Acupuncture Continuing Education

Acupuncture MRI Shows Lasting Pain Relief

Acupuncture induces lasting pain relief. Doctors using MRI neuroradiology scans captured images showing how acupuncture accomplishes enduring analgesia. The researchers state that the MRI images reveal that “acupuncture and pain mobilize overlapping brain regions and the same intrinsic networks.” They add that “acupuncture consists of specific brain activation–modulating patterns that outlast the needling period….” Insertion of acupuncture needles.

The researchers note that “most acupuncture studies conclude that the acupuncture-induced decrease in pain perception consists of acupuncture specific brain activations….” The current study concurs with prior research findings. In this investigation, the team of doctors tested pain relief in humans induced by manual needling of acupuncture points LI4, LV3 and ST36.

The LI4 and LV3 acupuncture point combination is a classic Traditional Chinese Medicine (TCM) prescription for pain relief. Together, these acupuncture points are called Si Guan, roughly translated as the four gates or four bars. They are a set of four acupuncture points located bilaterally on the hands and feet. ST36, translated as leg three miles and located on the lower leg, is also indicated for the TCM function of activating the channels and alleviating pain.

The researchers note that sham acupuncture and true acupuncture are different. They cite “a recent individual meta-analysis based on data from 29 randomized clinical trials with a total of 17,922 patients reported clear differences between real acupuncture and sham procedures for several chronic pain conditions.” Published in the Archives of Internal Medicine, the researchers conclude that acupuncture is effective for the treatment of chronic pain including neck and back pain, shoulder pain, osteoarthritis and headaches.

The new MRI findings demonstrate that the effective actions exerted by true acupuncture points are specific to certain brain networks. A great deal of research on the brain pathways and biochemical mechanisms relating to acupuncture treatments has been published within the last two years. One of the more intriguing studies demonstrates that a biochemical responsible for pain reduction is activated by acupuncture. 

The analgesic biochemical is a chemokine called CXCL10. Acupuncture stimulates its expression which, in turn, reduces pain and inflammation by activating natural opioids in the body. In general, chemokines attract white blood cells to sites of infection to assist in immune system responses. The chemokine CXCL10, when activated by electroacupuncture, triggers powerful anti-inflammatory responses. 

Hegu is LI4 and is located on the hand as shown here.

Electroacupuncture was shown to stimulate several other important responses including the augmentation of interferon (IFN)-gama and mRNA expression and increases in opioid peptide containing macrophages. The researchers add that electroacupuncture “elicited long-term antinociception,” reduced sensitivity to pain. The researchers found that CXCL10 regulates “opioid-containing macrophages as (a) key regulator of electroacupuncture-induced antinociception.”

The study measured that acupuncture “suppressed selected pro- and enhanced anti-inflammatory cytokines” and “increased the production of the cytokine IFN-gamma and the chemokine CXCL10 at the site of inflammation leading to an increase in opioid-containing CXCR3+ macrophages.” In addition, “Macrophage-derived opioid peptides could activate opioid receptors on peripheral sensory neurons and suppressed inflammatory pain. Taken together we identified a new molecular pathway of acupuncture-induced analgesia.”

Prior to this research, it was known that acupuncture caused opioid peptide releases in the spinal cord, brain and peripheral nervous system. The new research extends “these findings by demonstrating that electroacupuncture stimulated the increased numbers of leukocytes (macrophages) containing the three opioid peptides END, ENK, and DYN and that all three opioid peptides mediated antinociception to thermal and mechanical stimuli….”


Theysohn, Nina, Kyung-Eun Choi, Elke R. Gizewski, Ming Wen, Thomas Rampp, Thomas Gasser, Gustav J. Dobos, Michael Forsting, and Frauke Musial. "Acupuncture-Related Modulation of Pain-Associated Brain Networks During Electrical Pain Stimulation: A Functional Magnetic Resonance Imaging Study." The Journal of Alternative and Complementary Medicine (2014).
Author affiliations:
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
Complementary and Integrative Medicine, University of Duisburg-Essen, Essen, Germany.
University Clinic of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria.
Department of Neurosurgery, University Hospital Essen, Essen, Germany.
National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, Faculty of Health
Science, University of Tromsø, Tromsø, Norway.

Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. Published online September 10, 2012. doi:10.1001/archinternmed.2012.3654.

Schiapparelli P, Allais G, Rolando S, et al. Acupuncture in
primary headache treatment. Neurol Sci 2011;32 Suppl

Wang, Ying, Rebekka Gehringer, Shaaban A. Mousa, Dagmar Hackel, Alexander Brack, and Heike L. Rittner. "CXCL10 Controls Inflammatory Pain via Opioid Peptide-Containing Macrophages in Electroacupuncture." PloS one 9, no. 4 (2014): e94696.

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