Acupuncture Plus Gluten Free For Neuropathy

Today's post from ndnr.com (see link below) is a look at electropuncture and a gluten-free diet as possible effective treatments for severe neuropathy. There are two points to make here: 1) nothing like this should be tried before consulting with as many professionals as possible to see whether they approve of the idea and see it as a viable option and 2) both sides of the treatment take a considerable time to work (if they work at all in your case) and therefore require an extremely sympathetic insurance company, or sacks full of cash to pay for it. For many people, the latter is already a reason not to go down this route. The article is based on a case study, which makes interesting reading and you may be surprised at the parallels with your own situation. Changing to a gluten-free diet is both a hot topic and a controversial one, as the evidence is not overwhelming that it works in the case of nerve damage but many people seem to benefit from it so it may be something for you but again...with advice.

Acupuncture and Gluten Elimination for Peripheral Neuropathy: A Case Study
By Editor1 Posted July 4, 2013
Lydia Thurton, ND

Abstract

This study describes the case of a 55-year-old male with painful peripheral neuropathy, which was severely hindering his quality of life. Despite numerous pharmaceutical interventions, his pain was poorly managed. Electroacupuncture and a gluten-free diet were successfully utilized, resulting in pain resolution and a return of patient functionality.

Introduction

Peripheral neuropathy is a poorly understood chronic pain condition resulting from the demyelination and degradation of axonal nerve fibers. Neuropathies can be the result of toxic exposures, metabolic conditions, traumatic injuries, or infections.1 In some instances, the etiology cannot be elucidated. A neuropathy is commonly treated with a variety of medications, eg, non-steroidal antiinflammatory drugs, opioids, anticonvulsants, and antidepressants.2 The success of these pharmacologic interventions varies and complete cure is not expected. Recently, there has been growing concern about the abuse potential of opioid medication. With this growing recognition, a need for alternative solutions for chronic pain, including neuropathic pain types, is particularly relevant. This article will present the case of B.F., a 55-year-old male who presented with a case of peripheral neuropathy that was resolved with dietary gluten elimination and electroacupuncture treatments.

Case Presentation

B.F., a 55-year-old male, presented with classic paraesthesia symptoms of neuropathic pain: burning, tingling, and, as he described it, “biting” sensations in his feet, jaw, and fingers bilaterally. The pain began approximately 2.5 years prior to our first meeting in May, 2012. Tests for vitamin B12 deficiency, blood glucose, inflammation, and HIV were all unremarkable. B.F. did test positive for low serum testosterone, which was treated with intramuscular injections. Physical exam revealed hypesthesia bilaterally that was particularly focused on the medial aspect of the first toes. MRI, ultrasound, and circulatory imaging studies revealed only mild arthritis of the first MCP joint. A neurologist conducted electrophysiological testing, and B.F. was diagnosed with peripheral neuropathy.

B.F. had a history of alcoholism and working with toxic materials in the heating, ventilating, and cooling industry (HVAC). Alcohol abuse is an independent risk factor for peripheral neuropathy.3 B.F. was prescribed varying combinations of medications over a 2-year duration that included: allopurinol, naproxen, colchicine, prednisone, tramadol, gabapentin, morphine, pregabalin, ketorolac, nortriptyline, duloxetine, hydromorphone, and nabilone. B.F. was also obtaining morphine, methadone, marijuana, oxycontin, and occasionally cocaine from street sources to supplement his pain medication. B.F. expressed frustration with the medications, as he often experienced fatigue, dysphoria, impaired cognitive function and withdrawal effects, while his pain continued to increase in intensity.

Management and Care

B.F. commenced weekly acupuncture treatments. Point selection was based on a combination of his Traditional Chinese Medicine diagnosis and areas of maximal pain. Common points used were LI11, SJ5, LR2, SP2, SP6, GB40 and “well points” on the feet, which are the most distal points on each acupuncture channel. When treatment initially commenced, with a frequency of one pulse per second, the current level was at 24 mA (milliamps). After 10 months of treatment, the current level was reduced to 16 mA as his paresthesia began to heal. The frequency remained unchanged. Neuropathic pain was severely hindering B.F.’s activities of daily living. Activities like playing guitar, sustained walking and standing, and working as a HVAC technician were impossible when he first presented to me. His day-to-day functionality was used as a marker for treatment success, as well as his subjective rating of pain intensity.

After 1 month of electroacupuncture treatment, his symptoms, by his account, had improved by 75%. When B.F. started treatment, a folded towel would have to be placed on the floor because it was extremely painful for his feet to make contact with a hard surface. After 4 treatments, this measure was no longer necessary. After 5 months of treatment, B.F. was able to reduce treatments to biweekly.

Dietary change occurred slowly over the course of months, beginning with increasing his intake of plant-based foods, and progressing to elimination of refined sugar and gluten after 2 months. In the case of B.F., he did not manifest gastrointestinal symptoms characteristic of gluten-based enteropathies and he tested negative for anti-gliadin antibodies. However, by his own account, pain symptoms improved by 90% when he eliminated gluten. Currently, when B.F. consumes gluten in any significant quantity, he notes an almost immediate exacerbation of his foot neuropathy.

Medication weaning was done under B.F.’s own initiative and to date he has been able to eliminate all of the aforementioned medications except methadone. Currently he is participating in a methadone harm-reduction program to safely wean him from high-dose opioid medication. He uses marijuana sporadically and is a member of a marijuana compassion center. B.F. has resumed modified work duties and the day-to-day activities he enjoys.

Discussion

Peripheral neuropathy is a poorly understood but common manifestation of gluten sensitivity and celiac disease.4,5 The case of B.F. also suggests that even without the classic serum markers for celiac, adopting a gluten-free diet can assist in nerve pain resolution. Any patient presenting with bilateral sensory peripheral neuropathy should be screened for anti-gliadin antibodies. Neuropathy symptoms can precede or exist without gastrointestinal symptoms. While it is common for anti-neuronal antibodies to be present in celiac patients, serum measurements of antibodies do not directly correlate to subjective patient experience of nerve pain.6

Anti-gliadin IgG and IgA antibodies cross-react with synapsin-1, a ubiquitous phosphoprotein present on both central and peripheral nervous cells. Synapsin-1 is largely responsible for forming and regulating synaptic vesicles.7 Autopsy studies of patients with peripheral neuropathy and gluten sensitivity show destruction of the dorsal root ganglia and peripheral spinal cord columns. Malabsorption of micronutrients may also contribute to derangement of the nervous system in the celiac patient population.5 As gluten-free diets have notoriously low patient compliance, it is important that the attending ND provides dietary planning guidelines that support strict adherence and patient success.

Thanks to the research of Bruce Pomeranz, we know that acupuncture needling has the ability to manipulate nociceptors, proprioceptors and autonomic nerve pathways. Pain relief starts with a cascade of enkephalins, dynorphins and endorphins in the spine, midbrain and hypothalamus-pituitary region. In response to these chemicals, serotonin, norepinepherine, monoamines, and endorphins are released, decreasing substance P and the subsequent pain response. Electroacupuncture serves to add additional needle stimulation.8 Cha et al. (2010) found that electroacupuncture reduces nitric oxide synthase, thereby decreasing nerve allodyina.9 There are a number of research studies that support the use of acupuncture and electroacupuncture as a means of treating neuropathic pain of various etiologies. The most commonly studied neuropathies are those that are chemotherapy-induced, HIV-related, and diabetic.10,11,12,13

Conclusion

While case studies do not provide generalizable data, gluten elimination and electroacupuncture each have their own bodies of research to support their use as treatments for peripheral neuropathy. A limitation of this case, from a research perspective, is that dietary improvement and electroacupuncture were initiated simultaneously, making it difficult to isolate the individual effect of each treatment modality. However, B.F. was able to communicate some distinction. He noted that pain management was the best immediately after acupuncture and it would wane until his subsequent appointment. Furthermore, if B.F. was not stringent about his gluten avoidance, he would experience transient pain flare-ups. While this is a limitation in terms of research, in a clinical setting it is positive that NDs have numerous modalities that work synergistically to achieve patient healing.

Lydia Thurton, ND, graduated from the Canadian College of Naturopathic Medicine in 2010. Lydia maintains a general family practice in Pickering, Ontario and is also the naturopathic physician for the AIDS Committee of Durham Region. Her special area of focus is on African-Canadian, and Caribbean patient populations and she is a regular contributor to the Toronto Caribbean News.







References 
 
Peripheral neuropathy. Mayo Clinic Web site. Updated Novemeber 2, 2011. http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131/DSECTION=causes. Accessed May 10, 2013.
Rowbotham MC, Twilling L, Davies PS, et al. Oral opioid therapy for chronic peripheral and central neuropathic pain. N Engl J Med. 2003;348(13):1223-1232.
Ferrari LF, Levine E, Levine JD. Independent contributions of alcohol and stress axis hormones to painful peripheral neuropathy. 2013;228:409-417.
Hadjivassiliou M, Rao DG, Wharton SB, et al. Sensory ganglionopathy due to gluten sensitivity. 2010;;75(11):1003-1008.
Freeman HJ. Neurological disorders in adult celiac disease. Can J Gastroenterol. 2008;22(11):909-911.
Alaedini A, Okamoto H, Briani C, et al. Immune cross-reactivity in celiac disease: anti-gliadin antibodies bind to neuronal synapsin I. J Immunol. 2007;178(10):6590-6595.
Briani C, Zara G, Alaedini A, et al. Neurological complications of celiac disease and autoimmune mechanisms: a prospective study. J Neuroimmunol. 2008;195(1-2):171-175.
Pomeranz B, Stux G, eds. Scientific Bases of Acupuncture. Berlin, Germany: Springer-Verlag; 1989.
Cha MH, Bai SJ, Lee KH, et al. Acute electroacupuncture inhibits nitric oxide synthase expression in the spinal cord of neuropathic rats. Neurol Res. 2010;32 Suppl 1:96-100.
Phillips KD, Skelton WD, Hand GA. Effect of acupuncture administered in a group setting on pain and subjective peripheral neuropathy in persons with human immunodeficiency virus disease. J Altern Complement Med. 2004;10(3):449-455.
Wong R, Sagar S. Acupuncture treatment for chemotherapy-induced peripheral neuropathy–a case series. Acupunct Med. 2006;24(2):87-91.
Schröder S, Liepert J, Remppis A, Greten JH. Acupuncture treatment improves nerve conduction in peripheral neuropathy. Eur J Neurol. 2007;14(3):276-281.
Hwang HS, Yang EJ, Lee SM, et al. Antiallodynic Effects of Electroacupuncture Combined with MK-801 Treatment through the Regulation of p35/p25 in Experimental Diabetic Neuropathy. Exp Neurobiol. 2011;20(3):144–152

http://ndnr.com/pain-medicine/acupuncture-and-gluten-elimination-for-peripheral-neuropathy-a-case-study/

Can Acupuncture Improve Conduction Of Nerve Signals

Today's post from neuropathytreatment.co (see link below) looks again at the possibility of acupuncture being of help to neuropathy patients. It suggests that acupuncture can improve nerve conduction through improving blood and energy flows along the nerve pathways. It doesn't really explain how acupuncture can tackle specific nerve damage and talks in terms of a traditional medical approach which may seem alien to many people. However, acupuncture in its many forms can clearly help many people with medical problems, whether neuropathy is one of them is open to debate. The article suggests that the acupuncture treatment should be long-term (up to a year) and that may explain why so many people have found their acupuncture sessions to be of little benefit. Most insurance companies will not cover acupuncture, which leads to an expensive series of sessions and many people go to unqualified practitioners, whose skills may be questionable. It's certainly an alternative but also an accompaniment to traditional medicine but it may be worthwhile getting advice first. If you have benefited from acupuncture treatment, please let us know.

Acupuncture – Chinese Medicine as Treatment for Peripheral Neuropathy
MAY 18, 2013 BY WESLEY MILNE

With the still limited studies conducted on the nature of peripheral neuropathy—it’s causes, pattern, characteristics—treatments for the said condition are also currently limited. The most common type of treatment offered to patients is relief from the pain they are experiencing.

But the age-old art of acupuncture and Chinese medicine may be the key in treating peripheral neuropathy (PN) and its other types due to its scientifically proven effect on the patients with PN.

According to a research conducted by the Heidelberg School of Chinese Medicine located in Heidelberg, Germany, treatment using acupuncture has improved the nerve conduction in various patients experiencing peripheral neuropathy.

Further, the group found out that therapeutic acupuncture has a positive effect on the PN-afflicted subjects studied over a period of 1 year, according to their research published online in March 2007 in the website of the National Institute for Health (NIH).

Peripheral Neuropathy
The peripheral nervous system, one of the most important parts of the body, consists of the ganglia and the nerves in the exterior of the spinal cord and the brain. It connects the central nervous system to the various organs, limbs and muscles and conveys sensations all through the body as its main function, making it possible to feel.

With peripheral neuropathy, the nerves that help in the transportation of information from the limbs to the brain or vice-versa become impaired due to various factors.

A person might already have an existing condition such as diabetes, Acquired Immunodeficiency Syndrome (AIDS)/Human Immunodeficiency Virus infection (HIV), leprosy, undergoing cancer therapies (caused by poisoning from chemotherapy), alcoholism, or a hereditary disease prior to their condition to develop into peripheral neuropathy or also known as polyneuritis.

The condition of PN might also include causes such as penetrated injuries, carpal tunnel syndrome (due to entrapment or compression), pressures on the superficial nerves on the ulna or radial, which might be from prolonged position (such as using crutches), disjointed bones or fractures, physical injury directly affecting the nerve including trauma, atherosclerosis or radiation, prolonged exposure to cold, tumor or intraneural hemorrhage.

The condition of peripheral neuropathy is characterized by these symptoms: tingling of the distal limbs, the feeling of burning, numbing, aching, and pain and also includes itching or excessive sensitivity to even slightest touch. The symptoms are oftentimes bilateral (two-sided), and aggravated at night, which also affects the lower limbs more than the upper limbs. However, not all people afflicted with PN experience these symptoms upon diagnosis, making it more complicated to assess those needing treatments.

Acupuncture
The similarity of all the diseases above is that they have a severe lack of qi, yin which results to static blood being produced. For lasting effects, the origin of these factors should be addressed first, together with the treatment that will help invigorate the blood, given that the etiology (origin) of the blood stagnation is the lack of yin, blood and qi.

The practice of traditional acupuncture in treating various ailments has been proven not only by centuries of tradition but is supported with scientific facts as well.

In traditional Chinese medicine, it is taught that peripheral neuropathy is caused by the humidity or the dampness going to the limbs, blocking the natural flow of blood and the energy or the Qi flowing in them. There is a two-fold treatment in it: first is to determine the underlying reason that caused the accumulation of dampness and then to directly aid the Blood and Qi circulation in the affected parts. Through the improved circulation, nerve tissues within the affected area will be revived and nourished in order to restore the functions of the nerve and to reduce pain.

Moreover, peripheral neuropathy is one of the symptoms which showed the various patterns of dissonance existing within the body. The treatment done in the traditional Oriental Medicine sense is to treat and address the patients individually in order to assess their specific needs. The treatment will also have to depend on the reason behind the neuropathy and its manifestation, prognosis, etc.

With this, during the treatment, the acupuncturist may interview the patient and will ask about his or her own observation of the disease: what, where, when they exercised, sleep, drink, perspire, eat, felt pain, among others. The acupuncturist will also observe the tongue and take note of the pulse. The initial diagnosis will help the health team, physician, or the acupuncture practitioner to manage and create a special treatment plan to suit the individual patients.

Aside from acupuncture, there are also other treatments applied including transcutaneous electronic nerve stimulation (TENS), used to block the pain signals, cutaneous acupuncture wherein the physical therapy coupled with the herbal treatment could be combined for quicker results.

Acupuncture can also be partnered along with other treatments undergone by the patient.

http://neuropathytreatment.co/acupuncture-chinese-medicine-as-treatment-for-peripheral-neuropathy/

Acupuncture treatment for sciatic nerve pain

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Is Acupuncture An Option For Your Nerve Damage

Today's post from time.com (see link below) follows on from yesterday's post and adds a little more information to the argument as to whether acupuncture may help relieve your neuropathic symptoms or not. It's a sensibly written and short description of how acupuncture works and offers no guarantees but as the acupuncturist points out at the end; “...if you’re being prescribed opioids, or you’re considering surgery, you lose very little by trying acupuncture first.” Worth a quick read if you're worried about the amount of chemicals you're swallowing in order to keep the pain down.

You Asked: Does Acupuncture Work? 
Markham Heid @markhamh June 29, 2016

For certain conditions—particularly pain—there’s evidence it works. Exactly how it works is an open question.

You hear the term “acupuncture,” and visions of needles may dance in your head. But the 3 million Americans (and counting) who have tried it know there’s a lot more to the treatment than pokes and pricks.

A typical visit to an acupuncturist might begin with an examination of your tongue, the taking of your pulse at several points on each wrist and a probing of your abdomen. “They didn’t have MRIs or X-rays 2,500 years ago, so they had to use other means to assess what’s going on with you internally,” says Stephanie Tyiska, a Philadelphia-based acupuncture practitioner and instructor.

These diagnostic procedures inform the placement of the needles, Tyiska says. But a visit to an acupuncturist could also include a thoughtful discussion of your diet and personal habits, recommendations to avoid certain foods or to take herbal supplements and an array of additional in-office treatments—like skin brushing or a kind of skin suctioning known as “cupping”—that together fall under the wide umbrella of traditional Chinese medicine.

But does it work? Figuring out whether each one of these practices may be therapeutically viable is a challenge, and determining how all of them may work in concert is pretty much impossible. Combine them with acupuncturists’ frequent references to “qi,” or energy flow, and it’s easy for a lot of people to dismiss the practice as bunk.

Not so fast, though. A recent meta-analysis, which examines existing research on a topic, compared acupuncture treatment to standard medical treatment (the kind involving a doctor’s exam and drugs) for musculoskeletal pain, chronic headaches, and osteoarthritis. It also compared real acupuncture to “sham” acupuncture, a procedure where needles are inserted at random to make patients believe they were receiving acupuncture when they were not. “There are many poorly designed acupuncture studies out there, so we tried to include only the best trials,” says Andrew Vickers, a biostatistician at Memorial Sloan Kettering Cancer Center who coauthored the meta-analysis.

When comparing legit acupuncture to standard care, there was a statistically significant benefit to acupuncture, Vickers says. “We saw a measurable effect there,” he explains. “If acupuncture were a drug, we’d say the drug works.”

When Vickers and his team compared legitimate acupuncture to sham acupuncture, that benefit persisted, but shrank. There are a lot of ways to interpret this, Vickers says. “It could be acupuncture has a large placebo effect, or it could be that pressure points”—the precise locations at which needles are inserted—“are less important than acupuncturists claim,” he explains.

Many people equate placebo effects with scams. “The term placebo has always had this very negative connotation,” says Vitaly Napadow, director of the Center for Integrative Pain Neuroimaging at Harvard Medical School. But Napadow says our poor opinion of placebo needs revising. The human body has built-in systems for stoking or calming pain and other subjective sensations. “If a placebo can target and modulate these endogenous systems, that’s a good and a real thing,” he says.

But acupuncture may have effects even more profound than placebo. Napadow has conducted dozens of brain imaging studies on acupuncture in an effort to determine just how the treatment may or may not calm pain or related conditions like headache or arthritis. He says there are lots of ways acupuncture might work, and the specific mechanism may depend on the type of condition you’re trying to treat.

One possibility is that being jabbed with a needle induces a tiny injury, causing your immune system to respond by sending inflammatory proteins and other infection-fighting, would-healing chemicals to the source of that injury. “There’s the idea that by inducing many of these very small injuries, you’re ramping up the immune system so that it can deal with bigger problems,” Napadow says.

It’s also possible that the increased flow of blood and immune system chemicals to the poke site could help clear away accumulated cellular byproducts that may trigger or worsen a condition like plantar fasciitis or tendonitis, he says. “Or the needles might activate nerve receptors in the skin, which then pass info up into your spinal cord and brain,” he says. “That information might trigger a change in brain physiology, like the release of endorphins or those sorts of neurotransmitters that could lessen the sensation of pain associated with something like fibromyalgia.”

His research has borne out some of these potential mechanisms. One of his studies showed that after traditional acupuncture, opioid receptors were more available, or receptive, to the body’s natural pain-quelling chemicals. There was no such change after sham acupuncture.

It basically means opioid receptors were more available or receptive to the types of body hormones and chemicals that help quell pain.

Napadow says that more research has looked into the effect of expectancy on acupuncture outcomes—or whether people who believe the treatment will work experience more benefit than those who don’t. The evidence suggests that expectancy doesn’t improve acupuncture’s effectiveness. “Often it’s the guy who says his wife made him try it who has the greatest benefit,” he says.

Couple these promising findings with the fact that acupuncture is a low-cost treatment option with very few side effects, and Napadow says it makes sense to consider it a helpful partner to Western medicine—especially when it comes to chronic pain-related ailments for which Western medicine often relies on painkillers. “It won’t cure cancer,” he says. “But it could be effective for managing side effects of radiation or chemotherapy—things like pain or neuropathy or nausea.”

Tyiska, the Philadelphia-based acupuncturist, makes a similar argument. “I don’t tell people to stop seeing their doctors,” she says. “But if you’re being prescribed opioids, or you’re considering surgery, you lose very little by trying acupuncture first.”

http://time.com/4383611/acupuncture-alternative-medicine-pain/