There is increasing clinical evidence that reflex therapies such as massage, Gua Sha, cupping, wet packs, acupuncture etc. are helpful in reducing symptoms of chronic pain. However, the neurobiological basis of these effects has rarely been investigated even though the increasing knowledge of the pathophysiology of chronic pain syndromes allows for specific hypotheses. Reflex therapies are likely able to influence chronic pain at the level of the nociceptor and the spinal cord. Moreover, it can be speculated that these therapies have a strong impact on relaxation and maybe understood as a social, comforting interaction. Since it is well accepted that the positive effect of grooming has a neurobiological basis in non-human primates, its biosocial impact on wellbeing and pain processing in humans may be underestimated. A synopsis of the neurobiological foundations of pain perception, from the nociceptor up the spinal cord to brain mechanisms provides the basis for the investigation of the ‘way of action’ of reflex therapies. Specific hypotheses on their neurobiological bases and methods suitable for their investigation are outlined. Further clarification of the mechanisms of action of reflex therapies will support their clinical evidence and add to our understanding of the neurobiology of complementary medicine.

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