I was re-reading Lisa Rohleder's most recent book Punking: The Praxis of Community Acupuncture, which you can download FOR FREE at pocatech.org, and the following excerpt about how regular acupuncture can help people with persistent, chronic pain hit me pretty hard.

The majority of the patients in a community acupuncture clinic have some pain, somewhere. Even when patients come in with other complaints, I always ask them if they are having any pain, because acupuncture is so effective at treating it (at the same time as treating other things too). I've said it about a million times now, low back pain is the #1 thing we are asked to treat in the clinic, and neck/trap pain is probably #2. But for the most part when people ask HOW acupuncture treats pain, my response has been that in general, no one knows how acupuncture works, and that's ok with me as long as it DOES work. And it really does -- maybe not quickly, or maybe very quickly (everyone responds so differently). But reading the below excerpt explains the phenomenon of how regular acupuncture can actually change the circuitry in the brain, which is where all pain is ultimately experienced.

The following paragraphs from Lisa's book are fascinating to me, and I feel like I need to read them about 50 times to let the information really sink into my own brain. 

"Recent research shows that the neuroscience of persistent or chronic pain has overlaps with both the neuroscience of learning and the neuroscience of addiction, because of the nature of reward circuitry in the brain. Feeling pain is something we learn to do the way we learn to play a musical instrument: the more we do it, the more we practice, the better we get at it. And like addiction, feeling pain involves both anticipation and reward, in the form of relief from pain.

Just like alcoholism involves drinking more and more alcohol to get diminishing returns of pleasure and relaxation, persistent pain can involve diminishing returns in seeking relief by lying down on a couch or taking pain medication. Certain things swamp the reward circuits of the brain, like opiates, smoking, and junk food. The more the reward circuits are swamped, the faster those circuits get, which can look like a person in pain compulsively seeking relief, even when the methods of relief are helping less and less. Meanwhile, as the nervous system learns to feel pain more and more efficiently, it’s as if an amplifier has been turned up and the pain becomes more and more intense. Anticipation of pain increases pain; fear of pain increases pain.

A vicious cycle is engaged, where the back-of-the-brain circuits of anticipation and reward get faster and faster. Feeling pain and seeking relief take over a person’s experience in a similar way that addiction can take over a person’s life. Even if the person rationally knows that what will help with persistent pain is gentle exercise, the part of the brain that can make rational decisions is less and less accessible. The small, ordinary pleasures of day to day life get crowded out, which means that the person gets less practice feeling pleasure and more practice feeling pain. And of course, the social aspect of persistent pain can be as profound as the social aspects of addiction: as anticipation of pain leads a person to withdraw from the activities of daily life, they become isolated. Isolation increases stress and negative emotions, which in turn increase pain.

At this point, research suggests that the only way to heal the brain from the vicious cycle of compulsive relief-seeking and amplified pain is to gently re-establish connections in the brain that provide small, reliable doses of positive feeling. Over time, low-key rewards that don’t swamp and overwhelm the circuitry can begin to have an effect on the pain amplifier, and actually turn it down. Neuroplasticity can be engaged for the purpose of learning how to feel other things than pain.

Recovery from chronic pain is a gentle, supportive, non-judgmental, active process — which is where community acupuncture clinics can really shine. Many of the same principles involved in trauma informed acupuncture come into play, because using community acupuncture to address persistent pain is about people learning to use the clinic as a source of small, reliable doses of positive feeling. Relaxation is a skill. Accessing support is a skill. Being in a social setting even though you’re in pain is a skill. Community acupuncture patients tend to develop a sense of competence around receiving acupuncture, which means developing neural connections of learning and reward that are different from the grooves of the vicious cycle of persistent pain. It’s all about people being empowered to use the clinic on their own terms."

I know I can speak for all of the practitioners at PCA when I say that we understand that we are not the only ones practicing community acupuncture at the clinic. All of our patients, every time they come in for a treatment, are also practicing community acupuncture, developing their skills of relaxing, accessing support, and being in a social setting while in pain, the skills of using their community clinic. Another thing I have said a million times is that "it's different every time." Once someone has had one deeply relaxing or relieving treatment, they tend to hope for or expect that same experience every time, and end up being disappointed that it's not the same. But what's important, apparently, is not that every treatment ends up being incredibly relaxing or amazingly pain-relieving. What's important are these "small, reliable doses of positive feeling."

For the most part, everyone who leaves the clinic walks out of there in better shape than when they walk in. Their pain is still there, but the volume on it might be turned down for a little while - maybe all the way until their next visit. And over time, it rarely reaches the level it was at - constantly -  when they first started coming in. Acupuncture has literally changed their brains. More accurately, their practice of getting acupuncture has changed their brains. 

Sometimes when patients start seeing good results from getting regular acupuncture, they like to thank their practitioners profusely. And we receive that appreciation, don't get me wrong. But we also know that it's not us, per se. The needles really help, for sure -- they do a lot of the work, as does the community setting. But we also recognize that it is the hard work of making time in a busy schedule for this, the bravery that is required by many, it's the practice of the patients that gets the best results. If you are a patient reading this, thank you for practicing community acupuncture with us. We are grateful to see you in those recliners.