Dry Needling to Treat Peripheral Neuropathy

Dry Needling to Treat Peripheral Neuropathy Through Targeted Sympathetic Depression, Parasympathetic Stimulation, & Autonomic Nervous System Homeostasis: A Peripheral Neuropathy Destroyer

Can you treat peripheral neuropathy with dry needling? This is a question I get asked a lot, the first one. Dry needling, especially when combined with joint manipulation, is a powerful tool to treat peripheral neuropathy. In Physical Therapy Land, it is the most powerful tool we have. I do not know of another treatment in all of medicine that works for 100% of patients. Unless they are not applicable to receive DN, which is rare.

Every living human has pathologic tissue in various areas of the body. This may be due to prior physical or mental stress, strain, trauma, etc. Especially in chronic conditions, much of the time, the initial insult resolves, is no longer present, however, secondary impairments remain and oftentimes continue to get worse. A lot of autoimmune disease begins like this, including chronic idiopathic peripheral neuropathic pain.

When treating peripheral neuropathy, I don’t treat it much different than anything else. If you think about it, any pain in the periphery involves the peripheral nerves. Really, any pain not in your organs or intestines or something like that, is a form of peripheral neuropathy. This holds true even if there is no obvious peripheral musculoskeletal pathology. Idiopathic peripheral neuropathy is typically secondary to central sensitization of the central nervous system. Fibromyalgia and reflex sympathetic dystrophy (RSD) are examples of chronic sympathetic hyperactivity of the CNS/ANS disrupting homeostasis and peripheral nerve function / sensitivity.

I think people really overcomplicate things in physical therapy. Why does chronic peripheral neuropathy occur? Well, it may be from a trapped nerve passing through muscle or other soft tissue; may be from a displaced joint pushing on a nerve or pushing a muscle into a nerve, smushing it against whatever; may be from lateral foraminal spinal stenosis; may be from a plethora of other physical pathology; or, there may not be an obvious mechanical causative factor. All of these are common. Regardless of the cause, the sympathetic stressors hanging out in tissue throughout the body must be removed and the sympathetic nervous system must be depressed. This allows the brain to heal the body and the body to heal the brain.

Remember: the overwhelming majority of PT patients, or anyone suffering from mental or physical stress, strain, trauma, etc., present with sympathetic autonomic hyperactivity. This is the natural response of the human body to these things. Evolutionarily speaking, our bodies have evolved to overreact to trauma. For most of human history, aside from the last little while, when we were injured, we did not have the convenience of being in, or going to, a safe place like a hospital, or simply being indoors, for that matter. When we were living in the wilderness, our bodies had to maximally react to hopefully stave off further acute damage or infection. The long-term was not nearly as significant back then. Dying in the next day, however, was. So, our bodies and brains adapted.

The thing is, for the most part, in 2022, we no longer need our bodies to react so strongly. We have cool stuff like antibiotics and anti-inflammatories to help out. And we are not worried about an animal eating us. Unless you work as a fly fishing guide in Alaska, like I did for a decade. Then you are potential bear food on an hourly basis. Anyway, our mind and body do, in fact, overreact. Jerks. The older we are or the worse health we are in, if our sympathetics react too strongly and start a negative feedback loop, it often gets out of control and the ANS cannot recover, without specific intervention. This leads to all sorts of nasty mental and physical impairments, including peripheral neuropathy.

Specifically targeting and stimulating parasympathetics, along with removing pathologic tissue and joint deviation throughout the body, which stimulate sympathetic activity and depress parasympathetics, are part of almost all my treatments. This happens to be the best way to reduce and treat peripheral neuropathy. It’s also a simple and effective general train of thought when treating most neuromusculoskeletal impairments. The fastest, most effective and lasting way to accomplish all this is with the thoughtful combination of dry needling and joint manipulation.

Here are 7 easy tricks to maximize the awesome autonomic homeostatic & neuroplastic healing effects of dry needling treatment:

• Use more needles rather than less to treat as much pathologic tissue as possible. The only problem with too many needles is if the patient becomes overly sympathetically stimulated, leading to a vasovagal response.

• Needle bilateral (I don’t treat the unaffected side as thoroughly).

• Leave the needles in for 20-30 minutes - this allows the ANS to go through the cycle of initial sympathetic autonomic elevation followed by sympathetic depression with concomitant parasympathetic elevation, resulting in parasympathetic dominance compared to baseline. This is key, since our patients present with sympathetic hyperactivity and dominance. More time with the needles in the body under parasympathetic dominance, to a point, increases treatment efficacy.

• Connect the spinal level (through the multifidus to the laminar periosteum) of the nerve root or roots innervating the distal area of pathology. This increases neuroplasticity.

• Connect the right spine to the left extremity and vice versa. I have not seen any research on this, but I believe it increases the neuroplastic effect of needling.

• Target the PANS with your first needles, then needle whatever else you are going to treat. This limits the amplitude and duration of the initial sympathetic autonomic spike, which, per research, lasts about 15 minutes, on average. Target the ear for the auricular branch of the vagus nerve (Concha, cymba concha, inside of the tragus), the sacral plexus periosteum (S2-S4), & the suboccipital / C2 spinous process periosteum. Connect these areas to each other with 1 Hz microcurrent. Also use this frequency between the other needles. 1-5 Hz is the best frequency to induce endogenous opioid, beta endorphin, release from the hypothalamic-pituitary-adrenal (HPA) axis. This helps reduce pain and depress sympathetic activity via numerous known and unknown mechanisms. I like 1Hz because it is the closest to the, we think, desired heart beat.

• Following needle treatment, manipulate any deviated joints to neutral. Joints don’t move themselves and they cannot move without moving muscles. Treating only one or the other is only addressing half the battle.

If you are someone dealing with neuropathy with results not to your liking, and you have not been treated with the combination of thoughtful dry needling and joint manipulation, you have not reached your full potential. Let me know if you have any questions about anything or if you are looking for a practitioner we have trained.

If you are a practitioner looking to learn these techniques or are looking to advance your current needling and manipulative skills, let us know. We teach 4 DN and 3 manipulation courses and offer 3 unique certifications.

Check out our website to learn more about our 3 unique certifications:
Intricate Art Certifications

Thanks for reading.

Jason

DISCLAIMER: The content on the blog for Intricate Art Spine & Body Solutions, LLC is for educational and informational purposes only, and is not intended as medical advice. The information contained in this blog should not be used to diagnose, treat or prevent any disease or health illness. Any reliance you place on such information is therefore strictly at your own risk. Please consult with your physician or other qualified healthcare professional before acting on any information presented here.

References

Peripheral Neuropathy

• Bubnov, R., Kalika, L. and Spivak, M., 2019. Dry needling of myofascial trigger points under ultrasound guidance reduce the symptoms of peripheral neuropathy. In EFIC Congress.
• Ali, M., Anwar, S., Perveen, W., Akhtar, M., Hashmi, R. and Jabeen, Z., Effects of neurodynamic exercises on the management of diabetic peripheral neuropathy of the upper limb: a case series. Physiotherapy Quarterly, 29(1).
• Zhao, J., Li, Y., Xin, L., Sun, M., Yu, C., Shi, G., Bao, T., Liu, J., Ni, Y., Lu, R. and Wu, Y., 2020. Clinical features and rules of Chinese herbal medicine in diabetic peripheral neuropathy patients. Evidence-Based Complementary and Alternative Medicine, 2020.
• Gao, N., Guo, Y. and Wang, W., 2021. Acupuncture for HIV-associated distal symmetric peripheral neuropathy: A protocol for systematic review and meta-analysis. Medicine, 100(10).
• Dimitrova, A., Murchison, C. and Oken, B., 2018. The case for local needling in successful randomized controlled trials of peripheral neuropathy: A follow-up systematic review. Medical acupuncture, 30(4), pp.179-191.
• Perreault, T., Fernández-de-Las-Peñas, C., Cummings, M. and Gendron, B.C., 2021. Needling interventions for sciatica: Choosing methods based on neuropathic pain mechanisms—A scoping review. Journal of Clinical Medicine, 10(10), p.2189.

Vagus Nerve Stimulation

• Butt, M.F., Albusoda, A., Farmer, A.D. and Aziz, Q., 2020. The anatomical basis for transcutaneous auricular vagus nerve stimulation. Journal of anatomy, 236(4), pp.588-611.
• Garner, B.K., Hopkinson, S.G., Ketz, A.K., Landis, C.A. and Trego, L.L., 2018. Auricular acupuncture for chronic pain and insomnia: a randomized clinical trial. Medical acupuncture, 30(5), pp.262-272.
• Jaić, K.K., Turković, T.M., Pešić, M., Djaković, I., Košec, V. and Košec, A., 2019. Auricular acupuncture as effective pain relief after episiotomy: a randomized controlled pilot study. Archives of gynecology and obstetrics, 300(5), pp.1295-1301
• Johnson, R.L. and Wilson, C.G., 2018. A review of vagus nerve stimulation as a therapeutic intervention. Journal of inflammation research, 11, p.203.
• Kang, H.R., Lee, Y.S., Kim, H.R., Kim, E.J., Kim, K.H., Kim, K.S., Jung, C.Y. and Lee, J.K., 2017. A clinical study of electroacupuncture and auricular acupuncture for abdominal pain relief in patients with pancreatitis: A pilot study. Korean Journal of Acupuncture, 34(1), pp.47-55.
• Moura, C.D.C., Chaves, E.D.C.L., Cardoso, A.C.L.R., Nogueira, D.A., Azevedo, C. and Chianca, T.C.M., 2019. Auricular acupuncture for chronic back pain in adults: a systematic review and metanalysis. Revista da Escola de Enfermagem da USP, 53.
• Sator-Katzenschlager, S.M., Szeles, J.C., Scharbert, G., Michalek-Sauberer, A., Kober, A., Heinze, G. and Kozek-Langenecker, S.A., 2003. Electrical stimulation of auricular acupuncture points is more effective than conventional manual auricular acupuncture in chronic cervical pain: a pilot study. Anesthesia & Analgesia, 97(5), pp.1469-1473.
• Shah, A.N., Moore, C.B. and Brigger, M.T., 2020. Auricular acupuncture for adult tonsillectomy. The Laryngoscope, 130(8), pp.1907-1912.
• Sprouse-Blum, A.S., Smith, G., Sugai, D. and Parsa, F.D., 2010. Understanding endorphins and their importance in pain management. Hawaii medical journal, 69(3), p.70.
• Taylor, S.L., Giannitrapani, K.F., Ackland, P.E., Thomas, E.R., Federman, D.G., Holliday, J.R., Olson, J., Kligler, B. and Zeliadt, S.B., 2021. The Implementation and Effectiveness of Battlefield Auricular Acupuncture for Pain. Pain Medicine.
• Tsai, S.L., Fox, L.M., Murakami, M. and Tsung, J.W., 2016. Auricular acupuncture in emergency department treatment of acute pain. Annals of emergency medicine, 68(5), pp.583-585.
• Usichenko, T.I., Dinse, M., Hermsen, M., Witstruck, T., Pavlovic, D. and Lehmann, C., 2005. Auricular acupuncture for pain relief after total hip arthroplasty–a randomized controlled study. Pain, 114(3), pp.320-327.
• Usichenko, T.I., Kuchling, S., Witstruck, T., Pavlovic, D., Zach, M., Hofer, A., Merk, H., Lehmann, C. and Wendt, M., 2007. Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial. Cmaj, 176(2), pp.179-183.
• Usichenko, T.I., Lehmann, C. and Ernst, E., 2008. Auricular acupuncture for postoperative pain control: a systematic review of randomised clinical trials. Anaesthesia, 63(12), pp.1343-1348.
• Yeh, C.H., Chiang, Y.C., Hoffman, S.L., Liang, Z., Klem, M.L., Tam, W.W., Chien, L.C. and Suen, L.K.P., 2014. Efficacy of auricular therapy for pain management: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2014.
• Prescott, S.L. and Liberles, S.D., 2022. Internal senses of the vagus nerve. Neuron.
• Badran, B.W., Brown, J.C., Dowdle, L.T., Mithoefer, O.J., LaBate, N.T., Coatsworth, J., DeVries, W.H., Austelle, C.W., McTeague, L.M., Yu, A. and Bikson, M., 2018. Tragus or cymba conchae? Investigating the anatomical foundation of transcutaneous auricular vagus nerve stimulation (taVNS). Brain stimulation, 11(4), p.947.
• Bonaz, B., Sinniger, V. and Pellissier, S., 2021. Therapeutic potential of vagus nerve stimulation for inflammatory bowel diseases. Frontiers in neuroscience, 15, p.300.
• Burger, A.M., D’Agostini, M., Verkuil, B. and Van Diest, I., 2020. Moving beyond belief: A narrative review of potential biomarkers for transcutaneous vagus nerve stimulation. Psychophysiology, 57(6), p.e13571.
• Ottaviani, M.M., Wright, L., Dawood, T. and Macefield, V.G., 2020. In vivo recordings from the human vagus nerve using ultrasound‐guided microneurography. The Journal of physiology, 598(17), pp.3569-3576.

Neural Plasticity

• Dommerholt, J., Mayoral del Moral, O. and Gröbli, C., 2006. Trigger point dry needling. Journal of Manual & Manipulative Therapy, 14(4), pp.70E-87E.
• Calvo, S., Navarro, J., Herrero, P., Del Moral, R., De Diego, C. and Marijuán, P.C., 2015. Electroencephalographic changes after application of dry needling [DNHS© technique] in two patients with chronic stroke. Myopain, 23(3-4), pp.112-117.
• Hsieh, Y.L., Yang, C.C., Liu, S.Y., Chou, L.W. and Hong, C.Z., 2014. Remote dose-dependent effects of dry needling at distant myofascial trigger spots of rabbit skeletal muscles on reduction of substance P levels of proximal muscle and spinal cords. BioMed Research International, 2014.
• Sollie, M., Pind, R., Madsen, C.B. and Sørensen, J.A., 2021. Acupuncture (superficial dry-needling) as a treatment for chronic postherpetic neuralgia–a randomized clinical trial. British Journal of Pain, p.20494637211023075.
• Ren, L., Zhang, W.A., Fang, N.Y. and Wang, J.X., 2008. The influence of electro-acupuncture on neural plasticity in acute cerebral infarction. Neurological research, 30(9), pp.985-989.
• Xiao, L.Y., Wang, X.R., Yang, Y., Yang, J.W., Cao, Y., Ma, S.M., Li, T.R. and Liu, C.Z., 2018. Applications of acupuncture therapy in modulating plasticity of central nervous system. Neuromodulation: Technology at the Neural Interface, 21(8), pp.762-776
• Lo, Y.L., Cui, S.L. and Fook-Chong, S., 2005. The effect of acupuncture on motor cortex excitability and plasticity. Neuroscience letters, 384(1-2), pp.145-149.
• Liu, C.Z., Kong, J. and Wang, K., 2017. Acupuncture therapies and neuroplasticity. Neural plasticity, 2017, p.6178505.
• Li, X. and Wang, Q., 2013. Acupuncture therapy for stroke patients. International review of neurobiology, 111, pp.159-179.
• Kong, J., Gollub, R., Huang, T., Polich, G., Napadow, V., Hui, K., Vangel, M., Rosen, B. and Kaptchuk, T.J., 2007. Acupuncture de qi, from qualitative history to quantitative measurement. The Journal of Alternative and Complementary Medicine, 13(10), pp.1059-1070.
• Lee, J.D., Chon, J.S., Jeong, H.K., Kim, H.J., Yun, M., Kim, D.Y., Kim, D.I., Park, C.I. and Yoo, H.S., 2003. The cerebrovascular response to traditional acupuncture after stroke. Neuroradiology, 45(11), pp.780-784.
• Yang, Y., Eisner, I., Chen, S., Wang, S., Zhang, F. and Wang, L., 2017. Neuroplasticity changes on human motor cortex induced by acupuncture therapy: a preliminary study. Neural plasticity, 2017.
• Jiang, H., Zhang, X., Wang, Y., Zhang, H., Li, J., Yang, X., Zhao, B., Zhang, C., Yu, M., Xu, M. and Yu, Q., 2017. Mechanisms underlying the antidepressant response of acupuncture via PKA/CREB signaling pathway. Neural Plasticity, 2017.
• Tang, H., Guo, Y., Zhao, Y., Wang, S., Wang, J., Li, W., Qin, S., Gong, Y., Fan, W., Chen, Z. and Guo, Y., 2020. Effects and Mechanisms of Acupuncture Combined with Mesenchymal Stem Cell Transplantation on Neural Recovery after Spinal Cord Injury: Progress and Prospects. Neural Plasticity, 2020.
• Lai, H.C., Chang, Q.Y. and Hsieh, C.L., 2019. Signal transduction pathways of acupuncture for treating some nervous system diseases. Evidence-Based Complementary and Alternative Medicine, 2019.
• Pirnia, B., Bazargan, N.M., Hamdieh, M., Pirnia, K., Malekanmehr, P., Maleki, F. and Zahiroddin, A., 2019. The Effectiveness of Auricular Acupuncture on the Levels of Cortisol in a Depressed Patient. Iranian journal of public health, 48(9), pp.1748-1750.
• Yang, J.W., Ye, Y., Wang, X.R., Li, F., Xiao, L.Y., Shi, G.X. and Liu, C.Z., 2017. Acupuncture attenuates renal sympathetic activity and blood pressure via beta-adrenergic receptors in spontaneously hypertensive rats. Neural plasticity, 2017.
• Ye, Y., Zhu, W., Wang, X.R., Yang, J.W., Xiao, L.Y., Liu, Y., Zhang, X. and Liu, C.Z., 2017. Mechanisms of acupuncture on vascular dementia—a review of animal studies. Neurochemistry international, 107, pp.204-210.
• Li, Y., Wang, Y., Liao, C., Huang, W. and Wu, P., 2017. Longitudinal brain functional connectivity changes of the cortical motor-related network in subcortical stroke patients with acupuncture treatment. Neural plasticity, 2017.
• Wang, T., Wu, L., Liao, D., Zhou, X., Chen, Y. and Takeda, A., 2002. Effect of acupuncture on the expression of NT3 in the process of spinal plasticity. Hua xi yi ke da xue xue bao= Journal of West China University of Medical Sciences= Huaxi yike daxue xuebao, 33(1), pp.46-49.