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.
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:
- Acupuncture with wet cupping is effective for Ramsay Hunt syndrome.
- The treatment approach can be similar to that used for treating shingles and Bell's palsy.
- Damp heat pathogen is more severe and lasts longer in Ramsay Hunt.
- Dietary modification and Chinese herbal medicine are important in the treatment plan.
References (for Both Parts)
- Bell's Palsy and Ramsay Hunt Syndrome. Tampa Bay Hearing and Balance Center, 2020.
- Tan R, et al. The efficacy and safety of acupuncture for Ramsay Hunt syndrome: a protocol for systematic review. Medicine, 2020;99(13):e19582.
- Ramsay Hunt Syndrome. Mayo Clinic, 2020.
- Mancini P, et al. Prognostic factors of Bell's palsy: multivariate analysis of electrophysiological findings. The Laryngoscope, 2014;124(11):2598–2605.
- Giralt Sampedro I, et al. A severe case of Ramsay Hunt syndrome treated with acupuncture and related techniques. Compl Ther Clin Pract, 2020;39:101119.
- Cao H, Li X, Liu J. An updated review of the efficacy of cupping therapy. PLOS One, 2012;7(2):e31793.
- Zheng RW, et al. A case study of Ramsay Hunt Syndrome in conjunction with cranial polyneuritis. Medicine, 2017;96(47): e8833.
Wei (Vivien) Zhang, licensed acupuncturist and certified Chinese herbalist, is the first acupuncturist at the Department of Anesthesia, Critical Care and Pain Medicine of Mass. General Hospital; and also serves as a medical staff member of Emerson Hospital. As her new endeavor, she is working on integrative treatments for autism and other brain development-related conditions with Dr. Martha Herbert, a pediatric neurologist and brain development researcher, and Dr. June Kong, a primary care physician. Wei was a professor of New England School of Acupuncture from 1999-2008 before dedicating herself to full-time clinical care. She received her medical degree from Beijing University of Traditional Chinese Medicine, and master's degree in nutrition and health promotion from Simmons College.