The National Institute for Clinical Excellence (NICE) recently added acupuncture to its list of recommended treatments for patients with chronic primary pain and so I thought I should write something about pain and about how acupuncture might be able to help those suffering with chronic pain. But before I talk about acupuncture I want to look at the nature of pain itself and what NICE means by ‘primary’ pain.
When most of us think of pain we think of pain as a response to a stimuli – I hit my finger with a hammer (because I’m cack handed and DIY isn’t my thing) and it hurts. In a situation like that pain is a very efficient way for the body to let us know we’ve done or are doing something that is injuring us and its likely the pain will persist while the body heals in order that we take good care of our injury. This sort of pain would be described as acute pain.
Another sort of pain might result from a condition such as arthritis In this instance the pain results from the dysfunction of a joint due to an underlying condition (the arthritis) and the pain is likely to persist as long as the underlying condition does. This sort of pain would be described as chronic (lasting more than 3 months) secondary pain. Its chronic because its ongoing and its secondary pain because it results from an underlying condition (in this case the arthritis). Again the pain serves some useful purpose in that it encourages the careful use of joints damaged by the arthritis. And while such pain can be alleviated to some extent its unlikely to be eradicated without some improvement in the underlying condition. So what is chronic primary pain?
Chronic primary pain describes a condition in which the pain persists longer than 3 months without an underlying ‘cause’. So if, in the example above, I hit my finger with a hammer, I experience some acute pain, some pain while it heals but if that pain then persists long after the finger has healed I would be experiencing chronic primary pain. Because such pain doesn’t fit into out ‘common sense’ view of how pain works its taken a long time for the medical profession to really look at this sort of pain. People suffering in this way have often been written off as hypochondriacs or malingerers, with the suggestion that its ‘all in their minds.” However as this sort of pain has been better understood its become very clear that such pain is actually caused by dysfunction in the complex interaction between body and mind (which might be why acupuncture can be so effective). So it resides neither wholly in the body or the mind, but impacts both.
If I hit my finger with a hammer my nervous system sends signals to my brain that my brain understands as pain and in chronic primary pain it seems to be this signalling system that’s not working properly. In chronic primary pain it appears that in the first instance this signalling system gets jammed on, so you experience pain even in the absence of an obvious cause. However that’s not the complete picture. While the nervous system sends signals to the brain the brain also interacts with the nervous system in ways that may amplify the experience of pain. A patient suffering from chronic pain may experience difficulty with sleep, something that in itself can reduce a persons tolerance for pain thereby making the pain worse. But constant pain and a lack of sleep might also negatively impact on the patient’s mood.
The parts of the brain in which pain is processed are closely linked to the parts that process emotion and so negative emotional states such as depression, anger and anxiety will all make the pain worse. Lastly if we return to our simple model of pain as part of the body / mind’s protective response to injury then its less of a surprise that a body/mind subject to pain over a long period may actually become over-sensitised to stimuli and start to interpret even harmless stimuli as pain. Moreover its possible for such stimuli to be amplified by the body’s pain signalling system, which overreacts in a cascading way that can persist over long periods of time. This is called ‘wind- up’ and is one of the reasons why chronic pain is hard to treat and why recurring episodes are common. So how might acupuncture help?
There is evidence that treatment with acupuncture can help regulate levels of endorphins within the body. Endorphins are chemicals produced within the body in response to pain or stress. The theory suggests that insufficient endorphins leads to an exaggerated pain response, i.e. chronic pain.
Acupuncture has been shown to reduce inflammation within the body by stimulating the vagus nerve.
Acupuncture can reduce stress and anxiety by regulating levels of hormones like cortisol and dopamine, which are involved in the body’s stress response. As noted above the subjective experience of pain can be significantly altered by the sufferer’s mood and so lower stress should lead to lower pain levels.
Acupuncture has been found to help promote healthy blood circulation.
Acupuncture can relieve muscle tightness and spasms. These can be both caused by the experience of pain and a source of pain in and of themselves.
All this might be somewhat different from how pain is traditionally viewed by East Asian Medicine. The traditional view would be that most pain conditions are caused by a blockage or stagnation within the body and treatment would aim to clear any blockages and move stagnation, thereby easing the pain and restoring healthy function. My own view is that the explanation is less important than the effect. To find out more about how acupuncture can help you deal with chronic pain email bruce@resurgis.co.uk