Acupuncture and Pain Management
IN-DEPTH: INTEGRATIVE MEDICINE (COMPLEMENTARY & ALTERNATIVE MEDICINE) Acupuncture and Pain Management James D. Kenney, DVM There is a large and expanding body of scientific evidence supporting the use of acupuncture in pain management. In the last decade, our understanding of how the brain processes acupuncture anal- gesia has undergone considerable development. Profound studies on neural mechanisms underlying acupuncture analgesia have evolved rapidly and predominately focus on cellular and molecular substrate and functional brain imaging. The currently understood mechanisms of acupuncture analgesia are complex and involve direct and indirect neurohumoral effects that block pain percep- tion, reduce the pain response, relieve muscle spasms, and reduce inflammation. The analgesic mechanisms of acupuncture involve the spinal cord grey matter, hypothalamic-pituitary axis, mid- brain periaqueductal grey matter, medulla oblongata, limbic system, cerebral cortex, and autonomic nervous system. Electroacupuncture (EA) stimulation of these sites results in activation of descend- ing pathways that inhibit pain through endogenous opioid, noradrenergic, and serotonergic sys- tems. There are growing numbers of human trials supporting the use of acupuncture as an evidence- based practice for pain management in human medicine. There are many studies that support the efficacy of acupuncture for low back pain, neck pain, chronic idiopathic and migraine headaches, knee pain, shoulder pain, fibromyalgia, temporomandibular joint pain, and postoperative pain. Although the number of well-designed, controlled clinical research studies in veterinary medicine is lagging behind the number of studies in human medicine, much of the basic science research has been done in animals with neurophysiology that is more similar to veterinary patients than humans. Although there is research to support EA as an evidence-based practice for the control of back pain in horses, additional studies are needed in other clinical situations in veterinary medicine where pain manage- ment is required.
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