Acupuncture and Neuromodulation: Napadow Editorial

When a White Horse is a Horse:Embracing the (Obvious?) Overlap
Between Acupuncture and Neuromodulation

As some patients may know, I was going to present at the NYC North American Neuromodulation conference in August.  Due to family obligations, I had to cancel.  My presentation was on a group of migraine patients and whether the addition of TAVNS (Transcutaneous Auricular Vagal Nerve Simulation) improved the stress profiles of patients during acupuncture treatment.  The short answer was no.  At least not in the way I designed the study.  I am still enthused about this type of therapy however, since it is relatively cheap and something patients can do at home to help reinforce their acupuncture treatments.  Vitaly Napadow is a researcher at Harvard and one of the chairs of the Society for Acupuncture Research and a colleague of mine for many years.  He, also, became interested in this type of stimulation and has done some studies on it in patients with pelvic pain and migraine.

“There is now growing interest by the biomedical and even
pharmaceutical industry for more targeted electrical stimulation
therapies, for both pain and nonpain indications. At the
U.S. National Institutes of Health, the Common Fund’s Stimulating
Peripheral Activity to Relieve Conditions (SPARC)
is now focused on understanding nerve–organ interactions to
ultimately advance the neuromodulation field toward precise
treatment of diseases and conditions for which conventional
therapies fall short.* In fact, a recent publication in Nature
suggests that many neuromodulatory therapies can be considered
‘‘electroceuticals,’’ or in other words medicines that
use electrical impulses (as opposed to pharmacological agents,
as in ‘‘pharmaceuticals’’) to modulate body physiology.4
Interestingly, many neuromodulatory therapies target cutaneously
accessible peripheral nerves and receptors. In turn,
acupuncture in general, and electroacupuncture in particular,
which couples metallic (conductive) needles with electrical
stimulation,5 significantly overlap with many new technologies
falling under this broad neuromodulation umbrella. For instance,
researchers have even referred to certain forms of TENS as
‘‘acupuncture-like’’ TENS, when using low-frequency stimulation,
acupoint targeting, etc.6 Moreover, electroacupuncture and
TENS may be modulating similar anatomical targets.7 The
wealth of research already published covering neuromodulation
and electroacupuncture therapy needs to be better integrated to
further our understanding of mechanisms supporting these
therapies. My contention is that both of these fields have quite a
bit to learn from one another. Turning a blind eye to the (obvious)
links threatens to retard potentially valuable advances in our
understanding of how best to optimize promising directions in
peripheral nerve stimulation therapies.”…

“Another interesting example of overlap between cutaneous
neuromodulation and acupuncture is with auricular transcutaneous
vagus nerve stimulation,17 which has been shown to
modulate function in several visceral organs (e.g., cardiac18 and
gastrointestinal19 physiology) and typically targets a region of
the auricle (e.g., cymba and cavumconcha) that is thought tomap
to visceral organs such as the heart and gut in auricular acupuncture
theory.20 Stimulation of this region has been shown21 to
activate nuclei (i.e., nucleus tractus solitarii) containing the primary
brainstem synapse for the vagus nerve, whose efferent
fibers are known to innervate the heart and the gut. Even more
interestingly, such brainstem activation was found to be greater
when stimulation occurs during the exhalatory phase of the respiratory
cycle,21 possibly supporting the Chinese medicine
concept of the importance of respiratory phase for acupuncture
needle insertion to achieve tonification and dispersion, potentially
having distinct effects on organ physiology

Napadow White Horse final article

https://www.liebertpub.com/doi/full/10.1089/acm.2018.29047.vtn