Number of scientific references: 46
Level of Evidence: Level III What is this?
Note: Acupuncture has a pain-relieving effect in peripheral neuropathy and can even improve nerve function. Results from scientific evidences on benefits of acupuncture is encouraging and it can be utilised as an add-on therapy to standard treatment.
Peripheral neuropathy is said to be one of the major factors of disability in the elderly. Around 20% of the older population (above 60 years of age) in the industrialised countries experience neuropathic pain.
The idea of treating pain with some other form of pain seems a little infeasible. Acupuncture does not necessarily mean pain but for those who have not tried this therapy imagine it to be painful.
Apparently, the needle pricks are not as painful as they seem, but therapy may cause a dull ache or tingling sensation in some.
Acupuncture has been practised for over 2000 years in China. Its mechanism of action is supported by what is known as the meridian theory.
This meridian theory is developed based on observations. Doctors in the ancient era found that needling a certain location on the medial part of the lower leg relieved stomach aches better than needling of any other location of the body.
Based on such observations, doctors developed a map of 14 meridians or lines that corresponded to specific organ systems. Later, research identified that these acupoints are areas which are rich in sensory nerve receptors (nerves that support sensations such as touch).
These receptors are sensitised in case of a diseased state that makes the acupoint tender and painful. When the healthy balance is restored, the tenderness is relieved. Higher the number of tender acupoints, greater the number of sessions required for complete recovery.
Various research studies have investigated the role of acupuncture in nerve damage treatment.
Acupuncture helps in peripheral neuropathy by relieving pain and improving nerve function. It regulates various neurotransmitters and reduces inflammation to provide pain relief. It even exerts a neuroprotective action and initiates nerve repair.
6 Proven Benefits Of Acupuncture For Peripheral Neuropathy
Many studies have been conducted to evaluate the benefits of acupuncture in various types of peripheral neuropathy. Here I have included studies involving manual acupuncture only. Let’s understand the scientific literature better.
1.Research proves that acupuncture relieves nerve pain
A study published in Neuroscience 2011 answered multiple queries about acupuncture induced pain relief for nerve damage.
The first question was whether acupuncture ‘s effectiveness is affected by treatment at a single point or a combination of two points. Their study showed that both types of stimulation were effective in relieving nerve pain.
Table of Contents
- 1 6 Proven Benefits Of Acupuncture For Peripheral Neuropathy
- 1.1 1.Research proves that acupuncture relieves nerve pain
- 1.2 2.It exerts a neuroprotective action and supports nerve repair
- 1.3 3.Acupuncture is clinically proven to aid in diabetic neuropathy
- 1.4 4.Acupuncture is found to reduce neuropathic pain in cancer patients
- 1.5 5.It may benefit from alcohol-induced neuropathy
- 1.6 6.It may help with HIV associated neuropathy
- 2 Precautions with Acupuncture Therapy For Neuropathy
- 3 Conclusion
Further, their study demonstrated that the therapy is effective even at acute or sub-chronic phase of nerve damage. Acupuncture was found to be linked with the release of endogenous opioids, and its pain-relieving effect was comparable to that of gabapentin (a drug prescribed to relieve neuropathy symptoms).
Researchers from the Hubei University of Chinese, China have recently developed a unique biosensor system involving acupuncture needle that helps in real-time detection of serotonin levels in the cell.
Quite a unique innovation, right!? If it’s effectiveness is ascertained, it might be useful in treating pain related disorders.
This traditional Chinese therapy influences the levels of other neurotransmitters such as endogenous opioids and norepinephrine to support pain relief.
It also exerts an anti-inflammatory effect and interacts with our autonomic nervous system (fight or flight system) to mediate analgesic effect.
Coming to neuropathy, Cha et al. have proven that acupuncture relieves neuropathic pain. Their study demonstrated that the therapy reduced allodynia (painful response to a stimulus which is not likely to cause pain).
The researchers stated that this action is mediated by regulation of neurotransmitters, the response by the peripheral nervous system and by improved blood flow.
Further, in 2012, Choi et al. demonstrated that acupuncture exerts an anti-inflammatory and antioxidant action to reduce neuropathic pain. It inhibits the formation of reactive oxygen species in nerve injury and thus suppresses activation of microglia.
Microglia are cells that contribute to immunity of the central nervous response. In response to damage, these cells are activated, and they initiate inflammation to repair the cell, but if not controlled they can contribute to pain transmission.
A fairly intriguing study is the one published by Kong and his colleagues The Journal of Pain, 2005. Their study assessed the psychological outcomes of acupuncture therapy.
They compared manual, electro and placebo acupuncture. No response was seen in placebo group.
Both forms of the therapy significantly lowered pain ratings. 5 out of 11 individuals experienced significant pain relief. Of the 5, three responded only to manual acupuncture while two responded only to electroacupuncture.
The pain relief effect was described in different ways by every participant, but the most common description was numbness and soreness, rather than aching, burning or stabbing.
This study highlighted that efficacy of acupuncture depends on the individual as well as the mode or type of the therapy involved. Researchers suggested that switching the mode may be beneficial in patients who do not respond to one particular type of acupuncture.
Quick Gist: Acupuncture induced pain relief is a result of modulation of various biomolecules in the body. It stimulates the release of endogenous opioids, serotonin and other neurotransmitters to reduce nerve pain.
It ameliorates inflammation in the central nervous system to curb pain. Experimental studies find acupuncture as effective as conventional medicines used to treat neuropathy. The pain-relieving effect of acupuncture varies with every individual and the type of acupuncture involved.
2.It exerts a neuroprotective action and supports nerve repair
Apart from pain relief, some researchers have reported that acupuncture may also improve physiological parameters of the nerve such as nerve conduction velocity (ability to transmit signals or impulses).
They compared the traditional therapy with best pharmacological therapy for peripheral neuropathy. In the acupuncture group, 76% improved, 14% showed no change and 10% experienced worsening of symptoms.
Interestingly in the pharmacotherapy group, only 15% improved, 14% showed no change while 58% experienced aggravation.
Neurotrophins are a family of proteins that support survival and growth of neurons. Two highly researched members of this family are Nerve Growth Factor and Brain-Derived Nerve Growth Factor.
Another important role by which the traditional therapy protects nerve health is by preventing apoptosis or cell death.
A recent study published in Neural Regeneration Research 2016 revealed that acupuncture regulates the level of anti-apoptotic gene Bcl-2 (a gene that prevents cell death). This contributes to its neuroprotective activity and supports nerve regeneration.
Myelin sheath is the insulating covering that protects neurons. Degeneration of this covering in neuropathy is referred to as demyelinating neuropathies.
Quick Gist: Acupuncture exerts a nerve protective action in many ways. Research reveals that it may regulate neurotrophin levels (proteins that support nerve growth and development) to protect nerve cells.
It also prevents nerve cell death in response to injury and may even improve physiological parameters of nerve cells and aid in nerve regeneration.
3.Acupuncture is clinically proven to aid in diabetic neuropathy
Acupuncture benefits in diabetes by lowering blood sugar levels and increasing insulin synthesis.
A recent study published in Nutrition and Diabetes, 2016 demonstrated that acupuncture and metformin combined therapy is more effective than metformin alone in improving insulin sensitivity and lipid metabolism as well as reducing body weight and inflammation in type 2 diabetes patients.
There have been multiple studies that demonstrate the therapeutic efficacy of this traditional Chinese therapy in diabetic neuropathy. I have selected a few studies that I found vital to share with you, and they have been tabulated below:
|Author & Publication Date||Number of patients and duration of therapy||Results of the study|
|Abuaisha et al. , 1998||44 patients with ten weeks of classical acupuncture therapy||34 out of 44 showed significant improvement in neuropathy symptoms. Follow up for 18-52 weeks demonstrated that 67% of the patients reduced or stopped their medications. Only seven patients experienced complete relief from symptoms. Acupuncture was found to be safe and effective on long-term for diabetic neuropathy.|
|Ahn et al. 2007||Seven patients; 3 received Traditional Chinese acupuncture and 4 received Japanese acupuncture once a week for ten weeks||Both styles lowered pain as per the scale of pain score, but patients in Japanese group reported a reduction in neuropathic pain while in the Chinese group minimal effects were observed. Chinese style improved nerve function significantly.|
|Tong et al. 2010||42 patients treated with acupuncture and 21 exposed to sham acupuncture (placebo) for 15 days||Significant improvement was observed in motor and sensory nerve function in acupuncture group while no improvement was observed in the sham group.
Acupuncture also reduced numbness and pain in lower limbs and rigidity in upper limbs
|Garrow et al. 2014||45 patients treated with true or sham acupuncture for ten weeks||Improvement in lower limb pain, sleep, blood pressure and in patient-reported symptoms was observed in the true acupuncture group.|
|Lu et al. 2016||31 patients assigned to acupuncture group, 29 assigned to medication group (lipoic acid and alprostadil intravenously) for 30 days||Score for peripheral neuropathy reduced in both groups but was more significant in the acupuncture group. Acupuncture improved nerve conduction velocity better than medication group.
Response rate was 83.9% in acupuncture group and 62.1% in medication group; acupuncture was found to be superior to medication in treating diabetic neuropathy
|Bailey et al. 2017||25 patients received acupuncture once a week for ten weeks||19 out of 25 completed the study.
They reported a significant reduction in aching pain, burning pain, numbness, allodynia and prickling sensation.
No significant reduction in stabbing pain was observed.
Acupuncture as an add-on therapy in diabetic neuropathy demonstrates beneficial effects within 15 days to 10 weeks depending on the frequency of sessions. It aids in reducing burning sensation, numbness in lower feet, reduces rigidity and numbness of upper limbs in diabetic neuropathy.
Some scientific evidence state that the style of the therapy (Chinese or Japanese) may cause a difference in therapeutic outcome and some have found acupuncture to be better than medications for treating nerve pain in diabetes.
Quick Gist: Acupuncture benefits in diabetes by lowering blood sugar levels and improving insulin sensitivity and synthesis. This aids in protecting nerve health.
Various studies have found positive results with the traditional Chinese therapy as an add-on therapy in diabetic neuropathy and have reported a reduction in symptoms as well as improvement in nerve function.
4.Acupuncture is found to reduce neuropathic pain in cancer patients
High dose chemotherapy causes many adverse effects, and one of them is neuropathy. Acupuncture is looked forward to as a treatment modality for cancer pain.
The National Comprehensive Cancer Network guidelines for adult cancer pain recommend acupuncture as an add-on to conventional medications based therapy.
In 2011 researchers from The University of Maryland School of Medicine reported a successful case where acupuncture was used to relieve neuropathy symptoms caused by chemotherapeutic drug bortezomib.
Donald et al. have reported that this traditional therapy may have additional benefits apart from the reduction of symptoms of chemotherapy-induced neuropathy; it may reduce the use of painkillers and improve sleep.
In 2014, Bao et al. conducted a study involving 27 patients with multiple myeloma and who had been treated with bortezomib in the past. They received ten acupuncture sessions for ten weeks.
A significant reduction in pain and improvement in nerve function was observed. No change in nerve conduction was observed. Acupuncture was found to be safe and feasible for treating chemotherapy-induced nerve pain.
In 2017 Han et al. conducted an interesting study comparing methylcobalamin alone or in combination with acupuncture to treat chemotherapy induced nerve damage. The study lasted for three months.
The pain was reduced in both groups, but this effect was more pronounced in the acupuncture group. Improvement in daily functioning and nerve conduction velocity was higher in the combination group.
Acupuncture with methylcobalamin showed better therapeutic outcome than methylcobalamin alone.
As per a survey published in Journal of Complementary and Alternative Medicine, 2017 Acupuncture practitioners receive around ten patients per week who seek treatment for chemotherapy-induced peripheral neuropathy.
On an average they required approximately 12 sessions and 53% of the patients required one session per week. 60% of the patients reported the effectiveness as ‘moderately successful with moderate improvement seen’.
Quick Gist: Various clinical trials have found that acupuncture is a safe and feasible adjunct therapy for treating chemotherapy-induced peripheral neuropathy in patients at early stage of the disease.
Some studies report that it may also help reduce pain, use of painkillers and improve sleep and digestion in patients.
5.It may benefit from alcohol-induced neuropathy
Alcohol addiction or chronic alcohol intake can create systemic oxidative stress which impairs nerve health and contributes to peripheral neuropathy. Alcohol abstinence and vitamin B supplementation are the most common route of treatment for this condition, but in some cases, no treatment response is observed.
A group of Chinese researchers evaluated the benefits of acupuncture in chronic alcoholic peripheral neuropathy. 120 patients were enrolled in the study and assigned to following groups:
- Common treatment group
- Acupuncture group A (who received additional needling at certain points different from that of Group B)
- Acupuncture group B (who received additional needling at certain points different from that of Group A)
All groups received conventional medicines. First the therapy was performed once a day for 14 courses and then once every other day 14 times. The therapy lasted for eight weeks.
After eight weeks, Neurological Severity Score and Neurological Impairment Score in Lower Limbs were reduced in all three groups. This decrease in score was more pronounced in acupuncture groups, especially Group B.
Similarly, physiological parameters of the nerves (nerve conduction velocity) improved in all groups but were more pronounced in acupuncture groups.
Also, depression and anxiety scores were lowered in all three groups, but this was more pronounced in acupuncture group especially in Group B.
Acupuncture improved ‘neurofunction’ in patients with chronic alcohol-induced peripheral neuropathy and alleviated depression and anxiety.
This is perhaps the only study in humans that suggests that acupuncture, in addition to standard drug therapy, can reduce symptoms and improve nerve function in alcoholic neuropathy.
Quick Gist: Chronic alcohol intake impairs nerve health leading to painful neuropathy. A study in humans suggests that acupuncture in addition to standard drug treatment improves nerve function and reduces depression and anxiety in chronic alcoholic neuropathy. Further research on this aspect is required.
6.It may help with HIV associated neuropathy
There are six patterns of HIV associated neuropathy. Compared to diabetic neuropathy drug trials, clinical trials for HIV associated neuropathy treatment have little or no success.
A study published in JAMA 1998 reported that both acupuncture and amitriptyline are not more effective than placebo in relieving pain in HIV associated neuropathy.
Further, in 2004, Phillips et al. found that five weeks of the traditional therapy significantly reduced pain and other symptoms of HIV associated neuropathy. Reduction in burning, aching, pins and needles and numbness was also observed.
In 2010, Shiflett et al. reanalysed the findings of JAMA, 1998 study and published them in Explore (NY). The JAMA study involved three different and independent clinical trials.
The reanalysis revealed that both acupuncture and amitriptyline significantly reduced pain with time. Both treatments also improved mortality in patients whose health was poor before the therapy.
Acupuncture alone provided better pain relief than combination therapy. The death rate was 53% in the combination group while it was only 11% in acupuncture the only group. This indicated adverse interactions between the two treatments.
In 2011, Shiflett et al. reanalysed the acupuncture only treatment of the JAMA 1998 study and his analysis revealed that acupuncture was clearly effective in reducing the death rate in HIV patients especially in case of poor health at the start of the treatment. Its results in case of pain relief were mixed.
These studies show that the traditional therapy can be an effective add-on therapy for HIV associated neuropathy and it can improve survival rate in HIV patients.
Quick Gist: Various research studies have proven that acupuncture effectively reduces symptoms of HIV associated neuropathy and improves survival rate in the disease.
There have been some findings that indicate a possibility of adverse interactions with acupuncture and amitriptyline. More research is required to ascertain whether there are any other medicines which interfere with the therapeutic outcome of the traditional therapy and lead to adverse events.
Precautions with Acupuncture Therapy For Neuropathy
Studies investigating the benefits of acupuncture for neuropathy have found it to be safe and have not reported any significant side effects.
Most studies have found that it takes about 8-10 weeks (1-2 sessions per week) for acupuncture to work and show a reduction in symptoms of neuropathy.
A study published in Journal of Palliative Medicine, 2015 suggests that a minimum of four weekly sessions may be necessary before observing any benefits of the therapy in chemotherapy-induced neuropathy.
Please consult a licensed acupuncture practitioner for therapy. Also, consult your healthcare provider prior.
Acupuncture is a traditional therapy that targets various nerve receptors to relieve pain and other disease-related symptoms. In neuropathy, it regulates opioids and serotonin in the body for pain relief and protects nerve health by inducing production of neurotrophins.
Multiple studies, also in the form of randomised clinical trials, have reported that acupuncture as an add-on therapy reduces pain, burning pain, numbness in lower feet, pain in upper extremities etc. The beneficial effect is observable within 8-10 weeks.
The therapeutic outcome may be dependent on the style of the therapy as well as the individual. If no treatment response is observed with a particular style, then acupuncture practitioners should consider switching the mode.
B vitamins protect nerve health and may improve the efficacy of the therapy.
There are few review studies published in 2012-2013 that suggest that quality of studies assessing benefits of this traditional therapy is low and more rigorous and well-designed studies are required to make recommendations.
Few researchers state that such inconclusive results are obtained because of the poor understanding of pain relief mechanism of the traditional therapy.
A recent review study published in Journal of Complementary and Alternative Medicine, 2017 took into account 15 studies and found that most clinical trials showed benefit for acupuncture better than placebo for diabetic neuropathy.
They also reported that the therapy improves nerve function. The conclusion was that acupuncture is beneficial in some peripheral neuropathies, but better-designed studies are required to characterise its effect and optimal use.
Neuroscience is still to unravel the fine details of acupuncture’s mechanism of action in pain relief, but the evidence available to date for neuropathy treatment is encouraging.
Have you tried acupuncture as an adjunct therapy for peripheral neuropathy relief? Do leave your comments below.