Acupuncture and Stress Relief

Stress is one of the most common things we see in the clinic. Unsurprisingly, most people feel stressed to some extent. Whether it’s from paying the bills, having a huge workload or getting an assignment done on time, being stressed can feel fairly constant. And let’s face it; this last 2 years has got to be one of the most stressful yet!

 While using needles to help manage stress may seem counter-intuitive to some, we generally find that people walk away from their acupuncture treatment feeling more relaxed and better able to cope with their day-to-day stresses.

But what is acupuncture actually doing? Can acupuncture affect the body’s basic biological systems that keep stress under control? Recent clinical studies suggest that it can, but before we discuss that lets look at what stress actually does to the body.

Understanding the stress response

 One of the main ways the body responds to stress is by activating what is known as the HPA axis, or the Hypothalamic-Pituitary-Adrenal axis – this is quite a mouthful, so we’ll stick to HPA axis for now. When a stressful situation is encountered, say for example you have a major deadline at work or there’s a pandemic affecting your life, your hypothalamus, a tiny region in your brain, releases a hormone called CRH (Corticotropin Releasing Hormone). CRH then tells another tiny region in your brain, the pituitary gland, to produce ACTH (Adrenocorticotropic Hormone). ACTH makes its way to the adrenal glands, which are located above your Kidney’s and tells them to produce large amounts of cortisol.

Cortisol is considered one of the primary stress hormones. It initiates a number of activities throughout the body to allow us to focus on whatever stressful task we are facing. It increases the production of glucose so that the body can generate plenty of energy, it increases the availability of glucose in the brain so we can think clearly and it heightens short-term memory.

Cortisol also affects a number of the body’s activities that may be considered ‘non-essential’ in stressful situations. It reduces bone formation, alters the immune response and suppresses the digestive and reproductive systems as well as various growth processes (1). Just goes to show there really is quite a lot going on behind that feeling of mild or significant panic!

Usually once the stress goes away the level of cortisol returns to normal and we feel fine. However, long-term exposure to stress, like we are currently experiencing with the threat of Covid 19 and ongoing lockdowns, means that our cortisol levels might be staying too high for too long. This increases the risk of developing other problems like anxiety, depression, insomnia, chronic pain, digestive issues, lowered immunity and other more chronic illnesses.

How does Chinese medicine view stress?

According to traditional Chinese medicine theory, each of the major organ systems is affected by different emotions and it is the Liver that is the most affected by stress. Don’t worry, this doesn’t mean your liver will suddenly stop working. In Chinese medicine terms, the Liver makes sure the body’s energy, or Qi, flows smoothly around the body. Without this smooth flow of Qi none of the other organ systems can function properly.

If the Qi flow gets stuck for a long period of time people may start to experience a variety of symptoms. These may be emotional issues like irritability and moodiness, anxiety or depression, or they may be physical conditions like irritable bowel syndrome, irregular menstruation and insomnia. Liver Qi stagnation can also cause all types of pain, from period pain to tension or migraine headaches, to neck, shoulder or back pain.

You’ll notice that each of these are common symptoms that may be associated with high levels of cortisol, which can occur as part of the stress response.

Does acupuncture help to manage stress?

As we mentioned, from the responses we see each day in the clinic, we think the answer to this is yes, but is there any other evidence for this?

To date, only a few clinical trials have directly examined the effect of acupuncture on perceived stress-levels. The results from two small pilot studies suggest that acupuncture may be successful in reducing the symptoms of stress when compared to control acupuncture groups (2,3). Preliminary findings from another study done in U.S military personnel found that acupuncture may improve energy, social functioning and the perceived stress levels of service members (4).

A slightly larger study assessed the effect of acupuncture on the stress levels of staff and students in an urban college population. This study initially observed a similar reduction in stress levels between true acupuncture treatment and the sham control group. However, after 3 months, while the stress levels in the true acupuncture group remained low (5), the stress level in the sham acupuncture group went back up, indicating acupuncture has an ongoing and long-lasting effect on stress.

Can acupuncture affect stress hormones like cortisol?

It turns out that one of the ways acupuncture might be helping people de-stress is by moderating the activity of the HPA axis and affecting cortisol levels. A couple of studies have shown that treatment with acupuncture reduces cortisol levels in severely depressed patients (6,7). These patients also reported an improvement in their depression and decreased suicide ideation following 4-6 weeks of twice weekly acupuncture treatments.

Cortisol may also be decreased when acupuncture is given to people for pain relief (8.9.10). Salivary cortisol and pain levels were significantly reduced in a group of patients suffering pain from chronic musculoskeletal disorders (8). Interestingly, in this study physiotherapy treatments had a similar response. ACTH and cortisol levels were also decreased with acupuncture given to women during active labour, although this reduction was not significant compared to controls (9).

Further to these studies, a review examining how acupuncture might be working when treating visceral pain (i.e. pain originating from the thoracic, abdominal or pelvic regions) found CRH and cortisol levels were reduced with acupuncture treatments (10). This review also found that acupuncture generated an increase in pain relieving hormones like 𝛽-endorphin and feel-good neurotransmitters like serotonin – but these are perhaps topics we need to cover another time.

It has to be said that most of the above studies in humans are only looking at a small number of people and so more trials need to be done. However, the results from studies that have been done on animals show similar effects and as such back up the idea that acupuncture can reduce cortisol levels.

In the animal studies, which are mainly done on rats, stress is triggered through various stimuli, such as swimming in a freezing cold bath, food deprivation, social isolation or putting them through surgery (I know – poor little rats!). Acupuncture had a similar effect in each of these situations: inhibiting CRH expression and decreasing ACTH and CORT (the rat equivalent of cortisol) levels (11-15).

Taken together, all of these studies indicate that acupuncture is having a physiological effect on the body, in part through modulating the activity of the HPA axis to reduce cortisol levels and thereby reducing the amount of stress people feel.

Other techniques for reducing stress

Of course, acupuncture isn’t the only thing that can help to manage stress. There are a number of strategies you could try to reduce the body’s stress response and bring your cortisol level down.  These include things like:

·       relaxation techniques, for example meditation, yoga, tai chi or Qi gong

·       eating a healthy diet

·       exercising regularly

·       making time for things you enjoy like reading, listening to music or dancing like nobody’s watching

·       spending quality time with family or friends (tricky in Covid lockdowns, but maybe just give them a call…)

·       seeking professional counseling

·       and of course laughing – a lot!

No matter how you manage your stress, whether it is with acupuncture treatments or other tactics, the important thing is recognising when your stress might be getting a little too high and what you need to do about it. No doubt you’ll find that by keeping your stress levels under control you may just live a longer, healthier and happier life.

References:

1.     Mayo Clinic: Healthy Lifestyle, Stress Management (2019)

https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037

2.     Huang W, Howie J, Taylor A and Robinson N. (2011) An investigation into the effectiveness of traditional Chinese acupuncture (TCA) for chronic stress in adults: A randomized controlled pilot study. Comp Ther Clin Prac. 17(1):16-21

3.     Wild B, Brenner J, Joos S, Samstag Y, Buckert M, Valentini J. Acupuncture in persons with an increased stress level-Results from a randomized-controlled pilot trial. PLoS One. 2020 15(7):e0236004.

4.     Abanes J, Hiers C, Rhoten B, Dietrich MS, Ridner SH. Feasibility and Acceptability of a Brief Acupuncture Intervention for Service Members with Perceived Stress. Mil Med. 2020;185(1-2):e17-e22.

5.     Schroeder S, Burnis J, Denton A, Krasnow A, Raghu TS and Mathis K. (2017) Effectiveness of acupuncture therapy on stress in a large urban college population. J Acupunt Meridian Stud. 10(3): 165-170

6.     Vasquez R, Gonzalez-Marcias L,  Berlanga C and Aedo J. (2011) Effect of acupuncture treatment on depression: correlation between psychological outcomes and salivary cortisol levels. Salud Mental. 34:21-26

7.     Pirnia B, Mohammadi A R, Zahiroddin A , Mohammadzadeh Bazargan N, Malekanmehr P, et al. Evaluation of the Effectiveness of Auricular Acupuncture in Suicidal Ideation and Cortisol Level in Dysthymic Patients with Comorbid Opiate Use Disorders Enrolled in Methadone Maintenance Treatment: A Randomized, Double-Blind, Sham-Controlled Trial, Iran J Psychiatry Behav Sci. 2019 ; 13(2):e12498. doi: 10.5812/ijpbs.12498.

8.     Papandreou M, Philippou A, Taso O, Koutsilieris M, Kaperda A. The effect of treatment regimens on salivary cortisol levels in patients with chronic musculoskeletal disorders. J Body Mov Ther. 2020 Jan;24(1):100-108. doi: 10.1016/j.jbmt.2019.10.010. Epub 2019 Oct 15. PMID: 31987528.

9.     Mucuk S, Baser M and Ozkan T (2013) Effects of noninvasive electroacupuncture on labour pain, adrenocorticotropic hormone and cortisol. Alternat Ther Health Med. 19(3): 26-30

10.   Lee I, Cheon S and park J. (2019) Central and peripheral mechanisms of acupuncture analgesia on visceral pain: a systematic review. Evid Base Comp Alt Med. Article ID 1304152, 22 pages Doi: 10.1155/2019/1304152

11.   Wang S, Zhang J and Qie L (2014) Acupuncture relieves the excessive excitation of hypothalamic-pituitary-adrenal cortex axis function and correlates with the regulatory mechanism of GR, CRH and ACTHR. Evid Base Comp Alt Med. 2014:495379. doi: 10.1155/2014/495379.

12.   Wang S, Zhang J, Yang H, Wang F and Li S. (2015) Acupoint specificity on acupuncture regulation of hypothalamic-pituitary-adrenal cortex axis function. Comp Alt Med. 15:87

13.   Zhu J, Chen Z, Meng Z, Ju M, Zhang M, Genchong W, Guo H and Tian Z (2017) Electroacupuncture alleviates surgical trauma-induced hypothalamus pituitary adrenal axis hyperactivity via microRNA-142. Front Mol Neuro. doi: 10.3389/fnmol.2017.00308

14.   Eshkevari L, Permaul E and Mulroney SE (2013) Acupuncture blocks cold stress-induced increases in the hypothalamus-pituitary-adrenal axis in the rat. J Endocrinol. 217(1): 95-104

15.   Park H, Park H, Chae Y, Kim J, Lee H and Chung J. (2011) Effect of acupuncture on hypothalamic-pituitary-adrenal system in maternal separation rats. Cell Mol Neurobiol. 31(8):1123-1127