Dr. Dr. VamanVaman JN. PhD PGA ( Harvard)JN. PhD PGA ( Harvard)

How Nerve Pain Feels…

People with nerve pain feel it different ways. For some, it's a stabbing pain in

the middle of the night. For others, it's a chronic tingling or burning they feel all

day. Uncontrolled nerve pain can be hard to bear. But with treatment, it can

often be controlled.

Understanding Nerve PainUnderstanding Nerve Pain

Good Pain and Bad PainPain is supposed to be a warning. When your hand gets too close Pain is supposed to be a warning. When your hand gets too close to a to a

stove, the nerves send a pain signal to the brain stove, the nerves send a pain signal to the brain ---- and you pull back and you pull back

before you burn yourself. But if you have nerve pain, that systebefore you burn yourself. But if you have nerve pain, that system isn't m isn't

working. Damaged nerves may send false signals working. Damaged nerves may send false signals ---- and you feel real pain and you feel real pain

without another cause. Or damaged nerves may stop you from feeliwithout another cause. Or damaged nerves may stop you from feeling ng

pain when you have an injury.pain when you have an injury.

Nerve Pain TriggersSome find that certain body positions or activities -- like

standing in line or walking -- may become painful. Nerve damage may also make your body overly sensitive. Even a

gentle breezegentle breeze on your face may become excruciatingmay become excruciating.

Loss of Feeling

Nerve damage may cause loss of sensation, making it erve damage may cause loss of sensation, making it

harder to do things with your hands. Knitting, typing, and harder to do things with your hands. Knitting, typing, and

tying your shoes may become difficult. Many people with tying your shoes may become difficult. Many people with

nerve damage say that their sense of touch feels dulled, as nerve damage say that their sense of touch feels dulled, as

if they are always wearing gloves.if they are always wearing gloves.

Nerve Pain and Sleep(less) Nights

Nerve pain is often worst at nightNerve pain is often worst at night. The touch of sheets or the

pressure of lying down may be terribly uncomfortable. If you can't sleep

because of your nerve pain, make sure to mention it to your doctor.

Changing some habits or taking medicine could help.

Losing BalanceIn addition to dulling your sense of touch, nerve damagenerve damagemay decrease muscle strength. These two effects may

make it harder to keep your balance -- and that could lead to falls. Assistive devices -- like braces, canes, or walkers --

may help.

Unseen InjuriesNerve damage doesn't just cause pain. It may also Nerve damage doesn't just cause pain. It may also

cause numbness that may prevent you from feeling cause numbness that may prevent you from feeling

pain when it matters. People with nerve damage pain when it matters. People with nerve damage

sometimes hurt themselves without realizing it sometimes hurt themselves without realizing it --

Diabetics. Your doctor may recommend that you check Diabetics. Your doctor may recommend that you check

yourself for injuries regularly yourself for injuries regularly ---- especially your feetespecially your feet

Nerve Pain ProgressionLeft untreated, nerve damage may worsen over time. It

usually starts in the nerves farthest from the brain and

spinal cord -- like those in the feet and hands. Then it may move up into the legs and arms.

However, if you get control of your nerve pain promptly,

you may be able to stop the damage -- and even reverse it.

Assessing Your PainAssessing Your Pain

In many cases, nerve pain may be controlled. Start by In many cases, nerve pain may be controlled. Start by

getting an assessment at the Consultant Acupuncturist's getting an assessment at the Consultant Acupuncturist's

clinic. Be ready to answer questions. How long have you clinic. Be ready to answer questions. How long have you

had pain? What does it feel like? How does it affect you? had pain? What does it feel like? How does it affect you?

The answers will help your doctor figure out what's causing The answers will help your doctor figure out what's causing

your pain and how to treat it.your pain and how to treat it.

Conditions that Cause Nerve Pain

Many conditions -- such as diabetes, shingles, and diabetes, shingles, and

cancercancer -- may cause injury and nerve pain. Some people

develop nerve pain for no known reasonno known reason.

It is important to try and find out the underlying cause of

your nerve pain, such as uncontrolled diabetes, and seek treatment for it. It may help relieve your pain. But be sure

you seek treatment for your pain too.

OTC Treatments for Nerve PainOTC Treatments for Nerve Pain

OverOver--thethe--counter painkillers may be the first treatment your counter painkillers may be the first treatment your

doctor recommends. These may include nondoctor recommends. These may include non--steroidal antisteroidal anti--

inflammatory drugs (inflammatory drugs (NSAIDsNSAIDs) ) ---- such as ibuprofen such as ibuprofen ---- or or

analgesics, such as acetaminophen. Other options include analgesics, such as acetaminophen. Other options include

painkilling creams, ointments, oils, gels, or sprays that are painkilling creams, ointments, oils, gels, or sprays that are

used on the skin. used on the skin. These provide temporary relief.These provide temporary relief.

Natural Treatments for Nerve PainComplementary or alternative treatments will help. For

instance, many global studies have found that many global studies have found that

acupuncture may ease nerve painacupuncture may ease nerve pain. In some cases, nerve

pain is caused or aggravated by a deficiency of vitamin

B12. Taking supplements -- under your doctor's care --could help. Acupuncture is an effective treatment for Nerve

Pain.

Acupuncture is proven effective for Back Pain

GI problems - GERD

Fibromyalgia

Shoulder Pain/ Spondylitis/ Joint Pains/ Back Pain/ Myofascial Pain

Pain – Trigger Points

Migraine - Headache

Depression - PTSD

Arthritis - Strokes

OB/ GYN problems

Sports Injuries

Primary publications ….

• BMJ Editorial – cautiously positive

• BMJ Press release – acupuncture works!

HTA Monograph Thomas KJ, MacPherson H, et al. Longer term

clinical and economic benefits of offering acupuncture to patients with

chronic low back pain. Health Technology Assessment, 2005, Vol. 5 No.

32.

Paper I Thomas KJ, MacPherson H, et al. Randomised controlled trial

of a short course of traditional acupuncture compared to usual care for

persistent low back pain. British Medical Journal, 2006; 333: 623-626

Paper II Ratcliffe J, Thomas KJ, MacPherson H, et al. A randomised

controlled trial of acupuncture care for lower back pain: cost

effectiveness analysis. British Medical Journal, 2006; 333: 626-628

Media reports of trial results

• “Acupuncture more effective for treating back pain than traditional methods on the NHS”. The Independent, 15 September 2006,

p28.

• “Why acupuncture is better for back pain than a trip to the GP”. Daily Mail, 15

September 2006, p47.

• “Acupuncture is best remedy for Nerve pain”. Daily Express, 15 September 2006, p4.

Comparing visual stimulation (torch)

with acupuncture at BL-67 and

with non-acupuncture point

York fMRI Project• What are differences in brain response due to different needling depths at LI-4?

• 1. Japanese style:– Superficial (1 to 2 millimetres in depth)

• 2. TCM style:– Deep (1 to 2 centimetres in depth)Acupuncture

point (LI-4)

Methods

• Setting: York Neuroimaging Centre, University of York, UK

• Participants: Seventeen healthy right-handed volunteers, naïve to acupuncture, nine women and eight men.

• Study design: Randomised block design

Block design used for both superficial and deep needling

needleinsertion

needlewithdrawal

needle stimulation

needle stimulation

0 2 4 6 8 10 12 14 16

minutes

Scanning and fMRI analysis

• 3 Tesla GE MRI scanner

• FSL software – general linear model

• Activations: increase in BOLD response

• Deactivations: decrease in BOLD response

BOLD = blood oxygen

level dependent

Activation on Needle Stimulation

Maximum voxel:

Z score= 6.8

% Bold = 0.36 ± 0.05

x, y, z = 10, -44 ,-28

Cluster size = 141

P = 2.9 X 10-8

Superficial Needling (n=17) Deep Needling (n=17)

Maximum voxel:

Z score= 5.6

% Bold = 0.43 ± 0.07

x, y, z = 4, -48, -24

Cluster size = 62

P = 1.4 X 10-4

Cerebellum Cerebellum

Deactivation on Needle Stimulation

Maximum voxel:

Z score= 7.5

% Bold = -0.52 ± 0.07

x, y, z = -40, -68, 34

Cluster size = 4209

P < 1.0 X 10-10

Superficial Needling (n=17) Deep Needling (n=17)

Maximum voxel:

Z score= 7.6

% Bold = -1.02 ± 0.13

x, y, z = -44, -80, 2

Cluster size = 1469

P < 1.0 X 10-10

Left hemisphere deactivationsPrecuneus (BA39)Cingulate gyrus

Left hemisphere deactivationsOccipital lobe (BA19)Frontal lobe

Deactivation on Deep Needling

Activation on Deep Needling

Subtraction: deep minus superficial

Temporal lobe

Cerebellum

(N=17)

…. but differences not found to be significant:p > 0.5

Needle sensation:what is the impact of deqi?

• Literally deqi is “the obtaining of qi”– Often described as a “dull aching or spreading sensation”

• Most acupuncturists (85%)– Aim to elicit deqi on needling

– Associate deqi with a therapeutic effect

Are we seeing simply a pain response?

• Pain is primarily associated with activations – we observed deactivations predominating

• Median nerve (where LI-4 is located) is primarily associated with activations in somatosensory areas, which were not observed in our study (at our threshold)

Limitations re clinical context

• Healthy volunteers

• Experimental conditions:

– Single needle, single point

– Long needle stimulation periods

• Short-term responses

Conclusion 1: Depth of needling

• Depth of needling appeared to have an impact on the BOLD response

– BUT… statistically no differences between deep and superficial needling were found

• More deactivations overall than activations were observed

• Superficial needling does not appear to be an appropriate sham control for deep needling – or vice versa

Conclusion 2: Needle sensation

• Needle sensation was found to mediate the BOLD response

• Deqimore associated with deactivations, acute pain more with activations

Conclusion 3: Gender of participants

• Men and women show possible differences in patterns of activation and deactivation in response to needling

• Small sample size means this research must be replicated

Real Acupuncture MeditationSham Acupuncture

Decreases in Brain Blood Flow

Acupuncture is approved by US Acupuncture is approved by US

NIH NIH –– National Institute of Health, National Institute of Health,

WHO WHO –– World Health organizationWorld Health organization

Hundreds of Hundreds of RCTsRCTs have proved have proved

the effectiveness of acupuncturethe effectiveness of acupuncture

Pl visit Pl visit –– www.medaku.comwww.medaku.com for for

more detailsmore details

Natural Immune Natural Immune

BoostersBoostersGreen Green – RedRed – BrownBrown –

Colorful Goodness of Nature that BOOST Colorful Goodness of Nature that BOOST

your immunity, Health and wellbeing!your immunity, Health and wellbeing!

Dr. Dr. VamanVaman JN PhD PGA ( Harvard)JN PhD PGA ( Harvard)Source Source -- WebMDWebMD

WhiteWhite

WatermelonWatermelonHydrating and refreshing, ripe watermelon also has plenty of a powerful

antioxidant, glutathione. Known to help strengthen the immune system

so it can fight infection, glutathione is found in the red pulpy flesh near

the rind.

CabbageCabbageThis is another source of immune-strengthening glutathione. And

cabbage is easy and inexpensive to find during the winter months when

it's in season. Try adding cabbages of any variety (white, red, Chinese)

to soups and stews to sneak in extra antioxidants and boost your

meal's nutritional value.

AlmondsA handful of almondsalmonds may shore up your immune system from the

effects of stress. A recommended 1/4 cup serving carries nearly 50% of

the daily recommended amount of vitamin E, which helps boost the

immune system. And they have riboflavin and niacin, B vitamins that

may help you bounce back from the effects of stress.

GrapefruitGrapefruits have a good amount of vitamin C. But science has yet to

prove that you can easily get enough vitamin C through foods alone,

without supplementation, to help treat cold and flu. However, grapefruit

is packed with flavonoids -- natural chemical compounds that have

been found to increase immune system activation. Dislike grapefruits?

Try oranges or tangerines.

Wheat GermWheat GermWheat germ is the part of a wheat seed that feeds a baby wheat plant,

so it is full of nutrients. It has zinc, antioxidants, and B vitamins among

other vital vitamins and minerals. Wheat germ also offers a good mix of

fiber, protein, and some good fat. Substitute wheat germ for part of the

regular flour called for in baked goods and other recipes.

LowLow--Fat YogurtFat YogurtA daily cup may reduce your chances of getting a cold.

Look for labels listing "live and active cultures." Some

researchers believe they may stimulate your immune system to fight disease. Also look for vitamin D. Recent

studies have found a link between low vitamin D levels and

an increased risk of cold and flu.

SpinachKnown as a "super food," spinach is nutrient-rich. It has

folate, which helps your body produce new cells and repair

DNA. And it boasts fiber, antioxidants, such as vitamin C, and more. Eat spinach raw or lightly cooked to get the most

benefit.

TeaGreen or BlackBlack? Both are loaded with disease-fighting polyphenols and flavonoids. These antioxidants seek out cell-damaging free radicals and destroy them. Caffeinated and decaf work equally well.

Sweet PotatoSweet PotatoLike carrots, sweet potatoes have the antioxidant beta-

carotene, which mops up damaging free radicals. Sweet

potatoes also boast vitamin A, which is linked to slowing the aging process and may reduce the risk of some

cancers.

BroccoliEasy to find at the grocery store and incorporate into meals, broccoli is

an immune-boosting basic. One study reported a chemical in broccoli

helped stimulate the immune systems of mice. Plus, it's full of nutrients

that protect your body from damage. It has vitamins A, vitamin C, and

glutathione. Add some low-fat cheese to round out a side dish with

immune-enhancing B vitamins and vitamin D.

GarlicGarlicGarlic offers several antioxidants that battle immune

system invaders. Among garlic's targets are H. pylori, the bacteria associated with some ulcers and stomach cancer.

Cooking tip: Peel, chop and let sit 15 to 20 minutes before

cooking to activate immune-boosting enzymes.

What you are What you are –– is is –– What you EatWhat you Eat

Dr. Vaman JN. PhD MSAR MAHMA PGA ( HARVARD)Harvard Medical School DCE PGA Lifetime Member No Harvard Medical School DCE PGA Lifetime Member No -- JNV 9914JNV 9914

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