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Naalden, PENS en neuropathie

Met naalden de huid doorboren bij neuropathie wordt steeds meer 'mainstream'. Alleen het heet niet altijd meer acupunctuur... Waarom? Omdat artikelen met acupunctuur in de titel moeilijker gepubliceerd worden. Er zijn andere termen die ingezet worden, zoals "percutanious nerve stimulation", "high frequency muscle stimulation". En er ontstaat ook steeds meer inzicht in het mechanisme van acupunctuur bij neuropathie. Een voorbeeld:

Het boeiende van de percutane electrische stimulatie op de naald is, dat er steeds meer wetenschappelijk bewijs ontstaat dat deze methode van behandelen effecten heeft op de zenuwen en zelfs op de hersenen. [1] Ook fysiologen ontdekken deze behandelmethode. [2]. Wij werken al een aantal jaren hiermee en bij de patienten verhalen hoort u hoe het onze patienten bevalt!

PENS en diabetische neuropathie

Een boeiend onderzoek laat zien dat de klachten verbeteren na het stimuleren met PENS bij diabetische patienten met neuropathie.[3]

In het American Journal of Psychiatry een regulier tijdschrift, een boeiend artikel over acupunctuur en neuropathie. De auteurs wijzen op het feit dat een deel van de werking van acupunctuur bij pijn berust op het activeren van serotonerge zenuwen. Zij postuleren daarom dat acupunctuur samen met een serotonerg middel, zoals nefazodone, goede effecten zouden kunnen hebben. Uit de gevallen die ze beschrijven lijkt dat inderdaad waarschijnlijk. We geven het artikel in zijn geheel weer (Am J Psychiatry 157:1342-1343, August 2000):

    Acupuncture and neuropathy

    PAUL J. GOODNICK, M.D., KAREN BREAKSTONE, M.D., XUE/LAN WEN, M.D., and ADARSH KUMAR, PH.D.

    Acupuncture, initially developed in Chinese medicine in the fifth century B.C., has been increasingly applied to the alleviation of pain, particularly in the presence of cancer (12). Serotonergic pathways have been implicated in pain relief, and they have been useful in relieving discomfort in both fibromyalgia and neuropathy (34). Thus, it was hypothesized that acupuncture might work synergistically with serotonergic therapy for pain relief in neuropathy. Here, three cases show the possible synergism of serotonin (5-HT) effects induced by nefazodone with acupuncture. Each patient underwent six acupuncture treatments, two at each visit. Baseline platelet 5-HT content was measured once at baseline,once after 8 weeks, and three times during the acupuncture series. The patients were not specifically followed beyond the course of the acupuncture treatments.

     

    Mr. A was a 57-year-old man who improved somewhat after treatment with 450 mg/day of nefazodone over 8 weeks for diabetic neuropathy. He obtained substantial further benefit with the addition of acupuncture: his self-ratings of pain, paresthesia, and numbness all fell from 50 to 5 on a visual analog scale. Physician ratings for paresthesia fell from 1.5 to 0; ratings for numbness decreased from 1.5 to 0.5. His baseline platelet 5-HT content was 40.1 ng/108 platelets and increased to 73.7 by the end of 8 weeks of nefazodone treatment. During acupuncture treatment, it continued to rise to 95.1 and 102.4 before falling to 49.8 some time after completion of the series. 

    Mr. B was a 56-year-old man who also improved somewhat after treatment with 450 mg/day of nefazodone over 8 weeks for diabetic neuropathy. The addition of acupuncture to his nefazodone treatment produced additional improvement. His visual analog scale rating for pain fell from 55 to 25, and his rating for paresthesia fell from 80 to 55. Physician ratings for pain fell from 1.5 to 0.5, and ratings for paresthesia fell from 1.5 to 1.0. Mr. B’s baseline platelet 5-HT content was 44.7 and rose only to 47.6 during his initial nefazodone treatment. It increased to 110.9 and 124.4 when acupuncture treatment was added but fell to 51.0 after treatment. 

    Mr. C was a 61-year-old man who obtained minimal benefit from an initial course of nefazodone at a dose of 450 mg/day for diabetic neuropathy. During his acupuncture treatment, he obtained little added benefit. His visual analog scale ratings decreased only from 60 to 50 for pain, paresthesia, and numbness. Physician ratings for pain and paresthesia fell only from 1.5 to 1.0. Mr. C’s change in platelet 5-HT content was completely different from those of Mr. A and Mr. B. His baseline platelet 5-HT content was 28.3, at the end of the first 8 weeks of treatment it was 12.3, and during acupuncture treatment it was 11.9, 10.6, and 12.6.

     

    Thus, two of the three patients showed increased benefit when a series of six acupuncture sessions was added to ongoing nefazodone therapy for the treatment of diabetic neuropathy. It was reported during a follow-up telephone conversation that acupuncture benefits for the first two patients lasted at least an additional 6 months. The maximum benefit was shown by the individual who showed a platelet 5-HT content pattern of gradual increases, intermediate benefit was obtained by the individual whose platelet 5-HT content increased only during acupuncture treatment, and the least benefit was received by the individual whose platelet 5-HT content remained low during treatment. This effect may have significant implications for the effect of nefazodone on postsynaptic 5-HT receptors in alleviating pain, in conjunction with serotonin’s facilitatory role in acupuncture analgesia (5). More study is required in this area.

    Elektroacupunctuur werkt misschien beter 

    Deze beschrijvingen zijn boeiend. De laatste jaren komen er vanuit de wetenschap meer aanwijzingen dat acupunctuur, neuro-acupunctuur en elektroacupunctuur bij neuropatische stoornissen kan helpen. Zo werd er in 2008 ook een studie afgerond, waarbij het stimuleren met electriciteit bij diabetische neuropathie tot vermindering van de symptomen leidt. [4] Deze hoge tonus stimulatie is verwant met de zogenaamde Han stimulatie van de elektroacupunctuur, ook daar reageren de spieren met een hoge tonus.[5] De auteurs meenden:

    Among various forms of electrostimulation, high-tone external muscle stimulation (HTEMS) is a promising alternative treatment for symptomatic diabetic peripheral polyneuropathy (PPN), as demonstrated in a short-term study. 

    Bronnen

    1. Hsu DT: Acupuncture: a review. Reg Anesth 1996; 21:361–370[Medline]
    2. Urba SG: Nonpharmacologic pain management in terminal care.  Clin Geriatr Med 1996; 12:301–311[Medline]
    3. Jorge CM, Goodnick PJ: Chronic fatigue syndrome and depression: biological differentiation and treatment. Psychiatr Ann 1997; 27:365–371
    4. Goodnick PJ, Jimenez I, Kumar A: Sertraline in diabetic neuropathy: preliminary results. Ann Clin Psychiatry 1997; 9:255–257[CrossRef][Medline]
    5. Han JS, Tang J, Ren MF, Zhou ZF, Fan SG, Qiu XC: Central neurotransmitters and acupuncture analgesia. Am J Chin Med 1980; 8:331–348

Referentie

[1] Finazzi-Agr├▓ E, Rocchi C, Pachatz C, Petta F, Spera E, Mori F, Sciobica F, Marfia GA. | Percutaneous tibial nerve stimulation produces effects on brain activity: study on the modifications of the long latency somatosensory evoked potentials. | Neurourol Urodyn. | 2009;28(4):320-4.

[2] Powers RK. | "Extra" force evoked by percutaneous muscle stimulation: mechanisms and potential therapeutic applications. | J Appl Physiol. | 2009 Feb;106(2):353-5. Epub 2008 Dec 4.

[3] Hamza MA, White PF, Craig WF, Ghoname ES, Ahmed HE, Proctor TJ, Noe CE, Vakharia AS, Gajraj N. | Percutaneous electrical nerve stimulation: a novel analgesic therapy for diabetic neuropathic pain. | Diabetes Care. | 2000 Mar;23(3):365-70.

[4] Klassen A, Di Iorio B, Guastaferro P, Bahner U, Heidland A, De Santo N. | High-tone external muscle stimulation in end-stage renal disease: effects on symptomatic diabetic and uremic peripheral neuropathy. | J Ren Nutr. | 2008 Jan;18(1):46-51.

[5] Reichstein L, Labrenz S, Ziegler D, Martin S. | Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation. | Diabetologia. | 2005 May;48(5):824-8. Epub 2005 Apr 14.

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