Hi Alyssa!

What is your goal in utilizing dry needling with this patient?  Management of neuropathic pain?

This population is definitely not in my area of expertise. However, I do know that in demyelinating conditions, especially progressive ones, you can make a person regress by introducing too much stress to their system.  If you were to needle this patient, I'd recommend getting physical consent first. 

If the physician agreed to my treatment plan, I would opt for a conservative dosage.  Primarily superficial needling of the homeostatic points avoiding any areas of sensory denervation and progress to basic deep needling w/o manipulation as needed. 

If the patient already has easily fatigued muscles due to their demyelinating condition, a really low frequency (1 hz) would be recommended for estim to reduce fatiguability but still enhance needling effects.

I did find a case study where they utilized acupuncture to treat neuropathic pain in an individual with CIDP.  Sounds like they had positive results. I couldn't get access to the full study but provided the link to the abstract below. 

https://www.researchgate.net/publication/280208108_Neuropathic_Pain_Associated_with_Chronic_Inflammatory_Demyelinating_Polyneuropathy_Treated_with_Acupuncture.  

Keep me updated on your case! 

Natalie 

Thanks for your thoughts!

I was thinking of estim to provide some gentle low level input to the nerves and to encourage good blood flow. Most of his pain is proximal in the lumbar spine and glutes; he does have typical degenerative changes in addition to the CIDP with marked stenosis at L5/S1.

My biggest concern with needling is the dosing but I found some studies with needling in MS so wondered if it was worth considering. 

Thanks again!