Modern Acupuncture and Conditioned Pain Modulation

Dr. Kukurin presenting his neuroanatomical acupuncture techniques at a medial conference at Johns Hopkins

Acupuncture has been around for thousands of years. It was based on a complex quasi-metaphysical framework that considered the relationship between organs of the body, properties known as Yin and Yang and relationships between the human body and its environment. All these many interrelationships were woven into a clinical framework which would guide the practitioner as to where, when and how to treat each individual patient. For thousands of years this system was refined through trial and error into a useful approach to relieve human suffering and improve health.

The ancient practitioners of acupuncture were able to construct this clinical framework without the benefit of modern scientific technology and for centuries it served them well.

Examining traditional acupuncture tenets through the lens of modern neuroscience produces some fascinating results. For example, the concept of Yin and Yang aligns beautifully with the parasympathetic (Yin) and sympathetic (Yang) components of the autonomic nervous system.

Likewise maps of the traditional acupuncture channels or meridians overlay quite closely with modern neuroanatomical maps of peripheral nerves.

Even many of the environmental interrelationships of ancient acupuncture theory have modern neuroscientific counterparts. For example fluctuations in neurohormones are known to occur throughout the day. Also known changes in brain melatonin levels produce dramatic physiological affects on the body from summer to winter provide some support of the tenets of acupuncture,

So the ancient developers of the art of acupuncture, without the benefit of modern technology, had a reasonably sound theory when considered from a modern neuroscience perspective.

Where the traditional theory falls short is selecting specific points for treatment. Modern research methods have helped to unlock the mechanism of acupuncture point stimulation for relieving pain and improving health,

Neuroscientists have identified several circuits in nervous system that descend from brain to the spinal cord and block pain using the body’s own naturally occurring opioids. Activation of this circuit is like taking a shot of morphine. They call this the descending pain inhibiting pathway.

Pain researchers have discovered a number of reflexes that activate this descending pain inhibition pathway suggesting that acupuncture may work in part by this reflex mechanism.

Scientists generally call this pain relieving reflex Conditioned Pain Modulation or CPM for short. Let’s see how CPM works and how it might apply to modern acupuncture practice.

The general idea behind CPM is that pain relieves pain, let me explain. Let’s say you have long standing back pain. As a general rule, if pain persists and becomes chronic there is a failure of the descending inhibitory pain control circuit. If this circuit is working correctly, following an injury or illness, the descending pain inhibitory circuit will activate and eventually suppress the acute pain thus preventing it from becoming chronic.

In persistent or chronic pain, this circuit fails and pain continues long after the initial injury has healed.

An emerging method to reduce chronic pain is to cause reflex activation of the descending pain inhibitory circuit through Conditioned Pain Modulation.

You can activate CPM by inserting an acupuncture needle at the site of the pain, in this example, the trigger-points of the lower back. This reflex is known as homo-topic (same location) CPM. Or you can insert an acupuncture needle in a point far removed from the pain, for instance in the hand. This reflex is known as heter-topic (different location) CPM. Or you may choose several acupuncture points, some locally, some far removed to activate the descending pain inhibitory circuit.

By inserting a fine hair-like acupuncture needle into the body you produce a brief burst of activity in the ascending pathways, which in turn activate the descending pain inhibitory pathways.

Stated another way; pain inhibits pain.

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