HIV Peripheral Neuropathy, Acupuncture and Amitrypiline

This was actually a re-evaluation of a previous study on HIV neuropathy and acupuncture. I've cut it down, please link on the title for the full source.

Effects of acupuncture in reducing attrition and mortality in HIV-infected men with peripheral neuropathy.
Shiflett SC, Schwartz GE.
Laboratory for Advances in Consciousness and Health, Department of Psychology, University of Arizona, Tucson, USA. shiflett@email.arizona.edu
Abstract
A clinical trial reported in JAMA (Shay et al, 1998), involving acupuncture and amitriptyline in HIV-infected patients, concluded that there was no effect for either acupuncture or amitriptyline on neuropathic pain. However, a recent reassessment of this study showed that there were really three different and independent clinical trials, each with a different research design, which had been combined into a single database and consequently analyzed with a relatively insensitive statistics. When only the first substudy, factorially crossed design involving acupuncture and amitriptyline, was reanalyzed by itself using more powerful statistics, it was found that acupuncture and amitriptyline both worked independently to reduce pain, but also that acupuncture worked best in the absence of amitriptyline, and that there may have been adverse events associated with the combination of the two treatments. ..
RESULTS:
Whereas the results were inconclusive for the pain measures, acupuncture had a strong and positive effect on attrition and mortality...
CONCLUSIONS:
Acupuncture was clearly effective in reducing attrition and mortality in this sample, especially when health status was taken into account, but results for pain relief were mixed...The combined results of these two studies strongly support the importance of recognizing that interactions involving acupuncture and other treatments, may positively as well as negatively modify main effect results in clinical trials, and thus must be recognized and systematically explored...

Lots of interesting results in this study. First is that they took the time to re-evaluate a previous study. Two, that they were able to distinguish an actual difference in mortality rates. Three, that the combination of amitryptiline and acupuncture were not as effective. The only drug commonly stated to interfere with acupuncture is Prednisone. But I've privately wondered if Neurontin (Gabapentin) doesn't interfere with acupuncture also. Now questions about amitryptiline.
This is an important question, not only clinically, but because it may help us to understand the mechanism of action. For example, taking Prednisone may down regulate, or muck up the hypothalamic/pituitary axis response to acupuncture. Gabapentin is thought to reduce calcium currents in the brain, so perhaps that's part of the mechanism of action of acupuncture. Amitryptiline is a serotonin-norepinephrine reuptake inhibitor, so may, again, somehow interfere with acupuncture's effect.
more on my practice here

Acupuncture and the relaxation response for treating gastrointestinal symptoms in HIV patients on highly active antiretroviral therapy

I bring this study to your attention for a few reasons. It underscores the efficacy of acupuncture for gastrointestinal problems in general by addressing a serious and pernicious problem in HIV patients. The gut is highly innervated, and for that reason is actually easier to affect with acupuncture than one might think. The other interesting part of this study is that they combined the relaxation response with acupuncture to see if there was any difference and it turns out that they had a synergistic effect. The biofeedback device I use in my clinic to monitor Heart Rate Variability (HRV), a measure of the relaxation response, is designed to be used as a device for patients to learn to relax. I use it as a simple monitor, to see what happens during treatment. This makes me think I should go ahead and use it as intended, with patient participation. Who knows how much better my results would be? (For info on my practice, please click here.)

Acupuncture and the relaxation response for treating gastrointestinal symptoms in HIV patients on highly active antiretroviral therapy.
Chang BH, Sommers E.
Acupunct Med. 2011 Jun 24. [Epub ahead of print]

1VA Boston Health Care System, Boston, Massachusetts, USA.
Abstract
OBJECTIVES:

To examine the effect of acupuncture and the relaxation response (RR) for treating gastrointestinal (GI) symptoms in HIV patients who are using highly active antiretroviral therapy (HAART).
METHODS:

The authors conducted a 4-arm 2×2 double-blind randomised controlled trial in an acupuncture clinic in the USA. Sham acupuncture and health education were used as the control conditions of real acupuncture and RR elicitation, respectively. Enrolled patients were randomised to real acupuncture+RR (AR), sham acupuncture+RR (SR), real acupuncture+health education (AE) or sham acupuncture+health education (SE) study arm. Participants listened to CDs with RR-eliciting instructions or health education while receiving acupuncture intervention. Interventions were provided twice weekly for 4 weeks and once weekly for another 4 weeks. Participants used daily diaries to record GI symptom severity ratings (0-10). The authors estimated the intervention effect as the changes in symptom rating per intervention session increase using a mixed-effects regression model.
RESULTS:

A total of 130 people with HIV/AIDS who were on HAART and had persistent GI symptoms were enrolled and 115 started the study intervention. The AR group had greater intervention effects for loose stools symptoms than the other three groups (ß=-0.149, -0.151 and -0.144, p value=0.013, 0.013 and 0.018 comparing AR to AE, SR and SE, respectively). The AR group also had significant intervention effects on reducing nausea symptoms when the intervention was given twice per week (ß=-0.218, p=0.001).
CONCLUSIONS:

Our trial provided preliminary data demonstrating the potential synergistic effects of acupuncture and RR for treating GI symptoms in HIV patients on HAART.

HIV patients and Acupuncture

I just wanted to comment about this particular subset of patients. I see quite a few HIV positive patients for general "wellness," and I have to say that this is a most gratifying group to treat. The treatment plan usually consists of twice weekly visits initially to deal with specific problems and to get their immune systems optimized. I typically treat for stress and immune function in these patients, and then whatever other problems that they're faced with, eg sinusitis, tendonitis, lung problems and the like. If tolerated, an overall herbal formula with Astragalus is great for prevention of illness. Prevention is more than half the battle, especially when the patients have to travel a lot in planes (wow, do people get sick from planes...) After the initial series of about 4-6 visits, they usually come in once a month for treatment and to pick up herbs. What I've seen is that the acupuncture can help quite a bit with stress in these patients (of course that helps the immune system) and it keeps the number of ancillary infections, upper respiratory infections, diarrheal episodes etc... to a minimum. These are people who know their bodies and know their symptoms and can really attest to the benefits of the treatments, which is why it's so gratifying.


(To read more about acupuncture and my practice, please click here.)