ACUPUNCTURE A TREATMENT FOR PAINFUL DIABETIC NEUROPATHY S Haycocks, S Robson, D Macauley, P Chadwick Department of Podiatry, Salford PCT, Eccles Health Centre Introduction Painful diabetic neuropathy (PDN) is a distressing and disabling complication of diabetes, causing significant morbidity and impairment in quality of life.(Benbow et al 1998) Treatment regimes include application of film dressings, simple analgesics, tricyclic antidepressants, anticonvulsants and opiate derivatives. However these treatments can be ineffective and have a high incidence of side effects. Acupuncture was first brought into Europe in the 17th century. Acupuncture theory suggests the insertion of fine needles into points along the meridian are said to rebalance disharmonies in the body and allow it to regain natural balance and return to a state of health Acupuncture is used to treat many different conditions and is becoming more popular in the management of pain. There is limited evidence about the effectiveness of acupuncture in the treatment of PDN and the treatment was a new service development it was essential to evaluate the clinical effectiveness and benefit of the clinic. Acupuncture needles are inserted into four Traditional Chinese points on each leg. The points used are used for treating metabolic disorders, neuropathy and pain. One point on each hand is also used which is an important analgesic point. The needles are left in situ for twenty minutes. This is repeated every week for six weeks using the same acupuncture points. After six weeks the neuropathic pain scale is completed again and compared to the scale completed pre acupuncture treatment.   TABLE 1.   Mean NPS Item Scores NPS Item BASELINE WEEK 6 INTENSITY 7.3 2.9 SHARP 6.9 3.7 HOT 7.0 4.0 COLD 5.1 4.2 SENSITIVITY 6.3 5.0 ITCHY 4.8 3.6 UNPLEASANT 7.9 4.7 DEEP 7.3 4.5 SURFACE 6.8 4.5 The effect on serum phosphate at present does not show any significant results Discussion Neuropathic pain is associated with a large range of symptoms that range in their severity. Some sufferers may have mild symptoms from mild parasthesia in a few toes to severe unremitting pain involving both legs that can be nocturnally exacerbated and lead to disturbed sleep patterns. The NPS subsequently enabled the acupuncture practitioners to assess the distinct pain qualities among individuals with neuropathic pain and can thus potentially indicate the sensitivity of acupuncture to the various qualities. The results demonstrate that acupuncture is effective at reducing the symptoms of PDN. Acupuncture significantly reduces pain intensity, sharp, hot and unpleasant symptoms . The use of the NPS to measure the effect of a management of PDN is recommended. It allows a demonstration of specific pain sensations and different therapies may also produce different effects on each specific pain sensation type. Aim To evaluate the effectiveness of acupuncture treatment for painful diabetic neuropathy using the neuropathic pain scale. Results Thirty three patients were treated in the acupuncture clinic over a six month period. There were 14 female and 19 males all with Type 2 Diabetes. Figure 1 shows how many patients scored each sensation on the NPS All thirty three patients scored intense and unpleasant. Thirty two scored deep surface pain. Figure 1 The mean values of baseline scores ranged from 4.8 to 7.93. The highest scoring sensations were unpleasant, deep surface and intense pain. Results at baseline and at 6 weeks are shown in Table 1. Results show that there was a decrease in all NPS items. Of the 10 sensations the most significant improvement was intensity with a mean improvement score of 4.4. Unpleasant and sharp had a mean improvement of 3.2 Method People with diagnosed PDN are referred for a six- week course of acupuncture. An acupuncture information leaflet is sent to the patient before their initial appointment to inform them of the risks and benefits. It also informs of the groups of people for whom acupuncture is not appropriate. These include epileptics, pregnant women, people with needle phobia or allergies to metal. (Acupuncture Association of Chartered Physiotherapists 2000) The Neuropathic Pain Scale (NPS) is also sent to the patient to complete before acupuncture treatment commences. The NPS measures a variety of pain qualities most common to neuropathic pain syndromes. The scale assesses two global pain domains (pain intensity and unpleasantness), six pain qualities (sharp, hot, dull, cold, sensitive and itchy) and two pain locations (deep and surface pain). In addition each item includes a description and other words for that item. For example for “Sharp” it states “Words used to describe “sharp” feelings include “like a knife, “like a spike”,“jabbing” or “like jolts”. Each of the 10 items has a 0 to 10 numerical score in which 0 is “no pain or not ----- (item) and 10 is “the most ---- (item) sensation imaginable. Conclusion The results indicate that acupuncture is effective in reducing the intensity of the pain, sharpness, hot and unpleasant symptoms. Acupuncture cannot be regarded as a cure for PDN but it offers a relatively safe, non-pharmacological alternative to conventional therapies.