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

Blood Pressure Management and Acupuncture

This is another case study. This patient had severe peripheral neuropathy in her feet when she presented to the clinic. She suspected that it was due to a statin she was taking so discontinued it. She also had blood pressure that was out of control and wanted to try another approach.
The graph below shows her Blood Pressure the week before she came in to see me. Her first visit was 6/23/2011. Her last visit was 7/11/2011. The blood pressures for those days I took in my clinic. I didn't end up seeing her after those 4 visits, but contacted her to find out how she was doing and she gave me the last three readings.
So the acupuncture helped her blood pressure, but her blood pressure also was lowered because her feet improved dramatically so she wasn't in so much pain. This obviously helped her blood pressure also. (If I can get it together, I'll try to post her HRV readings in a later post since they were fascinating also.)



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