Understanding the Mechanism of Action of Western Acupuncture for Muscular System

Running head: ACUPUNCTURE-RELATED RESEARCH LITERATURE
Acupuncture-related research literature
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1ACUPUNCTURE-RELATED RESEARCH LITERATURE
Acupuncture is gaining popularity in the current years as an important modality of
complementary and alternative medicine in the western society. It is the insertion of needles for
stimulation of specific acupoints present in the body for facilitating recovery. There is increased
public attention and acceptance towards scientific exploration of physiological mechanism of
acupuncture. When needles are inserted into the body, it goes through multiple layers that
include skin, muscles and subcutaneous tissue considered as the beginning of healing process
initiated by biophysical, neuronal and biochemical reactions (Action 2009). It has a promising
efficacy in the treatment of postoperative pain and beneficial for pain management. Western
acupuncture is considered to be a form of alternative medicine that is used for pain relief
including shoulder stiffness, low back pain and knee pain (VanderPloeg and Yi 2009). This is
possible as it affects afferent nerve signalling and influences the release of endogenous opioids
for the promotion of pain relief. Acupuncture has a therapeutic effect that can be augmented by
ACTH and cortisol release, down-regulation of the signalling pathways through the pain fibres
(Zhu 2014). Western acupuncture is used for chronic back pain and a cost-effective therapy
adjunct to clinical care adapted from Chinese acupuncture. It is used for the treatment of
musculoskeletal pain that includes myofascial trigger where practitioners choose best points in
the body for stimulating nervous system. Therefore, the following assignment involves the
understanding of mechanism of action of western acupuncture for the muscular system having
therapeutic effects with its benefits and limitations.
Western acupuncture is a translation that modulates imbalances between the sympathetic
and parasympathetic activity. It has evolved from Chinese acupuncture where the practitioners
does not align to Yin/Yang and qi circulation and regarded as a part of the Chinese conventional
medicine designated as “alternative medical system”. This method acts through stimulation of

2ACUPUNCTURE-RELATED RESEARCH LITERATURE
nervous system and mode of action including local antidromic axon reflexes, extrasegmental and
segmental neuromodulation (Bai and Lao 2013). Western acupuncture involved fine needles
insertion that uses current knowledge of physiology, anatomy and pathology through evidence-
based medicine. This form of acupuncture is used for the treatment of symptoms supporting the
fact that it supports alleviation of types of pain and nausea. It does not have single mode of
action and the main therapeutic effect is achieved through nervous system or sensory stimulation.
This results in the production of natural substances inside the body like pain-relieving
endomorphins having long-lasting pain relief as compared to single treatment (Vickers et al.
2012). The needle insertion has local effects through antidromic and local axon reflexes, increase
in local nutritive blood flow and release of neuropeptides. Western acupuncture has clinical
effects on the musculoskeletal pain that can be explained through inhibition of nociceptive
pathway at dorsal horn. This can be explained by activation of descend inhibitory pathway
having segmental or local effects on the myofascial trigger points (Abdulla et al. 2013). The pain
relief mechanism is explained through “gate control theory” where western acupuncture activates
peripheral nerves for shutting the gate on the pain signals that travels through spinal cord (Chon
and Lee 2013). The interruption of pain signals acting as alterative therapy is called
transcutaneous electrical nerve stimulation (TENS). Various adjuncts like electrical acupuncture,
heat lamps, injection acupuncture and moxibustion with acupuncture is used for the pain relief
and management. In dry needling or trigger point needling technique, needle is inserted at
specific trigger points where the needle is dry or solid injection needle (Dunning et al. 2014).
Musculoskeletal pain affects muscles, bones, tendons, ligaments and nerves causing
acute or chronic pain either localized or widespread. It is often caused by an injury or jerking
movements, falls, accidents, fractures, direct blow to muscle or dislocations. It may also be

3ACUPUNCTURE-RELATED RESEARCH LITERATURE
caused by overuse affecting 33% of adults and lower back pain is the most common work-related
injury diagnosed in the Western society (Coggon et al. 2013). The damage to the muscle tissue
due to wear and tear can also cause musculoskeletal pain, repetitive movements, postural pain
and prolonged immobilization. Low back pain is the most prevalent and common work-related
injury that accounts for 29% lost working days (Balagué et al. 2012). Although, the
pathophysiology of musculoskeletal pain is not clear, fibrosis, inflammation, tissue degradation,
neurosensory and transmitter disturbances have been implicated. The musculoskeletal injury
causes increase in mediators and pro-inflammatory cytokines in the affected tissues leading to
peripheral nociceptor sensitization. This inflammation can cause fibrotic scarring called fibrosis
where there is increase in collagen between and within cells and tissues, reduction in tissue
gliding during movement that results in stretch injuries and increased pain (Nijs et al. 2013).
Tissue degradation also takes place where there is increase in inflammatory mediators which in
turn increases the degradation of extracellular matrices due to increased matrix
metalloproteinases enzyme. There is also lowering of tissue load tolerance resulting in further
injury and pain. Hypersensitivity, increase in neurotransmitter, cytokines and inflammatory
mediator levels cause central pain amplification with nerve compression. Various approaches are
present in acupuncture treatment of musculoskeletal pain and trigger point approach is used in
western acupuncture where needling of Ah Shi points reduces pain explained by biochemical or
neural mechanisms (Dommerholt and de las Penas 2013). The trigger point concept realizes that
musculoskeletal pain is located at some distance away from the area where an individual
experiences pain (Téllez-García et al. 2015). Therefore, stimulation of trigger points in muscular
system by western acupuncture can treat and manage musculoskeletal pain discussed in the
subsequent section.