Understanding Acupuncture for Analgesia
Exploring Acupoints and Mechanisms for Pain Relief
Pain arises from a network of interconnected pathways involving both body and mind. Research indicates that acupuncture (encompassing meridian-based methods, electroacupuncture, and dry needling) can modify these pathways to offer meaningful analgesic benefits. In particular, this approach addresses visceral hypersensitivity, chronic inflammatory conditions, and pain-related emotional distress.
Key Points
Pain Circuitry: Acupuncture engages key pain regulatory circuits, including the insular cortex (IC), anterior cingulate cortex (ACC), and amygdala (AMG).
Visceral Pain and Emotion: Treatments at certain acupoints calm excessive inflammation and reduce emotional distress linked to pain by modulating ACC/PFC pathways and amygdala function.
Acupoint Specificity: Points like BL25, ST25, ST37, SP6, ST36, GB34, PC6, and GB30 demonstrate distinct analgesic properties, from reducing hyperalgesia to dampening neuroinflammation.
Mechanistic Insights: Downregulation of pro-inflammatory mediators (e.g., IL-1β, TNF-α), astrocyte activation, and P2 receptors lowers sensitivity to pain.
Comprehensive Approach: Acupuncture targets both ascending pain signals and descending inhibitory pathways, offering a multifaceted solution for chronic and acute pain relief.
This diagram illustrates how signals travel through the nervous system to mediate pain relief via acupuncture. It depicts the ascending pathways (in black) that carry pain signals from areas like the primary (S1) and secondary (S2) somatosensory cortices toward higher brain centers, and the descending pathways (in blue) that project from structures such as the prefrontal cortex (PFC), anterior cingulate cortex (ACC), and amygdala (AMG) down through the periaqueductal gray (PAG) and locus coeruleus (LC) to the ventrolateral medulla (VLM). Together, these networks show how the brain both perceives pain and regulates it through top-down control mechanisms activated by acupuncture.
Source: Li YW, Li W, Wang ST, Gong YN, Dou BM, Lyu ZX, Ulloa L, Wang SJ, Xu ZF, Guo Y. The autonomic nervous system: A potential link to the efficacy of acupuncture. Front Neurosci. 2022 Dec 8;16:1038945. doi: 10.3389/fnins.2022.1038945. PMID: 36570846; PMCID: PMC9772996.
How Acupuncture Influences Pain Pathways
Acupuncture engages the body’s built-in system for managing pain by affecting both the pathways that carry pain signals to the brain and the pathways that help reduce or inhibit those signals. When a painful stimulus is first detected, it travels from nerves in the affected area through the spinal cord to higher brain centers that interpret and localize the discomfort. Parts of the brain involved in emotions, such as those responsible for fear or distress, can also influence how intensely this pain is perceived.
However, the brain doesn’t just receive pain messages; it can also send signals back down to decrease the severity of pain. These downward connections allow the release of natural painkilling chemicals and control how strong or weak pain impulses become before they reach higher levels of awareness. Acupuncture leverages this dual system by activating and fine-tuning these communication loops, helping the body both recognize and modulate pain signals in a balanced and more tolerable way.
Connection to Central Autonomic Network (CAN)
Multiple areas in the brain integrate nociceptive signals (those related to pain) and coordinate how the body responds. Regions such as the amygdala (AMG), ACC, and prefrontal cortex (PFC) not only interpret pain but also influence mood and emotional reactions.
Visceral Pain and Depression: Animal models show that visceral pain can be intertwined with mood disorders, highlighting the role of structures like the PFC. For example, electroacupuncture at BL25 significantly lowered P2Y12 receptor expression in the PFC, reducing both pain and depressive symptoms.
Role of the Amygdala in Pain-Related Emotion
The amygdala processes emotional responses to stimuli like pain. Overactivity here can amplify discomfort and stress:
SP6: Electroacupuncture at SP6 strengthens functional connections between the amygdala and regions in the brainstem, orbitofrontal cortex, and ACC, effectively reducing pain-linked emotional dysregulation (e.g., premenstrual syndrome).
ST36 + GB34: Research suggests these points can raise dopamine levels in the amygdala, curb inflammation, and thereby lessen pain and negative mood.
Reducing Neuroinflammation and Hyperalgesia
Acupuncture can decrease the release of inflammatory markers such as IL-1β or TNF-α, and moderate the activation of astrocytes:
ST25 + ST37: Particularly useful for irritable bowel syndrome (IBS) pain, decreasing astrocyte activation in the ACC and the medial thalamic nucleus (MT).
ST36: Often targets TRPV1-PERK signaling pathways in the amygdala and related brain areas, lowering both inflammation and hypersensitivity.
Inflammatory markers like IL-1β and TNF-α are chemical messengers that signal the body to activate its immune response, which can lead to redness, swelling, or heightened sensitivity when they’re overproduced. Astrocytes are helper cells in the brain that normally support healthy neuron function, but when they become too active, they can contribute to inflammation and pain. For example, acupuncture at ST25 and ST37 helps calm these overactive astrocytes in areas linked to pain processing—such as the anterior cingulate cortex and the medial thalamic nucleus—making it especially beneficial for irritable bowel syndrome. Similarly, stimulating ST36 can reduce inflammation and hypersensitivity by influencing TRPV1-PERK pathways in the amygdala and other related brain regions, further illustrating how acupuncture’s effects extend beyond local needling sites to modulate broader immune and pain-related processes.
Ascending and Descending Pathway Regulation
Ascending Activation: Acupuncture blunts the excessive forwarding of pain signals to higher centers, providing relief from visceral or musculoskeletal pain.
Descending Inhibition: By activating the periaqueductal gray (PAG), rostral ventromedial medulla (RVM), and other descending circuits, it increases the body’s natural pain-control output.
Acupuncture Points for Analgesia
Below is a brief summary of acupoints often cited in analgesia research, reflecting how they may alleviate various pain conditions:
| Acupoint | Indications for Pain Relief | Mechanisms / Key Effects |
|---|---|---|
| PC6 (Neiguan) | Chest pain, upper abdominal pain, emotional stress |
• Calms emotional distress via PFC/AMG pathways • Improves descending inhibition of pain signals |
| BL25 (Dachangshu) | Visceral pain in bowel disorders, e.g., IBD |
• Downregulates P2Y12 receptor in the PFC • Reduces IL-1β and microglial activation • Lowers depression-pain dual burden |
| ST25 (Tianshu) | Abdominal pain, IBS-related discomfort |
• Decreases reactive astrocytes in MT and ACC • Reduces visceral hypersensitivity through P2 × 3 receptor modulation |
| ST37 (Shangjuxu) | Visceral pain, IBS, and gut motility issues |
• Alleviates visceral hypersensitivity • Inhibits P2 × 3 receptor in ACC/PFC • Works with ST25 to address IBS pain |
| SP6 (Sanyinjiao) | Gynecological pain, PMS discomfort, lower abdominal pain |
• Enhances AMG connectivity with brainstem • Modulates pain-associated emotional dysregulation |
| GB30 (Huantiao) | Sciatic pain, hip pain |
• Regulates local inflammation in musculoskeletal issues • Potentially improves local circulation, reducing pain |
| GB34 (Yanglingquan) | Neuropathic pain, joint and muscle pain |
• Upregulates dopamine (DA) in AMG • Reduces TNF-α, IL-1β, GFAP in the brain • Often paired with ST36 for enhanced analgesic effect |
| ST36 (Zusanli) | General analgesia (fibromyalgia, neuropathic, visceral) |
• Reduces TRPV1-PERK inflammatory signaling • Enhances descending inhibition via PAG • One of the most researched points in pain management |
Conclusion
Acupuncture’s analgesic properties are closely tied to its regulation of central and peripheral mechanisms. By focusing on specific acupoints—such as BL25, ST25, ST37 for visceral pain, or ST36 and GB34 for broader pain and inflammatory issues—practitioners leverage acupuncture’s ability to calm the amygdala, ACC, and other neural hubs involved in pain perception. In doing so, it helps blunt the emotional and physiological intensity of pain, promoting overall well-being.
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Frequently Asked Questions (FAQ)
How does acupuncture help with chronic pain relief?
Acupuncture stimulates specific points on the body (acupoints) to influence pain pathways, including both peripheral and central nervous system mechanisms. This can reduce inflammation, modulate neurotransmitters, and activate natural painkillers (endorphins), making it highly effective for chronic pain management.
Can electroacupuncture and dry needling provide faster analgesic effects?
Electroacupuncture applies a mild electric current through the acupuncture needle, potentially enhancing stimulation and pain relief for conditions like fibromyalgia or neuropathic pain. Dry needling targets trigger points in musculoskeletal issues. Both can complement traditional acupuncture in certain pain-related cases, though effectiveness varies by individual and condition.
Which acupoints are most beneficial for pain and stress?
Commonly used points for analgesia and stress relief include ST36 (Zusanli), GB34 (Yanglingquan), and PC6 (Neiguan). These points have shown promising results in reducing inflammation, calming the central nervous system, and improving emotional well-being.
How many acupuncture sessions are needed before I see pain relief?
Each patient’s response is unique. Some individuals experience noticeable relief after one or two sessions, while others require a longer treatment plan—especially for complex or long-standing pain conditions. Your practitioner will tailor the frequency and duration of sessions to your specific needs.
Are there any risks or side effects with acupuncture for pain?
Acupuncture is generally safe when performed by a trained, certified practitioner. Mild side effects, such as bruising or soreness at the needling site, are possible but typically subside quickly. Serious complications are rare, especially when sterile, single-use needles are used according to best practices.
How does acupuncture reduce visceral pain?
By targeting autonomic and limbic circuits—particularly the prefrontal cortex (PFC), anterior cingulate cortex (ACC), and amygdala (AMG)—acupuncture downregulates pro-inflammatory markers and neuroreceptors linked to pain hypersensitivity, diminishing visceral discomfort.
Which acupoints are best for IBS-related pain?
Electroacupuncture at ST25 (Tianshu) and ST37 (Shangjuxu) has been shown to reduce IBS pain by modulating astrocyte activity and P2 × 3 receptors in pain-processing regions like the ACC and PFC.
Can acupuncture help with pain and depression together?
Yes. Research on acupoints like BL25 indicates it may ease pain and depressive symptoms simultaneously by regulating P2Y12 receptors and reducing neuroinflammation in the PFC.
Why are ST36 and GB34 often combined?
ST36 (Zusanli) and GB34 (Yanglingquan) complement each other by raising dopamine levels in the amygdala and suppressing key inflammatory markers, offering a synergistic effect for pain relief and improved emotional state.
Does acupuncture alleviate pain-related emotional stress?
Yes. By calming the amygdala and ACC—regions that handle emotional responses—acupuncture helps lessen stress and anxiety tied to chronic pain, providing a more holistic treatment benefit.
Sources:
Li YW, Li W, Wang ST, Gong YN, Dou BM, Lyu ZX, Ulloa L, Wang SJ, Xu ZF, Guo Y. The autonomic nervous system: A potential link to the efficacy of acupuncture. Front Neurosci. 2022 Dec 8;16:1038945. doi: 10.3389/fnins.2022.1038945. PMID: 36570846; PMCID: PMC9772996.
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