By Dr. Winson Chen
Acupuncture has been used for centuries as a therapeutic modality in traditional Chinese medicine, and its application for chronic lower back pain (LBP) has garnered increasing attention in the scientific community. This paper provides an in-depth overview of the neurophysiological mechanisms involved in acupuncture’s effectiveness in treating LBP, supported by empirical studies and clinical evidence.
Chronic LBP is a pervasive health issue affecting millions of individuals worldwide. It is a leading cause of disability and a significant contributor to health care costs and productivity loss (Balagué et al., 2012). Current treatment strategies often include physical therapy, pharmacological interventions, and, in severe cases, surgery, with varying degrees of success. However, these traditional methods often present side effects and do not always provide lasting relief. Therefore, alternative and complementary therapies like acupuncture have been sought after due to their reported efficacy and minimal side effects (Vickers et al., 2018).
Mechanisms of Acupuncture
Acupuncture involves the insertion of fine needles into specific points on the body, known as ‘acupoints.’ The precise mechanisms by which acupuncture works are complex and multifaceted, involving both peripheral and central processes.
One widely accepted theory explaining acupuncture’s analgesic effect is Melzack and Wall’s ‘Gate Control Theory’ of pain (1965). According to this theory, non-painful input closes the ‘gates’ to painful input, preventing pain sensation from traveling to the central nervous system. Therefore, acupuncture, by stimulating non-nociceptive fibers, can inhibit pain signals from reaching the spinal cord.
Furthermore, acupuncture needles, when inserted into acupoints, stimulate A-delta and C afferent fibers in muscles. This stimulation triggers a cascade of biochemical changes, including the release of endorphins and other natural pain-relieving chemicals in the body. These chemicals act as natural opioids, reducing the perception of pain (Han, 2004).
Another effect of acupuncture involves local peripheral changes. Acupuncture has been found to increase local blood flow and promote tissue healing (Komori et al., 2009). It also reduces inflammation and muscle stiffness, common issues associated with LBP, by inhibiting pro-inflammatory cytokines and promoting the release of anti-inflammatory cytokines (Zhao, 2008).
At the central level, neuroimaging studies have demonstrated that acupuncture can influence the brain’s pain-processing areas. Functional MRI (fMRI) studies show that acupuncture activates areas of the brain associated with pain modulation, including the anterior cingulate cortex, the insula, and the periaqueductal gray (Dhond et al., 2007).
In contrast, it also deactivates areas associated with the sensory-discriminative aspect of pain, such as the thalamus and the primary and secondary somatosensory cortices (Hui et al., 2009). This combination of activation and deactivation in different brain regions may explain the pain-relieving effects of acupuncture.
Interestingly, acupuncture has also been found to influence the limbic system, a group of structures involved in emotion, memory, and behavior. This may explain why some patients report improved mood and well-being after acupuncture (Hui et al., 2005).
In terms of empirical evidence, a significant volume of studies has shown acupuncture’s effectiveness in managing LBP. A meta-analysis of 22 randomized controlled trials involving 4985 participants found that acupuncture was more effective than sham acupuncture and no-acupuncture control for non-specific chronic LBP, showing improved function and pain relief (Yuan et al., 2015).
Another notable study, a randomized trial by Cherkin et al. (2009), involved 638 adults with chronic LBP. The researchers found that both individualized and standardized acupuncture resulted in more significant improvement in symptoms and function compared to usual care. The study concluded that acupuncture could be a reasonable option for patients with chronic LBP.
Additionally, a systematic review by Vickers et al. (2018) analyzed individual patient data from 29 high-quality randomized controlled trials. The review found that acupuncture was linked with significant reductions in pain intensity, improved functional mobility, and enhanced quality of life compared to no-acupuncture groups.
Conclusion and Future Directions
Emerging research on acupuncture’s role in managing chronic LBP presents an intriguing dialogue between traditional Chinese medicine and modern scientific understanding. There is a solid foundation of evidence illustrating both peripheral and central mechanisms behind acupuncture’s efficacy, with effects ranging from local tissue healing and endorphin release to modulating brain areas associated with pain perception.
However, more in-depth and extensive research is required to further elucidate the underlying mechanisms, optimize treatment protocols, and understand potential long-term effects. For instance, while numerous studies have investigated the immediate effects of acupuncture, long-term effects and how they might relate to changes in neurochemistry and neuroanatomy remain less clear.
Furthermore, as current understanding of acupuncture is primarily based on group-level data, individual differences in response to acupuncture are still not fully understood. Future research could also explore the influence of individual factors such as genetic predisposition, psychological characteristics, and specific pain conditions on the effectiveness of acupuncture.
As it stands, acupuncture represents a promising, non-invasive treatment for chronic LBP, providing a potential therapeutic avenue for this prevalent and debilitating condition.
Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. The Lancet, 379(9814), 482-491.
Cherkin, D. C., Sherman, K. J., Avins, A. L., Erro, J. H., Ichikawa, L., Barlow, W. E., … & Hsu, C. (2009). A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Archives of Internal Medicine, 169(9), 858-866.
Dhond, R. P., Kettner, N., & Napadow, V. (2007). Neuroimaging acupuncture effects in the human brain. The Journal of Alternative and Complementary Medicine, 13(6), 603-616.
Han, J. S. (2004). Acupuncture and endorphins. Neuroscience Letters, 361(1-3), 258-261.
Hui, K. K. S., Marina, O., Claunch, J. D., Nixon, E. E., Fang, J., Liu, J., … & Rosen, B. R. (2009). Acupuncture mobilizes the brain’s default mode and its anti-correlated network in healthy subjects. Brain Research, 1287, 84-103.
Hui, K. K., Liu, J., Marina, O., Napadow, V., Haselgrove, C., Kwong, K. K., … & Rosen, B. R. (2005). The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage, 27(3), 479-496.
Komori, M., Takada, K., Tomizawa, Y., Nishiyama, K., Kaw