Acupuncture biomechanism and the power of an exceptional topical in pain treatment protocols
Dr. Mona Robbins, DAOM, L.Ac.,
Advanced Therapeutix Founder/ Pain Researcher/ Practitioner
With this article I will attempt to bridge two meaningful treatment concepts that may not seem as directly related as they are. I hope to give you some clear talking points that may help you easily explain how acupuncture can meaningfully locally treat chronic pain and how a well-formulated topical can help patients extend and enhance those results.
Comprehensive pain treatments extend beyond acupuncture alone, incorporating other modalities such as heat therapy, massage, manual therapy, cupping, kinesio-taping, and the use of targeted topicals. Collectively, these therapeutic components can meaningfully address tissue stagnation, improve blood flow, increase collagen production, and help remove tissue breakdown products such as lactic acid, and inflammatory cytokines. The addition of a quality topical can enhance treatment outcomes, increase patient confidence, and can reduce the frequency of treatments when used appropriately. But you might be surprised just how this works.
With an advanced clinical doctorate in Eastern Medicine (DAOM) and Acupuncturist licensure (L.Ac.) from the Minnesota Board of Medical Practice, I have extensive clinical experience, having performed thousands of pain treatments. My doctoral thesis explored how acupuncture stimulates the innate immune system to shift local tissue macrophages from a destructive state (M1) to a reparative state (M2), facilitating pain relief and tissue healing.
A brief explanation to set the background:
In the tissue, the mighty macrophage dominates the innate immune system response, signaling other immune cells to do their jobs. The fundamental response of these immune cells is initiated by either damage associated molecular pattern (DAMPs) or pathogen associated molecular pattern (PAMPs). In acute injuries there is often broken skin, bacterial exposure and bleeding, both the DAMP and PAMP response will both be in high gear.
My focus today is on chronic pain. In chronic pain, it is generally DAMP response that causes local inflammation and pain. This includes tissue damage from over-use, old injuries, and arthritic/osteo tissue damage, to name a few. Most, if not all, include fascial binding and micro-tearing, the initiators of DAMP. Damage does not need to be external for the innate immune system to be actively defensive.
To keep things simple, think of PAMP involving pathogens such as getting cut or stepping on a dirty nail. Both DAMP and PAMP will be initiated. Generally speaking, chronic pain does not have classic western-recognized pathogens in the tissue causing inflammation and pain. But it has DAMP…ongoing tissue damage.
How does acupuncture affect these conditions?
Acupuncture has too often received mixed testing results due to poorly designed trails, structured by those unfamiliar with the understanding of what acupuncture initiates in the tissue. Poorly placed needles can still provide some relief because of the basic mechanism I am about to describe. But well-placed needles can vastly change targeted tissue from a destructive state to a reparative state.
Here’s how: The micro-trauma of an acupuncture needle creates a DAMP/PAMP reevaluation response as the tissue is damaged upon insertion and the body’s immune system immediately reacts. This reaction is due to the macrophage response and signaling of other immune cells such as mast cells. The micro-trauma causes the immune cells in the tissue to “reboot” and re-examine the situation. This is the key.
Since the needle is sterile and the damage is minimal, immune response is relatively calm. Often some redness around the needle will appear due to the degranulation of mast cells and the release of histamine. This redness is often more pronounced in certain types of patients who may be more responsive to stress or already have a high amount of systemic inflammation, they may even feel the area become itchy. Generally, the redness is the size of a dime or less and disappears within 20 minutes.
At the same time this redness appears many patients will sense a “heaviness” or “achiness” we call de-qi. This is strongly attributed to the mast cell’s histamine degranulation, exciting the nerves, and causing tissue constriction and sensation. This is what is called M1-type macrophage domination that is destructive in nature. It includes redness, swelling, heat and pain. This is meant to be temporary and stabilize the area. This response is a slight exaggeration or increase of what the patient was already experiencing with their chronic pain area. Hang in there, we are getting to the good part.
Now here’s where the magic starts to happen. During this initial “M1 destroy” response from the needle, the macrophages are “examining” the “new” situation, sending out stabilizing and protective measures. But, with no real pathogen from a sterile needle and no real damage due to the small size of the needle, the macrophages, through negative feedback, switch jobs. They do what is called immunomodulate, which means they change to a completely different cell function. They switch from the M1 destroy state to the reparative state called M2. They go from destroying tissue to repairing it. This switch usually only needs about 20 minutes to complete, more or less.
So how does this all fit together? Let’s use an example:
A patient has shoulder pain from a fall a year ago. The insertion points of certain rotator cuff muscles are tender to palpation. Needles are inserted where the tenderness is most notable. The patient feels a heavy, aching sensation within seconds (M1 response). After 20 minutes the heaviness is gone (M2 response). Removing the needles and palpating the shoulder again prove to have meaningfully reduced or eliminated the pain. This is because the macrophages have immunomodulated to M2 type.
When in M2 state macrophages create anti-inflammatory cytokines, endogenous opioids (our own body’s pain killers), and collagen, a meaningful aspect to tissue repair, among other healing mechanisms.
The therapeutic focus now is how to keep the tissue in an M2 state as long as possible. For many chronic pain patients, local acupuncture alone will reduce pain temporarily as the tissue state is often too ready to revert back to M1 destroy state. Actions that can help keep the tissue in an M2 state longer include:
1. Limiting strain on the tissue, not creating more damage instigating M1 behavior. For example, just because your knee feels better doesn’t mean you should go on a five-mile hike. This will rapidly throw your knee back into M1 tissue state.
2. Lowering stress cam meaningfully reducing the tissue’s readiness to slip back to M1. A systemically stressed system can’t hold a local area in M2 for long. This is why systemic acupuncture is always a good idea when treating local pain.
3. Repeated acupuncture treatments closer together to decrease the ease of reverting back to an M1 inflammatory state.
4. Massage and cupping to move stagnant interstitial fluid, old blood, and remove tissue breakdown products, reducing M1 response, which also allows necessary oxygenated blood flow and fresh fluid to the area.
5. Warmth instead of cold therapy to dilate blood vessels to heal tissue. Blood heals. But if tissue and vessels are tight due to pain and cold they can’t allow flow. Stagnation kills tissue.
6. Kinesiotape is an excellent way to allow continued interstitial fluid and blood flow, which helps to reduce pressure and pain. Kinesiotape kicks stagnation’s butt.
7. Finally, an excellent topical. Now, we will get to the second part.
What is so special about a topical?
Recent research indicates that cannabinoids, namely CBG, may activate similar immune responses as acupuncture, further supporting my integrative approach with topical usage. To be clear, the research points to CBG having an immunomodulation effect on macrophages from M1 to M2. It does not say that it works like acupuncture, because very few are aware of the relationship between acupuncture and macrophage activity. But the evidence certainly aligns.
Since this BLOG article does not site references, let me reassure you with some more detail. The reason I decided to research and write on this M1/M2 subject for my doctorate was due to meeting and befriending Dr. Charles D. Mills, PhD, a scientist from the University of Minnesota, and father of modern immunology. He and his research team discovered (circa 2000) the ability of macrophages to not only immunomodulate from destruction to repair, but also direct the innate immune response, which was met with great scientific resistance, at first.
Dr. Mills named the macrophage states (M1/M2) after their T-cell (T1/T2) sister cells. Any immunologist in the world is familiar with his work. I was extremely fortunate to meet Dr Mills. It was Dr. Mills himself that explained to me how acupuncture worked. Through his published research and other supporting published research, I wrote about acupuncture under a meta-study style paper. Eventually, this understanding will be more well-known and much easier to integrate into western chronic pain treatments.
My thesis remains unpublished because I have been focusing on making a fabulous pain cream. Until then, this information is out there if you desire to do your own research.
Back to pain creams:
In my clinical opinion, there are four aspects necessary to create a quality topical:
1) initial skin-feel, that provides a “gate theory-type” response (discussed further below)
2) meaningful CBD/CBG addition
3) a medicinal herbal formula that moves blood, relieves pain and facilitates healing
4) non-greasy application to facilitate kinesiology tape application
Many topicals today lack two or more of these four aspects. After testing a significant number of topicals currently on the market, I could not find one that performed to my clinical expectations. Therefore, I decided to create a line of topicals that did what I wanted them to do.
So, what does that mean?
Some popular pain creams have “Vaseline-like” oil structure suspending a large amount of menthol and camphor that are held on the surface of the skin due the viscosity of the oil. This is designed to allow a "TENS unit / Gate theory" type of PNS/CNS response. (only chemically instead of electrically). The intensity of the actives stimulates specific nerve fibers, which engages the inhibitory interneuron in the dorsal root, quieting the larger pain signaling nerves. This type of structure can be useful in a topical but should not be the main or only therapeutic aspect, as it is temporary and superficial, and not truly reparative.
A more effective pain cream will incorporate this “gate-theory” with actives that not only create this inhibitory interneuron response but also have a chemical structure that directly affects the tissue, such as the NSAID structure of wintergreen, which is more pain-reducing and anti-inflammatory than menthol or camphor alone.
The second aspect, after the incorporation of proper active ingredients, is meaningful levels of CBD and CBG. Popular CBD pain creams today generally have inadequate amounts of CBD and contain no CBG. Most likely due to CBG’s high expense because of the small amount in the plant (as it is the mother cannabinoid from which other cannabinoids are created), and unrealized exceptional therapeutic value.
CBD is known for its nerve calming and anti-inflammatory capabilities, while CBG, in recent studies, is showing promise to shift tissue macrophages from destructive M1-type to reparative M2-type, which create anti-inflammatory cytokines, endogenous opioids (our body’s own pain killers), and the release of collagen, a necessary aspect to tissue repair.
The third aspect is reparative medicinal herbal formula. Specifically, a traditional Chinese medicine-based dit da jow formula. Used by Shaolin monks to treat martial art training injuries, these formulas are time-tested foundations of topical healing, pain relief, and tissue repair.
The last aspect of a quality topical is one that offers fast absorption, non-greasy application, and is suitable for immediate kinesiology tape application, making it a valuable tool for practitioners and patients alike. Kinesiology tape is a simple yet powerful tool in reducing the re-occurrence of stagnation, allowing continued blood flow and tissue healing.
Not only can a quality topical increase and extend a treatment’s therapeutic effects, it also allows a patient’s continued relief and healing at home. This gives patients more confidence in treatment protocols and in the practitioner, leading to better treatment results and more positive prognosis.
We took all our knowledge and created the best pain creams we could create.
Advanced Therapeutix’s Formula 3 and Formula 5.
My signature product, Formula 5, was dubbed by my patients as "Dr. Mona’s Magic Potion Lotion". Formula 3 has the wintergreen removed to allow application in more sensitive areas, such as necks and aging skin. From a practitioner perspective, they have become an integral part of my practice, and my patients have told me time and again that these products have changed their lives. I can’t begin to tell you how wonderful that make me feel. It make all the time and effort and struggle worth every moment.
Advanced Therapeutix is a small family-owned business, and we will always strive to help you by offering quality and integrity in our products.
