Problems With HIV Drug Side Effects Try Acupuncture

Today's post from pacificcollege.edu (see link below) is a general article about the benefits of acupuncture for relieving the side effects of HIV combination drugs. It also specifically references neuropathy which may be of interest to regular readers. Many younger people, especially in the West, where HIV drugs have been significantly refined to reduce side effects considerably over the last few years, may well shrug their shoulders here and say that they have no side effect issues from combination therapy. However, the vast majority of people across the world who are living with HIV haven't achieved that luxury yet. They have to remain on older drug combinations because of resistance issues if they change, or non-availability and they may well have been living with side effects for so long that it's become part of their daily lives. In these cases, this article may be of value. It is important to consult a qualified acupuncturist who knows what he/she is doing and although it is relatively inexpensive compared to many therapies, cost may still be an issue. However, if you can afford it and feel you may benefit, why not try acupuncture/acupressure therapy. If you achieve relief from the symptoms, you may well be able to cut out, or reduce, other (non-HIV) drugs used to control pain.

Acupuncture to Ease the Side Effects of AIDS Drugs
No date or author provided

As drug cocktails continue to be used as a course of treatment for those who have HIV and AIDS, more patients are suffering through debilitating side effects that are caused by these medications. Often patients complain of a wide range of symptoms including, night sweats, nausea, vomiting, depression, insomnia, anxiety, peripheral neuropathy, muscle pains, and sinus congestion. However, acupuncture is now being used to alleviate some symptoms brought on by the powerful drugs. These treatments have been shown to boost the immune system and help fight the side effects brought on by HIV and AIDS.

Redge Norton of the San Francisco AIDS Foundation uses acupuncture, massage and nutritional therapy to combat the side effects of the powerful drugs. "It really helped to get my appetite back to normal," said Norton. "And I feel more like myself again."

Acupuncture is commonly thought of as an alternative form of therapy, although its history as a treatment for physical ailments predates the era of laboratory-produced drugs by several thousand years. Practitioners of this ancient tradition choose from a variety of treatment modalities when developing an individual treatment regimen for a patient. In addition to acupuncture, these modalities include therapeutic massage, stress reduction techniques, and the application of heat and herbs that is known as moxabustion.

A significant number of primary care providers have come to recognize that such therapies should not be thought of as alternatives to Western medicine, but rather as complementary therapies - therapies used in conjunction with, not instead of, conventional drug treatments.

Acupuncture may help relieve bloating, cramping, and appetite loss among HIV-infected people taking drug cocktails to keep the virus in check. In 2005 a study was presented at a meeting of the International AIDS Society. This study included 50 HIV-infected men and women taking HIV medications. About half had been diagnosed with full-blown AIDS.

At the start of the study, all of the participants complained that the drugs caused at least two digestive side effects: nearly 80% had gas, more than 40% had bloating, 50% had cramps, nearly 50% had appetite loss, and 10% had actually lost weight

The participants then received six weeks of acupuncture. For three weeks the acupuncture included four sites commonly associated with improvement of digestive symptoms, such as nausea, vomiting, and bowel upset. For another three weeks they received acupuncture at four sites nearby sites not noted for affecting digestive conditions.

The patients were unaware of which type of acupuncture they were receiving at any given time.

But after just three weeks of acupuncture treatments, only 60% had two or more digestive symptoms. Both sets of acupuncture points improved digestive symptoms. However, acupuncture at the sites targeting digestive symptoms was more effective in controlling loss of appetite, abdominal cramps, and bloating.

In addition, among the 20% of people who said they weren't taking their AIDS medications as directed at the start of the study, half reported improvement after acupuncture treatment. This points out, states researcher Elizabeth Sommers, research director of the AIDS Care Project/Pathways to Wellness in Boston, since they feel better after acupuncture, people are more likely to take their drugs properly, resulting in better disease control.

In this study, none of the participants complained of side effects from the acupuncture.

Pain, a frequent symptom in people with HIV disease, appears to be particularly responsive to the effects of acupuncture. While the exact mechanisms by which acupuncture relieves pain remain obscure, there is clinical evidence to show that it does work. Specifically, acupuncture has become a popular treatment for people with peripheral neuropathy, which is a common complaint of people with HIV. Neuropathy, or nerve damage, manifests as pain, tingling, or numbness in the extremities, usually the feet. After acupuncture treatments patients report less tingling and more flexibility in the joints.

Among the many attractive features of acupuncture therapy are its safety and its relatively affordable cost. Convenience is also a consideration: it is not necessary to plan one's life around acupuncture treatments, which is an additional benefit to individuals who must plan their lives around their HIV and AIDS drug therapy schedules.

Among the many attractive features of acupuncture therapy are its safety and its relatively affordable cost. Convenience is also a consideration: it is not necessary to plan one's life around acupuncture treatments, which is an additional benefit to individuals who must plan their lives around their HIV and AIDS drug therapy schedules.

http://www.pacificcollege.edu/news/blog/2014/04/26/acupuncture-ease-side-effects-aids-drugs

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Can Acupuncture Relieve Forms Of Neuropathy

Today's post from ascopost.com (see link below) is a thorough look at the value of acupuncture as a means of reducing neuropathic symptoms brought on by cancer or its treatments. It's not often that you come across an article in such detail about acupuncture as an alternative therapy for neuropathy and as such is worth reading for anyone suffering from neuropathic problems. Of course, this article concentrates on neuropathy as a result of chemotherapy treatment or cancer itself but that doesn't mean that it can't be applied to many forms of nerve pain arising from other causes. Worth a read.

Acupuncture Treatment for Cancer Pain and Chemotherapy-Induced Peripheral Neuropathy
By Bahar Javdan, BA, and Ting Bao, MD, DABMA, MS
November 15, 2014, Volume 5, Issue 18




While currently prescribed analgesics are inadequate in addressing chemotherapy-induced peripheral neuropathy and may induce adverse side effects, nonpharmacologic remedies such as acupuncture may be promising candidates for treatment.
—Bahar Javdan, BA, and Ting Bao, MD, DABMA, MS

Acupuncture is a traditional Chinese medicine technique that involves inserting and manipulating filiform needles into specific points of the body to achieve a therapeutic effect. According to traditional Chinese medicine, disruptions in the flow of “vital energy” (qi) throughout the body are the underlying reason behind certain pathophysiologic conditions. Acupoints are defined as anatomic locations that promote the flow of qi to correct imbalance and regulate visceral function.

In the United States and internationally, acupuncture is used to relieve stress, enhance immunity and reduce insomnia, often combined with conventional medication for the management of cancer pain. In 1997, the National Institutes of Health formally acknowledged acupuncture’s ability to achieve therapeutic effects, including relieving pain and nausea.1,2

Although its precise mechanism of action has yet to be definitively elucidated, acupuncture’s therapeutic effects are thought to occur via multiple pathways, including neurohormonal changes and immunomodulation. Animal research suggests that acupuncture induces analgesia by stimulating nerves in muscles, which then relay the signals to the spinal cord, midbrain, and hypothalamus-pituitary system, ultimately triggering release of neurotransmitters and hormones such as endorphins and enkephalins.3 Animal and human studies suggest that acupuncture works by improving the availability and utilization of brain nerve growth factor.4 Acupuncture has been associated also with significant reduction in proinflammatory cytokines, including interleukin (IL)-1β, IL-6, IL-17, and tumor necrosis factor (TNF)-α.5-10

Acupuncture points may be stimulated in various ways. With manual acupuncture, the filiform acupuncture needle is inserted in an acupuncture point and manually rotated to stimulate the point. With electroacupuncture, acupuncture points are stimulated by passing electrical current through inserted needles. Electrical current may be passed also through an electrode on the skin without inserting acupuncture needles, a technique called “noninvasive electrostimulation.” Acupressure is a form of acupuncture that uses only physical pressure with a finger or device such as an embedded stud in an elastic wrist band.

Acupuncture and acupuncture point stimulation are widely used as complementary therapies to treat a broad range of illnesses and symptoms and are frequently used by cancer patients. Growing evidence suggests that acupuncture is beneficial for the treatment of cancer pain and for chemotherapy-induced nausea and vomiting. It also appears to relieve symptoms such as radiotherapy-induced xerostomia, fatigue, hot flashes, depression, anxiety, and insomnia.

This article provides a synopsis of the role of acupuncture in alleviating cancer pain, with a special emphasis on acupuncture for chemotherapy-induced peripheral neuropathy.

Acupuncture for Cancer-Related Pain

Cancer pain is the most common and one of the most distressing and feared symptoms among cancer patients. It is estimated that up to two-thirds of patients with metastatic cancer suffer from cancer-related pain,11 and more than 75% of hospitalized oncology patients experience cancer-related pain.12-14 Due to its prevalence and importance, pain is often referred to as the “fifth vital sign” in oncology.

Cancer pain varies both by type of malignancy and by site of cancer involvement.15 The majority of cancer pain is caused by the direct effect of cancer as a result of visceral involvement, bony metastasis, soft-tissue invasion, or infiltration to the nerve or nerve plexus.16 Cancer treatments such as chemotherapy, radiation, and surgery also may induce cancer pain.17,18

Cancer pain typically is treated with opioids and with interventional anesthetic or neurosurgical procedures. Despite maximal use of pain medications and the application of interventional procedures, a significant portion of cancer patients still suffer from pain. In addition, the undesired side effects of long-term use of opioid pain medication, which include changes in mental status as well as constipation, nausea, and fear of dependency, are issues of concern. Consequently, cancer patients often turn to acupuncture and other complementary therapies for pain control.

Despite common use by oncology patients in efforts to control cancer pain, acupuncture has not been sufficiently documented via well-designed clinical trials. Many previous trials suffer from methodologic flaws such as poor study design, small sample size, and/or lack of appropriate data analysis.19 Consequently, two recent Cochrane systematic reviews of randomized controlled clinical trials showed no strong evidence for acupuncture’s effectiveness in reducing cancer pain.20,21 Another Cochrane systematic review assessed the value of transcutaneous electrical nerve stimulation in the management of cancer-related pain in adults; results were inconclusive due to a lack of suitable randomized controlled trials.22

Randomized Controlled Trials

Several recent, well-designed randomized controlled trials have studied the role of acupuncture in treating cancer pain. Summarized in Table 1,23-31 they include four trials that explored the efficacy of various types of acupuncture in controlling postoperative pain. Mixed results were found.

Deng et al’s study of 106 cancer patients experiencing post-thoracotomy pain showed no statistical difference between real vs sham acupuncture in patients’ pain scores as measured by the Brief Pain Inventory at 30, 60, and 90 days’ follow-up.23 The efficacy of the unique intradermal needles used in this study was questionable.

A smaller trial (N = 27) by Wong et al showed a trend of lower visual analog scale pain scores in patients receiving electroacupuncture compared with patients receiving sham acupuncture on postoperative days 2 and 6 and a statistically significant lower cumulative dose of patient-controlled analgesia on postoperative day 2 (P < .05).24 This study, however, was limited by its small sample size.

Mehling et al’s randomized controlled trial compared acupuncture plus massage therapy vs usual care in controlling postoperative pain, nausea, vomiting, and depressive moods in 93 cancer patients.25 It showed that postoperative acupuncture and massage in addition to usual care significantly improved pain control when compared to usual care alone.

Lastly, a study by Pfister et al showed that four weekly acupuncture treatments significantly reduced pain and improved function in cancer patients with chronic pain or dysfunction due to neck dissection, vs standard care alone.32 However, with no sham therapy group in the last two studies, it is difficult to tease out the placebo effect. It also leaves the question of whether professionally trained acupuncturists and massage therapists, as well as real vs sham acupuncture needles, are required for an intervention to succeed.

Chemotherapy-Induced Peripheral Neuropathy

A common side effect of chemotherapy, chemotherapy-induced peripheral neuropathy includes a variety of symptoms such as paresthesia, pain, and muscle weakness.33 Although the incidence of chemotherapy-induced peripheral neuropathy varies depending on the chemotherapy regimen and the duration of exposure, it is estimated to occur in approximately 38% of patients treated with multiple agents.34 The likelihood of developing the condition increases if the patient receives combinations of agents such as platinum drugs, vinca alkaloids, bortezomib (Velcade), or taxanes.35

Several characteristics of chemotherapy-induced peripheral neuropathy distinguish it from other forms of neuropathy such as carpal tunnel syndrome or metabolic neuropathy. Those diagnostic features include a symmetrical, distal, length-dependent “glove and stocking” distribution of the disorder, onset after administration of chemotherapy and progressive, dose-dependent continuation of chemotherapy, and predominantly sensory, rather than motor, symptoms.36 Nerve conduction studies have shown sensory axonal damage and reduced amplitude of sensory nerve action potential but unchanged motor nerve function throughout treatment.37

Chemotherapy-induced peripheral neuropathy can be serious enough to limit or delay the dose of administered chemotherapy and may warrant discontinuation of treatment. Long-term chemotherapy-related neuropathy often produces substantive functional decline and diminished quality of life.35,38

Treatment-Limiting Neuropathy

For patients with persistent chemotherapy-induced peripheral neuropathy, treatment may be limited to symptom management with narcotics, antidepressants, and antiepileptics.35 Studies suggest that analgesic regimens typically produce only modest relief of pain and other common side effects such as dizziness, sedation, dry mouth, and constipation.35 Antidepressants such as nortriptyline, and antiepileptics such as gabapentin and lamotrigine, may effectively reduce neuropathic symptoms associated with various conditions, not including chemotherapy-induced peripheral neuropathy.39-41

The only successful clinical trial for chemotherapy-related neuropathy treatment showed that the antidepressant duloxetine at 30 mg daily for 1 week followed by 60 mg daily for 4 more weeks caused a modest 1.06-point reduction in pain on a 10-point scale from baseline, compared with a 0.34-point reduction for placebo.42 However, duloxetine use was also associated with side effects, including fatigue and nausea, as well as a 12% dropout rate vs 1% for placebo.

The 2014 American Society of Clinical Oncology chemotherapy-induced peripheral neuropathy guidelines suggest a “moderate recommendation for treatment with duloxetine” and recommend further research in this area.33 Since there is currently no standard treatment for chemotherapy-induced peripheral neuropathy, new safe and effective treatments are needed.

Some relatively small studies have examined acupuncture’s ability to reduce the symptoms of chemotherapy-induced peripheral neuropathy. In a blinded randomized controlled trial, cancer patients with chronic peripheral or central neuropathic pain following cancer therapy were treated with auricular acupuncture. They experienced a 36% reduction in pain intensity vs a 2% reduction for sham-acupuncture–treated patients 2 months later (P < .0001).27

A case series of five patients suggested the potential efficacy of acupuncture in treating patients with chemotherapy-induced peripheral neuropathy.43 Another pilot study demonstrated that, among 11 patients with the disorder, 5 of 6 patients treated with acupuncture had improved nerve conduction vs only 1 of 5 patients who showed improvement in the control group.

In addition, objective nerve conduction studies demonstrated significant improvement with acupuncture approximately 3 months post intervention vs usual medical care.44 A positive correlation between improved chemotherapy-induced peripheral neuropathy and nerve conduction was found in 21 patients on acupuncture therapy vs 26 controls who received best medical care. A recent pilot study of 27 multiple myeloma patients with moderate to severe bortezomib-induced peripheral neuropathy demonstrated significantly reduced neuropathic pain and improved function following 10 weeks of acupuncture treatment.45

While currently prescribed analgesics are inadequate in addressing chemotherapy-induced peripheral neuropathy and may induce adverse side effects, nonpharmacologic remedies such as acupuncture may be promising candidates for treatment. The advantages of acupuncture include its low cost and minimal toxicity.

The preliminary research summarized here suggests that acupuncture may reduce chemotherapy-induced peripheral neuropathy symptoms, and that larger, more substantive randomized studies are warranted. Such studies should further evaluate acupuncture’s ability to reduce these symptoms and also should aim to elucidate the mechanism of action by which this effect occurs. ■

http://www.ascopost.com/issues/november-15,-2014/acupuncture-treatment-for-cancer-pain-and-chemotherapy-induced-peripheral-neuropathy.aspx

Acupuncture A Neuropathy Treatment Option

Today's article from tandurust.com (see link below) doesn't really go into any great detail about acupuncture methods for neuropathic symptoms but there are other posts on the blog which do (alphabetical list to the right). Instead, it is a good introductory article about neuropathy and its causes and current treatments, with the suggestion that acupuncture can be a worthwhile alternative. Two points: if you are considering acupuncture, please use a reputable acupuncturist who knows what he/she is doing and please be prepared for disappointment. Many people swear by acupuncture but equally as many have found no relief whatsoever; what's more, neurologists aren't that keen because of the lack of firm evidence but as with all neuropathy treatments - what works for you is evidence enough.

Peripheral Neuropathy And Acupuncture Treatment: Causes, Symptoms

Posted on December 12, 2012 by PUP

 

Peripheral neuropathy is a neurological condition in which the nerves that enervate the extremities are damaged. There are two types of nerves, sensory nerves and motor nerves. Mostly the sensory nerves are affected giving rise to tingling and numbness sensation in hands and feet. Movement of the person is affected when there is a lesion in motor nerve.

There are several reasons known to cause peripheral neuropathy such as trauma, diabetes, leprosy, vitamin deficiencies etc. Generally peripheral neuropathy improves with time. Results are promising when the underlying condition is treatable.

Besides the use of medicines, there are number of other natural methods to treat peripheral neuropathy.

 

One such effective alternative treatment is acupuncture. But before knowing how effective acupuncture is for treating peripheral neuropathy, let us find out the causes and how to identify its symptoms.

Causes Of Peripheral Neuropathy

The etiology in at least 40% of the patients suffering from peripheral neuropathy is not known. Several factors are known to cause peripheral neuropathy and they are;

• Diabetes: peripheral neuropathy is a prominent symptom in patient whose blood sugar is poorly controlled.
• Vitamin B12 deficiency is another factor for development in peripheral neuropathy.
• Post herpetic neuralgia is also common cause for peripheral neuropathy.

Alcoholism: people taking alcohol regularly are prone to peripheral neuropathy.

Autoimmune diseases; SLE, Polyarteritis nodosa, rheumatoid arthritis etc.

Traumatic injury where the peripheral nerves are damaged can result in peripheral neuritis.

Kidney disease, liver disease and hypothyroidism can also cause peripheral neuropathy.

Viral infections such as HIV, Hepatitis C.

Peripheral Neuropathy Symptoms

Clinical picture of peripheral neuropathy consists of sensory, motor, and autonomic disturbances. Sensory nerves receive the sensation of pain, heat, touch etc. Motor nerves control movement of muscles and autonomic nerves control blood pressure, heart rate, bladder function etc.
Sensory symptoms include: pain, burning and light band like sensation. Extreme sensitivity to touch, even light touch seems to be painful.
Motor symptoms include: muscle cramps, muscle weakness, wasting, tremor, and fasciculation etc.
Autonomic symptoms include: fainting spells, reduced or excess sweating, sexual dysfunction, anorexia, nausea indicates gastroparesis.

Acupuncture Treatment For Peripheral Neuropathy

There are several conventional medicines to treat peripheral neuropathy. This may include prescription medications such as antidepressants, anti epileptics, etc. Acupuncture is an alternative and effective therapy for improvement in nerve conduction in patients suffering from peripheral neuropathy. In this therapy, fine needles are inserted in the skin at specific points along what are considered to be lines of energy (meridians).
The system has originated in china. It is used to alleviate pain and it can also increase the immune response by balancing the flow of vital life throughout the body. By an estimate, at least 50 to 60 % of patients with chronic pain receive temporary relief when treated with acupuncture. While some patients experience long term relief as well.
Though there is a debate of its effectiveness among scientific fraternity beyond that of a placebo, it should not matter whether the effects are physical or merely psychological as long as the patient feels better. Acupuncture treatment should be continued for weeks and months for better results. The time interval also depends on severity of the symptoms.
Needles are inserted at specific points on the surface of body on both sides, in peripheral neuropathy. The points are located on hands or on the feet. It also depends which area has become numb.

http://www.tandurust.com/alternativetherapies/peripheral-neuropathy-acupuncture.html

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