Jou nal o Complemen a y The apies in Heal h
ISSN 2975-9323 |eISSN 2975-9552
Jou nal o Complemen a y The apies in Heal h 2025:3(3). doi:10.5281/zenodo.17257459 ins i u op c.com/jou nal-complemen a y- he apies
Re iew
In eg a ing T adi ional Chinese Medicine in o Ch onic Pain
Ca e in Po ugal:
Neu oimmunological and Clinical Pe spec i es.
Jo ge And é Ma os1, Cá ia Rel as1*, Ma ina Sil a1, and Daniel Sebas ião1.
1 ABS – Heal h Le el, A lân ico Business School, Vila No a de Gaia, Po o, Po ugal.
* Co espondence: ca ia el as[email p o ec ed]
Abs ac
Ch onic pain a ec s 42% o he Po uguese popula ion, wi h a high socioeconomic impac . T adi-
ional Chinese Medicine (TCM) o e s p omising he apies, such as acupunc u e, elec oacupunc-
u e, he bal medicine, mind-body exe cises (Tai Chi, Qigong), Tui Na massage, and moxibus ion.
This li e a u e e iew aims o c i ically analyse he neu ophysiological mechanisms and scien i ic
e idence o hese in e en ions in pain con ol. I concludes ha hese he apies modula e key neu-
oimmunological pa hways. Acupunc u e ac i a es endogenous analgesia (β-endo phins) and sup-
p esses in lamma ion ia TLR2/NF-κB. Phy o he apy blocks pain ecep o s and inhibi s glial ac i-
a ion. Qigong, as a mind-body exe cise, egula es he s ess axis (co isol). In addi ion, moxibus ion
imp o es ci cula ion and educes neu opa hic pain. The in eg a ion o hese app oaches o e s an
e ec i e mul idimensional s a egy, suppo ed by cu en e idence, al hough s anda dized, an-
domized clinical ials wi h la ge samples om di e en popula ions a e s ill needed.
Keywo ds: T adi ional Chinese Medicine; Pain Managemen ; Acupunc u e Mechanisms; He bal
Medicine; Qigong; Neu oimmunology; Ch onic Pain.
1. In oduc ion
Ch onic pain is a global public heal h p oblem, a ec ing mo e han 40% o he Po -
uguese popula ion and gene a ing signi ican socioeconomic cos s 1,2.
In Po ugal, 70% o eme gency cases a e ela ed o acu e pain, whose poo manage-
men os e s ch oni ica ion 3,4 while ch onic pain a ec s mo e han 30% o adul s, o en
associa ed wi h musculoskele al diso de s 5.
Ch onic pain in ol es cen al sensi iza ion and neu oimmunological dys egula ion.
Pe iphe al nocicep o s ac i a e ascending pa hways o he co ex, igge ing a p ocess o
pe sis en in lamma ion ha lowe s neu onal h esholds and ampli ies pain pe cep ion.
E ec i e con ol o his dys egula ion equi es s a egies ha ac on hese mechanisms,
such as TCM he apies.
Pain is he mos equen symp om associa ed wi h disease, and i is he esponsibil-
i y o heal hca e p o essionals o iden i y i s o igin, elie e su e ing, and es o e unc ion-
ali y 6. Acco ding o he Po uguese Di ec o a e-Gene al o Heal h 7, acu e pain is an im-
po an indica o o inju y o physiological dys unc ion and a common eason o seeking
ca e. I ep esen s a mul i ace ed senso y and emo ional expe ience, esul ing om inju y,
disease, o o he medical condi ions, whose ea men aims o imp o e quali y o li e and
op imize daily pe o mance 8.
Pain con ol should be a p io i y in heal hca e, in eg a ing he humaniza ion o se -
ices. The ansi ion om acu e o ch onic pain in ol es complex pa hophysiological
Ci a ion: Ma os J.A., Rel as C., Sil a
M., Sebas ião D. In eg a ing T adi-
ional Chinese Medicine in o Ch onic
Pain Ca e in Po ugal: Neu oim-
munological and Clinical Pe spec-
i es. Jou nal o Complemen a y
The apies in Heal h. 2025;3(3)
10.5281/zenodo.17257459
Academic Edi o : Jo ge Rod igues
Recei ed: 15 Sep embe 2025
Re iewed: 28 Sep embe 2025
Re ised: 2 Oc obe 2025
Accep ed: 2 Oc obe 2025
Published: 3 Oc obe 2025
Publishe ’s No e: IPTC s ays neu al
wi h ega d o ju isdic ional claims in
published maps and ins i u ional a -
ilia ions.
Copy igh : ©2025 by he au ho s.
Submi ed o open access publica-
ion unde he e ms and condi ions
o he C ea i e Commons A ibu ion
(CC BY) license (h ps://c ea i ecom-
mons.o g/licenses/by/4.0/).
Jou nal o Complemen a y The apies in Heal h 2025: 3(3). 2 o 10
Ma os J.A., Rel as C., Sil a M., Sebas ião D.
In eg a ing T adi ional Chinese Medicine in o Ch onic Pain Ca e in Po ugal: Neu oimmunological and Clinical Pe spec i es doi:10.5281/zenodo.17257459
mechanisms, including ac i a ion o pe iphe al nocicep o s, ansmission o he cen al
ne ous sys em, neu onal ac i a ion in he halamus and co ex, and pe iphe al and cen-
al sensi iza ion, all o which ampli y pain pe cep ion 9. The lowe ing o neu onal ac i a-
ion h esholds and he expansion o he sensi i e a ea con ibu e o he ch oni ica ion o
pain.
TCM, aligned wi h na ional guidelines 7,10, add esses pain as a mul idimensional ex-
pe ience (senso y, emo ional, psychological, social, and cul u al). TCM employs ech-
niques such as acupunc u e and elec oacupunc u e (in eg a ed in o na ional p o ocols
o neu opa hic pain) o es o e unc ional balance h ough modula ion o neu al pa h-
ways and endo phin elease 11,12.
This e iew analyses he pa hophysiological mechanisms and he e ec i eness o
hese he apies, aiming o suppo hei clinical applica ion in b oade scena ios.
2. Me hodology
This na a i e e iew aims o c i ically analyse some neu ophysiological mechanisms
and he scien i ic e idence ega ding TCM he apeu ic in e en ions in pain managemen .
A bibliog aphic sea ch was conduc ed in PubMed, SciELO, ScienceDi ec , and Google
Schola (up o Augus 2025), using he keywo ds: “T adi ional Chinese Medicine”, “pain
managemen ”, “acupunc u e mechanisms”, “he bal medicine”, “qigong”, “neu oimmunology”,
and “ch onic pain”, wi h he pu pose o selec ing ele an a icles o add ess ou esea ch
ques ion: Wha a e he mechanisms o ac ion o TCM in pain managemen acco ding o
cu en scien i ic e idence?
Inclusion c i e ia we e de ined as andomized clinical ials (RCTs), sys ema ic e-
iews, and me a-analyses published in Po uguese and English, wi hou empo al e-
s ic ion, bu gi ing p e e ence, whene e possible, o s udies published in he las h ee
yea s.
Exclusion c i e ia included s udies w i en in o he languages no co e ed by he in-
clusion c i e ia, ex s no a ailable in ull, o i ele an o answe ing he esea ch ques-
ion.
Da a we e hema ically o ganized by in e en ion: acupunc u e, he bal medicine, Tui
Na massage, moxibus ion, Qigong, and Tai Chi, wi h assessmen o mechanisms o physi-
ological ac ion, clinical e icacy, and espec i e limi a ions
3. Resul s
3.1. Acupunc u e
The mos ecognized mechanisms o ac ion o acupunc u e, in ligh o cu en e i-
dence, include ac i a ion o Aδ/C ib es and he elease o β-endo phins and descending
modula ion o μ-opioid ecep o pa hways 2,11. This p ocess igge s unc ional eo gani-
za ion o he cen al ne ous sys em, including b ain ewa d ne wo ks 13
Al hough TCM elies on diagnos ic me hods ha enable pe sonalized ea men
plans o each pa ien , se e al acupunc u e poin p o ocols a e ecu en ly used in expe -
imen al se ings o es ablish e idence-based clinical app oaches. Manual o elec os imu-
la ion o poin s LI4, LR3, ST36, PC6, and SP6 has shown posi i e esul s in educing mus-
culoskele al pain in olde adul s a e ou sessions o ea men 11 (Table 1).
In oncological pain, he combina ion o acupunc u e wi h analgesics inc eases he a-
peu ic e icacy and educes ad e se e ec s 14. Acupunc u e enhances cance pain manage-
men h ough syne gis ic mechanisms: by s imula ing he elease o endogenous opioids
(endo phins and encephalin) in he cen al ne ous sys em (which ac on he same ecep-
o s [μ, δ, κ] as exogenous opioids such as mo phine) i ampli ies pha macological anal-
gesia. Simul aneously, i modula es he in lamma o y esponse by educing p o-in lam-
ma o y cy okines (TNF-α, IL-6) associa ed wi h umou pain and neu oin lamma ion. In
cases o neu opa hic pain, equen in me as ases, acupunc u e no malizes neu onal hy-
pe exci abili y in he soma osenso y co ex and halamus, inhibi ing cen al sensi iza ion.
I also egula es he hypo halamic–pi ui a y–ad enal (HPA) axis and inc eases se o onin
Jou nal o Complemen a y The apies in Heal h 2025: 3(3). 3 o 10
Ma os J.A., Rel as C., Sil a M., Sebas ião D.
In eg a ing T adi ional Chinese Medicine in o Ch onic Pain Ca e in Po ugal: Neu oimmunological and Clinical Pe spec i es doi:10.5281/zenodo.17257459
le els, he eby a enua ing anxie y, dep ession, and he a ec i e dimension o pain, p o-
mo ing a mo e e ec i e mul idimensional app oach.
Some e iewed s udies inno a ed by de eloping and es ing ma hema ical models
15,16 o designing indi idualized ye scien i ically ep oducible p o ocols. These models
use complex equa ions g ounded in basic TCM heo ies such as Yin–Yang Theo y (dy-
namic ene ge ic homeos asis), he ch onobiology o Zang Fu (in eg a ed o gan sys ems),
and he la es knowledge o mic osys ems ha ana omically e lec pain by soma o opy.
The model is based on in eg a ed neu ophysiological mechanisms, whe e indi idualized
acupoin selec ion ac i a es pain modula ion pa hways h ough h ee main axes: (1) s im-
ula ion o myelina ed Aβ ne e ib es, which inhibi nocicep i e ansmission a he do sal
ho n o he spinal co d ia Ga e Con ol Theo y, blocking unmyelina ed C- ib e signals;
(2) ac i a ion o descending neu oimmunological ne wo ks, including elease o endoge-
nous opioids (β-endo phin, dyno phin) and supp ession o p o-in lamma o y cy okines
(TNF-α, IL-6) h ough he HPA axis; and (3) no maliza ion o unc ional b ain connec i -
i y, demons a ed in se e al s udies by unc ional magne ic esonance imaging ( MRI) 17,18,
ebalancing de aul mode ne wo ks (DMN) and hype exci able soma osenso y a eas,
he eby e e sing cen al sensi iza ion. These mechanisms a e ma hema ically quan i ied
h ough algo i hms ha in eg a e a iables such as ana omical pain loca ion, ci cadian
hy hms, and in lamma o y bioma ke s, ans o ming empi ical p inciples o Chinese
Medicine in o ep oducible p o ocols wi h in eg a ed analgesic ac ion.
The syne gy be ween neu oimaging, immunology, and ma hema ics alida es acu-
punc u e as a sys emic neu omodula ion he apy, whe e ana omical p ecision o poin s
p oduces clinically measu able and ep oducible e ec s.
3.2. Elec oacupunc u e
Elec oacupunc u e enhances he analgesic e ec s o adi ional acupunc u e
h ough wo undamen al neu oimmunological mechanisms. I supp esses he TLR2/NF-
κB signalling pa hway, signi ican ly educing he p oduc ion o p o-in lamma o y cy o-
kines such as TNF-α and IL-6 19-21 (Figu e 2). I also p omo es neu ophil ec ui men and
local elease o endogenous opioids, pa icula ly β-endo phins, he eby s eng hening pe-
iphe al analgesia 20. Clinically, he echnique demons a es obus e icacy, wi h s udies
epo ing a 30–45% educ ion in he use o con en ional analgesics in pa ien s wi h in-
lamma o y o neu opa hic pain (Table 1).
Figu e 1. Neu oimmunological pa hways o Acupunc u e/Elec oacupunc u e.
Jou nal o Complemen a y The apies in Heal h 2025: 3(3). 4 o 10
Ma os J.A., Rel as C., Sil a M., Sebas ião D.
In eg a ing T adi ional Chinese Medicine in o Ch onic Pain Ca e in Po ugal: Neu oimmunological and Clinical Pe spec i es doi:10.5281/zenodo.17257459
I s ands ou o i s supe io i y in speci ic condi ions: in pe iphe al neu opa hic pain,
me a-analyses con i m g ea e e icacy compa ed wi h NSAIDs, wi h signi ican educ-
ions in oedema and hype algesia; in heuma oid a h i is, i is associa ed wi h dec eased
in lamma o y ma ke s (such as C- eac i e p o ein) and imp o ed join mobili y 19. Addi-
ionally, elec oacupunc u e shows excellen cos -e ec i eness, wi h lowe long- e m
complica ion cos s compa ed o con en ional pha macological he apies 22.
In Po uguese clinical con ex s, he echnique is applied h ough op imized p o ocols
combining classical poin s (such as ST36 and LI11) wi h speci ic s imula ion equencies
(2–100 Hz) o maximize neu oimmunological modula ion. I is in eg a ed in o na ional
pain uni s, pa icula ly o educing opioid use in cance pa ien s wi h neu opa hic pain,
in alignmen wi h he guidelines o he Na ional P og am o Pain Con ol 12.
Figu e 2. Mechanism o TLR2/NF-κB Pa hway Inhibi ion by Elec oacupunc u e.
Despi e i s bene i s, limi a ions emain, no ably he me hodological he e ogenei y in
neu opa hic pain s udies, which equi es u u e s anda diza ion o pa ame e s such as
s imula ion in ensi y and du a ion.
3.3. He bal Medicine
He bal medicine in TCM ac s h ough speci ic neu opha macological mechanisms.
Alkaloids such as e ahyd opalma ine (Co ydalis yanhusuo) block dopamine gic and opi-
oid ecep o s while simul aneously inhibi ing glial ac i a ion associa ed wi h neu oin-
lamma ion 23 (Figu e 3). O he compounds, such as de i a i es o Sinomenium acu um,
modula e ion channels and supp ess key in lamma o y pa hways, including cyclooxygen-
ase-2 (COX-2) inhibi ion and he nuclea ac o kappa B (NF-κB) pa hway, he eby educ-
ing he p oduc ion o p os aglandins and p o-in lamma o y cy okines (e.g., TNF-α, IL-
1β).
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Ma os J.A., Rel as C., Sil a M., Sebas ião D.
In eg a ing T adi ional Chinese Medicine in o Ch onic Pain Ca e in Po ugal: Neu oimmunological and Clinical Pe spec i es doi:10.5281/zenodo.17257459
Table 1. Clinical S udies on Acupunc u e and E idence o Elec oacupunc u e.
Re .
S udy Objec i e
In e en ion / P o ocol
Main Resul s
13
E alua e cen al e ec s o acu-
punc u e
P o ocol no speci ied; unc ional analy-
sis o CNS
Func ional changes in he CNS; eo gani-
za ion o neu al unc ions associa ed
wi h emo ions and pain pe cep ion
14
Compa e acupunc u e + pha ma-
cological analgesia s. medica ion
alone in cance pain
LI4, LR3, ST36, PC6, SP6 + analgesic
he apy
Highe elie a e; lowe pain in ensi y;
ewe ad e se e ec s; as e onse ; longe
du a ion o e ec
15
De elop and apply a ma hema i-
cal model o indi idualized poin
selec ion
Yin–Yang balance, “Chinese clock,” an-
gula combina ions, soma o opy, ashi
poin s
Me hodological p oposal o a ional
poin selec ion; ounda ion o indi idu-
alized and eplicable p o ocols
16
Apply a ma hema ical model o
indi idualized acupunc u e in
unila e al musculoskele al pain
S uc u ed p o ocol in eg a ing “Chi-
nese clock,” soma o opy/mi o co e-
spondence, iden i ica ion o ashi poin s;
sys emic and indwelling needles; chan-
nel selec ion by angula calcula ions; in-
a-session adjus men guided by VAS
In 5 clinical cases, immedia e and sus-
ained pain educ ion; VAS 0 in 4/5
cases; sys ema ized, eplicable p o ocol
compa ible wi h clinical indi idualiza-
ion; need o alida ion in la ge sam-
ples
19
E alua e e ec s o elec oacu-
punc u e on CFA-induced in lam-
ma o y pain
Elec oacupunc u e a speci ic poin s;
low-in ensi y s imula ion
A enua ion o in lamma o y pain ia
egula ion o CaMKII p o ein
21
In es iga e he ole o he TLR2
ecep o in elec oacupunc u e-in-
duced analgesia in in lamma o y
pain
Elec oacupunc u e in an animal model
o in lamma o y pain
Modula ion o he TLR2 pa hway; educ-
ion o p o-in lamma o y cy okine p o-
duc ion; pain elie
20
E alua e pe iphe al mechanisms
o elec oacupunc u e in in lam-
ma ion
Local applica ion o elec oacupunc u e
a in lamed a ea
Neu ophil ec ui men ; inc ease in β-en-
do phins; local analgesia
22
E alua e economic impac o elec-
oacupunc u e in ch onic pain
Elec oacupunc u e in pa ien s wi h
e eb al synd ome wi h i adia ion
Mul imodal analgesia educing NSAIDs,
ia endogenous opioids, adenosine, se -
o onin, GABA, and modula ion
Figu e 3. An i-in lamma o y Mechanisms o Co ydalis and Sinomenium.

Jou nal o Complemen a y The apies in Heal h 2025: 3(3). 6 o 10
Ma os J.A., Rel as C., Sil a M., Sebas ião D.
In eg a ing T adi ional Chinese Medicine in o Ch onic Pain Ca e in Po ugal: Neu oimmunological and Clinical Pe spec i es doi:10.5281/zenodo.17257459
Clinically, he bal comp esses ha e been shown o signi ican ly educe pain in ensi y
and in lamma o y ma ke s (such as C- eac i e p o ein) in issue inju ies 24 (Table 2). How-
e e , applica ion equi es specialized supe ision due o he isk o pha macological in-
e ac ions, pa icula ly wi h an icoagulan s o immunosupp essan s 25.
This phy o he apeu ic app oach o e s a a ge ed analgesic al e na i e, al hough he
s anda diza ion o o mula ions, moni o ing o ad e se e ec s, and especially he po en-
ial o in e ac ion wi h o he he apies emain ope a ional challenges.
3.4. Mind–Body Exe cises
Qigong
Qigong ac s h ough ege a i e bio eedback 26-29, egula ing he hypo halamic–pi ui-
a y–ad enal (HPA) axis and educing co isol and in e leukin-6 (IL-6) le els 30. I s clinical
e icacy is demons a ed when p ac iced a leas h ee imes pe week unde specialised
supe ision (Table 2).
Tai Chi
This p ac ice combines mo emen and medi a ion, p omo ing imp o emen s in mo-
bili y, balance, and psychological well-being 29,31-33. Al hough i s bene i s a e p o en in
cases o os eoa h i is, scien i ic e idence emains limi ed o he ea men o ch onic low
back pain (Table 2).
3.5. Tui Na massage
Tui Na massage employs manual p essu e and ic ion echniques ac ing di ec ly on
myo ascial igge poin s and me idians, imp o ing blood ci cula ion and educing Qi
s agna ion 34. P elimina y s udies demons a e i s e icacy in managing ch onic low back
pain associa ed wi h anxie y 35 (Table 2), al hough e idence s ill equi es consolida ion
h ough mo e obus clinical ials.
3.6. Moxibus ion
Moxibus ion uses he combus ion o A emisia ulga is o s imula e speci ic poin s,
p omo ing inc eased blood ci cula ion and modula ion o in lamma o y p ocesses. Ac-
co ding o me a-analyses, i demons a es compa a i e supe io i y o e NSAIDs in he
ea men o pe iphe al neu opa hic pain, al hough his conclusion is limi ed by me hod-
ological he e ogenei y o he s udies analysed 36 (Table 2).
4. Discussion
4.1. Neu oimmunological Syn hesis
TCM he apies modula e he neu oimmune axis h ough complemen a y mecha-
nisms, wi h p ac ical e ec s alida ed by e idence.
Elec oacupunc u e p ima ily ac s on supp ession o he TLR2/NF-κB pa hway, in-
hibi ing he elease o p o-in lamma o y cy okines (TNF-α, IL-6) and educing oedema in
condi ions such as a h i is 20,21,36. This mechanism, combined wi h neu ophil ec ui men
and local β-endo phin elease, allows a 30–45% educ ion in he use o con en ional anal-
gesics, posi ioning i as a cos -e ec i e al e na i e o pha maco he apy in neu opa hic
pain 22.
He bal medicine ocuses on modula ion o μ-opioid ecep o s h ough alkaloids such
as e ahyd opalma ine (Co ydalis yanhusuo), o e ing analgesia wi hou he isk o espi -
a o y dep ession, a c i ical ad an age o e syn he ic opioids 23. He bal comp esses ha e
shown educ ions in in lamma o y ma ke s (e.g., C- eac i e p o ein) in issue inju ies 24,
hough hey equi e specialized supe ision o p e en d ug–he b in e ac ions 23.
Jou nal o Complemen a y The apies in Heal h 2025: 3(3). 7 o 10
Ma os J.A., Rel as C., Sil a M., Sebas ião D.
In eg a ing T adi ional Chinese Medicine in o Ch onic Pain Ca e in Po ugal: Neu oimmunological and Clinical Pe spec i es doi:10.5281/zenodo.17257459
Qigong and Tai Chi egula e he HPA axis, lowe ing co isol and IL-6 le els, which
ansla es in o educed s ess ma ke s and imp o ed psychological well-being 29-33. P ac-
iced a leas h ee imes pe week unde guidance, hey show consolida ed e icacy in
os eoa h i is, al hough e idence o ch onic low back pain emains limi ed 32,33.
Table 2. Summa y o mechanisms o ac ion and e idence o non-in asi e he apies (He bal Medicine, Qigong, Tai Chi, Tui Na,
Moxibus ion).
Re .
S udy Objec i e
In e en ion / P o ocol
Main Resul s
23
Re iew analgesic alkaloids de-
i ed om TCM in pain man-
agemen
Re iew o compounds ( e ahyd opal-
ma ine – Co ydalis yanhusuo; sinomenine
– Sinomenium acu um; ligus azine –
Ligus icum chuanxiong; lappaconi ine –
Aconi um ca michaelii; gelsemine – Gelse-
mium elegans)
Mechanisms: dopamine gic/opioid ecep-
o s, inhibi ion o glial ac i a ion, modu-
la ion o ion channels and neu o ansmi -
e s; po en ial o acu e and ch onic pain
24
E alua e TCM he bal com-
p esses in pain and in lamma-
ion
Adhesi e wi h: Common monkshood
oo (15 g), Achy an hes biden a a (15 g),
bi e o ange (15 g), ga den balsam s em
(15 g), sa lowe (10 g), g ound bee le (10
g), ginge (10 g), Haichow Elshol zia he b
(10 g)
Pain educ ion; dec eased in lamma o y
cy okines; imp o ed quali y o li e in so
issue inju ies
25
Desc ibe he use o plan -based
analgesics in pain- ela ed dis-
eases and ale o isks
Highligh ing: Ha pagophy um p ocumbens
(de il’s claw), Cu cuma longa ( u me ic),
Zingibe o icinale (ginge )
Widesp ead use; po en ial bene i s as ad-
junc ; possibili y o ad e se e ec s and
d ug–he b in e ac ions; need o p o es-
sional moni o ing
30
Re iew e idence on in e nal
Qigong in pain ul condi ions
Sys ema ic e iew o clinical ials (p ac-
ice o in e nal Qigong)
Indica ions o pain educ ion in a ious
condi ions; me hodological quali y a ia-
ble, mo e obus RCTs needed
31
Assess he in luence o Qigong
on ch onic pain
Sys ema ic e iew o clinical s udies
E ec i e in pain elie when p ac iced
co ec ly and egula ly, ideally unde su-
pe ision
33
Desc ibe he applica ion o Tai
Chi in ch onic pain manage-
men
Na a i e e iew; desc ip ion o physio-
logical mechanisms and clinical bene i s
E idence o imp o emen in pain, physi-
cal unc ion, balance, and o e all well-be-
ing in a ious ch onic pain condi ions
32
Re iew and analyse RCT e i-
dence on Tai Chi in ch onic
pain ul condi ions
Sys ema ic e iew and me a-analysis o
RCTs; di e en Tai Chi p o ocols
Signi ican educ ion in pain and im-
p o emen in physical unc ion; he e oge-
nei y in p o ocols
35
Analyse ends and e idence on
Tui Na in he ea men o
ch onic pain
Bibliome ic analysis and li e a u e e-
iew
G owing e idence o e ec i eness; em-
phasis on po en ial in musculoskele al
pain; need o mo e high-quali y RCTs
36
E alua e e ec i eness and cos -
e ec i eness o acupunc u e
and moxibus ion in pe iphe al
neu opa hic pain
Ne wo k me a-analysis simul aneously
compa ing mul iple in e en ions based
on classical p obabili y and cos -e ec-
i eness assessmen
Moxibus ion showed po en ial in educ-
ing pe iphe al neu opa hic pain, some-
imes wi h esul s supe io o NSAIDs,
bu e idence is o a iable quali y and e-
qui es mo e obus RCTs
4.2. Clinical Syne gy and Rele ance
The con e gence o mechanisms o ac ion ac oss hese he apies, namely an i-in lam-
ma o y supp ession (elec oacupunc u e), sa e opioid modula ion (he bal medicine), and
neu oendoc ine egula ion (Qigong/Tai Chi), a ge s he mul iple dimensions o ch onic
pain:
Jou nal o Complemen a y The apies in Heal h 2025: 3(3). 8 o 10
Ma os J.A., Rel as C., Sil a M., Sebas ião D.
In eg a ing T adi ional Chinese Medicine in o Ch onic Pain Ca e in Po ugal: Neu oimmunological and Clinical Pe spec i es doi:10.5281/zenodo.17257459
• Cen al sensi iza ion, e e sed by no maliza ion o b ain connec i i y ( MRI s udies)
17,18;
• In lamma o y cascades, inhibi ed a he molecula le el 21,23;
• Emo ional componen s, a enua ed by HPA axis egula ion and se o onin inc ease
14,15,30.
This mul idimensional app oach, aligned wi h he Po uguese Na ional P og am o
Pain Con ol 7,12, p o ides an in eg a i e ca e s a egy o imp o e quali y o li e in pa ien s
wi h ch onic pain while main aining economic sus ainabili y.
Despi e ad ances, c i ical challenges pe sis : he de ini ion o a na ional s a egy o
minimize side e ec s om in e ac ions ( h ough guideline c ea ion), p o ocol s anda di-
za ion, and alida ion in di e se popula ions a e essen ial o s eng hen scien i ic ep o-
ducibili y 36. The in eg a ion o hese he apies in o mul idisciplina y ca e models, aligned
wi h he guidelines o he Po uguese Na ional P og am o Pain Con ol, ep esen s a
p omising and scien i ically alida ed pa h owa d inclusion in public heal h policies. This
pa ien -cen ed app oach combines clinical e iciency (30–45% educ ion in analgesic use),
economic sus ainabili y (cos -e ec i eness compa ed wi h pha maco he apies), and a a-
ou able sa e y p o ile, minimizing ad e se e ec s and enhancing in eg a i e esponses
in managing ch onic pain in Po ugal.
5. Conclusion
TCM is consolida ing as a alid and scien i ically g ounded he apeu ic esou ce o
ch onic pain managemen , suppo ed by demons able neu oimmunological mecha-
nisms. Th ough acupunc u e and elec oacupunc u e, in lamma o y pa hways a e mod-
ula ed and endogenous analgesia is enhanced, educing dependence on con en ional
d ugs. He bal medicine p o ides bioac i e compounds wi h speci ic ac ions on ecep o s
and in lamma o y cascades, o e ing analgesia wi hou he sys emic isks associa ed wi h
syn he ic opioids. Mind–body exe cises (Qigong, Tai Chi) egula e s ess and p omo e neu-
oendoc ine homeos asis, add essing he psychosocial dimension o pain.
Howe e , ull in eg a ion in o he Po uguese Na ional Heal h Se ice (SNS) equi es
o e coming challenges such as p o ocol s anda diza ion and comp ehensi e aining o
heal hca e p o essionals ega ding isks o he bal medicine in e ac ions. Ano he aspec
o conside is he need o obus RCTs in Wes e n popula ions.
C edi au ho s a emen : Concep ualisa ion, J.A.M., Me hodology, J.A.M. and C.R.; So wa e, M.S.;
Valida ion, C.R.; Fo mal analysis, J.A.M., M.S., D.S., and C.R.; In es iga ion, J.A.M., M.S., D.S., and
C.R.; Resou ces, M.S. and D.S., Da a Cu a ion, , J.A.M. and C.R.; W i ing - O iginal D a , J.A.M.,
M.S., D.S., and C.R.; W i ing - Re iew & Edi ing, M.S., J.A.M., and C.R.; Visualiza ion, M.S., D.S.,
J.A.M., and C.R.; Supe ision, D.S.; P ojec adminis a ion, J.A.M. All au ho s ha e ead and ag eed
o he published e sion o he manusc ip .
Funding: This esea ch did no ecei e any speci ic g an om unding agencies in he public,
comme cial, o no - o -p o i sec o s.
Con lic o In e es : The au ho s decla e ha he e a e no con lic s o in e es .
Ins i u ional Re iew Boa d S a emen : No applicable.
In o med Consen S a emen : No applicable.
Da a A ailabili y S a emen : The o iginal con ibu ions p esen ed in his s udy a e included in
he a icle. Fu he inqui ies can be di ec ed o he co esponding au ho .
Jou nal o Complemen a y The apies in Heal h 2025: 3(3). 9 o 10
Ma os J.A., Rel as C., Sil a M., Sebas ião D.
In eg a ing T adi ional Chinese Medicine in o Ch onic Pain Ca e in Po ugal: Neu oimmunological and Clinical Pe spec i es doi:10.5281/zenodo.17257459
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