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New light on acupuncture mechanism

A new paper in Nature Neuroscience has contributed to our understanding of how acupuncture relieves pain (Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture:

We found that adenosine, a neuromodulator with anti-nociceptive properties, was released during acupuncture in mice and that its anti-nociceptive actions required adenosine A1 receptor expression. Direct injection of an adenosine A1 receptor agonist replicated the analgesic effect of acupuncture. Inhibition of enzymes involved in adenosine degradation potentiated the acupuncture-elicited increase in adenosine, as well as its anti-nociceptive effect. These observations indicate that adenosine mediates the effects of acupuncture and that interfering with adenosine metabolism may prolong the clinical benefit of acupuncture.

This work was done in mice so its relevance to human acupuncture remains to be shown. But probably the authors' research does explain part of the analgesic effect of acupuncture. In their discussion they make a couple of interesting points. One, with which I agree, is that the mechanism of action of other kinds of physical treatment, such as chiropractic and osteopathy, may be similar to that of acupuncture. Another is that non-penetrating pressure on the skin, used in some attempts to find a placebo for acupuncture trials, may also cause transient increases in adenosine. Adenosine has anti-inflammatory effects as well as relieving pain, which may explain how acupuncture works for acute injuries such as sprains and tenosynovitis.

Manual stimulation (twisting) of the needles was necessary to produce the effect.

The authors appear to discount the central effects of acupuncture (effects on the spinal cord and brain). But there is a lot of research to support a central mechanism and I think it likely that the adenosine mechanism is part but not all of the explanation for how acupuncture works.


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