Patient diagnosed with Peripheral Neuropathy

[andyc1952]

I am a London Acupuncturist, I am currently treating a gentleman aged 69 who has been diagnosed with Peripheral Neuropathy. He presents with pain in the ischial tuberosity in the right buttock  with pain going down the right leg and a burning sensation in the right foot, at this point there is nothing unusual, however, he insists that it only happens every other day, so he refers to a "good day" and a "bad day". He has had this problem for around 10 years, he has seen a number of Neurologists in London, who are all a little puzzled (as am I) we have all suggested that subconciously he is doing something compensatory after a bad day; it could be how he sits, or how he stands to alleviate the problem. He takes 50mg of amitryptiline, which helps for a while, but he does not take this regularly.

It would appear idiopathic, he does not have diabetes, chemotherapy, none of the usual causes, all the tests have shown nothing out of the ordinary, MRI shows nothing (admittedly MRN would  perhaps show a nerve entrapment), blood test have proved nothing, no B12 deficiency, and his immune system appears to be normal.

I have treated him 5 times and I have elicited some reaction, he reports that I have made the bad days worse and the goods days better. I have adhered to what we call a "point prescription" but I did stop the electro acupuncture after the second visit.

He did mention that this problem started about 10 years ago and he thinks that it coincided with  an inguinal hernia operation !! No one seems to have picked up on this, Anyway, my thought process has led me to think that perhaps the pudendal nerve could be implicated. Before I go down this road, where I would be using needles in the perineum (a point called Ren 1 in Chinese Medicine) I wanted an opinion as to whether you think my thought process is flawed in anyway.

Many thanks

Andrew Colombini BSc. (Hons) TCM  MBAcC MAcSCA


On palpation I found what feels like  fusion at T5/T6 and at L4/L5. I have concentrated on manipulating the T3, T7 and L2, 3, 4, 5 I have used electro acupuncture.

[Sallysmart]

Good day bad day thing you mention, I have neuropathy and there is a good day bad day kind of wonky pattern, sometimes for me it might be if I ate anything bad for my diet and sometimes it is cause I felt really good one day and felt like doing lots more and I feel it next day and sometimes I really dont think anything happened but I wake up feeling really crappy anyway.
You mentioned he had no chemo and doesnt have diabetes, the usual causes, it is now known that there is much more causing neuropathies like long exposure to things like aluminum and chemicals or had lime disease and there is so much more that should be asked because he might not even know something that is happening in his life is causing this disease.
I have to admit there is no real way for me to know what causes a good day or bad day, I even think sometimes how I slept is what makes a day go totally wrong and painful, I have even woke up with a leg off the bed for who knows how long and it feltt heavy and had more tingles then the other.
Also you mention amitriptoline, is this a drug that only works if taken on  a regular basis? most of mine are only helpful after taken daily for a while then they will kick in and take the edge of the pain off, not sure how amitriptoline works so had to ask, might help if he is taking it as prescribed if he does not now. .
I know nothing about accupuncture BTW except I had what I would think was tennis elbow and yet it was blamed on my neuropathy and I was sent to accupuncture for treatment, it did not help me and yes I had some really bad and some really good days after but no real let up in my arm, it even got worse after a while but that could have bin cos I tried to use it still and it wasnt nearly ready for that till "Time and Healing" was prescribed by my doctor, the less treatment and doing nothing but a few ten min exercises  a day with a ball seemed to make it feel better each day. Not to knock accupuncture but for me that was not the answer at that time whether it was or was not a neuropathy event, I still think it was tennis elbow as a separate event. Hope this helps anyway.

[Dr. A. Srivastava]

Thank you for your question. Although without being able to examine him I can not offer you the specific advice on diagnosis and treatment that he needs, but I would try to provide you some relevant information about his health concern.

This could be a possibility but can not assure you until examine him. Mainly, Peripheral neuropathy causes parasthesia is the feeling of tingling, pins and needles or numbness in an extremity. It is a symptom of peripheral neuropathies such as compression or irritation of nerves either in extremity or in spinal cord or a vitamin deficiency. Ask your neurologist to examine them when they're causing symptoms. Until he gets an appointment, whatever the underlying diagnosis try using an anti-inflammatory medication and Vitamin B-Complex supplement on a regular basis for a couple of weeks. Hope this helps.