Thoughts on Acupuncture’s Mechanism of Action

Thanks to my friend the Etch-A-Sketchist for this beautiful tribute to an exciting philosopher. Jean Baudrillard. From the archives

In the immortal words of Jean Baudrillard, “In the same way that we need statesmen to spare us the abjection of exercising power, we need scholars to spare us the abjection of learning.”

Although I’m no true scholar, and I won’t go into the critical theory of how Traditional East Asian Medicine may be itself considered “abject” in its own way (sheesh ok I had to go there), I hope to spare you some of the brain-pain associated with sifting through the research in acupuncture and Traditional East Asian Medicine. My goal for this site is to create a meeting-place and resource center for acupuncturists, patients, and anyone interested in our field of medicine. Thank you for stopping by.

So I have compiled the results of the poll from the last post, and we had a healthy 16 responses, woohoo! Thank you for your input! Of course, you can still weigh in with your very important vote (wink).

Despite the piddly n-value, we do have a response to the question “What is the best use of Traditional East Asian Medicine Research, currently?” There is a solid interest in “Learning more about the human being by studying the mechanism of acupuncture” with a whopping 37.5%, closely followed by “Helping us participate in a common language with other medical professionals when necessary” at 25%.

Well I think that’s a reason to look at the mechanism of acupuncture, don’t you?

DON'T YOU KNOW YOU CAN RELEASE ENDOGENOUS OPIOIDS WITH ACUPUNCTURE?  [Please, pardon Jean-Luc Piccard's Francais.]

DON’T YOU KNOW YOU CAN RELEASE ENDOGENOUS OPIOIDS WITH ACUPUNCTURE? [Please, pardon Jean-Luc Piccard’s Francais.]


I recently added a page outlining a good chunk of current research about acupuncture’s Mechanism of Action. Currently, the two main categories of inquiry boil down to (1) the exciting but ultimately incredibly complex investigation of acupuncture’s effect on multiple neural pathways, giving insight into how acupuncture regulates the autonomic nervous system (endogenous opioid, adenosine, and ACTH release, along with mu-opioid receptor binding availability, etc)  and (2) the more tangible connective tissue manipulation and biochemical / biomechanical effects of acupuncture manipulation on the fascial structure (ATP stimulation, nitric oxide (NO) release, fibroblast response). In my simplified interpretation, we are looking at the zappy and the twisty types of acupuncture stimulation (neuropeptide release vs change in fibroblast behavior). Please see the full page for a more professional explanation of these concepts.

One major way in which the study of acupuncture’s mechanism of action can benefit the perception of acupuncture in general is by showing how exactly the placebo effect operates in acupuncture studies. One study used the idea of four prongs of treatment: 1) sham acupuncture which they actually told the patients wouldn’t work (“overt” placebo); 2) sham acupuncture that the patients were blinded to (placebo/control); and 3) true acupuncture that they told the patients would work and 4) true acupuncture that the patients were blinded to. By comparing the overt and non-overt placebo, and the conditioned and non-conditioned true acupuncture, researchers could determine what neurological mechanisms (using fMRI) may be involved in the pronounced “placebo effect” of many acupuncture studies. Furthermore, the study revealed a distinct difference in neural activation of the insula between the true acupuncture and either of the placebo acupuncture groups. (Kong, J., Kaptchuk, T. J., Polich, G., Kirsch, I., Vangel, M., Zyloney, C., … & Gollub, R. L. (2009). An fMRI study on the interaction and dissociation between expectation of pain relief and acupuncture treatment. Neuroimage47(3), 1066-1076.) This explanation is my analysis of the excerpt below.

Quoting from Lijun Bai and Lixing Lao, “Neurobiological Foundations of Acupuncture: The Relevance and Future Prospect Based on Neuroimaging Evidence,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 812568, 9 pages, 2013:

Harris et al. also investigate both short- and long-term effects of acupuncture versus sham treatment on in vivo μ-opioid receptor (MOR) binding availability in chronic fibromyalgia pain patients [40]. They suggest that acupuncture therapy could evoke both short-term and long-term increases in MOR binding potential in multiple pain and sensory processing regions associated with reductions in clinical pain, whereas such effect presented absent or even small reduction in the sham group. Another study enrolled fourteen patients with osteoarthritis of the thumb and designed two placebo controls (nonpenetrating Streitberger needle and an overt placebo) to explore both the specific effect of real acupuncture and the nonspecific effect of treatment expectation. The overt placebo was a nonpenetrating surface skin prick, bearing exactly the same stimulus as the Streitberger needle. However, patients were told in advance that this manipulation had no therapeutic effect. For the specific effect, by comparing the real acupuncture and Streitberger needle, the insula ipsilateral to the site of needling was activated to a greater extent during real acupuncture than during the placebo intervention. For the nonspecific effect, by comparing the Streitberger needle and overt placebo, the only difference was activation in dorsal lateral prefrontal cortex, rostral anterior cingulate cortex, and midbrain, suggesting a possible mechanism for the placebo effect involving acupuncture. The finding demonstrated that expectation in acupuncture treatment has a physiological effect on the brain network which mediates a potential nonspecific clinical response to acupuncture. These lines converge into one notion that divergent neural mechanisms may mediate specific dimensions of acupuncture effects in comparison with the placebo effects.

AND for your viewing pleasure, and as a resource for your patients as well, here is a fantastic documentary about the Science of Acupuncture, produced by the BBC. Hugh MacPherson, a leading acupuncture researcher, makes an appearance in the fMRI study toward the last 1/3 of the program!

In case you were wondering, we have here the complete result of the poll:

What is the best use of Traditional East Asian Medicine Research, currently? Count  Percent

Learning more about the human being by studying the mechanism of acupuncture

6 37.5%

Helping us participate in a common language with other medical professionals when necessary

4 25%

Comparing different Chinese medicine approaches for comparative effectiveness.

2 12.5%

Policy and strengthening knowledge of the medicine in another ‘language’

2 12.5%

Helping create appropriate policy decisions

1 6.25%

Please don’t do research- it seems irrelevant/ provides fuel for placebo debate/ distracts from clinical reality

1 6.25%

Defining our terms by studying the anthropology and history of our medicine

0 0%

Translating classical texts to preserve the essence of our medicine

0 0%

What research? I only read classical texts.

0 0%
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