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.
It is therefore important that the patient expects Acupuncture to work and that it is applied in the correct therapeutic context. As such what we say and how we deliver Acupuncture as part of our treatment is very important.
These changes limbic fMRI activity may explain why we observe a clinical reduction in not only the intensity of pain but perhaps more significantly the ‘unpleasantness’ associated with that pain.
The ability of Acupuncture to moderate the emotive aspects of pain may account for why we have patients who report they still have pain, but it bothers them less. This is a real clinical outcome, particularly for chronic pain sufferers and may hopefully lead to behavioural changes such as improved function and increased exercise tolerance.This in turn may lead to further reductions in pain intensity - reference. As such, we should consider Acupuncture as having a facilitatory role and supports its use as part of an integrated approach to pain management.