Pain and Acupuncture

Depending on the type of imbalance, it may disperse excess conditions such as stagnation, inflammation, acute or traumatic pain, or tonify deficiency such as energetic insufficiency, tissue weakness, and chronic pain. This regulation allows for a gradual reduction of pain and an improvement in function.

Acupuncture is used in pain management by combining traditional medical frameworks with modern neurophysiological findings. Needle insertion at specific points stimulates peripheral nerve fibers (A-delta and C fibers), transmitting signals to the spinal cord and central nervous system. This stimulation activates pain-modulating mechanisms at the spinal level, particularly through the inhibition of nociceptive signals in the dorsal horn.

At the central level, acupuncture activates brain structures involved in pain regulation such as the brainstem, thalamus, and cortex, and induces the release of neurotransmitters and neuromodulators including endorphins, enkephalins, serotonin, and norepinephrine, contributing to analgesia. Brain imaging studies also show changes in neural networks involved in pain perception and regulation.

It also influences the autonomic nervous system by reducing sympathetic overactivity and improving heart rate variability, which directly affects pain perception. Anti-inflammatory effects have also been observed through the modulation of cytokines and inflammatory mediators.

Overall, acupuncture acts through a combination of neurophysiological, biochemical, and contextual mechanisms and is integrated as a complementary approach within a multidisciplinary pain management strategy.

From a clinical perspective, numerous studies show that acupuncture has a moderate but significant effect in certain chronic pain conditions, with outcomes superior to usual care and sham acupuncture in several controlled trials. However, the effect varies depending on patients, protocols, and therapeutic context.

Organizations such as NICE in the United Kingdom and the World Health Organization recognize acupuncture as a therapeutic option for certain chronic pain conditions.

Conditions with the strongest evidence include chronic low back pain with significant improvement in pain and function, tension headaches and migraines with reduced frequency and intensity, knee osteoarthritis with improved pain and mobility, post-traumatic pain such as after falls or accidents with improvement in persistent pain and functional recovery, post-herpetic neuralgia with reduction in neuropathic pain, neuropathic pain including phantom limb pain with variable results but reported benefits, and sciatica and lumbar radiculopathy with moderate improvement in pain and quality of life.

In these contexts, effects are generally more pronounced in chronic pain than in isolated acute pain, and depend on the duration of the condition and the patient’s profile.

Key scientific references

Major meta-analyses: 

• Vickers AJ et al. (2012) Acupuncture for chronic pain: individual patient data meta-analysis published in Archives of Internal Medicine 
• Vickers AJ et al. (2018) Acupuncture for chronic pain: update of an individual patient data meta-analysis published in The Journal of Pain
• Vickers AJ et al. (2022) Acupuncture for chronic pain: updated systematic review also published in The Journal of Pain.

Key neurophysiological mechanisms: 

• Han JS. (2004) in Acupuncture and endorphins published in Neuroscience Letters
• Zhao ZQ. (2008) in Neural mechanism underlying acupuncture analgesia published in Progress in Neurobiology
• Langevin HM & Wayne PM. (2018) in What is the point? The problem with acupuncture research published in Journal of Alternative and Complementary Medicine.

Clinical guidelines:

• NICE Guidelines (UK, 2021) on chronic pain in adults 
• World Health Organization (2002) report Acupuncture: review and analysis of reports on controlled clinical trials.

Specific indications: 

• Sun Y et al. (2010) on postherpetic neuralgia in Pain Medicine
• Kim KH et al. (2016) on knee osteoarthritis in the Cochrane Database of Systematic Reviews
• Li Y et al. (2017) on migraine prophylaxis in Cochrane Reviews
• Wang SM et al. (2018) on neuropathic pain in Current Pain and Headache Reports.