The physiology behind acupuncture for bladder and pelvic pain

Acupuncture can be used to manage bladder and pelvic pain in patients, but how it works physiologically is not always well understood. In this dvm360 interview, Bonnie D. Wright, DVM, DACVAA, CVMA, CVPP, CCRT, CCRP, a veterinary anesthesiologist, pain specialist, and acupuncturist, explains how acupuncture influences pain and organ function in patients. She outlines 3 key physiologic pathways through which acupuncture works and discusses why specific regions, from paraspinal sites to the medial hind limb, play a central role in treating bladder and pelvic pain.

Below is a partial transcript, lightly edited for clarity.

dvm360: How does acupuncture physiologically influence bladder and pelvic pain pathways in patients?

Wright: Acupuncture works through 3 major physiologic pathways. There's neuromodulation of the nervous system, there's fascial modulation along the recognized myofascial kinetic chains, and then there's kind of a fluid, lymphatic interstitial portion of acupuncture, because interstitial fluid moves along those myofascial kinetic chains and houses the immune system. Any particular topic in acupuncture, you're going to think about those 3 mechanisms as being the ways in which acupuncture works.

I'll do each one of those for bladder and pelvic pain. The only way to neuromodulate those through the nervous system is at the paraspinal locations that relate to where those nerve bundles emerge, dive deep, and go to the organs. That is in the thoracolumbar junction as part of the innervation to the bladder, and then over the pelvic nerve, which is in the lumbosacral and sacral section, for more to the bladder and…other pelvic organs.

So with acupuncture, you're—for these deep structures—only really able to get that paraspinal input for a lot of things. With acupuncture, we also want to get something closer to the organ. And of course, with both of those, that's not an option. That said, the tibial nerve, [especially], has been shown to have a lot of effect on the bladder. I don't know [whether] you've seen those nerve stimulators for incontinence that they have for people; they're basically using points on the tibial nerve that were co-opted from acupuncture points that are recognized to have cross talk to the pelvic organs….