HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 2, NUMBER 1

2015

Pain Relief Effect of Acupuncture and Moxibustion
Nobuyuki Otsuka
Hotal Ancient Medicine Research Institute (HARI)
3-2-1 Hotarugaike-nakamachi, Toyonaka, Osaka, 560-0033 Japan
E-mail: nj00ot@kmj.biglobe.ne.jp
Keywords: chronic pain, nociceptive pain, neuropathic pain, antidepressants,
acupuncture and moxibustion treatment, autonomic nerve

Chronic pain is defined as pain associated with a progressive noncancerous disease with pain lasting longer than expected for treatment. Pain is classified bysource, nociceptive pain, neuropathic
pain, psychogenic pain [1-3].
In addition to nociceptive pain, patients
who complain of chronic pain due to neuropathic pain or psychogenic pain are increasing. [4, 5]
In particular, since pain generated after
surgery is involved in tension and emotionof the sympathetic nerve, it is difficult tocontrol with drugs, and the effect ofacupuncture and moxibustion is expected.
In this paper, the analgesic effect byacupuncture and moxibustion treatment
is discussed based on new findings concerning pain.
Acupuncture and moxibustion therapy is a method of using sensations related to pain in therapy for treatment in
human senses. By touching or stabbing
the acupuncture with the skin, the dull
nerve function is excited and excited functions are suppressed, and the body's discomfort is treated [6]. The indications for
acupuncture discussed in WHO (World
Health Organization) are shown below. A
lot of cases in which pain is caused bypain itself or disease are included [7].
Neurological and musculoskeletal disorders: headache and migraine, trigeminal neuralgia, early of facial paralysis,
paralysis after stroke attacks, peripheral
neuropathy, early of sequelae of polio,
Ménière's disease, neurogenic bladderdysfunction, nocturnal enuresis, intercostal neuralgia, Cervical arm syndrome,frozen shoulder, tennis elbow, sciatica,back pain, osteoarthritis.
Upper respiratory tract: acute sinusitis,
acute rhinitis, common cold, acute tonsillitis.
Respiratory system: acute bronchitis,
bronchial asthma.
Eye disorders: acute conjunctivitis, central
retinitis, childhood myopia, unalteredcataract.
Mouth disorders: toothache, pain after
tooth extraction, gingivitis, acute andchronic pharyngitis.
Gastrointestinal disorders: esophagus andcardiac convulsions, hiccups, gastroptosis,
acute and chronic gastritis, stomach hyperacidity, chronic duodenal ulcer, complication free duodenal ulcer, acute andchronic enterocolitis, acute bacterial diarrhea, constipation, diarrhea, paralytic
ileus.

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 2, NUMBER 1
If acupuncture and moxibustion treatment can relieve neuropathic pain whichis particularly problematic in chronic pain,
it is considered to be a great gospel forthe patient. With neuropathic pain,
rewriting of the body part regeneration
map is performed, and further pain iscaused. Conversely, by increasing the input from the nerve, the body part reproduction map can be rewritten and thepain can be suppressed. If you actively increase the nerve input from the part thatfeels pain, you can also relieve chronic
pain by rewriting the body part reconstruction map. Acupuncture stimulation,
electroacupuncture stimulation, scraping
acupuncture, childhood acupuncture excite the receptor present in the skin andincrease the neural input. As a result,
there is a possibility that pain is suppressed by rewriting the body part reconstruction map relating to pain with a stimulus that does not feel pain. Since analgesics are not always effective for everyone, it is expected that combining ananalgesic with acupuncture will improvethe effect.
Cases of patients diagnosed withcomplex regional pain syndrome (CRPS)
have been reported [8]. A 69-year-old
woman. The main complaint is painaround the right ear. There was tinnitus
hearing loss. She consulted an otorhinology. Vitamins and vasodilators were prescribed because of unknown cause. The
symptoms improved, but pain around theright auricle remained. She was transferred to another hospital and she was diagnosed as CRPS (Complex Regional Pain
Syndrome). DCT (Drug Challenge Test) did
not give any results. Pregabalin (Lyrica) for
peripheral neuropathic pain remedy was2015prescribed but it did not work. Since thenthe symptoms worsened, she was transferred to a university hospital. The benzodiazepine antiepileptic drug rivotril andthe anti-anxiety drugs depas worked well.
The visual analog scale (VAS) of the pain
was reduced to one hundredth. As the
medicine was reduced, it worsened, so
the symptoms became lighter by increasing the medicine. After that, doctors wereconcerned about increasing the amountof medicine and recommended acupuncture.
She was hypersensitivity, spontaneous pain, stress, depressed tendency,
and a multi-word. There is no edema or
insomnia. In the HRQOL (Health Related
Quality of Life) scale, the eight subscale
SF-8 were generally less than 50. Especially 20 mental health (MH), vitality (VT),social life function (SF), summary score(spirit) etc. were bad. The physical function was 54, which was standard. For the
purpose of stabilizing the autonomic nervous system, the needle was placed in
acupuncture point of the spinal column,
tension part of the multifidus muscle,
acupuncture point of the abdomen for 10
minutes. Electric acupuncture 1 Hz was
performed for L14 - LU6, ST36 - SP6 for 20
minutes. Acupuncture was also performed on TE5. In the first treatment, VAS
became 0 immediately after the operation. Later, she felt pain, but due toweekly treatment, there were days when
pain did not occur 3 or 4 days a week.
Mental points improved to over 40.
This patient was diagnosed as complex regional pain syndrome CRPS, but it
is doubtful whether it was really CRPS.
Psychogenic effects are also conceivable.

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Currently, the pain is totally taken, she
continues treatment once a week for systemic adjustment.
The situation of acupuncture andmoxibustion treatment in Japan has also
been reported [8]. The first place of thecausative disease of chronic pain is low
back pain, most of which is an exercise
apparatus and orthopedic disease. The
waist and shoulders are 80%. Chronic pain
holders are about 10% in Japan and 20 to
30% in France, with many chronic pain
holders. Musculoskeletal pain is mostly inthe 30 to 50 years old age, only aging is
not a problem. Chronic pain is more common in people who do not move theirbody like professionals than those whomove their bodies. Hospital visits are 60%,
and treatment at facilities other than hospitals is also about 40%. Besides the hospital, it seems that it will become an osteopathy clinic or a chiropractics clinic.
Acupuncture and moxibustion clinic is
about 8%. There are 40% of orthopedic
surgery, and 20% of chiropractic and massage. Anesthesiology department andpain clinic are extremely few as 1%. The
contents of treatment are 20% for hospitals and clinics, and about 20% for private
therapies. There are 20% for medication,
30% for massage, 10% for acupuncture
moxibustion.
Acupuncture and moxibustion is being incorporated into the treatment of
painful patients. On the other hand, forneuropathic pain, acupuncture treatment
is about 1%. About 80% of people who
can not get pain or numbness complain of
pain treatment. There is no satisfactory
explanation, but people are 30%. Thereare 30% of people who did not under-

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stand the pain. In the 2009 survey, 20%
say that pain is relieved. As far as medical
institutions are concerned, in the reportof 2011, 10% of people are satisfied, 40%of people are somewhat satisfied, andthey are considerably improved. Momentum exercising for orthopedic surgery
Only 30% of patients with chronic pain
are satisfied. Those who returned to society were 40% who improved greatly after
treatment after hospitalization and 2%
who improved.
Psychological factors include cognitive
bias and psychosocial factors. There are
psychosocial factors based on cognitive
bias other than organic factors as reasonsfor pain chronicity. Therefore, it makes
treatment difficult. It is not aimed at eliminating pain but a viewpoint other thanpain, for example, what it is not possible
to do, and what it is not done. For
acupuncture and moxibustion therapy,
evaluation and target setting from a viewpoint other than reduction of pain are important. Treatment that increases what
you can do is important. As an effect ofwhole body exercise therapy, there are reports that pain has been alleviated byphysical activity or improved by walking.
There was no analgesic effect on theshoulder, but there was also a report thatthe motion of the knee had an analgesic
effect.
Patients with low back pain have reported that they do not exercise limited
to the waist but that various physical activities can reduce pain and improve mental activity [9]. Pain and physical function
improved by performing comfortable
walking for 10 minutes against chronic
low back pain [10]. For shoulder myalgia,

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 2, NUMBER 1
there is a report that the movement on
the affected side has no analgesic effect,
but the motion of the knee has an analgesic effect [11]. There is a report thatcognitive behavioral therapy is effective
for chronic pain [12-14]. For example, thegoal of acupuncture and moxibustion
treatment should be to suppress insomnia
improvement and irritation. It can lead to
improvement of quality of life and lifestyle by relieving other complaints such as
shoulder stiffness and improving appetite
often appealed by chronic pain patients.
Currently, the acupuncture and moxibustion treatment does not show evidence from clinical research more thanthe effectiveness in animal experiments.
Therefore, the acupuncturist needs toknow the type and mechanism of pain
and know that acupuncture and moxibustion is not effective pain. Acupuncturists
need to understand the psychologicalthinking of chronic pain patients, deal
with both cognition and behavior, and approach in a pleiotropic manner. Approaches to behavioral targets from aviewpoint other than pain are important.
Acupuncturists need to treat acupuncture
and moxibustion that is not bound by
pain alone.
Considering from the above results. In
acupuncture and moxibustion therapy, itaims at mitigating general symptoms.
Therefore, the acupuncturist can directly
work on the sympathetic nerve and emotion. By analyzing the relationship between acupuncture and moxibustion
treatment and chronic pain suppression
based on sympathetic nerve and emotion,
it is thought that treatment effect can be
improved. Especially acupuncture stimula-

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tion, scraping acupuncture and childhood
acupuncture are thought to be able tosuppress pain by exciting the receptor
present in the skin, increasing the nerve
input, and restoring the sense map of thecerebral cortex. There seems to be a lot ofrequests for treatment of numbness sensation of people with dementia, but they
are not cured by surgery, and when pain
disappears, there are many cases where
the numbness disappears. Reasons thatsurgery is not being carried out on patients with dementia may be difficult toperform rehabilitation on a regular basis,
and adaptation of acupuncture and moxibustion is also a future subject.
As a nerve input to rewrite the bodypart reproduction map, a stimulus input
including image training was executed
and wisdom flow. More specifically, irritation (burning, pleasing) other than pain isadded. These are not acupuncture stimuli,
but it seems that similar effects can beobtained by acupuncture and moxibustion therapy. When electricity is passed
through acupuncture, contraction of themuscles occurs, which seems to be an effective stimulus. In acupuncture and moxibustion therapy, approaches to autonomic nerves are being made rather thanOriental medicine selection. It suppresses
sympathetic tone and puts emphasis on
activation of descending nerve suppression system.
Acupuncture and moxibustion therapy requires treatment of the wholebody. Combined regional pain syndrome(CRPS) is not incompatible in cases withacupuncture and moxibustion effect. Because pregabalin does not work, it is not
nervous. If pain increased after stopping

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 2, NUMBER 1
medicine, it is considered to have been
psychogenic pain.
It is diagnosed a gall bladder meridian
disease. The acupuncture points are L14,
LR3. In the treatment of GB 41, it is conceivable that the parasympathetic nerve
is enhanced by electric stimulation to themuscle. Temporal pain is thought to be atriple energizer meridian disease. The
acupuncture points are TE1, TE2, TE3,
TE4, TE6, TE10. TE 5 is easy to use, there
is a possibility that it will be widely usedin the future. Approach to autonomic
nerve rather than oriental medical choice
is also important. In order to suppress the
sympathetic tone, it is considered effective to apply acupoints to acupuncture
points related to descending nerve suppression system. For patients with chronic
pain, it is difficult only with acupuncture
and moxibustion, so cooperation between
acupuncturists and doctors is important.
Currently, there is no indication of evidence from clinical research for acupuncture and moxibustion treatment forchronic pain. It is necessary to know that
direct stimulation to the nerve byacupuncture is not effective pain.
Acupuncturists need a pleiotropic approach that understands the psychological thinking of chronic pain patients andaims to improve the overall physicalhealth of the patient. Especially, it is important to set behavioral targets of viewpoints other than pain. Acupuncture andmoxibustion treatment not only needs
pain, there is a need to improve the treatment effect with the goal of improving
the general condition of the patient
through adjustment of autonomic nerves
and improvement of circulation of qi and2015

blood.
In summary, there are increasingcases of complaining of not only nociceptive pain but also chronic pain due to neuropathic pain and psychogenic pain. In thecase of neuropathic pain, gene expression
in dorsal root ganglion cells due to increased input from primary afferent nerve
associated with nerve injury has been revealed. Anti-inflammatory drugs are used
as analgesics, but recently analgesic treatment using antiepileptic drugs and antidepressants has become important. Because
patients with chronic pain of nociceptive
pain contain neuropathic pain, pregabalin(Lyrica) is prescribed for inhibiting pain by
inhibiting pain transmission. Based on thisnew finding concerning pain, it is important to accumulate the evidence of analgesic effect on these pain by acupuncture
and moxibustion therapy.
Acupuncture moxibustion stimulation, electroacupuncture stimulation,
scraping
acupuncture,childhoodacupuncture excite the receptors present
in the skin, increase the nerve input, andcan rewrite the body part regeneration
map relating to pain with a stimulationthat does not feel pain. As a result, pain
can be suppressed. In addition, combining
an analgesic with acupuncture can also
make an effect.
In acupuncture and moxibustion therapy, it is necessary to understand psychological thinking of chronic pain patients. It
is necessary to keep in mind how to deal
with both cognition and behavior. A
pleiotropic approach to behavioral targets
from a viewpoint other than pain is required. Chronic pain may be caused bydecreased dopamine or decreased activ-

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 2, NUMBER 1
ity in the nucleus accumbens region of
the cerebrum in the descending control
system. In particular, pain that occurs after surgery is involved in sympathetic tone
and emotion. Therefore, it is difficult tocontrol with drugs, and the effect ofacupuncture and moxibustion is expected.
Acupuncture and moxibustion treatment
needs to improve not only pain but also
treatment effect by targeting improvement of patient's general condition
through adjustment of autonomic nerve
and improvement of qi and blood circulation.

2015[8] Junji Miyazaki, The Japan Society of Acupuncture and Moxibustion
Kansai Branch Seminar A, Osaka, Sep. 2015.
[9] E.L. Hurwitz et.al., Am. J. Public Health, vol.95, pp.1818-1824, 2005.
[10] M. Suzanne et.al., Clin. J. Pain, vol.29, pp.972-981, 2013.
[11] L. Lannersten et.al., Pain., vol.151, pp.77-86, 2010.
[12] B.E. Compas et.al., J. Consult. Clin. Psychol., vol.66, pp.89-112,
1998.
[13] S. Morley et.al., Pain vol.80, pp.1-13, 1999.
[14] A.C. Williams et.al., Cochrane Database Syst Rev., vol.11, 2012.

(Received 1 December 2015)[1] Kazuo Maruyama, The way of thinking of pain, Nankodo, 2014.
[2] Natsu Koyama, Basic knowledge of pain and analgesia, GijutsuHyohron, 2010.
[3] Eiji Furuya, Toyo Therapy Association edited Textbook Acupuncture
Theory[4] Nobuo Nara, Toyo Therapy Association edited Textbook Clinical
Medicine General Edition 2nd edition.
[5] Nobuo Nara, Toyo Therapy Association edited Textbook Clinical
Medicine Detailed Exposition 2nd edition.
[6] Fuminori Ando, Toyo Therapy Association edited Textbook Oriental
medicine clinical theory.
[7] Bannerman RH. The World Health Organization viewpoint on
acupuncture. Am J Acupunct, vol. 8, pp.231-235, 1980.

Dr. Nobuyuki Otsuka
He graduated from Tohoku University in 1985 and completed the firsthalf term of doctoral course of Tohoku University graduate school in
1987. He was awarded doctor degree in 1997 from Tohoku University.
He established Hotal Ancient medicine Research Institute (HARI) in
1999. Now, he is enrolled at Meiji school of oriental medicine from2014. He is engaged in research on oriental medicine such as traditional
Chinese medicine, acupuncture and moxibustion, qigong etc.

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