Treating Neuropathy and Other Difficult Cases

My post on Managing Unsuccessful Cases prompted a question about the protocols I used from a Facebook Friend who had a neuropathy case that did not respond to treatment. I invited this poster to give some details of this case and I encourage others to do the same with their difficult cases. Please provide details regarding the symptoms such as how long the patients has had them, the severity and if they are consistent or vary, the patients age and general health condition. Also please include how many treatments were done over what period of time. I don’t need to know the points used. I will be happy to respond with my thoughts and suggestions.

Matthew Bauer

Thank you for your time & expertise Matthew!

I began treating a 68 yr old retired patient with “idiopathic neuropathy” on

12/ 28/12. He has had 6 treatments to date and is scheduled for the 7th treatment 1/26/13. He describes his symptoms as “discomfort in the soles of both feet” mostly while walking and standing. More disruptive is a feeling like his left foot (ball area) “is asleep” or “tingling, like pins and needles.” Symptoms began August 2012. After the 2nd treatment he said “both balls had a decrease in discomfort”- Intensity 6/10 initially, down to a 4/10 after treatment. Again, after the 3rd treatment Jan. 9th 2013 same reaction: “slight improvement.”

At this point and for the 4th, 5th, & 6th treatments I changed my point prescription (out of comfort for the patient) and also began focusing on the patient’s anxiety. The patient is very skeptical at this point and says “all he thinks about is the pain.” He is wondering if anything at all is happening to show improvement. I have been clear from the beginning that this type of condition may take a series of treatments. I described 1 series of treatments in this case as 6 treatments  “twice a week for 3 weeks.” I believe there have been small noticeable changes, especially right after treatment, however it is difficult for the patient to see this improvement. I am struggling to keep this patient coming in for treatment. Thank you for laying out the fundamentals in regards to communicating a realistic treatment protocol for the patient. I may need to communicate this better with the patient. In addition, I like your 4 point marker system when questioning the pain/discomfort levels: 1) intensity 2) frequency, 3) stress capacity (in other words, what sets off the pain), and 4) rebound capacity. I have chosen not to use herbs at this point for the patient, mostly because he is currently on high doses of medications for anxiety, depression and for the Neuropathy.

Very helpful discussion so far. I so appreciate your further comments. Thank you ~ Maureen 

Maureen Hartker

Maureen Hartker

All makes sense and thank you for your prompt response.

I will keep you posted.

You are welcome and please do give an update. I hope to give some more information on needle sensation and neuropathy within the next few days. 

Matthew Bauer

 thank you ~

Maureen Hartker

Hi Mo  – I remember you saying this patient was sensitive to needles so yes, it is best to use smaller gauge needles but whatever gauge you use try to monitor if he has less than normal sensation to those needles in the lower extremity points. If not, if they react within the same range as points farther up the leg, it means it is not so serious a case. If you can please let me know – is his main issue numbness or pain? The more details I have about the specific symptoms the better advice I can give.

And just a word about needle sensitivity  – Of course everyone has their own range of needle sensitivity. Those more sensitive should have smaller gauge needles and more mild needle stimulation while those insensitive need either larger gauge needles and/or stronger stimulation. We are trying to send signals with these needles within the patient’s self-monitoring system so more sensitive systems do better with softer stimulation and less sensitive ones need stronger. If they feel anything at all – the signal is getting through so no need to make that signal stronger.  

Matthew Bauer

I see a number of people using classical acupuncture for neuropathy. I treat a number of cases with good success however the neuropathy comes back usually after a week or so due to the same reason it started in the first place qi blood deficiency ect. I use a concept of energetic leverage. The farther away from the problem the more power you have to move the qi. I use all hand points for neuropathy on the feet and vice versa. I use small thin needles and this allows for comfort. I have tried feet and hand points and find by far the hand points work better for numbness of the feet. I think you will find also for foot pain this also works better. There was a recent study i read using P7 for heal pain and found it to be significantly better than local points.  I will share another secret yinlingchuan and yanglingchuan opposite side strong stimulation for any shoulder pain. Enjoy that magic bullet.

R.Ac.

Thanks so much for your post and clinical pearls. There are so many different ways to apply acupuncture because it is a true art. One thing I have observed is that if you are able to make chronic pain subside quickly, there is a good chance it will come back quickly. If you take a longer time and gradually wear the pain (or other symptoms) down, the symptoms will tend to stay down longer. As you said, chronic Blood and qi deficiency cannot be turned off quickly even if you can shut the pain down quickly by using certain techniques. That is why I said in my book that it is a good idea to learn those techniques that get quick results but it is also good to learn how to get your patients to keep working with you over a longer period so that you can get to a deeper level where the results last longer.    

Matthew Bauer

Matthew Bauer

I received the posting below (and my reply) on the thread “I Could Use Help On..” and directed the poster to this thread. I will one day try to group all these posting into categories but for now please try to look through the several pages of posting to see if there may be a thread on the topic you are interested in. 

“Have you had any luck with neuropathy?  I’ve got a new client next week who has tingling only in hands and feet.  It started 6 years ago after a bad cold.  He said he’s had several consults with neurologists and the only thing they could come up with is that the virus may have settled in nerve endings and may or may not get better with time.  I’ve never had very good luck with neuropathy–I’ve already told him in my experience it can be very stubborn and take a long time to see results, but he would like to try.  Any ideas?  Thanks so much.

In other news, I’m billing my first insurance client this week!

Leah Olson www.wholefamilyacupuncture.com “Example is not the main thing in influencing others. It is the only thing.” –Albert Schweitzer”

Hi Leah  – good luck on your insurance patient. Let me know if you have any question on that. As for neuropathy, there is a thread on that subject in these Forums. I am putting your posting there so it should now show up on the first page. There are several pages of posting here now and I have yet to organize them into specific topics so I know it can be hard to search all of them. Anyway – please read of those posts and let me know if you have any more questions. I will say that for the hands, I like to use the points LI3,4,11 TH4,5 and SI3. As a general rule, if the patient has numbness evenly across all finger and toes, it will be harder to treat then if focused on certain digits. 

Matthew Bauer

Update:  I had the first appointment with this patient.  40 year old male who appears to be in good health otherwise, not on any medications.  The tingling in his feet started after a sinus infection, then started in his hands.  It is just tingling–no numbness, weakness or pain.  As I said before, the neurologist thought it was perhaps the result of a virus, and that his symptoms may or may not get better on their own.  Interestingly, he had a strep infection in his low back at age 23 that almost went septic.  He was in the hospital for three weeks on antibiotics.  Since the tingling started in his hands and feet he feels more fatigued.  He also had a surprisingly nasty tongue.  It was red, very cracked and had a peeled coat.  I’ve only ever seen a tongue that bad in a textbook.  I’ll let you know how things progress.

Leah Olson www.wholefamilyacupuncture.com “Example is not the main thing in influencing others. It is the only thing.” –Albert Schweitzer

Thanks for the update. Since these symptoms started after a sinus infection, I was wondering if he was put on antibiotics for that because the tingling could have been a side effect even though it does not really matter as far as the treatment goes. The tongue you describe is a sign of a system that has been fighting internal distress causing a lot of heat. Even though he is in general good health, that is a sign that his system has been quite stressed. Please keep the updates coming and best success with this patient.

Matthew Bauer