Acupuncture Affecting Skeletal interoception regulates joint homeostasis and PGE2-induced pain
Acupuncture needling
What’s New in Acupuncture and Pain: Your Skeleton May Be a Sensory Relay
Interoception is the body’s ability to sense what is happening inside itself. Signals continuously travel between the brain and peripheral organs, helping regulate heart rate, breathing, digestion, temperature, and other functions needed for physiological balance.
What’s new in this article is the idea of skeletal interoception: the skeletal system may act as an active sensory relay between the brain and bone, particularly in response to weight-bearing and mechanical stress. Bone is not merely inert scaffolding. It releases chemical signals that tell the nervous system what is happening, while the brain sends instructions back to help maintain skeletal health.
One important messenger in this two-way circuit is prostaglandin E2, or PGE2. PGE2 participates in inflammation, pain signaling, bone remodeling, and the response to mechanical loading. Abnormal PGE2 signaling may contribute to low-back pain and osteoarthritis, including ankle osteoarthritis.
This model suggests that joint pain may involve more than damaged cartilage or local inflammation. It may also reflect changes in how the brain receives and responds to signals from the skeleton.
The authors propose that acupuncture and electroacupuncture might influence this communication network. Acupuncture stimulates sensory nerves and affects pain-processing pathways in the spinal cord and brain. It may also modify local inflammatory signaling, potentially including PGE2-related pathways.
This does not yet prove that acupuncture treats osteoarthritis by “resetting” skeletal interoception. That remains a hypothesis requiring further research. But it offers a compelling new perspective: acupuncture may act as neuromodulation, influencing the ongoing conversation among the brain, nervous system, immune system, and skeleton.
The larger lesson is fascinating. Our bones don’t merely support us. They sense, signal, adapt—and help the body maintain balance.
https://pubmed.ncbi.nlm.nih.gov/42595748/
Hu Q, Qi B, Dong Y, Pan Y, Liu Y, Chen Z, Fang J, Liang Y, Zhang P. Skeletal interoception regulates joint homeostasis and PGE2-induced pain: implication of disease-modifying treatment. Bone Res. 2026 Aug 13;14(1):84. doi: 10.1038/s41413-026-00561-1. PMID: 42595748; PMCID: PMC13473667.
Abstract
Interoception is a core process through which the body perceives its internal state and regulates physiological homeostasis via bidirectional communication between the central and peripheral nervous system. Skeletal interoception is a specific circuitry for the brain control of the weight-bearing system, particularly responsible for sensing bone-derived internal signals to maintain skeletal homeostasis in response to mechanical loading. Recent studies uncovered that prostaglandin E2 (PGE2) plays a crucial role in skeletal interoception, and is therefore involved in major skeletal disorders and pain conditions such as low back pain, osteoarthritis and particularly ankle osteoarthritis (AOA). Ankle pain is clinically common, with a prevalence of 9%-15% among adults, severely impairing work productivity and quality of life. This article reviews the progress of skeletal interoception in skeletal pathogenesis and pain, with ankle osteoarthritis AOA as an example. Specifically, it discusses PGE2 and skeletal interoception in relation to pain and inflammation. We also attempted to interpret non-steroidal anti-inflammatory drugs (NSAIDs), surgical interventions and Traditional Chinese Medicine (TCM) therapies, especially acupuncture and electroacupuncture, in the therapy of pain and osteoarthritis from the viewpoint of skeletal interoception. Interoception is an emerging science in understanding how the brain regulates peripheral organs. Skeletal interoception mediated by PGE2 provides an opportunity to understand the potential of NSAIDs and acupuncture in regulating interoception for the treatment of skeletal disorders including ankle pain.