Pain resulting from surgical trauma is a significant challenge for healthcare providers. Opioid analgesics are commonly used to treat postoperative pain, but these drugs are also associated with a number of undesirable side effects. Additionally, in 2015, the U.S. Department of Health and Human Resources issued a statement of an endemic Opioid Crisis, whereby opiate medications were shown to be wildly over-prescribed and overused, leading to widespread chemical addiction. Research is showing that acupuncture can effectively stimulate the production of the body’s own “endogenous opioids” as well as natural anti-inflammatory compounds. Acupuncture facilitates better usage of the body’s own natural chemistry to relieve pain, and creates the potential for similar or, in some cases, benefits superior to synthetic drugs - without the risks of addiction or side effects.

Acupuncture and Related Techniques for Postoperative Pain: a Systematic Review of Randomized Controlled Trials

A meta-analysis of 15 studies meeting rigorous standards, including a sample size of 1,166 patients, concludes that acupuncture reduces “postoperative pain intensity.” The research was conducted by investigators in the Department of Anesthesiology at the Duke University Medical Center, and subsequently published in the British Journal of Anaesthesia. This independent meta-analysis demonstrates that acupuncture results in a significant reduction of opioid drug use for the management of postoperative pain. Acupuncture resulted in an average of 21% – 29% less opioid medication use and a significant reduction of pain intensity levels.

Sun, Yanxia, Tong Joo Gan, J. W. Dubose, and A. S. Habib. "Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials." British Journal of Anaesthesia 101, no. 2 (2008): 151-160.

The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis

Thirteen studies carefully selected, including 682 patients total, were systematically reviewed and analyzed to evaluate the effectiveness of acupuncture and acupuncture-related techniques in treating postoperative pain. The meta-analysis found that patients treated with acupuncture or related techniques had less pain and used less opioid analgesics on Day 1 after surgery compared with those treated with control (P < 0.001).

Wu M-S, Chen K-H, Chen I-F, Huang SK, Tzeng P-C, Yeh M-L, et al. (2016) The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. PLoS ONE 11(3): e0150367. doi:10.1371/journal.pone.0150367

Mechanisms of Acupuncture-Electroacupuncture on Persistent Pain

A variety of animal models have been used to study the effect and mechanisms of electroacupuncture on persistent pain. This review synthesizes and analyzes 206 studies to give an overall picture of how electroacupuncture alleviates pain through peripheral and central mechanisms of the body, and to show that a number of bioactive chemicals are involved in electroacupuncture inhibition of pain. The review found that electroacupuncture blocks pain by activating a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms. These include opioids, which desensitize peripheral nociceptors and reduce proinflammatory cytokines peripherally and in the spinal cord, and serotonin and norepinephrine, which decrease spinal N-methyl-D-aspartate receptor subunit GluN1 phosphorylation.

Zhang R, Lao L, Ren K, Berman BM. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology. 2014;120(2):482-503.

Neural Mechanism Underlying Acupuncture Analgesia

Acupuncture has been accepted by the World Health Organization to effectively treat acute and chronic pain by inserting needles into the specific "acupuncture points" (acupoints) on the patient's body. During the last decades, our understanding of how the brain processes acupuncture analgesia has undergone considerable development. This review reveals that diverse signal molecules contribute to mediating acupuncture analgesia, such as opioid peptides (mu-, delta- and kappa-receptors), glutamate (NMDA and AMPA/KA receptors), 5-hydroxytryptamine, and cholecystokinin octapeptide. Among these, the opioid peptides and their receptors in Arc-PAG-NRM-spinal dorsal horn pathway play a pivotal role in mediating acupuncture analgesia.

Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Progress in neurobiology. 2008;85(4):355-75.

Acupuncture Helping Reduce Use of Pain Killers in Army

“Brig. Gen. Norvell V. Coots, deputy commanding general of the U.S. Army Medical Command and assistant surgeon general for force projection, testified… at a hearing of the Senate Veterans Affairs Committee about overmedication concerns. In 2011, 26 percent of all service members were prescribed at least one type of opioid medication, Coots said. That number was brought down to 24 percent [in 2013], Coots continued, partly due to the use of… acupuncture. The Army has had a large upswing in the use of [acupuncture] in the past few years, Coots said, and its use has been written into the Army's Comprehensive Pain Management Campaign.”

Sheftick, Gary. "Acupuncture Helping Reduce Use of Pain Killers in Army." Www.army.mil. U.S. Army News Service, 2 May 2014. Web. 25 Jan. 2017.

Acupuncture for Chronic Pain: Individual Patient Data Meta-Analysis

This landmark meta-analysis was conducted using data from 29 of 31 eligible randomized controlled trials (RCTs), with a total of 17,922 patients analyzed. It was undertaken to determine the effect sizes of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain, and to reduce some of the common disparities found in acupuncture trial reporting standards. After exclusion of an outlying set of 2 RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs.

Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of internal medicine. 2012;172(19):1444-53.

Comparative Clinical Effectiveness of Management Strategies for Sciatica: Systematic Review and Network Meta-Analyses

A recent systematic review and network meta-analyses of 21 different interventions for sciatica found that acupuncture produced significantly better outcomes for global effect and pain reduction than all other therapies (including opioid analgesia), except a Cytokine-modulating procedure still in experimental stages.

Lewis RA, Williams NH, Sutton AJ, Burton K, Din NU, Matar HE, et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. The spine journal : official journal of the North American Spine Society. 2015;15(6):1461-77.

Oriental Medical therapies use pathways, called meridians or channels, to direct energy and nutrients throughout the body. This is an ancient view of the body, one that international efforts of modern science are only recently beginning to successfully measure with technology.

The ancient Chinese used metaphor to explain the nature and function of the body's meridians: Let's consider a river. A river is more than just the water in the river; it includes the riverbed, the riverbank, the plants and animals living in the river, as well as the plants and animals surrounding the riverbank. A river is a complex of moving parts that all work together to nourish and be nourished by its larger environment.

Likewise, the meridian network is a system of pathways through which the vital energy and nutrition of the body move. Meridians can be thought of as spacial regions within which one might find nerves, blood vessels, and lymphatic circulation. In respect they serve to unify or integrate the anatomical structures associated with particular internal organs. They act as pathways not only for the flow of substances around these anatomical structures, but also for the flow within the structures. For example, the pathway known as the Lung Meridian includes certain muscle groups, nerves, and lymphatic vessels on the forearm, throat, and chest. It also includes the nose, and enters the Lung organ itself. Healthy circulation within and around these structures will fall within the scope of what Chinese Medicine calls "the Lung Meridian."

An additional aspect of a meridian is the fascial plane. If we look closely at the point locations along each meridian, they fall along lines, or planes, of fascia - the connective tissue that wraps and integrates muscles. Studies[1],[2],[3],[4] have examined the effect of acupuncture stimulation of these planes, finding that needle insertion and manipulation stimulates mechanicoreceptors in the fascia, and creates a cascade of effects along that fascial plane. Considering that fascial planes are contiguous throughout the body, meaning that they are found in and connect all the regions of the body to each other, they are an important part of how those regions of the body “speak” to one another. However, it is important to remember, like the riverbed is only one aspect of a river, fascial planes are only one aspect of the meridian system.

Another part to consider is the muscular system. Let’s say a patient comes in with “tennis elbow,” and I find that there is significant muscle shortening around the elbow and forearm. Informed by my training, I insert needles to release trigger points on the flexor carpi radialis brevis and the extensor digitorum. I have essentially done a local meridian treatment on the “Large Intestine” and “San Jiao” meridians. Muscles are included in the meridian system, and many points are potent in part due to their anatomical location.

Blood vessels are another facet of the meridian system. Returning to the Lung Meridian as an example, one of its acupuncture points, called Tai Yuan or "Great Abyss," is classified as the "Influential Point of the Pulse and Blood Vessels." It is no coincidence that this point happens to be found just beside the radial artery on the wrist, and that needling it affects the body's circulatory system.

Perhaps most interesting are the Bonghan Channels, named after Kim Bonghan of North Korea, who published papers describing them in the 1960s. Recently, A group of Korean researchers have rediscovered these threadlike microscopic anatomical structures[5], and found that they also correspond with the layout of acupuncture meridians. Bonghan Channels have been found inside of blood and lymphatic vessels and they also form networks that overlay internal organs. According to David Milbradt, L.Ac’s article[6] in Acupuncture Today,

Although [Bonghan’s] discoveries were confirmed by the Japanese researchers Fujiwara and Yu in 1967, his work was discounted by other scientists because he never revealed his formula for the staining dye that revealed these structures. Almost 40 years later, [his] discoveries have been confirmed by a variety of studies with rats, rabbits and pigs. Stereo-microscope photographs and images from transmission electron microscopy in the research papers show assemblies of tubular structures 30 to 100 μm wide (red blood cells are 6-8 μm in diameter).

Apparently these structures have remained undiscovered for so long because they are almost transparent and so thin that they are barely visible with low-magnification surgical microscopes. They are also easily confused with fibrin, which coagulates and obscures these structures [visually] when there is bleeding in dissected tissues. Now that they have been rediscovered, researchers are investigating their composition and function. The tubular structures that make up Bonghan Channels contain a flowing liquid that includes abundant hyaluronic acid, a substance that cushions and lubricates the joints, eyes, skin and even heart valves. Also visible in the photographs are small granules of DNA or microcells about 1-2 μm in diameter that contain chromosomal material highly reactive to stem-cell antibody stains. When these cells were isolated and then induced to differentiate, they grew into cells of all three germ layers. These may be our body's natural source of pluripotent adult stem cells, with the potential to develop into any cell in the body.

Bonghan Channels could account for acupuncture’s ability to stimulate the body to more rapidly heal tissues, but they remain only a piece of the whole that characterizes acupuncture’s immense and far-reaching therapeutic effects.

If we review the older concepts of waterways, we can see that the picture is much broader than a simple line of water running through land. Similarly, we need to conceptualize the meridian system as more than simple lines on the body. Like the longitudinal and latitudinal lines on a map, meridians make an excellent reference for acupuncture, massage, etc., and like the terrain those maps represent, meridians truly encompass a much fuller and richer depth of the human body's form and function.

[1] Langevin HM, and Yandow, JA. (2002), Relationship of acupuncture points and meridians to connective tissue planes. Anat. Rec., 269: 257–265. doi:10.1002/ar.10185

[2] Langevin HM, Churchill DL, Cipolla MJ. 2001a. Mechanical signaling through connective tissue: A mechanism for the therapeutic effect of acupuncture. FASEB J 15: 2275–2282.

[3] Langevin HM, Churchill DL, Wu J, Badger GJ, Yandow JA, Fox JR, Krag MH. 2002. Evidence of connective tissue involvement in acupuncture. FASEB J 16: 872–874.

[4] Langevin HM, Churchill DL, Fox JR, Badger GJ, Garra BS, Krag MH. 2001b. Biomechanical response to acupuncture needling in humans. J Appl Physiol 91: 2471–2478.

[5] Johng, Hyeon-Min et al. “Use of Magnetic Nanoparticles to Visualize Threadlike Structures Inside Lymphatic Vessels of Rats.” Evidence-based Complementary and Alternative Medicine 4.1 (2007): 77–82. PMC. Web. 23 Sept. 2016.

[6] Milbradt, David, L.Ac. "Bonghan Channels in Acupuncture." Acupuncture Today 10.4 (2009)