Acupuncture Combined With Migraine Prophylaxis More Effective

Migraine is one of the most common types of headache as we know. Prophylactic drugs are often used to prevent migraine headaches but are not always effective in reducing the frequency of migraine attacks. New research has shown that Acupuncture may be very useful in supplementing the effect of prophylactic drugs.

The objective of a recent study from the Beijing University of Chinese Medicine by Foroughipour et al (2013)  was to assess the effects of adding acupuncture to conventional migraine prophylaxis.

One hundred patients with migraine (41 male, 59 female), in whom prophylactic drugs had not produced a fall of at least 50% in the number of attacks, entered the study. The patients were randomised into two groups, sham and true acupuncture. The patients in both groups continued their prophylactic treatment and received 12 sessions of either true or sham acupuncture.

Patients in the true acupuncture group received Acupuncture according to their involved meridians (Shaoyang, Yangming,Taiyang or Jueyin) and their Chinese medicine syndrome differentiation, thus adding individualised acupuncture to the semi-standardised protocol based on meridian diagnosis, while patients in the sham acupuncture group were needled superficially, not in ‘real’ Acupuncture points. The traditional Chinese medicine diagnosis was made by the acupuncturist in the same way for both groups.

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Stress, Oxytocin and Acupuncture

I recently listened to a TEDx talk by health psychologist Kelly McGonigal (@kellymcgonigal) where she discusses the role of stress in our lives and how our interpretation of stress can have an impact on whether or not we are likely to die due to a stress related condition. Sounds a little dramatic doesn’t it?

Make stress your friend

She discusses interesting research which showed that those who interpret stress as being harmful to our health are more likely to develop stress related health complications and subsequent mortality. This negative consequence of stress was not seen in those who interpreted stress more positively, as a way of preparing the body for a challenging event or situation. Her line ‘make stress your friend’ may help those, including myself at times, who find managing stress an ongoing challenge.

Later in the talk she went on to discuss the role of Oxytocin in the stress response. Just to remind you, oxytocin is a a mammalian neurohypophysial hormone, secreted by the posterior pituitary gland, that acts primarily as a neuromodulator in the brain. Its often referred to as the ‘bonding’ or ‘cuddle’ hormone.

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Why Zebras Don't Get Ulcers

The catchy title of the post is actually the title of a very good book by Robert Sapolsky in which he describes how zebra's in the wild are very good at going about there business in a state of relaxed responsiveness, what he would call the 'green zone'.

Then a lion is on the attack, there is an immediate reactive shift into the red zone when the fight or flight response kicks in. It's all go, a primal biological response geared at self preservation. Once the attack is over and the threat removed, zebra's as well as others in the wild are pretty good at returning to the green zone as the fight or flight response winds down. The zebras then return to going about their business in a state of relative calm but alert to potential threats and ready to respond when needed.

As humans we are susceptible to many threats, some real and some imagined, both internal such as pain, infection and disease and some external such as threats to our physical or emotional well-being, perhaps a combination of both.

How does this relate to people?

Let's take pain as a perceived threat, one we are all familiar with having to deal with as therapists.

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Local Pain Relief In Response To Suggestion

It is generally considered that the opioid analgesic response which constitutes part of the extra segmental mechanisms of Acupuncture has an ‘all over body’ effect. This may partly explain why it is possible to suppress pain, regardless of where the needle is inserted. This response is more likely to be triggered by the non specific effects of Acupuncture relating to context and expectation.

However, a very interesting study by Benedetti and his colleagues showed that we can also experience a localised anaesthesia response in response to suggestion.

In the study, localised pain was induced by injecting capsaicin into 4 different parts of the body simultaneously. An inactive placebo cream was then applied to just one of these areas which produced local analgesia ONLY in the area where the cream was applied. Furthermore the analgesic response was blocked by naloxone suggesting the opioid systems were at work.

As Benedetti went on to conclude:

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Using Acupuncture To Affect Behavioural Change And A Return To Exercise

There are a number of proposed central regulatory effects of Medical Acupuncture. It is the ability of Acupuncture to moderate the emotive component of pain (i.e. the extent to which it bothers, is considered to be unpleasant or evokes feelings of concern, worry or anxiety) which has received the most interest in research terms.

When considering how Acupuncture can influence our emotive state, it is the response of the limbic and paralimbic areas, in particular the anterior cingulate cortex which appear to be most important (Hui et al, 2000).

We know that in addition to the needle stimulus Acupuncture effects are partly dependant on expectation and preconditioning of the ‘reward’ centres of the brain. It is these so called central nonspecific or ‘placebo’ effects which may explain why those receiving placebo induced analgesia show reduced activity on fMRI within the anterior cingulate cortex as well as the thalamus and insula - reference.

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