Editor's Note: Pt. 1 of this article appeared in the November issue.
Therapeutic Focus / Goals
The patient received eight acupuncture treatments over the course of five calendar weeks, lying on his right side and prone. Points were selected with both local and whole-body approaches. The acupuncture points applied included ST 4, 6, 7-8 and 36, BL 2, GB 2, 8, 12, 20-21 and 34, Taiyang, neck Jiaji, TW 17 and 20, SI 10, 16 and 18, and LI 4 and 11. Moderate manual stimulation was applied based on patient's tolerance. One-inch, 36-gauge acupuncture filiform needles were used.
Wet cupping and moving cupping also were applied on visits 1-5 and seven. Chinese herbs were suggested when necessary. Two treatments per week were offered for the first weeks and in the week when weaning off pain medication (week four). Self-facial-muscle exercise was suggested to sustain and improve facial muscle tone and function. We also discussed his diet, eliminating spicy food and increasing fruit and vegetable intake.
The treatment goals, established with a joint effort, were: 1) Reduce and eventually eliminate pain; assist in weaning off pain medication; and 2) Regain facial muscle function, improve quality of life.
Follow-Up and Outcomes
The patient was compliant with all forms of his therapy. At the initial visit, the patient reported his pain was gone once the acupuncture needling was completed; and that he had fallen asleep while resting with the needles.
The patient experienced pain reduction starting from the initial visit, becoming sustainable in three treatments. In the second week of the treatment, he had a pain flare-up after a spicy lunch and a dental appointment on the same day. His gabapentin use went up to 900 mg, three times a day, with tramadol at 50 mg, 1-2 times per week as needed.
In week four, after five treatments, the patient started to wean off his pain medication. In week five, after completing seven treatments, the patient reported his pain severity was down to 1/10 from 8/10, and gabapentin use was down to 600 mg, three times a day, without tramadol and other pain medication use.
The patient started to regain facial function in week two and had 75 percent improvement by the end of week three (four treatments). By the end of the last visit, he had experienced more than 90 percent recovery, and was able to drive without any complaints.
Date | Intervention | Result |
| Week #1 06-19-20 | Visit #1: original MYMOP + acupuncture treatment; wet cupping | 1) Pain: pretreatment 8/10, MYMOP score 6. Posttreatment 2-3/10. Gabapentin, 600 mg three times a day; tramadol, 50 mg as needed. 2) Facial function: MYMOP score 5. |
| 06-23-20 | Visit #2: acupuncture treatment; wet cupping | 1) Pain: Post-last-visit pain remained at 2-3/10 for two days, then went up to 7-8/10 for a day. Pretreatment pain level 1-2/10. Posttreatment level 2/10. 2) Facial function had no change. |
| Week #2 06-26-20 | Visit #3: acupuncture treatment; wet cupping | 1) Pain: Post-last-visit pain was gone, then comes and goes at a level of 2-3/10 for two days. Yesterday after spicy foods for lunch and dental work, pain went back up to 8/10. Gabapentin increased to 900 mg three times a day. Took tramadol two times. 2) Facial function starting to recover: eye is closing and blinking closer to normal, can drink water w/o leaking and able to blow air with mouth sealed. |
| 06-30-20 | Visit #4: acupuncture treatment; wet cupping | 1) Pain: Post-last-visit pain remained around 2-3/10. Able to work in the yard and drive. 2) Facial function recovered more. |
| Week #3 07-03-20 | Visit #5: acupuncture treatment; wet cupping; Chinese herb (Long Dan Xie Gan Tang) for 12 days | 1) Pain: Post-last-visit pain in head was gone, but experienced shooting pain down to the neck and scapular for a couple of days after treatment. 2) Facial function 75% recovered. |
| Week #4 07-10-20 | Visit #6: acupuncture treatment | 1) Pain: Post-last-visit pain was gone, then comes and goes at a very low level; almost not noticeable (2/10). Gabapentin down to 600 mg / 600 mg / 900 mg. No tramadol use. 2) Facial function is 80% recovered. |
| Week #5 07-14-20 | Visit #7: acupuncture treatment; wet cupping | 1) Pain: Post-last-visit pain was gone; then comes and goes at a very low level. Almost not noticeable (2/10). Gabapentin down to 600 mg three times a day, with aspirin a couple times over the past few days. No tramadol. 2) Facial function is 90% recovered. |
| 07-17-20 | Visit #8 acupuncture treatment; follow-up; MYMOP | 1) Post-last-treatment pain was not noticeable (1/10). MYMOP score was at second lowest (1). MYMOP score related to his inability to drive was rated at the high level of 1. Gabapentin down to 600 mg, three times a day; no aspirin or tramadol. 2) Facial function is more than 90% recovered. MYMOP score 1. |
Discussion / Key Takeaways
A PubMed search found only two case reports and no systematic reviews regarding the efficacy and safety of acupuncture for Ramsay Hunt syndrome.5,7 Acupuncture and cupping have a long history as effective traditional Chinese medicine therapy for shingles and Bell's palsy.6 I approached this case in a similar fashion, but treated it as a more severe version.
The patient's outcome is encouraging. His pain was under control within two weeks and facial muscle function recovered to more than 90 percent within a month after initial acupuncture treatment. There was slight relapse of the pain after a spicy lunch in combination with a dentist appointment.
While the patient's tongue continued to display yellow, greasy coating, and he reported cravings for food, this may suggest damp heat pathogen is strong and lasts longer in Ramsay Hunt syndrome. After modifying the patient's diet and adding Chinese herbs, the condition was better controlled again.
The key takeaways from this case, in my clinical opinion, are the following:
References (for Both Parts)
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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