Contemporary Medical Acupuncture Program


Neurofunctional Treatment of Pain and Dysfunction

Functional Neuromodulation Techniques in pain management

By Dr. Alejandro Elorriaga Claraco
Articles
March 21, 2019

Pain related problems continue to consume great amounts of healthcare resources with only marginal improvements in the overall rate of clinical success, particularly in the area of chronic pain. The main reason for this situation is the complex nature of chronic pain, when the unpleasant feeling has expanded beyond the sensory cortex to affect other areas of the brain, particularly those dealing with emotion and cognition (thought). As a result, chronic pain patients suffer a wide array of dysfunctions at the psychoemotional, psychosocial, behavioural, metabolic, endocrine and immune system levels. 

So far, pharmacological and surgical approaches have provided benefits only to a relatively small number of cases, while having contributed along the way to create a national “opioid crisis” due to the addiction and adverse effects of these drugs in patients taking them on an ongoing basis. The solution to chronic pain? Neither easy nor singular, but definitely includes more knowledge about the nature of the problem.

According to current evidence, the most effective tool we currently have to deal with chronic pain conditions is the Multidisciplinary Pain Management approach, with over 40 peer reviewed scientific papers published in the last decade supporting this model. 

Multidisciplinary pain management programs are based on the bio-psycho-social model, and integrate different physical and psychological treatment approaches by an inter-disciplinary therapeutic team. High treatment intensity (mean 27 hours per week) is important and, according to research, interventions of less than 100 hours are not sufficient to show im-provements for patients suffering from disabling low back pain. The focus of the treatments is to help patients to self-manage their condition. To validate this approach, here is one of the recommendations from the American College of Physicians, just published in February 2017:

“For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.”

MULTIDISCIPLINARY PAIN MANAGEMENT PROGRAMS ARE BASED ON THE BIO-PSYCHO-SOCIAL MODEL, AND INTEGRATE DIFFERENT PHYSICAL AND PSYCHOLOGICAL TREATMENT APPROACHES BY AN INTERDISCIPLINARY THERAPEUTIC TEAM

Interestingly, many of the recommended techniques seem to work by leveraging physiological mechanisms of neuromodulation, a well-known property of the nervous system to regulate its own activity in response to internal and external stimuli. Based on this, we can name these techniques collectively “Functional Neuromodulation Techniques” (FNT). Some FNT involve the use of solid needles, such as electro-acupuncture, traditional acupuncture, and dry needling, and research from the last decade has validated its use not only for the treatment of pain but also for other conditions in which the nervous system function has been impaired.
One important discovery from re-cent years has been the lasting effects of these treatments for pain problems. A recent review by Prof Hugh MacPherson (University of York, UK) concluded that “…acupuncture has benefi ts that extend over a longer period than was previously thought. Short courses of acupuncture, 10 to 12 sessions commonly provided on a weekly basis, are associated with sustained benefi ts lasting one or two years in cases of back and neck pain, and IBS (irritable bowel syndrome)”.
For years it has been known that numerous neurotransmitters and neuropeptides are released in the central and peripheral nervous system in response to electroacupuncture stimulation, such as those from the endogenous opioids system, known since the 70’s. In recent years, new chemical substances produced in the body have also been implicated in the analgesic and anti-inflammatory effects of acupuncture, such as the endocannabinoid system or the cholinergic anti-inflammatory refl ex that works in conjunction with the potent anti-inflammatory effects of met-enkephalin.

Additional mechanisms discovered also include the modulatory effects of acupuncture on the autonomic nervous system which controls our vascular system. This could explain the observed effects on hypertension. According to Prof. John Longhurst (University of California), electroacupuncture applied for 30 mins, once weekly for eight weeks, lowered blood pressure in hypertensive patients after 4-6 weeks for as long as one month after cessation of treatment.

In conclusion, ongoing scientifi c research continues to validate the value of integrating Functional Neuromodulation Techniques such as electro-acupuncture into an effective multidisciplinary pain management plan.

This article was originally published on the Hospital News website.