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14-September-2008 18:02:37 - Scientific theories regarding acupuncture This article was considered for deletion and requires cleanup according to the discussion. Please improve this article if you can. December 2007 The neutrality and factual accuracy of this article are disputed. Please see the relevant discussion on the talk page. December 2007 Scientific studies have been conducted concerning the hypothesized principles underlying the proposed mechanism of action of acupuncture. Contents 1 Nerve-reflex theory 2 Gate-control theory of pain 3 Neurohormonal theory 4 References Nerve-reflex theory This article or section may contain original research or unverified claims. Please improve the article by adding references. January 2008 The nerve-reflex theory developed by Ishikawa and Fujita et al. in the 1950s proposed the reflex interactions between the periphery and the autonomic nervous system. This theory states that the skin cutaneous surface and internal organs visceras are intimately connected by these reflexes - viscera-cutaneous reflex and cutaneous-viscera reflex. These reflexes can be related to the neuroendocrine-autonomic responses, which is mediated partly by the hypothalamic-pituitary-adrenal axis HPA axis. HPA axis is a complex set of feedback interactions between the hypothalamus located in the midbrain, the pituitary located beneath the brain and the adrenal glands located in the kidneys. The HPA axis is a major part of the neuroendocrine system that regulates stress responses and maintains the homeostatic condition of autonomic responses directly or indirectly, such as circulation regulation, breathing regulation, feeding behavior, weight control and digestion, immune responses, pain responses, acute stresses and chronic stresses, mood states, sexual/reproductive responses, growth, fluid balance and metabolic energy balances. In 2006, a broad sense hypothalamus-pituitary-adrenal BS-HPA axis model was proposed to explain the hypothesized analgesic effect of acupuncture based on observed neuroimaging brain scanning results using fMRI functional resonance magnetic imaging technique.1 The model incorporated the stress-induced HPA axis model together with neuro-immune interaction including the cholinergic anti-inflammatory model. Gate-control theory of pain The gate control theory of pain developed by Ronald Melzack and Patrick Wall in 19622 and in 19653 proposed that pain perception is not simply a direct result of activating pain fibers, but modulated by interplay between excitation and inhibition of the pain pathways. According to the theory, the gating of pain is controlled by the inhibitory action on the pain pathways. That is, the perception of pain can be altered gated on or off by a number of means physiologically, psychologically and pharmacologically. The gate-control theory was developed in neuroscience independent of acupuncture, which later was proposed as a mechanism to account for the hypothesized analgesic action of acupuncture in the brainstem reticular formation by a German neuroscientist in 1976.4 This leads to the theory of central control of pain gating, i.e., pain blockade at the brain i.e., central to the brain rather than at the spinal cord or periphery via the release of endogenous opioid natural pain killers in the brain neurohormones, such as endorphins and enkephalins naturally occurring morphines. Neurohormonal theory Pain transmission can also be modulated at many other levels in the brain along the pain pathways, including the periaqueductal gray, thalamus, and the feedback pathways from the cortex back to the thalamus. Pain blockade at these brain locations are often mediated by neurohormones, especially those that bind to the opioid receptors pain-blockade site. Analgesic pain-killing action of acupuncture was demonstrated to be mediated by stimulating the release of natural endorphins in the brain. This effect can be inferred scientifically by blocking the action of endorphins or morphine using a drug called naloxone. When naloxone is administered to the patient, the analgesic effects of morphine can be reversed, causing the patient to feel pain again. When naloxone is administered to an acupunctured patient, the analgesic effect of acupuncture can also be reversed, leaving the patient with intense pain again. This demonstrates that the site of action of acupuncture is mediated through the natural release of endorphins by the brain, which can be reversed by naloxone.5678 Such analgesic effect can also be shown to last more than an hour after acupuncture stimulation by recording the neural activity directly in the thalamus pain processing site of the monkey's brain.9 It should be noted, however, that studies using similar methodological procedures, including the administration of naloxone, have suggested a role of endogenous opioids in the placebo response, demonstrating that this response is not unique to acupuncture. 10 There is also a large overlap between the nervous system and acupuncture trigger points points of maximum tenderness in myofascial pain syndrome11. Research has also suggested that the sites of action of analgesia associated with acupuncture administration are mediated through the thalamus using fMRI functional magnetic resonance imaging12 and positron emission tomography PET13 brain imaging techniques,14 and via the feedback pathway from the cerebral cortex using electrophysiological recording of the nerve impulses of neurons directly in the cortex, which shows inhibitory action when acupuncture stimulus was applied.15 Similar effects have been observed in association with the placebo response. One study using fMRI found that placebo analgesia was associated with decreased activity in the thalamus, insula and anterior cingulate cortex 16. References ^ Cho ZH, Hwang SC, Wong EK, Son YD, Kang CK, Park TS, Bai SJ, Kim YB, Lee YB, Sung KK, Lee BH, Shepp LA, Min KT. Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms. Acta Neurol Scand. 2006;113:370-7. ^ P.D. Wall, R. Melzack, On nature of cutaneous sensory mechanisms, Brain, 85:331, 1962. ^ R. Melzack, P.D. Wall, Pain mechanisms: A new theory, Science, 150:171-9, 1965. ^ Melzack R. Acupuncture and pain mechanisms Anaesthesist. 1976;25:204-7. ^ Pomeranz B, Chiu D. Naloxone blocks acupuncture analgesia and causes hyperalgesia: endorphin is implicated. Life Sci 1976;19:1757-1762. ^ Mayer DJ, Price DD, Raffii A. Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone. Brain Res 1977;121:368-72. ^ Eriksson SV, Lundeberg T, Lundeberg S. Interaction of diazepam and naloxone on acupuncture induced pain relief. Am J Chin Med. 1991;19:1-7. ^ Bishop B.Pain: its physiology and rationale for management. Part III. Consequences of current concepts of pain mechanisms related to pain management. Phys Ther. 1980, 60:24-37. ^ Sandrew BB, Yang RC Jr, Wang SC. Electro-acupuncture analgesia in monkeys: a behavioral and neurophysiological assessment. Arch Int Pharmacodyn Ther. 1978 231:274-84. ^ Amanzio, M., Pollo, A., Maggi, G., Benedetti, F. 2001. Response Variability to Analgesics: a Role for Non-specific Activation of Endogenous Opioids. Pain 90 3: 205-215. ^ Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain 1977;3:3-23. ^ Li K, Shan B, Xu J, Liu H, Wang W, Zhi L, Li K, Yan B, Tang X. Changes in FMRI in the human brain related to different durations of manual acupuncture needling. J Altern Complement Med. 2006;12:615-23. ^ Pariente J, White P, Frackowiak RS, Lewith G. Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture. Neuroimage. 2005;25:1161-7. ^ Shen J. Research on the neurophysiological mechanisms of acupuncture: review of selected studies and methodological issues. J Altern Complement Med. 2001;7 Suppl 1:S121-7. ^ Liu JL, Han XW, Su SN. The role of frontal neurons in pain and acupuncture analgesia. Sci China B. 1990 33:938-45. ^ Wagner, T.D., Rilling, J.K., Smith, E.E., Sokolik, A., Casey, K.L. et al. 2007. Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain. Science 303 5661: 1162-1167.. v d e Acupuncture Concepts Acupuncture point · Meridian · Qi · Regulation of acupuncture · Scientific theories regarding acupuncture Types Auriculotherapy · Dry needling · Electroacupuncture · Medical acupuncture Category · Portal Retrieved from http://en..org/wiki/Scientific_theories_regarding_acupuncture Categories: AcupunctureHidden categories: Cleanup from December 2007 | All pages needing cleanup | Accuracy disputes from December 2007 | NPOV disputes from December 2007 | Articles that may contain original research since January 2008 | All articles that may contain original research Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 23 July 2008, at 10:01
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