Acupuncture and neuropathic pain

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Hi all
I have been using acupuncture lately as a treatment modality for neuropathic pain.
for those in the know I have been needling bafengs, liv3 and GB34.
Pts, without exception, get relief.
For some it is instant and lasts 'forever' (ie. the last four months) from the first treatment.
For others it lasts a day or two.
And one whom I saw while she was on holiday here over Christmas reported relief for the first time in her experience (28 yrs diabetic neuropathic pain) but it only lasted 2 hrs the first time and then I don't know the second because she went back home.
My questions are
1. Anyone know any other channels/points to needle for the more recalcitrant pain?
2. Anyone had any similar experiences with acupuncture and neuropathic pain relief and can they pass on any anecdotes?
3. Has anyone performed acupuncture on these types of pts and had a buildup of pain relief?
Any advice/discourse would be muchly appreciated-private message or forum is A-OK
Cheers
Mahtay

 

G'day Mahtay,

I'm looking forward to a few more joining in on these acupunture chats!

I've been missing for a few days, but another interesting article was posted by Newsbot today on the use of acupuncture in the treatment of peripheral neuropathy. I've asked for more info.

It's my experience in using acupuncture for this problem, is that you usually get an accumulating effect, in that the response improves per treatment as long as they are not too far apart. Ideally you can repeat treatments before the pain returns and monitor the extent (area) of superficial sensitivity as it reduces per treatmernt.

I also use the Bafeng points and (optional) Liv3 with Sp6 as another useful point as an alternative for GB34. Of course, everyone is different and point selection will oiften vary from person to person depending on how they present.

Cheers
Shane

 

I feel like playing devils advocate. Been ages since we had a good row.

Have you tried sticking random bits of the people and seeing what happens or have those pesky ethical considerations got in the way. I ask because anecdotal evidence is available for all sorts of weird and wonderful stuff. (including marigold cream to reduce IM angles in HAV and orthotics for infertility )

I remain highly sceptical about a treatment modality with no rational more reliable than some sketches by ancient oriental dudes!

Is it enough to think that something does work without knowing how?

Regards
Robert

 

Hi Robert,

Ther's one every time acupuncture comes up and so I've less enthusiasm about getting into defending the use of acupuncture as it's been done by myself and others on previous threads. It's easy to post the query and sit back and pardon me for saying this but if you were seriously interested you could do some study into it (we're all human, and this is not personal at you Robert as I enjoy your participation in this forum, and I probably do the same thing about other things that some folk do)

Just to say that the EBM comes out in support of acupuncture being effective in the treatment of certain condtions. As for how being up in the air, their are theories just as their are for orthotic therapy, with most theories not really explaining everyhting. Certainly the effect of the intervention can be measured and has been done in numerous studies. The evidence is more than anecdotal.

No, not really. I was taught some protocols, followed them and they worked.
Humans have been doing this to the best of their ability for many centuries and I've got no good reason to mess with that. There is some evidence of galvanic skin responses being different at Ac points and points often being in strategic places eg muscle motor points, neurovascular bundles, etc

Is that worse than the pods who prescribe orthoses and think that they know how they work and really don't have a clue?

 

Sorry, I pressed submit when intending to review and check/fix and say a little bit more, but you get the drift and I'd also like to point out that I'm not against orthotic therapy, just know enough about it to suggest that in general we still can't agree amongst ourselves about why they often work. What's so different? I also have a recollection of sham points not being as effective. I've been doing it for 15 years and honestly wouldn't bother if it wasn't working. See the post by Newsbot on peripheral neuropathy. I've had great results with that condition and don't know of anything else that can do that!

Cheers
Shane

 

Sorry you're enthusism for this particular debate is waning. Consider me to be akin to a ten year old nagging you to take them out fishing in the rain when you REALLY don't want to. I probably enjoy it more than you!

As you say i could (and do) study it myself but it's soooo much more fun to have a conversation with a real live person. So far as i'm concerned you can get as personal as you like and you have no need of my pardon! It all adds to life's rich pattern and i am neither fragile nor insecure enough to dish it without taking it!

This is indeed true. I have read some good large sample double blind studies supporting acupuncture. I have also read some equally large equally good equally double blind studies indicating NO significant benifit! Which brings us to...

Assuming i understand this statement right i would disagree. Orthotic therapy generally has a rational. As in, move the foot this way and it takes strain of this structure. Is there such a logical thought process for acupuncture which does not rely on invisible energy flows and other unmodelable, unmeasurable and unquantifiable things?

No. That ticks me off as well!

Feel free to ignore this post if you don't want to do the whole EBM thing again! I certainly would'nt hold that against you as there is certainly nothing new under the sun. Nor is this a thread about EBM.

Or come out in the rain and play...



Go on.
You Know you want to

Regards
Robert

 

Hi Robert,

It's time for breakfast and getting off to work, where I usually 'pin' about 60% of my patients one way or another at some stage. Thsi includes dry needling trigger points, which comes under the umbrella of acupuncture.
I'll continue this chat later. One thing thatamazes me is that some folk such as yourself contribute so much to this forum. I just seem to get a bit of time from time to time.

Cheers
Shane

 

Hi Robert, I don't know if this will work, but you started the thread below back in November. You can see that I can't leave it alone. I'm between breakfast and shower now.

Go Back Podiatry Arena > General > Biomechanics, Sports and Foot orthoses
Reload this Page Acupuncture, legitimate or not

Cheers
Shane

 

Again Robert, a couple more minutes.

This seems to be what you really want to talk about

How about the studies showing that different areas of the brain light up when needles are stuck into various places. That study has been widely reported and in the arena somewhere. So it seems there is a neurological response to acupuncture (and I'd say that there is also at least a local chemically mediated response and probably more). That's not so strange for an unwesternized person to call that energy flowing from one part of the body to another. They know that if you stick a needle into a certain point on the hand you have a good chance of relieving/ameliorating that particular type of headache. Another type of headache may be better helped by needling a point in the trapezius.

Those guys in China had to pay up if they didn't help the problem. We could do with a bit of that - it'd tighten up some orthotic therapy! I'm passionate about orthotic therapy as well and disappointed at a lot odf what I see, not so much the theories but the management. I consider it a contract to achieve a result when you start with someone and that you follow through until you get the result as good as you possibly can.
With acupuncture you often need to do a number of treatments - so there needs to be a response and progress to continue. I've certainly not continued treatment when there was no response (seems logical). Tha Ac is part of the stuff I throw at the presenting problem, the mix based on experience/logic/intuition etc and whatever single or combination modality that looks like giving the quickest result is pursued.
I don't have to believe any theory on acupuncture and don't with orthotic therapy either. I go for what works until I find something better.

So at least you know how I justify what I do. I don't buy that there is any more justification for orthotic therapy. It's great for us that some folk do the research and they have 'proved' that custom made devices are no more helpful in treating plantar fasciitis than off the shelf devices. We know that is not true and relates to the study design and so you get mixed results in research. Nevertheless, the positive results are hard to argue with.

Cheers
Shane

 

Shane

Thanks for playing!

You are correct. Pod arena is a monster which has eaten my life. It comes from a lack of more formal training and the recent sad loss of my mentor of 8 years. With no one else to drive my development (which he did with boundless patiance enthusiasm and passion) i have to turn to the world wide wonder web. It drives the wife insane as she never gets chance to use broadband! Having a baby who thinks cicadian rythms are something to do with beetles rather than sleeping when i want to also gives me time.

The tricky thing with research is that you cannot prove a negative (witness the MMR / autism debate). There is enough research around to convince me that acupuncture does SOMETHING. This irritates me no end! i could dismiss it as placebo and sleep peacfully if these studies did not exist. However until my new world order comes into being and i control all thought and information (estimated 2009 assuming we can get the leaflets printed) i cannot ignore this evidence.

The Dbl blind studies which show no significant effect don't help my position at all! Could have been a rubbish acupuncturist! Could be that it does not work for that condition.

However i keep coming back to the same problem. I cannot accept that we have cause (needling), effect (areas of the brain lighting up / proven symptom relief) but a yawning gap in between these two points! WHY is there a chemical response? HOW does sticking a point in the hand help a headache? The two appear to be no more linked anatomically than any other two parts of the body.

Its like an itch i can't scratch!

In the dark musty armpit of my soul i will admit to doing this sometimes with orthotics. However i always lose sleep until i figure out WHY it works and so far i have yet to have any conundrum which i have not explained eventually.

I absolutly agree. Please don't misunderstand me. You can practice any way you like and i'm sure you do better with your broader range of treatment options than i do with mine. I have no problem with that and i am not throwing rocks in your direction.

I am just cursed with an enquiring mind and acupuncture is well researched enough to prove THAT it can work but not HOW it works!

Here's a relevant question. Is it possible to do harm with acupuncture? If so how? If not why not? Always an interesting assumption with "alternative" medicine (although acupuncture seems to be defecting to the mainstream) is the presumption that because it is "natural" or "non medical" it can only have a positive effect. Assuming Acupuncture has a genuine objective chemical / neurological effect, is it possible to create too much effect or the wrong effect?

As always I appreciate your input. By giving your time and knowledge you add to the community knowledge not just mine. Consider it karma returned for anything you have learned from others on the site.

Unfortunatly i am in serious karmic debt at the mo. I'll repay when i know more!

Regards

Robert

 

Hi Robert,

There seem to be two points that are itching and you're entitled to scratch them and see what you can find out. I can give my opinions and would like some more deeply trained or academic podiatrists to join in. There's no doubt a benefit in discussing these points. Personally, I get forced to think.
Perhaps the first of them:

into my hands has just arrived a book written by a compatriot of yours.
Anthony Campbell, titled "Acupunture in Practice
Beyond Points and Meridians"

He is a medical acupunturist and believes that acupuncture can be explained through a modern understanding of anatomy, physiology and pathology, that is by science. He sets out to explain how in this book. I'll be interested to read it. It's unlikely that I'll be able to explain how acupuncture works, but there are folk out there who could probably do a good job.
Maybe you could read the book as well, as it may relieve one of your itches.

The second itch was

Ther is some evidence of acupuncture being used for and also accidentally causing abortions. There are points that are advised against during pregnancy. I wouldn't put them to the test.
There's also the usual list of adverse results from infections etc, sticking into wrong parts (example lungs= neumothorax) etc
There also apparantly are reports of mental conditions being activated and epileptic attacks being brought on.
No question that an increase in pain or new pains may occur.
Acupunturists need to be well trained, with having a medical background a great asset.

Cheers
Shane

 

Could'nt find this on Amazon. I'll try to track it down. Perhaps when you have read it you could hit the highlights for us!

I find that very interesting and fairly compelling evidence in favour of acupuncture. How sick would you feel if you gave a patient who had come in for heel pain a Pneumothorax?! got to laugh.

The fundamental itch remains. What is the mechanism and is it safe to operate without understanding it. Mind you i think we understand the mechanism for orthotics fairly well and still get some fairly impressive abberactions there!

I refer you, (and myself) to Javiers classic chicken crossing the road answer

Classic

Regards

Robert

 

Try this Robert,

http://www.acampbell.ukfsn.org/acupuncture/updates/mechanisms.html

Shane

 

I have not found any double blinded prospective studies that prove showering is beneficial. You could be wasting time, water, and soap here. Breakfast, however, is supported by EBM.

 

And a recent study has shown that 100% of patients who died of ANY type of cancer had a history of breathing...

 

It looks like this thread is fading away without any discussion by those who actually use acupuncture in any of its forms.
So, we shall take our chances on copping some flack from the sceptics and carry on about using acupuncture in the treatment of peripheral neuropathy.
As in practical modalities there is a wide range in how the principles of acupuncture are interpreted and used. There is Taditional Chinese, various westernised versions, "modern medical' etc. How do you approach this condition?

This is not the first time discussions on acupuncture end up simply becoming discussions about explaining how it may work, and that's fine but doen't mean we can't still discuss how we do what we do and why etc.

I know there are some very well trained/experienced in acupuncture podiatrist out there.

Cheers
Shane

 

I agree Shane, I just wanted to know who does anything like I was discussing and do they have any tips.
Maybe in future people can poo-poo what we do in another thread and leave us hippies to our own long-haired happenings...man!
Mahtay

 

I resent the implication that i poo poo. I've never poo pooed in my life. I'm ever so backed up!

Did'nt mean to divert your thread! However if you don't want to have questions asked of you by those who may not agree with you this is not the right forum! Maybe if it troubles you that much you should specify "people who agree or ask easy questions only" in the thread title. Maybe we could have a special "poo poo" ing thread run off to one side! Why so sensitive?

Also asking questions does not preclude anyone else offering opinions or "sticking to the point.

Contrary to popular belief being a skeptic is a valid viewpoint and not an indication that somebody is a closedminded bigot. It does'nt necessarily mean i disagree either.


I shall now stop cluttering your thread. I shall however continue to watch it with interest. I've already learnt a lot thanks to shane, who knows but i might learn more.

Thanks for that link BTW Shane.

Respectfully

Robert

skeptic

 

Hi Robert,

You're always welcome to ask questions (they require thoughtful responses, which is always beneficial) and I'd also have loved to discuss this modality with others who use it. It was not because of you that they haven't appeared and the invitation still is out there. I hope I didn't imply the thread was hijacked.
This thread seems to have followed a familiar path. Maybe we need a few more using the modality to generate a good practical discussion.

Cheers
Shane

 

Herbal Sienna is good for the backed up mode...or so the hippies say!

Robert-I am not in the least bit afraid of questions, comments, criticisms or whatever...I just think that if the thread is about the amazing results that treatment of diabetic neuropathic pain with acupuncture achieves, and the question is does anyone have any suggestions to help augment a newbies repetoire, then it would make sense to start a new thread discrediting people who use this modality or the modality itself instead of wading into the pack holus bolus arms flailing and cats screeching.

Herendethethreadforme
Mahtay

 

Hi Robert,

There seemed to be some following of this thread and where it was going so why not continue. I'll still play.

When you use acupuncture we could then talk about how to use it. The amazing thing is that by sticking a few acupuncture needles you can reverse the discomfort.

Meanwhile, Campbell doesn't mention neuropathy in his book and seems to miss some of the uses of traditional acupuncture in his quest to scietifically explain the modality. And that's just a scan of his book.

Did you find any information to help the itch on the link?

Cheers
Shane

 

Shane Mahtay lurkers et al.

Sorry i dropped of the grid for a bit there. Things went all a bit mad at work and home, you know how that goes.

Some very interesting stuff in that link! However it is a bit of a tease in that is a pier rather than a bridge. Some thoughts :-

Local effects
The thing seems to be that local stimulation creates local chemical effects in much the same way as LLLT and trauma. This would seem logical but how would that sort of volume of chemical travel from where you are needling to where it was needed? Does acupuncture ever involve needling at the site of pain?

Oxytocin
This is a very interesting idea which would seem to fit the pattern of acupunture being useful for just about everything! Howver it leaves the question of why sticking pins in somebody would cause this chemical to be released.

LTP and LTD

This, for me, is the most convincing of the "what it does" type theories. Neural plasticity fits rather neatly with the effects of acupuncture and definatly (for me) qualifies as a rationale. However like oxytocin it leaves the question of Why a needle one inch to the left has the effect and one inch to the right will not.
If anyone out there is sitting on any other information about neural plasticity i would love to read it!

It appears to me that scientists are doing well at making their way from the "What it does" side of the chasm. The pier on the "how it does it" side is still a pile of girders and some builders sucking their teeth and commenting that they don't usually do this type of work!

Regards
Robert

PS

I could'nt find any either. Lacking the facility to carry out a full DB study i carried out a smaller pilot study. Subject group (n) was 1. The subject refrained from using soap and water for 3 days. The test criteria was based on marital reactions. The tester was blinded in that she was not informed of the nature of the experiment. After three days there was a 100% increase in the incidence of hearing "you stink you filthy F****** pig". This was considered to be an undesireable reaction showing a clear benifit to using soap and water.

Concluesion
The data of this study though not statistically significant, would seem to fit the anecdotal evidence and the rationale that soap disorganises the hydrophillic/hydrophobic bonds of lipids, effectivly "de clumping" them and allowing the mechanical effects of laminar water flow to effectivly remove accretions which may contain gram positive and negative bacteria which may cause smells. Further investigations would be required before this hypothesis could be considered proven. A suggestion for this might be to carry out a demographic survey of population groups who do not traditionally shower as often (eg people sharing bathrooms, students, teenage boys etc).

 

Dear Mahtay2000,
Back to the original aspect of this forum, have you tried EA on these points?
Regards
Brenton

 

No I haven't tried EA yet, it's mainly because I wouldn't know where to start and don't have the gadgetry.
I am doing a 'next level' course in a few weeks and that will have electro in it.

But...without the EA I have had crazy results. The best is one retired GP and the other a retired vet. They both don't believe in it but the pain was so bad they would try anything. And both have no pain now. The GP has dropped his Lyrica medication by half (can't let go) and the vet takes none. He keeps shaking his head and muttering 'How does it work? How does it work?' (Maybe he is Robert Isaacs incognito!)

Can you tell me anything about EA? ie better worse different etc.

Mahtay

 

Dear Mahtay2000

Electroacupuncture works by electrical stimulation of acupuncture points and different frequencies release different peptides that produce analgesia and anaestehesia. This is how acupuncture anaestehesia is produced. I often use these techniques on painful joints but have yet to try the EA anaesthesia technique for nail surgery! EA produces quite a different effect from manual stimulation techniques with patients aware of the electrical sensation between points, but generally you don't get channel activation.
Regards,
Brenton

 

Hi Robert et al,

I also find it difficult being constantly on the arena - it's almost a luxery!

Robert, try this link for another take on explanations which may help with some of your queries

http://www.tufts.edu/med/ebcam/eastAsianMed/acupunctureOverview.html

Also you wrote

We certainly do needle at the site of pain and even in some cases may 'peck' a painful bone site with the needle. Interestingly, if, for example, the skin is broken or there is infection at the painful site, then we would needle on the opposite limb to get the same effect. I'm in no doubt that there is a local and a CNS response to the needling.As I've mentioned I've no doubts about acupuncture working (it's something humans have been fine tuning for possibly a couple of thousand years) and am interested in reading about how the research is going.

This thread started about neuropathic pain and I mentioned a patient who had severe neuropathic pain (particularly, bilateral burning toes, that had required her taking medication to sleep at night for the previous few months.
I only needled one foot. I also mentioned that after each treatment that the effect lasted longer. I saw her during the week and she has not had to take that medication for the past month and there was no treatment during that month. At first she got a few days relief and it returned, during another break in treatment it took 2 weeks to return and this time no return after a month.

Also

I still think, as you obviously do, that there is a long way to go in explaining 'how it works'. Mostly, explanations are about pain relief. However, acupuncture is traditionally used for much more. How will we explain about reducing hypertension or altering hormone levels?
Also, if there is a measurable increase in the blood levels of endorphins, for example, following a treatment, how is it that you reach a stage fairly quickly, that the pain has gone but you are not re-stimulating the release of the endorphins?
And, it seems it works towards balancing systems, homeostasis, and so overshooting the mark in theory doesn't happen.
We are very long way from explaining it.


Lastly, it's interesting also to see electroacupuncture. I haven't used it for many years but did find it very effective in pain treatment. Although would not have used it for treating the neuropathic pain in this patient.

Cheers
Shane

 

How indeed?

This sounds interesting. I've always been curious about modalities which improve homeostasis rather than sending the variable one way or the other. This is the claim beloved of homeopaths. The abberactions we discussed earlier in the thread seem to imply a unidirectional stimulus. How can one do harm by improving homeostasis?

Ta for the link. will just go read

Regards

Robert

 

hey guys, just to say one of my diabetic patients had no feeling what so ever in his feet for 17 years and after one treatment with my chinese acupuncturist he is relearning to walk as he can now feel the ground and the fluff in his slippers. no more marionette walking for him.

i like walking in the rain, but fishing!!! what's that all about lol!

 

Thanks twinkletoes for you message below

A lot a water has passed under the bridge since we were engaged in this thread!

Personally, I've had numerous cases with significant reductions including complete cessation of neuropathic pain. I also teach pods how to approach this problem and have had great feedback from other Podiatrists who have tackled the problem using acupuncture. What I have found is that a single treatment will have an effect that wears off and the duration of response increases over a few treatments. Always response will be on a case by case basis and the result you report is extremely impressive.

There is more evidence for the mechanisms producing the results from the insertion of needles which were not well gathered at the time we were engaging in this thread.

Acupuncture initiates physiological responses and I'll mention some of them just to because they were not mentioned earlier.
Firstly, I'll just mention the local response to needle stimulation of tissue, which initiates an axon reflex which causes the release of various substances including CGRP (calcitonin gene related peptide) which in turn causes local blood vessel dilation in the skin and local tissue which enhances healing. Increased levels of adenosine have also been measured locally which has an anti inflammatory and analgesic effect. Locally then, an improved blood supply to peripheral nerves may well cause a tendency toword improved/normal function.
The needles have been shown to initiate responses segmentally and extra segmentally in the nerrvous system and to also have central regulating responses.

Enough for now, happy to make a rare comment back in the arena

Cheers
Shane

 

Press release:
Acupuncture effects on neuropathic pain: A study on signal pathways