This is my response to the most recent acupuncture article in the Wall Street Journal on April 23rd 2011.This is another important dimension for the understanding of pain mechanisms since pain and/or discomfort is a public health issue.Here is the link to the original article:
There are many hypotheses behind acupuncture’s mechanism of action and all involve needling specific points on imaginary meridians.As you described in the article, patient input is required to find involved specific acupuncture points.Yet, for acupuncture points to be objectively found, why is subjective patient input necessary?Shouldn’t these body points be readily apparent to others?Shouldn’t finding such involved acupuncture points be among the most important factors in obtaining clinical results?Is invasive insertion of a needle necessary?Considering three dimensions, upon insertion, what if the needle is deflected from stimulating the specific acupuncture point due to tissue resistance or the specific point lies below the depth to which the needle can penetrate? On finding the correct point, should the needle be inserted only once, should it be oscillated, should several needles be inserted in that same point, and should needles be withdrawn if at the wrong point?What objective criteria determines how many needles need to be inserted in a treatment session, how deep should the needles be inserted, how long should needles remain at each point and how long should the treatment session last?Independent of patient report, are there quantifiable factors that determine whether treatment was a failure or success?
If acupuncture effects are mainly attributed to release of endorphins, why is it that endorphins released during exercise, not only fail to relieve, but aggravate pain of those who suffer from neuromuscular conditions, such as myofascial pain and fibromyalgia?
The mediate source of pain and/or discomfort in the majority of individuals, including those suffering from concussion who improved with acupuncture, appears reversible ischemia (deficient blood supply) at trigger points.This is due to relaxation of vice-like clamping effects that shortened and tight involved muscles produce on intramuscular blood vessels and nerves, specifically concentrated at trigger points.These shortened and tight muscles result from spinal nerve root irritation related to aging compounded by trauma.The mixture of reversible as well as permanent nerve damage also leads to a tugging effect of involved muscles on pain sensitive coverings on bones and joints to which they attach.This traction magnifies the pain and/or discomfort associated with the aforementioned ischemic effects.The degree of suffering appears dependent on the duration, type and extent of nerve damage.
Acupuncture points have been identified to be trigger points (neuromuscular junctions) and these points can be objectively recorded with electromyography (please see enclosed peer reviewed published manuscripts).Among the best stimuli to excite nerves is electricity, not mechanical stimulation as with the needle.When neuromuscular junctions are excited, the involved muscle that is innervated responds with twitch contractions.This twitch induced active exercise can produce an internal stretch where muscle spasm and/or muscle shortening is concentrated, namely the trigger point.This way, many shortened and tight individual muscles can be painlessly stretched and exercised individually to improve the microcirculation.By such action, the underlying local muscle ischemic changes are reversed.Consequently, involved muscle twitch elicitation is often accompanied by “pleasant and pleasing” sensations, leading to relief of pain or discomfort.Acupuncture on the correct points may also achieve this, albeit with less consistency than electrical stimulation, through obtaining twitches or micro-twitches, similarly relieving pain or discomfort.However, it is the electrical excitation of local trigger points with the elicitation of focal twitches, strong enough for observation to note that the action of the treated muscle was reproduced, preferably in an antigravity manner, and that this objective finding is associated with predictable production of pain relief.The time needed to seek and treat the trigger points should be objectively quantifiable, as revealed by the susceptibility and excitability of the trigger points to electrical stimulation.Therefore, freed from meridians and patient subjectivity, objective criteria for treatment parameters and efficacy now exist.
If nerve damage is present in multiple areas in many muscles, an improvement in how acupuncture is performed is desirable and necessary.This allows the treatments to be provided multiple times daily on a long term basis without side effects and without pain during treatment, leading to better treatment acceptance by patients, including those who are needle phobic.Advanced technology for needle-less acupuncture that can stimulate deep trigger points is now available, befitting 21st-century medicine.