• Chinese Medicine Demystified (Part I): A Case of Mistaken Identity
• Chinese Medicine Demystified (Part II): Origins of the Energy Meridian Myth
• Chinese Medicine Demystified (Part III): The “Energy Meridian” Model Debunked
• Chinese Medicine Demystified (Part IV): How Acupuncture Works
• Chinese Medicine Demystified (Part V): A Closer Look At How Acupuncture Relieves Pain
• Chinese Medicine Demystified (Part VI): 5 Ways Acupuncture Can Help You Where Drugs and Surgery Can’t

In this article we’re going to take a closer look at one of the latest theories on how acupuncture relieves pain. I’m going to break it down in plain language for my readers who don’t have a scientific background, but I’ll also provide references at the end of the article for those of you that want the nitty-gritty detail.

Keep in mind that pain research is a constantly evolving topic, and more is being learned each year about the mechanisms of pain relief via acupuncture. (Although as an interesting side note, according to Professor Bruce Pomeranz of the University of Toronto, we know more about acupuncture analgesia than many chemical drugs in routine use. For example, we know little about the mechanisms of most anesthetic gases but still use them regularly. ¹)

What I’m going to share with you here represents the latest information from the American Academy of Pain Management and papers published in major peer-reviewed journals.

The physiology of pain

Before I explain the mechanism, I have to give you a little background on the physiology and neurology involved.

There are two types of nerves involved in our perception of pain: sensory (nocioceptive) and position (proprioceptive) nerves. Both of these nerve types are firing at the same time in an area where we’re experiencing pain. These nerves travel to the spine and pass their information on to neurons in the spinothalamic tract. This tract travels up the lateral dorsal horn of the spinal cord to the mid-brain.

The sensory nerves register pain. The position nerves tell the brain where that pain is coming from. So the sensory nerves say “ouch!” and the position nerves say “my knee!”.

There are two different types of sensory nerves involved in the acupuncture response. There are A-Delta fibers, which transmit sharp, burning pain messages. And there are C-fibers, which transmit dull, throbbing pain messages. A-Delta fibers are responsible for acute pain, and the signals they send are short-lived. They fire for a while and then the signals die off. C-fibers are responsible for chronic pain, and fire over an extended period of time.

A-Delta fibers are surrounded by a fatty, myelin sheath and the signals they send travel at 60 ft/second (that’s fast!). C-fibers are unmyelinated and their signals travel at 20 ft/second.

The A-Delta fibers mediate what is known as the “gamma loop”. The gamma loop is what gets activated when you stick your hand in a fire and your hand jumps back. These nerve fibers respond so quickly that your hand is immediately pulled back out of the fire. Chronic pain is a C-fiber problem, so C-fiber signals don’t travel quite this quickly.

Now, if the signal strength of the position nerves (the ones that register the location of pain) is what it’s supposed to be, the brain will release powerful natural pain relieving substances called enkephalins when it starts to receive those C-fiber messages. The enkephalins then plug up pain receptor sites in the brain, spine and capillary beds where the pain is located. This stops the pain in its tracks.

When things go wrong

Unfortunately, this is not what happens in people with chronic pain. Why? The current explanation is that the position nerve signal going up to the brain is too weak. The mid-brain can’t figure out where the pain is coming from, so the enkephalins don’t get released. This is why people in chronic pain often have trouble identifying exactly were the pain is. The neural threshold of the position nerve pathway is too low, so these people aren’t getting a clear signal where the pain is emanating from.

Because the brain isn’t getting the message, the nerves keep firing. And keep firing. After a while the nerves become inflamed, which in turn further weakens the signal’s ability to jump the threshold and get the message to the brain.

So that’s the first problem. The nerve signals are too weak and aren’t stimulating the brain to release the natural painkillers.

The second problem involves a survival mechanism that the brain evolved a very long time ago. Let’s take a knee injury as an example. When we bang our knee into something, the brain immediately takes measures to protect it. The brain doesn’t know what happened to the knee, but it assumes a worst-case scenario. Maybe you were bitten by a poisonous snake, or perhaps you seriously cut your knee and are losing a lot of blood.

What the brain does in this situation is restrict the blood supply going into the knee and the blood return coming out of the knee. This is actually a very intelligent choice. If you were bitten by a venomous snake, reducing blood flow around the knee will lessen the chance that the poison will spread. And if you were cut badly, reducing the blood flow will lessen your chances of bleeding to death.

This phenomenon is known as “guarding”. One of the results of reducing blood flow to the knee is that it becomes stiff and weak (sound familiar?). The brain wants it to feel weak because it is attempting to protect the knee. The brain doesn’t want whatever happened to the knee to threaten your chances for survival. So the brain sacrifices the health of the knee in order to keep you alive.

This was a great strategy before the advent of western emergency medicine. Almost everyone would prefer to lose function in their knee to death. But this isn’t a choice most of us have to make anymore, because when we cut our knee or get bitten by a snake we can go to the hospital and they can save our lives. And the problem is that cutting off blood flow to the knee – while it may have saved our lives in times past – dramatically limits the knee’s ability to heal.

Why? Because everything we need to heal is in the blood. The blood contains analgesics (painkillers), anti-inflammatories, nutrients absorbed from food, oxygen, hormones and immune substances to fight infection. If the blood flow is restricted to a particular area, healing won’t occur. No blood flow, no healing.

Stop and think about this for a minute. It’s such an obvious fact that it’s often overlooked in medicine. It’s not taught in such a direct way in medical school, but when I’ve explained it to a couple of doctors they both said something to the effect of, “Huh. I never thought of it that way, but it makes perfect sense.”

How acupuncture helps

Okay, now we’re finally coming to the part where I explain how acupuncture fits into this picture. Inserting needles into the skin at peripheral sites “jumps” the neural threshold on the position nerve pathway, so that the signal can reach the brain. Once the signal reaches the brain, the whole series of events I described in the paragraphs above kicks in. The brain recognizes there is pain and where it’s coming from and releases enkephalins (painkillers).

This initial response is very fast. It should be perceived as almost instantaneous by the patient. But after the needling therapy the patient goes home and the pain comes back. The old bad habit of the nerve chronically firing below the threshold re-establishes itself. The body, just like the mind, has a hard time breaking bad habits.

But if the patient returns in a couple of days to get another treatment, the neural threshold will be jumped again. And if you keep jumping the neural threshold, eventually the central and peripheral nervous system figure out that it’s better to operate in the non-pain state than in the pain state. The technical term for this is re-establishment of neurological homeostasis.

Once this happens, the brain is no longer receiving pain signals from the knee. It no longer thinks the knee is injured or threatening the survival of the body. Now, instead of restricting blood flow to the knee, the brain does the opposite. It immediately vasodilates the capillaries and venules around the knee, which increases blood flow and begins the healing process.

What I’ve described above is how acupuncture relieves pain via the peripheral and central nervous system. There’s another pain relief mechanism that involves activating the immune system. Acupuncture needles are seen as foreign invaders to our body. Inserting a needle into the skin creates a micro-trauma that in turn stimulates the activity of immune cells that control inflammation.

There are millions of immune cells called mast cells in the dermis of the skin. These cells are like water balloons full of fatty molecules called leukotrienes and prostaglandins A & B. When a needle is inserted into the skin, it pops the mast cells and releases the leukotrienes and prostaglandins. Prostaglandins cause the cutaneous nerve in the area to fire (which activates the process described in the previous paragraphs). Leukotrienes are the strongest anti-inflammatory substance the body can produce.

Leukotrienes cause local capillaries to vasodilate and become permeable. White blood cells called macrophages leak out through the capillaries and immediately begin to heal the damage caused by the needle stick.

However, the healing caused by the needle insertion isn’t limited to the damage caused by the needle. If there is other damage in the area from previous traumas or injuries, that will also be addressed by the immune chemicals released by the needle insertion.

What’s more, the micro-trauma caused by the needle starts a systemic immune response. This promotes healing of the soft tissue throughout the body – not just at the needling site. After the needles are removed, the needle-induced lesions continue to stimulate the body until the lesions heal. This means that the anti-inflammatory effect of acupuncture persists for 2-3 days (and sometimes as long as a week) after the needle is withdrawn.

Summary

Genetically the body is not designed to be in chronic pain. It will do everything it can to get us out of pain. Acupuncture “reminds” the body how it should be functioning, and helps its powerful inbuilt pain relieving mechanisms kick into gear. It’s a bit like jump starting a car. You’re not changing how the car works, or even adding anything to the engine. You’re just giving the battery a little jolt so the car can run how it’s supposed to.

It’s important to understand that this neurochemical mechanism not only provides pain relief, but also promotes homeostasis and tissue healing and regulates the immune, endocrine, cardiovascular and digestive systems. This explains why getting acupuncture treatment for your knee pain also addresses other problems you might have, such as asthma, irritable bowel, high blood pressure, anxiety and insomnia.

In the next and final article of this series, I’ll explain the advantages of Chinese medicine over western medicine for the prevention and treatment of most common health conditions.

Recommended resources for more information

• Biomedical Acupuncture for Pain Management, by Yun-Tao Ma, Mila Ma & Zang Hee Cho
• The Dao of Chinese Medicine, by Donald Kendall
• The Biology of Acupuncture, by George Ulett & Songping Han
• The Neuroimmune Basis of Anti-inflammatory Acupuncture, by Ben Kavoussi & Evan Ross
• Acupuncture in Medicine Journal (part of British Medical Journal)

Related posts:

1. Chinese Medicine Demystified (Part IV): How Acupuncture Works
2. Chinese Medicine Demystified (Part VI): 5 ways acupuncture can help you where drugs and surgery can’t
3. Chinese Medicine Demystified (Part II): Origins of the “Energy Meridian” Myth

But, faithful readers, you already knew that. Right?

The report is part of the National Institute of Mental Health-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project – the largest study of the treatment of depression conducted in the United States. It showed that findings from clinical studies used to gain FDA approval of antidepressants are not applicable to most patients with depression.

Researchers at the University of Pittsburgh Graduate School of Public Health compared symptoms and outcomes in depressed patients who met phase III study inclusion criteria to those who did not. Phase III studies for antidepressants determine the effectiveness of the drug in comparison to a placebo.

The inclusion criteria for these studies aren’t standardized or subject to any federal guidelines. Typically this means that patients with milder forms of depression, chronic depression, or other psychiatric or medical conditions in addition to short-term depression are excluded from studies.

In other words, the majority of “real world” patients with depression who end up taking antidepressants are excluded from clinical studies. It should be obvious why this is a problem. In a normal, clinical setting many patients with depression do also have other illnesses, such as diabetes, chronic fatigue syndrome or irritable bowel syndrome (IBS). It’s not unusual for them to have anxiety and insomnia, as well. In fact, it wouldn’t be presumptuous to expect that a depressed person might be suffering from a number of conditions that are either contributing to or caused by their illness.

Yet the only people that “qualify” for the clinical trials which determine whether antidepressants get approved by the FDA are those with short-term depression, no history of depression, no other psychiatric conditions such as anxiety, and no physical illnesses like heart disease or diabetes. This is the only subgroup of the general population for which we have any data on the efficacy of antidepressants.

By the same token, this means is that we have almost no clinical data on how antidepressants work for the “real world” patients who are most likely to be taking them. Indeed, after assessing 2,855 patients treated with citalopram (Celexa), the study authors found that fewer than one in four, or 22.2%, of the patients met the usual criteria for inclusion in phase III clinical trials.

According to study lead author, Stephen Wisniewski, Ph.D., professor of epidemiology and co-director of the Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, “This raises major concerns about whether results from traditional phase III studies can be generalized to most people with depression, who also often suffer from anxiety, substance abuse and other medical and psychiatric problems.”

When Wisniewski and his colleagues looked at the efficacy of antidepressants in those who did not meet phase III inclusion criteria – meaning the majority of people who take the drugs in real life – they found that their outcomes were much worse than those who did qualify for the trials. The depression remission rate in the patients who met the criteria was 34.4 percent, compared to only 24.7 percent in the ineligible group.

So, here’s the bottom line: antidepressants are nowhere near as effective as research suggests.

And that is really bad news for the drug companies, because research already suggests that antidepressants aren’t very effective at all. In fact, as I explained in a previous article, antidepressants are no more effective than placebo for most people. If antidepressants are no more effective than placebo in the patients that do meet phase III criteria, and we know that antidepressants are less effective for patients who don’t meet phase III criteria (the vast majority of “real world” depression patients), then couldn’t we assume that antidepressants are less effective than placebo for most patients?

Yes, we could.

For more information on this topic, check out this index of my articles (as well as selected off-site resources) on depression and antidepressants.

Related posts:

1. Placebos as effective as antidepressants
2. Mindfulness-Based Cognitive Therapy (MBCT) more effective than antidepressants
3. Research alert – Antidepressants & Cholesterol

Well, it appears that even mainstream scientists are beginning to acknowledge the very real risks that statins present for pregnant mothers and fetuses.

Current clinical guidelines already recommend that women who are pregnant should stop taking statins but the advice is based on the knowledge that cholesterol is essential for normal fetal development.

But new research from The University of Manchester has shown that even water-soluble or ‘hydrophilic’ statins, such as pravastatin, can affect placental development leading to worse pregnancy outcomes.

According to Dr. Melissa Westwood, a Senior Lecturer in Endocrinology based at the Maternal and Fetal Health Research Centre at St. Mary’s Hospital, Manchester:

Fat-soluble statins like cerivastatin were already known to adversely affect the placenta, resulting in reducing growth. But the researchers also found that pravastatin – the water-soluble statin thought to be potentially compatible for use in pregnancy – had the same detrimental effect.

Related posts:

1. Statins for pregnant women and kids?
2. Research alert – Antidepressants & Cholesterol
3. The hidden truth about statins

Low Serum Cholesterol May Be Associated With Suicide Attempt History

I’ve written before about the association of low cholesterol with aggressive and violent behavior as well as an increased risk of suicide. A recent study published in the Journal of Clinical Psychiatry adds weight to the already considerable body of evidence suggesting that low cholesterol is dangerous to your health.

In this study ‘low cholesterol’ was defined as less than 160mg/dL (4.16 mmol/L). This level has been noted several times in the medical literature as a level below which suicide is more likely. And you should note that this level is well within what is considered ‘healthy’ by a cholesterol-lowering, drug pushing health industry.

This is consistent with studies showing that low blood cholesterol levels are associated with suicide and that cholesterol levels in certain areas of the brain are lower in those who commit suicide by violent means than in those who commit suicide by non-violent means.

Cholesterol is a health-promoting substance. It is a critical component of cell membranes, the precursor to all steroid hormones, a precursor to vitamin D, and the limiting factor that brain cells need to make connections with one another called synapses, making it essential to learning and memory.

If you understand the vital role cholesterol plays in health – especially in the brain – it’s not difficult to figure out why low cholesterol could increase the risk of suicide and violent behavior.

This is yet another reason to avoid cholesterol-lowering statin drugs. If you haven’t read it already, you might want to check out my post called Cholesterol Doesn’t Cause Heart Disease.

(J Clin Psychiatry October 21, 2008: e1-e8; pii: ej07m03866)

Two Antidepressants Taken During Pregnancy Linked To Heart Anomalies In Babies

In another disturbing study, researchers from Israel, Italy and Germany found that pregnant women taking two popular antidepressants, paroxetine (Paxil) and fluoxetine (Prozac), were three and four times more likely to give birth to children with heart problems.

Researchers have advised women taking the drugs to continue unless they are advised to stop by their doctor or consultant.

I’ve written extensively here about the risks of antidepressant drugs, especially for pregnant women. In my recent post Statins For Pregnant Women and Kids? I presented evidence that statin drugs can cause birth defects and changes in the brain that predispose the child to emotional problems later in life. Here’s a brief excerpt:

If you’re pregnant or considering getting pregnant, please – for the sake of your baby – speak to your psychiatrist or doctor about getting off antidepressant drugs before you conceive.

Related posts:

1. Research alert: statins dangerous for pregnant women!
2. Statins for pregnant women and kids?
3. Antidepressants not as effective as research suggests

According to Dr. Stanley Goldfarb and Dr. Dan Negoianu of the University of Pennsylvania in Philadelphia, there are four prevalent myths about water intake:

1. Leads to more toxin excretion
2. Improves skin tone
3. Makes one less hungry
4. Reduces headache frequency

Dr. Goldfarb and Dr. Negoianu reviewed all of the published studies which examined the health benefits of water consumption. They concluded that people in hot, dry climates, athletes or people with certain diseases might do better with increased fluid intake, but for average healthy people, more water did not mean better health.

“There is no clear evidence of benefit from drinking increased amounts of water,” Dr. Goldfarb wrote, but he also added, “There is also no clear evidence of lack of benefit.” In other words, the scientific research doesn’t tell us one way or the other whether there’s a benefit or not.

Fortunately, nature has endowed us with a mechanism that can in fact help us determine how much water we need to be drinking per day. It’s called thirst. If we simply pay attention to our thirst and respond appropriately, it’s likely that we will take in as much water as we need. Four to six glasses per day is probably sufficient for most people; but then again, the evidence indicates there is no harm in drinking more, so if you enjoy drinking a lot of water then knock yourself out!

There is no evidence that increased water consumption helps to excrete toxins. The kidneys perform that function in the body, and as long as they are healthy they do it very well. Dr. Goldfarb: “The kidneys clear toxins. This is what the kidneys do. They do it very effectively. And they do it independently of how much water you take in. when you take in a lot of water, all you do is put out more urine but not more toxins in the urine.”

There is no evidence supporting the other three myths either; namely, that it improves skin tone, reduces hunger and alleviates headaches. But again, if your experience is different and you find that water does help with these conditions – then there is absolutely no reason not to continue what you’re doing now (other than perhaps more frequent trips to the bathroom!) Just don’t go crazy with the water intake, because extremely high levels of water consumption can affect the fluid balance in the body, causing “water intoxication” and even death.

Finally, I’d be remiss if I didn’t emphasize that the quality of the water we drink is much more important than the quantity. My recommendation is that you invest in a high-quality water filter and install it in your home. Avoid bottled water, which is often simply tap water packaged in a plastic bottle that can potentially leach toxins into the water – especially when left in the sun. (You know that “plasticky” smell when you drink water from a plastic bottle that has been around for a while? Not good. Not good at all.) Nalgene bottles should also be avoided as they can leach another unsafe chemical called BPA into your water. Instead, buy a stainless steel water bottle and fill it up with your filtered water at home before you go out.

Also, both tap water and filtered bottled water contain fluoride, a highly toxic bone poison that should be avoided at all costs. Many commercial water filters unfortunately do not remove fluoride, which is present in our water supply because of the gross misconception that it supports dental health. But more on that myth in another article.

Related posts:

1. Warning: drinking bottled water could make you fat!
2. The "chemical imbalance" myth
3. Bad news for tea drinkers

Zocor and Zeita lower cholesterol by different mechanisms, so the idea was that combining them into a single drug (Vytorin) would dramatically lower cholesterol and, they assumed, reduce heart disease.

They got the first part right. Vytorin did indeed lead to dramatic reductions in cholesterol levels in those who took the drug. However, it also increased the risk of heart disease – exactly the opposite result they were hoping for.

The worst part about this is that Merck & Schering-Plough sat on this data for almost two years, while over five million people around the world continued to take a drug that was proven to nearly double the risk of heart disease. Congress has launched a full-scale investigation and the NY Times is publicly demanding a new law to prevent this from happening again.

Yesterday another article was published in the Times with an update on the investigation, including emails sent by the lead investigator on the Vytorin trial indicating that Merck & Schering-Plough were deliberately delaying publication of the results of this trial.

Yet another case of gross malfeasance by the pharmaceutical industry. Consumers beware.

Related articles

• Accusations of Delays in Releasing Drug Results
• Doubt Cast on Two Drugs Used to Lower Cholesterol
• Editorial: Overpromoted Cholesterol Drugs

Related posts:

1. When drug trials go terribly wrong
2. Research alert – Antidepressants & Cholesterol
3. Cholesterol-lowering drugs reduce brain function