Page 48 - IDF Journal 2023

IDF – Webinar Series IDF News – Spring 2023
An Introduction to Medical Acupuncture
Dr Federico Campos
When talking about acupuncture, the first thing that comes to mind is Traditional Chinese Medicine. Traditional acupuncture is
an ancient practice involving the insertion of fine needles into specific somatic points known as ‘acupoints’. As it
is not based on conventional scientific knowledge, it is hard to explain it in modern terms. Conversely, medical acupuncture, as taught
by the British Medical Acupuncture Society (www. medical-acupuncture.co.uk) is an adaptation of traditional acupuncture that follows the principles of evidence-based medicine. It is based on current medical knowledge and an understanding of anatomy, physiology and pathology.
Thanks to decades of rigorous
research, we have now achieved a
good understanding and insight into the mechanisms through which acupuncture provides its therapeutic effect. These can be simplified in three main mechanisms: local, segmental and central.
Local
Needling an acupuncture point sets
off action potentials in the network
of sensory nerves within the layers of
the skin. The action potentials trigger
the release of various substances e.g. calcitonin gene-related peptide (CGRP) and nerve growth factor (NGF). These substances induce local vasodilation, blood vessel proliferation and nerve growth, promoting local tissue healing. The local effect of acupuncture can be used to treat skin lesions such as discrete ulcers, eczema or hypertrophic scars.
Another local effect of acupuncture is the effect on myofascial trigger points (MTrP). When a muscle is suddenly stretched, strained or overloaded e.g. by maintaining an awkward posture or by carrying something heavy, it can develop a palpable area of damage that can be slow to heal and cause persistent pain, both local and referred, in a predictable fashion. The referred pain from a MTrP can often be misdiagnosed. Examples include trigger points in the Piriformis muscle causing sciatica-like pain and unilateral headaches caused by MTrP in the Trapezius muscle.
Clinically, myofascial trigger points are tender ‘knots’ found within a taut band of skeletal muscle. When needled, a MTrP ‘deactivates’, often providing instantaneous pain relief.
Segmental
The action potentials generated locally by needling travel up the afferent nerve and reach a segment of the spinal cord. The effect is a downregulation of the activity of the dorsal horn, which in turn reduce the response to painful stimuli in the whole segment. The acupuncture treatment
of osteoarthritis of the knee exploits this mechanism as the internal structures
(e.g. capsule, cartilage) where the pain originates from cannot be needled directly. Instead, needling the muscles around the knee (e.g. tibialis anterior, quadriceps) will send afferences to the same spinal segment as the internal structures and consequently reduce the pain in the whole knee.
Central
After reaching the midbrain, the action potentials go on to influence various other structures in the brain including
the cortex, hypothalamus and limbic system. A number of substances such as endorphins, adrenocorticotropic hormone (ACTH) and oxytocin are also released, contributing to the central effect of acupuncture.
The above translates into the well-known calming, anxiolytic and wellbeing- promoting effect of acupuncture. Often the first thing a patient reports after an acupuncture session, regardless of the presenting complaint, is feeling better, more relaxed and motivated, and having an overall more positive outlook on life.
Several good quality studies suggest the efficacy of acupuncture in treating anxiety and depression, either as a standalone intervention or as an adjuvant to conventional treatment such as selective
Thanks to decades of rigorous research, we have now achieved a good understanding and insight into the mechanisms through which acupuncture provides its therapeutic effect.
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