"I didn't want to kill myself," said the 31-year-old, who is originally from Brazil, "but I did consider it. My entire body was in non-stop pain and no drugs could touch it. It was horrible."
Peripheral neuropathy is nerve damage that affects any nerve beyond the brain or spinal cord (the central nervous system). In Maira's case, the damage was a complication of her type 1 diabetes, which she was diagnosed with at the age of 11.
"I didn't understand the seriousness of the diabetes diagnosis at the time," said Maira. "I ate things I wasn't supposed to—I was a bit of a rebel—so my diabetes was poorly controlled."
Maira also developed the eating disorder bulimia as a teenager, which made it even harder to keep her blood sugar levels in check. As she later discovered, this was to have disastrous consequences for her health.
At around age 16, Maira started having uncomfortable tingling sensations in her extremities, especially her feet, and it wasn't long before the whole of both her legs were affected.
"I didn't take much notice of it at first," said Maira, "but then there was a big jump from mild tingling to intense pain, and it spread from my hands and legs to the rest of my body."
Maira went to see her GP, but none of the drugs he prescribed could alleviate the pain, which got so bad she couldn't let anything touch her skin.
"I couldn't even put clothes on," said Maira. "It felt like I was being burnt. My back was the only part of my body that wasn't too bad, so I'd lie on my back naked in my bedroom. I couldn't go to school or see my friends."
When Maira's muscles began to waste away and she felt too weak to lift even her own body weight, she and her mother decided that enough was enough, and booked a trip to Brazil—where Maira's family are from—to consult the doctors there.
"I tried everything my doctor in the UK prescribed, but nothing worked. He didn't even seem to know what I had," Maira said. "Going back to Brazil seemed like the best option."
Despite a challenging journey, Maira made it to Brazil, and the doctor she saw diagnosed her immediately as having diabetic peripheral neuropathy.
He reassured Maira that she would be OK—although Maira later learned that, actually, "he didn't think I was going to make it"—and prescribed a drug treatment she hadn't tried before: antidepressants.
In fact, in addition to treating depression, antidepressants are a mainstay in the treatment of a variety of chronic pain conditions, including peripheral neuropathy, even when depression isn't recognized as playing a role. The drugs do appear to have some painkilling effects—independent of any effects on mood1—although there's a lack of convincing evidence that they're beneficial for neuropathic pain (see box, below).
In her case, Maira's doctor thought they were worth a try, but warned her that they could take a while to work—maybe six months to a year. In the meantime, he suggested she try acupuncture.
Needling the pain away
Although she was highly sceptical of the traditional Chinese technique, Maira was so desperate for pain relief that she decided to book a session straight away.
Thanks to her aunt, who Maira was staying with in Brazil, Maira managed to get an acupuncture appointment the next day—and was completely converted after her first session.
"The pain was considerably more bearable and my energy levels were restored. I had to be carried into the consultation room, but I came out on my own."
After that, Maira started having acupuncture twice a week. "After each session, the pain would reduce and I'd have lots of energy. The pain would start to return after a while, although not to the same level as it was before, then the following session would reduce it a little bit more."
Over the next few months, Maira's pain gradually reduced until it disappeared completely. "I can't pinpoint exactly when it stopped," said Maira, "but after about six months, I could start wearing skirts again and, by nine months, I could wear trousers. I can't tell you how happy I was just to be able to wear trousers!"
Maira believes her recovery was down to a combination of the medication she was taking—the antidepressant duloxetine her doctor had prescribed—and the acupuncture sessions which, she says, had an immediate and cumulative effect. Indeed, experts admit that neuropathic pain is notoriously difficult to treat, and it's unlikely that any one intervention alone would lead to a complete cure, at least when it comes to conventional treatments (see box, left).
Beyond pain relief
After nine months in Brazil, Maira felt well enough to return to the UK and, once back in London, her life began to go back to normal. She completed her A Levels (she'd had to abandon them due to her ill health) and went on study biochemistry at university.
But Maira couldn't get acupuncture out of her head. "I had such a close connection to it. It literally saved my life," said Maira. "My studies were leading me towards a career in the pharmaceutical industry, but I decided to follow a professional path that is genuinely interested in promoting good health."
Not only did this decision change Maira's career path, but it also had a life-changing impact on her health.
She enrolled at the College of Naturopathic Medicine (CNM) to study acupuncture and naturopathy, and one of her teachers there suggested she try a ketogenic diet for her diabetes.
"That changed everything," said Maira. "After two months on the diet, I started menstruating. I had never menstruated before because of the diabetes. I couldn't believe it."
Maira's diabetes also became "well-controlled" for the first time, and she was able to reduce her medication. "I'd always found it hard to keep my blood sugar levels under control," Maira said. "But after two months on the diet, my blood sugar levels were fine."
The ketogenic diet, which is low in carbs and high in fat, is very restrictive, but Maira still sticks to it today and says the effort is well worth the rewards. She also takes a variety of herbs to support her overall health, including Lobelia, which she believes has helped her conquer her bulimia for good.
Maira is now looking ahead to 2019—when she'll be a qualified acupuncturist—and beyond, when she hopes to realize her dream of opening a holistic therapy centre offering a range of complementary and naturopathic therapies.
She's grateful to have a future she can think about now, rather than just focusing on surviving from one day to the next. And she doesn't take anything for granted—not even putting on her clothes.
Antidepressants and neuropathy
Although antidepressants are often prescribed to people suffering from neuropathic pain, their benefits have not been confirmed in large clinical trials.1 In fact, a recent review by the Cochrane Collaboration of studies of amitriptyline, a tricyclic antidepressant that, for years, has been a first-line treatment for neuropathic pain, revealed "no supportive unbiased evidence for a beneficial effect".2 Similarly disappointing conclusions were reached by several other, recent Cochrane reviews of studies of individual antidepressants for neuropathic pain.3
One antidepressant deemed effective by a Cochrane review is duloxetine, which showed "moderate quality evidence" for treating diabetic peripheral neuropathy, at least at higher doses. However, only a small proportion of people achieved an improvement of at least 50 per cent, the researchers found.4
Indeed, neuropathic pain is difficult to treat effectively whichever conventional treatment is used, say Cochrane researchers, "with only a minority of people experiencing a clinically relevant benefit from any one intervention". They also point out that medical treatment for neuropathic pain is no different from that for other chronic pain conditions in that "only a minority of people will achieve satisfactory pain relief".2
Acupuncture and neuropathy
Acupuncture is based on the concept that all living things are infused with a subtle form of energy (qi), and that any disturbances to this energy will result in illness.
Using fine needles at precisely located points throughout the body, the goal of acupuncture is to treat illness by improving the quality, balance and flow of this essential energy.
There's a substantial body of evidence to show that acupuncture works—over and above the placebo effect. Indeed, the technique has proved useful for treating a variety of pain conditions,1 including peripheral neuropathy.
When a recent review and meta-analysis (a pooled analysis of several studies) by researchers at the Oregon Health and Science University, in Portland, analyzed 13 randomized controlled trials (RCTs)—considered the 'gold standard' for clinical trials—of acupuncture for neuropathic pain, they found that acupuncture had a beneficial effect in most of them.
"...[T]he majority of RCTs showed benefit for acupuncture over control in the treatment of diabetic neuropathy, Bell's palsy, and carpal tunnel syndrome," the researchers said.
What's more, acupuncture appeared to have beneficial effects on both sensory and motor nerve function.2
Fact file: type 1 diabetes
•Type 1 diabetes is a condition in which the insulin-producing beta cells in the pancreas are destroyed through an autoimmune process, thereby preventing the body from making enough insulin to control blood sugar (glucose) levels.
•Treatment involves regular insulin injections to keep glucose at normal levels. If blood sugar levels are too high for too long, the result is damage to nerves, blood vessels and organs.
•Eating disorders are more common in people with Type 1 diabetes than in the general population, and can increase the risk of ketoacidosis (a life-threatening buildup of acid in the blood), hospitalization, and long-term complications like retinopathy (damage to the eye's retina) and neuropathy (nerve damage).1
Useful contacts and resources
Association of Traditional Chinese Medicine and Acupuncture UK (ATCM): www.atcm.co.uk; tel: 020 8457 2560
Ketogenic diet: https://authoritynutrition.com/ketogenic-diet-101/
College of Naturopathic Medicine (CNM): www.naturopathy-uk.com;
tel: 01342 410 505