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Acupuncture, initially developed in Chinese medicine in the fifth century B.C., has been increasingly applied to the alleviation of pain, particularly in the presence of cancer (1, 2). Serotonergic pathways have been implicated in pain relief, and they have been useful in relieving discomfort in both fibromyalgia and neuropathy (3, 4). Thus, it was hypothesized that acupuncture might work synergistically with serotonergic therapy for pain relief in neuropathy. Here, three cases show the possible synergism of serotonin (5-HT) effects induced by nefazodone with acupuncture. Each patient underwent six acupuncture treatments, two at each visit. Baseline platelet 5-HT content was measured once at baseline, once after 8 weeks, and three times during the acupuncture series. The patients were not specifically followed beyond the course of the acupuncture treatments.
Mr. A was a 57-year-old man who improved somewhat after treatment with 450 mg/day of nefazodone over 8 weeks for diabetic neuropathy. He obtained substantial further benefit with the addition of acupuncture: his self-ratings of pain, paresthesia, and numbness all fell from 50 to 5 on a visual analog scale. Physician ratings for paresthesia fell from 1.5 to 0; ratings for numbness decreased from 1.5 to 0.5. His baseline platelet 5-HT content was 40.1 ng/108 platelets and increased to 73.7 by the end of 8 weeks of nefazodone treatment. During acupuncture treatment, it continued to rise to 95.1 and 102.4 before falling to 49.8 some time after completion of the series.
Mr. B was a 56-year-old man who also improved somewhat after treatment with 450 mg/day of nefazodone over 8 weeks for diabetic neuropathy. The addition of acupuncture to his nefazodone treatment produced additional improvement. His visual analog scale rating for pain fell from 55 to 25, and his rating for paresthesia fell from 80 to 55. Physician ratings for pain fell from 1.5 to 0.5, and ratings for paresthesia fell from 1.5 to 1.0. Mr. B’s baseline platelet 5-HT content was 44.7 and rose only to 47.6 during his initial nefazodone treatment. It increased to 110.9 and 124.4 when acupuncture treatment was added but fell to 51.0 after treatment.
Mr. C was a 61-year-old man who obtained minimal benefit from an initial course of nefazodone at a dose of 450 mg/day for diabetic neuropathy. During his acupuncture treatment, he obtained little added benefit. His visual analog scale ratings decreased only from 60 to 50 for pain, paresthesia, and numbness. Physician ratings for pain and paresthesia fell only from 1.5 to 1.0. Mr. C’s change in platelet 5-HT content was completely different from those of Mr. A and Mr. B. His baseline platelet 5-HT content was 28.3, at the end of the first 8 weeks of treatment it was 12.3, and during acupuncture treatment it was 11.9, 10.6, and 12.6.
Thus, two of the three patients showed increased benefit when a series of six acupuncture sessions was added to ongoing nefazodone therapy for the treatment of diabetic neuropathy. It was reported during a follow-up telephone conversation that acupuncture benefits for the first two patients lasted at least an additional 6 months. The maximum benefit was shown by the individual who showed a platelet 5-HT content pattern of gradual increases, intermediate benefit was obtained by the individual whose platelet 5-HT content increased only during acupuncture treatment, and the least benefit was received by the individual whose platelet 5-HT content remained low during treatment. This effect may have significant implications for the effect of nefazodone on postsynaptic 5-HT receptors in alleviating pain, in conjunction with serotonin’s facilitatory role in acupuncture analgesia (5). More study is required in this area.
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