels within a system6. This shows us that the body which is a living system has connections and is networked. Acupuncture takes all these “levels” into account - a holistic approach. Hence, it would be important to understand these connections when treatment is carried out. Much of the attraction of these unorthodox forms of treatment is due to their holistic philosophies based on the principle of the whole body: the recognition that our bodies, minds and spirits are all related and affect each other. It was the scientific revolution that initiated the reductionist approach to healthcare7. Acupuncture has however been able to show beneficial effects only in certain conditions. It fails to show any beneficial effects on some conditions, and in some it is inconclusive. Chronic back pain, osteoarthritis of the knee and headaches are some conditions that acupuncture has been able to have a positive effect where as in rheumatoid arthritis acupuncture does not seem to have any beneficial effect. Research is being done to find out the conditions that acupuncture has a positive effect on. Some people might feel better after undergoing acupuncture treatment, because there could be a placebo effect. Placebo effect is the beneficial effect produced by a treatment due to the patient’s belief in the treatment. There is, thus, an influence of the mind on the body. Because of this reason acupuncture has been controversial over the past few years, but, on the other hand there is also a very plausible physiological basis for acupuncture as I have expounded earlier. However there’s no proof for the presence of meridians and qi. Some research shows that there is a placebo effect of acupuncture, and some shows that there’s a real physiological effect and that it is not a placebo effect. For example study conducted in 2005 by the University of Southampton and University College London using a sham acupuncture technique using blunt needles, showed that there’s no placebo effect and that acupuncture truly works. It is difficult to use a correct scientific control in acupuncture, hence making it difficult to ascertain whether a placebo effect is present or not. I have attempted to illustrate that acupuncture has both a physiological and a placebo effect by having a brain and a chemical synapse. The brain represents the possibility of a placebo effect where as the synapse represents the physiological effect thus the release of neurotransmitters and thereby relieving pain. There’s a balance between the two and hence it helps to restore the patient’s well being. The first picture shows that there’s a balance between the two and that this balance makes the patient stay in a state of well being. The second picture shows that when the balance between the two is disrupted, the patient is not anymore in a state of well being.

Acupuncture is not without its risks. Since acupuncture is a very delicate procedure involving nerve stimulation, it should be done cautiously with adequate care and skill – if not it could lead to harmful side effects. Bleeding can occur if acupuncture is not carried out properly, in most cases if it is carried out by an inexperienced acupuncturist. In England, the practice of acupuncture is not regulated by the government. This means that anyone can call themselves an acupuncturist, even if they have no training or experience8. Patients are advised to make sure that the acupuncturist they go to is well qualified and experienced. This is to minimize any risks to themselves. If acupuncture is carried out by an inexperienced acupuncturist, then the imbalance that I have shown in my second diagram could well be aggravated and this will lead to more adverse effects. Furthermore acupuncture may cause drowsiness, bleeding, bruising and may even worsen pre-existing conditions. The incidence of severe injuries with acupuncture are rare but they may cause further disharmony in the patient’s energy system and affect the state of well-being. Adverse outcomes of acupuncture may include injuries such as brain damage and other organ damage or strokes which may result from very deep needling.

In conclusion, acupuncture is gaining popularity among the eastern and the western worlds, especially when conventional medicine fails and fail to make any difference, and give a solution to the patient’s health condition. Many, but not all, complementary practitioners have a multifactorial and multilevel view of human illness9. In my GP placement I came across several instances where patients had resorted to acupuncture when conventional medicine did not provide a solution. Most of these patients had chronic back pains and osteoarthritis. In such cases, conventional medicine usually involves the use of painkillers but acupuncture looks at and treats the real cause of the pain through a holistic approach. Patients seem to prefer the more holistic approach used in acupuncture as the diagnosis is based on the individual rather than on the symptoms. Since Illness and its remedies lie at many levels within a system6 it is important to see the picture as a whole and identify the problems in different systems and address them in their entirety. Patients may also prefer the motivation, courage and confidence that is given to them by acupuncture during treatment and it could be due to this confidence of the patients that self-healing occurs. Since acupuncture looks at the problem as a whole, its therapeutic interventions promote self repair and self healing by manipulating the body’s own immune system and establish balance and resilience, rather than triggering an artificial immune response through external medication such as pills, and arresting the symptoms as achieved through conventional medicine. The body's capacity for self repair, given appropriate conditions, is emphasized9 in acupuncture. The effects of acupuncture could take longer to manifest but it lasts longer than complementary medicine in which the effects are seen immediately but may not last long. Another reason why patients prefer acupuncture is that it has fewer side effects than conventional medicine which may cause serious illnesses through side effects on other parts of the body.

Taking into account what I have learned and understood from lectures and my tutorials, I now feel that conventional medicine could gain by taking a more holistic approach to treatment. Acupuncture complements conventional medicine as they both have their own unique approaches and are distinct from each other, and neither may be better than the other. Surely it would bring conventional medicine forward and to the next level if alternative medicine principles are integrated to provide better healthcare and restore the well-being of people within our society.

Thisarana Wijayaratne

Whole Person Care, Year One, 2012

References

1Ernst E, Pittler M.H, Wider B (ed.), The desktop Guide to Complementary Medicine. Second Edition: Mosby Elsevier; 2006

2National Centre for Complementary and Alternative Medicine, Acupuncture: An Introduction [Online]. Available from: http://nccam.nih.gov/health/acupuncture/introduction.htm. [Accessed 18th March 2012]

3Acupuncture Foundation of Canada Institute (AFCI), What is Acupuncture [Online]. Available from: http://www.afcinstitute.com/AboutAcupuncture/WhatisAcupuncture/tabid/73/Default.aspx . [Accessed 18th March 2012]

4British Acupuncture Council, What is Traditional Acupuncture [Online]. Available from: http://www.acupuncture.org.uk/index.php?option=com_k2&view=item&layout=item&id=218&Itemid=100. [Accessed 18th March 2012]

5WebMD, Medical Acupuncture [Online]. Available from: http://www.emedicinehealth.com/medicalacupuncture/page4em.htm#Acupuncture Physiology. [Accessed 18th March 2012]

6Dr. Thompson T. Big Ideas of Whole Person Care. Lecture at the University of Bristol, 2012

7Rankin-Box D.F. Complementary Health Therapies: A Guide for Nurses and the Caring Professions. New South Wales: Croom Helm; 1988

8NHS Choices, Acupuncture- Safety and Regulation [Online]. Available from: http: //www.nhs.uk/Conditions/Acupuncture/Pages/Risks.aspx [Accessed 18th March 2012]

9Zollman C. A Basic Introduction to Complementary and Alternative Medicine (CAM) for Medical Students. Lecture at the University of Bristol, 2012