Agopuntura e Medicina Occidentale: quale integrazione

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INDICATIONS AND MECHANISMS OF ACUPUNCTURE IN
PAIN
Quirico Piero Ettore M.D. Acupuncture School
C.S.T.N.F. - Torino F.I.S.A. - Italian Federation
of Acupuncture Societies
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For over 3000 years Acupuncture has been used to
treat many diseases, as

• infectious diseases
• musculoskeletal diseases
• internal diseases
• metabolic diseases
• hormonal imbalances
• mental and nervous system diseases

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Acupuncture has been practiced for over fifty
years in Western countries, achieving great
success in treating different diseases. More
than 10,500 scientific publications are
available on Medline database, demonstrating
Acupuncture effectiveness and safety.
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Acupuncture in pain
Acute and chronic painful pathologies are one of
the more interesting fields of application of
Acupuncture, that often can cure, alone or with
other therapies, many diseases difficultly
treatable only by the conventional resources.
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So many diseases treated suggest a wide variety
of acupuncture effects, as follows

• anti-inflammatory
• analgesic
• decontracting-miorelaxing
• vasoregulatory
• sedative
• neuroendocrine regulatory

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Vasoregolatory-trophic effect
Documented from the thermography and other
fluxmetric methods, it restores the correct blood
flow in the affected area. Painful diseases are
often characterized by local ischaemia or light
inflammation, frequently associated to edema.
This situation favors the accumulation of waste
and the evolution towards fibrosis, with
functional failure.
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Infrared thermography in Acupuncture
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The tissue distress
In the affected area we can see limited zones
very painful

• naturally
• after pression

capable of causing pain locally and in a distant
area.
These areas correspond to the traditional Ah Shi
acupoints and to the Trigger points (TP)
described from Travell and Simons as ischaemic
zones with larger metabolic needs. Each TP
embodies a warm hyperexcitated area, that can
cause reflex phenomena locally and at some
distance.
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The ischaemic-irritative tissue condition
of TP zones, through the afferent nerves,
can maintain this distress. Reflex nervous
pathways are involved and these
mechanisms can play a role

• reflex constriction of Vasa Nervorum
• nociceptive autonomic feedback
• release of vasoactive peptides (SP, CGRP) from
  afferent C fibres, that increases the stimulation
  of nociceptive pathways

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The silent afferences
In 1994 G.D. Schott (Brain, 117397-413) pointed
out the role of autonomic nervous fibres in the
origin of chronic visceral and
musculoskeletal pain. These afferent fibres
represent over 50 of the amielinic C fibres
found in the different tissues (skin, joints,
muscles, viscera).
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Silent fibres become sensitive and they are
capable of evoking a reaction only after longtime
injuries, as inflammatory and ischaemic
processes. The activation of these afferences can
lead to a central sensitisation, with an
enlargement of receptive fields, causing a more
intense and continuing activity. In this way
chronic pain mantains itself.
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Ischaemic-irritative condition of TP and
oedematose-phlogistic state of affected areas
can both activate C silent fibres and lead to a
chronic condition of the painful disease. Through
the convergence-facilitation and
-projection mechanisms, pain can get the chronic
condition also in the projection zones,which
sometimes are very far from its origin.
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Deactivation of Trigger Points
Mechanic disorganization of TP area can resolve
at the same time local and projected symptoms,
breaking at the root the vicious circle
mantaining the painful disease. The injection of
anestetic drugs inside the TP does not give
better results than dry needle method. Needle
infixion must reach the center of TP and the
stimulation must be strong it is also very
important to obtain the De Qi (needle
sensation) and the propagated sensation of the
needle along the channels.
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Thermal stimulation the moxibustion
Failing visible phlogosis symptoms, the
vasodilating effect is increased from local
application of heat. So, it is possible to
resolve ischaemic pathology forever. The recovery
of a correct blood flow in the affected areas is
the mean condition capable to ensure

• the elimination of waste
• the restoration of tissue nourishment

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Moxibustion different methods
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1
4
6
5
3
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Anti-inflammatory effect
The recovery of the tissue nourishment and of the
blood flow, aid the intervention of cellular and
humoral components of the immune system in the
affected areas.Many trials demonstrate the
effect of Acupuncture stimulation on different
components of immune function.
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Antalgic-analgesic effect

• It is possible to get it through two ways
• Electroacupuncture (EA) applied for over 60 min.
  due to the release of endogenous opiates by
  CNS employed in surgical analgesia the
  effect may last some hours
• Manual stimulation for a brief time (few seconds)
  segmental and suprasegmental reflex mechanisms
  are involved, as gate-control system and
  descending anti-nociceptive system short
  lasting and low importance effect

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DIFFUSE CORTEX
SENSITIVE CORTEX
FRONTAL CORTEX
THALAMUS
ILN
LVPN
PAG
DESCENDINGSYSTEMS 2th level
LYMBICOSYSTEM
HYPOTALAMUS
RMN
PGCN
HYPOPHYISIS
Ser
Nor
F. NST
ENDOPHINS3TH level
F. PSRT
ACUPUNCTURE ANTALGIC EFFECT AND CNS LEVELS
GATE CONTROL 1th level
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Inibition of nociceptive afferences in the
posterior medullar horn (gate control system)
Dorsal
Paleospinothalamic
Neospinothalamic
column
tract
tract
E
S
-
-



G
A
A
d
C
b
G gabaergic interneuron, E enkefalinergic
interneuron, S efferent deutoneuron
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Acupuncture electroanalgesia and CNS
G gabaergic interneuron E enkefalinergic
interneuron S efferent deutoneuron Nrm rafe
magnus nucleus PGC parvigigantocellular
nucleus PAG periaqueductal grey
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Acupuncture electroanalgesia (EA)
This method was conceived from Chinese
Acupuncturists in 1958 and later it spread
accross the world, favoured by its good degree of
efficacy. Athough limited to some
operations and thanks to its spectacularity, it
was very appreciated by mass media. Now EA is not
very practised, but it had the historical
role of introducing Acupuncture scientific
research in Western Medicine, pointing out its
capacity to produce endorphins in CNS.
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Maoist Acupuncture
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Manual Acupuncture and EA
Over the millennia Acupunture has been
always executed by hand, to cure the
diseases and not only their painful symptoms. EA,
due to an increased production of endorphines in
CNS, only points out a single effect and it cant
explain by any means the large therapeutic value
of Acupuncture.
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Antalgic effect therapeutic value
Although Acupuncture antalgic effect has
not a true therapeutic role, it can be
useful for treating
musculoskeletal diseases.
Some analgesia degree, even if for a short time,
aids joints mobilization after the treatment and
favours the functional recovery of the affected
areas.
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Decontracting-miorelaxing effect
Muscle contracture depends on segmentary distress
and it represents an attempt to protect the
diseased area. The quick decontracting effect of
Acupuncture involves reflex nervous
mechanisms and affects proprioceptive and
nociceptive pathways. Muscle decontraction and
relaxation permit the
resolution of painful diseases and the
recovery of a suitable tissue
nutrition.
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Sedative effect
Patients suffering from painful and chronic
diseases are often afflicted with anxiety and
depression, caused by the sufference and
the fear thath they will not be cured. The
Acupuncture sedative-antidepressive effect is
very important to improve the patients mental
condition, including the quality of sleep.
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Conclusions
We can say that Acupuncture has a main role in
painful diseases therapy, through its proven
effects. In Western countries Acupuncture
technique is not always the same and often its
quality is not adequate. Acupuncture and
Reflextherapy are in addition often confused,
inside a big group of alternative cares. This
fact favours a big disorder and the diseased
people take all the consequences on themselves.
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Elements for a
gold standard Acupuncture....

• a complete acupoint prescription
  (local, regional, distal and general points)
• deep infixion in the local points
  (needle sensation radiated in the
  affected area)
• accurate stimulation of the distal points
  (propagated sensation towards affected area)
• accurate selection of the general points
  (based on the individual clinical
  picture)

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Acupuncture in painful diseases
main clinical indications

• Musculoskeletal diseases
  arthrosis, disk disorders, shoulder and
  hip periarthritis, tendinitis, tennis elbow,
  carpal tunnel syndrome, joints distortions,
  muscles contractures and cramps
• Neurological diseases
  neuralgias, tensive and vascular headache
• Gastrointestinal diseases gastritis
  and peptic ulcer, hiatal hernia and esophageal
  spasm, hemorrhoids

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• Gynecological diseases
  dismenorrhea, pain relief during delivery
• Urological diseases
  interstitial cystitis, renal colic
• Hearth diseases
  angina pectoris
• Otorhinological diseases
  sinusitis, otitis