(The Article is part of FIT's #DecodingPain series, where we pull apart the many layers of pain–the sensation, the causes, the stigma, and the treatments.)
What would you try to stop feeling pain?
Would you drink mysterious herb concoctions? Would let bees sting you? Would you let someone stick tens of tiny needles in you?
And what if one of these nuskas actually worked?
Acupuncture is one of the few traditional alternative healing practices that has been able to rise above modern skepticism to be reluctantly embraced by mainstream medicine.
There is scientific evidence attensting to acupunture being able to treat years of chronic pain (among other ailments) but a cloud that still hangs over the ancient Chinese practice is that how it works is still not entirely clear.
In this article, FIT gets to the bottom of what acupuncture really is, how it works and how it works.
The Ancient Chinese and the Energy Pathways
The ancient Chinese believed the body is made up of energy pathways, known as the meridian system. Through these pathways flows energy, or Qi (pronounced 'chee') in Chinese.
"In this physical body of ours we have energy, and there are various energy channels through which it flows all through the body," says Dr S Ranjan, an MBBS doctor turned medical acupuncturist.
Dr Niharika, Director, Dr Niharika Acupuncture Clinic in Delhi explains, "disruptions in these pathways leads to a disruption in the flow of energy which leads to all kinds of dysfunctions."
Acupunture has been around for over 5000 years now, and in ancient China it is thought it have been used not only to heal but also as a preventive treatment for holistic good health.
According to Dr Aadil Khan, another acupunturist in Delhi, acupunture works by increasing one's natural healing ability.
Acupunture for pain: How does it work?
Doctors of acupunture explain pain, and really any bodily dysfunction, as a result of subtle changes in the energy channels.
By poking very fine needles into 'pressure points' in the body's Meridien system, they are able to "unblock the channels", explains Dr S Ranjan.
Dr Khan corresponds this mechanism to that of modern neurology.
"We stimulate the central nervous system which actives the nerves and sends the signals to the brain, through the spinal cord, and then from the brain it is sent to the affected organs."Dr Aadil Khan, Acupunturist
"We release these chemicals by stimulating the nerves. All this happens by putting the acupunture needles in particular points," he further explains.
Acupunture works on a similar theory as the 'gate control' theory of pain that FIT discusses in a previous article–according to which pain is understood as passing through 'gates' in the spinal cord.
"Acupunture works on multiple areas. It works by stimulating the neurotransmittors, directly works on our pain receptors, as well as controls the pathways of the pain signals to the brain. It also helps with secretion of endorphins."Dr Niharika
Acupunture for Chronic Pain
When it comes to chronic pain, Dr Khan says, it's important to figure out the root cause.
"First, we sit down and we talk. We try to figure out what the root cause is. According to that we try to see what are the organs that are affected, and what are the organs that we need to work on. Based on this, we select the pressure points to work on."Dr Aadil Khan, Acupunturist
"Lets take the case of migraine for example. Migraine can be because of many different reasons from fatigue to digestive issues."
Dr Niharika, agrees, adding, "migraine is only the name of the symptom. What we target is the cause."
"For instance, if the patient complaining of a migraine has emotional blockages, or hormonal imbalance, acupunture will work on removing that blockage or balancing the hormones respectively, which will indirectly correct the migraine also."Dr Niharika
Dr Khan further explains this with an example. "Say if the patient is having a migraine because of cervical spondylitis, then we collect a selection of points that would help treat the sponylitis and the migraine is sorted."
But, Does It Really Work?
Not everyone is convinced, though. There have even been many studies that point to acupuncture working the same as placebo.
An argument that proponents of acupuncture have is, 'if it works, does it matter?'
The placebo effect is defined as the phenomenon where a person's body responds positively (or negatively) to a treatment which in intelf may not have therapeutic value. Although the science behind the placebo effect in itself is foggy, it is generally attributed to 'power of the mind'.
But the thing with the placebo affect is that it leads to actually physiological responses. In the case of people suffering from pain, it could mean they no longer feel pain.
Which is esentially the end goal with chronic pain treatments.
But there have also been studies like the one published in the journal Brain conducted on patients of Carpel Tunnel Syndrome–a neuropathic pain disorder.
The study found that while both real and sham acupuncture improved patient-reported CTS symptoms, physiological improvements were noted only in the case of real acupunture.
In the case of real acupunture brain remapping also took place, which is linked to long-term improvement in CTS symptoms.
The scientific evidence supporting acupunture must be strong indeed considering all over the wrold, it is begining to be accepted formally.
Chinese acupunture was recognised by the Ministry of Health and Family as an independent medical practice in 2019.
"If a person who was in incredible pain and in now able to walk and climb stairs and live a pain free life, even 5 years later, then how can you dismiss it as just placebo?"Dr Niharika
Futhermore, Dr Khan argues that accupunture cannot be written off as placebo because not only does it help relieve pain, but also helps in cases of paralysis, diabetes and other ailments.
"Those who say we are numbing the pain, but if we are simply numbing the pain, what about those who are paralysed? With acupunture, we are trying to get their sensation back. How could I treat hormonal imbalance or infertility with a placebo?" he adds.
A major reason why skeptical eyebrows are still raised at acupuncture is because we are still unable to consolidate the ancient Chinese concepts of Qi, 'Yin and Yang' and 'energy flow' to that of our modern understanding of biology and medicine.
"This is very subtle energy and cannot be measured by mainstream medical instruments," says Dr Ranjan
"There have been some experiments that have been conducted by injecting radioopaque dye in particular energy points which demonrtated how this energy travelled through the different channels."Dr S Ranjan
One such study was conducted on mice using polymer Mercox– a type of vescular casting dye in an attempt to visualise the routes of the meridian system.
The study found that the pathways of the accupunture meridien were distinct from either the lymphatic or blood vascular routes.
Doing It the Right Way
Like any medical practice, there is a right way and a wrong way of doing it.
"You have to be very particular in placing the needles, and the depth of the needles. You have to be especially careful at the acupunture points that are just around where the vital organs are."Dr Aadil Khan, Acupunturist
Dr Ranjan adds to this, saying "a beginer will usually work on the limbs beyond the elbow or knee areas. These are relatively low risk.
" Once you're trained well, you can do on the chest area or the face area where chances of injury of blood vessels or vital organs is more," he adds.
Apart from getting it done from someone who knows what they're doing, Dr Khan also speaks of some cases where doing acupuncture should be avoided, like in the case of DVT (Deep Vein thrombosis)–a condition that leads to blood clots in the veins.
"There are also some acupunture points that are contraindications in pregnancies. We also don't do acupunture if the person has any kind of infection, or viral illness," he says.
Dr Khan also adds that in most cases it is safe to do.
(Want answers to your painful woes? Send in your questions to fit@thequint.com, and we will get pain experts to answer them for you.)
(At The Quint, we question everything. Play an active role in shaping our journalism by becoming a member today.)