When most people think about acupuncture, the first thing that comes to mind is that acupuncture helps pain. When I’m speaking with new patients and I ask if they have tried acupuncture before and their response is “Yes”, they have usually had acupuncture for some sort of muscle or joint pain. The thing is that pain can be difficult to understand.
Pain is an intangible sensation and intensely subjective, which means that everyone’s perception of pain can vary. It can vary depending on pain threshold (the level at which pain becomes perceptible) and pain tolerance threshold (the maximum amount of pain a person can tolerate). Basically, pain is what a person says it is.
In general, it is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is both a physical and psychological event and can occur in spite of negative physical findings or investigations. It is a complex process, it can be magnified or minified, coloured, and reinterpreted by experience. Although it is often an unpleasant experience, it can help to prevent injury and causes automatic avoidance reactions to prevent more injury.
Specifically, pain is a multi-factoral experience: biologically, it is a sign the body has been harmed. Psychologically, there can be emotional suffering – many people with chronic pain can suffer from depression. Behaviorally, it can alter the way a person moves and acts. Cognitively, a patient will automatically think about where the pain has come from and how to get rid of it. Spiritually, it can be a reminder of our own mortality, and culturally, pain has been used to test a person’s fortitude or force their submission.
Physiologically, the body has different ways of perceiving stimulus. Exteroception refers to superficial perception such as touch and temperature change. Proprioception is a deeper perception allowing us to sense deeper pressure and muscle and joint position. Interoception is visceral perception and allows us knowledge of our autonomic nervous systems. Distant reception includes senses such as smell, sound and taste. All of these are correlated, integrated and interpreted in the cerebral cortex: a pain signal occurs and travels along the nerves to the brain. The brain responds to the strength, repetitiveness and duration of the signal. At this point the brain alters the signal through the pain inhibitory system or through the release of pain suppressing hormones (serotonin, endorphins). The brain response then travels through the cerebral cortex and limbic system where pain becomes a conscious and emotional experience. That being said, anything that alters the pain inhibitory system or release of pain suppressing hormones will increase the sensation, which include insomnia, depression, anxiety, narcotics, sedatives, drugs and alcohol.
There are different speeds at which sensations travel along the nerves fibers. The conducting speed of touch is by far the fastest and the interpretation flows through A-beta fibers. The conducting speed of acute pain is not quite as fast and interpretation flows through A-delta fibers. The conducting speed of chronic pain is quite slow and flows through C-fibers.
Most people know the difference between acute and chronic pain, though it is important to make some distinctions. Acute pain is a symptom. Chronic Pain is a disease. Acute means short term (less than 3 months), it has a known cause, temporarily hampers movement, can cause anxiety, responds well to treatment and is not perpetuated by the brain. Chronic pain lasts longer than three month, may not have a known cause, hampers mobility indefinitely, can cause anxiety, fear, depression and anger, is often resistant to treatment and is perpetuated by the brain. During regeneration of a nerve there can be ill-repair, resulting in that nerve not being able to understand normal stimulation and spontaneous firing of that nerve.
How Does Acupuncture Help?
The short answer: no one knows for sure.
The long answer: there have been many studies that show that acupuncture influences the release of endorphins and serotonin, which stops pain signals from reaching the brain. Basically, the stimulation of nerves influences the body’s interpretation of sensation. Some studies also suggest that acupuncture influences the pituitary gland and thus the release of cortisol, a hormone which is known to reduce inflammation.
What is Pain According to Chinese Medicine?
Will Maclean and Jane Lyttleton give a good breakdown, and this next bit is based on their writings.
Qi and Blood Stasis is the Root of All Pain. Obstruction- or stagnation/stasis, which can lead to pain, is the disruption to the distribution of Qi and Blood. This can be due to many factors such as external invasion of pathogens, internal deficiency, or both, resulting in obstruction. Thus, when treating the principles of treatment often include moving Qi and Blood.
Painful Obstruction is Located in the Musculoskeletal System. The musculoskeletal system is considered yang and external relative to the organ system, thus we say that painful obstruction is primarily an external disorder. While the internal organs and the external channels are intertwined, systemic circulation of Qi and Blood may not be affected by the obstruction of the external channels. On the other hand, if there is a weakness or dysfunction of an internal organ, it can predispose to, or exacerbate a painful disorder by influencing the integrity and flow of Qi and Blood.
Painful Obstruction Syndrome Involves the Exterior, Interior or Both. Purely external pathology is the result of trauma or pathogenic invasion and is only in the musculoskeletal system and treatment is local. External and internal pathology is often seen in chronic painful conditions. In this case, the symptoms are external but the state of the internal organs influences the perpetuation of pain. This is due to a lingering or unresolved external pathogen impacting the organ system or due to internal organ dysfunction allowing invasion of pathogens. Internal pathology can also result in pain due to the systems affected, such as low back pain due to Kidney deficiency.
Deficiency & Excess. Pain is generally an excess condition, though its underlying cause can be due to an internal or local deficiency. Excess type is due to a local obstruction, usually due to trauma or spasm, resulting in acute and severe pain with redness and swelling. Deficient type is due to malnourishment of an area, this is usually chronic and results in mild to moderate pain that is aching and dull with the area appearing atrophic, pale or cool.
How Does Chinese Medicine Classify Pain?
External pathogens enter the body more frequently when it is in a deficient and vulnerable state and when the individual is surrounded by a specific environment, such as prolonged time in cold, hot or damp places, or in windy places – including places with air conditioning and fans. Though, for a pathogen based diagnosis, no environmental influences are necessary, pain is also classified based on its characteristics and presentation.
Type of Pain
|Wind||Light, active, airy, changeable. Disperses Wei Qi, enabling other pathogens to enter body and also brings deep pathogens to the surface of the body. Relies on a systemic or local Blood deficiency.||In early stages of syndrome, pain wanders to different places in the body. Tends to affect the upper body, and the intensity of the pain varies.|
|Cold||Freezes and constricts. Inhibits circulation of Qi and Blood. Can be due to cold lodging or Yang Qi deficiency.||Severe and localized pain with stiffness, relieved with warm applications. Often attacks joints, especially joints of the hands and feet.|
|Damp||Sticky, congesting, heavy, congealing. Impedes Blood flow. Stickiness causes it to adhere to host tissue, slow to resolve. Can be due to Spleen deficiency or damp constitutions.||Deep or dull aching or heaviness, usually with swelling and edema. Tissues feel boggy when palpated. Tends to sink and often affects the lower body. Worse with damp weather.|
|Heat||Usually acute and systemic with external conditions. Can be transformed from a cold or damp pathogen or created by organ system dysfunction.||Pain with redness and swelling. May feel hot to the touch.|
Internal organ dysfunction can predispose people to certain types of muscle pain. Every organ and a certain function in relation to Qi and Blood. If there is a dysfunction, certain symptoms can present. That, or a deficiency of an organ can leave the body vulnerable to invasion.
|Lung & Large Intestine||Anterior aspects of the shoulder, lateral elbow, radial aspect of the wrist, thumb and index finger.||Heat in the Large Intestine can exacerbate inflammatory conditions in Yang Ming channels. Lung Deficiency causes people to slouch putting stress on the upper thorax and neck, which can lead to chronic pain|
|Spleen & Stomach||Jaw, knees, ankles.||Spleen Qi deficiency results in general Qi and Blood deficiency resulting in muscles not being nourished and prone to injury and hyperextension. Contributes to damp obstructions.|
|Liver & Gallbladder||Sub-occipital area, posterior shoulder, neck, hip, groin, lateral aspects of the trunk, thigh, ankle and big toe.||Liver Qi stagnation results in sinew dryness, loss of elasticity, stiffness and creaking of the joints.|
|Kidney & Urinary Bladder||Spine, many joints, sacrum, coccyx, posterior leg, knee, heel and sole||The Kidney controls the bones and pathology can lead to bone and joint degeneration|
|Qi & Blood Deficiency||Multiple areas of weakness that expose the tissues to invasion and encourage degeneration.||External pathogens easily invade, tissues repair slower.|
|Phlegm||Lodges in joints, has nodules.||Chronic degenerative changes in joints with nodules. More numbness than pain. Often associated with Blood Stasis|
Pathogens and internal organ disharmonies are often seen together, especially in chronic cases. Your TCM acupuncturist or practitioner has been trained to distinguish between the different types of pain and be able to implement their associated treatments. To go through the different methods of treatment would make for far too long of a blog post, please contact us with any questions!
Is There Anything I can do at Home?
Yes! Absolutely! Diet and Nutrition is the Key!
Eat Nutrients that Relieve Inflammation. These kind of nutrients have a direct effect on the release of serotonin and prostaglandins. These include Omega 3 (EPA & GLA) found in dark cold-water fish oils, flaxseed and evening primrose oil. Also ALA– Alpha-Linolenic Acid found in green veggies such as spirulina, algae, chlorella, wheat grass and alfalfa. Others include tumeric, boswellin, ginger, protein digesting enzymes and antioxidants.
Eat Nutrients that Build Serotonin. Foods rich in Vitamin B (salmon, broccoli, asparagus, romaine lettuce, red peppers, parsley), Omega 3, and Tryptophan (poultry, legumes, nuts and seeds).
Eat Nutrients that Boost Brain & Nerve Health.
- Vitamin A protects brain cells by fortifying membranes
- Vitamin B helps mood, energy, nerves and sensitivity
- Vitamin C manufactures neurotransmitters and protects from free radicals
- Vitamin E helps with inflammation, slows brain aging, protects brain from dietary fat
- Magnesium calms the nerves and helps cells absorb nutrients
- Selenium is an antioxidant and also helps the body relax
- Lecithin is a building block for memory and helps focus
- Phosphatidyl Serin is more powerful than Lecithin and helps conduct nerve impulses, manufactures neurotransmitters, and blocks cortisol
- Acetyl L Carnitine revs up energy production in brain and helps the hemispheres work together
- Ginseng helps body and brain adapt to biochemical changes, buffers stress, is a balanced stimulant, and increases adrenalin without causing its release
- Gingko Biloba improves blood circulation to brain
- Phenylalanine is an amino acid that helps the brain defeat pain and stops breakdown of endorphins
Things to Avoid: overeating or under eating as well as high fat diets. Avoid foods that you have an allergy or sensitivity to because they can trigger inflammatory responses. There are also foods that can destabilize our hormonal balance and stress the Liver. These include dietary fat, sugar, chocolate and alcohol.
Is There Anything Else I Can Do?
We spoke earlier in this article about Serotonin. This is one of the hormones is essential for “closing the pain gate”. What else keeps Serotonin flowing? Keeping a positive frame of mind. Sometimes it seems that the whole world is against us and when we are in a lot of pain, it can be hard to stay positive. Meditations or surrounding yourself with positive affirmations and positive people can really help with the mental and emotional aspect that accompanies pain, especially chronic pain. Even watching comedic TV shows and movies – things that make us laugh can help. In Chinese Medicine we say that laughter “scatters Qi,” and for those in a painful body this can help to break up painful stagnations. Another thing that I’ve noticed that helps is changing your perspective and making it more positive – every time you have pain, instead of reacting with negative thoughts and actions, quickly react with positive thoughts and actions. Our minds are beautiful and amazingly complex and keeping them positive can do wonders for you and your body.
Caroline Prodoehl, R.TCMP
For more information contact us at
Radiance Chinese Medicine and Wellness Centre
Maclean, W. & Lyttleton, J. (2010). Clinical Handbook of Internal Medicine: The Treatment of Disease with Traditional Chinese Medicine, Vol. 3: Qi, Blood, Fluid, Channels. Pangolin Press,Hong Kong.
Yan, Jeson (2008). Integrated Pain Management Course Notes. TorontoSchoolof Traditional Chinese Medicine. Toronto,Ontario.