So now we're going to start to take a look at the treatment and how we can utilize acupuncture to actually treat the peripheral neuropathy. key thing is, what men are going to look at is more evidence based treatment. So the main aim of today is to provide an evidence based understanding of the use of acupuncture for the management of painful peripheral Muffy brown in this session, you'll have evidence based on the standing of the use of acupuncture in the management of painful peripheral neuropathy. I mean, which is something I use quite frequently with regard to that. But however, if you start to look at the your first line treatment with regards to the management of this condition, in most cases, if somebody was to go to the GP, the first thing they would actually prescribe a medication to medication has been classified as the first line treatment with regard to that, but however, With the overall evidence to support the medication, you know, we've gone through a few of the medications, some of them is coming out with fair reports, but however some of them is coming out with not so good reports with regards to the use of the actual medication.

The key thing is, in most severe cases, they're actually treated with more opioid treatment approaches actually limited and it does have a number of side effects. The evidence for the use of gabapentin, again, is fair, there is some evidence to support the use of it. But however, once you start to look at medications such as amitriptyline, which is prescribed quite frequently, there's a lack of evidence to actually support the use of amitriptyline. I mean, overall, it has been suggested that there may be significant benefits for the medication but therefore, if it's actually prescribed in high dosage, the biggest problem that actually comes with that is the severe side effects. Many patients is going to stop taking the actual medication itself. So therefore, it does have its limitations as to you know how well they will actually benefit the actual patient.

Now this is caused many patients who may well be suffering from peripheral neuropathy, particularly painful peripheral neuropathy to turn to alternative medicine. Now, key studies have actually been taken to try and assess the number of patients that's actually taking complimentary medicine, particularly when they have peripheral neuropathy, when it main ones with this particular study where the assess 180 patients 43% of those presented that they'd actually I should say the reported that they're actually taking complementary medicine. Now, this range from Mega vitamins, which will be mainly your B vitamins that I've actually taken high dosage of that. Magnets have actually should be used. Acupuncture has actually been using a good third of that population. And herbal medicine has actually also been used.

Some of them will be taken a combination of war than one, alternative medicine in as opposed to taking more your mainline medication from the GP. Now, however, across Europe, a larger study was actually done consistent or 342 subjects 35% of those had actually been utilizing complementary or alternative medicine. However, only 3% once I'd actually been diagnosed with cancer continued or was using complementary or alternative medicine, mainly acupuncture. I mean it within that particular study, it did show that there was a high percentage prior to them being diagnosed with cancer, but once it actually been diagnosed with cancer, that percentage reduced to only 3%. Now Let's start to take a look at the use of acupuncture. What are some of the main points that's actually going to be utilized with regard to the management of peripheral neuropathy?

Now, you will find throughout these studies and particularly through the review in which I've done myself, there's two key points that does stand out. And there's a good reason for that, which we'll cover more in our next presentation. But for now, this study mainly looked or should I say this review mean looked at nine papers, randomized controlled trials, and this was mainly focused on chemo induced peripheral neuropathy. Overall out of these nine studies, overall, it was presented that acupuncture had a positive effect in regards to the management of painful peripheral neuropathy. Now a larger study was actually undertaken, mainly looking at painful peripheral neuropathy in diabetics, and overall what the basic found out of 450 Input spent a significant improvement was actually noted in neuropathic pain. And that was throughout all the studies.

What we also found was points selection retention time. And also number of treatment sessions that varied and you're gonna find generally that does tend to vary, I found overall, once you start to look at systematic reviews and a key things that they do tend to report is on the methodology. And I have found when I undertook a systematic review, eight, nine years ago, and I'm looking at doing reviews and systematic reviews, currently now, the standards have actually improved. more so in the academic intervention, once you start to look at the outcome into intervention, what you mainly find is in China, or other countries, the academic intervention is more focused on whereas the methodology of the study doesn't don't tend to pay as much attention whereas now in those countries, the methodology has improved significantly, so they are scoring higher on the methodology. However, here in the Western world is the other way around, the focus is on the methodology.

Let's focus on the acupuncture intervention. If the economic intervention isn't correct, then you are going to get treatment failure but we look more closely at that as to what point selection and methods have actually been used. So again, you will find in many systematic reviews, once they come to summarize or conclude that's going to be one of the key things to go into actually Paul is on the methodology is that major sister these words have more of poor methodological quality. So that is something that does need to be addressed throughout is choosing the appropriate points and also making sure that they are meeting the appropriate standard for the methodology. Now, the main thing is the most important and most common points that was chosen Is stomach 36 and spleen six. Now once you start to understand the physiology and how these two points function, then you can start to understand why they may well be the most common points.

Actually, that was chosen throughout these studies is a group that has actually undertaken two studies in one was done in 120 17. The other one is done in 2018. But we'll come across the other one in a short while now. In the first review, you undertook assessing 15 studies in total that was assessing the effect of acupuncture. The main conditions that there was actually looking at was diabetic peripheral neuropathy, carpal tunnel syndrome, Bell's palsy, HIV, and also idiopathic conditions. While the basic found overall that there was a significant improvement from those subjects in comparison to the control group that was treated with the acupuncture mainly the diabetic Bell's palsy and carpal tunnel now, merely because of the difference methods in assessment, they could only pull the data of the bell palsy and a diabetic peripheral together.

Once that data has actually been pulled and meta analysis was actually taken, or they basically found it that acupuncture, it was indicated that acupuncture was more beneficial than a control in the management of the symptoms of peripheral neuropathy. So overall, that's basically showing a good positive outcome. The second slide again, what the basic found was a positive outcome but however, when a key things that was noted in the second study was that the acupuncture points are found close to nerve trunks of the upper and lower extremities. Now, if you're any of any of you who has got my first book on acupuncture, you will find in there it does outline the location And the proximity of acupuncture points, and you will find it will outline the fact that acupuncture points are found quite close to blood vessels and nerve trunk. So therefore, it stated that acupuncture has part of its effect through the nervous system, whether it's a central or peripheral nervous system and that is correct.

But however, it also has an effect its effect through other mechanisms such as the endocrine system and also allowing the body to release certain amino acids into the circulation. So it will have effect in different manners but part of it yes is through the nervous system. But however, it does have other methods of having its effect. Other key areas is once we start to look at the style, the style of acupuncture such as you Japanese, now, Japanese is quite extensively used. Now the key thing about Japanese style acupuncture is that it's very shallow needling. Now that doesn't need to be understood by many practitioners because if you look again at many studies, Japanese style acupuncture is what they're actually utilizing a sham acupuncture.

So I'm assuming that many of these practitioners is not aware of Japanese style acupuncture, there are other style of acupuncture that use shallow needling. But Japanese is most common style that use very shallow needling. Most cases, when they actually needle they barely break the skin and mainly because they're trying to get a very pain free style of actual needling, whereas TCM, normally you needle in that much deeper and that's normally classified as standard acupuncture where shallow needling is normally classified as sham acupuncture but as you can actually see from the finding from these studies, is the fact that Japanese style or shallow needling is more effective at reducing the Pain. However, you TCM style acupuncture is more effective at improving nerve conductivity. So if we stick look at nerve conductivity, nerve conductivity is quite an important effect of acupuncture if acupuncture will affect in many different ways pain, reduction of pain being one of them, nerve conductivity being the other.

And that's quite important. And several studies have demonstrated the effect of acupuncture improving nerve conductivity, particularly from a pedometer viewpoint, when it made things that we tend to do is to look at an assessment of vibration using the tuning fork. We also look at hit hot, cold perception and also determine we've got numbness or using the monofilament. So there are key things that we do use with regards to doing a particularly a neurological assessment on the foot. And what you basically find is acupuncture has been shown to improve all these key features So therefore, you can start to see how acupuncture is more beneficial than taking the medication by itself. But the other thing to bear in mind within those is the main points and the most common points again was stomach 36 and spleen six that was used within those studies.

So, thank you for listening. If you've got any questions at all, then by all means, post it into the discussion, or you can get back to me on info at Steve Bailey acupuncture calm