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Neuropathic pain: a new theory for chronic pain of intrinsic origin
  1. C Chan Gunn
  1. Visiting scientist and consultant, Multi-disciplinary Pain Centre, University of Washington School of Medicine, Seattle, USA
  1. Gunn Pain Clinic, 828 W. Broadway Vancouver, B.C. V5Z 1J8

Summary

Why is acupuncture accepted in the East, especially for the treatment of chronic pain, but not in the West? One reason is that the modus operandi of acupuncture is not fully understood; another is the enigmatic nature of chronic pain. This article introduces a new concept of chronic pain, and suggests how acupuncture may relieve it.

Chronic pain may arise from sources that are extrinsic to the nervous system (for example, ongoing injury or inflammation), but it can also be intrinsic and the result of abnormal hypersensitivity (supersensitivity) in neuropathic or partially denervated structures. Neuropathic pain typically affects the musculoskeletal system, and a pivotal component of this type of pain is muscle spasm or shortening. Spasm can cause pain localised to muscle, but sustained muscle spasm or shortening mechanically overloads tendons and their attachments, and can produce pain in these structures.

Since neuropathic pain is different from nociception or inflammation, its treatment is also distinct (desensitisation of supersensitivity). Most physical treatment modalities for this type of pain, such as heat, massage or transcutaneous electrical nerve stimulation (TENS), desensitise by reflex stimulation of the affected part via its intact innervation. However these modalities are passive and limited in scope. Stimulation ends when their application is terminated. In contrast, injection techniques, including acupuncture, are more effective and long-lasting, because the tissue injury that they produce can unleash the body’s healing source of bio-energy through the current of injury. Tissue injury also releases the platelet-derived growth factor (PDGF), which can promote healing.

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