Understanding Western Acupuncture: Research and Therapeutic Effects

This report provides a comprehensive overview of acupuncture-related research, specifically focusing on the application of western acupuncture in the treatment of musculoskeletal pain. It explores the mechanisms of action, including local antidromic axon reflexes, segmental and extrasegmental neuromodulation, and the influence on the nervous system. The report highlights the benefits of western acupuncture, such as its efficacy in pain relief through the release of endogenous opioids and the modulation of sympathetic and parasympathetic activity. It also discusses the layering method used by physiotherapists, integrating both traditional Chinese acupuncture (TCA) and western clinical reasoning. The report delves into the treatment of musculoskeletal pain, the use of trigger point approaches, and the application of techniques like electroacupuncture and dry needling. The report also examines various pain mechanisms, including nociceptive and neurogenic pain, and how western acupuncture can be applied to manage them. Overall, this report provides an in-depth analysis of western acupuncture, its therapeutic effects, and its role in pain management.

Running head: ACUPUNCTURE-RELATED RESEARCH LITERATURE
Acupuncture-related research literature
Name of the Student
Name of the University
Author note

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.

4ACUPUNCTURE-RELATED RESEARCH LITERATURE
Physiotherapists use acupuncture for treating musculoskeletal pain by following a
clinical reasoning process (CRP) for the manual therapy interventions. In western acupuncture,
the “layering method” is specifically developed for the physiotherapists for the treatment of
musculoskeletal conditions via mechanism-based approach (Patil et al. 2016). It is aimed at
targeting the different physiological processes within CNS for providing best effect for each
patient diagnosed with musculoskeletal pain. However, it also integrates traditional Chinese
acupuncture (TCA) into western clinical reasoning. This method allows physiotherapists to
progressively target the pathophysiology of condition of patient while using the effects of
acupuncture on CNS. Within western acupuncture, clinical reasoning requires asking series of
questions as what the main aim of needling technique is and what is required from it (Chang
2012).
Various mechanisms underpins the layering method where the clinician need to
understand the acupuncture points, anatomy knowledge, segmental innervations and peripheral
neuroanatomy for the treatment of musculoskeletal pain. Pain mechanisms are understood via
various methods of pain classification where western acupuncture is effective for various pain
types, diagnosis that also underpin prognosis determination and treatment decisions (Smart et al.
2012). Nociceptive pain results from nociceptor stimulation that relies on nervous system in the
peripheral tissues. The mechanisms can be via inflammatory, mechanical or ischaemic associated
with tissue injury or acute pain. In the spinal cord, the dorsal horn neurons and peripheral nerve
endings become sensitized; however these processes resolve when the tissue is healed and self-
limiting (Fornasari 2012). In this mechanism, stimulus-response relationship prevails between
pain provocation and experience. Therefore, in this mechanism, nociceptive pain has been
illustrated to respond positively to the western acupuncture treatment. Neurogenic pain arises

5ACUPUNCTURE-RELATED RESEARCH LITERATURE
from dorsal root ganglion or nerve segment due to axon damage reacting to sensory inputs and
non-noxious inputs sustain or evoke pain resulting in neurogenic pain that is characterized by
hyperalgesia and allodynia (Cox 2012). Conventional acupuncture is not effective for neurogenic
pain and low-intensity, high-frequency electroacupuncture is applied for activation of non-opioid
or noradrenergic pathway in spinal cord.
The yes/no question format is a way of problem-solving method as to presentations in
tissue and pain mechanisms, appropriate stimulation points and parameters that can be used to
deliver optimum intervention. The questions are asked in terms of peripheral and segmental
effects and chronic nociceptive pain. The next layer is segmental sympathetic effects followed
by analgesia (supraspinal effects) and sympathetic points (supraspinal motor cortex),
supraspinal effects and finally immune effects (Patil et al. 2016).
In the layering method of western acupuncture, a checklist is provided for the treatment
of musculoskeletal pain through needling. If the peripheral effect is present, the needle is injected
away from the injured tissue and if the answer is yes, the needle is injected directly into tissue
that gently maximize stimulation of local effects in the treatment of superficial injuries. A low
intensity, high frequency electro-acupuncture is used for blood flow to skin through reduction in
sympathetic tone (Yuan et al. 2016). For spinal or segmental effects, if the answer is no, needle
tissues is injected away from the damage tissue with different extra segmental or segmental
nerve supply. If the answer is yes for needle insertion into damaged tissue, it chooses local points
situated nearby or in damaged tissue anatomically. Acute nociceptive pain uses few needles in
segmentation (low intensity and high frequency), electroacupuncture for maximizing spinal cord
inhibition then progressing towards electroacupuncture or manual acupuncture. For chronic
nociceptive pain, more needles are used in segment. In this segment, an extra layer can be added

6ACUPUNCTURE-RELATED RESEARCH LITERATURE
where a spinal point is chosen that influences segment that shares nerve supply at the spinal level
where the needle is injected for 10-20 minutes (Yuan et al. 2016).
For supraspinal effects, if the answer is no, moderate stimulation with needle is given for
10-15 minutes on segmental points to damaged tissue and does not take “big points” into
consideration. If the answer is yes, extra segmental points are chosen with “big points” of feet
and hand, however, these points are considered in TCA. Strong stimulation is given by needle for
20-40 minutes that result in activation of descending inhibitory systems from diffuse noxious
inhibitory controls (DNIC) and hypothalamus. When the condition of the patient is not
improving via somatic treatment, the question is asked regrading sympathetic outflow. If the
answer is no, the clinician treat the patient as per principles of somatic nerve supply. If the
answer is yes, segmental tissue level is chosen by the clinician and at the spinal level, needle
Bladder Point or Huatuo Jiaj is taken into consideration. Sympathetic outflow to neck (C8 to T4)
and head, lower limbs (T10 to L2) and T5 to T9 upper limbs are activated via needling. A distant
tissue point is chosen innervated with sympathetic segmental nerve supply as per the clinician’s
wish to influence nerve. Strong stimulation by needle for 10 minutes can help in increasing
sympathetic outflow or decrease outflow through gentle stimulation. As autonomic nervous
system is controlled by hypothalamus, stimulation need to be given in the same manner as it is
provided in analgesic supraspinal effects. Large points, feet and hands are chosen where strong
stimulation is given for at least 20 to 40 minutes. For immune effects, points are chosen at
segmental level of lung, spleen and thymus. General strong points can also be chosen that
influence hypothalamus and regulation of autonomic outflow in feet and hands. Strong
stimulation and repeated treatments, 30 minutes stimulation on auricular points can also be given
that affects activity of vagal efferent nerves (Yuan et al. 2016).

7ACUPUNCTURE-RELATED RESEARCH LITERATURE
Trigger point approach is used in western acupuncture for the treatment of
musculoskeletal pain where it is compared on the basis of distal and local points and
determination of Ah Shi points. The method of needling based on location is explained through
this approach from the western acupuncture. Other approaches like TCM acupuncture, ear and
meridian acupuncture are also used to explain the process of needling and treat musculoskeletal
pain. The surface energetic in human body is explored with methods that influence them through
these approaches based on parameters like use of palpitation for diagnosis and way in which
distal points and Ah Shi or local points are chosen (Quintner et al. 2014). On a contrary, in TCM,
relevant Ah Shi points are located distal or proximal, adjacent or local to the pain area. Trigger
points are permanent and local contractions in the muscle fibres where on palpitation, nodules or
taut bands are experienced that are responsible for pain patterns. The pathology of trigger point is
explained through referred pain where it is not necessary that pain need to coincide with the area
that patients report. This approach is also known in Chinese medicine, however, in medical
literature, referred pain is explained by neural mechanisms where perceptual errors occur in
sensory cortex or errors occur in spinal cord. This kind of pain is difficult to localize as it may
change or move during disease progression. Initially, the pain is experienced in close proximity
to origin of symptoms; however, later it progresses proximally or distally to initial area. This
trigger point approach is of paramount importance in the treatment of musculoskeletal pain
(Couto et al. 2014).
Trigger point concept has been pioneered by Kellgren in 1938 where it is stated that
muscle pathology is the main cause of pain, however clinicians focus on joints, bones, nerves
and bursae. The medical explanation pose major problem in explaining trigger point approach as
it does not follow nerve pathways nor occur within same myotome, dermatome or sclerotome.

8ACUPUNCTURE-RELATED RESEARCH LITERATURE
However, it is stated that trigger point concept and referred pain follow a well researched and
predictable pattern. The main causes for trigger-points activation are trauma to tendons, muscles
or joints, chronic stresses on the muscles by bad posture, overuse or involuntary muscle tension
as a result of emotional stress. On a contrary, in TCM, it is caused due to exposure to damp
weather, cold or drafts or contact with external pathogens (Dommerholt and Fernandez de las
Penas 2013).
Various types of trigger points cause pain where all are not actively participating in the
pain mechanism and therefore, it is important for a clinician to identify the accurate trigger
points that are responsible for pain pattern. A precise and definite pictorial representation of pain
is critical for the accurate diagnosis of musculoskeletal pain as verbal descriptions are misleading
and imprecise. A blank body form is used for recording patient’s pain routinely. In this approach,
it is outlined that details are important like which side of limb hurts, description of pain like
concentrated or skipping within a joint. The vague generalizations may lead to misdiagnosis and
it is important to find out the exact location of pain to deliver accurate treatment. Once the
muscle is identified, clinician locates nodules and taut bands through careful palpitation in
muscle fibres that are soft on pressure and may induce referred pain in the patient. Palpitation
technique is performed on slight stretched muscle where the practitioner rolls over the muscle
skin gently perpendicular to the muscle belly. In this method, initially light pressure is applied
for assessing superficial muscles and gradually there is increase in pressure for reaching deeper
muscles (Liu et al. 2015).
The distal and local points are located and needling technique for the treatment of
trigger points causing musculoskeletal pain. Different possibilities of trigger point treatment are
proposed where western acupuncture is considered accurate as in physiotherapy or medical

9ACUPUNCTURE-RELATED RESEARCH LITERATURE
acupuncture, local points or trigger points sites are needled called dry needling (Mejuto-Vázquez
et al. 2014). Needles are used according to western acupuncture principles and do not use TCM
knowledge of meridians. This needling method is quite effective and accurate, however distal
point usage as per meridian theory only increase trigger point needling effectiveness. For an
effective treatment of musculoskeletal pain, precise point of trigger point needs to be addressed.
Trigger point needling is a precise and acquired art where accurate trigger point is located and
stabilize manually. The practitioner uses non-needling thumb and apply firm pressure to tight
band side or Kori so that needle reaches trigger and there is no rolling away of muscle fibres.
Needling method is performed deeply like TCM which is quite controversial. On a contrary,
clinician use superficial needling to 5-10 mm depth and dos not reach trigger point itself. For
needles that are left in situ for not more than 30 seconds, also provide equal results with less pain
to patient (Rainey and Charles 2013).
Several protocols have been proposed for the treatment of trigger points in
musculoskeletal pain where trigger point needling is considered the best approach. In this
protocol, the marks are pointed, activation of involved tendino-muscular meridian takes place
and finally appropriate treatment is given to spinal segment for addressing the root problem.
Finally, needling is done on trigger points superficially with mild needle stimulation and left in
place for a short duration and the process is repeated for more positive effects. If any patient does
not respond to the mild needling, deeper treatment is applied with vigorous manipulation. Needle
can be applied in varied directions covering the entire area of Kori or tight band present around
the trigger where muscle attachments may be located and needled (Dunning et al. 2014)
Western acupuncture is an effective and holistic approach in the treatment of pain like
musculoskeletal pain. The most important benefit of this method is that it is relatively pain-free

10ACUPUNCTURE-RELATED RESEARCH LITERATURE
and helps in reducing pain in a natural way without any medication and unwanted side effects.
This method shows promising results in postoperative and chemotherapy vomiting and nausea
and dental pain. The National Institute of Health consider acupuncture safe and it is used for
various disease conditions. It helps in the reduction of migraines and headaches as a non-
pharmacological tool through “sham” sessions where needles are placed randomly resulting in
reduction in pain intensity and symptoms of migraine and headaches (Robinson et al. 2012).
Arthritis pain or chronic pain of neck, back and knee is also treated through acupuncture where
patients feel less pain and quite reasonable referral option for pain relief and management.
Insomnia is also treated through acupuncture where there is decrease in its symptoms adding
better effects as compared to herbal treatments or medications used in TCM. According to the
National Cancer Institute, western acupuncture helps in boosting immunity and speeding up
recovery of patients following cancer treatment (Paley et al. 2015). Platelet count enhancement
along with protection of healthy cells is also mediated via acupuncture after patients undergo
chemotherapy or radiation therapy. Acupuncture is also effective in the prevention of cognitive
decline like in Parkinson’s disease as age-related decline causes neural response in specific areas
of brain. There is improvement in symptoms like walking, tremor, slowness, handwriting,
depression, sleep, anxiety and pain showing no adverse effects (Liu et al. 2014). Despite of
growing popularity for the use of acupuncture, there is lack of evidence for understanding the
effectiveness or its efficacy. Moreover, there are certain risks of using acupuncture like it should
not be used in patients who take blood thinners or have a bleeding disorder. As needles are
inserted, bruising, bleeding and soreness can also occur and one should avoid using unsterilized
needles that can result in infection. During insertion, needle can break and damage underlying

11ACUPUNCTURE-RELATED RESEARCH LITERATURE
organs. Therefore, it is advisable that acupuncture should be used along with conventional
medical treatments in cases of severe or chronic illness.
From the above discussion, it can be concluded that western acupuncture is one of the
popular method stemming from TCM where trained practitioners use thin needles for stimulating
specific points in the body. It originated in ancient China and until now, it is used for treating
various disease conditions. This method involves the insertion of needles having therapeutic
effects on musculoskeletal pain being one of the most common work-related injuries witnessed
in the West. For the treatment and pain relief in musculoskeletal disorders, trigger point approach
is used where Ah Shi points are needled that eventually reduces pain. This approach recognizes
that pain is generated at some point away from the area where pain is experienced. The
stimulation of trigger points in the musculoskeletal system helps in the treatment of pain through
clinical reasoning process (CRP) used by clinicians. In CRP, layering method is used for the
treatment of musculoskeletal pain where a checklist containing questions in yes or no format is
used by clinical practitioners so that best intervention is delivered to the patient. The local and
distal points are located and needling technique is delivered. Several benefits and limitations of
western acupuncture are also outlined in the assignment using needling method. Therefore, it can
be concluded that western acupuncture has therapeutic effects on musculoskeletal pain by
triggering points in the muscular system.

12ACUPUNCTURE-RELATED RESEARCH LITERATURE
References
Abdulla, Aza, Nicola Adams, Margaret Bone, Alison M. Elliott, Jean Gaffin, Derek Jones, Roger
Knaggs, Denis Martin, Liz Sampson, and Pat Schofield. "Guidance on the management of pain
in older people." Age and ageing 42 (2013): i1-57.
ACTION, MODES OF. "Western medical acupuncture: a definition." Acupunct Med 27, no. 1
(2009): 33.
Bai, Lijun, and Lixing Lao. "Neurobiological foundations of acupuncture: the relevance and
future prospect based on neuroimaging evidence." Evidence-Based Complementary and
Alternative Medicine 2013 (2013).
Balagué, Federico, Anne F. Mannion, Ferran Pellisé, and Christine Cedraschi. "Non-specific low
back pain." The Lancet379, no. 9814 (2012): 482-491.
Chang, Shyang. "The meridian system and mechanism of acupuncture—a comparative review.
Part 1: the meridian system." Taiwanese Journal of Obstetrics and Gynecology 51, no. 4 (2012):
506-514.
Chon, Tony Y., and Mark C. Lee. "Acupuncture." In Mayo Clinic Proceedings, vol. 88, no. 10,
pp. 1141-1146. Elsevier, 2013.
Coggon, David, Georgia Ntani, Keith T. Palmer, Vanda E. Felli, Raul Harari, Lope H. Barrero,
Sarah A. Felknor et al. "Disabling musculoskeletal pain in working populations: is it the job, the
person, or the culture?." PAIN® 154, no. 6 (2013): 856-863.
Couto, Cláudio, Izabel Cristina C. de Souza, Iraci LS Torres, Felipe Fregni, and Wolnei Caumo.
"Paraspinal stimulation combined with trigger point needling and needle rotation for the

13ACUPUNCTURE-RELATED RESEARCH LITERATURE
treatment of myofascial pain: a randomized sham-controlled clinical trial." The Clinical journal
of pain 30, no. 3 (2014): 214-223.
Cox, James M. Low back pain: mechanism, diagnosis and treatment. Lippincott Williams &
Wilkins, 2012.
Dommerholt, J., and Fernandez de las Penas C. Trigger. "Point Dry Needling: An Evidence and
Clinical-Based Approach." London, UK: Churchill Livingstone Elsevier (2013): 135-6.
Dunning, James, Raymond Butts, Firas Mourad, Ian Young, Sean Flannagan, and Thomas
Perreault. "Dry needling: a literature review with implications for clinical practice
guidelines." Physical therapy reviews 19, no. 4 (2014): 252-265.
Fornasari, Diego. "Pain mechanisms in patients with chronic pain." Clinical drug
investigation 32, no. 1 (2012): 45-52.
Liu, Fang, Zhuang-Miao Li, Yi-Jing Jiang, and Li-Dian Chen. "A meta-analysis of acupuncture
use in the treatment of cognitive impairment after stroke." The Journal of Alternative and
Complementary Medicine 20, no. 7 (2014): 535-544.
Liu, Lin, Qiang-Min Huang, Qing-Guang Liu, Gang Ye, Cheng-Zhi Bo, Meng-Jin Chen, and
Ping Li. "Effectiveness of dry needling for myofascial trigger points associated with neck and
shoulder pain: a systematic review and meta-analysis." Archives of physical medicine and
rehabilitation 96, no. 5 (2015): 944-955.
Mejuto-Vázquez, María J., Jaime Salom-Moreno, Ricardo Ortega-Santiago, Sebastián Truyols-
Domínguez, and César Fernández-de-las-Peñas. "Short-term changes in neck pain, widespread
pressure pain sensitivity, and cervical range of motion after the application of trigger point dry

14ACUPUNCTURE-RELATED RESEARCH LITERATURE
needling in patients with acute mechanical neck pain: a randomized clinical trial." journal of
orthopaedic & sports physical therapy44, no. 4 (2014): 252-260.
Nijs, Jo, Nathalie Roussel, C. Paul Van Wilgen, Albère Köke, and Rob Smeets. "Thinking
beyond muscles and joints: therapists' and patients' attitudes and beliefs regarding chronic
musculoskeletal pain are key to applying effective treatment." Manual therapy 18, no. 2 (2013):
96-102.
Paley, Carole A., Mark I. Johnson, Osama A. Tashani, and Anne-Marie Bagnall. "Acupuncture
for cancer pain in adults." The Cochrane database of systematic reviews 10 (2015): CD007753.
Patil, Shilpadevi, Sudipta Sen, Matthew Bral, Shanthi Reddy, Kevin K. Bradley, Elyse M.
Cornett, Charles J. Fox, and Alan David Kaye. "The role of acupuncture in pain
management." Current pain and headache reports 20, no. 4 (2016): 22.
Quintner, John L., Geoffrey M. Bove, and Milton L. Cohen. "A critical evaluation of the trigger
point phenomenon." Rheumatology 54, no. 3 (2014): 392-399.
Rainey, Charles E. "The use of trigger point dry needling and intramuscular electrical stimulation
for a subject with chronic low back pain: a case report." International journal of sports physical
therapy 8, no. 2 (2013): 145.
Robinson, Timothy W. "Western acupuncture in a NHS general practice: anonymized 3-year
patient feedback survey." The Journal of Alternative and Complementary Medicine 18, no. 6
(2012): 555-560.
Smart, Keith M., Catherine Blake, Anthony Staines, Mick Thacker, and Catherine Doody.
"Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of

15ACUPUNCTURE-RELATED RESEARCH LITERATURE
central sensitisation in patients with low back (±leg) pain." Manual therapy 17, no. 4 (2012):
336-344.
Téllez-García, Mario, Ana I. de-la-Llave-Rincón, Jaime Salom-Moreno, Maria Palacios-Ceña,
Ricardo Ortega-Santiago, and César Fernández-de-las-Peñas. "Neuroscience education in
addition to trigger point dry needling for the management of patients with mechanical chronic
low back pain: A preliminary clinical trial." Journal of bodywork and movement therapies19, no.
3 (2015): 464-472.
VanderPloeg, Kristin, and Xiaobin Yi. "Acupuncture in modern society." Journal of acupuncture
and meridian studies 2, no. 1 (2009): 26-33.
Vickers, Andrew J., Angel M. Cronin, Alexandra C. Maschino, George Lewith, Hugh
MacPherson, Nadine E. Foster, Karen J. Sherman, Claudia M. Witt, Klaus Linde, and for the
Acupuncture Trialists' Collaboration. "Acupuncture for chronic pain: individual patient data
meta-analysis." Archives of internal medicine 172, no. 19 (2012): 1444-1453.
Yuan, Qi-ling, Peng Wang, Liang Liu, Fu Sun, Yong-song Cai, Wen-tao Wu, Mao-lin Ye, Jiang-
tao Ma, Bang-bang Xu, and Yin-gang Zhang. "Acupuncture for musculoskeletal pain: A meta-
analysis and meta-regression of sham-controlled randomized clinical trials." Scientific reports 6
(2016): 30675.
Zhu, Heming. "Acupoints initiate the healing process." Medical acupuncture 26, no. 5 (2014):
264-270.