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Ask an expert - neuro and psycho logical - parkinson's

2 questions

Q:  My wife has had Parkinsons for 5 and a half years. For the last couple of years or so she has been experiencing severe pain in both legs for which the GP was unable to prescribe satisfactory analgesia. The local pain clinic recommended Oxycodone (up to 40 mg) both as controlled release and instant acting for breakthrough pain. Despite all of this her pain is still more than is bearable and we are at our wit's end to find something to help. Would acupuncture be of value in such a case? I realise I have not given any other clinical info, but would welcome any comments you can make.

The treatment of Parkinson's disease when it starts to manifest in the kind of muscle tightening and freezing is not that well researched. We tend to be a little tentative when we have discussed this in the past. A not untypical answer was:

From the perspective of research studies alone it would be difficult to give any firm recommendations for acupuncture as a treatment of Parkinson's Disease. There are a number of studies, some undertaken in the US but the vast majority in China, which show some positive signs, but not of sufficient change in a significant number of patients under study to draw any firm conclusions. You can see some of the studies if you google 'ncbi acupuncture parkinson's disease' - the National Centre for Biotechnical Information in the States is a convenient way to find many of the the more significant papers. There is also a Cochrane Review of a protocol for assessing the value of acupuncture, but as far as we are aware this has not been put into action yet.

  

With all chronic degenerative conditions the extent to which acupuncture can help has to be carefully explained. It is often, as one rather ironic patient said, a case of 'getting worse slower', and this is extremely difficult to quantify in a condition like Parkinson's where the disease progression is neither smooth nor predictable. Anecdotally there are many accounts of patients finding that treatment helps with some of the manifestations of the disease, such as the periods of rigidity and freezing, and a general sense of well-being, but these are not documented sufficiently well to be able to claim any undisputed levels of efficacy.

 

The best course of action is to see whether a BAcC member local to you will give you an honest assessment from an eastern perspective of what they might be able to achieve for your own unique patterns. There may be elements of how the condition manifests which they may feel that they can help.

That said, acupuncture has a long track record of being used as pain relief. When it first became more public in the West after Nixon's visit to China in 1976, one of the main areas of research was into the use of acupuncture for pain relief and control, driven by graphic images of people having operations while awake and needled. It is also a very straightforward area for measurements; the neurotransmitters are well known and researched, and the levels quickly determined to establish whether treatment is increasing the amount the patient has. The usual question with acupuncture used in this way is not 'does it work?' but 'how much does it work and how long does the effect last?' If it does, the ultimate determinant is the cos-benefit analysis: is the relief sufficient to warrant the expenditure? For people with deep pockets this is not an issue; for the majority of us it is.

Another useful indicator is that acupuncture is very widely used in China after strokes, often being applied on the same day as the stroke, to overcome paralysis and spasticity in the muscles. The firmly held belief is that this reinstates the flow of energy which has been disturbed by the stroke as soon as possible and before the body had 'set'. Evidence suggests that this is being taken more seriously in the West.

In summary, we think it is an avenue worth exploring, but given the nature of the problem we would expect the judgement of how effective treatment is to be fairly rapid. If it is going to work, it will offer some relief pretty much immediately. It may take two or three sessions to reach a definite conclusion, but where we have seen it used (one of our close friends suffered from Parkinsons and we were used to his episodes of freezing and muscle locking) when acupuncture was used it did help fairly quickly. Of course, from a Chinese medicine perspective everyone is unique and different so one cannot generalise from single cases or case studies, but we believe that there is sufficient anecdotal evidence to warrant a short course of treatment to see what level of relief it can offer.  

From the perspective of research studies alone it would be difficult to give any firm recommendations for acupuncture as a treatment of Parkinson's Disease. There are a number of studies, some undertaken in the US but the vast majority in China, which show some positive signs, but not of sufficient change in a significant number of patients under study to draw any firm conclusions. You can see some of the studies if you google 'ncbi acupuncture parkinson's disease' - the National Centre for Biotechnical Information in the States is a convenient way to find many of the the more significant papers. There is also a Cochrane Review of a protocol for assessing the value of acupuncture, but as far as we are aware this has not been put into action yet.

 

 

With all chronic degenerative conditions the extent to which acupuncture can help has to be carefully explained. It is often, as one rather ironic patient said, a case of 'getting worse slower', and this is extremely difficult to quantify in a condition like Parkinson's where the disease progression is neither smooth nor predictable. Anecdotally there are many accounts of patients finding that treatment helps with some of the manifestations of the disease, such as the periods of rigidity and freezing, and a general sense of well-being, but these are not documented sufficiently well to be able to claim any undisputed levels of efficacy.

 

The best course of action is to see whether a BAcC member local to you will give you an honest assessment from an eastern perspective of what they might be able to achieve for your own unique patterns. There may be elements of how the condition manifests which they may feel that they can help.

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