Peripheral Neuropathy and Acupuncture

Peripheral neuropathy is a condition that I have treated successfully maybe more often than any other condition discussed on my website. I have probably performed over 3000 treatments for peripheral neuropathy. I can say that in most cases it responds well to acupuncture–though there have been a few people I have been unable to help.

When I originally composed this article, I placed that number at 10%. I have had some very difficult cases lately, largely due to the business this article attracted. I am going to revise the number to 20%. If I am going to err, I feel it is better on the conservative side.

I gained most of my experience treating peripheral neuropathy during the 7-8 years when I was the primary acupuncturist in Sacramento treating AIDS patients (from 1994 to 2001). I had a very good working relationship with the Sacramento Aids Foundation, an institution which unfortunately no longer exists, and C.A.R.E.S., which no longer funds alternative therapies like acupuncture. Almost every patient sent to me during this period had peripheral neuropathy as a primary complaint, usually caused by the heavy prescription drugs they were taking. I treated at least 10 neuropathy patients per week for several years and was able to develop an effective treatment protocol.

If you are taking the time to read this article, you probably already know what peripheral neuropathy is, but in case you don’t:

Peripheral neuropathy is a condition in which there is damage to the nerves enervating the extremities, hence the word “peripheral.” “Neuro” means “nerve” and “pathy” means “suffering or disease.” Generally, the sensory nerves are most affected, causing sensations of pain, tingling and numbness at times the motor nerves are affected, causing problems with movement. In the most common type of neuropathy, the feet are affected first, and the pain and numbness can then progress up the leg. In other cases, the hands can be affected first, with pain progressing up the arms. The pain can often be quite intense. When numbness is severe, the patient’s proprioception is affected, meaning that he or she does not receive sufficient sensory feedback from the feet or hands to allow comfortable walking or use of the hands.

In my experience, there are essentially 3 types of peripheral neuropathy, categorized by causality: drug-induced, diabetic and idiopathic. My AIDS patients suffered from the first type, due to all the strong medications they had to take. Now that there is no longer funding for these patients, I primarily see types 2 and 3. Type 2 is a common side effect of diabetes. Type 3 is more mysterious.The word “idiopathic” is a medical term derived from the Greek language which essentially means that nobody knows what the cause is.

The treatment for peripheral neuropathy is given on both sides of the body—points are needled on the hands or feet, or both, depending on where the pain or numbness is located. The patient is generally lying face up for this part of the therapy. The patient then lies face down and points are treated in the lumbar or cervical areas (or both, if the neuropathy is in the hands and the feet) close to where the spinal nerves exit from the spinal column. This strategic combination of local points around the spine and distal points on the feet and hands helps to reduce the sensitivity of the nerves and restore them to a state where they function normally. The treatments are actually quite relaxing, and patients often experience other health benefits as well.

Results are generally not immediate—the effects of acupuncture for this condition are cumulative. Usually the patient will be feeling some benefit by the end of the fourth treatment, though it takes more treatments than four for the condition to completely clear up. However, most patients do respond positively, as I said earlier.

For practitioners and students:

Since publishing my article on peripheral neuropathy to my website, I have received several email inquiries from acupuncturists and medical doctors asking for more specific information on my treatment protocol. I have therefore decided to expand the scope of the article with this addendum.

As I mentioned in my article, it is important to needle points on the affected extremities. My needle selection on the feet depends on whether the pain and/or numbness is on the dorsum of the foot or the sole.

If the symptoms are on the dorsum, then conventional acupuncture points are appropriate, such as Lv 2 or 3, St 44, Sp 3, GB 43, Bl 65, or one can simply needle the “bafeng” points. If the sides of the feet are also affected, then one can expand the repertoire to include location-specific points such as Ki 2 and Bl 63. It the symptoms are on the sole of the foot, one must be a little more creative, as there is only one classical acupuncture point in this area, Ki 1. In this case, I simply needle the areas around the metatarsal-phalangeal joints on the sole, as if the classical points on the dorsal aspect of the foot projected through to the bottom of the foot.

Because the skin on the sole of the foot is often calloused, these points can be more painful to needle, so I use thinner needles when necessary, usually Seirin 40 gauge. Since many neuropathy patients complain of numbness in the feet, however, it is common for them not to feel the insertions at all. If the insertions do begin to hurt after a few treatments, it is a sign that the condition is starting to improve.

For upper extremity neuropathy (i.e. numb and/or painful hands) I usually needle the “Baxie” points.

As I mentioned earlier in the article, I feel it is important to needle points around the spine as well—the huato points for at L4, L5, S1 for lower-extremity neuropathy and bilaterally at C6, C7 and C8 for upper-extremity neuropathy.

I feel I should mention that I am not the only acupuncturist who treats neuropathy in this way. My only innovation has been to needle the soles of the feet—the rest I learned from seminars I attended. When I discussed my treatment methods last year with another acupuncturist I respect, I discovered that she needles the soles of the feet also. Most acupuncturists I have discussed the topic with do not, and many do not treat points near the spine, which I think is essential.

I generally see patients once per week. Generally, I discontinue treatment if I have not seen any results in 4-5 visits. I have found that patients who have neuropathy because of chemotherapy have to continue their treatments throughout the time they are taking these drugs or they will backslide after making progress. The same is true for patients with HIV who are on antiretroviral medication. Patients with diabetic neuropathy or idiopathic neuropathy generally maintain their improvement for long periods of time after a series of treatments and do not need to have ongoing or maintenance care. Of course, there are some individuals who unfortunately do not respond at all, though the majority do.

I would also like to add that I am not claiming that this protocol is the only way to treat peripheral neuropathy with acupuncture. It is simply the approach that has worked for me. Oriental medicine is a rich tradition with a diverse number of treatment methods. It is possible that the patients I have not been able to help with my method could be helped by another, therefore no patient should give up hope. I invite any practitioners who have had success using different methods to email me, as I am always endeavoring to expand my knowledge.

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