Neuroscientific Mechanisms of Acupuncture Stimulation

Acupuncture stimulation engages peripheral mechanoreceptors and nociceptors before transmitting signals to central neural networks. Needle insertion and manipulation evoke a distinctive composite of sensations known as deqi, which is associated with recruitment of Aδ and C fibres in the skin, muscle and connective tissues. Neuroimaging studies have demonstrated that acupuncture modulates resting-state functional connectivity within key pain circuits, including the descending pain modulatory system (DPMS), thalamocortical networks and limbic structures. The periaqueductal grey (PAG) serves as a central node, integrating afferent signals and engaging endogenous opioid and monoaminergic pathways to attenuate nociceptive input. Acupuncture also influences large-scale networks such as the default mode network (DMN) and executive control network, suggesting effects on attention, cognition and emotional appraisal. Through interaction between the ventral tegmental area (VTA) and amygdala, acupuncture may engage reward and affective pathways, further contributing to analgesia and wellbeing. These convergent mechanisms underscore acupuncture’s capacity to induce both local and system-wide neurophysiological changes, offering insight into its therapeutic applications for chronic pain and affective disorders.

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Technical terms

Deqi: A composite sensation including aching, heaviness and tingling elicited by needle insertion, associated with clinical efficacy.

Resting-state functional connectivity (rsFC): Correlation of spontaneous neural activity between brain regions measured when the subject is at rest.

Descending pain modulatory system (DPMS): A brain–spinal cord network, centred on the periaqueductal grey, that inhibits or facilitates nociceptive transmission.

Periaqueductal grey (PAG): A midbrain region critical for endogenous analgesia via opioid and monoaminergic pathways.

Default mode network (DMN): A set of interconnected brain regions active during rest and self-referential thought, often deactivated by task engagement.

Thalamocortical circuits: Pathways linking the thalamus with cortical regions to relay sensory information and modulate cognitive and affective processes.

References

1. Modulation effects of different treatments on periaqueductal gray resting state functional connectivity in knee osteoarthritis knee pain patients. CNS Neuroscience & Therapeutics (2023).
2. Thalamocortical Mechanisms Underlying Real and Imagined Acupuncture. Biomedicines (2023).
3. Characterization of the "deqi" response in acupuncture. BMC Complementary Medicine and Therapies (2007).
4. Acupuncture Treatment Modulates the Connectivity of Key Regions of the Descending Pain Modulation and Reward Systems in Patients with Chronic Low Back Pain. Journal of Clinical Medicine (2020).