The perception of pain is a very complex phenomenon that affects many levels in the central nervous system. There is good evidence that acupuncture influences these processes and so modulate pain perception. This includes the placebo response, which we should not forget is not in any sense unreal; it is based on changes in the central nervous system.
In very brief summary, we can say that the perception of pain depends on a balance between excitation and inhibition. To modulate pain we can either decrease excitation or increase inhibation. Acupuncture appears to be a mechanism for increasing inhibition.
Probably the most convenient place to read more on this large topic is Medical Acupuncture: A Western Scientific Approach, edited by Jacqueline Filshie, Adrian White, and Mike Cummings. Second Edition, Elsevier,2016.
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