Chronic pain, often defined as pain lasting for at least twelve weeks, affects huge numbers of people. Existing treatments for chronic pain heavily depend on opioid drugs, such as morphine, codeine and tramadol. However, these drugs have disadvantages including side effects, addiction and tolerance, which cause many pain sufferers to turn to alternative treatments, such as acupuncture.
While acupuncture has many devotees, its efficacy has proven hard to document and its success is often highly variable. However, ground-breaking research is beginning to shed light on the physiological basis of acupuncture, and opens up new possibilities for chronic pain treatment that may bridge the gap between conventional and alternative medicine.
Peripheral pain relief
Unlike mainstream painkillers, which target the central nervous system (the brain and spinal cord) where pain is perceived, acupuncture targets the peripheral nerves in the rest of the body. Developed in China over 4,000 years ago, it is perhaps the most widely-accepted of all the ‘alternative’ forms of medicine.
Acupuncture claims to be a side effect-free form of pain relief – when it works. But so far there is no scientific explanation for its action, and its effects vary significantly from patient to patient, and even day to day. Some of acupuncture’s effects are thought to result from the release of opioid chemicals in the central nervous system, but this by no means explains its entire action, particularly at a more peripheral level.
Chronic pain may be of two types: inflammatory pain associated with tissue damage, and neuropathic pain associated with nerve damage. Researchers developed mouse models to characterize both these situations, and showed that acupuncture suppresses both types of pain in these animals. Simultaneously, they found that a small molecule, adenosine, was released at the site of the acupuncture treatment. They later confirmed that the same ‘neuromodulator’ is released during acupuncture treatment in human patients.
Adenosine was already known to have pain-relieving properties, mediated through receptor molecules called ‘adenosine A1 receptors’, which are found throughout the human body. Research showed that these A1 receptors are essential for the adenosine released during acupuncture to cause pain relief. He also found that injecting mice with CCPA, a molecule that mimics adenosine’s interaction with A1 receptors, brings relief from pain without the need for acupuncture itself. Finally, he showed that inhibiting certain enzymes that degrade adenosine, thus allowing it to build up in the body, could prolong the effect of acupuncture treatment. These findings offer a fascinating insight into an entirely new form of pain relief based around stimulating A1 receptors in the peripheral nervous system.
Pathway to pain relief
Acupuncture is not a quick fix therapy : it often provides only a few hours respite, with long-term relief coming only after multiple treatments. However, now that its mechanism of action is known, it may be possible to manipulate the physiological pathways involved to achieve more effective or longer-lasting relief. There is much still to discover but, through the research, we could be on the cusp of a new paradigm for pain relief, bringing hope to many millions of sufferers.
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Reference source: https://researchfeatures.com/2017/08/21/chronic-pain-acupuncture-needles-analgesia/
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