SummaryAcupuncture is a specialised sensory stimulation that is analysed through sensory neural pathways Therefote to understand its action we have to analyse the anatomv physiology and pharmacology of the nerious system, aided with a knowledge ot' neuroendocrinology and the chemoarchitecture of the brain. Various neural theories have been developed to explain the mechanisms of acupuncturc. lt is now evident that acupuncture reacts at local, regional (spinal cord) and Seneral (brain) levels. Thetefore, inserting one or more needles at particulat poitlts (or areas) of the body actlvates neural pathways on three different levels, ptovoking local, re7ional, and Eeneral reactionsThe local reaction is a multifactorial phenomenon. The electric injury potential due to the needle, the presence and synthesis of opioid peptides at the site of injury, and substance P, histamine like subsknces, badikinin, serctonin and prcteolitic enzyme release around the needle, alloccur during needlinS.The reg,ional reaction concens the activation of a larger area (2 3 dermatomes) via reflex arches. we can analyse the viscero-cutaneous, cutaneo-visceral, cutaneo-muscular and viscero-muscular reflexes and also the vegetative, stretch and polysynaptic segmental rcflexes.The general reaction mainly activates the brain cenlral mechanism of internal homoeostasis we can explain the action ol acupuncturc ln acute and chtonic pain syndromes, in addiction and in psychiatric disease throu7h the role of central neurotransmitters and the modulatory systems that are activatecl by acupoints: opioid, non-opioid and central sympathetic inhibitory mechanisms.

This paper reports a rare iatrogenic complication of acupuncture-induced haemothorax and comments on the importance and need for special education of physicians and physiotherapists in order to apply safe and effective acupuncture treatment. A 37-year-old healthy woman had a session of acupuncture treatments for neck and right upper thoracic non-specific musculoskeletal pain, after which she gradually developed dyspnoea and chest discomfort. After some delay while trying other treatment, she was eventually transferred to the emergency department where a chest X-ray revealed a right pneumothorax and fluid collection. She was admitted to hospital and a chest tube inserted into the right hemithorax (under ultrasound guidance) drained 800 mL of bloody fluid (haematocrit (Hct) 17.8%) in 24 h and 1200 mL over the following 3 days. Her blood Hct fell from 39.0% to 30.8% and haemoglobin from 12.7 to 10.3 g/dL. The patient recovered completely and was discharged after 9 days of hospitalisation. When dyspnoea, chest pain and discomfort occur during or after an acupuncture treatment, the possibility of secondary (traumatic) pneumo- or haemopneumothorax should be considered and the patient should remain under careful observation (watchful waiting) for at least 48 h. To maximise the safety of acupuncture, specific training should be given for the safe use of acupuncture points of the anterior and posterior thoracic wall using dry needling, trigger point acupuncture or other advanced acupuncture techniques.

Auricular acupuncture (placement of press needles) was applied at the stomach point (according to Nogier) and sometimes at the point of psychological balance (Shenmen) for the control of anxiety and for help in weight loss in 800 patients over a two year period. Press needles were inserted and left in for 10 to 15 days at the auricular acupuncture point and resited again after 4 to 5 days. At the same time, instructions were given for the standard treatment of obesity (information leaflet, low calorie diet, aerobic exercise, behaviour modification, psychological support, etc.). The patients were followed up for a period of one year. The participants were 683 women and 117 men aged between 15 and 76 years. The Body Mass Index (weight/height) was used to determine the degree of obesity, and cases were divided into three groups according to the number of acupuncture sessions as follows: 468 patients (Group A) had one acupuncture session, 278 (Group B) 2 to 4 sessions, and 54 (Group C) had over 4 sessions, all conducted at 15 to 20 day intervals. A reduction in overeating was reported by 81.1% of patients, and 46.7% of the 697 patients who had noted anxiety symptoms claimed that treatment had helped in the reduction of anxiety. Regular exercise was encouraged, and started by 43.4% of the 703 who had no such habit. There was no significant weight loss in 35.2% of patients. During the first 3 months there was an overall significant weight loss in 64.8% and 35.5% at 6–12 months. The percentage weight loss was higher in Groups B and C and remained higher at six months and one year after the start of acupuncture treatment. Group B presented a good six month result in 61.2% of patients and a good annual result in 39.1%. In Group C results were 88.9% and 77.8% respectively. The control of overeating and anxiety using auricular acupuncture al the stomach and Shenmen points in this audit has been beneficial. Its correct use in an integrated obesity control programme may prove of significant long tem help.

Microglial cells are specialized macrophage cells of the central nervous system responsible for the innate immunity of the spinal cord and the brain. They protect the brain and spinal cord from invaders, microbes, demyelination, trauma and remove defective cells and neurons. For immune protection, microglial cells possess a significant number of receptors and chemical mediators that allow them to communicate rapidly and specifically with all cells of the nervous tissue. The contribution of microglia in neuropathic pain challenges conventional concepts toward neurons being the only structure responsible for the pathophysiological changes that drive neuropathic pain. The present study is a narrative review focusing on the literature concerning the complex interaction between neurons and microglia in the development of neuropathic pain. Injury in the peripheral or central nervous system may result in maladaptive changes in neurons and microglial cells. In neuropathic pain, microglial cells have an important role in initiating and maintenance of pain and inflammation. The interaction between neural and microglial cells has been proven extremely crucial for chronic pain. The study of individual mechanisms at the level of the spinal cord and the brain is an interesting and groundbreaking research challenge. Elucidation of the mechanisms by which neurons and immune cells interact, could constitute microglial cells a new therapeutic target for the treatment of neuropathic pain.