What is an evidence-based practice?
Evidence-Based Practice, (EBP), uses current research to inform clinical decision making and provide patients with the safest and best clinical outcome. There are 3 basic parts to EBP. At Carefree Regen Medical we serve Carefree, Cave Creek, Scottsdale, Glendale and Gilbert.
Utilization of the *best available research
Incorporating individual clinical experience
Considering patient preference
Why use evidence-based research?
Using newly acquired information has been a part of TCM since the beginning. The ancient sages did not just rely on the previous generations’ teachings but always added new information as it became available.
Arizona Naturopath
Scottsdale naturopath
Carefree naturopath
Cave creek naturopath
Glendale naturopath
Gilbert naturopath
Naturopath medicine
Natural medicine
House calls
Consult my Chinese Medicine Website for more information: https://drgreenfield.nccaomdiplomates.com/
An experienced practitioner that scrutinizes scientific research of valid evidence-based studies conducted with random controlled trials, research reviews and meta-analysis (statistical computation of multiple studies), can select body and auricular acupuncture points employing electrical acupuncture (EA) and manual acupuncture (MA), as well as adjunctive wet cupping (WCT) and adjunctive injections of B12 (AIT) treatments, with the knowledge of point selection, duration and frequency to appropriately address the principles derived from the TCM pattern determined during a TCM consultation.
Medical and lay terms can help to teach patients the complex association of Chinese medicine treatment and Chinese medicine diagnosis.
What to expect at Carefree ReGen Medical
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Dr Jacquie will have you complete specific quantitative surveys from time to time to help evaluate your progress as well as perform appropriate muscle testing or sensory testing when there is pain.
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Pattern of Imbalance is determined by Traditional and Advanced analysis employing the 10 Questions, face, skin temperature, coloration, pulse and tongue diagnostic tools.
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Bio-physiologyl and Pathophysiology knowledge is utilized to recognize early and frank signs for medical referral.acupuncture
Examples of Quantitative Surveys use by Dr Jacquie:
Pain rating scale
BPI Brief Pain Inventory
Here is what Dr Jacquie will do utilizing Evidence-Based practice in the treatment of Peripheral Neuropathy:
Timing the strategic selection of low intensity electrical stimulation for a duration of up to 30 minutes to acupuncture points, body and auricular acupuncture points, WCT, AIT, and supportive herbal formulas is based on prevailing research and 25 years experience, traditional methods of analysis given with patient preferences and safety in mind.
Acupuncture intervention for Peripheral Neuropathy, (NP). NP is a syndrome having persistent nerve pain related to pressure, temperature stimuli and non-stimulus triggers. It can be a metabolic cause like diabetes or liver disease, vascular insufficiency damaging the nerves or as the result of a physical trauma. NP can have motor symptoms of muscle weakness, muscle atrophy, paralysis, spasms and cramps. PN nerve damage is dysfunction in nerve conduction and pain signaling. There can be intensified pain sensation from light touch or an unusually high pain sensation from a less noxious pain stimulus.
Types of Peripheral Neuropathy: trigeminal neuralgia (TN), chronic NP after peripheral nerve injury:trauma or post-surgical, painful polyneuropathy, postherpetic neuralgia, and painful radiculopathy.
Some of the research includes systematic reviews and meta-analyses.
2023 (Feng) systematic review and meta-analysis of RCTs of acupuncture treating neuropathic pain, They evaluated “the effect on pain intensity and safety of acupuncture in patients with NP.” Conclusion: “The acupuncture group had higher effectiveness than sham intervention or blank control for changes in pain intensity, but there is no significant difference between acupuncture and conventional treatments in treating NP. The acupuncture-induced adverse events were mild and reversible.”
Feng, Z., Cui, S., Yang, H., Wang, Y., Zhou, X., Wong, J., Lai, L., Yang, Z., Huang, B., Zheng, H., & Xu, M. (2023). Acupuncture for neuropathic pain: A meta-analysis of randomized control trials. Frontiers in neurology, 13, 1076993. https://doi.org/10.3389/fneur.2022.1076993
Effectiveness & Safety is also a concern:
2020 (Jin) systematic review and meta-analysis focused on the “Efficacy and Safety of Acupuncture against Chemotherapy-Induced Peripheral Neuropathy”.
Analysis of Efficacy: “This systematic review shows that the overall effectiveness of acupuncture treatment of CIPN is superior to that of neurotrophic drugs…the recovery of sensory function is significantly better than motor function. It is interesting to see that many non-CIPN symptoms caused by chemotherapy, like nausea, appetite change, and drowsiness, had also improved, suggesting that acupuncture for CIPN can impact on a wider range of symptoms.” Adverse effects were occasional bruising or tingling sensations rated as mild.
Jin, Y., Wang, Y., Zhang, J., Xiao, X., & Zhang, Q. (2020). Efficacy and Safety of Acupuncture against Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM, 2020, 8875433. https://doi.org/10.1155/2020/8875433
2020 (Lu) “Acupuncture for Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer Survivors: A Randomized Controlled Pilot Trial.”
Results: “This randomized pilot trial demonstrated that an 8-week acupuncture intervention, versus usual care, led to clinically meaningful and statistically significant improvements in neuropathic sensory symptoms in breast cancer survivors with mild and moderate CIPN after the completion of chemotherapy.”
“Exploratory analyses suggested that a lower-intensity acupuncture program also led to clinically meaningful reductions in sensory CIPN symptoms, but effects may have taken longer to occur.
Figure 1 Analgesic mechanism of acupuncture against diabetic neuropathy in the peripheral nerves and spinal cord in rats. Intraperitoneal injection of STZ induces diabetic neuropathy (red), and acupuncture treatments in various acupoints attenuate neuropathy (blue) in rats. P65, CBS, P2X3R p-PKC GPR78, and caspase-12 are upregulated after STZ injection. However, acupuncture treatment in various acupoints upregulated the downregulated molecules. Furthermore, in the spinal cord, there is an STZ injection-induced upregulation of the NGF, SP, TRPV1, P2X4, and OX42 upregulation and downregulation of the GAD. Abbreviations: CBS, cystathionine β synthase; GAD-67, glutamic acid decarboxylase-67; GPR78, G-protein coupled receptor 78; NGF, nerve growth factor; OX42, microglia marker; P2X3, P2X purinoceptor 3; P2X4, P2X purinoceptor 4; p-PKC, p-protein kinase C; SP, substance P; TRPV1, transient receptor potential vanilloid 1.
Lu, W., Giobbie-Hurder, A., Freedman, R. A., Shin, I. H., Lin, N. U., Partridge, A. H., Rosenthal, D. S., & Ligibel, J. A. (2020). Acupuncture for Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer Survivors: A Randomized Controlled Pilot Trial. The oncologist, 25(4), 310–318. https://doi.org/10.1634/theoncologist.2019-0489
2021 (Cho) Effect of Acupuncture on Diabetic Neuropathy: A Narrative Review. 5 animal studies and 10 human studies were analyzed.
Conclusion: “In conclusion, based on the results obtained from all the included studies, we suggest that acupuncture could be considered a useful treatment method for diabetic neuropathy.”
Figure 2 Human maps of acupoints used in neuropathic pain studies. The locations of acupoints are marked in the figure.
Cho E, Kim W. Effect of Acupuncture on Diabetic Neuropathy: A Narrative Review. Int J Mol Sci. 2021 Aug 9;22(16):8575. doi: 10.3390/ijms22168575. PMID: 34445280; PMCID: PMC8395323.
Adjunct therapy Wet Cupping (WCT)
2021 (Hidayati) “Increase in the glutamate transporter 1 and time withdrawal latency following wet cupping therapy in chronic constriction injury in rats.”
Results: “Our study revealed WCT reduce the pain significantly and increase the count of GLT-1 in CCI neuropathic pain model.”
Conclusions: “A previous study hypothesized that WCT may function in a manner similar to acupuncture: it may stimulate particular parts of the body that include the release of neurotransmitters, this study confirmed that WCT can increase GLT-1 (transporter of glutamate neurotransmitter). It has been revealed that skin has the role as neuroendocrine immune organ. This concept combines the concepts of endocrinology, neurobiology and immunology to unravel the multidirectional communications between brain, the endocrine and immune systems and peripheral organs. The direct stimulation of dermal, adnexal, or subcutaneous cellular components could secondarily lead to the production of biological mediators with definite systemic effects and the activation of skin immune cells can enter the circulation and have distant immunological or regulatory effect. The application of WCT in the skin could be explained by ‘the role of the skin as neuroendocrinology organ’ concept.”
Hidayati HB, Machfoed MH, Kuntoro, Subadi I, Khaerunnisa S, Widjiati. Increase in the glutamate transporter 1 and time withdrawal latency following wet cupping therapy in chronic constriction injury in rats. Anaesth. pain & intensive care 2021;25(1):50-56.
Adjunct Therapies in Treating Neuropathy – Acupoint Injection with Vitamin B12 (AIT)
The local application through acupoint injection of vitamin B12 is understudied. Most studies focus on oral supplementation or random intramuscular injection of B12. B12 has been shown in animal models and human trials to be an effective pain reliever.
Clinical experience indicates injection of B12 into acupoints near the local area of neuropathic symptoms is helpful regardless of the type of neuropathy.
Buesing, S., Costa, M., Schilling, J. M., & Moeller-Bertram, T. (2019). Vitamin B12 as a Treatment for Pain. Pain physician, 22(1), E45–E52.