Neuropathy "The Painful Enigma"

Tinnitus is defined as the perception of sound without an external acoustic stimulus. It is a prevalent complaint in ENT offices, but the etiology of this condition has not yet been elucidated fully. However, it is believed that the root cause of the sound is perceived without any external stimulation is due to abnormal neural activity along the hearing path from the cochlear apparatus to the auditory cortex. In addition, tinnitus accompanies a wide array of conditions like sleep disturbances, stress, and reduced work efficiency. Furthermore, its treatment is complex, and 5-15% of those patients with tinnitus report that the symptoms are still present. Therefore, alternative therapies such as supplements and acupuncture have been proposed to reduce tinnitus symptoms positively.

Acupuncture Therapy as Tinnitus Treatment:

Acupuncture as tinnitus treatment has been extensively reported in books. Indeed, acupuncture’s effectiveness in treating tinnitus relies on the electric stimulations promoted by the needles, which initiates action potentials to rebalance the body’s systems. 

A study to determine acupuncture efficacy to reduce tinnitus symptoms was performed in 105 patients. This study compared the effects of two types of acupuncture, verum acupuncture and sham acupuncture, for five weeks, twice weekly. In addition, the study used the Tinnitus Handicap Inventory (THI) questionnaire and the visual analog scale to measure the treatment’s efficacy.

THI: 

The Tinnitus Handicap Inventory is a survey of 25 questions that are answered by the patient with a scoring system of 3 options:

Yes (4 points)

Sometimes (2 points) 

No (0 points)

After answering the 25 items, the points are added, and the result classifies the degree of tinnitus as grade 1 (0–16 points), grade 2 (18–36 points), grade 3 (38–56 points), grade 4 (58–76 points), or grade 5 (78–100 points). This survey is associated with the quality of life of the patient.

VSA

The Visual Analog Scale is a verbally administered scale to determine the degree of discomfort caused by tinnitus. It is ranged by scores starting with 0, indicating no discomfort, up to 10, which means an unbearable amount of pain.

Furthermore, this study reported that the group with the lowest THI and VAS scores was the one who received verum acupuncture. Additionally, this study reported a three-month follow-up, which determined that the tinnitus symptoms increased after stopping the acupuncture sessions.

One of the most exciting findings in tinnitus acupuncture treatment is that the VAS score decreases from 9.56 to 2.88. This same finding is reported by many authors who used the THI score in their studies. Nevertheless, this study concluded that acupuncture therapy is highly effective in reducing tinnitus symptoms, and it can potentially increase the patient’s quality of life. However, the changes promoted by this treatment are temporary and seem to diminish over time. 

Ginkgo biloba:

Over time pharmaceutical treatments have been used to diminish the severity of tinnitus. Indeed, medications like calcium channel blockers, vasodilators, muscle relaxants, anticonvulsants, antihistamines, anesthetics, and even barbiturates form part of the tinnitus treatment. However, these medications have shown little to no effects when compared with placebo. 

Once again, the lack of an etiology makes tinnitus hard to treat. However, new research has pointed to oxidative stress as one of the proposed mechanisms for the development of tinnitus. In addition, the increase of glutamate as an excitatory neurotransmitter in combination with neurotoxicity leads to the inflammation and necrosis of dendrites. Consequently, dendrite damage and inflammation of the afferent cochlear Corti organ cells is due to the production of free radicals.

The literature strongly supports the use of Gingko Biloba to treat tinnitus due to its varied bioactive constituents such as phytochemicals including alkanes, lipids, sterols, benzoids, carotenoids, phenylpropanoids, carbohydrates, flavonoids, and terpenoids. Furthermore, the Gingko Biloba acts like a monoamine-oxidase inhibitor (MAOI), improving tinnitus symptoms caused by ischemia. This mechanism of action is mainly due to myricetin, quercetin, ginkgolide, and bilobalide terpenoids. In conclusion, Gingko Biloba can reduce tinnitus symptoms by regulating vascular tone, and it acts as a scavenging agent of primary and secondary free radicals.

Despite all the medical research in tinnitus, no recommended treatment can reduce all the symptoms. Indeed, this is associated with tinnitus being a multifactorial disease and should be carefully evaluated to determine its treatment. The conclusion of many experts on this topic determines that the treatment should be a combination of sustainable and secure treatments. Therefore, Ginkgo Biloba and acupuncture studies can be used together to improve tinnitus outcomes in a conservative measure. – Ana Paola Rodríguez Arciniega, MS

References:

Mahmoudian Sani, M. R., Hashemzadeh-Chaleshtori, M., Asadi-Samani, M., & Yang, Q. (2017). Ginkgo biloba in the treatment of tinnitus: An updated literature review. International Tinnitus Journal, 21(1), 58-62.

Kuzucu, I., & Karaca, O. (2020). Acupuncture Treatment in Patients with Chronic Subjective Tinnitus: A Prospective, Randomized Study. Medical acupuncture, 32(1), 24–28. https://doi.org/10.1089/acu.2019.1367

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General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

More individuals are reporting extreme levels of stress. Studies indicate that an increasing number of individuals are feeling worried, anxious, or depressed regularly from various stressors. Maintaining the body's health includes:

• Following a balanced diet
• Getting enough exercise
• Taking vitamins or supplements to ensure the body gets what it needs for optimal function.

However, research has found that a sudden increase in stress, specifically stress associated with anger, can trigger:

• Arrhythmias
• Heart attacks
• Sudden death

This type of stress can affect individuals that did not know they had heart disease. Intense short-term stress can have dangerous effects on the body's health, leading to chronic stress. Chronic stress continues at a low level for weeks, months, or years. It can significantly change the way the body functions. Stress management is crucial for overall well-being. Learning how to handle stress properly is the goal.

Poor Stress Management

When stress hits, it triggers the brain to release various hormones. These hormones increase heart rate and raise blood pressure. This comes from evolution that helped early humans escape from predators and stay safe from different types of physical danger. This same stress reaction is what we go through; however, it is not to escape danger but to deal with work, family, school, commuting, social issues, etc. And when the stress response happens regularly, it can have serious and long-term effects on the body's ability to function properly. Stress includes mental, behavioral, and physical symptoms. The most familiar effects of stress are related to mood. Mood changes that can result from chronic low-level stress include:

• Feelings overwhelmed
• Increased anxiety
• Generalized anxiety that is not connected with anything specific
• Unmotivated or unfocused
• Sadness
• Depression
• Irritability
• Impatience
• Unusually quick to anger
• Restlessness

These mood changes can be tied to changes in behavior. The following behaviors are associated with increased stress levels:

• Alcohol and/or drug abuse
• Starting or increasing tobacco use
• Eating changes - undereating or overeating
• Withdrawing from friends and family
• Avoiding social interaction
• Little to no physical activity

Physical effects that are associated with long-term stress.

Chronic stress that lasts for a long period can affect the whole body. The immune system, digestive system, sleep cycles, etc. Physical symptoms include:

• Tension in the neck and back
• Persistent headaches
• Stomach aches
• Constant fatigue, even after waking up
• Sleeping pattern changes
• Insomnia
• Muscle pain
• Changes in libido
• Being more prone to infections because of a weakened immune system
• Chest pain

Learning Healthy Stress Management

Mental health is now an important part of living a healthy life. Stress comes from all kinds of different places. We can’t always change these moments, but we can change our reactions to reduce the negative effects and results. To manage stress, it is important to know what is causing it.

• It could be an argument with a boss, co-worker, family member, or significant other.
• Work deadlines
• School grades, teachers, kids, etc
• Bills
• Repairs

Clearly identifying the main stressors will help individuals anticipate them and form a plan. There are different ways of dealing with it. The different strategies need to be researched and tried by individuals to see what works for them. Think about what helps the mind and body relax and unwind. A few recommended ways include:

• Watching favorite shows or movies
• Listening to music
• Breathing techniques
• Spend time with friends or family
• Make time for yourself to do something you love - alone time
• Unplug from devices like phones, tablets, or computer
• Play a sport
• Practice yoga
• Physical activity
• Take a nature hike
• Write, paint, sculpt, knit, sew, crafts, make music, play instrument/s - real media, or digital.
• Meditate and practice mindfulness techniques

These are strategies that can be incorporated into regular daily life. Be sure to set time aside to focus on mental wellbeing. Learn to recognize the signs when getting overwhelmed. Don’t hesitate to ask for help when needed. This can be a support system or mental health professional. This is to empower individuals to take better care of themselves in both body and mind.

Body Composition

Setting Attainable Goals

Individuals that have trouble achieving health goals might want to look at the goals themselves. Individuals typically have a general idea of their fitness journey. However, it is hard to reach those goals without a map. Losing weight or getting healthy is the goal, but these goals are not measurable. This is too broad that can be different things to different people. Trying to accomplish a vague goal makes it hard to plan, making it happen, or seeing progress. A recommended strategy for goal setting is to use the SMART system. The acronym stands for:

• Specific
• Measurable
• Attainable
• Realistic
• Timed

When goals fall into these parameters, it provides a clear picture of what is trying to get accomplished and plan accordingly. An example could be: An individual will work out at home or the gym for one hour, five days a week for one month. This is a specific and measurable goal when compared to I’m going to work out more. This provides clear guidelines of what needs to happen to achieve success.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Bailey, Ryan R. “Goal Setting and Action Planning for Health Behavior Change.” American journal of lifestyle medicine vol. 13,6 615-618. 13 Sep. 2017, doi:10.1177/1559827617729634

Carlson, Linda E et al. “Integrative Approaches to Stress Management.” Cancer journal (Sudbury, Mass.) vol. 25,5 (2019): 329-336. doi:10.1097/PPO.0000000000000395

Jamison, J R. “Stress management: an exploratory study of chiropractic patients.” Journal of manipulative and physiological therapeutics vol. 23,1 (2000): 32-6. doi:10.1016/s0161-4754(00)90111-8

Jamison, J. “Stress: the chiropractic patients' self-perceptions.” Journal of manipulative and physiological therapeutics vol. 22,6 (1999): 395-8. doi:10.1016/s0161-4754(99)70085-0