Tuesday, 30 September 2014

Substitutes For Lidocaine Patches For Kids With Neuropathy

Today's post from ask.metafilter.com (see link below) is taken from a forum discussion on finding an alternative for lidocaine patches to use with children living with neuropathy. Here the aim is to find cheaper options but lidocaine patches can also be too strong for smaller children. The responses to the original question are shown below. We often forget that children can also suffer from neuropathy and although it is less frequent, the pain and sicomfort can be every bit as difficult to deal with. Children aren't as able to rationalise their pain as adults are, so treating them 'kindly' with our medications is very important.

Lidocaine patch substitute for child's neuropathy.
September 25, 2014 
 

Looking for a cool (as in chilly), inexpensive, gel-like patch to replace Lidocaine patches for a child with nerve pain.

Little Orsonet, who is 7, has small nerve fiber neuropathy which manifests as a burning sensation in her feet. The pain varies in intensity and is not present all the time. Her neurologist just prescribed Lidocaine patches, which we tried today and she loves them.

Yeah! However, they are $8 a patch ($240 for a month's supply of the generic) and Medicaid doesn't pay for them. She's on Medicaid because she was adopted through foster care. I have a hunch that what she likes about them is the cool gooeyness (sp?) rather than the actual lidocaine and I'd like to test that hypothesis by finding a patch that I can buy over-the-counter for, hopefully, a lot less money.

I found this on Amazon, but it's basically the same price. I've looked at pain patches, but some of them contain aspirin (a no-no) and most of them appear to lack the cooling gel goodness. Anyone have any suggestions? A worried mom appreciates any input.


If it's relevant, she takes 5 ML of Gabapentin twice a day and Tramadol as needed. posted by orsonet to Health; Fitness (11 answers total) 3 users marked this as a favorite

They aren't super cheap, but they are cheaper than that and can be reused: lansinoh soothing gel breast pads intended for nursing mothers.
posted by bq at 5:48 PM on September 25 [1 favorite]

Will she be walking on them (or at least walking on them a lot), or is it something she does with her feet up?
posted by Lyn Never at 5:56 PM on September 25

What about Biofreeze? Its not a patch, but I would use those exact adjectives (cool and gooey) to describe the sensation.
posted by Nickel Pickle at 5:57 PM on September 25 [1 favorite]

She doesn't need to be able to walk on them.
posted by orsonet at 6:00 PM on September 25

there are menthol gel patches you can buy in the drugstore, and they are indeed cool and gooey.
posted by The Elusive Architeuthis at 6:03 PM on September 25 [1 favorite]

I immediately thought of BioFreeze too. I have chronic wrist pain and use it frequently and it sounds like what you describe.
posted by kbanas at 6:09 PM on September 25 [1 favorite]

FWIW the ones you linked to are $6.99 for a four-pack, not per patch.
posted by celtalitha at 8:05 PM on September 25 [1 favorite]

The methanol gel patches that I like are Salon Pas. They are pretty cheap, and they give a cool feeling.
posted by heathrowga at 8:08 PM on September 25 [1 favorite]

Thanks everyone!
posted by orsonet at 3:53 AM on September 26 


http://ask.metafilter.com/269052/Lidocaine-patch-substitute-for-childs-neuropathy

Monday, 29 September 2014

Nutritional Advice For Neuropathy

Today's post from chiroeco.com (see link below) looks at the value of nutrition and nutrition supplements in helping to control the worst aspects of neuropathy. Either used together with pain medications (as mentioned below) or separately, there are certain nutrients, vitamins and minerals that will help restore nerve function. However, just as with drugs, there are no cures here, just options to help your system stay as healthy as possible. Worth a read but bear in mind that the cost of these things can be high.

Natural hope for neuropathy 
Research supports nutritional remedies for a common diabetic ailment. 

by Terry Lemerond
Pins and needles. A burning that begins in the feet and legs and progresses to the arms. An unpleasant crawling sensation that travels under the skin. Stabbing, intense leg pain that keeps one awake at night. The symptoms of peripheral neuropathy can develop suddenly or progress slowly, sometimes over years. Neuropathy is the most common complication of diabetes, affecting 50 percent of patients with Type 1 or 2.1

Prescription drugs, including anti-depressants, anti-seizure medications, pain relievers, and anti-nausea drugs are used in the treatment of neuropathy. But none of them result in repairing delicate blood vessels and nerve endings or helping the body learn to properly metabolize sugar again. Fortunately, nutrition research has found that along with lifestyle choices, specific nutrients can relieve — and even reverse — the symptoms and causes of neuropathy.

Bioactive B vitamins

B vitamins are crucial for blood sugar metabolism and proper nerve function. Inadequate or deficient levels of B vitamins are often noted in patients with diabetes. Replenishing this vitamin not only improves blood sugar control but also reduces inflammatory homocysteine levels and relieves the pain of neuropathy.

Clinical effects in neuropathy treatment may be improved with the use of the active forms of specific B vitamins, which do not require conversion into a usable form by the liver. Pyridoxal-5'-phosphate (vitamin B6), methylcobalamin (vitamin B12), and folate (vitamin B9) are examples of B vitamins in their active forms.

A study of epidermal nerve fiber density in patients with Type 2 diabetes treated with an oral combination of vitamin B9, B12, and B6 reported that nearly 75 percent of patients showed an increase in nerve fiber density, and slightly more than 80 percent of patients experienced reduced frequency and intensity of burning, tingling, and abnormal sensitivity to touch.2

Benfotiamine is a fat-soluble form of vitamin B1 that is retained in the body at five times the concentrations of standard water-soluble thiamine. A scientific study at the University of Florida College of Medicine showed that benfotiamine prevented glucose toxicity and brought elevated blood sugar levels down to normal.3

This form of vitamin B1 has also been clinically proven to reduce pain and complications of diabetic neuropathy, the “pins and needles” and “tingling” sensation that people with diabetes may feel in their feet and legs.

In a Serbian clinical study, patients with diabetes were treated with a combination of benfotiamine and vitamin B6 for 45 days. At the end of the study, just over 85 percent of the patients reported a significant reduction in overall pain. Hyperpathia (pain due to the loss of muscle fibers) was also reduced from 90 percent of patients to around 30 percent. The researchers felt that these results “confirmed that benfotiamine was a good starting choice for the treatment of diabetic polyneuropathy.”4

Chelated minerals

Chromium is essential for blood sugar metabolism. It activates insulin receptors, helping prevent the buildup of glucose in the bloodstream. In one clinical study, individuals taking chromium reduced their fasting blood glucose level from an average of 197 to 103 in just three months, and their triglyceride and LDL cholesterol numbers were brought down to healthier levels as well.5

Zinc stabilizes pancreatic storage of insulin and inhibits oxidative stress that promotes insulin resistance and diabetes. Research published in Diabetes, Obesity, and Metabolism reported that reduced zinc levels in the pancreas are associated with diabetes, and proper amounts of this mineral tend to keep insulin levels on an even keel.6,7

Although many forms of minerals are available as supplements, amino acid chelated forms are more easily and efficiently used by the body. The bonding of a mineral to the amino acid glycine creates a mineral form that passes through the intestinal wall and is incorporated into the blood stream more efficiently.

Blood sugar lowering nutrients

Alpha lipoic acid can boost levels of glutathione to protect delicate nerves from oxidative damage. In a review by researchers at Oregon State University, the evidence shows that alpha lipoic acid

(ALA) fights diabetic neuropathy by helping to normalize the muscles’ blood sugar intake, which reduces the pain and tingling of peripheral nerves. Other laboratory research published in Diabetes found that ALA reversed markers of diabetic neuropathy and improved peripheral nerve function.8,9

Boswellia (Boswellia serrata) is one of nature’s most powerful anti-inflamma- tory medicines. It is a specific inhibitor of 5-LOX, an enzyme that activates inflammation-inducing leukotrienes. One of the biggest challenges for people with diabetes and nerve damage is the pain and inflammation that accompany the condition.10,11

The most active and beneficial of the boswellic acids is known as AKBA (acetyl-11-keto-?-boswellic acid). However, not all boswellia extracts are equally beneficial. For example: In unstandardized boswellia products, AKBA levels can be quite low — sometimes as small as 1 percent. To make sure you get the best product, look for boswellia standardized to at least 10 percent AKBA. Additionally, unstandardized boswellia contains a pro-inflammatory compound called beta boswellic acid (BBA), which must be reduced to less than 5 percent for optimal effectiveness.

Heal naturally

There is a growing awareness of the benefits of nutrients for slowing or reversing disease.

For example: Following the clinical trial published in Diabetes Research and Clinical Practice, researchers concluded that micronutrients, including B1, B2, B6, B12, folate, and zinc could “ameliorate diabetic neuropathy symptoms.”12 These interventions are starting to garner wider acceptance as linchpins for effective treatment protocols.

The damage done by elevated blood sugar levels (as seen with Type 2 diabetes) happens over time. The disease is not always noticed at first. But through a sensible exercise regimen, disciplined eating habits, and well-guided use of nutrient ingredients, the pain, numbness, and tingling of neuropathy can be overcome.

Terry Lemerond is a natural health expert with more than 40 years’ experience. He has owned health food stores, founded dietary supplement companies, and formulated more than 400 products. A published author, he appears on radio, television and is a frequent guest speaker. He can be contacted through europharmausa.com.

References


1Quan D, Lin HC, Khardori R, et al. Diabetic Neuropathy: Practice Essentials. Medscape. emedicine.medscape.com/article/1170337-overview. Updated May 29, 2013. Accessed June 17, 2014.

2Jacobs AM, Cheng D. Management of diabetic small-fiber neuropathy with combination L-methylfolate, methylcobalamin, and pyridoxal 5'-phosphate. Rev Neurol Dis. 2011;8(1-2):39-47.

3Oh SH, et al. Detection of transketolase in bone marrow-derived insulin-producing cells: benfotiamine enhances insulin synthesis and glucose metabolism. Stem Cells Dev. 2009;18(1):37-46.

4Nikoli? A, Kacar A, Lavrni? D, Basta I, Apostolski S. The effect of benfothiamine in the therapy of diabetic polyneuropathy. Srp Arh Celok Lek. 2009;137(11-12):594–600.

5Sharma S, Agrawal RP, Choudhary M, Jain S, Goyal S, Agarwal V. Beneficial effect of chromium supplementation on glucose, HbA(1)C and lipid variables in individuals with newly onset type-2 diabetes. J Trace Elem Med Biol. E-pub ahead of print; May 11, 2011.

6Wijesekara N, Chimienti F, Wheeler MB. Zinc, a regulator of islet function and glucose homeostasis. Diabetes Obes Metab. 2009;11 Suppl 4:202-14.

7Senapati A. Zinc deficiency and the prolonged accumulation of zinc in wounds. Br J Surg. 1985;72(7):583-4.

8Shay KP, Moreau RF, Smith EJ, Smith AR, Hagen TM. Alpha-lipoic acid as a dietary supplement: molecular mechanisms and therapeutic potential. Biochim Biophys Acta. 2009;1790(10):1149-60.

9Kishi Y, Schmelzer JD, Yao JK, et al. Alpha-lipoic acid: effect on glucose uptake, sorbitol pathway, and energy metabolism in experimental diabetic neuropathy. Diabetes. 1999;48(10):2045-51.

10Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006;72(12):1100-16.

11Poeckel D, Tausch L, Altmann A, Induction of central signalling pathways and select functional effects in human platelets by beta-boswellic acid. Br J Pharmacol. 2005;146(4):514-24

12Farvid MS, et al. Improving neuropathy scores in type 2 diabetic patients using micronutrients supplementation. Diabetes Res Clin Pract. 2011;93(1):86-94.

http://www.chiroeco.com/news/chiro-article.php?id=15478

Sunday, 28 September 2014

Chronic Pain In The States (Vid)


Today's 5 minute video is an interview with Dr Paul Christo, who is a well-known pain expert. He addresses the problem of chronic pain in the USA which is pretty much repeated throughout the 1st world. He concentrates on improving people's knowledge of pain and what to do when it becomes a problem. His best advice is to form a relationship with your doctor so that you can both work on the problem together to achieve the best outcomes.

Chronic Pain in America - Dr. Paul Christo on Lifetime Television's The Balancing Act Show
Dr. Paul Christo Published on 6 Jun 2013

Dr. Paul Christo, leading pain expert from The John Hopkins Hospital and host of the radio show Aches and Gains, appears on The Balancing Act to talk about the epidemic of chronic pain in America, and where pain sufferers can go for relief.




 https://www.youtube.com/watch?v=apmsF1hhS1c#t=185

Saturday, 27 September 2014

Neuropathy And Cold Laser Treatment

Today's post from cdapress.com (see link below) makes the point that some neuropathies are easier to treat than others and that there are various options available for treatment of neuropathies caused by pressure in the spine. Not everybody agrees that chiropractic treatments are helpful but the idea of cold laser treatment sounds interesting. Maybe worth discussing with your neurologist. Short but interesting post.
 
Cold laser treatment for neuropathy
DR. WAYNE FITCHER/Natural Spine Solutions Posted: Wednesday, September 3, 2014

Although nerve damage can be tricky to treat, some forms of the condition are easier to treat than others. Peripheral neuropathy caused by diseases such as multiple sclerosis, lupus, AIDS and cancer are the most difficult. However, a significant percentage of cases are due to more easily treatable causes such as vitamin deficiencies and compressed or trapped nerves. All of the above can be helped to a lesser or greater extent by applying a variety of treatment options; among the most useful of these are an improvement in diet, and receiving regular chiropractic care.

Getting oxygen and nutrients to damaged nerves is key in treating peripheral neuropathy, which is why eating plenty of fruits and vegetables rich in vitamins and antioxidants is important. These will feed the nerves and help to destroy the free radicals that cause damage to the body's cells, leading to an interference with nerve transmission.

When the vertebral joints of the spine begin to degenerate (which is common as we get older), they can press on the roots of the spinal nerves, causing the classic symptoms of neuropathy. Chiropractors are trained to relieve this pressure, performing spinal adjustments to bring the vertebrae back into alignment, releasing trapped or compressed nerves.

According to a study published in the British Medical Journal in 2004, chiropractic adjustments "with or without exercise, improved symptoms more than medical care did after both 3 and 12 months."

Along with chiropractic care, cold laser therapy has been shown to effectively reduce painful symptoms.

Recent research has shown that cold laser therapy can help treat the underlying causes of neuropathy and help with symptom management.

Cold laser therapy helps by actually stimulating microcirculation around the nerve fibers, which increases blood flow to the nerves and helps to heal and reduce neuropathic pain. Laser light energy penetrates the skin and stimulates increased oxygen on a cellular level. This increase in microcirculation around the nerve has been shown to help regenerate fibers and help heal peripheral nerves. Cold laser therapy is painless and has been proven to decrease neuropathy and inflammation, and aid in the healing of wounds and tendons.

Dr. Wayne Fichter, D.C., is the lead doctor at Natural Spine Solutions, with more than 15 years of experience treating families. He also has been the lead doctor in handling serious neck and back problems through non-surgical spinal decompression. Call for all spinal and wellness needs. (208) 966-4425.

http://www.cdapress.com/news/healthy_community/article_baad2697-b0de-5224-bb01-5952a67626f5.html

Friday, 26 September 2014

Balance Issues With Neuropathy

Today's post from absolutefootcarelv.com (see link below) looks at a common problem for people living with neuropathy and that is maintaining balance on various surfaces. You think you have everything under control and then a sudden loss of balance can take you unawares and lead to potential injury. Yoy have to try to be aware of your footing at all times but this is often easier said than done. This short article gives some useful tips and therapies you can carry out at home to improve your balance. Worth trying out.
 
Don’t Take Balance for Granted
Dr. Noah Levine Sept. 22

Every afternoon, Las Vegas witnesses the Fall of Atlantis. It’s true—every hour, from 11 AM to close at Caesars Forum Shops, a spectacular fountain show with lights, pyrotechnics, animatronics, and of course water spouts reenacts the dramatic fall of the mythical kingdom. It’s a fun, 11-minute show that’ll entertain your whole family. Of course, if you have diabetes, Atlantis isn’t the only fall that should concern you. Your own sense of balance might be compromised by the disease.
 

Diabetes slowly degrades your nerves, inhibiting them. Your feet are particularly susceptible, so it’s fairly common for diabetics to develop peripheral neuropathy, especially if you struggle with controlling your blood sugar levels. The problem is that this also weakens your sense of balance. Numbness in your lower limbs increases your odds of falling by having weak muscles that are unable to maintain your balance.

Exercises and therapy to improve your balance, however, can help you stay on your feet and avoid injuries from falling. Here are a few simple ones you can do at home:

Heel-toe walking – Walk in a straight line across a room, carefully setting your heel down first, then lowering the ball of the foot and the toes. Set the next step directly in front of the first, so the heel of that foot touches the toes of your other.

One-leg balancing – Stand on one leg for 30 seconds without holding anything for support. When that gets easier, extend your time or close your eyes.

Unstable surface balancing
– Balance on one foot while standing on a pillow, mini trampoline, or some other soft surface. You may need to start while holding a chair, then slowly let go and try to balance for 30 seconds.

Ankle circles
– Sitting with your feet in front of you, rotate your feet at the ankles in clockwise and counterclockwise circles, 10 rotations in each direction.
Heel raises – Stand with your feet apart. Slowly rise up on your toes, then lower to flat. Repeat 10 – 20 times. Your sense of balance is important for your mobility. It’s hard to walk around and be active if you can’t stay upright! Don’t take your balance for granted, particularly if you have diabetes.

http://www.absolutefootcarelv.com/blog/dont-take-balance-granted/

Thursday, 25 September 2014

My Diabetic Neuropathy: A Personal Account

Today's post from kerrykobashi.com (see link below) talks about his discovery that his diabetes had led to neuropathy and how he felt about that realisation. It's always interesting to read about other people's personal experiences with neuropathy because it helps us put our own into perspective. Whatever the cause of your neuropathy, I'm sure you will recognise elements of this story.

I Got Diabetic Neuropathy.
Published on September 18th, 2014 | by Kerry Kobashi 
 
For the past 4 months I’ve noticed my body screaming out in pain during the night. When lying down in bed, I have been getting harsh, quick prick like pain in my thighs, legs, and toes. Sometimes, I get it in my hands and arms but on less occasion. They come randomly, and when they hit, it freaking hurts.

During the day, when I walk, my legs and thighs would get really weak, sore and tired. Looking at myself physically in the mirror, I look in good shape. But, there is a noticeable problem of atrophy in my thighs and legs. The muscle mass is missing.

Earlier today, I went to see a neurologist and described to him my symptoms. As we talked about my situation, he basically sat there in his chair typing into a computer everything I was saying. Strangely, he never came to any conclusion what I may have. I mean, I did tell him and write on the patient information sheet that I am diabetic.

Now mind you, I was waiting during the entire office visit for him to recommend a drug to help me with my immediate pain. Yes, you know I’m in pain! Instead, the doctor wants me to go through tests including MRI LS Spine scan, and an EMG/NCV on my legs. The MRI I am to get within the next two weeks and the electro tests on my next office visit which is in two weeks.

But Doc, I’m in freaking pain!

Now, I had seen on a television commercial about a month ago a prescription drug called Lyrica. It is used to treat muscle and nerve pain caused by diabetes. I asked him about it. He responded that he will prescribe GabaPentin instead.

Late tonight, I did a little Internet research. I’m pretty sure that I have diabetic neuropathy. This is basically my nerves being damaged from high blood sugar levels from diabetes. This got me thinking. The Mayo Clinic says there is no cure for diabetic neuropathy. The only ways to make the patient feel better is to reduce the blood glucose levels by eating right and getting regular exercise. That, and prescription drugs like GabaPentin.

So I basically see no point in an MRI scan or a very painful electromyogram test where they stick electrodes on my body, insert a 2 foot long needle into my leg, and turn on the electricity (cringe). I already know what I got and its diabetic related.

Let’s see if GabaPentin (Neurontin) gets rid of the pain. I figure its going to take a few weeks to get into my system. I’ll update this post as time passes to give you, the reader, an idea of what I’m going through. I will also from time to time, write about the idea of eating foods with a low glycemic index. Talk about the index, post diabetic food recipes, exercise ideas, and tools to assist diabetics like myself.

Diabetes sucks. Let’s get through it successfully together.


http://kerrykobashi.com/life/got-diabetic-neuropathy

Wednesday, 24 September 2014

Chemotherapy And Neuropathy: A Guide

Today's post from caring.com (see link below) is a very good summary of the link between chemotherapy as a cancer treatment and the possibility of neuropathy following after. Unfortunately as more and more people are suffering from one cancer or another, there is a parallel rise in neuropathy cases but as the cancer is of course the first priority for treatment, any consequent nerve damage has (at the moment) to be accepted as unavoidable. This article explains the situation and offers some ideas as how best to cope. It should be stated here that by no means all chemotherapy treatments cause neuropathy but it is a possibility and one you may want to be ready for.
 

Neuropathy and Chemotherapy: What You Can Do 
By Melanie Haiken, Caring.com senior editor
 

Neuropathy Symptoms

Chemotherapy drugs are toxic to healthy nerve cells as well as to cancer cells. Neuropathy is the medical term for nerve damage, usually to the peripheral nerves in the hands, feet, arms, and legs. When those nerves begin to stop working, the result is tingling, numbness, weakness, pain, and even an impaired sense of touch.

Loss of feeling in the hands and feet can make it hard to pick up small objects and can cause clumsiness and difficulty walking. Some people with nerve damage first notice a "pins and needles" feeling, not unlike when an arm or leg falls asleep. This same nerve damage can also cause constipation and bladder problems. 


Neuropathy Causes

Common chemotherapy drugs such as cisplatin (Platinol), carboplatin (Paraplatin), vincristine (Oncovin), and paclitaxel (Taxol) can strip the coatings from the nerves, particularly those in the hands, feet, arms, and legs. The higher or more frequent the dose of the chemotherapy drug, the greater chance it will cause neuropathy.

Radiation treatment can also lead to neuropathy, and conditions such as diabetes, kidney problems, and malnutrition can cause nerve damage, too. In some people, the cancer itself may be the cause of neuropathy.
Preventing Nerve Damage and Injury From Neuropathy

Before beginning chemotherapy, talk to the doctor about which chemotherapy agent she plans to use and whether it's one that's likely to cause neuropathy, so you'll be prepared and on the lookout for symptoms.

Unfortunately, doctors can't do much to prevent neuropathy from developing. There is one protective medication sometimes prescribed to patients before beginning chemotherapy, amifostine (Ethyol), but recent research has not substantiated its benefit.

A few small recent studies have shown that the minerals calcium and magnesium, given intravenously as part of hydration during chemotherapy, can help prevent neuropathy. This is worth discussing with the doctor ahead of time.
Testing for Neuropathy

If the person you're caring for complains of numbness or tingling, tell his doctor, who will administer tests to evaluate the strength of sensation in his hands, feet, arms, and legs. The doctor may also test his reflexes to see whether muscles are affected.

As a caregiver, it's important to recognize neuropathy as soon as possible because the loss of feeling can prevent patients from being able to do certain tasks, such as buttoning clothes, holding onto pots and pans, and driving. It can be frightening and dangerous to spill a pot of hot water or to stumble and fall. 


Neuropathy and Injuries

If your loved one begins losing feeling in his hands and feet as a result of nerve damage, he's going to be prone to small injuries and infections that could go unnoticed. That makes it important that he avoid, as much as possible, using knives, scissors, and other sharp objects. Make sure, too, that his fingernails and toenails are trimmed regularly, because with the loss of sensation, it's easy for him to scratch or hurt himself. If it's a man who has neuropathy, suggest that he switch from a razor blade to an electric shaver. If it's a woman, take her for a manicure and pedicure, but tell the manicurist not to cut her cuticles; this will help avoid infection.

At home, keep an eye on the thermostat, as extremes of hot and cold can cause increased pain for some people with neuropathy.

Managing Pain From Neuropathy

Neuropathy can cause a great deal of pain. If you see signs of suffering, ask the doctor about pain medication, which can make day-to-day activities much easier to bear. According to the latest research, analgesics are the best bet for controlling pain associated with neuropathy. Ask your doctor about the risks and benefits of over-the-counter and prescription painkillers and about topical analgesics such as numbing lidocaine patches, which can reduce pain in specific areas.

When talking to the doctor, describe the symptoms of nerve damage as accurately as possible. Fortunately, doctors have a long list of medicines they can try, so if one doesn't work, don't hesitate to ask for another.

One specific chemotherapy agent, oxaliplatin, causes toxicity that can be helped by taking calcium and magnesium. Talk to your doctor about it, though, because there is some concern that taking these minerals may decrease the effectiveness of the chemotherapy. In the realm of more alternative treatments, some patients find that a topical cream made from chili pepper extract (capsaicin) works well to relieve pain in the hands and feet. Some people don't tolerate it well because it causes a burning sensation on the skin, but this feeling will go away if it's used regularly.

Chemotherapy can deplete the body of B vitamins and magnesium, and these deficiencies can exacerbate neuropathy. You might want to suggest that the person you're caring for take a combination B vitamin with plenty of folic acid and a magnesium supplement (except if the chemotherapy is oxaliplatin; see above.)

Some cancer patients find that high doses of powdered glutamine help with neuropathy, but don't start any nutritional supplement without talking to your doctor about your specific treatment.

Alternative Treatments for Neuropathy Pain
Neuropathy and Acupuncture

Many cancer patients have found acupuncture to be an effective means of controlling the pain of neuropathy. Doctors vary in their attitude toward such alternative therapies, but there's growing acceptance of acupuncture for pain relief at many major cancer centers. As long as the doctor doesn't actively oppose the use of acupuncture, it's worth a try.
Exercise for Neuropathy

Although neuropathy causes many cancer patients to feel less mobile, exercise is one of the best ways to prevent and treat neuropathy because it gets blood flowing to the extremities. The most effective exercises for people with nerve damage are walking and swimming. If the person in your care has any interest in either of these, try taking him for a gentle swim or stroll. Before you go for a walk, make sure he has comfortable, sturdy walking shoes that fit well.
When to Ask for Extra Help

In most cases, neuropathy triggered by chemotherapy goes away over time. However, long-term nerve damage sometimes results. If the person you're caring for is having trouble with mobility, ask the doctor what services are available. Physical therapy can help many cancer patients regain strength and flexibility, while occupational therapy can help them learn strategies for daily tasks such as getting dressed and preparing meals.

http://www.caring.com/articles/what-is-neuropathy

Tuesday, 23 September 2014

What Is The Common Link In Most Neuropathies?

Today's post from neuropathydr.com (see links below) is a two part article from Dr John Hayes Jr, who is a very well respected practitioner with a vast experience of neuropathy treatment. He maintains that the common link between neuropathies is a loss of oxygen at neuronal junctions and it is not enough to simply categorise neuropathy as either peripheral, autonomic or idiopathic. More study is needed into the true etiology of the condition thus leading to much needed new approaches to treatment. Well worth a read and an inspiration for further research.

What’s the Common Link in the Neuropathies? – Parts 1 & 2
Posted by john on September 23, 2010

The common link in all of these peripheral neuropathies, regardless of the cause, appears to be hypoxia.

Hypoxia is simply a word that describes loss of oxygen. This occurs at what are called the neuronal junctions. That is, the areas in the human body where one nerve cell communicates to another.

At a simplistic level, nerve cells communicate electrochemically across a gap. In neuropathy caused by hypoxia, this neuronal gap widens, which is theorized to be responsible for the symptoms that include not only the burning and the tingling but the shooting pains as well.

Neuropathy and chronic pain is characterized by pain, numbness, loss of tactile feedback, and poor tissue perfusion. These symptoms may indicate that oxygen is not getting to all the cells causing dysfunction.

Because the patient’s quality of life is decreased, these results are often devastating. Pain medications do not cure the condition; it only helps mask it and, eventually, leads to complications with adverse side effects such as mental confusion and intestinal problems.

As a result of conducting our own research and reviewing published studies from around the world, we have been led to new models concerning the causes of neuropathy and chronic pain. We have concluded that it is not reasonable to merely label neuropathy and chronic pain symptoms as diabetic, peripheral, vascular, or “idiopathic”. What is needed is a more full understanding of the etiology of the condition so new technology can be brought to bear with both ameliorative and therapeutic benefits.

What is the Common Link in Neuropathies? – Part 2


Posted by john on September 24, 2010

Neuropathy and chronic pain results when nerve signal propagation is reduced between adjacent nerve cells due to insufficient oxygen being available to support nerve cell metabolism. This is responsible for 90% of all neuropathy and chronic pain cases. The remaining 10% is caused by physical trauma. Thus it appears that the main precipitating factor for neuropathy and chronic pain is hypoxia and demineralization of the synaptic fluid which creates shrinkage of the nerve cells which widens the gap between these cells making it more difficult for normal sensations to propagate, and loss of electrical conductivity in the synaptic fluid itself.

A temporary hypoxia of nerve tissue can be traced to most causes of neuropathy and chronic pain. The primary negative effects of this hypoxia are as follows:
A defensive contraction of the nerve cell resulting in oversize synaptic junctions
A loss of electrical conductivity of the synaptic fluid between nerve cells
A defensive change in the electrical potentials of the cell membrane resulting in a higher resting state of the trigger level which effectively limits the sensitivity to incoming signals

For example, when the lumbar area experiences a muscle spasm, blood flow is restricted through that muscle resulting in reduced oxygen availability to the surrounding tissue, including nerve cells. Because muscles can use either oxygen or glucose metabolic pathways, they can recover quickly from a temporary reduction in the level of available oxygen. Nerve cells, on the other hand, are limited to the Krebs oxidative reductive metabolic system and must take immediate defensive steps to assure survival during this hypo oxygen state. One of the ways they accomplish this is to contract along their longitudinal axis like a rubber band, reducing their surface area and thus lowering their need for oxygen. (This also occurs when these cells are attacked by a harsh agent in the blood such as chemotherapeutic drugs, Agent Orange, environmental toxins, insecticides, etc.) The synaptic junctions between the axons of one nerve cell and the dendrites of the next nerve cell widen. Normal nerve transmission is now compromised because a nerve signal of normal intensity cannot jump this newly widened gap. The synaptic fluid between the nerve cells must be electrically conductive. Pure water does not conduct electricity, so this conductivity relies on minerals and specific neurotransmitters such as serotonin in the synaptic fluid to enable the propagation of the nerve signal. These minerals are delivered via the perfusion of adjacent tissues with fresh blood and kept in suspension by the periodic ionization of successfully transmitted nerve signals across the junction. When nerve signals are reduced because of these larger dimensions of the synaptic junction, necessary minerals are no longer held in place by electrical tension and are slowly leeched out. This adds to the impairment of effective nerve transmission.

Common short term remedies with prescription drugs only ameliorate the pain temporarily and do little or nothing to mitigate or cure the underlying condition. They may provide some level of temporary relief, but as the disease progresses, the effective dosage of the drug needed to continue suppressing the pain increases concurrently. The side effects of these types of drugs are difficult to deal with and add to the patient’s discomfort. When the increased drug dosage reaches a threshold level, the patient can become confused, ataxic, constipated, confined to a wheelchair or may become bedridden. Symptoms similar to Alzheimer’s may soon follow.
 
When nerve signals can no longer jump the enlarged synaptic gap, the electrical tension that normally holds these minerals in place is absent, causing the synaptic fluid to leach out its mineral content. Electrical conductivity is reduced, thereby inhibiting the transmission of the normal nerves’ electrical signals across this gap.

http://neuropathydr.com/what%E2%80%99s-the-common-link-in-the-neuropathies-part-1/

http://neuropathydr.com/common-link-neuropathies-part-2/

Monday, 22 September 2014

Neuropathy : Treatment Strategies

Today's post from neuropathy.org (see link below) reinforces the message that there is no current treatment that can actually repair nerve damage. Every available treatment so far, addresses either the underlying cause or the symptoms produced by neuropathy. It also advises a multi-disciplinary approach to treatment which this blog completely supports. It goes on to highlight the current FDA approved treatments for the main divisions of neuropathy but it is by no means exclusive and I would point out that other medications are used as well, depending on where you live. I would still be very wary of using Lyrica (pregabalin) for neuropathic symptoms brought about by diabetes or HIV-related causes. Pfizer themsleves withdrew their own positive recommendations for Lyrica in these cases two years ago and have not re-instated their support for their own drug since, (after considerable problems and court cases concerning side effects). Please talk this over with your doctor or specialist if he or she is prescribing Lyrica for your condition.

Understanding Treatment Strategies for Neuropathy
By Natacha T. Pires, MBBS, Director, Medical and Public Affairs June 30, 2014

With over 100 forms of neuropathy, there is no one size fits all treatment strategy. While there is no cure, the only treatments available for the over 100 forms of neuropathy are aimed at treating the underlying medical conditions that cause the neuropathy, or treating the symptoms such as neuropathic pain. None treat the actual nerve fiber dysfunction or fiber loss, or help nerve fibers regenerate.

Effective treatment strategies help manage symptoms, improve function, and address emotional health. Patients are encouraged to incorporate a multi-disciplinary approach to improve function and quality of life.

Working with a neurologist specializing in neuromuscular diseases

For people with neuropathy, the neuromuscular neurologist serves as “primary care provider” who makes the neuropathy diagnosis, identifies treatment approaches, follows-up on your care, and as needed coordinates with other care providers. The neurologist will refer you to other specialists in the community as needed, and work with you to ensure a comprehensive and coordinated approach to your care.

Understanding treatment strategies

There are currently FDA-indicated medications for only a handful of neuropathies:

Chronic Inflammatory Demyelinating Neuropathy (or CIDP)

- Gamunex-C (immune globulin injection [human], 10% caprylate / chromatography purified)

Diabetic Nerve Pain

- Cymbalta (duloxetine)

- Lyrica (pregabalin)

- Nucynta (Tapentadol extended release)

Multifocal Motor Neuropathy (or MMN)


- Gammagard (Immune Globulin Infusion [Human] 10%)

Neurogenic Orthostatic Hypotension

- Northera (droxidopa)

Post-Shingles Nerve Pain (Post-Herpetic Neuralgia or PHN)


- Cymbalta (duloxetine)

- Gralise (gabapentin, once daily formulation)

- Lidoderm (lidocaine patch 5%)

- Lyrica (pregabalin)

- Qutenza (topical capsaicin 8%)

It is important to work with your doctor to understand the medication strategy, how the medication works and how much symptom relief to expect, and be aware of the side effects that might arise -- understanding this helps set achievable treatment goals with your physician.

Exploring medications In clinical research studies

Medications in development include those that are in clinical research studies, as well as those that are being reviewed by the FDA:

Charcot-Marie-Tooth Disease (a form of hereditary neuropathy)

- PXT-3003 for Charcot-Marie-Tooth type 1a

Chemotherapy-Induced Peripheral Neuropathy (or CIPN)

- KRN5500 for chronic chemotherapy-induced peripheral neuropathy that is refractory to conventional analgesics

- Tetrodotoxin for chemotherapy-induced peripheral neuropathy

Chronic Inflammatory Demyelinating Neuropathy (or CIDP)

- Fingolimod

- Subcutaneous immunoglobulin (IgPro20)

Diabetic Neuropathy

- CBX129801 (PEGylated synthetic human C-peptide) for type 1 diabetic neuropathy

- Clonidine topical gel for diabetic nerve pain

Lambert-Eaton Myasthenic Syndrome

- Firdapse (amifampridine phosphate or 3,4-diaminopyridine phosphate)

Neuropathic Symptoms Associated with Sarcoidosis

- ARA 290

Small Fiber Neuropathic Pain Associated with Fabry Disease

- Gabapentin

Transthyretin-Mediated Amyloidotic Neuropathy (Familial Amyloid Polyneuropathy or FAP)

- ISIS 420915

- Patisiran (ALN-TTR02)

The decision to participate in a clinical research study is a personal one. It should be discussed with your doctor, family, and friends. Most importantly, it should be an informed decision. Participating in a clinical study allows you to be proactive in the management of your health, have access to new treatments in development before they become available to the general public, and help others by contributing to medical research. If you are considering participating in a clinical study, make it a point to find out as much as you can about the treatment, talk with other participants in the study, and discuss the study with your doctor.

Working with a multidisciplinary team of health care specialists

Effective treatment strategies help manage symptoms, improve function, and address emotional health. If you have weakness, poor balance, and other related neuropathy symptoms, working with rehabilitative care specialists (such as physical and occupational therapists) is important. If your predominant symptoms are pain-related, working with a pain management specialist is important. If you have an inherited neuropathy, working with a genetic counselor is important.

Getting the best neuropathy care involves having the expertise of many different healthcare professionals — each contributing in a unique way to the management of the disease and the symptoms it can cause. In general, it is important to incorporate a multi-disciplinary approach to improve care, function, and quality of life.

Providing emotional support


Much like other chronic diseases, neuropathy has physical, emotional, and psychosocial components that can be overwhelming and can complicate your health care provider’s efforts to help you effectively manage your neuropathy. These comorbidities -- anxiety, depression, mood changes, and sleeping disorders -- may not always appear at diagnosis; they surface over time, and are often unreported and untreated because we -- patients and health care providers alike -- are focused on the physical symptoms of neuropathy such as neuropathic pain, lack of coordination, and imbalance to name a few. However, it is important that these comorbidities be recognized and proactively managed – this helps additionally to improve treatment outcomes in general.

Another aspect of emotional support is the support that comes when family and friends understand neuropathy's toll and are able to appreciate and chip in to help overcome the challenges. Hence, It is also important to help family members, friends, and the public at large to better understand neuropathy – this is as much about getting the support, understanding, and care people with neuropathy need as it is about changing the public’s perception of the neuropathy epidemic.

http://www.neuropathy.org/site/News2?page=NewsArticle&id=8705&security=1&news_iv_ctrl=1101

Sunday, 21 September 2014

Neuropathy Images And Text To Make You Think

Today's post from recent posts on the Neuropathy Association's Facebook page (see link below) is nothing more than a series of images which may teach you something you didn't know about neuropathy. They are loosely based on the rarer neuropathies. Remember, there are over 100 different types of neuropathy although most people suffer from very similar symptoms, irrespective of the cause. These images may open your eyes to the variety of suffering that neuropathy can bring and you may have to Google a few terms to get an explanation but that's surely not too hard to widen your knowledge! Millions across the world suffer from debilitating nerve damage and we're nowhere nearer any sort of cure than we were 50 years ago!

Selected Neuropathy Association Facebook page Images
2014



Photo: PLEASE SHARE! Be sure to join us next week, Sept. 17th for our "Rare Diseases" Facebook Chat...: http://on.fb.me/1uoKw7c

FACEBOOK CHAT:  “Rare Neuropathies: Getting Diagnosed, Getting Help”
WHEN: September 17, 2014 (7-8:30 p.m. ET)
WHERE:  www.facebook.com/NeuropathyAssociation
GUEST HOSTS:
- Jeff Levenson (Adult Polyglucosan Body Disease Foundation);
- Jack Johnson (Fabry Support & Information Group)
- Courtney Hollett and Lori Sames (Hereditary Neuropathy Foundation); 
- Dr. Jinny Tavee (Cleveland Clinic Lerner College of Medicine)
- Dr. Edwin Kolodny (NYU)

Of the over 100+ different types of neuropathies impacting millions in the U.S. alone, there are several neuropathies that are considered "rare diseases." The following are just some of the rare neuropathies that we will be discussing during the Chat...we look forward to having you join us!
Catching up on the Facebook chat is possible via the neuropathy association home page


Photo: PLEASE SHARE! It's #ThrowbackThursday ... and we're going back to Spring 2013 -- when we launched our debut Neuropathy Word Cloud campaign. The goal: to create a powerful visual representation of what it means to have neuropathy. Why? Simply put—to get the neuropathy epidemic on the public’s radar. Read about it here - http://bit.ly/1mZ5rx5 #tbt

Photo: Today marks the start of Pain Awareness Month. Chronic pain affects more people in the United States than these three major health conditions. 

Share to raise awareness for chronic pain. 

#painawarenessmonth #chronicpain

Foto: Fact: Fabry disease really only has two outward signs, but they don't occur in everyone. There is a very characteristic eye finding that can only be seen with a slit lamp called a corneal opacity and a rash like appearance on the skin. The rash is made up of many small dark red to purplish dots that can vary somewhat in size and are called angiokeratoma. In males they are usually in the belly button and may occur on the trunk down to the knees in what is referred to as a bathing suit distribution. They are less predictable in females.

Foto: HAVE SARCOIDOSIS AND NEUROPATHY? There is a new clinical research study assessing whether “ARA 290” is effective in the treatment of the neuropathic symptoms of sarcoidosis...: http://1.usa.gov/1fjWvsm. 

Although the study is already closed to new participants, another trial may be opening up in 2015. More information will be available later, but if you have any questions, please contact the research study team at martint5@ccf.org.

Foto: PLEASE SHARE! "Like" this post to show your support for Charles Wood for sharing his inspiring MMN journey with our community. Read Charles' story here - http://bit.ly/1ogNDJ0

Foto: PLEASE SHARE! Focused on Multifocal Motor Neuropathy, this ‘Ask the Doctor’ column address Kari M.’s question: “I am 54-year old business executive and I’ve had a right “drooping foot” for three years. I had surgery on my right foot five months ago, but it did not help. My symptoms have been gradually worsening with cramping of the leg muscles. My doctors did a nerve conduction study which showed multifocal conduction blocks in the motor nerves, but not in sensory nerves. He also explained that my lab studies showed high titers of serum antibodies to the ganglioside M1 (GM1) and to the asialo-GM1, which are markers of myelin (the insulation of the nerve). I was diagnosed with multifocal motor neuropathy and treated with intravenous immunoglobulin (IVIG) which improved my symptoms dramatically. I’d like to get a better understanding for my diagnosis. What is multifocal motor neuropathy?”  Read Dr. Jin Lou’s response here…: http://bit.ly/1sgEF04

Foto: FACT: Fabry disease is a rare genetic disease that usually presents in childhood or early adolescence. Symptoms include an inability to perspire, little body hair, fevers, gastrointestinal problems, renal complications leading to renal failure, and heart enlargement…: http://bit.ly/1oQfd0n

Foto: PLEASE SHARE! David Gibson shares his childhood experiences with pain and his Fabry Disease diagnostic journey…: http://bit.ly/1wwu4VD





Foto: PLEASE SHARE! "Like" this post to show your support for Rosina Johnson for sharing her inspiring CMT/CIDP journey with our community. Read Rosina's story here - http://bit.ly/14b0LpJ. https://www.facebook.com/NeuropathyAssociation

Saturday, 20 September 2014

Carbamazepine Plus Morphine: A Better Treatment For Neuropathy?

Today's post from sciencedaily.com (see link below) looks at new attempts to combine two types of medication to produce a better result than using one on its own. In the current climate where opioids are receiving so much negative publicity and genuine chronic pain patients are suffering the backlash, this may be an attempt to lessen the impact of the opiate by combining it (in this case) with an epilepsy drug (carbamazepine) which is also often used to treat neuropathy in isolation. Over the years this returns to the headlines as an option but never really seems to have taken off and become first-line treatment. if the claims are as beneficial as is being stated, it may be worth talking to your doctor or specialist about.

Combining epilepsy drug, morphine can result in less pain, lower opioid doses
Date: September 15, 2014 Source: Indiana University
 

Summary:

Adding a common epilepsy drug to a morphine regimen can result in better pain control, fewer side effects and reduced morphine dosage, according to research. The result could bring significant relief to many patients with neuropathic pain, a difficult-to-treat condition often felt in the arms and legs and associated with nerve tissue damage.

Adding a common epilepsy drug to a morphine regimen can result in better pain control with fewer side effects. Moreover, the combination can reduce the dosage of the opioid needed to be effective, according to a team of pain researchers at Indiana University.

The result could bring significant relief to many patients with neuropathic pain, a difficult-to-treat condition often felt in the arms and legs and associated with nerve tissue damage.

"There is a huge unmet need for better treatments for neuropathic pain," said Fletcher A. White, Ph.D., the Vergil K. Stoelting Professor of Anesthesia at the Indiana University School of Medicine.

In laboratory tests using rodents, White and his colleagues found that while morphine lost its pain-relieving effectiveness three weeks after nerve injury, a combination therapy of morphine and carbamazepine -- used to prevent epileptic seizures -- could effectively reverse this loss of drug action. Their findings were reported in the journal PLOS ONE.

Although morphine and related opioid drugs are effective in treating pain, they can result in dependence and produce side effects including respiratory depression, nausea, constipation and other problems. In addition, such drugs can, paradoxically, actually cause pain, a condition called opioid-induced hyperalgesia.

"People immediately think, 'Oh, it's tolerance, the patient needs more of the drug for pain control,'" Dr. White said.

In fact, research indicates that the pain of hyperalgesia occurs because the morphine latches on not only to cellular targets that reduce pain sensation but to other "non-opioid" targets that result in activation of pain-sensing neurons. Dr. White and his colleagues had previously identified a key cellular factor -- known to be a specific voltage-gated sodium ion channel -- involved in that non-opioid process of pain nerve stimulation. Meanwhile another IU School of Medicine researcher, Theodore Cummins, Ph.D., professor of pharmacology and toxicology, had previously determined that carbamazepine alone has the opposite effect on the same ion channel.

Combining the two drugs could prevent the escalating doses of opioids that are sometimes prescribed to provide pain relief in the clinic.

"We know that opioids have benefits," Dr. White said. "If we can diminish the off-target effects, that's good. If we can diminish the opioid dosages required for pain relief, then you've really got something."

Because both drugs are approved for use by the Food and Drug Administration, physicians have tested the combination with patients, resulting in anecdotal reports of significantly improved pain management, Dr. White said. More formally, Dr. White and physician-researchers have begun testing the combination of morphine and a close relative of carbamazepine with patients in a small clinical trial at the Indiana University Melvin and Bren Simon Cancer Center.

In addition to Dr. White, researchers contributing to the study were Michael R. Due, Xiao-Fang Yang, Yohance M. Allette, Aaron L. Randolph, Matthew S. Ripsch, Sarah M. Wilson and Erik T. Dustrude of the IU School of Medicine; and Rajesh Khanna of the College of Medicine, University of Arizona.

The research was funded by National Institutes of Health grants NIDDK DK100905 and NIDA DA026040 and the Indiana Spinal Cord and Brain Injury Research Fund.

Story Source:

The above story is based on materials provided by Indiana University. Note: Materials may be edited for content and length.

Journal Reference:
Michael R. Due, Xiao-Fang Yang, Yohance M. Allette, Aaron L. Randolph, Matthew S. Ripsch, Sarah M. Wilson, Erik T. Dustrude, Rajesh Khanna, Fletcher A. White. Carbamazepine Potentiates the Effectiveness of Morphine in a Rodent Model of Neuropathic Pain. PLoS ONE, 2014; 9 (9): e107399 DOI: 10.1371/journal.pone.0107399 


http://www.sciencedaily.com/releases/2014/09/140915153613.htm

Friday, 19 September 2014

Falling On The Stairs -A Neuropathy Problem

Today's post from webmd.boots.com (see link below) looks at how risky having neuropathy in feet and legs can be if you have to climb stairs frequently. As is so often the case, it is addressed at diabetic neuropathy sufferers but whatever the cause of your neuropathic problems, this will apply to you to. It's a short article but an interesting one. Worth a read.

Diabetic neuropathy increases stair falls risk
By Nicky Broyd WebMD UK Health News
17th September 2014 - Medically Reviewed by Dr Keith David Barnard

  New UK research suggests that people with diabetic peripheral neuropathy (DPN), a complication of diabetes that affects the nerves in the limbs, often sway more during stair climbing and are, therefore, more likely to fall.

The researchers, from Manchester, acknowledge that while it would be impractical to suggest patients with DPN avoid stairs completely, they are at higher risk of having a fall and should take measures to keep themselves safe.

They say: "Avoiding particularly steep and/or long flights of stairs may be advisable, especially if an elevator is available as an alternative. Using a handrail on stairs if available could also help patients with DPN prevent falls."
Stairs

Patients with DPN are known to be unsteady on their feet and to have an increased risk of falling. Whilst some studies have found increased postural sway during quiet standing and walking on level ground in patients with DPN, no data exists on measures of balance when using the stairs.

Since walking on stairs is one of the most dangerous daily activities in terms of fall risk, this study, which has been conducted by researchers at Manchester Metropolitan University and the University of Manchester, investigated the underlying mechanisms of unsteadiness in patients with DPN during stair ascent and descent.


Measuring sway

Motion and pressure data were collected for 22 diabetes patients with DPN (average age 57) and 40 diabetes patients without DPN (average age also 57), plus 32 healthy people without diabetes (average age 50 years). All patients were from Manchester or the surrounding area.

Movement was measured using a 3D motion analysis system from reflective markers placed on the body to calculate whole-body centre-of-mass.

The centre-of-pressure under the feet was measured using sensitive pads mounted into the middle four steps of a seven step staircase, which participants ascended and descended at least three times.

The ability of a person to maintain balance was quantified by assessing the separation between the centre-of-mass and centre-of-pressure.


Findings

The authors conclude: " Diabetes patients with peripheral neuropathy display greater extremes in magnitude of medial-lateral sway during stair ascent and descent as well as displaying higher variability during stair ascent and descent. This indicates that patients with DPN have difficulty regulating control of balance during this challenging task.

"A larger and more variable medial-lateral sway means that patients with DPN are more likely to lose control of balance and experience a fall during what is known to be an activity —using stairs —where the risk of falls is already very high."

The findings have been presented at this year’s annual meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria.
Future interventions

The Manchester research team is carrying out more investigations to identify and further understand factors that may contribute to unsteadiness and in turn the increased risk of falls.

They add: "Many issues that affect balance in patients with DPN stem from deterioration of muscle size and function, so whilst it is not currently possible to positively improve the sensory deterioration, we have been looking at elements that we can positively influence, such as strength training and interventions to help vision focus and avoidance of obstacles. We are investigating the impact of such interventions and how they might translate to improvements in gait and balance control."

http://www.webmd.boots.com/diabetes/news/20140917/diabetic-neuropathy-stair-falls-risk

Thursday, 18 September 2014

Gentle Yoga For Neuropathy

Today's post from neuropathylandolakes.com (see link below) takes a look at yoga as being a possible help with neuropathy pain. We often hear about yoga, or acupuncture, or Tai Chi and others as being useful for neuropathy sufferers but very few sites show us exactly how. This article isn't that much better but does provide one or two ideas for getting you started. As you've probably heard from yoga fanatics; yoga is anything but gentle although the benefits are said to be awesome. Here it's advised that you do use the more gentle yoga poses to help relieve your symptoms and as any neuropathy sufferer will tell you, gentle can be strenuous and painful enough. Maybe worth further investigation. 
 
A Simple and Effective Treatment for Foot Neuropathy: Gentle Yoga Posted by john on September 4, 2014

Ease the pain of neuropathy in feet with a simple yoga practice—even if you’ve never done yoga before.

Peripheral neuropathy can be an aggravating and chronic condition, and it’s tough to treat using traditional medications. But there’s a treatment you can do on your own—in a class, or at home—that can be very beneficial over time, and that’s gentle yoga.

Yoga isn’t just about spiritual growth or physical fitness anymore. Many neuropathy patients are finding that simple yoga poses can alleviate uncomfortable tingling or numbness in the fingers and toes. Best of all, many basic yoga poses are easy to learn and don’t require special equipment.

Some of the benefits of a regular yoga practice include: 


Increased circulation to the hands and feet. Many yoga poses use the pull of gravity to shift habitual blood flow patterns, particularly to the feet. (Don’t worry, this doesn’t require a headstand!)


Improved body self-awareness. A regular yoga practice can help you connect with your body sensations and really notice what your body is telling you.


Relaxation and peacefulness. A simple, non-strenuous yoga practice for 10 to 30 minutes before bed can help you relax and sleep better. Or, if you prefer, use yoga as a gentle wake-up practice in the morning to set a peaceful tone for your day.

In general, yoga is a wonderful form of self-care that can be modified for your own unique physical goals and needs.

If you have no experience with yoga, it’s best to begin with assistance from a teacher. You can look for a local “gentle yoga” class or use a beginning yoga DVD as a guide at home.

Here’s one very simple yoga technique to get you started with relief for your feet. Sit cross-legged with your shoes and socks off. Weave your fingers one by one through the toes of the opposite foot, and hold this position for about 20 seconds. Then, switch to using the other hand and foot. You may want to do this 2 or 3 times for each foot.

http://neuropathylandolakes.com/a-simple-and-effective-treatment-for-foot-neuropathy-gentle-yoga/

Wednesday, 17 September 2014

Pain Research In The Future

 Today's post from inthefaceofpain.com (see link below) is a very useful article for anyone trying to find out what is being done about the chronic pain problem which seems to be a media hype these days. It looks into the areas of investigation for research groups and companies and tries to use a crystal ball to see how pain medication and treatment is developing for the future. As a neuropathy patient, dealing with varying degrees of pain on a daily basis, this sort of research is very important for you because it shows at least a willingness to move away from the traditional analgesic drugs and opiates. It will reassure you that they are looking very hard for new treatment options but of course seeing it in print and seeing it on your pharmacist's shelves are two different things. Worth a read for sure.
 
National Institutes of Health: What is the Future of Pain Research?
2013


This section is intended for use by health care professionals to explore additional ways that you can advocate for better pain management through your employers, professional societies or state licensing boards.



In the forefront of pain research are scientists supported by the National Institutes of Health (NIH), including the National Institute of Neurological Disorders and Stroke. Other institutes at NIH that support pain research include the National Institute of Dental and Craniofacial Research, the National Cancer Institute, the National Institute of Nursing Research, the National Institute on Drug Abuse, and the National Institute of Mental Health. Developing better pain treatments is the primary goal of all pain research being conducted by these institutes.

In the summer of 2009, key elements of the National Pain Care Policy Act were incorporated into the Patient Protection and Affordable Care Act, which President Barack Obama signed into law on March 23, 2010. These provisions include:
Mandating an Institute of Medicine (IOM) conference on pain to address key medical and policy issues affecting the delivery of quality pain care; this has been completed. Click here to access the IOM report


Establishing a training program to improve the skills of health care professionals to assess and treat pain.


Enhancing the pain research agenda for the NIH. This effort has been started through the Interagency Pain Research Coordinating Committee (IPRCC). The Committee accepts nominations for scientific and public members on an annual basis. You may want to consider nominating a colleague or pursuing a nomination for yourself!

Advocacy organizations are now working with appropriations committee members to ensure that this portion of the law is adequately funded. Check with pain-related organizations for the latest updates and ways that you can support.

Pain Research on the Horizon

One objective of investigators working to develop the future generation of pain medications is to take full advantage of the body’s pain “switching center” by formulating compounds that will prevent pain signals from being amplified or stop them altogether. Blocking or interrupting pain signals, especially when there is no injury or trauma to tissue, is an important goal in the development of pain medications. An increased understanding of the basic mechanisms of pain will have profound implications for the development of future medicines.

The following areas of research are bringing us closer to better pain care
:


Systems and imaging: The idea of mapping cognitive functions to precise areas of the brain dates back to phrenology, the now archaic practice of studying bumps on the head. Positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and other imaging technologies offer a vivid picture of what is happening in the brain as it processes pain. Using imaging, investigators can now see that pain activates at least three or four key areas of the brain’s cortex – the layer of tissue that covers the brain. Interestingly, when patients undergo hypnosis so that the unpleasantness of a painful stimulus is not experienced, activity in some, but not all, brain areas is reduced. This emphasizes that the experience of pain involves a strong emotional component as well as the sensory experience, namely the intensity of the stimulus. 


Channels: The frontier in the search for new drug targets is represented by channels. Channels are gate-like passages found along the membranes of cells that allow electrically charged chemical particles called ions to pass into the cells. Ion channels are important for transmitting signals through the nerve’s membrane. The possibility now exists for developing new classes of drugs, including pain cocktails that would act at the site of channel activity. 


Trophic factors: A class of “rescuer” or “restorer” drugs may emerge from our growing knowledge of trophic factors, natural chemical substances found in the human body that affect the survival and function of cells. Trophic factors also promote cell death, but little is known about how something beneficial can become harmful. Investigators have observed that an over-accumulation of certain trophic factors in the nerve cells of animals results in heightened pain sensitivity, and that some receptors found on cells respond to trophic factors and interact with each other. These receptors may provide targets for new pain therapies. 


Molecular genetics: Certain genetic mutations can change pain sensitivity and behavioral responses to pain. People born genetically insensate to pain – that is, individuals who cannot feel pain – have a mutation in part of a gene that plays a role in cell survival. Using “knockout” animal models – animals genetically engineered to lack a certain gene – scientists are able to visualize how mutations in genes cause animals to become anxious, make noise, rear, freeze, or become hypervigilant. These genetic mutations cause a disruption or alteration in the processing of pain information as it leaves the spinal cord and travels to the brain. Knockout animals can be used to complement efforts aimed at developing new drugs.


Plasticity:
Following injury, the nervous system undergoes a tremendous reorganization. This phenomenon is known as plasticity. For example, the spinal cord is “rewired” following trauma as nerve cell axons make new contacts, a phenomenon known as “sprouting.” This in turn disrupts the cells’ supply of trophic factors. Scientists can now identify and study the changes that occur during the processing of pain. For example, using a technique called polymerase chain reaction (PCR), scientists can study the genes that are induced by injury and persistent pain. There is evidence that the proteins that are ultimately synthesized by these genes may be targets for new therapies. The dramatic changes that occur with injury and persistent pain underscore that chronic pain should be considered a disease of the nervous system, not just prolonged acute pain or a symptom of an injury. Thus, scientists hope that therapies directed at preventing the long-term changes that occur in the nervous system will prevent the development of chronic pain conditions. 


Neurotransmitters: Just as mutations in genes may affect behavior, they may also affect a number of neurotransmitters involved in the control of pain. Using sophisticated imaging technologies, investigators can now visualize what is happening chemically in the spinal cord. From this work, new therapies may emerge, therapies that can help reduce or obliterate severe or chronic pain.


Hope for the Future

Thousands of years ago, ancient peoples attributed pain to spirits and treated it with mysticism and incantations. Over the centuries, science has provided us with a remarkable ability to understand and control pain with medications, surgery, and other alternative and complementary treatments. Today, scientists understand a great deal about the causes and mechanisms of pain, and research has produced dramatic improvements in the diagnosis and treatment of a number of painful disorders. For people who fight every day against the limitations imposed by pain, the work of the National Institute of Neurological Disorders and Stroke (NINDS)-supported scientists holds the promise of an even greater understanding of pain in the coming years. Their research offers a powerful weapon in the battle to prolong and improve the lives of people with pain: hope.

http://www.inthefaceofpain.com/take-action/health-care-professional-advocacy/

Tuesday, 16 September 2014

Fluoroquinolone Antibiotics And Neuropathy: A Report

Today's important post from the Journal of Investigative Medicine at hic.sagepub.com (see link below) is another piece of the jigsaw showing how dangerous fluoroquinolone antibiotics can be for people whether living with, or prone to, nerve damage (neuropathy). It's quite long but worth reading because it's very important to check what sort of antibiotics your doctor is prescribing. Permanent neuropathy from an antibiotic is no joke and is so easily avoided - it's in your own interests to check the label on the box and question your doctor's choice afterwards.
 



Permanent Peripheral Neuropathy
A Case Report on a Rare but Serious Debilitating Side-Effect of Fluoroquinolone Administration

Published July 27, 2014, doi: 10.1177/2324709614545225 Journal of Investigative Medicine High Impact Case Reports April-June 2014 vol. 2 no. 2 2324709614545225

Jacquelyn K. Francis, BA1
Elizabeth Higgins, MD1
1Albany Medical College, Albany, NY, USA
Jacquelyn K. Francis, Albany Medical College, 47 New Scotland AvenueAlbany, NY 12208, USA. Email: francij@mail.amc.edu

Abstract

The health risks and side effects of fluoroquinolone use include the risk of tendon rupture and myasthenia gravis exacerbation, and on August 15, 2013, the Food and Drug Administration updated its warning to include the risk of permanent peripheral neuropathy. We present a case of fluoroquinolone-induced peripheral neuropathy in a patient treated for clinically diagnosed urinary tract infection with ciprofloxacin antibiotic.

Introduction

While there has been success in recent years in decreasing the numbers of unnecessary antibiotic administrations,1 still rampant in medical practice is the inappropriate use of antibiotics. Fluoroquinolones administration is no different. These bactericidal agents are capable of central nervous system (CNS) penetration,2 with an impressive treatment profile that includes an enhanced spectrum of activity, high oral bioavailability, high serum drug concentration that parallels that of intravenous drug administration, and rapid mechanism of action. It is for this reason that physicians favor these drugs for treatment of simple infections, which range from uncomplicated urinary tract infections (UTIs) and gastrointestinal infections to lower respiratory infections and pneumonias. According to established guidelines, however, these antibiotics are recommended as drugs of last resort and for treatment of cases refractory to other safer antibiotic alternatives. Reports in recent years of the adverse drug events of these drugs are on the rise, with not only an overrepresentation of common antibiotic complaints, including diarrhea, nausea, and headache that occur at rates higher than most other antimicrobials on the market,3 but there is also mounting evidence suggesting the potential for long-term adverse peripheral nervous system (PNS) effects from fluoroquinolone usage. The need for physicians to be judicious when prescribing these drugs is therefore paramount.

Case Presentation

A 57-year-old Caucasian female presented to outpatient clinic with complaints of dysuria, polyuria, and urinary urgency. Urinalysis showed 2+ leukocytes and trace blood. Based on her clinical presentation, she was treated for UTI with a ciprofloxacin regimen of 250 mg twice a day for 5 days. Subsequent urine culture showed no evidence of organism, and against advice for reevaluation, she was lost to follow-up. She presented 2 months later reporting whole body burning and alopecia. The burning, she claimed, started 2 or 3 days after completion of the prescribed course of ciprofloxacin. The burning lasted 3 weeks and resolved only to recur, unrelentingly, 3 weeks later. She had been unable to adorn clothing during this time, for she said this triggered whole body burning. At the point wherein she was finally able to wear clothing, she presented to the clinic. Hydration and Epsom salt soaks provided no relief. She reported pain of 10/10. Her past medical history is significant for trigeminal neuralgia, in remission for 12 years. The patient was on no medications at the time of her visit. She has no specific medication allergies, but does get gastrointestinal symptoms with opioids, namely, fentanyl. Physical examination was unremarkable. Vitals at the time that she was seen included the following: blood pressure 132/78 mm Hg, temperature of 97°F, heart rate of 60 beats per minute, respirations of 18. Her body mass index was 17.94, down from 20.3 two months earlier. On detailed neurologic examination, cranial nerves II through XII were intact bilaterally. There was no pronator drift of outstretched arms. There was some muscle wasting in biceps; however, overall tone was normal. Strength was full bilaterally. Reflexes were 2+ and symmetric at the biceps, triceps, knees, and ankles. Plantar responses were flexor. Light touch and pinprick produced pain and paresthesias diffusely in the upper and lower extremities; however, position sense and vibration sense were intact in fingers and toes. Rapid alternating movements and fine finger movements were intact. There was no dysmetria on finger-to-nose and heel-knee-shin. There were no abnormal or extraneous movements. Romberg was absent. The patient’s posture was normal. Gait was steady with normal, though tentative, steps, base, arm swing, and turning. Heel and toe walking were normal. Tandem gait was normal. She had no discernable rash or skin lesions.

Subsequent complete blood work analysis to check for an electrolyte abnormality basis of her complaints was unremarkable. Her complete blood count was normal with a hematocrit of 41%. Her vitamin B12 level was 258 pg/mL, with a normal range of 200 to 900 pg/mL. Her thyroid stimulating hormone level was 2.05, with a normal range of 0.4 to 6.0. Her immunoglobulin levels were normal. Her vitamin D level was 13 nmol/L (optimal >30 nmol/L). Copper level was 98 mg (normal 50-80 mg). Vitamin E was normal at 12.7 µg/mL (normal range = 5.5-17 µg/mL). Vitamin B1 was normal at 5.4 µg/dL (normal range = 2.5-7.5 µg/dL).

Her blood work and further questioning could provide no new medical etiology for her symptoms, and so the patient was subsequently sent for complete neurological workup. Workup included heavy metal toxicity screening to assess for possible heavy metal exposure to lead, mercury, cadmium, and zinc. Electrophysiological studies were also done to assess neuromuscular nerve action potential transmission, a test that could discern a neuromuscular disorder etiology. Three-millimeter skin punch biopsy to assess for small fiber density and possible neurologic process were also done. These tests were all negative. Neurological workup could not determine a unique cause of her symptoms. It was concluded that if her symptoms were neurologic-based, it was, in fact, a multifocal process.

Two years after the initial onset of symptoms, the patient continues to suffer from polyneuropathies chronologically related to ciprofloxacin use. At her most recent visit, she describes constant pain of 7/10 and is unable, she states, to ambulate for more than 2 minutes, without intense shooting pains up and down her lower extremities. She describes “pins and needles” up and down her legs and thighs radiating to her buttocks and feet. She claims that her upper body and abdomen have now been spared of such feelings. She describes severe alopecia and ambulates now with a broad-based gait. She describes being on permanent disability because of her condition. The rest of her physical examination remains unchanged. There are no gross neurological deficits discernible on neurologic examination. The patient remains on amitriptyline 20 mg daily for control of her pain symptoms.

Discussion

Fluoroquinolones are fluorinated quinolones, the only bactericidal agent in the antibiotic class capable of directly inhibiting DNA synthesis. They do this by promoting cleavage of bacterial DNA in the DNA–enzyme complexes of DNA gyrase and topoisomerase IV.2 Generally, gram-negative antibacterial activity correlates with inhibition of DNA gyrase, and gram-positive antibacterial activity corresponds with inhibition of DNA type IV topoisomerase.2,4 With the introduction of these drugs in the 1960s, physicians were able, for the first time, to treat severe gram-negative infections orally.3 The first successful fluorination of part of the quinolone drug in 1986, in the form of norfloxacin, brought with it the capability of crossing the blood–brain barrier and achieving CNS penetration.5 This and the already great treatment profile in the form of enhanced spectrum of activity, high oral bioavailability, high serum drug concentration comparable to intravenous infusion, and rapid mechanism of action added to the popularity of these drugs ultimately resultingin the indiscriminate use of these drugs. The enhanced treatment profile of these drugs came at a price however, with adverse effects so severe that use of many fluoroquinolones since then being restricted or the drugs withdrawn from the market entirely.6,7

One of the challenges of diagnosing a patient with fluoroquinolone-associated peripheral neuropathy is the diffuse, confusing, and delayed array of symptoms that can occur. A 1996 study first brought these adverse effects to light.7 While patients on the fluorinated drugs exhibited less side effects than those associated with first-generation quinolone predecessors, such as nausea and gastrointestinal disturbances, 0.9% to 1.6% experienced adverse reactions relating to the peripheral and central nervous system, including headache, dizziness, drowsiness, agitation, psychosis, and convulsions, as well as peripheral sensory disturbances, symptoms that had never been complained of prior, at least not on any significant scale. Of these patients, 81% had symptoms occurring within 1 week of drug administration, with paresthesia being the mainly reported symptom. Five years later, a 2001 study found that contrary to previous reports suggesting that fluoroquinolone-associated PNS events are mild and short term, 80% of study participants reported severe events that typically involved multiple organ systems, especially the PNS, with symptom onset as early as 24 hours within initiation of treatment. 58% of these cases had symptoms lasting greater than 1 year.8

Another 2001 formal study that sought to assess the prevalence of fluoroquinolone-induced PNS adverse side effects highlighted the severity of these effects. The study concluded that there was a high association between fluoroquinolone antibiotics and severe, long-term adverse PNS and multiple organ system effects that included PNS sensory symptoms (91%), peripheral neuropathy motor symptoms (55%), and CNS effects (75%). Over 80% of the patients surveyed had sequalae stemming from fluoroquinolone use that lasted for greater than 1 year.9 A subset of these patients and their adverse drug events are included in Table 1.


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Table 1.

15 of the 45 Total Reported Cases of Fluoroquinolone-Associated Events in the Literature6.


Despite these seemingly significant numbers and overwhelming reports from patients, physicians continue to prescribe fluoroquinolone antibiotics unsystematically, against US Food and Drug Administration recommendations. The pressures of health care facilities and patients alike to increase patient turnaround and quickly alleviate symptoms may compound this problem 10.

As highlighted in the aforementioned case, the peripheral neuropathy reported with fluoroquinolone administration can be severe, debilitating, and permanent. It is for this reason that physicians need to practice due diligence when prescribing not only antibiotics, but any drug. Physicians also need to practice vigilance in the event of an adverse reaction. They can do this with careful follow-up of patients and ensure that patients are aware of all the side effects that may be associated with their prescribed drug. Patients need to know what to look for and where to go in the event that one of these symptoms become manifest. It is our hope that the updated FDA warning and presentation of this case will encourage physicians to be more conscientious of their treatment selections.

Take Home Points


The FDA recommends that fluoroquinolones be used as a drug of last resort and for treatment of cases refractory to other safer antibiotic alternatives.

The FDA updated their black box warnings on all fluoroquinolones to stress the rapidity of onset and permanence of peripheral neuropathy associated with their use.

Physicians should be aware of the risks and side effects associated with the drugs that are prescribed and be able to inform patients of the risks associated with the use of these drugs.

Physicians should always aim to administer the least broad spectrum antibiotic possible based on known sensitivities and regional resistance patterns.

Article Notes


Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

This article is distributed under the terms of the Creative Commons Attribution 3.0 License (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (http://www.uk.sagepub.com/aboutus/openaccess.htm).

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