Acupuncture and Neural Mechanism in the Management of Low Back Pain—An Update

Low back pain is one of the most prevalent musculoskeletal conditions worldwide, affecting more than 511 million people and representing the leading cause of years lived with disability according to the Global Burden of Disease Study 2016. This comprehensive review examines the neurological mechanisms by which acupuncture provides relief for low back pain, integrating knowledge from traditional Chinese medicine with modern scientific findings. The authors analyzed decades of research, including randomized controlled trials, neuroimaging studies, and molecular investigations, to elucidate how acupuncture exerts its therapeutic effects. The most commonly used acupuncture points for low back pain include BL-23, BL-25, and BL-40, which correspond to specific anatomical locations with high densities of nerve endings.

Needle insertion at these points triggers a cascade of physiological events: first, ATP (adenosine triphosphate) is released due to tissue microtrauma, followed by conversion to adenosine, which acts on purinergic receptors to produce analgesia. This mechanism has been demonstrated through studies in transgenic mice that lack adenosine A1 receptors and do not respond to acupuncture. At the same time, stimulation activates Aδ and C afferent nerve fibers, which transmit signals to the central nervous system, culminating in the release of endorphins and other natural neurotransmitters. The review highlights that German clinical trials (GERAC) with 1,162 patients demonstrated that both real and sham acupuncture were nearly twice as effective as conventional therapy after six months.

Functional neuroimaging studies revealed that acupuncture modulates activity in brain regions associated with pain processing, including the thalamus and cerebral cortex. The authors address the controversy regarding placebo effects, explaining that even sham acupuncture produces tactile stimulation that activates sensory receptors. However, real acupuncture consistently shows superior results due to more specific stimulation of points with unique anatomical properties. Integration of acupuncture with conventional treatments has proven particularly promising, offering synergistic benefits without the adverse effects of opioids, which affect 25–30% of patients.

The article also explores the anatomical basis of meridians, suggesting correlations with connective tissue networks and the primo-vascular system. Studies have shown that acupuncture points have lower skin electrical resistance and greater mast cell density compared with surrounding areas. The review concludes that acupuncture represents a scientifically grounded therapeutic modality for low back pain, with clearly elucidated molecular mechanisms involving purinergic signaling, neural modulation, and release of endogenous neurotransmitters. The authors emphasize the need for greater integration of acupuncture into healthcare systems, given its demonstrated efficacy, safety, and cost-effectiveness.