Acupuncture and Pharmacotherapy: A Dual Approach to Spinal Injury Pain

Acupuncture and pharmacotherapy may have synergistic effects on neuropathic pain.

Combining acupuncture and pharmacotherapy may be an effective option for relieving spinal cord injury (SCI)-induced neuropathic pain, according to a review published online in Complementary Therapies in Medicine.1

“The adequate treatment of SCI-induced neuropathic pain still remains an unresolved problem,” write Young S. Gwak, PhD, and colleagues from the College of Korean Medicine at Daegu Haany University in South Korea, noting that many patients report dissatisfaction with current therapeutic options, such as morphine, anticonvulsants, antidepressants, and antiepileptics.

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In the review, investigators described physiological mechanisms that support a dual-pronged approach to treatment, and summarize studies of acupuncture in SCI-induced neuropathic pain.

Underlying mechanisms of acupuncture

The critical aspect of acupuncture therapy is the stimulation of the acupuncture needle at a specific acupoint rather than needle insertion itself, write Dr Gwak and colleagues.

Vibration, twirling, or electrical impulses can prevent, alleviate, or attenuate conditions such as pain, depression, and anxiety by activating inhibitory descending pathways to suppress ascending pain signals associated with enhanced neuronal excitability and neuropathic pain.

Animal studies have demonstrated that use of acupuncture after spinal nerve ligation and spinal cord injury modulates central and peripheral redistribution of pain-mediating agents, such as opioids, pro-inflammatory cytokines, neurotrophins, neurotransmitters, neuropeptides, as well as pain-mediating ephrin-B/EphB and MAPK-ROS molecules.

According to the authors, the efficacy of acupuncture in attenuating neuropathic pain and facilitating neuropathic recovery has been demonstrated in several studies, and is likely mediated via neuronal-glial mechanisms.

Treating Psychiatric and Sensory Aspects of SCI

SCI causes various abnormalities in sensory functions, including neuronal hypersensitivity to pain. This can result in hyperalgesia — an exaggerated response to pain — and allodynia, the experience of pain from non-painful tactile or thermal stimulation. These responses are exacerbated as the emotional drive to avoid painful stimuli increases.