Acupuncture - Diabetic Peripheral Neuropathy (DPN)

Acupuncture:

Diabetic Peripheral Neuropathy (DPN)

Traditional Chinese Medicine (TCM) is a holistic healthcare system that originated in China thousands of years ago, offering a different approach to health and wellness compared to Western medicine. TCM focuses on balancing the body’s energy, or “Qi” (pronounced “chee”), which is believed to flow along channels in the body called meridians. Any imbalance or blockage of the flow of Qi is believed to lead to illness.

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Integrative, Complementary and Alternative Medicine

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Acupuncture for Diabetic Peripheral Neuropathy (DPN)

Diabetic peripheral neuropathy (DPN) is a common and debilitating complication of diabetes mellitus, affecting 30–90% of patients, with prevalence increasing with disease duration. Painful DPN is experienced by 15–50% of diabetic patients, manifests as burning, stabbing, or electric shock-like pain, numbness, tingling, and sensory abnormalities in the limbs, often in a “stocking-glove” distribution.

These symptoms significantly impair quality of life, contributing to foot ulcers, amputations, falls (especially in the elderly), and comorbidities such as sleep disturbances, depression, and anxiety. DPN imposes a substantial economic burden, with annual US costs for related complications estimated at $460–1,370 million, accounting for 27% of diabetes-related medical expenses.

Conventional treatments, including gabapentin, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and alpha-lipoic acid, aim to alleviate pain and improve microcirculation but often provide limited relief—fewer than 1 in 7 patients achieve significant pain reduction—and cause side effects like somnolence, dizziness, and nausea.

Complementary and alternative therapies, such as acupuncture, vitamin B12, alpha-lipoic acid supplementation, and physical therapy, are increasingly utilized to address these limitations.

Acupuncture, a traditional Chinese medicine practice involving physical stimulation of specific points, has gained attention for its potential to reduce pain, improve nerve function, and enhance quality of life with minimal adverse effects.

This summary synthesizes five systematic reviews and meta-analyses evaluating acupuncture’s efficacy and safety for DPN, offering evidence-based guidance.

(Zhou et al., 2023;
Zhang et al., 2023;
Wang et al., 2023;
Yu et al., 2020;
Ge et al., 2024)

Key Findings

Zhou et al. (2023) (Frontiers in Neurology, DOI: 10.3389/fneur.2023.1281485):
- Study: Meta-analysis of 25 RCTs (1,561 patients) comparing acupuncture (manual, acupoint injection, moxibustion) plus conventional treatment to conventional treatment alone.
- Efficacy: Significantly reduced pain and neurosensory symptoms (e.g., numbness) across all modalities.
- Safety: Adverse effects were mild and reversible.
- Mechanisms: Increases superoxide dismutase (SOD), reduces spinal glutamate, p38MAPK signaling, and inflammatory markers (e.g., TNF-α, hs-CRP), mitigating oxidative stress and neuroinflammation.
- Clinical Note: Acupuncture enhances conventional treatments, making it a practical adjunct for DPN management.

Zhang et al. (2023) (Frontiers in Neurology,

- Study: Meta-analysis of 9 RCTs (751 elderly patients) comparing acupuncture to conventional treatments (e.g., methylcobalamin, vitamin B).
- Efficacy: Reduced pain, numbness, and TCSS scores, with significant improvements in median and common peroneal nerve conduction velocities (SNCV, MNCV). Improved blood glucose control.
- Safety: Lower adverse events and dropout rates than pharmacological therapies.
- Mechanisms: Improves blood flow (e.g., reduced viscosity, fibrinogen), decreases inflammatory cytokines (e.g., via P2X4 regulation), and enhances nerve conduction.
- Clinical Note: Particularly effective for elderly patients, reducing fall risk and supporting non-pharmacological therapy.

Wang et al. (2023):

- Study: Meta-analysis of RCTs comparing manual acupuncture to routine care (e.g., gabapentin, SNRIs) and sham acupuncture.
- Efficacy: Reduced pain (VAS: MD -1.45 vs. routine care, -0.97 vs. sham, p < 0.0001–0.004) and improved SNCV (MD 2.29, p < 0.0001) and MNCV (MD 2.87, p < 0.0001) with high certainty of evidence for nerve outcomes. Effective for 3–4 and 6–10 week durations.
- Safety: Minor, transient adverse effects.
- Mechanisms: Mediates neuroimmune crosstalk and signal transduction, addressing nerve fiber pathologies.
- Clinical Note: Outperforms sham acupuncture, reinforcing specificity of effect for PDPN pain relief.

Yu et al. (2020) (Journal of Clinical Pharmacy and Therapeutics, DOI: 10.1111/jcpt.13351):

- Study: Overview of 18 systematic reviews comparing acupuncture to non-acupuncture treatments (e.g., methylcobalamin).
- Efficacy: Improved pain, numbness, and motor/autonomic dysfunction, with increased NCV, suggesting neuroprotection.
- Safety: Few adverse reactions, supporting low-cost, safe therapy.
- Mechanisms: Mitigates oxidative stress, improves microvascular circulation, and modulates central pain pathways (e.g., thalamic regulation).
- Clinical Note: Highlights need for improved study quality but supports acupuncture’s role in PDPN management.

Ge et al. (2024) (Frontiers in Neurology, DOI: 10.3389/fneur.2024.1500709):

- Study: Meta-analysis of 20 RCTs comparing acupuncture (manual, electroacupuncture, acupoint injection, warm acupuncture) to drugs, sham acupuncture, or combined therapies.
- Efficacy: Outperformed drugs in improving symptoms (pain, numbness) and effective rate, with significant SNCV/MNCV improvements. Acupuncture plus medication was superior to medication alone for NCV and quality of life.
- Safety: Fewer adverse effects than drug therapy, with no serious reactions.
- Mechanisms: Regulates neurotrophic factors (e.g., NGF), reduces AGEs, and inhibits inflammatory mediators (e.g., IL-6, TNF-α), improving microcirculation and nerve repair.
- Clinical Note: Supports acupuncture’s integration for PDPN, particularly for patients with drug intolerance.

Clinical Implications

Acupuncture is a safe, effective adjunct for PDPN, consistently reducing pain (VAS (1-10) reductions: 0.97–2.50), numbness, and sensory abnormalities across diverse patient populations, including the elderly (Zhang et al., 2023). It outperforms conventional treatments (e.g., alpha-lipoic acid, gabapentin) and sham acupuncture, with high certainty of evidence for improving nerve conduction velocities (SNCV, MNCV).

SNCV (Sensory Nerve Conduction Velocity) is a test that assesses the speed at which electrical signals travel along sensory nerves, helping to diagnose nerve damage or dysfunction. This test is particularly useful in evaluating conditions like diabetic neuropathy, carpal tunnel syndrome, and other neuropathies.

MNCV (Motor Nerve Conduction Velocity): Measures the speed at which electrical signals travel along motor nerve fibers, which control muscle movement.

MNCV and SNCV are essential for diagnosing and managing conditions affecting the peripheral nervous system, such as diabetic neuropathy, carpal tunnel syndrome, and various forms of peripheral neuropathy. These tests help clinicians identify nerve damage, assess its severity, and monitor the effectiveness of treatment.

Acupuncture Mechanisms

Acupuncture reduces oxidative stress, inflammation, and AGEs while enhancing microcirculation and nerve repair—address DPN’s complex pathogenesis, offering neuroprotection and symptom relief. With minimal adverse effects (mild, transient, or none), acupuncture is ideal for patients intolerant to pharmacological side effects (e.g., somnolence, dizziness).

Combining acupuncture with conventional therapies enhances outcomes, making it a practical addition to pain management protocols.Acupuncture specialists can optimizes conventional DPN treatment, reduces disability, improves quality of life, and eases economic burdens for patients when able to return to work

Limitations

All five studies reported low to very low evidence quality levels due to:

High Risk of Bias: Unclear randomization, lack of allocation concealment, and poor blinding, particularly challenging in acupuncture trials due to physical intervention (Ge et al., 2024).
Heterogeneity: Variable treatment protocols, outcome measures (e.g., VAS, TCSS, MDNS), and patient characteristics (e.g., DPN duration, diabetes type) increased heterogeneity Wang et al., 2023; Zhou et al., 2023).
Study Quality: Small sample sizes, low-quality RCTs, and incomplete reporting (e.g., no trial registration, conflict-of-interest disclosures; Yu et al., 2020).
Lack of Long-Term Data: Most trials lacked follow-up, limiting assessment of sustained efficacy (Zhang et al., 2023; Ge et al., 2024). Future research must prioritize large-scale, high-quality RCTs with standardized protocols, robust blinding (e.g., improved placebo needles), and long-term follow-up to enhance evidence credibility.

Recommendations

Pain patients should consider acupuncture as a first-line adjunct for DPN, particularly for patients with inadequate response to, or intolerance of, conventional medications.

References

Emphasis on Education

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

Should you wish more information regarding any of the subjects listed – or not listed – here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

Acupuncture – Diabetic Peripheral Neuropathy (DPN)