Last Saturday I attended the autumn scientific meeting of the British Medical Acupuncture Society in London, an annual event which usually attracts some top speakers from around the world giving an insight into their areas of clinical interest and research.
This year we got to hear from Vitaly Napadow, a Ukrainian-born American neuroscientist and acupuncturist. He is associate professor at Harvard Medical School and the Martinos Center for Biomedical Imaging. He is also the director of the Center for Integrative Pain NeuroImaging and the co-president of the Society for Acupuncture Research.
Vitaly gave a a very interesting presentation based on his recent pilot study1 which showed that acupuncture can in effect ‘rewire’ the brain when using the technique to treat carpal tunnel syndrome.
Carpal tunnel syndrome is the most common entrapment neuropathy were the median nerve gets ‘trapped’ and irritated within the small carpal tunnel at the wrist. The median nerve is competing for space in this tunnel made up of bone and connective tissue with the many tendons which pass through the same tunnel to the hand and fingers. As such it can become compressed and irritated with the development of neuroinflammation which may result in pain and pins and needles to the 2nd and 3rd fingers as well as numbness and a loss of finger strength.
When assessing the impact of the compression and irritation on the ability of the nerve to convey signals along the nerve, a nerve conduction study (NCS) can be used. A nerve conduction study is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves. Its can be useful when making a diagnosis but also to determine whether or not certain treatments have been effective.
Vitaly showed us, based on the results of his pilot study, that treating with electroacupuncture in the wrist and forearm region, targeting areas supplied by the median nerve itself, as well as needling directly over the median nerve (just before it enters the carpal tunnel) resulted in improvements in pain, as well as improvements as shown on NCS suggesting the nerve was better able to convey nerve signals after acupuncture treatment.
However what was very interesting to observe, were the changes shown in the brain revealed using functional MRI imaging of the part of the sensory cortex of the brain which receives sensory information from the fingers. Before acupuncture treatment, this part of the brain showed a distorted somatotopic representation, in other words the fingers were too far apart and blurred when ‘seen’ through the eyes of an fMRI scanner compared to those who did not have carpal tunnel syndrome. After acupuncture this had reversed. This is one of the first studies to show that acupuncture has a central ‘rewiring effect’ in the brain which may impact on sensory integration and function of the fingers affected by carpal tunnel syndrome.
This study has given further support from a physiological mechanisms point of view to my integration of acupuncture in the treatment of carpal tunnel syndrome here at the clinic. I usually also provide therapeutic exercises, pain management education as well as manual therapy techniques when indicated. This integrated approach has thankfully allowed the majority of my clients suffering with carpal tunnel syndrome to avoid the need for surgery.
1. Maeda Y, Kim H, Kettner N, Kim J, Cina S, Malatesta C, Gerber J, McManus C, Ong-Sutherland R, Mezzacappa P, Libby A, Napadow V. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain. 2017 Apr 1;140(4):914-27.