Information for Healthcare Providers

Overview

Understanding peripheral neuropathy

Peripheral neuropathy encompasses diverse conditions stemming from nerve damage in the arms, legs, hands, and feet. Etiology is multifaceted, encompassing:

• Diabetic neuropathy – the most common cause, resulting from high blood sugar damaging nerve fibres.
• Chemotherapy induced peripheral neuropathy (CIPN) 
• Toxic exposure to heavy metals or certain medications can induce nerve damage.
• Alcoholic neuropathy is associated with chronic alcohol abuse, leading to nutritional deficiencies and nerve damage.
• Autoimmune diseases such as lupus and rheumatoid arthritis can trigger inflammation, damaging nerves.
• Vitamin deficiencies in B vitamins (B1, B6, B12) can impair nerve function.
• Genetic disorders such as Charcot-Marie-Tooth disease cause progressive nerve degeneration.
• Physical trauma to nerves can result in direct nerve damage.

Clinical presentation

Symptoms vary widely, depending on the type and severity of neuropathy. Sensory symptoms include paraesthesia, burning sensations, sharp/stabbing pain, increased sensitivity to touch (allodynia), loss of sensation. Motor symptoms include muscle weakness, atrophy, cramps, foot drop, impaired coordination and gait. Autonomic symptoms include changes in blood pressure, heart rate, sweating, digestive issues (constipation or diarrhoea), bladder dysfunction.

Diagnosis

Diagnosis relies on a thorough history, physical examination, and neurological tests.

• Detailed medical history – focus on symptoms, risk factors, and any co-morbidities.
• Physical examination to assess reflexes, muscle strength, sensation, and coordination.
• Electrodiagnostic studies (EDS), including nerve conduction studies (NCS) and electromyography (EMG) are crucial for identifying nerve damage and its location.
• Blood tests to assess blood sugar, vitamin levels, and markers of autoimmune diseases.
• Imaging studies such as MRI or CT scans may be used to rule out other conditions.

Management of peripheral neuropathy

Management strategies are tailored to the underlying cause and symptoms. Involving acupuncturists in the treatment plan at an early stage can significantly enhance patient wellbeing while reducing the burden on other health care professionals.

• Addressing underlying causes – strict blood sugar control in diabetics, alcohol cessation, vitamin supplementation, treatment of autoimmune diseases.
• Pain management – medications such as gabapentin, pregabalin, tricyclic antidepressants, and opioids (used cautiously) are often prescribed. A less risky and often more effective approach uses acupuncture from trained professional acupuncturists. (see research tab for lastest studies)
• Physiotherapy exercises to improve strength, range of motion, and coordination.
• Occupational therapy using adaptive techniques to enhance daily living activities.
• Supportive measures such as proper footwear to prevent injuries, avoiding excessive heat or cold, regular foot care.
• Monitoring and evaluation – acupuncturists will regularly monitor patient progress, assessing pain levels, functional capacity, and overall well-being. They can adjust the treatment plan as needed based on patient response.

Acupuncturists supporting patient education and wellbeing

Patient education is paramount. Acupuncturists will be seeing the patients twice weekly at first and they can assist by educating patients about the nature of their condition and its potential causes, the importance of managing risk factors (eg blood sugar control), and self-management strategies, such as regular foot care and exercise.

Evidence-based acupuncture treats peripheral neuropathy

Patients’ first experience of acupuncture is often surprisingly relaxing and pleasant. Small, single-use needles are inserted into the skin on acupuncture points that are closely related to nerve pathways (known as neuro-vascular nodes or bundles) to regulate nerve activity, stimulate blood flow, and help regenerate nerves. Patients feel comfortable and they often report improved overall wellbeing.

Many high-quality studies have demonstrated the safety and effectiveness of professional acupuncture treatments in improving around 75% of peripheral neuropathy cases. For more information, visit acunow.org. The acupuncturists in the Christchurch Peripheral Neuropathy Initiative have all been expertly trained by Matthew Bauer and/or by Dr Poney Chiang.

There have been several studies showing the effectiveness of acupuncture for peripheral neuropathy due to all causes. For more information and links to these studies, visit “lastest research” our website www.neuropathy.nz.

Cost

This is not a free service. Patients are encouraged to check with the treatment providers regarding their fees.

Enquiries are welcomed from patients regarding seeking WINZ support and how to ask for ACC cover for chemotherapy-induced peripheral neuropathy (in these cases, they will be referred to their GPs).

For more information about cost and services offered please contact individual members of the Christchurch Peripheral Neuropathy Initiative: https://neuropathy.nz/index.php/acupuncture-and-peripheral-neuropathy/