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Dry Needling + Manipulation for Psychotherapy

Dry Needling + Manipulation for Psychotherapy

“I believe it is impossible to fully treat or achieve the best possible patient outcomes in psychotherapy, without concomitantly addressing neurophysiologic and musculoskeletal pathology. If the ANS is not homeostatic, severe physical and mental impairments often follow. Even if ANS impairment is not the cause of the mental dysfunction, one can’t fully treat the mental dysfunction without also addressing any neuromusculoskeletal dysfunction. Sometimes I like to think of psychotherapy as a treatment focused on regulating the nervous systems and structures, especially the brain. The brain will never be regulated to the best possible outcome if it is constantly receiving negative afferents from any other part of the body. This inhibits psychologic improvement. Painful or non-painful dysfunction (like latent trigger points), originating from any part of the body, typically pushes the ANS into sympathetic hyperactivity. Sympathetic autonomic nervous system (SANS) hyperactivity alters hormone and neurotransmitter release from the hypothalamic-pituitary-adrenal (HPA) axis and the gut-brain axis.”

“Doesn’t it make sense to use treatments like SSRIs, dopaminergics, psychedelics, and psychotherapy in conjunction with electrical needling and manipulation? You can’t have a healthy body without a healthy mind, and you can’t have a healthy mind without a healthy body. These things are intimately and intricately intertangled and should be treated as such.”

Psychotherapy, and how the brain changes in response to it, is one of my favorite areas of scientific study, especially the reemergence of psychedelic psychotherapy with things like ketamine, MDMA, psilocybin, and Iboga, to name a few. Recently, I had a great meeting with Dr. Dan Engle, an MD psychiatrist, who uses ketamine-assisted psychotherapy along with a ton of other awesome healing treatments. His clinic is, by far, the coolest clinic I have ever seen! Psychotherapy, chiropractors, saunas, IVs, massage, sensory deprivation tanks, you name it. We need far more clinics like this one. Dr. Engle is totally awesome.

Johns Hopkins University has an entire department devoted to studying the effects of psilocybin on the human brain and mind. Matthew Johnson, PhD, is the lead psychologist of this department. Super interesting dude who is getting stunningly positive results.

The positive results from a single experience are long-lasting and incredibly promising. Iboga is the most insane psychedelic I have come across; it comes from the roots of the Iboga tree in Africa. The psychoactive chemical within it is called Ibogaine. People with severe heroin and other drug addictions can take this natural substance. It stimulates a multi-day trip, and afterwards, they often have zero physical withdrawals and no desire to use the drug again. To me, the lack of physical withdrawals is the most fascinating aspect. Imagine the neural plasticity this natural substance must induce to allow the brain to rewire itself, eliminating physical AND mental withdrawal signs and symptoms. Mind boggling. Electrical dry needling, in conjunction with manipulation, also induces elevated neural plasticity. Hmmm…..

While living in South America for almost a decade, when I was (“was” is debatable) a degenerate fishing bum, I had the opportunity to experience ayahuasca a multitude of times with real-deal shamans. It was awesome. These experiences and lessons learned were incredibly powerful and helpful for me in a multitude of ways, and they remain with me today, over a decade later. These are similar to the insanely positive results researchers and clinicians are having through studying and using the effects of psychedelics in conjunction with psychotherapy.

Dry Needling + Manipulation = Synergistict Adjunct to Psychotherapy

I believe the regulatory effect that thoughtful needling and manipulation have on the autonomic nervous system (ANS) could—and should—be used as a synergistic adjunct to psychotherapy. We know electrical needling, in particular, can significantly improve cerebral neural plasticity. I see dramatic improvements in stress, anxiety, and personality on a consistent basis with my patients as a result of improved ANS homeostasis. PTs are not seeing patients specifically for psychological stuff, although I’m not so sure about that. Either way, a large percentage of our patients present with psychological impairments and show dramatic improvements as their ANS becomes more homeostatic.

If you focus treatment on regulating the ANS as a stand-alone or along with whatever else you are doing, primarily depressing sympathetic and elevating parasympathetics, you will see fast, obvious, and significant improvements in physical and psychological impairments. A common phrase I hear from my patients is, “I don’t know what you did, but it feels like you fixed my soul.” Yes, yes, I know, total quackery, magical BS, right? We understand so little of how everything works in our body, so is it any surprise that a lot of this seems like magic? If we could quantify all the medical and scientific knowledge needed to fully understand the human mind and body, I bet we know less than 5% of the whole. So exciting. Lots of new, cool stuff to discover!

Why regulating the ANS is important

Regulating the ANS is key to solving just about every medical pathology we know about, including psychological impairments. Nothing works properly without ANS homeostasis. The ANS regulates things like hormone production, organ function, and our enteric nervous system (part of the ANS) through pathways like the hypothalamic-pituitary-adrenal (HPA) axis. When performed properly, needling has an astoundingly powerful effect on bringing the ANS towards homeostasis. As far as physical therapy goes, and psychotherapy, for that matter, most of our patients have elevated sympathetics, including (SANS). Pain, anxiety, and stress are three common causes of, or results from—or both—SANS hyperactivity. How many patients have none of these symptoms? Exactly. This leads to devastating neurophysiologic consequences.

Lucky for us, thoughtfully performed dry needling, in conjunction with manipulation, is a powerful tool that can be used to stimulate the parasympathetic portion of the ANS (PANS), thus depressing the sympathetics via numerous pathways. One of these pathways is Beta-endorphin release. B-endorphin is a potent endogenous opioid and neurotransmitter released from the HPA in response to needling and manipulation. Neurohormone is another term frequently used to describe B-endorphin. Some scientists believe this substance plays as big a role as other major neurotransmitters, like Ach, epinephrine, norepinephrine, etc.

Aside from being a potent analgesic, there are a number of studies on B-endorphin indicating it plays a far larger role than a simple opioid. Its effect on behavioral patterns such as alcoholism, drug addiction, and obesity as well as on psychiatric diseases, to name a few, have all been studied, to some degree or another. The results show significant correlation to these diseases when B-endorphin concentrations are abnormal. Regulating the ANS has a regulatory effect on B-endorphin concentration throughout our bodies. If anyone is interested, I have included some of these studies in the references.

As far as we know, the human brain is the most complicated structure in our universe. We know more about how the sun works than we know about how the brain works. Just think about that for a sec… Nuts. One of the things we do know, however, is that ANS homeostasis is vital to overall physical and mental well-being. Without ANS homeostasis, nothing else in our body works properly.

Pelvic floor + ANS regulation

I believe it is impossible to regulate the ANS to the fullest capacity a lot of the time without treating the pelvic floor, assuming the pelvic floor is pathologic (it is in most people). The pelvic floor musculature is directly connected to the PANS via the sacral plexus. If these muscles are not addressed, continuous negative afferents are sent to the brain, disrupting homeostasis. Regulating the ANS toward homeostasis, in turn, facilitates homeostatic epigenetic expression—how our genes are actually expressed. At the moment, it is thought that our epigenome controls 80% and our actual genes only 20% of things like heritability and day-to-day gene expression. Furthermore, it is impossible to properly treat the vast majority of PT-related impairments without specifically focusing on regulating the ANS. Therefore, it is impossible to properly treat the majority of PT patients without treating the pelvic floor. See what I did there? I’m sneaky like that. Hahaha.

But seriously, no joke. It is also impossible to fully address many other impairments, like low back pain, hip pain, knee pain, bla bla bla, without treating the pelvic floor. Just think about it. All these muscles are attached to our pelvis and our PANS via the sacral plexus, S2-S4. If any of the pelvic floor muscles are transmitting negative afferent signals to the brain, via the sacral plexus, our ANS begins receiving these negative messages, oftentimes unconsciously. At a certain threshold, our ANS just says screw off and makes everything dysfunction and hurt, regardless whether it should be painful or not. The subsequent impairments may present themselves as completely unrelated, but they are not. Aside from that, the pelvis is the center of our mass. If our center of mass is off kilter, it leads to lots of bad stuff, both on a neurologic and musculoskeletal level.

Note: The pelvic floor is one of the most comfortable areas of the body to be needled. It is totally counterintuitive, but true. It seems like it would be horrible, but I’m telling you, it’s no problem. Also, quite a bit of the pelvic floor can be directly treated with needles without exposing the genitalia.

Note: I like to use somewhere between 1-5 Hz (I like 2 Hz) of microcurrent through my needles. I put the positive lead—the cathode—over the most pathologic tissue to place positive ions into the tissue. This makes the sarcomeres more positive and less likely to fire. Muscle firing stimulates sympathetics. Remember, -35 millivolts is the typical resting potential of skeletal muscle cells, with -70 millivolts typically eliciting an action potential. In pathologic tissue, the threshold gets less negative, making spontaneous electrical firing more possible, leading to muscle spasms. Low frequency microcurrent is an excellent way to restore normal electrical potential across various tissue substrates, including the brain. 1-5 Hz has been shown, thus far, to be the best range of frequencies to release endogenous opioids, like B-endorphin from the HPA axis, into the bloodstream. As most of my patients have pain and sympathetic hyperactivity, endogenous opioid release is awesome for a number of reasons.

Remember: The majority of physical and psychotherapy patients suffer from sympathetic hyperactivity. Impairments resulting from parasympathetic hyperactivity typically fall outside the PT scope of practice, so we don’t see a whole lot of that. They are also less common than sympathetic-hyperactivity-related impairments. That is not to say we can’t target and treat both parts of the ANS—the PANS and SANS, but the majority of our patients have sympathetic hyperactivity. So, let’s assume that our goal is sympathetic depression, parasympathetic elevation, and ANS homeostasis.

Note: The three areas of the body PTs have safe access to target the PANS are the sacral periosteum (S2-S4), the upper cervical and suboccipital periosteum (brainstem nuclei), and the concha of the ears (direct vagus nerve innervation, auricular branch). Connecting all 3 with about 2 Hz of microcurrent induces amazingly positive responses. I use the combination of these needles with the majority of my patients, sometimes on their own, sometimes along with whatever else I am treating. Give it a shot, and you will see awesome improvements, both physically and mentally.

I like to needle the concha of the ear when treating most of my patients. I use this needle for a lot of stuff. The concha is the only tissue we can needle that is directly innervated by the vagus nerve, auricular branch. Needling this area has been shown to have positive effects on all sorts of cool things like pain, depression, bowel dysfunction, psychosocial dysfunction, ANS regulation, and immune function, to name a few. Remember, the vagus innervates the enteric nervous system, which is part of the ANS and plays a primary role in regulating our immune system. The connection between the vagus and the enteric nervous system is commonly referred to as the gut-brain-axis, which includes the hypothalamic-pituitary-adrenal axis (HPA). Think of the gut-brain axis as interoceptive awareness—what’s going on inside our bodies. The HPA regulates our bodies’ response to stress via hormone production and release. As far as we know, the gut-brain-axis and the HPA are primary controllers of physiologic homeostasis. The endocannabinoid system is another super important one, and I will write a blog on that in a bit. Again, if we have maximum ANS homeostasis, we should never get sick or really have any significant issues of any kind.

Vagus nerve and PANS stimulation have been shown to reduce pro-inflammatory cytokines and tumor necrosis factor alpha (TNF-a), bringing the body back toward homeostasis, giving us the best shot at maximally utilizing our incredible, innate ability to heal ourselves mentally and physically. Vagus nerve stimulation (VNS) is used, and is being studied to use, for a variety of impairments including sepsis, ADHD, lung injury, rheumatoid arthritis, stroke, traumatic brain injury, obesity, diabetes, cardiovascular control, a variety of mental dysfunctions, and pain management. VNS has also been shown to significantly improve immune function via regulation of the ANS and enteric nervous system. The enteric nervous system is thought to have somewhere between 200 and 600 million neurons, one of the largest collections of neurons in a specific system we have found thus far. If our ANS and enteric nervous system are pathologic, think about 500 million pissed off neurons sending oftentimes subconscious signals every second to our brain, telling it that something is wrong. Yeah, no bueno is right.

80-90% of the vagus fibers are afferent. That is a lot. It appears the vagus’ main function is to tell the brain what is going on in our gut and organs so the body and brain can properly self-regulate to stay alive. These are mainly subconscious functions. However, our ANS has been shown to be susceptible to conscious control (Huberman Lab podcast has a cool episode on this). Like I said before, superpowers. These functions are vital to mental and physical well-being. There are lots of really cool studies on this, and I have included some in the references.

So, imagine a person with bowel or organ pathology. This produces a constant stream of negative afferents to the brain, which eventually overload the ANS and cause dysfunction. Think about this as similar to central sensitization of the CNS. ANS dysfunction can cause central sensitization, along with a host of other health issues, without much problem. These impairments cause pain receptors to become hypersensitive. This leads to bad stuff...

Needling is primarily effective secondary to the significant changes we can make to the nervous systems, the ANS, in particular, as we have discussed. Adding manipulation into the equation amplifies, improves, and prolongs these effects. I believe this effect is regulated by some type of sclerotomal quantum field entanglement of particles in our body. If we could figure out just a bit more about quantum processes, especially in warm biologic settings, we could learn to treat and cure an insane amount of stuff with simple tools like needling, manipulation, and psychotherapy.

In theory, if our ANS is in perfect homeostasis, we would never get sick. If you don’t believe me, find me any sick person, with any type of illness, who has a homeostatic ANS, and we can talk. This is quickly turning from theory to fact as we learn more about the human body. Dr. David Sinclair, from Harvard Medical School, is a pioneer in this area of study. He is one of the dudes responsible for figuring out how to regrow the optic nerve in mice. They can blind mice by damaging the optic nerve and repair their vision with one injection, no surgery. They can also reverse cellular senescence via epigenetic alteration with natural substances, like nicotinamide mononucleotide (NMN), a precursor to NAD+, which leads to increased concentration and activity of Sirtuins (homeostasis regulators), especially Sirtuin-6. In other studies, mouse spinal cords have been non-surgically repaired from complete severing by injecting a cool new viscous fluid into the spinal canal that allows the spine to heal itself. Our bodies have an incredible, innate ability to heal. Sometimes, however, we need to provide a little help, allowing our bodies and minds the optimal or enhanced opportunity to heal and restore homeostasis.

This is so cool. Parts of our bodies regularly regenerate, like skin. What if our internal structures, organs, smooth muscle, heart, brain tissue, etc., also hold the potential for self-healing and regrowth but cannot consistently express that potential on their own like skin can? What if we can unlock these inherent mechanisms? Some animals can do this stuff, like lizards and tardigrades (water bears), for example. Remember: People with certain conditions, like diabetes, do not heal nearly as well as a healthy person. What if, with a little help, human internal structures could regenerate? We know this to be possible! Stem cell therapy and platelet-rich-plasma are a couple examples in this area of study, with much cooler stuff in the works from people like Dr. David Sinclair and Dr. Dan Engle.

Neural plasticity is a poorly understood mechanism, although we are learning more and more about it. There are many unfortunate, mainstream ideas out there that are completely false. Go figure… One that I see the most is the assumption that stroke, TBI, or other brain injury patients only have a certain amount of time to recover function following injury, after which point, there is supposedly little to no room for improvement. This is 100% false. Early treatment makes things easier, although it’s not as though you can’t make significant improvements at any point. I have had a multitude of patients with significant deficits from brain pathology, years and years ago, that have shown dramatic, positive, and lasting responses to the combination of electrical needling and manipulation.

Electrical needling induces enhanced neural plasticity and the ability to possibly re-wire and/or repair neural circuits and structures. This has been evidenced in numerous dry needling and acupuncture studies, looking at brain fluctuations with fMRI, like electrical activity and blood perfusion, during and after needling. On a subjective level, this phenomenon is quite obvious to see when treating patients. How else do you explain complete resolution of a variety of issues, some totally unexpected, that have been present for decades, bilaterally, after a few needles unilaterally? Aside from magical powers, I can accept that.

Psychiatry and psychology are typically thought of as brain and mind sciences. This is undoubtedly true; however, more focus should be placed on specifically regulating the ANS and enteric nervous system, along with the rest of the body, in conjunction with psychotherapy. Acupuncture has been used for things like anxiety, headaches, pain, mental disorders, nervous system regulation (although I believe acupuncturists would use different terminology), etc., for thousands of years. Things that don’t work don’t persist through millennia. Unfortunately, in current western medicine, the medical establishment is so money-driven and corrupt that many safe and effective techniques have been buried and not studied in favor of new, super expensive, oftentimes less effective and more harmful treatments.

The addition of needling and manipulation into psychotherapy practice has vast potential. Let’s go back to the ANS for a sec. Let’s say you have a psychotherapy patient who has been in some kind of distress for some time now. The majority of these patients are going to have a hyperactive SANS, either causing, or resulting from the patients’ physical and/or mental distress. Remember, both physical and mental impairments affect the ANS. Either way, a negative feedback loop initiates. If the ANS is not specifically addressed throughout the course of treatment, this cycle may be depressed for a time with various treatments, with temporary results, but eventually the problem will reemerge, whatever the original cause. The HPA and gut-brain axis will remain dysfunctional, hormone and neurotransmitter concentrations remain pathologic, chemically amplified pain continues, the PANS and enteric nervous systems malfunction, immune function is hindered, and everything goes to shit.

Again, if the ANS homeostatic, theoretically, we should not have frequent physical or psychological problems. Physical impairments can cause psychological impairments and vise versa, so this is why it is so important to treat both simultaneously. The most depressed I have ever been in my life, and I am not that type of person, was after I broke my hip and couldn’t walk for 4 months. It was horrible. At the same time, people with zero physical injury suffer from extreme pain. Without question, physical and mental wellbeing are intricately connected, and we all know this from personal life experiences. So, why are mental and physical impairments treated as completely separate and disconnected in most cases?

Typical drugs like SSRIs target specific chemicals, like serotonin. Thoughtful needling, in conjunction with manipulation, has a regulatory effect on the entire ANS—the whole deal, which has a regulatory effect on the gut-brain axis (enteric nervous system and brain), the HPA axis, and just about all chemical reactions in our body. Don’t forget: The enteric nervous system plays a huge role in serotonin production and concentration in our body along with many other things. Enteric pathology also causes a form of Parkinson’s disease, with the misfolded proteins traveling from the gut, up the vagus nerve, to the brain.

I believe it is impossible to fully treat or achieve the best possible patient outcomes in psychotherapy without concomitantly addressing neurophysiologic and musculoskeletal pathology. If the ANS is not homeostatic, severe physical and mental impairments often follow. Even if ANS impairment is not the cause of the mental dysfunction, one can’t fully treat the mental dysfunction without also addressing any neuromusculoskeletal dysfunction. Sometimes I like to think of psychotherapy as a treatment focused on regulating the nervous systems and structures, especially the brain. The brain will never be regulated to the best possible outcome if it is constantly receiving negative afferents from any other part of the body. This inhibits psychologic improvement. Painful or non-painful dysfunction (like latent trigger points), originating from any part of the body, typically pushes the ANS into sympathetic hyperactivity. SANS hyperactivity alters hormone and neurotransmitter release from the HPA axis and the gut-brain axis.

Doesn’t it make sense to use treatments like SSRIs, dopaminergics, psychedelics, and psychotherapy in conjunction with electrical needling and manipulation? You can’t have a healthy body without a healthy mind, and you can’t have a healthy mind without a healthy body. These things are intimately and intricately intertangled and should be treated as such.

References

Psychedelic-Assisted Psychotherapy

  • https://drdanengle.com
  • https://www.amazon.com/Dose-Hope-Story-MDMA-Assisted-Psychotherapy/dp/1544521022/ref=cm_cr_arp_d_product_top?ie=UTF8
  • https://www.kuya.life
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Neural Plasticity

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  • Li, X. and Wang, Q., 2013. Acupuncture therapy for stroke patients. International review of neurobiology, 111, pp.159-179.
  • Kong, J., Gollub, R., Huang, T., Polich, G., Napadow, V., Hui, K., Vangel, M., Rosen, B. and Kaptchuk, T.J., 2007. Acupuncture de qi, from qualitative history to quantitative measurement. The Journal of Alternative and Complementary Medicine, 13(10), pp.1059-1070.
  • Lee, J.D., Chon, J.S., Jeong, H.K., Kim, H.J., Yun, M., Kim, D.Y., Kim, D.I., Park, C.I. and Yoo, H.S., 2003. The cerebrovascular response to traditional acupuncture after stroke. Neuroradiology, 45(11), pp.780-784.
  • Yang, Y., Eisner, I., Chen, S., Wang, S., Zhang, F. and Wang, L., 2017. Neuroplasticity changes on human motor cortex induced by acupuncture therapy: a preliminary study. Neural plasticity, 2017.
  • Jiang, H., Zhang, X., Wang, Y., Zhang, H., Li, J., Yang, X., Zhao, B., Zhang, C., Yu, M., Xu, M. and Yu, Q., 2017. Mechanisms underlying the antidepressant response of acupuncture via PKA/CREB signaling pathway. Neural Plasticity, 2017.
  • Tang, H., Guo, Y., Zhao, Y., Wang, S., Wang, J., Li, W., Qin, S., Gong, Y., Fan, W., Chen, Z. and Guo, Y., 2020. Effects and Mechanisms of Acupuncture Combined with Mesenchymal Stem Cell Transplantation on Neural Recovery after Spinal Cord Injury: Progress and Prospects. Neural Plasticity, 2020.
  • Lai, H.C., Chang, Q.Y. and Hsieh, C.L., 2019. Signal transduction pathways of acupuncture for treating some nervous system diseases. Evidence-Based Complementary and Alternative Medicine, 2019.
  • Pirnia, B., Bazargan, N.M., Hamdieh, M., Pirnia, K., Malekanmehr, P., Maleki, F. and Zahiroddin, A., 2019. The Effectiveness of Auricular Acupuncture on the Levels of Cortisol in a Depressed Patient. Iranian journal of public health, 48(9), pp.1748-1750.
  • Yang, J.W., Ye, Y., Wang, X.R., Li, F., Xiao, L.Y., Shi, G.X. and Liu, C.Z., 2017. Acupuncture attenuates renal sympathetic activity and blood pressure via beta-adrenergic receptors in spontaneously hypertensive rats. Neural plasticity, 2017.
  • Ye, Y., Zhu, W., Wang, X.R., Yang, J.W., Xiao, L.Y., Liu, Y., Zhang, X. and Liu, C.Z., 2017. Mechanisms of acupuncture on vascular dementia—a review of animal studies. Neurochemistry international, 107, pp.204-210.
  • Li, Y., Wang, Y., Liao, C., Huang, W. and Wu, P., 2017. Longitudinal brain functional connectivity changes of the cortical motor-related network in subcortical stroke patients with acupuncture treatment. Neural plasticity, 2017.
  • Wang, T., Wu, L., Liao, D., Zhou, X., Chen, Y. and Takeda, A., 2002. Effect of acupuncture on the expression of NT3 in the process of spinal plasticity. Hua xi yi ke da xue xue bao= Journal of West China University of Medical Sciences= Huaxi yike daxue xuebao, 33(1), pp.46-49.

Vagus Nerve Stimulation

  • Sprouse-Blum, A.S., Smith, G., Sugai, D. and Parsa, F.D., 2010. Understanding endorphins and their importance in pain management. Hawaii medical journal, 69(3), p.70.
  • Usichenko, T.I., Dinse, M., Hermsen, M., Witstruck, T., Pavlovic, D. and Lehmann, C., 2005. Auricular acupuncture for pain relief after total hip arthroplasty–a randomized controlled study. Pain, 114(3), pp.320-327.
  • Usichenko, T.I., Kuchling, S., Witstruck, T., Pavlovic, D., Zach, M., Hofer, A., Merk, H., Lehmann, C. and Wendt, M., 2007. Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial. Cmaj, 176(2), pp.179-183.
  • Jaić, K.K., Turković, T.M., Pešić, M., Djaković, I., Košec, V. and Košec, A., 2019. Auricular acupuncture as effective pain relief after episiotomy: a randomized controlled pilot study. Archives of gynecology and obstetrics, 300(5), pp.1295-1301
  • Taylor, S.L., Giannitrapani, K.F., Ackland, P.E., Thomas, E.R., Federman, D.G., Holliday, J.R., Olson, J., Kligler, B. and Zeliadt, S.B., 2021. The Implementation and Effectiveness of Battlefield Auricular Acupuncture for Pain. Pain Medicine.
  • Shah, A.N., Moore, C.B. and Brigger, M.T., 2020. Auricular acupuncture for adult tonsillectomy. The Laryngoscope, 130(8), pp.1907-1912.
  • Garner, B.K., Hopkinson, S.G., Ketz, A.K., Landis, C.A. and Trego, L.L., 2018. Auricular acupuncture for chronic pain and insomnia: a randomized clinical trial. Medical acupuncture, 30(5), pp.262-272.
  • Kang, H.R., Lee, Y.S., Kim, H.R., Kim, E.J., Kim, K.H., Kim, K.S., Jung, C.Y. and Lee, J.K., 2017. A clinical study of electroacupuncture and auricular acupuncture for abdominal pain relief in patients with pancreatitis: A pilot study. Korean Journal of Acupuncture, 34(1), pp.47-55.
  • Moura, C.D.C., Chaves, E.D.C.L., Cardoso, A.C.L.R., Nogueira, D.A., Azevedo, C. and Chianca, T.C.M., 2019. Auricular acupuncture for chronic back pain in adults: a systematic review and metanalysis. Revista da Escola de Enfermagem da USP, 53.
  • Tsai, S.L., Fox, L.M., Murakami, M. and Tsung, J.W., 2016. Auricular acupuncture in emergency department treatment of acute pain. Annals of emergency medicine, 68(5), pp.583-585.
  • Yeh, C.H., Chiang, Y.C., Hoffman, S.L., Liang, Z., Klem, M.L., Tam, W.W., Chien, L.C. and Suen, L.K.P., 2014. Efficacy of auricular therapy for pain management: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2014.
  • Sator-Katzenschlager, S.M., Szeles, J.C., Scharbert, G., Michalek-Sauberer, A., Kober, A., Heinze, G. and Kozek-Langenecker, S.A., 2003. Electrical stimulation of auricular acupuncture points is more effective than conventional manual auricular acupuncture in chronic cervical pain: a pilot study. Anesthesia & Analgesia, 97(5), pp.1469-1473.
  • Usichenko, T.I., Lehmann, C. and Ernst, E., 2008. Auricular acupuncture for postoperative pain control: a systematic review of randomised clinical trials. Anaesthesia, 63(12), pp.1343-1348.
  • Johnson, R.L. and Wilson, C.G., 2018. A review of vagus nerve stimulation as a therapeutic intervention. Journal of inflammation research, 11, p.203.

Autonomic Nervous System

  • Li, Q.Q., Shi, G.X., Xu, Q., Wang, J., Liu, C.Z. and Wang, L.P., 2013. Acupuncture effect and central autonomic regulation. Evidence-Based Complementary and Alternative Medicine, 2013.
  • Park, S.U., Jung, W.S., Moon, S.K., Park, J.M., Ko, C.N., Cho, K.H., Kim, Y.S. and Bae, H.S., 2008. Effects of acupuncture on autonomic nervous system in normal subjects under mental stress. The Journal of Korean Medicine, 29(2), pp.107-115.
  • Haker, E., Egekvist, H. and Bjerring, P., 2000. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. Journal of the autonomic nervous system, 79(1), pp.52-59.
  • Bäcker, M., Grossman, P., Schneider, J., Michalsen, A., Knoblauch, N., Tan, L., Niggemeyer, C., Linde, K., Melchart, D. and Dobos, G.J., 2008. Acupuncture in migraine: investigation of autonomic effects. The Clinical journal of pain, 24(2), pp.106-115.
  • Uchida, C., Waki, H., Minakawa, Y., Tamai, H., Miyazaki, S., Hisajima, T. and Imai, K., 2019. Effects of acupuncture sensations on transient heart rate reduction and autonomic nervous system function during acupuncture stimulation. Medical acupuncture, 31(3), pp.176-184.
  • Uchida, C., Waki, H., Minakawa, Y., Tamai, H., Miyazaki, S., Hisajima, T. and Imai, K., 2019. Effects of acupuncture sensations on transient heart rate reduction and autonomic nervous system function during acupuncture stimulation. Medical acupuncture, 31(3), pp.176-184.
  • Butts, r., dunning, j. And serafino, c., 2020. Dry needling strategies for musculoskeletal conditions: do the number of needles and needle retention time matter? A narrative review of the literature. Journal of bodywork and movement therapies.
  • Castro-Sánchez, A.M., Garcia-López, H., Fernández-Sánchez, M., Perez-Marmol, J.M., Leonard, G., Gaudreault, N., Aguilar-Ferrándiz, M.E. and Matarán-Peñarrocha, G.A., 2020. Benefits of dry needling of myofascial trigger points on autonomic function and photoelectric plethysmography in patients with fibromyalgia syndrome. Acupuncture in Medicine, 38(3), pp.140-149.
  • Loaiza, L. A., Yamaguchi, S., Ito, M., & Ohshima, N. (2002). Electro-acupuncture stimulation to muscle afferents in anesthetized rats modulates the blood flow to the knee joint through autonomic reflexes and nitric oxide. Autonomic Neuroscience : Basic & Clinical, 97(2), 103–109. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12132642.
  • Morikawa, Y., Takamoto, K., Nishimaru, H., Taguchi, T., Urakawa, S., Sakai, S., … Nishijo, H. (2017). Compression at myofascial trigger point on chronic neck pain provides pain relief through the prefrontal cortex and autonomic nervous system: A pilot study. Frontiers in Neuroscience, 11(APR). https://doi.org/10.3389/fnins.2017.00186.
  • Sillevis, R., Van Duijn, J., Shamus, E. and Hard, M., 2021. Time effect for in-situ dry needling on the autonomic nervous system, a pilot study. Physiotherapy theory and practice, 37(7), pp.826-834.
  • Lázaro-Navas, I., Lorenzo-Sánchez-Aguilera, C., Pecos-Martín, D., Jiménez-Rejano, J.J., Navarro-Santana, M.J., Fernández-Carnero, J. and Gallego-Izquierdo, T., 2021. Immediate Effects of Dry Needling on the Autonomic Nervous System and Mechanical Hyperalgesia: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 18(11), p.6018.
  • Abbaszadeh-Amirdehi, M., Ansari, N.N., Naghdi, S., Olyaei, G. and Nourbakhsh, M.R., 2017. Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points. Acupuncture in Medicine, 35(2), pp.85-92.
  • Castro-Sánchez, A.M., Garcia-López, H., Fernández-Sánchez, M., Perez-Marmol, J.M., Leonard, G., Gaudreault, N., Aguilar-Ferrándiz, M.E. and Matarán-Peñarrocha, G.A., 2020. Benefits of dry needling of myofascial trigger points on autonomic function and photoelectric plethysmography in patients with fibromyalgia syndrome. Acupuncture in Medicine, 38(3), pp.140-149.
  • Skorupska, E., Rychlik, M. and Samborski, W., 2015. Intensive vasodilatation in the sciatic pain area after dry needling. BMC complementary and alternative medicine, 15(1), pp.1-9.
  • Clark, N.G., Hill, C.J., Koppenhaver, S.L., Massie, T. and Cleland, J.A., 2021. The effects of dry needling to the thoracolumbar junction multifidi on measures of regional and remote flexibility and pain sensitivity: A randomized controlled trial. Musculoskeletal Science and Practice, 53, p.102366.
  • Sánchez-Infante, J., Navarro-Santana, M.J., Bravo-Sánchez, A., Jiménez-Diaz, F. and Abián-Vicén, J., 2021. Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis. Physical Therapy, 101(3), p.pzab070.
  • Eftekharsadat, B., Babaei-Ghazani, A. and Zeinolabedinzadeh, V., 2016. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial. Medical journal of the Islamic Republic of Iran, 30, p.401.
  • Li, Q.Q., Shi, G.X., Xu, Q., Wang, J., Liu, C.Z. and Wang, L.P., 2013. Acupuncture effect and central autonomic regulation. Evidence-Based Complementary and Alternative Medicine, 2013.
  • Mori, H., Nishijo, K., Kawamura, H. and Abo, T., 2002. Unique immunomodulation by electro-acupuncture in humans possibly via stimulation of the autonomic nervous system. Neuroscience Letters, 320(1-2), pp.21-24.
  • Sakatani, K., Kitagawa, T., Aoyama, N. and Sasaki, M., 2010. Effects of acupuncture on autonomic nervous function and prefrontal cortex activity. In Oxygen Transport to Tissue XXXI (pp. 455-460). Springer, Boston, MA
  • Haker, E., Egekvist, H. and Bjerring, P., 2000. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. Journal of the autonomic nervous system, 79(1), pp.52-59.
  • Shu, Q., Wang, H., Litscher, D., Wu, S., Chen, L., Gaischek, I., Wang, L., He, W., Zhou, H., Litscher, G. and Liang, F., 2016. Acupuncture and moxibustion have different effects on fatigue by regulating the autonomic nervous system: a pilot controlled clinical trial. Scientific reports, 6(1), pp.1-11.
  • Matić, Z. and Bojić, T., 2020. Acupuncture, autonomic nervous system and biophysical origin of acupuncture system. Vojnosanitetski pregled, 77(1), pp.79-86.
  • Uchida, C., Waki, H., Minakawa, Y., Tamai, H., Hisajima, T. and Imai, K., 2018. Evaluation of autonomic nervous system function using heart rate variability analysis during transient heart rate reduction caused by acupuncture. Medical acupuncture, 30(2), pp.89-95.
  • Napadow, V., Beissner, F., Lin, Y., Chae, Y. and Harris, R.E., 2020. Neural Substrates of Acupuncture: From Peripheral to Central Nervous System Mechanisms. Frontiers in neuroscience, 13, p.1419.
  • An, S. and Keum, D., 2021. Effect of Acupuncture at the Field of the Auricular Branch of the Vagus Nerve on Autonomic Nervous System Change. Journal of Korean Medicine Rehabilitation, 31(2), pp.81-97.
  • Kupari, J. and Ernfors, P., 2020. Pricking into Autonomic Reflex Pathways by Electrical Acupuncture. Neuron, 108(3), pp.395-397.
  • Kurita, K., Kiyomitsu, K., Ogasawara, C., Mishima, R., Ogawa-Ochiai, K. and Tsumura, N., 2019. Effect of acupuncture on the autonomic nervous system as evaluated by non-contact heart rate variability measurement. Artificial Life and Robotics, 24(1), pp.19-23.
  • Dommerholt, J., Hooks, T., Chou, L.W. and Finnegan, M., 2019. A critical overview of the current myofascial pain literature–November 2018. Journal of bodywork and movement therapies, 23(1), pp.65-73.
  • Morikawa, Y., Takamoto, K., Nishimaru, H., Taguchi, T., Urakawa, S., Sakai, S., Ono, T. and Nishijo, H., 2017. Compression at myofascial trigger point on chronic neck pain provides pain relief through the prefrontal cortex and autonomic nervous system: a pilot study. Frontiers in neuroscience, 11, p.186.
  • Dommerholt, J., Mayoral, O. and Thorp, J.N., 2021. A critical overview of the current myofascial pain literature–January 2021.

B-endorphin

  • Bernstein, H.G., Dobrowolny, H., Bogerts, B., Keilhoff, G. and Steiner, J., 2019. The hypothalamus and neuropsychiatric disorders: psychiatry meets microscopy. Cell and tissue research, 375(1), pp.243-258.
  • Roschina, O.V., Levchuk, L.A., Boiko, A.S., Michalitskaya, E.V., Epimakhova, E.V., Losenkov, I.S., Simutkin, G.G., Loonen, A.J., Bokhan, N.A. and Ivanova, S.A., 2021. Beta-Endorphin and Oxytocin in Patients with Alcohol Use Disorder and Comorbid Depression. Journal of Clinical Medicine, 10(23), p.5696.
  • Rocchi, G., Sterlini, B., Tardito, S., Inglese, M., Corradi, A., Filaci, G., Amore, M., Magioncalda, P. and Martino, M., 2020. Opioidergic system and functional architecture of intrinsic brain activity: implications for psychiatric disorders. The Neuroscientist, 26(4), pp.343-358.
  • Lu, Y., Ann, L. and McCarron, R., 2021. Steroid-induced psychiatric symptoms: What you need to know. Current Psychiatry, 20(4), p.33.
  • Maslov, M.Y., Foianini, S., Orlov, M.V., Januzzi, J.L. and Lovich, M.A., 2018. A novel paradigm for sacubitril/valsartan: beta-endorphin elevation as a contributor to exercise tolerance improvement in rats with preexisting heart failure induced by pressure overload. Journal of cardiac failure, 24(11), pp.773-782.
  • van der Venne, P., Balint, A., Drews, E., Parzer, P., Resch, F., Koenig, J. and Kaess, M., 2021. Pain sensitivity and plasma beta-endorphin in adolescent non-suicidal self-injury. Journal of Affective Disorders, 278, pp.199-208.
  • Furness, J.B., 2000. Types of neurons in the enteric nervous system. Journal of the autonomic nervous system, 81(1-3), pp.87-96.
  • McCullough, J.E., Liddle, S.D., Close, C., Sinclair, M. and Hughes, C.M., 2018. Reflexology: a randomised controlled trial investigating the effects on beta-endorphin, cortisol and pregnancy related stress. Complementary therapies in clinical practice, 31, pp.76-84.
  • Maslov, M.Y., Foianini, S., Orlov, M.V., Januzzi, J.L. and Lovich, M.A., 2018. A novel paradigm for sacubitril/valsartan: beta-endorphin elevation as a contributor to exercise tolerance improvement in rats with preexisting heart failure induced by pressure overload. Journal of cardiac failure, 24(11), pp.773-782.
  • Cui, L., Cai, H., Sun, F., Wang, Y., Qu, Y., Dong, J., Wang, H., Li, J., Qian, C. and Li, J., 2021. Beta-endorphin inhibits the inflammatory response of bovine endometrial cells through δ opioid receptor in vitro. Developmental & Comparative Immunology, 121, p.104074.

Enteric Nervous System, Gut-Brain Axis

  • Furness, J.B., 2012. The enteric nervous system and neurogastroenterology. Nature reviews Gastroenterology & hepatology, 9(5), pp.286-294.
  • Spencer, N.J. and Hu, H., 2020. Enteric nervous system: sensory transduction, neural circuits and gastrointestinal motility. Nature Reviews Gastroenterology & Hepatology, 17(6), pp.338-351
  • Drokhlyansky, E., Smillie, C.S., Van Wittenberghe, N., Ericsson, M., Griffin, G.K., Eraslan, G., Dionne, D., Cuoco, M.S., Goder-Reiser, M.N., Sharova, T. and Kuksenko, O., 2020. The human and mouse enteric nervous system at single-cell resolution. Cell, 182(6), pp.1606-1622.
  • Heiss, C.N. and Olofsson, L.E., 2019. The role of the gut microbiota in development, function and disorders of the central nervous system and the enteric nervous system. Journal of neuroendocrinology, 31(5), p.e12684.
  • Fung, C. and Vanden Berghe, P., 2020. Functional circuits and signal processing in the enteric nervous system. Cellular and Molecular Life Sciences, 77, pp.4505-4522.
  • De Vadder, F., Grasset, E., Holm, L.M., Karsenty, G., Macpherson, A.J., Olofsson, L.E. and Bäckhed, F., 2018. Gut microbiota regulates maturation of the adult enteric nervous system via enteric serotonin networks. Proceedings of the National Academy of Sciences, 115(25), pp.6458-6463.
  • Niesler, B., Kuerten, S., Demir, I.E. and Schäfer, K.H., 2021. Disorders of the enteric nervous system—a holistic view. Nature Reviews Gastroenterology & Hepatology, 18(6), pp.393-410.
  • Mayer, E.A., Tillisch, K. and Gupta, A., 2015. Gut/brain axis and the microbiota. The Journal of clinical investigation, 125(3), pp.926-938.
  • Cryan, J.F., O'Riordan, K.J., Cowan, C.S., Sandhu, K.V., Bastiaanssen, T.F., Boehme, M., Codagnone, M.G., Cussotto, S., Fulling, C., Golubeva, A.V. and Guzzetta, K.E., 2019. The microbiota-gut-brain axis. Physiological reviews.
  • Ma, Q., Xing, C., Long, W., Wang, H.Y., Liu, Q. and Wang, R.F., 2019. Impact of microbiota on central nervous system and neurological diseases: the gut-brain axis. Journal of neuroinflammation, 16(1), pp.1-14.
  • Bonaz, B., Bazin, T. and Pellissier, S., 2018. The vagus nerve at the interface of the microbiota-gut-brain axis. Frontiers in neuroscience, 12, p.49.
  • Benakis, C., Martin-Gallausiaux, C., Trezzi, J.P., Melton, P., Liesz, A. and Wilmes, P., 2020. The microbiome-gut-brain axis in acute and chronic brain diseases. Current opinion in neurobiology, 61, pp.1-9.
  • Kim, N., Yun, M., Oh, Y.J. and Choi, H.J., 2018. Mind-altering with the gut: Modulation of the gut-brain axis with probiotics. Journal of Microbiology, 56(3), pp.172-182.
  • Tan, H.E., Sisti, A.C., Jin, H., Vignovich, M., Villavicencio, M., Tsang, K.S., Goffer, Y. and Zuker, C.S., 2020. The gut–brain axis mediates sugar preference. Nature, 580(7804), pp.511-5