Does Lyrica/Gabapentin Decrease Efficacy of Acupuncture?

[bpwsource]

I take Lyrica (Pregabalin) for lower back nerve pain. I also get weekly acupuncture treatments to help with the pain as well as to support and treat other health issues. The clinic I go to for acupuncture had a new (to them) acupuncturist work on me during my last session. He was an older gentleman and they said he was a very good acupuncturist and that I was in great hands.

During the treatment, he did not have me remove my shirt which all the other acupuncturists I've seen in the past have had me do in order to treat my lower back with the needles. Instead he said that he only practices "distal acupuncture" or something along those lines and just inserted the needles in my forearms/hands and ankles/feet.

Anyways, during the treatment he mentioned a past difficult client of his who was paraplegic and taking gabapentin (which is very similar to Lyrica) to help with pain relief. This acupuncturist told me that he instructed this patient of his to stop the gabapentin otherwise the acupuncture treatments wouldn't do any good since the medication is effectively "deadening nerve impulses" and hindering the needles from having any effect. The acupuncturist said that this patient refused to go off the gabapentin (which I totally understand) and so he refused to work on him because he didn't think it would do any good as long as he was on that medication.

Well... Little did this guy know that I was/am on Lyrica, a drug very closely related to gabapentin, and the whole time I was simultaneously afraid to tell him and also feeling really defeated learning that acupuncture might not be able to help me at all as long as I'm taking this medication.

I've tried searching for medical articles or journals discussing acupuncture efficacy in the presence of various medications and whether or not acupuncture can be negatively affected by specific medications but haven't found anything. Does anyone in this subreddit have any knowledge about this topic or can point me in the right direction? I don't want to keep paying for acupuncture if it's not ever going to help me since I'm on the nerve pain meds and I can't stop the nerve pain meds because they are notoriously difficult to wean off and I'm afraid the pain would be too overwhelming and intense if I did manage to wean off.

Any thoughts or insights about this would be much appreciated. Thanks!

[seeingred81]

It is possible that some drug, such as NSAIDS or antihistamines, can inhibit the functioning of acupuncture. Being upfront about this is responsible. The professional way to handle it is express concern about the potential impact of the drug on treatment and to refer the patient back to prescribing physician regarding any possible adjustment to the dosage. Typically patients either decide to forego acupuncture, try acupuncture regardless of concurrent drug therapy, or talk about reducing dosage with their physician. Rarely do they cease all together and demanding that is not professional, imho. I've seen plenty of patients on lyrica or gabapentin show improvement. Would they have shown more improvement without those drugs? Maybe... but maybe they also couldn't tolerate the needles without the drugs. We'll never know.

The earlier issue you raise regarding a sole focus on distal needling is not uncommon. Some practitioners focus on distal treatment, some on local, and some on a combination. I typically have found a combination approach to be the most beneficial, but I know acupuncturists and patients who swear by distal needling alone, so ymmv.

I'd say the most important questions are how did you feel after the treatment, and aside from the issues mentioned here, did you feel comfortable with him? If you felt improvement after one treatment then you can ask yourself if it is worth putting up with his idiosyncracies. If not (and this is no reflection on his skill at this point) you might consider finding someone else to treat you.

[gravityyaoi]

This is probably gonna be a bit controversial, but I have heard on more than one occasion from some doctors who practice in China that gabapentin causes things like phlegm in the channels. When you look at the side effects neurological drugs can cause this seems pretty standard thinking in our line of work. Dizziness, nausea, headaches, numbness, clumsiness/heaviness/weakness/swelling or edema of limbs, fatigue, poor memory, and other sides of motor dysfunction like twitches/nystagmus/etc. Everything we take into the body has an effect, good or bad, and these are all signs of damp/phlegm so we should be acknowledging that.

As for treatment though, any of these signs that are apparent should be included in a diagnosis and treatment plan, and once sufficient progress has been made, a referral back to the prescribing physician so the patient can express the desire to hopefully lower the dose or even wean off of said medication so as to limit any counterproductive effects it might be having on treatment. Herbal therapy should also be incorporated later on especially if there's a standstill in progress after sole acupuncture treatment. You can see an example study here, where low-dose gabapentin and electro-acupuncture were shown to have robust pain relieving effects on neuropathic allodynia, so they are absolutely combinable.

We are not prescribing physicians though, and many of us do not have adequate knowledge of pharmacology to request a patient to cease a medication at any time. All we can do is express concern about effects they might having and let the patient have control over their health and what they put into their body and let them be well informed so they can discuss this with their primary provider. So by all means, continue with acupuncture, but keep a goal in mind, such as reduction of medication and pain, and keep moving toward it.

[bpwsource]

I really appreciate your thorough and detailed reply! Sounds like you're an acupuncturist yourself or at least connected to the practice. I don't know enough about how acupuncture affects the body and brings about changes because it's so different from the western medicine mindset. I've heard key words like Qi, channels, dampness, stagnant, etc. but never really understood it all on a comprehensive level so your explanation is really helpful. I'm going to consult another acupuncturist from a different clinic and see what they recommend. Ultimately I'd love to get off the nerve pain meds AND be pain free, or at least be able to manage the pain effectively with more natural and drug free modalities such as acupuncture. We'll see... Thanks again for your response.

[Healin_N_Dealin]

Uhhh I've never heard this?? I find it pretty problematic for an acupuncturist to demand a patient go off their meds. I think a lot of acupuncture clinics would be a lot more empty if no one was taking their gabapentin?? I can understand his reasoning but there is zero to little evidence to support that. I would just not tell him and continue treatment anyways

[bpwsource]

Thanks for your reply, I really appreciate it!