Being Alive Newsletter, Being Alive/Los Angeles - June 1993
Mark Denzin

The causes of this disease are uncertain, though some researchers feel it may relate to HIV infection of nerve root ganglia. This, however, has not been documented. CMV may be responsible in some cases. The prognosis is generally poor, although a few patients seem to respond to ganciclovir.

Burning, aching and the sensation of bruising are also known side effects of the antiretroviral nucleosides ddI and ddC. The most common toxicity of ddI, after diarrhea, is painful, tingling, burning, aching peripheral neuropathy of the legs and feet, occurring early in treatment. Discomfort may be disabling, prohibiting walking, disturbing sleep and making the activities of daily life difficult. DDC causes the same adverse reaction and, with both drugs, the symptoms may worsen even after the dosage is lowered or the drugs discontinued.

In my own personal observation of hundreds of HIV patients, peripheral neuropathy is almost always associated with drug-related toxicities. Aside from ddI and ddC-related neuropathies, I have observed many patients who present neuropathies shortly after initiating high or prolonged doses of AZT, as well as Septra, an antibiotic frequently prescribed for infections and sometimes as a prophylactic for PCP. The burning, aching sensations of neuropathies of the legs and feet are one of the most painful and debilitating conditions associated with AIDS.

In Chinese medicine, nerve pain is caused by disharmony in the liver, affecting the nerves. When the excessive Yang of the liver flares up, the nerves are injured and feel as if on fire. Treatment is directed toward purging the liver fire, protecting the kidney essence and heart Yin, and reducing the pain with appropriate herbs. In most cases, herbs to remove heat toxin from the blood are also appropriate.

Acupuncture therapy may be effective if the neuropathy is of recent onset. An aggressive treatment plan is indicated, 2 to 3 acupuncture treatments per week, 12 to 18 treatments in all, followed by rest and a second course of treatment as needed.

Recent research has shown that capsaicin (the active ingredient in hot peppers) cream massaged into painful areas is beneficial for patients with diabetic neuropathy and renal failure-related neuropathy. In my own practice, I have found capsaicin cream (available as Zostrix from GenDerm Corporation) in combination with acupuncture, massage and other medicinal herbs to be helpful for patients with extremely painful neuropathies. DDI and ddC, however, must be eliminated or prescribed in lower dosages for acupuncture therapy to be of any benefit.

(Mark Denzin is a licensed acupuncturist and physician of Chinese medicine, practicing in San Francisco. He may be reached at 415.252.9040. Reprinted from the San Francisco Sentinel, April 29, 1993.)
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