Pain and the Brain

 Pain and the Brain: It's all in your head!

The most common condition people seek an acupuncturist for is pain. Pain is such a subjective topic that most doctor's or healthcare providers cringe at the idea of treating pain because they feel it's so mundane or it's just in people's heads! Well, it is! Acupuncture excels at treating all kinds of pain, but why? Are the needles magical? Does the acupuncturist use some mysterious healing power? No! I'll try to lay it out as simply as possible.

Pain is both what you feel (subjective) and a physical change in the body (objective). If you twist your ankle, you feel pain and see marked redness and swelling. How does acupuncture help with both and why is Acupuncture different than taking pain medicine or anti-inflammatories? Any pain medicine basically has a band-aid effect. Pain is your body's way of saying something is wrong, so pay attention! Would you ignore your gas light coming on? No, you would fill your tank before you ran out of gas. Taking pain med's simply disrupts the signal and turns the warning light off. Both the feeling of pain and the physical change of our bodies come from one place: our brains.

Acupuncture affects the brain. The brain is our master control center. Without your brain, you're, well, dead! How does it affect the brain, you ask? There are two pathways of the brain—the one that goes to the brain and the one that goes away from the brain. Acupuncture directly changes the signal to the brain. Once that signal is changed, the signal back to the sensation is obviously altered. Acupuncture points have been found to match the exact location of microscopic fibers called C Fibers, which are nerve endings that send signals to and from the brain. C fibers are responsible for telling the brain when a sensation is detected of either temperature, touch, body position change or pain (nociception). The pathways that C fibers travel along to send their message to the brain is along the spinal cord, brain stem, insular cortex and the thalamus and hypothalamus.

A large study was done with three groups of patients. The first group was aware they were not receiving real acupuncture and a needle simply touched the skin. The second group thought they were receiving real acupuncture, however trick needles were used, which touched the skin and appeared to puncture the skin but did not. The third group received real acupuncture. Looking at a brain scan (PET scan), scientists found that the second group all had areas of their brain stimulated where natural opiates and endorphin's are produced (in the hypothalamus); opiates and endorphin's are responsible for the feeling of decreased pain, sedation, overall well-being and euphoria and are often supplemented through recreational drugs to produce this powerful feeling. The brain scans of the third group who had real acupuncture also had areas of opiate/endorphin production light upon their scan, but the insular cortex was heavily affected as well. The insular cortex is an area in the brain responsible for the following (to list just a few): Emotions (including love, anger, fear, sadness, happiness, sexual arousal, disgust, aversion and unfairness), motor control, self-awareness, cognitive functioning, perception, interpersonal experience, sense of inner body, blood pressure, warmth and coldness, motivation, food/drug cravings, formation of memories and balances of your 'fight or flight' and'rest and digest' responses (sympathetic and parasympathetic).

So, let's recap: When a needle is inserted, it stimulates C fibers, which transmit signals and travel along nerve pathways, up the spinal cord, through the brain stem and land at their final destination at the hypothalamus, where opiates are produced to decrease pain; the thalamus, where alertness or sleepiness are determined; and the insular cortex, which plays a big role in emotions and experiences. If you've had acupuncture before, a good sign that your C fibers are being stimulated is the sensation of warmth around the needles or itchiness. These responses are specific to the stimuli of C fibers. So, if acupuncture can help stimulate the insular cortex, which is responsible for how you feel about the pain and remember the pain, how can acupuncture help with symptoms like swelling, inflammation and healing an injury?

Inserting an acupuncture needle mobilizes your body's own defense mechanisms. Acupuncture stimulates an amino acid called Calcitonine Gene-Related Peptide, or CGRP,which has the ability to both prevent and promote inflammation. CGRP works in close contact with Substance P, which is responsible for any swelling or edema and contains the injury to one area, bringing white and red blood cells to the site. Acupuncture has also been found to stimulate beta-endorphin's, which are specific to decreasing the sensation of pain. Cytokines are also released, which area composite of white blood cells that provide an immune response and spark cellular growth. So there you have it! That is simply the known effects of how acupuncture helps with pain. As mentioned before about the empty gas tank, acupuncture has the ability to help stimulate substances that are deficient, basically helping your body to create more gas to put into the tank. So instead of just turning the warning light off, gas is added to the tank, which in turn, turns the light off. We know that the insertion of acupuncture needles into specific areas at specific depths in unique, and custom combinations of points have the effect of releasing opiates and endorphin's, changing the feeling or sensation of the pain and helping the immune system and the inflammation process to help the body heal itself.

The wonderful thing about my job is that I don't just stick people with needles. There are other ways to essentially stimulate these processes. The utilization of other therapies such as cupping, electrical stimulation, massage, medicated oils, dietary and herbal therapy all help your body help itself. If you're afraid of needles, have no fear! I have been specially trained in the ancient style of needling called Free Hand Needling, which is far more comfortable for the patient. A majority of traditional American acupuncturists use what's called a guide tube, which is placed on the skin and the needle is tapped through the tube. This excites the nervous system too much and alerts it of possible pain; the needle is slowly pressed through each layer of skin. With free hand needling, there is no guide tube used and the needle is simply inserted quickly with one rapid movement. Instead of each layer of skin feeling a pins and needles sensation, the speed of free handing goes right to the bottom layer of skin, where virtually no needle sensation is felt. The ideal warming and itching feeling is obtained rapidly. Acupuncture is a fascinating process. It's difficult to understand the full possibilities of it, since the theory of acupuncture is that every person is unique and no two people should be treated alike. Health and healing are all quite possible with the right tools and knowledge about your body.

Karen Salmansohn once said, "Often it's the deepest pain which empowers you to grow into your highest self."