Central and Peripheral Mechanism of Acupuncture Analgesia on Visceral Pain: A Systematic Review

Abstract

Background/Aims. Despite the wide use of acupuncture for the management of visceral pain and the growing interest in the pathophysiology of visceral pain, there is no conclusive elucidation of the mechanisms behind the effects of acupuncture on visceral pain. This systematic review aims to provide an integrative understanding of the treatment mechanism of acupuncture for visceral pain. Methods. Electronic and hand searches were conducted to identify studies that involved visceral pain and acupuncture. Results. We retrieved 192 articles, out of which 46 studies were included in our review. The results of our review demonstrated that visceral pain behaviors were significantly alleviated in response to acupuncture treatment in groups treated with this intervention compared to in sham acupuncture or no-treatment groups. Changes in the concentrations of β-endorphin, epinephrine, cortisol, and prostaglandin E2 in plasma, the levels of c-Fos, substance P, corticotropin-releasing hormone, P2X3, acetylcholinesterase (AchE), N-methyl-D-aspartate (NMDA) receptors, and serotonin in the gut/spinal cord, and the neuronal activity of the thalamus were associated with acupuncture treatment in visceral pain. Conclusions. Acupuncture reduced visceral pain behavior and induced significant changes in neuronal activity as well as in the levels of pain/inflammation-related cytokines and neurotransmitters in the brain-gut axis. Further researches on the thalamus and on a standard animal model are warranted to improve our knowledge on the mechanism of acupuncture that facilitates visceral pain modulation.

Electroacupuncture Ameliorates Gastric Hypersensitivity via Adrenergic Pathway in a Rat Model of Functional Dyspepsia

“…Acupuncture was reported to inhibit visceral nociceptors/afferent fiber sensation, inflammatory cytokine release, and CNS activation by regulating the levels of endogenous opioids, serotonin, and NE, and so on. (26).The autonomic mechanism was found to play a role in the ameliorating effect of EA on gastric hypersensitivity in the present study. Alternations of the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis have been implicated in the development of visceral hypersensitivity in patients with FGID (27).…”

Identification of Acupoint Indication from Reverse Inference: Data Mining of Randomized Controlled Clinical Trials

“…Among distal acupoints, low back pain was the indication for BL40 in the lower limb, while insomnia was the indication for acupoint HT7 in the wrist ( Figure 5 ). Classification of acupoint indications into regional and distal types is consistent with the approach used in previous studies, where both regional and distal acupoints were mainly used for pain management during acupuncture, based on data mining from clinical trials [ 1 , 8 , 11 ].…”

“…The associations between symptom differentiations and acupuncture prescriptions are relatively clear in classical textbooks, although the associations from these classical textbooks are not likely to be prominent in clinical practice [ 9 , 10 ]. Previous studies have identified selections of acupoints for various diseases such as lumbar disc herniation, dysmenorrhea, rheumatoid arthritis, and visceral pain [ 11 , 12 , 13 , 14 ]. However, these findings do not directly reveal the specificity of acupoint indication; they only indicate which acupoints can be selected specifically for a particular disease [ 15 ].…”

Traditional Chinese Medicine Could Play an Important Role in Integrative Palliative Care in China

“…For example, acupuncture and Chinese herbal medicines are recommended for cancer pain and serve to reduce opioid abuse. [27][28][29][30][31][32][33] TCM can also improve digestive symptoms, such as nausea, caused by radiotherapy and chemotherapy. [34][35][36] Moreover, psychiatric symptoms, such as anxiety and depression, in methamphetamine addicts during abstinence can be improved with electroacupuncture, 37 whereas depression-related insomnia and insomnia in cancer survivors can be treated with acupuncture, herbal medicines, and/or t'ai chi.…”