Acupuncture Reduces Protein Linked To Stress

Acupuncture reduces protein linked to stress in first of its kind animal study.

More news on the possible mechanisms of acupuncture!  A researcher at Georgetown University Medical Center has found molecular evidence of acupuncture's ability to reduce stress by lowering the blood levels of a protein called neuropeptide Y.  This protein is secreted by the sympathetic nervous system during stressful periods and constricts blood flow to many parts of the body.  Although this is a preliminary animal study, it follows that by reducing this protein, acupuncture can help return blood flow to the extremities and digestive organs so people may feel less pain and more relaxed overall.  This experiment will need to be replicated in humans before we can say for sure, but this finding may prove to be one more piece of the mechanism puzzle!

Tendonitis: Cortisone vs. Platelet-Rich Plasma

Tendonitis of the elbow, often called "Tennis elbow" is often not an inflammation, as the suffix "itis" leads us to believe, but a degeneration of the tendon fibers from over-use.  For this reason, doctors are now using the term "tendonopathy"  to denote a problem with the tendon.

Cortisone shots are commonly used to treat tendonitis, but may hinder long-term recovery from injury.  A NYT article a few weeks ago cited a large-scale review in the Lancet that showed, while cortisone shots relieved tendonopathy pain in the short-term, there are often significantly slower rates of healing in the long-term.  Cortisone shots may simply mask the pain and hinder the body's natural healing process, making it easier to re-injure yourself in the long run.

There is another technique, fairly new in western medicine, called Platelet-Rich Plasma injections (PRP).  In preparation for PRP injections, doctors take blood from the patient and separate out the platelets from the red blood cells (RBC).  Blood is normally composed of about 93% RBC and 6% platelets, but with PRP injections, the blood has been reconstituted to have 94% platelets and 5% RBC.  The idea behind these injections is that platelets are responsible for healing the tissue by promoting hemostasis, construction of new connective tissue, and the repair of blood vessels in the area.  They release proteins responsible for attracting macrophages and other cells that promote removal of dead tissue and encourage tissue regeneration and healing (Sampson, et al).  Tendons do not generally receive significant blood flow.  By injecting platelet-rich blood, they are nourishing the tendon more than it would be nourished by the body normally.  It would seem that these PRP injections are a better alternative to troublesome cortisone shots for tendon injuries.

TCM Connection:

In a TCM sense, these types of injuries often result from a yin deficiency not nourishing the muscles or tendons, leaving them less supple and easier to tear. This therapy is injecting a highly Yin substance into the area of injury to facilitate healing.   Although it is in line with TCM philosophy on a local level, systemically the patient may continue to be yin deficient and may have more injuries as a result.  A Chinese medical doctor would treat the person constitutionally as well as locally to bring the body into balance and prevent further injuries.

Sampson, Steven, Michael Gerhardt, and Bert Mandelbaum. Platelet rich plasma injection grafts for musculoskeletal injuries: a review.  Curr Rev Musculoskelet Med. 2008 December; 1(3-4): 165–174.  Published online 2008 July 16. doi: 10.1007/s12178-008-9032-5.

Bu Tong Zi Tong: How TCM treats functional pain

Western Medicine has brought us many great things, however, there are a few things that it still doesn't handle very well.  One of these things is functional pain, or pain without a clear cause.  An article in the New York Times (11/22/10) highlights WM's lack of understanding of functional abdominal/stomach pain. Many people suffer from stomach pain, but diagnostic tests show nothing physically wrong with the patient.  Patients often hear that it's "all in their head" and tire of having to go from diagnostic test to diagnostic test with no results.  Many MDs recognize that TCM is useful in the arena of functional pain and are referring their patients to acupuncturists for treatment.

Traditional Chinese Medicine (TCM) has a different system of diagnosis from WM, which is one of the reasons that it's so well-known for treating pain.  At the heart of TCM's pain-treating philosophy is the Mandarin phrase, Bu Tong Zi Tong.  Bu Tong Zi Tong literally means, "No movement [there] is pain", or stagnation of any kind will result in pain.

Stagnation is a common concept in Chinese medicine and is applied to many ailments, but it can arise from many different causes.  For instance, too little exercise causes stagnation, resulting in various ailments from back pain to hypertension.  On the other hand, too much exercise can exhaust your yin and qi and cause stagnation, even if temporarily, (think lactic acid build-up in the muscles, or sports injuries that take a long time to heal).  Emotional stress can also cause stagnation, and is often one underlying cause of those previously mentioned stomach pains.

The key to treatment in TCM is figuring out what cause is underlying the stagnation.  Our ability to do that lies in the patient interview, our understanding of the yin-yang relationship, and qi flow in the body.  Chinese medicine asks a lot of questions that don't seem at all related to the pain, differentiates based on a range of a person's symptoms, both physical and emotional, and uses the location of the pain as a guide for treatment.  Acupuncture is used to open the meridians and get qi flowing on the surface of the body, and herbs may be used to move qi and blood on an internal level.  (The exact mechanism of how acupuncture works is still basically unknown in a western medical sense, and will be the topic of future posts!)  Dietary recommendations are often given as well.

WM is just getting on board with a more holistic approach.  By looking at the whole patient and understanding the patterns of qi flow in the body, Chinese medicine has been treating acute, chronic, and functional pain for thousands of years.

Prevention tip:

Moderate exercise is the best way to avoid stagnation before it starts to cause you pain.  Even if you're not ready to go jogging or get on a bike, taking a walk after meals, and exercises like Yoga and Tai Chi are things that most people can do on a regular basis.  Also, strong emotions can cause stagnation, so finding appropriate ways to observe your emotions and let them pass by can help avoid stagnation on a deeper level in the body.