traditional medicine

Don’t dismiss acupuncture yet – it may help relieve chronic pain by working on the brain

New research shows that bodily response is not the only means by which acupuncture works.

Acupuncture is a form of traditional medical therapy that originated in China several thousand years ago. It was developed at a time bereft of tools such as genetic testing or even a modern understanding of anatomy, so medical philosophers did the best they could with what was available – herbs, animal products and rudimentary needles. In the process, perhaps, they stumbled on an effective medical approach.

In the past century, some modernisation has taken place. For instance, acupuncture has been paired with electrical currents, allowing for stimulation to be more continuous and to penetrate deeper into the body. This approach was termed electro-acupuncture and represents a convergence between the ancient practice of acupuncture therapy and modern forays into targeted electrostimulation delivered to the skin or nerves. Such approaches have attracted the attention of the pharmaceutical industry and are part of a growing class of neuromodulatory therapies.

So why all the rancour against acupuncture from some corners of the internet (and academia)? Shouldn’t we apply our modern research methods to see which classical acupuncture techniques have solid physiological backing?

Measuring pain

It’s not as easy as it seems. Let’s look at the clinical research. A recent landmark meta-analysis threw together data from thousands of chronic-pain patients enrolled in prior clinical trials, finding that acupuncture might be just marginally better than sham acupuncture (in which non-inserted needles are used as a placebo control). The differences were statistically significant, but lack of a larger difference could be due to the clinical outcome measure that the researchers studied.

Symptoms such as pain (along with fatigue, nausea and itch) are notoriously difficult for different people to rate in a consistent manner. Conventional wisdom says that these kinds of symptoms are improved by placebo, but what about improvements in the body’s physiology?

For instance, in a recent study that assigned an albuterol inhaler for asthma to some patients and sham acupuncture to others, patients reported both as effective. But objective physiological measures demonstrated significant improvement only for albuterol. It’s clear that in evaluations of acupuncture, research should explicitly hunt for potential physiological improvements, in addition to patient reports.

While most chronic-pain disorders lack such established, objective outcomes of disease, this is not true for carpal tunnel syndrome, a neuropathic pain disorder that can be validated by measuring electrical conduction across the median nerve, which passes through the wrist. Interestingly, the slowing of nerve conduction at the wrist does not occur in isolation – it’s not just the nerve in the wrist that’s affected in carpal tunnel syndrome.

My own department’s research and others’ has clearly demonstrated that the brain, and particularly a part of the brain called the primary somatosensory cortex or S1, is re-mapped by carpal tunnel syndrome. Specifically, in functional magnetic resonance imaging or fMRI brain scans, the representation of fingers innervated by the median nerve are blurred in S1. We then showed that both real and placebo acupuncture improved CTS symptoms . Does this mean that acupuncture is a placebo? Maybe not. While symptom relief was the same immediately following therapy, real acupuncture was linked to long-term improvement while sham acupuncture was not. And better S1 re-mapping immediately following therapy was linked with better long-term symptom reduction. Thus, sham acupuncture might work through an alternative route, by modulating known placebo circuitry in the brain, while real acupuncture rewires brain regions such as S1, along with modulating local blood flow to the median nerve in the wrist.

Where you stick the needle might matter as well. While site-specificity is one of the key features of acupuncture therapy, it has been controversial. Interestingly, in the S1 region of the brain, different body areas are represented in different spatial areas – this is how we localise the mosquito that’s biting us, and swat it. Different S1 areas might also pass along information to a diverse set of other areas that affect different bodily systems such as the immune, autonomic and other internal motor systems.

As far as acupuncture is concerned, the body-specific map in S1 could serve as the basis for a crude form of point specificity. In our study, we compared patients receiving real acupuncture locally to the wrist with patients receiving real acupuncture far from the wrist, in the opposite ankle. Our results suggested that both local and distal acupuncture improved median nerve function at the wrist. This suggests that the brain changes resulting from acupuncture might not just be a reflection of changes at the wrist, but could also drive the improved median nerve function directly by linking to autonomic brain regions that control blood vessel diameter and blood flow to the median nerve.

This new research clearly demonstrates that bodily response is not the only means by which acupuncture works; response within the brain might be the most critical part. Once we better understand how acupuncture works to relieve pain, we can optimise this therapy to provide effective, non-pharmacological care for many more chronic-pain patients.

This article first appeared on Aeon.

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Advice from an ex-robber on how to keep your home safe

Tips on a more hands-on approach of keeping your house secure.

Home, a space that is entirely ours, holds together our entire world. Where our children grow-up, parents grow old and we collect a lifetime of memories, home is a feeling as much as it’s a place. So, what do you do when your home is eyed by miscreants who prowl the neighbourhood night and day, plotting to break in? Here are a few pre-emptive measures you can take to make your home safe from burglars:

1. Get inside the mind of a burglar

Before I break the lock of a home, first I bolt the doors of the neighbouring homes. So that, even if someone hears some noise, they can’t come to help.

— Som Pashar, committed nearly 100 robberies.

Burglars study the neighbourhood to keep a check on the ins and outs of residents and target homes that can be easily accessed. Understanding how the mind of a burglar works might give insights that can be used to ward off such danger. For instance, burglars judge a house by its front doors. A house with a sturdy door, secured by an alarm system or an intimidating lock, doesn’t end up on the burglar’s target list. Upgrade the locks on your doors to the latest technology to leave a strong impression.

Here are the videos of 3 reformed robbers talking about their modus operandi and what discouraged them from robbing a house, to give you some ideas on reinforcing your home.

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2. Survey your house from inside out to scout out weaknesses

Whether it’s a dodgy back door, a misaligned window in your parent’s room or the easily accessible balcony of your kid’s room, identify signs of weakness in your home and fix them. Any sign of neglect can give burglars the idea that the house can be easily robbed because of lax internal security.

3. Think like Kevin McCallister from Home Alone

You don’t need to plant intricate booby traps like the ones in the Home Alone movies, but try to stay one step ahead of thieves. Keep your car keys on your bed-stand in the night so that you can activate the car alarm in case of unwanted visitors. When out on a vacation, convince the burglars that the house is not empty by using smart light bulbs that can be remotely controlled and switched on at night. Make sure that your newspapers don’t pile up in front of the main-door (a clear indication that the house is empty).

4. Protect your home from the outside

Collaborate with your neighbours to increase the lighting around your house and on the street – a well-lit neighbourhood makes it difficult for burglars to get-away, deterring them from targeting the area. Make sure that the police verification of your hired help is done and that he/she is trustworthy.

While many of us take home security for granted, it’s important to be proactive to eliminate even the slight chance of a robbery. As the above videos show, robbers come up with ingenious ways to break in to homes. So, take their advice and invest in a good set of locks to protect your doors. Godrej Locks offer a range of innovative locks that are un-pickable and un-duplicable. To secure your house, see here.

The article was produced by the Scroll marketing team on behalf of Godrej Locks and not by the Scroll editorial team.