Hello, and welcome back. So now we're going to take a look at the pathophysiology of chemo induced and diabetic induced peripheral neuropathy. So therefore, you can start to get an understanding of the causative factor and the mechanism behind the onset of peripheral neuropathy. So as we've seen before, the main common cause is diabetic and chemo induced, and they're going to be the more common cases that you're actually going to see presenting in your clinical setting. So the main aim is to introduce you to the pathophysiology of peripheral neuropathy, and by the end of presentation you'll have an understanding of the cause of chemo induced and diabetic induced peripheral neuropathy. So if we start off by taking a look at chemo induced peripheral neuropathy effects of chemo induced is mainly effects The nervous system.

And this is primarily going to depend on the drugs and the medication in which the individual is actually taken. It's mainly classified as a axonal or a sensory or motor neuropathy. And again, it can affect the central as well as the peripheral nerves which can lead to nerve damage through neural toxicity. So, the key thing is there is a multitude of factors that may will lead to the induction of chemo induced peripheral neuropathy. And when it key areas it's going to start to affect is the macro, macro tubal disruption, oxidative stress. Now oxidative stress is going to affect both diabetic as well as chemo induced so And will it mean cells that actually affect is the mitochondrial cells.

And once you start to get much control cell damage, then that's going to have a knock on because that is Generally the powerhouse of all cells within the body. And particularly once you start to look at things such as schwann cells, particularly which tends to regenerate the metallic sheath, once they start become damaged, then the rebound ation of the nerve cells or the nerves itself will start to be affected, and therefore nerve conductivity will then start to be affected as well. So, that's one of the key areas that starts to get affected both in diabetic and within chemo induced peripheral neuropathy. There is alterations in our internal activity. As we were saying about the myelin sheath damage, man sheath damage can be brought about by inflammatory reaction, that then will start to have a direct effect on the myelin sheath DNA damage and same again immunological process through the actual inflammation because obviously you're going to have certain cells within the function process, which is going to cause quite a bit of disk destruction.

Now, key thing is, as we say, it depends on the amount of drugs and the quantity of drugs that's actually been taken. There is damage control cells through an increased production of free radicals, and otherwise reactive oxygen species. So that's one of the key areas that's actually going to take place. So particularly once you start looking at the buildup of that within mitochondrial cells, it turn reduces the capacity of the mitochondria cells then to function and regenerate energy. So once that starts took place, then that's gonna start to reduce the function or other cells within that area. It causes deamination and impairment of nerve conduction, as we've seen beforehand, and it cause activation of the immune process and once you start to get your pro inflammatory cytokines means that starts to present themselves now.

They may well To prevent themselves from the activation of glial cells, now, glial cells will then activate the whole inflammatory process. And particularly, it's more your immune response. And those cells that's actually going to be activated then or you call your tumor necrotic, factor A, interleukin six, and also including bt cells. Once these are actually floating around in around the nerves, and in around the actual general area, what this will actually start to do is to sensitize the area. And that's where you're going to start to get your neuropathic pain, it will start to activate certain areas of the brain where signals will actually go back to areas of the brain such as this somato sensory cortex, and that will start to initiate pain and discomfort. If it's there for any length of time, then what you're going to start to get is not just peripheral sensitization, but also central sensitization.

So as we're saying again, it will affect the peripheral nerve. The spinal nerve, and also the super spinal nerve, such as the periaqueductal gray. Now, the key thing about the periaqueductal gray is that controls descending pain pathways. So it's your brain able to eliminate pain at different levels of the actual spinal cord. So if that's affected, then it compromises your body's ability to reduce pay at certain levels of the actual spinal cord. So segmental II, it compromises its ability.

But however, if you start to look at acupuncture, acupuncture have a strong effect on the prerequisite gray, merely food Hopper, thalamus pituitary axis. So that's how it's going to have its effect releasing endorphins from that system, which then has an effect on the periaqueductal gray. So once these areas are actually being affected, then again, you're going to get inflammatory process causing neuropathic pain with reduce your body's Reduce ability to actually deal with that particular pain. If we start to look at diabetic induced peripheral neuropathy very similar to chemo, as we've seen before diabetic comes on much quicker than what chemo therapy will actually induce. Now, as we say it fit, it affects more than one nerves it affects all the motor, sensory and the autonomic. So therefore it's more of a polyneuropathy.

The pain intensity doesn't necessarily mean that if you've got retinopathy or any other areas, such as the kidneys that's been affected doesn't necessarily mean that your painful peripheral is going to be any worse than some other diabetic that doesn't have those particular condition. So the pain intensity is isn't down to the extent in which you've got diabetes or peripheral neuropathy in itself. The pathogenesis is primary cause of toxic through hypervisor glycaemia, which leads to complications a range of complications where it affects the blood to the peripheral nerves, glial cells activation similar to that that's actually occurred once you start to look at chemo induced peripheral neuropathy, which then caused inflammation to the nerves, changes in sodium channels. And also you've got a central pain mechanism. Again, effect in descending pain pathways. In other words, it starts to affect the peripheral good aqueduct, great.

Similar to chemo induced, so slightly different mechanism. The other key difference here is this one's hyperglycemia induced whereas the other one is neurotoxic due to the medication in which the individual is actually taken. So you've got age are better known as advanced glycation end product or alternative age can Cause release of pro inflammatory cytokines gene and free free radicals again, gonna affect both the mitochondrial cells and also directly affect the nerve food inflammation. So, again, these can lead to more complications such as retinopathy nephrotic, with the neuropathy and cardio myopathy, so again affecting different organs within the body. As we learn about oxidative stress, the key thing to bear in mind, you can liken that to an athlete such as a sprinter who will run over 100 meters, the match control cells got to work that much harder, that much quicker. And then what you basically start to find with the mat control cells is because it cannot convert glucose into energy quick enough.

So now you start to get free radicals and oxidative stress starts to take place in bombards the match Qandil cells, which then starts to be disrupted, breaks down and down. can also cause damage to the surrounding muscles. And therefore what you start to get now as the athlete starts to tie up, cannot go any further, mainly because there's no further energy being produced. Same thing is actually happening here but on a different scale, and in a different method mainly through the buildup. So where you're going to find with regards to an athlete is going to get a buildup of hydrogen ions, which is going to start to cause oxidative stress. In this case, what you're basically getting here is a buildup of either toxins within the area, whether it's glucose buildup from hyperglycemia, and that's going to cause cause the oxidative stress on the mitochondrial cells are the key things seem to the athlete.

Key amino acids glucose along is actually released. The body is unnatural amino acid that's actually released by the body is produced by the body and released by the body and that reduces oxidative stress. Same way in which it's going to do in an athlete, whether it's running 100 meters, 400 meters, that will actually start to be released in large amount. In order to reduce the oxidative stress however, we're going to get in somebody who's got chemo or hyperglycemia, larger amounts is going to really be released until it becomes depleted. Once that becomes depleted, then there's less control of the buildup of free radicals within the mitochondrial cells. And therefore they start to become damaged, and an overtime period, generally mitochondrial cells on function, and that's what's going to call it stopped causing a weakness within the actual muscle itself.

So the mathcad your cells are very, very, very important. And a function of those is important. If you look at schwann cells, they have a lot of much congeal cells within them. And the schwann cells are important in order to be able to reproduce the myelin sheath that gets damaged from the inflammation. On the peripheral nerves, so that's going to be quite important. Otherwise it can't produce ATP and convert that into energy.

And therefore, the whole system is going to be actually compromised. So as we were saying beforehand, the importance of the schwann cells, if you've got your max potential cells being broken down in there, they become licensed. And then you've also got damage to the schwann cells through oxidative stress, then that is going to start to cause an inflammatory reaction on the nerves, and also a reduction in the actual remail nation of actual nerves. And then, therefore, that's going to lead to reduce nerve conductivity, what you've got your DML nation as we've seen beforehand, so that's going to be quite important to monitor that. The key thing is once you start to look at the the acupuncture points that's actually uses two key acupuncture points that's actually utilized and it just so happens that these two key acupuncture points You throughout the majority of studies that I've actually reviewed with regards to preparing these presentations, and what you mainly find these important things about these two particular points, is they have a direct effect on the mitochondrial cells and reduces oxidative stress has a direct direct effect on the inflammatory process.

So at least what you're basically doing here is not just purely targeting pain, you can actually target more so you're going to target the actual underlying causes, and help to improve the schwann cells, improve nerve conductivity and also improve nerve function. And what we're basically looking at next is these particular points as to how they actually achieve that goal. So thank you for listening. I look forward to seeing all the next presentations. If you do have any questions, as I said beforehand, by all means, post them into the discussion discussion. I'll either answer them Question otherwise, hopefully it's your other colleagues that may well be knowledgeable in that area and we'll answer it, at least if anybody else come along with the same question.

If they're looking at this question, then they will have the answer and see all the people having to keep answering the same question. If you don't want to get in touch with me directly, then by all means, do so you can get to me on info at Steve Bailey acupuncture calm. Look forward to seeing you again.