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Medical Author:

Joseph Sciammarella, MD, FACP, FACEP

Joseph Sciammarella, MD, FACP, FACEP

Dr. Sciammarella graduated from American University of the Caribbean in June, 1985. He is a Diplomate of the American Board of Internal Medicine, and the American Board of Emergency Medicine and has practiced Emergency Medicine for 19 years.

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Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Since the 1970s, much scientific information has been gathered about the physiologic mechanism by which acupuncture works. Most of this research has been focused on acupuncture's ability to relieve pain.

Early on, the placebo effect was dismissed as the main mechanism of action (a placebo means no active procedure or medication is actually given). Animals are not capable of demonstrating the placebo effect, yet, veterinary medicine uses acupuncture as an effective means of pain relief in the treatment of animals. Also, acupuncture pain relief is able to be blocked by certain drugs and reversed by administering the opiate-receptor antagonist naloxone. Both of these facts argue that a physiologic mechanism is involved in producing acupuncture pain relief.

• When an acupuncture needle is inserted into a traditional acupuncture point, certain nerve fibers are stimulated, which results in a nerve impulse being sent to the spinal cord. Here, endorphogenic cells are stimulated to release endorphins (brain chemicals) such as enkephalin and dynorphin. These substances provide local inhibition (blocking) of the incoming pain signal.



• In addition to causing effects in the spinal cord, the nerve impulse produced by the acupuncture needle is also transmitted to the periaqueductal gray area of the mid-brain, where enkephalin is released. Enkephalin, in turn, brings about the release of the monoamine neurotransmitters serotonin and norepinephrine in the spinal cord. These monoamines play a role in suppressing the transmission of the pain impulse. In addition to its role in reducing pain, serotonin is involved in producing an antidepressant effect in the brain. In fact, many of the newest antidepressant drugs work by prolonging the effect of serotonin in the brain.



• A third effect brought about by acupuncture is the release of beta-endorphin and adrenocorticotropic hormone (ACTH) from the pituitary gland into the bloodstream and cerebrospinal fluid. The endorphins produce system-wide pain relief, remote from the area where the acupuncture needle was inserted. ACTH, in turn, activates the adrenal gland to release cortisol into the bloodstream. Cortisol is a naturally occurring steroid substance that has anti-inflammatory properties.

The net result of these three areas being stimulated is an inhibition of the incoming pain sensation locally, a general, morphinelike, pain-relieving effect throughout the body, an anti-inflammatory effect, and a general sense of improved well-being.

The precise choice of acupuncture points, regarding whether they are near the painful site or farther away, determines which of the three pathways mentioned are primarily activated. Placing needles near the painful site brings about a more intense pain relief, because it activates all three centers (spinal cord, midbrain, and pituitary gland). Local needling also maximizes inhibition of the incoming pain signal at the segmental region of the spinal cord. Needling acupuncture points distant to the painful area predominantly affects the mid-brain and pituitary gland. In general, a combination of local and distant acupuncture points are used together during a treatment, in order to maximize the effects at all three centers.

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