Patients presenting with aches and pains are the bulk of most acupuncture practices. Why? Well quite simply it helps. It can help reduce the intensity of pain and the frequency of painful episodes, but ‘pain’ can mean a lot of different things to different people. In this blog I’d like to have a look at how an acupuncturist interprets the symptom of pain and how it affects the points he or she chooses and whether we can find a explanation in our own language and medical model of how it might work.
Pain for an acupuncturist usually translates as either ‘Qi stagnation’ or ‘Blood stagnation / stasis’. Qi stagnation is seen as the milder of the two – yet that’s not to say it can’t be extremely painful, but can be characterised by pain that comes and goes. An example of this might be the muscles aches in the upper body so often seen with fibromyalgia. The shoulders can feel really tender and sore for a few days in a row then the patient might feel the pain ease off for a day or two. The pain from Qi stagnation can move around so one day it might feel worse near the neck and then the next day it could be the tops of the shoulders. The words used to describe the pain felt from from Qi stagnation are usually ‘dull, grindy, nervy, niggly, achy’. The goal of the acupuncturist is to get the Qi moving, first by needling points on the affected meridians and then by choosing points that invigorate Qi throughout the body. The simplest of these is known as ‘Four Gates’ and is taught even on acupuncture weekend courses to physios and chiropractors. An acupuncturist might also want to consider why the Qi became stuck in the first place and add in extra needles to try and prevent it from returning and suggest lifestyle changes and specific exercises.
Moving onto ‘blood stagnation and stasis’ which sounds a bit severe, and well yes it can be. The pain here is usually more fixed in its location and presents more consistently. An example of blood stasis could be endometriosis, a gynecological condition that can cause overwhelming pain throughout the menstrual cycle. Aside from local needling, points are chosen on the affected meridians that address blood stasis specifically. Another example would be physical injury – like a broken bone or torn ligament.
Further to that we look to see if the pain is hot or cold in nature – for example signs of redness or inflammation around a joint would say heat to us. We also look to see if it is excess or deficient – if it feels better when pressure is applied then we think deficient. All this information helps an acupuncturist decide whether to use additional therapies like Tui-Na, massage, heat lamps and moxa plus whether to use strong needling techniques or gentle.
Ok – so what happens if the traditional Chinese medicine theory of Qi and Blood not to mention YinYang doesn’t resonate with you? Luckily the effects of acupuncture are not dependent an individual’s belief system (though as with any health intervention if you think you’ll get better you are more likely to – so think positive!). Acupuncture has a good reputation for helping those in pain so there’s been a good bit of work done to discover what actually happens when an acupuncture needle is inserted. It has been suggested that the tingling ache often felt during acupuncture is the direct stimulation of afferent nerve fibres located in muscles and other tissues with leads to a release of endorphins, neuropeptide Y and serotonin – which can all affect perception of pain. A study also saw an increased release of adenosine which has anti-nociceptive properties while two others looked at the reduction of inflammation during acupuncture. Several things can be seen to happen as a result but no-one is yet sure what is having the biggest affect and perhaps it is everything together.
If you are wondering whether acupuncture can help it really is a case of getting started – you’ll probably know at the end of the first session whether acupuncture is something you’d like to continue with.