Wednesday, 1 July 2015

Tackling Neuropathic Pain With Alternative Treatments

Today's post from (see link below) looks at some of the alternative treatments for neuropathic discomfort; whether supplements or homoeopathic and you are advised to make up your own mind as to whether you take these recommendations seriously or not. Actually, this is not negative advice: many neurologists recommend exactly the same things, especially in cases where chemical medications are not helping. There is the cost of course and you shouldn't expect miraculous results after two or three weeks - you're probably in for the long haul with alternative treatments but that is no reason to reject them out of hand. Many people have benefited from trying one or more of these options but always remember, with neuropathy, what works for one doesn't work for all - it's a question of trying things out until you find relief...or not! Remember too - the word 'diabetic' in the title does not exclude you if you have neuropathy caused by something else - neuropathy symptoms are pretty much universal.

Soothe Diabetic Foot Pain And Peripheral Neuropathy With Effective Home Remedies and Alternative Treatments 
Posted by JB Bardot Tuesday, June 23, 2015

Peripheral or diabetic neuropathy affects 60-70 percent of all diabetics with stabbing, burning pain in the hands, feet and especially the toes, according to Additionally, many non-diabetics are affected with painful neuropathies of no known cause. Initially experienced as numbness, and tingling of the affected parts, neuropathies often develop into feelings of having hot or icy needles stabbing sensitive flesh. Pharmaceutical medicines may or may not help manage pain, and often produce unwanted side effects. Fortunately, there is a more natural, multi-disciplinary approach to pain management using a variety of home remedies, herbs, supplements, homeopathic remedies, and lifestyle adjustments.

Herbs, supplements and homeopathic remedies

• Topical applications of cayenne pepper mixed with olive or coconut oil relieves neuropathy pain for some people. Capsicum, the active ingredient in cayenne, may feel hot to the skin initially; however, it binds to the body’s pain receptors, fooling the neural pathways and lessening pain over a period of time.

• Omega 3 fatty acids in the form of fish oil supplements provide healthy fats that soothe nerves, helping to relieve pain and inflammation from peripheral neuropathy. Omega 3 fatty acids are also found in flax seeds and oil, borage oil and Evening primrose oil.

• Homeopathic remedies are effective at providing relief from peripheral neuropathies for many people. Remedies such as Plumbum Met, Phosphoric Acid, Phosphorous, Zincum Met, Pulsatilla, Graphites, Lachesis, Gelsemium, Baryta Carb, Causticum, Zincum Phos, Agaricus, Mercurius, Sulphur, Cuprum Met, and Rhus Tox. This list is not exhaustive. Consult a homeopath for the correct remedy based on your individual case.

• Acupuncture and Traditional Chinese Medicine (TCM) reduce stress hormones which can be the cause of some neuropathies. Treatment eventually leads to the reduction of inflammation and pain.

• Lecithin, a fat emulsifier, will reduce diabetic neuropathy pain by working to protect the liver and pancreas from the effects of eating oils high in trans fats and hydrogenated fats. Lecithin is found naturally in the body and is important in the production and transmission of energy. The myelin sheaths that cover nerves are made primarily from lecithin. Most lecithin is made from eggs or soy and it’s important to use a product that’s organic and labeled non-GMO.

• High doses of the B vitamin, Inositol added to one’s diet has been shown to reduce pain and the frequency of peripheral neuropathies. Additionally, increase doses of vitamin B-complex — especially B-6 and B-12 — to help calm and repair damaged nerves and provide pain relief.

• Alpha Lipoic Acid (ALA) works to regenerate nerves damaged by diabetes and other causes. ALA is a sulfur-containing compound found naturally in the body. Some studies suggest that this antioxidant may actually improve circulation, enhance the action of insulin and reduce oxidative stress, thus preventing neuropathies.

• Keep your body alkaline by drinking a pH drink from 1 to 3 times daily. Mix 2 Tbs. fresh lime or lemon juice with 1/2 tsp. baking soda. Allow all foaming and fizzing to go flat. Add 10 – 12 oz. water and drink all at once.

• Manage pain and frequency of attacks by keeping glucose levels stable, suggests pain specialist Dr. Robert Gerwin, of Johns Hopkins University. There are a number of ways to maintain blood sugar. Eat foods lower on the glycemic index scale and avoid those whose numbers are high. Take a daily supplement consisting of cinnamon and chromium to lower glucose levels and help prevent diabetic neuropathies.

Lifestyle adjustments

• Wear well-fitting shoes, with large toe boxes.

• Protect hands and feet in winter with warm socks, gloves and shoes that keep feet dry.

• Sit with legs uncrossed to encourage good circulation.

• Stop smoking cigarettes. Smoking causes the blood vessels to constrict, worsening circulation and aggravating neuropathy pain.

See also:

Herbs, Home Remedies and Foods that Reduce Swelling

Home care solutions provide gout pain relief for painful feet

(Photo credit: Gwenllian Evans Flicker)

Tuesday, 30 June 2015

Surviving HIV Carries A Price Tag

Today's well-written post from (see link below) are personal accounts of people who have been lucky enough to survive many years with HIV and progress into old age. Thanks to improvements in HIV medication, there are many more people in exactly the same situation but this doesn't mean that they can live wholly healthy lives - unfortunately, there is often a price to pay for surviving with HIV. These stories includes fibromyalgia and neuropathy as health problems many people with HIV have to live with and there's a certain irony to the fact that the majority of the pills they take, are for conditions other than HIV. Definitely worth a read.

As people with HIV live longer, aging presents challenges
Lolly Bowean Chicago Tribune (TNS) 9:02 PM, Jun 27, 2015

CHICAGO — It’s been 30 years since Greg Sanchez was diagnosed with HIV, the human immunodeficiency virus that causes AIDS, and he keeps his more than two dozen bottles of pills and other medications on his wooden nightstand so he can get to them easily.

But he takes only a single pill for HIV. The rest of his prescriptions, a crowd of white-topped orange plastic bottles, are to treat the many ailments and conditions that he says are a result of aging with the virus, along with years of taking the sometimes toxic medications to treat it.

At 50, Sanchez has coronary artery disease, fibromyalgia and arthritis, among other illnesses. He suffers chronic pain in his knees and back and walks with a cane because of vertigo and neuropathy. Advancing bone disease has left him in need of hip surgery.

“I’m grateful to still be alive, but my body is probably about 20 years older than I actually am,” said Sanchez, who lives in an apartment in Chicago’s Rogers Park neighborhood filled with plants and photographs of loved ones. “I’m going to the doctors constantly. Sometimes it’s hard to put my finger on if it is the HIV, or if it’s just getting older.

“Sometimes I feel like an old man.”

In the decades since HIV emerged, it has evolved from a diagnosis with an almost certain death sentence to a chronic illness, one that medical advances have made manageable and less urgent. Now, those diagnosed while relatively young have lived into middle age and even longer with the disease. In some cases, they have lived with HIV for more than a quarter-century.

As these long-term survivors get older, though, some are finding their bodies wearing out, their internal organs battered by potent and sometimes toxic medications, the devastatingly permanent conditions that come with aging leaving their mark a lot faster.

Statistics suggest that more and more HIV and AIDS patients will experience aging that way, and that the urgency over the disease’s killing prowess will give way to how it slowly takes a different toll on its patients. According to the Centers for Disease Control and Prevention, 26 percent of the estimated 1.2 million people living with HIV in 2011 were 55 or older. In 2013, 27 percent of the estimated 26,688 new AIDS diagnoses were in people 50 and older.

Those demographic changes are forcing a new conversation among health care professionals about how patients manage HIV and the other illnesses that come with growing older. Indeed, this is the first group to live so long with the virus, offering a first glimpse of what it is like to grow old with the disease, as well as a first test for doctors for how to treat it.

Some in that group are men like Sanchez, who was diagnosed in 1985, when the condition was far more deadly. The rest may have contracted the disease later in life. Either way, the inflammation HIV causes makes the body work harder and show symptoms of aging faster.

Few studies have examined age-related health problems among HIV patients and how to slow what looks like an accelerated aging process. One study at the University of California, Los Angeles suggests that HIV-positive blood samples showed signs of aging 14 years faster than the blood of healthy individuals. But researchers examining those samples still have more work to do to determine why, said Tammy Rickabaugh, an assistant researcher with the project at the school’s AIDS Institute and Center for AIDS Research.

“We definitely see from studies that HIV-infected people tend to have clinical conditions earlier: frailty, diabetes, high blood pressure,” she said. “What’s difficult to tease out is how much of that is because of the virus and how much of that is from drug treatment. We know the drugs have some effects.”

At the Howard Brown Health Center, on Chicago’s North Side, doctors and other health care providers have begun counseling young HIV patients on heart disease, diabetes, kidney and liver disease and cancers and are testing them for those conditions earlier. They advise them that if they overcome HIV, other issues are likely to arise, said Dr. Magda Houlberg, a chief clinical officer, internal medicine physician and geriatric expert at Howard Brown.

“Some patients are exhausted because they have experienced chronic illness for so long and now they are growing old,” Houlberg said. “They think, ‘Wow, this doesn’t go away. I have all these other new things and I can only expect more things to come.’”

Roy Ferguson, 63, has lived with HIV for 18 years.

Three times, he was near death with pneumonia. In 2011, he went to the Hines VA Hospital thinking he would die, he said. Instead, he made it through the crisis.

“Then it became clear that I was going to live, not die,” he said. “I thought, ‘Now what do I do with myself?’ “

Ferguson worked for years as a field service technician installing equipment until he was downsized. He has emerged as an activist pushing for better access to medication and research for people infected with HIV. These days, he sticks with a disciplined two-hour workout regimen of pushups, squats and bench presses and can be obsessive about his diet. To keep an upbeat disposition, he works with HIV-positive military veterans and volunteers with the AIDS Foundation of Chicago.

Unlike Sanchez, he takes only five pills a day, three of them to manage HIV.

“It helps to think of the benefits of aging, instead of giving in to fear,” he said. “Now I’m prepared to live.”

It’s not just the physical problems that make aging with HIV a challenge. There is also a psychological toll: the guilt from having survived when so many others died. There is a fatigue, too, that can set in from dealing with so many ailments and taking so much medication.

Then there are those who didn’t financially prepare because they didn’t expect to live long enough to retire. Others find themselves debt-ridden from medical bills.

Even as an educator on HIV and aging who talks about the issue often, Brian Bongner said it’s different living through it. He was diagnosed in 1987, took medications that possibly damaged his organs and watched dozens of his friends succumb to AIDS-related illnesses.

“I was told three different times by doctors that I would not go home from the hospital,” he said. “I was told I would never see 23.”

Now, at 47, he finds purpose in teaching about the condition.

“You feel isolated,” Bongner said at a recent training session, speaking to leaders from agencies that work with HIV-positive clients. “You don’t want your friends to see you sick. You don’t want to go to the doctor and be told you’re dying from something else. Your organs are already damaged by HIV, then there’s the medication to treat it, then there’s the aging. At one point we didn’t have an aging HIV-positive population. Now we have 85-year-olds coming through the door.”

Sanchez tries to strategize to overcome his limitations. He has a home health aide who helps him with cooking and other basic tasks. He records reminders of things he has to do and sets his phone alarm so he won’t forget when to take his medications.

“I try to take the bulk of my meds at night so I’m better during the day,” he said. “I have to gauge my energy level.”

Sanchez was only 19 when he learned he was HIV positive. The first thing he did was cash out his life insurance policy, thinking it would never mature. It took him seven years and nearly dying to come to terms with it and begin taking medication.

But while he pushes to rehabilitate, he lives from one health crisis to another. Some weeks, he is at the doctor’s office two to three times. He keeps handy a neat, typewritten list of all his ailments and medications so he can let doctors know what he’s taking.

He often reads about men his age who also have HIV but who are more robust and active.

But that’s not his life.

He misses out on music festivals because he can’t stand for long periods of time. Going to dinner is arduous because of his diet restrictions. Alcohol doesn’t mix well with his medications. His aches and pains make being social tough.

He spends a lot of time alone.

“They show pictures of men climbing mountains, running marathons and conquering the world,” he said of some of the magazines he reads. “I feel I’m not represented. Our community wants us to be a certain way, and when we’re not, we are isolated.”

Monday, 29 June 2015

Stem Cell Injections For Nerve Pain

Today's post from (see link below) could potentially be as important an announcement as any other so-called neuropathy breakthroughs of the last few years. if only it were as simple as the title suggests. One of the major causes of nerve pain is the disintegration or degeneration of the myelin protective sheath around nerves. As with electrical wiring, if the insulation material is damaged (in this case, myelin), the live wire is exposed, causing short-outs etc. Finding something that can repair myelin at the point of damage, would be a major discovery in the fight against neuropathic pain and other symptoms. This article suggests that they may have found exactly that and by simply injecting certain cells extracted from bone marrow, the myelin sheath can be restored, thus blocking off the cause of pain. Whoopee! However, now come the disclaimers! As always with this sort of news, we discover that the research is only at the lab animal testing stage and that this particular form of stem cell therapy is closer to theory than practical application. This means that once more hopes are raised but the reality is that we're still years away from practical treatments. Okay, we'd rather hear about good news in the research field than be kept in the dark but there should always be a subtitle in heavy print, warning the neuropathy patient that they shouldn't start planning to restore their full and busy lives just yet. It's the nature of the beast!

Stem cell injections improve diabetic neuropathy in animal models 
Public Release: 23-Jun-2015 Putnam Valley, NY. (June 23, 2015)

 Bone-marrow-derived mesenchymal cells promote blood vessel growth and re-myelination of peripheral nerves
Cell Transplantation Center of Excellence for Aging and Brain Repair

 - Diabetic neuropathy (DN) is a condition in which perpetually high blood sugar causes nerve damage, resulting in a myriad of symptoms such as numbness, reduced ability to detect painful stimuli, muscle weakness, pain, and muscle spasms. DN affects up to 60 percent of patients with diabetes, is often the cause of foot ulcers, and can ultimately result in amputations. There is no curative therapy for DN, but a recent study carried out by a team of researchers in the U.S. and Korea has found that laboratory animals modeled with DN can experience both angiogenesis (blood vessel growth) and nerve re-myelination following injections of mesenchymal stem cells derived from bone marrow (BM-MSCs).

Their study will be published in a future issue of Cell Transplantation and is currently freely available on-line as an unedited early e-pub at:

The researchers used mesenchymal stem cells, which can be easily isolated from a variety of sources, such as adipose (fat) tissues, tendons, peripheral blood, umbilical cord blood, and bone marrow. MSCs derived from bone marrow (BM-MSCs) have been among the most successfully transplanted cells, offering therapeutic benefits for a wide range of conditions, from serious burns to cardiovascular diseases, including heart attack and stroke.

In this study, laboratory rats modeled with diabetes were randomly assigned to BM-MSC or saline injection groups 12 weeks after the induction of diabetes. The non-diabetic control group of rats was age- and sex-matched. DN was confirmed by latency in nerve conduction velocity tests.

"We investigated whether local transplantation of BM-MSCs could attenuate or reverse experimental DN by modulating angiogenesis and restoring myelin, the electrically insulating substance surrounding nerves that is reduced by DN," said study co-author Dr. Young-sup Yoon, Professor at the Department of Medicine, Division of Cardiology at Emory University School of Medicine. "In this study we have provided the first evidence that intramuscular injected BM-MSCs migrate to nerves and can play a therapeutic role."

According to the researchers, their findings indicate that intramuscular injection of MSCs resulted in an increase of multiple angiogenic and neurotrophic factors associated with blood vessel growth and subsequently aided the survival of diabetic nerves, suggesting that BM-MSC transplantation restored both the myelin sheath and nerve cells in diabetic sciatic nerves.

"We identified several new mechanisms by which MSCs can improve DN," said the researchers. "First, we demonstrated that numerous engraftments migrated to and survived in the diabetic nerves. Second, we demonstrated a robust increase in vascularity. Third, we found the first evidence that MSCs can directly modulate re-myelination and axonal regeneration."

The researchers concluded that DN, for which there is no other therapeutic option, can be an "initial target for cell therapy" and that transplantation of BM- MSCs "represents a novel therapeutic option for treating DN."

"Currently, the only treatment options available for DN are palliative (focused on alleviating pain) in nature, or are directed at slowing the progression of the disease by tightly controlling blood sugar levels, "says Dr. John R. Sladek, Jr., Professor of Neurology, Pediatrics, and Neuroscience, Department of Neurology at the University of Colorado School of Medicine. "This study offers new insight into the benefits of cell therapy as a possible treatment option for a disease that significantly diminishes quality of life for diabetic patients. Safety and efficacy for human application must be evaluated to further determine the feasibility of BM-MSC transplantation for treatment of DN."

Contact: Dr. Young-sup Yoon, Professor of Medicine, Department of Medicine, Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, WMB 3009, Atlanta, GA 30322, USA.
Phone: 404-727-8176
Fax: 404-727-3988

Citation: Han, J. W.; Choi, D.; Lee, M. Y.; Huh, Y. H.; Yoon, Y-S. Bone marrow-derived mesenchymal stem cells improve diabetic neuropathy by direct modulation of both angiogenesis and myelination in peripheral nerves. Cell Transplant. Appeared or available on-line: May 13, 2015.

The Coeditors-in-chief for CELL TRANSPLANTATION are at the Diabetes Research Institute, University of Miami Miller School of Medicine and Center for Neuropsychiatry, China Medical University Hospital, TaiChung, Taiwan. Contact, Camillo Ricordi, MD at or Shinn-Zong Lin, MD, PhD at or David Eve, PhD or Samantha Portis, MS, at

News release by Florida Science Communications

Sunday, 28 June 2015

Neuropathy Caused By Necessary Medications (Personal Story)

Today's post from (see link below) is a personal account of having neuropathy as a result of cancer drug treatment but will resonate with many neuropathy patients. He makes a very good point, that many people encounter neuropathy as a result of the drugs they have been taking for other conditions and it's ironic that most neuropathy treatments also involve drugs used to treat other conditions. He points out that his doctors shrug their shoulders as if to say, well it's par for the course, which only highlights the importance of finding new treatments as quickly as possible. Science is busy doing just that and there certainly seems to be a new wave of interest in finding solutions for nerve damage but in the meantime, patients need the patience of a saint while they wait in discomfort and pain.

Living with and tackling PERIPHERAL NEUROPATHY 
Posted on May 28, 2015 by frankobserver

Peripheral neuropathy is caused when there has been damage to the nerves of the peripheral nervous system causing a loss of touch sensation or a loss of motor function in certain parts of the body; whilst this can be predominantly to the hands and feet, many different parts of the body can be affected..

Whilst diabetes and shingles (Herpes Zoster) are two common causes of peripheral neuropathy, there are several other major illnesses, diseases and treatments that can be the basis of it. 

I’ve had the neuropathy for well over six years to some degree although the severity has diminished somewhat in recent times.

It first appeared during the chemotherapy that followed my operation for cancer. The treatment was called “Folfox” and it was administered at the Drogheda Oncology Unit in County Louth during 2009. The staff and the treatment I received was excellent and for many, one can argue that peripheral neuropathy is a small price to pay but it is still frustrating!

By no means am I unusual in that I have developed peripheral neuropathy, in fact, it appears to be fairly common, especially after Folfox chemotherapy. For some it lasts six or twelve months and then goes away; for others it seems that the damage may be permanent.
When one asks someone in the medical profession “what one can do to resolve this problem”, it is normally met by a “shrug of the shoulders” It seems that, despite their incredible skills, they are technically stumped on this one. However, the medical profession make wonderful advances and there are indications that the instances of peripheral neuropathy, caused by treatment, can and will be reduced for future patients.

Accordingly, when the Folfox treatment is administered now in Ireland, there is an additional drug which can help reduce the instances of peripheral neuropathy in patients. It is considered that Xaliproden reduces neuropathy caused by FOLFOX and seriously reduces the risk of same associated with oxaliplatin which is incorporated in Folfox; this is great news for patients and for people recovering from colorectal cancer; however, the drug has to be administered at the time of ones chemotherapy – it is not practical after the treatment has been completed apparently.

My peripheral neuropathy was caused by Folfox Chemotherapy and there has been little I can do to relieve the symptoms; additionally the amount of numbness to the toes & feet can differ considerably for those affected. But for all people with peripheral neuropathy, it seems the amount of pain can vary considerably from patient to patient, and depending on the parts of the body most affected.

So for large numbers of people, the nerve damage that leads to peripheral neuropathy is caused by the drugs that have been administered to treat other diseases and not necessarily from the illness itself.

Tackling this problem is difficult but from my own experience I have found that vitamin B6 in doses of 100mg per day can assist and reduce the numbness but it remains a significant problem even now. Squeezing a tennis ball helps the hands and fingers as does exercising the toes (standing on tip toes, moving them as much as possible and massage) but it’s a gradual process.
Peripheral neuropathy caused by chemotherapy may be ‘a small price to pay’ especially if chemotherapy has helped to save your life!! But ‘non-cancer’ patients may experience problems following exposure to other toxins, some heavy metals and organophosphate pesticides. Lupus & rheumatoid arthritis can also be causes of peripheral neuropathy .There are also hereditary diseases such as Charcot-Marie-Tooth disease. Syphilis patients too can experience this and HIV can cause peripheral neuropathy as can the necessary treatment for same. 

There are many sites that discuss this issue but the best place to start is probably with your own doctor or GP. My own experiences are covered in a log that I made at the time of my treatment. Please visit COLON CANCER – MY EXPERIENCES.
Good luck and best wishes to all.

Saturday, 27 June 2015

Quinolone Antibiotics And Neuropathy

Today's post from (see link below) is yet another story of the damage caused by quinolone antibiotics - in this case, severe neuropathy. Despite FDA warnings and case studies from all across the world, doctors are still widely prescribing this family of antibiotics but the damage they can cause to existing and potential neuropathy patients, speaks for itself. If your doctor proposes prescribing fluoroquinolones for your infection, please don't just accept it but start a serious discussion with him or her to see whether they are in fact the right sort of antibiotic for you. There are alternatives but remember, once you have nerve damage you can't turn the clock back. For the sake of a serious discussion, you could save yourself years of misery. Other articles on this subject can be found by using the search button to the right of this page.

Busy Mom Tells Harrowing Story of Quinolone Peripheral Neuropathy 
By Amanda Antell June 16, 2015

Quinolone antibiotics are some of the most commonly prescribed medications in the United States, designed to treat all varieties of infections. Unfortunately, these famous drugs have been linked to several severe side effects like blindness and nerve damage.

In one of the most recent examples of these cases, a young mother that was prescribed Levaquin was diagnosed with peripheral neuropathy soon after. Not even 40 years old, this mother now struggles to walk and must undergo intense physical therapy several times a week; she complains that she will lose strength in her legs if she does not do this.

It all started last summer when the young mom, Shannon, had been diagnosed with a sinus infection and was prescribed Levaquin to treat it. Soon after starting the medication, Shannon started feeling a burning-like pain in her legs, along with her feet and eyes. After three months and four doctors, she was finally diagnosed with peripheral neuropathy. Her doctor had come to this conclusion based on the correlation between her symptoms and her Levaquin prescription.

The doctors involved in the case stated that they were not surprised by this incident, as they had read many similar cases from different cities. One of the diagnostic doctors, Dr. Charles Bennett, is one of the chairs of a drug safety watchdog agency at the University of South Carolina. He had recently petitioned for the FDA to add new black box warnings for Levaquin.

The FDA already required recent label updates for quinolone drugs regarding the side effects of tendon rupture, muscle weakness, and nerve damage. However Dr. Bennett insists that stronger warnings need to be attached to quinolone drugs, like Levaquin, because statistics show that 1,200 people have died from these side effects with nearly 100,000 injuries.

When Shannon learned that she was suffering nerve damage allegedly caused by her antibiotic, she was devastated, but feels lucky that her condition was not serious enough to be life-threatening. Currently, Shannon is trying to stay positive and is hoping that her nerves will regenerate themselves so she can resume her life. Family members state that they find it difficult to watch her struggle, and wish that the drug companies had provided stronger warnings and conducted sufficient research.

Levaquin’s manufacturing company, Johnson & Johnson, had emailed a statement to WCNC regarding Shannon’s case. The company insisted that Levaquin is a highly important medication that has been used to treat bacterial infections for more than 20 years, and has proven to have more benefits than risks when evaluated. Many patients disagree with this sentiment, after being left with permanent nerve damage, blindness, or other physical scarring.
Overview of Quinolone Peripheral Neuropathy

The concern of quinolone peripheral neuropathy became rampant when the FDA issued a public warning in August 2013 that stated that serious nerve damage could occur when taking a quinolone antibiotic. The agency warned that nerve damage could be permanent and can occur as soon as a week after starting the medication. A year later, in August 2014, a study published in Neurology found that quinolone injections or oral tablets could double the risk of peripheral neuropathy, as well as permanent nerve damage. The medications included in the FDA’s warning are Levaquin (levofloxacin), Cipro (ciprofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin), and Factive (gemifloxacin).

Peripheral neuropathy occurs when nerves that connect the brain and spinal cord, otherwise known as the central nervous system, somehow become disrupted. These nerves are vital in sending signals between the brain and the rest of the body, so any interferences can impair muscle movement, cause severe pain, and prevent sensation signals from reaching the arms and legs. Currently, it is unknown as to what causes peripheral neuropathy but doctors believe that quinolones somehow cause the nerves to cross signals with each other.

Doctors warn that this condition is fast and aggressive, resulting in permanent nerve damage in some cases. Numerous patients have filed legal action against Johnson & Johnson and other quinolone manufacturing companies for failing to protect them against the dangers of their products.

Friday, 26 June 2015

Anaesthetics And The Treatment Of Neuropathy

Today's post from (see link below) is a general assessment of neuropathy treatment at the moment, from the American Society of Anaesthesiologists and looks particularly at anaesthetics as pain killers, including such drugs as ketamine. The problem is that there are no definite conclusions here. Ketamine is seen as a promising analgesic agent for neuropathy sufferers but there's little discussion of opioids in general and no mention of methadone for instance, which is proving very successful in nerve pain cases. Nevertheless, this does look at neuropathy treatment from the point of view of anaesthesiologists and as such gives us another angle on the subject.

Causes of Neuropathic Pain Guide Treatments
Timothy Lubenow, M.D., Philip Peng, M.B.B.S., and Jianguo Cheng, M.D., Ph.D. 2014

Neuropathic pain is one of the most complex and difficult management challenges physician anesthesiologists face. Hundreds of distinct neuropathic pain syndromes have been documented and many are refractory to multiple treatments.

“Neuropathic pain affects 18 percent of the general U.S. population,” said Jianguo Cheng, M.D., Ph.D., Professor and Director of the Pain Medicine Fellowship Program at the Cleveland Clinic in Cleveland. “It is a major part of our practice and very resource-intensive. Medical costs for neuropathic pain patients are threefold higher compared with matched control subjects.”

Neuropathic pain is caused by a lesion or insult in the peripheral or central nervous system. The resulting plasticity in the peripheral and central nervous system leads to sensitization and hyperexcitability of neurons in the dorsal root ganglion, the spinal cord and the brain. The result is hyperalgesia, allodynia and spontaneous pain.

Causes include post-surgical, post-traumatic or post-herpetic neuralgia, diabetic neuropathy, HIV neuropathy, hypothyroidism, toxic exposures, lesions of the central nervous system, complex regional pain syndromes and more.

“Treatment of neuropathic pain has two goals,” said Timothy Lubenow, M.D., Professor of Anesthesiology, Rush University Medical Center, Chicago. “We want to alleviate or eliminate the cause of the underlying disease and to relieve symptoms.”

Treating the underlying cause is vital to long-term control, he said. For example, it is virtually impossible to successfully treat diabetic neuropathy until the underlying diabetes is brought under control.

Step therapy is standard for treating neuropathic pain, Dr. Lubenow said. Most patients can be treated with drug therapy, typically combinations of agents with different mechanisms of action. Multiple medical societies have issued guidelines for neuropathic pain, most with somewhat different recommendations. There are a wealth of anecdotal reports and open-label studies, and a dearth of strong evidence.

“When the evidence is soft, it is more open to interpretation and opinion,” he said. “You want a drug or a combination of drugs that are useful in alleviating pain, but you also want to minimize side effects.”

Pregabalin, gabapentin and duloxetine appear as preferred agents in most guidelines, Dr. Lubenow said. Other agents frequently recommended include sodium valproate, oxycarbazepine, venlafaxine, amitriptyline, dextromethorphan tramadol, morphine, oxycodone and capsaicin.

For patients with recalcitrant pain, spinal cord stimulation and intravenous infusion may be viable alternatives.

There are data supporting the use of I.V. lidocaine, bisphosphonates, phentolamine and immunoglobulin, said Philip Peng, M.B.B.S., Professor of Anesthesiology and Pain Management at Toronto Western Hospital, University of Toronto. But the duration of analgesia tends to be short, and severe adverse events are common.

Ketamine is one of the most promising I.V. agents for neuropathic pain, he said. Most studies use 50 mg or less infused over 30 minutes to two hours and the analgesic effect lasts less than two days. Trials using larger doses over longer infusion periods show much greater effect.

A study using anesthetic doses infused over five days showed significant pain relief up to six months following treatment, but there were significant psychotropic effects, muscle weakness and infections. Later trials using lower doses showed less severe adverse events but also less analgesia.

Early data from a Toronto Western Hospital trial using six-hour outpatient infusions for five days showed slightly more non-responders than responders, Dr. Peng reported. But responders showed greater than 50 percent pain relief up to three months after treatment.

“Responders tend to have less pain by the end of the second day,” he said. “At this point, we have no good tool for predicting responders. We are hoping for more robust data as the protocol progresses.”

Thursday, 25 June 2015

The Mystery Of Neuropathy

Today's post from (see link below) is a reader-friendly description of neuropathy and how it affects us. Less focussed on the science but more on how we feel when we have neuropathic symptoms. Relating it to other systems which we're more aware of, is always useful - it helps put neuropathy in a meaningful context in people's minds and especially reassures them that they're not alone in feeling as they do. It includes the very sensible statement that the best neuropathy diagnosis is obtained by listening to the patient's testimony but can be followed up by certain diagnostic tests - if only most doctors agreed with that order of events!

Peripheral neuropathy’s cause remains mystery for millions of Americans
By Premier Health
Monday, June 22, 2015

A person’s brain and spinal cord serve as the mainframe from which important messages are sent throughout the body via the peripheral nervous system.

The peripheral nervous system helps the body’s internal organs function properly and provides important signals regarding its response to the outside environment such as when a person’s feet are hot or their hands are cold. Trauma, infections, disease and injury can all cause damage to the peripheral nervous system and when this happens, a person may notice the feelings they have taken for granted all these years have become distorted or are suddenly gone.

This condition, known as peripheral neuropathy, causes numbness and tingling in a person’s extremities, and in extreme cases, can limit a person’s mobility and affect their ability to breathe. According to the National Institute of Neurological Disorders and Stroke (NINDS), peripheral neuropathy affects more than 20 million Americans, and for a significant number of individuals the cause of the disease is unknown.

“Peripheral neuropathy distorts the messages that travel from the brain and spinal cord to the outlying parts of the body including hands, feet and sometimes a person’s face,” said Christopher Scheiner, MD, PhD, a neurologist with the Clinical Neuroscience Institute. As the NINDS describes it, the disease is much like static on a telephone line, interrupting messages that should be carried throughout a person’s body, but which never properly reach their destination.

Dr. Scheiner said in most cases, symptoms of peripheral neuropathy happen gradually. As a result, individuals may dismiss symptoms until the disorder progresses to a point where they can no longer deny their existence. Carpal tunnel syndrome, where the median nerve in the wrist is damaged, is one of the better known peripheral neuropathies where this is often played out, Dr. Scheiner said.

“People may attribute the loss of sensation in their hands simply to their positioning on the steering wheel,” Dr. Scheiner said. “However, they will begin to notice that it is happening more often and becoming more painful. But it is when they do something outside of their normal routine such as holding a paintbrush for five minutes that they realize something is wrong.”

Peripheral neuropathy is best diagnosed through a clinical exam in which a neurologist will ask a series of questions about a patient’s symptoms. A physician’s diagnosis can then be supported through additional testing. One common test that is done is an electrodiagnostic test called an electromyography (EMG). An EMG delivers electricity through a small shock to the areas of the body where a patient is having symptoms. This enables a doctor to determine any damage to the nerves in that area.

Dr. Scheiner said it’s important to be evaluated for peripheral neuropathy because in some cases it could signal an underlying health issue that needs immediate attention. The most common form of peripheral neuropathy is diabetes. Up to 70 percent of diabetics have the disorder, according to the Foundation for Peripheral Neuropathy. In some cases, diabetes may be discovered through the presence of peripheral neuropathy, he said.

HIV/AIDS patients and those taking certain chemotherapy drugs also experience the disorder. According to the Foundation for Peripheral Neuropathy, the disorders affect up to 40 percent of chemotherapy patients and a third of all HIV/AIDs patients.

The disorder can sometimes be cured when an underlying health issue is brought under control. In some cases, peripheral neuropathy can cause a person pain and when this happens medication can be prescribed to help alleviate it.

“These medications help to turn off the nerves that are causing pain,” Dr. Scheiner said. “They are different than what a patient would receive from an over-the-counter medication like Tylenol, but still allow a patient to function without the sensation that they are being controlled by a substance.”

Premier Health Specialists is one of the largest groups of specialty care practices in Southwest Ohio. More than 130 physicians serve patients in a variety of specialties such as bariatric, breast care, burn and wound, cardiology, cardiothoracic surgery, cardiovascular-thoracic surgery, general surgery, gynecologic oncology, hand and reconstructive surgery, infectious diseases, maternal-fetal medicine, neurosciences, obstetrics and gynecology, orthopedic surgery, orthopedic spine surgery, ophthalmology, palliative care, physiatry, plastic surgery, podiatry, psychology, pulmonology, sports medicine and urology. Premier Health Specialists is part of Premier Health, which includes Miami Valley Hospital, Good Samaritan Hospital Dayton, Atrium Medical Center and Upper Valley Medical Center. For more information, visit

Wednesday, 24 June 2015

Neuropathy: An HIV-Related Pain Problem

Today's post from (see link below) looks at the remarkably high incidence of neuropathy associated with HIV infection. The article mentions a figure of 30% of all people living with HIV, also contracting neuropathy but you will find many experts quoting figures of up to 45% and 50%. Neuropathy can arise from the virus itself attacking the nervous system; or long-term HIV drug use, or any of the other 100 causes that affect the rest of the population. Whatever the accuracy of the statistics, it is clearly a problem for HIV patients and one that is widely underestimated and often poorly treated. Worth a read.
Peripheral Neuropathy and HIV-Associated Nerve Pain 
Pain Medicine Specialist, Dr. Paul Christo 2015
Most people in the U.S. are aware that HIV (human immunodeficiency virus) causes AIDS, but many might not know that the condition itself and medications associated with HIV/AIDS can end up causing severe pain for those who suffer from it. According to AVERT, a UK-based HIV and AIDS charity, neuropathic pain affects approximately 30 percent of people with AIDS.

Like other serious health issues, such as cancer and diabetes, HIV can cause damage to the peripheral nerves of the body. Symptoms are usually felt in both feet or both hands and can progress up the body in a “stocking and glove” pattern. Minor everyday injuries like a paper cut or sunburn injure these nerves in healthy people. However with a condition like HIV, this nerve damage can lead to burning pain, numbness, or even paralysis. Patients may also feel numbness, tightness, or clumsiness. According to The Peripheral Nerve Center at Johns Hopkins, peripheral neuropathy is one of the most frequent neurological complications of an HIV infection.

On a past episode of Aches and Gains, I spoke with Hotchkiss Brain Institute neurologist and neuroscientist, Dr. Douglas Zochodne. He is a pioneer in the field of nerve regeneration whose work centers around stimulating nerve re-growth in an effort to restore sensory and motor function, as well as ease pain. It’s the work of Dr. Zochodne and other medical pioneers that may give patients who suffer from neuropathic pain of various types some relief and the ability to live a fuller life.

GBS is a condition that can be associated with HIV (and Lupus); it attacks the nervous system and can cause painful, stinging, needle-like sensations along with numbness and weakness. GBS is also referred to as Chronic Acute Inflammatory Demyelinating Polyneuropathy (CIDP) and Landry’s Ascending Paralysis. The cause of GBS/CIDP is unknown, but those with HIV-associated GBS are typically treated similarly to other GBS patients.

Treatment of HIV/AIDS-associated neuropathy varies greatly depending on the level and type of pain. Often, doctors use medicines like gabapentin (Neurontin), pregabalin (lyrica), or duloxetine (cymbalta) and see pain improvement. Peripheral neuropathy caused by certain medications is often treated by reducing the dosage of the drug or completely eliminating it. Though in some cases the damage may be permanent, many patients start to feel less neuropathic pain within a few weeks or months after stopping the medication.

The month of June features two annual observances of HIV/AIDS awareness: National Caribbean-American HIV/AIDS Awareness Day on June 8 and National HIV Testing Day on June 27. For more information on HIV/AIDS neuropathy, visit The Foundation for Peripheral Neuropathy website.

Learn more about nerve pain by listening to podcasts from previous Aches and Gains episodes:
The Mystery of Chronic Inflammatory Demyelinating Polyneuropathy (CIPD)
The Miracle of Nerve Restoration
Painful Diabetic Neuropathy

Each week on Aches and Gains radio show, I outline a new pain source, what causes it, who can be affected, and most importantly, how it can be treated or managed. Visit the radio show page for a complete list of podcasts for past episodes. Tune into Aches and Gains every Saturday at 5 p.m. and 5:30 p.m. on SiriusXM Family Talk Radio Channel 131.

Tuesday, 23 June 2015

New Discovery Curbs Nerve Pain Without Drug Side Effects

Today's post from (see link below) is one of those complex technical ones that often leave us scratching our heads to wonder how it could possible affect our own personal situations. However, if you take a little time to read it, you should get the gist of what it's saying and what the implications are. It starts off with a neuropathy-patient-friendly call for treatments that work well on people and not just laboratory mice. We are so used to the newest developments being announced at the rodent-testing stage, that we lose faith that they will ever be translated to human treatment. This article tries to show that the gulf between lab-rats and humans in this case, is not so large after all. Worth a read.

Potent approach shows promise for chronic pain
Inhibitor discovered through human, mouse genetic studies curbs pain without narcotic side effects 

Date:June 17, 2015 Source:Boston Children's Hospital

Non-narcotic treatments for chronic pain that work well in people, not just mice, are sorely needed. Drawing from human pain genetics, an international team led by Boston Children's Hospital demonstrates a way to break the cycle of pain hypersensitivity without the development of addiction, tolerance or side effects.

Their findings, reported June 17 in the journal Neuron, could lead to treatments for chronic pain conditions caused by nerve damage, such as diabetic peripheral neuropathy (DPN) and post-herpetic neuralgia (PHN), as well as chronic inflammation, like rheumatoid arthritis. Current treatments provide meaningful pain relief in only about 15 percent of patients.

"Most pain medications that have been tested in the past decade have failed in phase II human trials despite performing well in animal models," notes Clifford Woolf, MD, PhD, director of Boston Children's F.M. Kirby Neurobiology Center and a co-senior investigator on the study with Michael Costigan, PhD. "Here, we used human genetic findings to guide our search from the beginning."

In 2006, Costigan, Woolf and colleagues showed in Nature Medicine that people with variants of the gene for GTP cyclohydrolase (GCH1)--about 2 percent of the population--are at markedly lower risk for chronic pain. GCH1 is needed to synthesize the protein tetrahydrobiopterin (BH4), and people with GCH1 variants produce less BH4 after nerve injury. This suggested that BH4 regulates pain sensitivity.

"We wanted to use pharmacologic means to get the same effect as the gene variant," says Alban Latremoliere, PhD, also of Boston Children's Kirby Center, who led the current study along with Woolf and Costigan.

In a "reverse engineering" approach, the researchers modeled the human biology in mice. They first showed that mice with severed sensory nerves produce excessive BH4, churned out both by the injured nerve cells themselves and by macrophages--immune cells that infiltrate damaged nerves and inflamed tissue. Mice engineered to make excess BH4 had heightened pain sensitivity even when they were uninjured, suggesting that BH4 is sufficient to produce pain. On the flip side, mice that were genetically unable to produce BH4 in their sensory nerves had decreased pain hypersensitivity after peripheral nerve injury.

"We then asked, if we could reduce production of BH4 using a drug, could we bring about reduction of pain?" says Latremoliere.

The answer was yes. The researchers blocked BH4 production using a specifically designed drug that targets sepiapterin reductase (SPR), a key enzyme that makes BH4. The drug reduced the pain hypersensitivity induced by the nerve injury (or accompanying inflammation) but did not affect nociceptive pain--the protective pain sensation that helps us avoid injury.

Fine-tuning pain relief

Because BH4 is active all over the body, with important roles in the brain and blood vessels, the goal of any treatment would be to dial down excessive BH4 production, but not eliminate it entirely. Latremoliere and colleagues showed that blocking SPR still allowed minimal BH4 production through a separate pathway and reduced pain without causing neural or cardiovascular side effects.

"Our findings suggest that SPR inhibition is a viable approach to reducing clinical pain hypersensitivity," says Woolf. "They also show that human genetics can lead us to novel disease pathways that we can probe mechanistically in animal models, leading us to the most suitable targets for human drug development."

Story Source:

The above post is reprinted from materials provided by Boston Children's Hospital. Note: Materials may be edited for content and length.

Journal Reference:
Clifford J. Woolf et al. Reduction of Neuropathic and Inflammatory Pain through Inhibition of the Tetrahydrobiopterin Pathway. Neuron, June 2015 DOI: 10.1016/j.neuron.2015.05.033

Monday, 22 June 2015

Are Tens Units Any Good For Neuropathy?

Today's post from (see link below) reflects the varying opinions about the benefits of electrical nerve stimulation machines such as Tens, for people with nerve damage. As a result, this article can only be seen as one person's opinion and the best advice would be to consult as many people as possible (including your doctor) and do your own research before  starting using such appliances. That said, if numbers are to be believed, thousands of people across the world do get some benefit from using Tens and others but that can be said from almost all given neuropathy treatments. Do all the research you can but remember, as with all neuropathy treatments, what works for some doesn't work for others - it remains a minefield.

Using Electrical Nerve Stimulation Machine for Diabetic Neuropathy Should Be Considered  

No visible author 18 Jun, 2015

 The most common forms of electro-analgesia is the Tens machine. There has been several clinical reports and ongoing research with regards to the use of Tens machines for certain medical conditions such as arthritic pain, myofacial, lower back pain, bladder incontinence, visceral pain, post operative pain and neurogenic pain. Due to these studies being inconclusive, the question as to whether the Tens are more effective than a placebo in combating pain is still unresolved. The mechanisms currently proposed with regards to the Neuro modulation that Tens produces include pain control, restoration of input afferent, and presynaptic inhibition in the dorsal horn of the spinal cord and direct inhibition of an abnormal excited nerve.

Studies revealed that the electrical stimulation reduces pain via nociceptive inhibition in the horn of the spines dorsum horn at a presynaptic level and in turn limits its central transmission and that the electrical nerve stimulation machine on the skin myelinated nerve fibres and the electrical stimuli activates a low threshold. With low frequency Tens a marked increase in met-enkephalin and beta endorphins were noted and also demonstrated antinociceptive reversal effects by naloxone. Through micro opioid receptors the effects were postulated. However, naloxone was not reversed with high frequency Tens analgesia, implicating a dynorphin binding receptor that is naloxone resistant. Increased levels of dynorphin A were revealed in cerebral spinal fluid samples. Pain in interpreted when painful peripheral stimulation occurs as the C fibres carry the information which causes the T cells to open the gate which in turn the cortex and thalamus receive the pain transmission centrally. This theory explains the gate control theory, as the gate is usually closed. A range of both positive and negative outcomes have been noted in a wide range of medical conditions when using the Tens machine. Due to several trials and studies conducted there has been an overall consensus in favour of the use of Tens. Around 70 to 80% of patients experience initial pain relief provided by Tens, and around 20 to 30% success rate decreased after a few months of using Tens. In order to establish the full benefits, the Tens should be applied for at least an hour.

The stimulus preferences differ, and studies revealed that 57% of patients that used the Tens machine daily most definitely benefited as well as displayed different stimuli to particular pulse patterns and frequencies and were found to be adjusting their stimulators in subsequent treatment sessions. Tens has also proved positive for mild levels of pain post operative and post traumatic and proved ineffective for acute pain and tension headaches. However, Tens proved positive for painful diabetic neuropathy and treatment using Tens should be considered for this disorder.

Sunday, 21 June 2015

Exercising Safely With Neuropathy Problems

Today's post from (see link below) talks once again about exercise for people living with neuropathy. I know that this blog constantly harps on about the value of exercise but it is so important, both to help the body stay as fit as it is and prevent further degeneration thanks to inactivity. It doesn't matter what levels of exercise you can achieve as long as you make the effort, despite the pain and discomfort it can bring. This short article gives some exercise alternatives if your feet and legs are so painful that the very thought sends you running for your bed. You don't have to make the pain worse but it may get worse and your muscles and nervous system may grind to a halt if you do nothing. At least exercise your eyes by giving it a read - the rest is up to you.

How Can I Stay Active With Neuropathy?
By Everyday Health Guest Contributor Published Apr 10, 2015

Ask the Fitness Expert, Jennifer Bayliss

Q: I have diabetes-related neuropathy and I’m a little afraid to exercise because of it. Can you give me some ideas on how to get active and avoid further complications?

A: Your reservations about exercise are common, but it’s great that you’re interested in getting active. After all, physical activity can help you control your blood sugar levels, improve your mood, and manage stress and emotions. It can also aid in weight loss, which helps lessen tension and pain in your lower body. Overall, being physically active can help everything seem a bit more manageable.

Here are five things to consider if you have diabetic neuropathy and want to continue or start exercising:

1. Talk to Your Doctor

Speak to your physician and make sure that it is safe for you to exercise. You may have other health risk factors, and you want to make sure your doctor is on board with your exercise plans. Your capabilities and limitations depend on the degree to which the neuropathy hinders your movement. Some effects of neuropathy include muscle weakness, loss of sensation, numbness, tingling, pain, or a loss of body position awareness (proprioception). If neuropathy is affecting your lower body — foot, ankle, and leg — your balance and walking may be impacted.

2. Try Seated Exercises
If your sense of balance or proprioception is affected — or if you have considerable pain with standing — consider focusing on seated exercises. They can be beneficial in managing neuropathy because they help you improve your circulation, range of motion, and strength without worrying about balance or bearing too much weight. To get started, you will need a sturdy chair or an exercise ball and a pair of hand-held weights. Choose a weight that is challenging, but allows you to get through all of the repetitions within your workout without sacrificing form.

3. Practice Balance Training
Balance training helps work the muscles in your lower body and core, and aids in constructing the brain-body connection you need to prevent falls and build a strong foundation. When performing balancing exercises, use a wall or stable chair for assistance. However, please note that you should introduce standing exercises in your routine only when you’re sure you can tolerate them.

4. Find the Right Cardio for You
If you are experiencing some of the side effects of peripheral neuropathy, it doesn’t mean you need to rule out cardio completely. Is walking, jogging, or running too tough to manage comfortably? Try swimming or water aerobics, riding a stationary or recumbent bike, or using an upper body ergometer.

5. Check in With Your Feet

When you have numbness or pain in your feet, you may not be able to feel when a blister or a sore is forming. Make sure you have appropriate footwear for your activity, and check your feet daily for any blisters, sores, or ulcers. It’s also important to wear clean socks that fit you well during exercise. Cotton is not always the best choice, but socks made out of material that pulls moisture away from your skin can be helpful. Prevention is key because healing a sore once it has formed can be quite challenging.

If you don’t have trouble with balance and aren’t in significant pain, you will probably be able to tolerate more moderate-intensity activity. Try adding walking or resistance training to your daily activity.

Recommendations for Exercising with Diabetes-Related Complications

Cardio (Aerobic Training) Resistance (StrengthTraining)
Moderate intensity aerobic training for more than 30 minutes/day on 5+ days/week (at least 150 minutes weekly) 2-3 times/week on nonconsecutive days
Vigorous intensity aerobic training for more than 20 minutes/day on 3+ days/week (at least 60-75 minutes weekly) 5-10 exercises using major muscle groups
OR a combination of moderate- and vigorous-intensity aerobic exercise to achieve a similar amount of training 1-3 sets of 8-15 repetitions

Jennifer Bayliss is a fitness expert and coach at Everyday Health. She is a certified strength and conditioning specialist through the National Strength and Conditioning Association, a AFAA certified personal trainer, and holds both an undergraduate and a graduate degree in exercise science.

Balducci, S, Iacobellis, G, Parisi, L, Di Biase, N, Calandriello, E, Leonetti, F, and Fallucca, F. “Exercise training can modify the natural history of diabetic peripheral neuropathy”; Journal of Diabetes and its Complications; 2006 Jul-Aug; 20(4):216-223.

Saturday, 20 June 2015

Accepting The Pain Of Neuropathy And Moving Forward

Today's post from (see link below) is a self-help article with a difference - it makes sense! Most self-help articles are well-meaning but stuffed with clichés and so-called new age philosophy and go over most people's heads. What we need is to know why we need to become proactive in our health problem and why that will do us good. This article sets out to explain how not fighting our pain (as we're expected to do) is the first step towards learning to live with it and improve it. Worth a read...even for cynics.

Finding Hope in Acceptance  
Author: Murray J. McAllister, PsyDPosted on August 26, 2013

At first thought, it might seem crazy to accept that your pain is chronic. When I bring it up with patients, many of them tell me, not without some irritation in their voice, “I’ll never give up hope of finding someone who can fix me!” Indeed, it’s common to think that accepting the chronicity of your pain is the same thing as giving up hope that you’ll ever get better. So, why in the world would you ever want to accept that your pain is chronic?

Contrary to what you might think, accepting that your pain is chronic is the first step in actually getting better. It opens up a whole new way of getting better, a way that takes into account the realities of your pain condition. As such, it’s a new and more realistic way to have hope.

To understand the point more clearly, let’s briefly review two different models of healthcare – two different ways that we get better when having an illness or injury. These two models are what we might call the ‘acute medical model’ and the ‘rehabilitation model.’ The latter is sometimes called the ‘self-management model.’ (For a more thorough review of these models of healthcare, click on this post here.) 

Acute Medical Model

The acute medical model of healthcare is what most of us think of when we go to see a healthcare provider. When sick or injured, we go to a provider who determines what’s wrong and provides a treatment that cures us. The healthcare provider is an expert who usually knows more about the condition and the treatments than we do. The treatments themselves are usually medications or procedures that act on us. We don’t typically get better by doing things ourselves. Rather, it’s the treatments that get us better and we rely on healthcare providers to provide us with those treatments. Lastly, getting better in the acute medical model is usually thought of as getting cured. We return to our usual state of health — how we were before we became ill or injured.

Hope of getting better within the acute medical model lies in finding the right healthcare provider who knows what’s wrong and knows how to cure you. In this model, hope lies external to you. You find it in the expertise and treatments of a healthcare provider.

Now there’s nothing wrong with the acute medical model. It’s all well and good when we have a condition for which there actually is a cure. Indeed, it’s likely the best thing to do. But, what do you do when you have a condition for which there is no cure?

Rehabilitation Model

The answer to the question, of course, isn’t to give up hope and do nothing. There’s actually a different way of getting better. It’s the rehabilitation model of care. It requires, however, redefining how to get better and even redefining what it means to get better.

In the rehabilitation model of care, the emphasis is on what you, the patient, do to get better — not on what the healthcare provider does to get you better. Specifically, the focus is on the patient acquiring the abilities to make healthy changes, which, when done over time, have a positive impact on the chronic health condition that you have. These changes fall into two categories: a) changes in health behaviors, or what’s often referred to as lifestyle change, and b) changes in coping, or what’s often referred to as stress management. The goal of learning and engaging in these health behaviors over time is two-fold: you reduce the symptoms of the condition and you reduce the impact that the chronic health condition has on you. In other words, you get so good at self-managing the condition that it no longer is as problematic as it once was. As a consequence, you can move on with the rest of your life, engaging in the meaningful activities of life – such as work, family activities, social and recreational activities.

Notice that the rehabilitation model doesn’t promise a cure. The reason is that the conditions for which the rehabilitation model is best suited are those conditions that are chronic. They have no cure. Nonetheless, the patient does get better in very real and meaningful ways.

Notice too that hope gets redefined. It allows for having hope even when there is no cure. Finding a cure is not the only way to get better. Therefore there’s still hope. It’s just a different way to have hope, a hope that realistically takes into account the chronic nature of the condition you have, but nonetheless points to how to how you still can get better.

The conditions for which the rehabilitation model is best suited are chronic conditions, where there is no cure, such as chronic pain syndromes, diabetes, heart disease, and spinal cord injuries, among others.

Finding Hope in Acceptance

Acceptance that your pain is chronic is the first step in pursuing the rehabilitation model of care. Rehabilitation is hard work. It also takes time. You don’t do it if you think that a cure is just around the corner. Once you recognize, though, that your chronic pain really is chronic, it becomes your life-saver – or life-retriever. You start to get your life back. You learn how to self-manage your pain and you practice it to the point that you move on with the rest of your life. Your life doesn’t have to be about chronic pain.

Patients can keep their life on hold when they insist on finding hope only in a cure. They seek out appointment after appointment, attempting to find the right specialist who will know what to do to make their pain go away. Oftentimes, they seek out surgeries or interventional procedures that seem as if they might be a cure, but aren’t. Each time they seek out a new specialist, there is hope. Each time, though, it gets dashed because there really is no cure for chronic pain. Chronic pain really is chronic.

The point, here, is not a criticism of such patients. What we are describing makes sense if you think of healthcare as only the acute medical model. If we think of healthcare providers as specialists who fix us when sick or injured, it makes all the sense in the world to look for the right one who can do the job – even if you have to try one after another. It’s a hard lesson to learn when realizing that it’s only sometimes that healthcare providers act like a mechanic. A lot of the time, we have no fixes. So, again, I’m not judging when I describe patients who fail to accept that their pain is chronic. We can all understand how it happens. They are trying to find hope in a cure.

What if, though, at the end of the day, the hope is really a false hope? It can become a vicious cycle that leads to depression and oftentimes more pain. Hope is found with each new procedure, but each procedure fails to cure the pain and so hope is dashed. If hope is defined by finding a cure, and if there really is no cure, then you are left helpless – and hopeless.

Maybe it’s best to find a new way to have hope.

You find it by accepting that chronic pain really is chronic. You accept that you are not going to get better by finding a cure. Rather, you accept that you are going to get better by learning to self-manage it. You learn how to make healthy changes in your life that, when done over time, reduce your symptoms and reduce the impact that chronic pain has on your life. You get so good at managing chronic pain that it is no longer the preoccupying problem that it once was. Your life consists of the stuff of life and chronic pain comes along for the ride, but remains in the side car.

It’s okay if you don’t know how to do it yet. Most patients have to learn how to do it. Oftentimes, I remind patients that you’re not born with the knowledge of how to self-manage pain successfully. People have to learn it. And it’s okay if you don’t know how and have to learn it.

What matters, though, is that you learn how. It’s possible to learn how to self-manage pain and do it successfully. People learn how to do it everyday in chronic pain rehabilitation programs. And you can too.

You just have to first accept that your chronic pain is really chronic.

(For more information, please see: “What is chronic pain?” or “Why the healthcare system refuses to accept the chronicity of chronic pain.”)

Friday, 19 June 2015

Can Viagra Help Your Neuropathy?

Today's post from (see link below) throws up as many questions as answers, as to whether sildenafil (most commonly known as viagra) can help reduce neuropathic symptoms. Furthermore, what about women? Does it work for them too - given that the theory is that it increases blood flow to the sciatic (and other) nerves? It's a story that's beginning to take root across the Net and if it proves to be true that viagra can give the average neuropathy sufferer with erectile dysfunction an added bonus, then makers of little blue pills across the world can expect significantly increased sales! This article refers to diabetic neuropathy although there is no reason that it should not apply to all nerve damage, irrespective of the cause. It's also still in the 'testing on mice stage', which means we have some way to go before anything's proved and its prescription becomes commonplace. However, you may ask yourself what have you got to lose if you need this sort of erectile enhancer anyway? One problem may be the cost of brand name sildenafil but half the world seems to find a way around that already. An interesting article - worth a discussion with your doctor.
Erectile dysfunction drug relieves nerve damage in diabetic mice
Date: March 17, 2015 Source: Henry Ford Health System

New animal studies at Henry Ford Hospital found that sildenafil, a drug commonly used to treat erectile dysfunction, may be effective in relieving painful and potentially life-threatening nerve damage in men with long-term diabetes.

The research targeted diabetic peripheral neuropathy, the most common complication of diabetes, affecting as many as 70 percent of patients.

The study was recently published online in PLOS ONE.

Lei Wang, M.D., the Henry Ford neuroscientist who led the research, said that although numerous drugs have been shown to be effective in earlier animal experiments, most have not provided benefits in clinical trials.

"Generally, young diabetic animals with an early stage of peripheral neuropathy are used to investigate various drug treatments," Dr. Wang explains. "But patients with diabetes who are enrolled in clinical trials often are older and have advanced peripheral neuropathy.

"Failure to develop and properly evaluate treatments in the laboratory that properly reflect the target clinical population with diabetic peripheral neuropathy may contribute to the failure of clinical trials."

To mimic clinical trials in which diabetes patients have advanced peripheral neuropathy, the Henry Ford researchers chose male mice with type II diabetes that were 36 weeks old, roughly equivalent to middle age in humans.

Earlier animal experiments from the Henry Ford group showed that sildenafil, commonly known by the brand name Viagra, improved blood supply to the sciatic nerve.

In addition, it was noted that diabetes patients who took Viagra for erectile dysfunction had fewer symptoms of peripheral neuropathy.

However, it was not known if this therapeutic effect held true for long-term peripheral neuropathy because the diabetic mice used in the previous experiments were relatively young -- 16 weeks old.

So the Henry Ford researchers chose diabetic mice that were more than twice as old. In one group, 15 such mice were treated with an oral dose of sildenafil/Viagra every day for eight weeks. A control group of 15 age-matched diabetic mice were treated daily with the same amount of saline.

After a battery of nerve and function tests were performed on both the drug-treated and control groups, results "revealed that sildenafil markedly improved sensory function starting at six weeks after treatment compared with saline-treated diabetic mice," Dr. Wang says.

"These data indicate that sildenafil improves neurological function even in middle-aged mice with long-term diabetic peripheral neuropathy."

While stressing that the findings remain experimental, Dr. Wang says they provide new insights into the underlying mechanisms of long-term diabetic nerve damage and may lead to the development of a sildenafil treatment for long-term diabetic peripheral neuropathy.

Diabetic peripheral neuropathy is particularly insidious because, as it progresses and damages nerves in extremities and other parts of the body, many patients are unaware of it because pain sensors are numbed.

As a result, a cut or sore on the bottom of a foot, for instance, may not be noticed until an infection sets in and spreads, possibly leading to amputation or even death.

Because diabetic neuropathy results from chronically high blood sugar levels, diabetes patients are strongly encouraged to closely monitor those levels and control them through diet.

Over-the-counter and prescription drugs -- including antidepressants and opiates -- are available to treat neuropathy pain, but often have undesirable side effects.

Story Source:

The above post is reprinted from materials provided by Henry Ford Health System. Note: Materials may be edited for content and length.

Journal Reference:
Lei Wang, Michael Chopp, Alexandra Szalad, LongFei Jia, XueRong Lu, Mei Lu, Li Zhang, Yi Zhang, RuiLan Zhang, Zheng Gang Zhang. Sildenafil Ameliorates Long Term Peripheral Neuropathy in Type II Diabetic Mice. PLOS ONE, 2015; 10 (2): e0118134 DOI: 10.1371/journal.pone.0118134

Thursday, 18 June 2015

Neuropathy A Factor In Long Term HIV

Today's post from (see link below) looks at the various health problems that may affect long-term and older HIV-patients and these include neuropathy. HIV medication is now so effective, that most people can expect to live a virtually normal life span but that doesn't mean that they are free from HIV-related co-morbidities (either caused by the virus or long-term medication, or normal old age) that can seriously affect their quality of life. The question will always be: are these complications the result of normal ageing, or are they HIV-related? Most experts seem to agree that HIV can definitely be a factor in contracting neuropathy but other diseases may come from other sources. Worth a read.
Geriatric conditions common in middle-aged and older HIV-positive men
Michael Carter Published: 17 June 2015

Geriatric conditions were common in middle-aged and older HIV-positive adults in a San Francisco clinic, investigators report in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes. Common conditions included pre-frailty, difficulties with activities of daily living and cognitive impairment. A quarter of patients reported falls or urinary incontinence. The authors were concerned that these conditions of older age were occurring earlier in their HIV-positive patients – who had a median age of just 57 years - compared to individuals in the general population.

“Our findings suggest that even in middle-aged HIV-infected adults with controlled HIV, the burden of geriatric syndromes is important and will need to be addressed clinically to minimize age-related complications in this population,” comment the investigators.

Improvements in treatment and care mean that many HIV-positive patients now have an excellent life expectancy and are living well into old age. But there’s now a considerable corpus of research showing that HIV-infection is associated with a number of co-morbidities - such as cardiovascular disease and reduced bone mineral density – normally associated with older age.

Geriatric syndromes such as frailty, falls and functional impairment are multifactorial conditions used to identify vulnerable older adults. Little is known about the prevalence and risk factors for these syndromes in patients with HIV. Investigators from the University of California San Francisco therefore designed a cross-sectional study to determine how common these factors are in older (aged 50 plus) HIV-positive individuals and to see if any HIV- and non-HIV-related factors increased the risk of these syndromes.

Their study population comprised 155 patients enrolled in the SCOPE study (an ongoing study of HIV infection in adults). All were taking antiretroviral therapy with viral suppression for a median of three years; median CD4 count was over 500 cells/mm3.

Using questionnaires and physical examinations, the patients were assessed for geriatric syndromes including falls, urinary incontinence, functional and mobility impairment, impaired hearing and vision, depression, cognitive impairment and frailty. Data were also gathered on co-morbid conditions and use of medication to treat these ailments.

Participants had been living with HIV for a median of 21 years. Almost all (94%) were men. Co-morbid conditions were highly prevalent, with a median of four per patient, and individuals were taking a median of nine non-antiretroviral medications to control these conditions. The most common co-morbidities were elevated lipids (63%), hypertension (50%) and peripheral neuropathy (40%).

The majority of patients (54%) had two or more geriatric syndromes. The most common conditions were pre-frailty (56%), difficulty with one or more functional tasks (47%) and cognitive impairment (47%). At least one fall was reported by a quarter of patients and a similar proportion reported urinary incontinence. Mild depression was reported by a fifth of patients with 18% meeting the criteria for the diagnosis of moderate-to-severe depression.

A lower nadir CD4 count (IRR = 1.16; 95% CI, 1.06-1.26) and increasing number of co-morbidities (IRR = 1.09; 95% CI, 1.03-1.15) were associated with an increased risk of geriatric syndromes.

The authors were concerned that the prevalence of problems such as frailty, falls and incontinence observed in their patients was similar to or higher than that recorded in HIV-negative men living in a community for individuals aged 65 years or older. Geriatric conditions therefore seemed to be occurring earlier in patients with HIV.

‘The association with lower CD4 nadir suggests that earlier antiretroviral treatment initiation may help to prevent aging-related complications, and the association with increasing number of co-morbidities suggests that treatment and prevention of other co-morbid conditions are equally important to the management of HIV in the aging HIV population,” conclude the authors. “Consideration of how to incorporate assessment of geriatric syndromes into HIV care and development of targeted interventions for risk factors of geriatric syndromes is needed as the HIV-infected population continues to age.”


Greene M et al. Geriatric syndromes in older HIV-infected adults. J Acquir Immune Defic Syndr 69: 161-67, 2015.