Friday, 18 August 2017

Stimwave Device To Make Life Easier For Neuropathy Patients

Today's post from businesswire.com (see link below) announces FDA approval of a small, wireless, electro-stimulatory device for people suffering from various forms of neuropathy. Basically, it's a less invasive and smaller version of the spinal devices that have been on the market for some time and in that sense, it seems to be an improvement. The press announcement makes a big thing of the fact that patients can still undergo MRI scans in the future, without the device having to be removed as is now seemingly the case but whether this is as revolutionary a marketing tool as suggested is open to doubt. Naturally, people may need MRI scans during their lifetime but the press release is loaded with suggestions that this is a major breakthrough. It seems to me that the biggest advantage of this device is the size, which makes it's insertion far less invasive and also reduces the need for long cables and attachment to monitor devices, which are often an underestimated problem for patients. Basically, the market has been crying out for smaller neuro modulation devices, which after all, are designed to stimulate pretty small nerve targets. This may be a market winner  - maybe time to have a chat with your neurologist to see if it may be meaningful in your case (remember, these devices are not suitable for every nerve damage patient) but also with your insurance company to see if it will be covered by your policy (always an issue).


Revolutionary Tiny Device Offers Alternative to Opioids for Chronic Pain Sufferers
August 09, 2017 POMPANO BEACH, Fla.--(BUSINESS WIRE)--

Stimwave Receives FDA 510(k) Clearance for the First Full-Body MRI Scan Ready Wireless Peripheral Nerve Stimulator (PNS) System


Stimwave LLC, a leading innovator in wireless medical device technology and independent research institute, has received FDA 510(k) clearance for the first wireless, micro-technology neuromodulation device that can enable ongoing full-body MRI scans under certain scanning conditions for the relief of chronic peripheral nerve pain.

“This is great news for many chronic pain patients who previously did not have a minimally-invasive implant option available for peripheral nerve-related pain and will continue to require frequent MRI scans throughout their body for management of their pain and monitoring of their current and future medical needs”

Representing a life-changing technological breakthrough for the more than 400 million people worldwide who suffer from severe intractable chronic pain, the StimQ Peripheral Nerve Stimulator (PNS) System offers an alternative for those who do not want to rely on invasive surgical procedures or ongoing opioid treatments. The smallest neuromodulation device available, the StimQ device can be placed in a minimally-invasive, outpatient procedure for the treatment of various pain syndromes, including, but not limited to: shoulder pain, upper extremity neuropathy, mid and lower back pain, and lower extremity neuropathy. The new FDA clearance enables the pain sufferer to have frequent and necessary MRI scans of any part of their body without removing the implant.

“Thanks to our revolutionary wireless device, we are the only neuromodulation company cleared by the FDA to help patients reduce their chronic neuropathic pain by pinpointing stimulation directly to the affected peripheral nerves with a multi-electrode programmable device, which enables ongoing MRI scans,” said Stimwave Chairman and CEO Laura Tyler Perryman.

"This is great news for many chronic pain patients who previously did not have a minimally-invasive implant option available for peripheral nerve-related pain and will continue to require frequent MRI scans throughout their body for management of their pain and monitoring of their current and future medical needs,” said Dr. Konstantin Slavin, professor of neurosurgery at University of Illinois at Chicago and author of the book “Peripheral Nerve Stimulation.” “While PNS has been shown in literature to be an effective treatment, for many years device placement has been difficult due to the bulk and length of cables, connectors and pulse generators needed to stimulate a small nerve target. This miniature wireless peripheral nerve stimulator that minimizes the need for surgery in patients who are already suffering from pain, while allowing on-going care with full body MRI scan capabilities may provide a viable, non-opioid option for long-term pain management.”

The state-of-the-art device, which is less than five percent of the size of other standard implanted options, provides pain relief by delivering small pulses of energy in a fully-selectable manner to electrodes placed at a peripheral nerve enabling the brain to remap specific pain signals. The implant is powered by a small, flexible and comfortable wearable external unit. The company previously received FDA clearance for the Freedom-8A/4A Spinal Cord Stimulation (SCS) System, which is also full body MRI scan cleared and utilizes the same technology specifically for back and leg pain based on placements in the spinal column region. Both the Freedom SCS System and the StimQ PNS System are available now, and more information can be found at www.stimwave.com.

About Stimwave LLC


Stimwave LLC is a privately held medical device company engaged in the development, manufacture, and commercialization of wirelessly powered, microtechnology neurostimulators, providing patients with a convenient, safe, minimally invasive, and highly cost-effective pain management solution that is easily incorporated into their daily lives. Stimwave’s goal is to evolve its patented, cutting-edge platform into the default for neuromodulation, increasing the accessibility for patients worldwide while lowering the economic impact of pain management.

Contacts

Glodow Nead Communications

Evan Nicholson, Sonia Sparks, Kati Stadum or Sarah Rogers, 415-394-6500

stimwavepr@glodownead.com

http://www.businesswire.com/news/home/20170809005263/en/Stimwave-Receives-FDA-510-Clearance-Full-Body-MRI

Thursday, 17 August 2017

Gabapentin And Lyrica: Official Concern

Today's post from nejm.org (see link below) is an expert summary of the two drugs mainly used in treating neuropathic pain - gabapentin (neurontin) and Lyrica (pregabalin). It suggests that these are being prescribed as alternatives to consider before turning to opioids and that may partly explain why, despite horrendous adverse publicity regarding Lyrica for instance (side effects), sales have pretty much doubled since 2012! Actually both drugs have been commonly prescribed long before the current 'opioid crisis' and despite withdrawal of FDA approval for Lyrica for neuropathy and widespread reports of gabapentin side effect issues, doctors continue to prescribe them as a matter of course. Now regular readers of this blog will know that Lyrica is regarded as potentially dangerous, yet super efficient marketing has not resulted in any dip in sales. The pharmaceutical companies know they're still sitting pretty because of the lack of viable alternatives but both Lyrica and gabapentin do have considerable side effect issues. It's advisable to have a serious talk with your doctor before beginning either of these drugs. This article more or less backs this up and find both drugs lacking in efficacy regarding neuropathic pain and also warns of side effects. It's difficult to know what else to say: despite the facts, sales of both drugs continue to sky rocket but patients need to be aware of the risks and then make considered decisions for themselves. Do the benefits outweigh the risks? If ever the phrase 'let the buyer beware' was relevant...it is here!



Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern?
Christopher W. Goodman, M.D., and Allan S. Brett, M.D. N Engl J Med 2017; 377:411-414 August 3, 2017 DOI: 10.1056/NEJMp1704633

Audio Interview

Interview with Dr. Christopher Goodman on important concerns about increased prescribing of gabapentin and pregabalin for pain. (9:28)
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Treatment of chronic noncancer pain during the opioid epidemic has become challenging for clinicians. Patients want their pain to be adequately managed, and clinicians are searching for safe, effective alternatives to opioids. Recent guidelines from the Centers for Disease Control and Prevention (CDC) recommend that clinicians consider several other medication classes before turning to opioids for patients with chronic noncancer pain.1 For example, acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) are mentioned as first-line options for pain related to osteoarthritis and low back pain. However, acetaminophen is often ineffective, and NSAIDs are associated with adverse effects that limit their use, particularly in patients with complex conditions. The CDC guidelines also recommend gabapentinoids (gabapentin or pregabalin) as first-line agents for neuropathic pain. We believe, however, that gabapentinoids are being prescribed excessively — partly in response to the opioid epidemic.

The Food and Drug Administration (FDA) has approved gabapentinoids for the treatment of postherpetic neuralgia (gabapentin and pregabalin), fibromyalgia (pregabalin), and neuropathic pain associated with diabetes or spinal cord injuries (pregabalin). However, while working in inpatient and outpatient settings, we have observed that clinicians in our practice community are increasingly prescribing gabapentin and pregabalin for almost any type of pain. Our experience is supported by national prescribing data.2 In 2016, gabapentin was the 10th most commonly prescribed medication in the United States: 64 million gabapentin prescriptions were dispensed, up from 39 million in 2012. Brand-name pregabalin (Lyrica) ranked 8th in invoice drug spending (i.e., spending that excludes rebates and discounts) in 2016, with sales of $4.4 billion — more than double the amount from 2012 (see graphs


  

Dispensed Prescriptions for Gabapentin and Nondiscounted Spending for Pregabalin, 2012–2016.). Only three brand-name drugs typically prescribed by primary care physicians ranked higher in sales than Lyrica: Lantus insulin, Januvia (sitagliptin), and Advair (fluticasone–salmeterol). The remaining brand-name drugs that had higher sales are extremely expensive and usually prescribed by specialists for specific disorders (e.g., Humira [adalimumab] and Enbrel [etanercept] for autoimmune diseases and Harvoni [ledipasvir–sofosbuvir] for hepatitis C.

An increasing prevalence of diseases for which gabapentinoids are FDA-approved — or a growing tendency for clinicians to prescribe them for these conditions — probably can’t explain the recent rise in gabapentinoid use. Rather, we suspect that clinicians who are desperate for alternatives to opioids have lowered their threshold for prescribing gabapentinoids to patients with various types of acute, subacute, and chronic noncancer pain. For some of these patients, NSAIDs are contraindicated; for others, previous courses of acetaminophen and NSAIDs have proven inadequate or the patient or clinician may perceive them as “not strong enough.” Some patients, drawing on past experience, consider opioids to be their only source of adequate pain relief, and some specifically request opioid prescriptions. In such cases, clinicians may turn to gabapentinoids as one of the few nonopioid, non-acetaminophen, non-NSAID options.

Past marketing practices also help explain the growing use of gabapentinoids for various types of pain. Neurontin (the original branded gabapentin) was approved as an antiseizure drug in 1993. During the next several years, the manufacturer (Parke-Davis, a subsidiary of Warner-Lambert, which was later acquired by Pfizer) engaged in an extensive marketing campaign to increase off-label prescribing of Neurontin for pain.3 Research had suggested that the drug had analgesic properties, but postherpetic neuralgia was the only pain-related indication for which there was sufficient evidence from clinical trials to justify FDA approval. Eventually, in 2004 (after Neurontin’s patent had expired and gabapentin had become available as a generic), the manufacturer admitted to improper off-label marketing and paid a penalty.

Pregabalin, which is still available only as brand-name Lyrica, was approved for treating diabetic neuropathy and postherpetic neuralgia in 2004 and fibromyalgia in 2007. In 2012, the manufacturer paid a settlement for misleading promotion of the drug for off-label indications. In recent years, the company has used extensive direct-to-consumer advertising to promote Lyrica for painful diabetic neuropathy and fibromyalgia. Although Lyrica is approved for both these indications, the advertising probably promotes a perception that it has more general application as a pain medication. Some clinicians may implicitly use the fibromyalgia indication to justify off-label prescribing not only for ill-defined pain that appears similar to fibromyalgia pain, but also for more defined conditions such as low back pain and pain from osteoarthritis. In addition, clinicians are probably influenced by guidelines and review articles that extrapolate from the literature on diabetic and postherpetic neuropathies and endorse gabapentinoids for any pain perceived as neuropathic.

But even if the increasing use of gabapentinoids reflects — at least in part — a desire among clinicians to prescribe possibly safer alternatives to opioids, we believe there are several reasons to be concerned about this trend. First, reasonably robust evidence supports the efficacy of some medications for off-label uses, but that isn’t the case for gabapentinoids. We found that most recently published clinical studies of gabapentinoids for pain examined single-dose or short-course gabapentinoids for mitigating postoperative pain, an indication that isn’t relevant to general outpatient practice. Relatively few clinical trials have assessed the use of gabapentinoids in the common pain syndromes for which they are prescribed off-label — and many of those trials were uncontrolled or inadequately controlled and of short duration. Among the few well-conducted, properly controlled, double-blind studies, results have been mixed at best. In a recent rigorously conducted placebo-controlled trial, pregabalin was ineffective for patients with painful sciatica.4

Second, gabapentinoids can have nontrivial side effects. Sedation and dizziness are relatively common, and some patients experience cognitive difficulties while taking these drugs. For example, in the sciatica trial, 40% of patients taking pregabalin reported dizziness, as compared with 13% of those taking a placebo.4 Although these adverse effects aren’t always severe and are reversible when the drugs are discontinued, gabapentinoids are often prescribed together with other drugs that have central nervous system side effects. Such polypharmacy might affect neurologic function in subtle but clinically important ways.

Third, evidence suggests that some patients misuse, abuse, or divert gabapentin and pregabalin.5 Some users describe euphoric effects, and patients can experience withdrawal when high doses are stopped abruptly. The likelihood of gabapentinoid abuse is reportedly heightened among current or past users of opioids and benzodiazepines. Whether misuse and abuse of gabapentinoids will become an important public health issue remains to be seen.

Finally, indiscriminate off-label use of gabapentinoids reinforces the tendency to view the treatment of pain through a pharmacologic lens. Clinicians assume (perhaps incorrectly, in some cases) that patients generally expect or demand to be given a drug prescription, and they feel pressure to satisfy these perceived patient expectations. Some clinicians express concern that resisting patients’ demands for opioids might lead to lower scores on patient-satisfaction surveys, poor practice ratings, and even reduced income. However, appropriate management of both acute and chronic pain involves examining how the patient’s pain is affecting activity and function and setting realistic goals that may include coping with or mitigating pain, not necessarily eliminating it. This approach requires time (which is often lacking in rushed outpatient practices), expertise in communicating about a difficult and often emotionally charged symptom, and patient access to timely follow-up and continuity of care. Writing a prescription and moving on is considerably easier and less stressful for clinicians. Although guidelines typically encourage nonpharmacologic approaches to chronic pain — such as cognitive behavioral therapy or referral to a multidisciplinary pain practice — such options may be unavailable or unaffordable for many patients.

Patients who are in pain deserve empathy, understanding, time, and attention. We believe some of them may benefit from a therapeutic trial of gabapentin or pregabalin for off-label indications, and we support robust efforts to limit opioid prescribing. Nevertheless, clinicians shouldn’t assume that gabapentinoids are an effective approach for most pain syndromes or a routinely appropriate substitute for opioids. Although gabapentinoids offer an alternative that is potentially safer than opioids (and presumably more effective in selected patients), additional research is needed to more clearly define their role in pain management.

Disclosure forms provided by the authors are available at NEJM.org.

No potential conflict of interest relevant to this article was reported.

Source Information

From the Department of Medicine, University of South Carolina School of Medicine, Columbia.

http://www.nejm.org/doi/full/10.1056/NEJMp1704633

Wednesday, 16 August 2017

Understanding Neuropathy: The Basics

Today's excellent post from mollysfund.org (see link below) is an extensive but well-explained and very readable guide to neuropathy. As regular readers will know, every now and then this blog publishes a general guide to neuropathy for the benefit of people new to the disease, as well as family members, work colleagues and friends. However, experienced neuropathy sufferers will also benefit from these posts as new information is found and put forward. It's important that the knowledge base for neuropathy is expanded and kept up to date, so that people can be made aware of the latest developments, treatments and medications as they occur. The problem is that neuropathy treatment hasn't moved on much in decades and even now, progress is painfully slow but understanding the basics puts us on a much better footing with our doctors and helps us push for better and more effective research. It also gives us a manageable overview of what's happening in our nervous system. It's a frustrating disease that works differently for each individual and patients need to have inexhaustible patience but in the case of nerve damage...knowledge is most definitely power. Absolutely worth a read!
 
What is peripheral neuropathy?
Article by : Karrie Sundbom 2017


Peripheral neuropathy is a general term for a series of disorders that result from damage to the body’s peripheral nervous system. The body’s nervous system is made up of two parts; the central nervous system (CNS) and the peripheral nerve system (PNS). The CNS includes the brain and the spinal cord. The PNS connects the nerves that run from the brain and spinal cord to the rest of the body. This includes the legs, arms, hands, feet, joints, eyes, ears, mouth, nose and skin. These neurons transport signals about physical sensations back to your brain. An estimated 20 million people in the United States have some form of peripheral neuropathy, a disorder that results from damage that occurs to your peripheral nerves. These damaged or destroyed nerves can no longer send out messages, or they send incorrect or distorted information, between the brain and spinal cord and the skin, muscles or other parts of the body.

 Generally speaking, this often causes unusual sensations, burning, numbness, weakness, loss of balance, and even pain. The symptoms usually occur in your hands and feet, but other areas of your body can also be affected. There are three types of peripheral nerves and all of them can be affected by peripheral neuropathy. Peripheral neuropathy is also categorized by the size of the nerve fibers involved, large or small. The three types peripheral nerves are: 

Sensory Nerves: These connect to your skin
Motor Nerves: These connect to your muscles
Autonomic Nerves: These connect to your internal organs.

It can be scary to get diagnosed with any disease, especially one with a ominous sounding name like peripheral neuropathy. We hope that by providing information in this blog, about the symptoms, diagnosis, treatment, prevention and some potential causes of peripheral neuropathy, you will feel more empowered, and armed with the information that will help you live your best life with this condition. 


What causes peripheral neuropathy?

There are many causes of neuropathy. Approximately 30% of neuropathies are “idiopathic,” meaning that the cause is unknown and in another 30% of cases, diabetes is the cause. According to some studies, nearly 60 percent of diabetics have some sort of nerve damage. This damage is often due to high blood sugar levels, and the risk for neuropathy increases for diabetics who are over the age of 40, have high blood pressure, or are overweight.


 Having a family history of peripheral neuropathy increases the chances of developing the disorder. However, a variety of factors and underlying conditions may also cause this condition. Some other causes of peripheral neuropathy may include:

Autoimmune disorders: Diseases in which the immune system attacks the body’s own tissues can lead to nerve damage. This can include disorders such as systemic lupus erythematosus, Sjögren’s, rheumatoid arthritis, etc.


Infections: This can include certain bacterial or viral infections such as Lyme disease, shingles, Epstein Barr virus, hepatitis C, leprosy, HIV, and diphtheria.


Heredity: Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.


Tumors: Peripheral neuropathy can occur as a result of tumors or growths putting pressure on nerves.


Nutritional imbalances and vitamin deficiencies: B vitamins, including B-1, B-6 and B-12, vitamin E and niacin are crucial to nerve health, imbalances and deficiencies can lead to peripheral neuropathy.


Traumatic injury: Traumatic injury from sports or vehicular accidents can sever or damage peripheral nerves. Pressure on nerves may also result from having a cast, using crutches or repeating a motion many times, such as typing (this is often referred to as carpal tunnel syndrome, a type of peripheral neuropathy).


Exposure to poisons or toxins:
This includes those that contain heavy metals or chemicals, lead, mercury, and arsenic. In addition, neuropathies have also been known to have been caused by certain insecticides and solvents.


Certain medications:
The medications used to treat cancer (chemotherapy) can cause neuropathy. In addition, anticonvulsant agents (medications used to reduce seizures) and even some medications prescribed to treat heart and blood pressure can cause peripheral neuropathy. In most cases, when these medications are discontinued or dosages are adjusted, the neuropathy resolves.


Disorders of the bone marrow: Peripheral neuropathy may also be caused by lymphoma, disorders that include abnormal protein in the blood, some forms of bone cancer, and amyloidosis (a disorder where amyloid, an abnormal protein that is usually produced in your bone marrow builds up in any tissue or organ).


Other diseases:
These could include connective tissue disorders, liver disease, kidney disease, liver disease, and an underactive thyroid (hypothyroidism), vasculitis.
Alcoholism: Heavy alcohol consumption is a common cause of peripheral neuropathy. Chronic alcohol abuse often leads to certain nutritional deficiencies (particularly thiamine, B 12, and folate) that are linked to neuropathy. Damage may not be reversible but if the person stops drinking alcohol, the symptoms may lessen.

What are the symptoms of peripheral neuropathy?

Symptoms of peripheral neuropathy may be experienced over a period of days, weeks, or years. They can be acute or chronic. In acute neuropathies, the symptoms will appear suddenly, rapidly progress, and resolve slowly as damaged nerves heal. In chronic forms of neuropathy, the symptoms often begin subtly and progress slowly. Some people may have periods of little symptomatic activity (remissions) followed by periods of increased symptoms (flares). Others may reach a stage where symptoms stay the same for many months or even years. Many chronic neuropathies worsen over time. Although peripheral neuropathy may be potentially debilitating, very few forms are fatal. The specific symptoms of peripheral neuropathy will vary depending on whether motor, sensory, or autonomic nerves are damaged. These are some of the most common symptoms:


Tingling in hands and/or feet
Pain described as sharp, stabbing or burning
Loss of balance
Numbness in hands and/or feet
Heavy feeling in the arms and/or legs, sometimes described as feeling like your legs or arms “lock” in place
The feeling of wearing tight gloves or socks when you are not
Buzzing, vibrating or shocking sensation in muscles

Often the symptoms are symmetrical involving both hands and/or both feet. Because these symptoms occur in areas covered by gloves or stockings, peripheral neuropathy is often described as having a ‘glove and stocking’ symptom distribution. In many cases these symptoms improve with treatment especially if the underlying cause or condition is treatable.


Here are the symptoms that might be experienced when the different types of nerves are involved:

 


Motor nerve damage symptoms: The motor nerves control voluntary movement of muscles such as those used for walking, grasping things or talking. If these motor nerves are damaged, the following symptoms might occur:

Muscle weakness
Cramping
Decreased motor skills
Atrophy (shrinking) of the muscles
Twitching
Cramping
Slower reflexes

Sensory nerve damage symptoms: The sensory nerves have a broad range of sensory functions. Any damage to these nerves might cause a person to experience these symptoms: 


Decreased sensations of touch. This can lead to not experiencing the pain from a cut or injury, or the feeling of wearing gloves or stocking when they are not.


A loss of ‘sense of position’ which can make coordinating complex movements like walking or buttoning a shirt very difficult. Balance might also be affected.


Difficulty in transmitting temperature sensations which could lead to burns. This loss of pain sensation can be a very serious problem for those suffering from diabetes and may contribute to a high rate of lower limb amputations among this group.


Increased sensation of pain is often a debilitating symptom of neuropathy. Instead of numbness, it can produce the opposite effect of an increased sensation of pain or feeling severe pain from stimuli that would normally be painless. It can severely affect quality of life, ability to sleep, emotional well-being, and the ability to work.

Autonomic nerve damage symptoms: If the autonomic nerves are involved, nearly every organ can be affected. The autonomic nerves control the functions of the body that happen automatically. Autonomic neuropathy can have symptoms that affect the loss of control of some of these functions. Symptoms may include:


Problems with heart rate
Difficulty with the body’s ability to regulate blood pressure which may cause dizziness or light-headedness
Problems with digestion (this may include diarrhea, or constipation)
Loss of bladder control
Inability to sweat normally which could lead to heat intolerance or overheating
Difficulty eating or swallowing

Seek medical care right away if you notice unusual pain, weakness or tingling in your hands or feet. Early diagnosis and treatment offer the best chance for preventing further damage to your peripheral nerves and controlling your symptoms. 


How is it diagnosed?

Peripheral neuropathy is not a single disease, but rather describes damage to the nerves that produces varying symptoms. Because there are many potential causes for peripheral neuropathy, your doctor will need to examine where the nerve damage is in your body and attempt to determine what may be causing it. A neurologist is typically the type of doctor who will diagnose and treat neuropathy. A diagnosis of peripheral neuropathy usually requires: 


Complete medical history: Your physician will first review your medical history, this will include discussions of any current or past medical conditions, your lifestyle, any exposure to toxins, your drinking habits, and any family history of nervous symptom diseases.


Physical exam


Neurological exam: Your physician will check your reflexes, muscle tone and strength, ability to feel sensations, coordination and posture.


 


Blood tests: Blood tests can detect vitamin deficiencies, liver or kidney dysfunction, diabetes, other metabolic disorders, and/or any signs of abnormal immune system activity

Diagnostic and imaging tests: This may include CT or MRI scans to show muscle quality and size, look for tumors, herniated discs or any other abnormality that might be causing your symptoms. Electromyography involves inserting a fine needle into a muscle to record electrical activity when muscles are at rest and when they contract. This can determine if your symptoms are being caused by muscle or nerve damage.


Nerve biopsy: This is where a small portion of a nerve is examined to determine the cause of your specific nerve damage.


Skin biopsy: A skin biopsy would be taken to observe the number of nerve endings in the skin. A reduction of nerve endings can signal neuropathy.


Other tests to analyze nerve function: Sweat tests to record how your body sweats, autonomic reflex screen test that will record how the autonomic nerve fibers are functioning, and other sensory tests to indicate how you feel touch, temperature changes, and vibrations.

If your lab and other diagnostic tests do not indicate any underlying condition, your doctor may recommend ‘watchful’ waiting to see if your neuropathy symptoms improve. If either exposure to toxins or alcohol consumption are the suspected causes of your condition, your doctor will recommend avoiding those substances to see if your symptoms improve before prescribing any medications or developing a treatment protocol.


How is it treated?

Peripheral neuropathy can be very uncomfortable and debilitating. Fortunately, treatment can be very helpful in the management of neuropathy symptoms. But before any treatment can begin, the most important step is to determine the underlying cause of the neuropathy to plan the correct course of treatment. Some of the treatments for peripheral neuropathy may include: 


Medications

 
 


Over-the-counter or non-prescription pain relievers: Over-the-counter pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including acetaminophen, ibuprofen, aspirin, etc. can be very helpful in relieving mild or moderate symptoms. For more-severe symptoms, your doctor may recommend prescription painkillers. Because these drugs can affect your liver or stomach function, it is very important to avoid using them for an extended period of time, especially if you regularly drink alcohol.

Prescription medications: Medications containing opioids can lead to dependence and addiction and are therefore generally prescribed only when other treatments fail. These drugs can include tramadol, oxycodone, conzip and others, COX-2 inhibitors, etc.


Steroid Injections: Corticosteroid injections can help with pain and inflammation
Anti-seizure medications: Medications developed to treat epilepsy may also relieve nerve pain. These medications can may cause side effects that include drowsiness and dizziness.


Capsaicin: Capsaicin is a substance naturally in hot peppers and can cause modest improvements in peripheral neuropathy symptoms. Doctors may suggest you use this cream with other treatments. However, some people can’t tolerate it and side effects such as skin burning and irritation may occur (these often lessen over time). Topical lidocaine, an anesthetic agent might also be prescribed for localized chronic neuropathic pain such as pain from the shingles virus. Their helpfulness in the treatment of diffuse chronic diabetic neuropathy is limited.


Antidepressants: Certain antidepressants have been shown to interfere with the chemical processes in the brain and spinal cord that cause the body to feel pain. These medications may include tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline (Pamelor).


Immunosuppressant medications
: Medications to reduce the immune system’s reaction, such as prednisone, cyclosporine (Neoral, Sandimmune, others), mycophenolate mofetil (CellCept) and azathioprine (Azasan, Imuran), may also help people with peripheral neuropathy associated with autoimmune conditions such as [lupus] and [RA].


Other medications: Pregabalin (Lyrica) is a medication that is used for the treatment of postherpetic neuralgia (postherpetic neuralgia is a complication of shingles) and diabetic peripheral neuropathy. Duloxetine (Cymbalta) has been approved for use in the treatment of diabetic peripheral neuropathy. 


Therapies

Various therapies and procedures may help ease symptoms of peripheral neuropathy.
 

Intravenous immunoglobulin and plasma exchange: This treatment is also very common in the treatment of chronic inflammatory demyelinating polyneuropathy (a disorder characterized by progressive weakness and impaired sensory function in the legs and arms) and other inflammatory neuropathy. In immune globulin therapy, you receive high levels of proteins that work as antibodies. This helps to suppress immune system activity. Plasma exchange (called plasmapherisis) involves removing your blood and then removing antibodies and other proteins from the blood. The blood is then returned to your body.

Transcutaneous electrical nerve stimulation (TENS): TENS is a non-invasive intervention used for pain relief for a range of conditions, and a number of studies have described its use for neuropathic pain. In TENS, varying currents of gentle electrical current is delivered through adhesive electrodes placed on the skin. It is recommended that TENS should be applied for 30 minutes daily for about one month.


 


Physical therapy: Physical therapy can help improve your movements and counteract muscle weakness. Assistive medical devices such as canes, walkers, hand/foot braces might also be needed and helpful for those with mobility issues related to neuropathy.

Surgery: If pressure on the nerves is being caused by tumors for example, surgical intervention might be required and recommended to reduce the pressure. In carpal tunnel, where there is typically injury to a single nerve, surgery may be an effective solution. Some surgical procedures reduce pain by destroying the nerve when other treatments have failed to provide relief. Typically, diabetic neuropathy is not treated with surgical intervention.


Nerve block: A nerve block is an injection of anesthetics directly into the nerves.

Many treatments can bring relief to neuropathic symptoms and can help you to return to your regular activities. Often, a combination of lifestyle adjustments, treatments and therapies may work best. 


Alternative treatments and self-care options

Complementary and alternative treatments
have been shown to provide relief of peripheral neuropathy symptoms. The following therapies have shown some promise despite the fact that researchers have not studied these techniques as thoroughly as they have most traditional pharmaceutical medications. Some of these complementary and alternative treatments may include:


Fish oil supplements:These supplements, which contain omega-3 fatty acids, may reduce inflammation, improve blood flow and improve neuropathy symptoms in people with diabetes. Check with your doctor before taking fish oil supplements if you’re taking anti-clotting medications.


Herbs: Certain herbs, such as evening primrose oil, may help reduce neuropathy pain in people with diabetes. Some herbs may interact with medications or make some medications less effective, so please discuss any herbs or supplements that you are considering adding to your diet with your doctor.


Acupuncture: Acupuncture, which involves inserting thin needles into various points on your body, may reduce peripheral neuropathy symptoms. Multiple sessions might be required before any significant symptom improvement is noticed. Always be sure find a certified acupuncture specialist using sterile needles.


Chiropractic care: This can include massage, muscle stimulation, ultrasound therapy and manipulation.


Massage


Alpha-lipoic acid: This antioxidant has been used as a treatment to help reduce symptoms of peripheral neuropathy in Europe for years. Blood sugar levels may be affected by this antioxidant, so please discuss using alpha-lipoic acid with your physician. Other side effects could include skin rash and stomach upset.


Amino acids: In people who have undergone chemotherapy and in people with diabetes, amino acids, such as acetyl-L-carnitine, may help improve peripheral neuropathy. Side effects may include nausea and/or vomiting.


Some suggestions to help you self-manage peripheral neuropathy


Quit smoking: Cigarette smoking can affect circulation by constricting the vessels that supply nutrients to the peripheral nerves, increasing the risk of foot problems and other neuropathy complications.


Exercise: Ask your doctor about starting an exercise routine. Regular gentle exercise, such as walking, or swimming may reduce neuropathy pain, control cramping, improve your muscle strength, prevent the muscles from atrophy, and help control blood sugar levels. Yoga and tai chi might also help.


Eat a balanced diet: Healthy eating is especially important to ensure that you get essential vitamins and minerals. Emphasize low-fat meats and dairy products and include lots of fruits, vegetables and whole grains in your diet. Protect against vitamin B-12 deficiency by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. If you’re vegetarian or vegan, fortified cereals are a good source of vitamin B-12, but also talk to your doctor about B-12 supplements. Speak with your doctor about using various dietary strategies to improve gastrointestinal symptoms from neuropathy.


Avoid excessive alcohol: Alcohol may worsen peripheral neuropathy.


Meditation
 

Monitor your blood glucose levels:

   

Monitoring your blood glucose levels, if you have diabetes, will help keep your blood glucose under control and may even help improve your symptoms of neuropathy.

Take good care of your feet, especially if you have diabetes: Wash and inspect your feet daily for any injuries, blisters, cuts or calluses. Help to keep the skin moist with lotion. Timely treatment of injuries can help prevent permanent damage. Wearing soft, loose cotton socks and shoes with padded inserts may also help. To keep bedcovers off of hot or sensitive feet and provide a better night’s sleep, you may wish to use a semicircular hoop. These can be found in medical supply stores. 


Making Your Home Safe

If you have peripheral neuropathy, you are potentially at greater risk for accidents in the home due to muscle weakness, loss of balance, decreased sensitivity to sensations of pain, etc. Here are few things to keep in mind to make yourself safer in your home and decrease your chances of injury:


Protect your feet by always wearing shoes.
Things laying around on the floor can be a tripping hazard, so try to keep your floor clear.
Use your elbow, not your hand or foot to check the temperature of your bath or dishwater.
Installing handrails in your bathtub or shower, as well as anti-slip bath mats can reduce the odds of falling or slipping and injuring yourself.
For those whose work involves sitting for long periods of time, make the effort to get up and move around a few times each hour to improve circulation. It is important to not stay in one position for too long.

In Conclusion

Peripheral neuropathy, while it cannot be cured, can most likely be well-managed if it is caused by a treatable underlying condition. The best way to prevent peripheral neuropathy is to manage those conditions that may put you at risk, such as diabetes, alcoholism or rheumatoid arthritis. Even if you have a family history of this disorder, you may be able to prevent its onset by taking the following precautions to lower your risk: 


Being aware of any toxins that you might be exposed to at work or at school
Protecting your feet during sports, especially those that involve kicking
Never inhaling toxins like glue to get high
Managing your alcohol intake
Avoiding tobacco and smoking
Maintaining a healthy weight and lifestyle
Avoiding factors that may cause nerve damage such as repetitive motions, staying in one position for long periods of time, staying in cramped positions

 


The goal of treatment and therapy for peripheral neuropathy is targeted at treating the underlying disease and improving the symptoms with the right combinations of medications and therapies. Finding a knowledgeable and experienced neurologist who listens and supports you, and makes you feel more comfortable can greatly improve your quality of life. It is very important to find a neurologist as soon as you notice any of the above-listed symptoms. This will provide the opportunity for you to receive the necessary treatment that can stop the disease before it has a chance to cause permanent damage help to ensure your best possible health. Neuropathy, fibromyalgia, lupus, rheumatoid arthritis and many other conditions are considered invisible illnesses meaning they cannot be seen, but they exist. Being misunderstood and judged are two of the most common frustrations with those suffering from invisible illnesses. In addition to educating yourself about peripheral neuropathy, you might find it helpful to provide your family, friends and co-workers with information as well. Sharing this blog might be a good start! We want you to know that you are not alone as you learn to navigate living with a chronic and invisible illness. Our Facebook community is a great place to share and get great support from others who know exactly what you are experiencing and our online support groups are also a great way to get connected. We are here for you. 

Sources:
 


 http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm

http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/basics/definition/con-20019948, http://www.healthline.com/health/peripheral-neuropathy#Overview1

http://www.medicinenet.com/peripheral_neuropathy/article.htm

https://www.foundationforpn.org/, http://www.neuropathy.org/site/PageServer?pagename=About_Facts 

*All images unless otherwise noted are property of and were created by Molly’s Fund Fighting Lupus. To use one of these images, please contact us at info@mollysfund.org for written permission; image credit and link-back must be given to Molly’s Fund Fighting Lupus. **All resources provided by Molly’s Fund are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your medical provider with any specific questions or concerns.

http://www.mollysfund.org/peripheral-neuropathy/

Tuesday, 15 August 2017

Hyperalgesia: More Pain Killers Can Mean More Pain

Today's post from sciencemag.org (see link below) is an interesting article reflecting one of the arguments anti-opioid campaigners use when criticizing opioid prescription and that is that opioids cause hyperalgesia. Basically, hyperalgesia means that the opioid dampens the pain in the beginning but eventually inflames the nerves to the point where taking the opioid actually increases the pain, thus requiring higher doses to achieve the same effect. However, instead of being a convincing argument to prohibit opioid prescription, this actually further highlights the need for careful control of how the drug is working and changing it when it threatens to cause hyperalgesia. This requires far more doctor participation and control than is often currently the case. However, as the article points out - it doesn't mean taking the opioids away from a patient for whom there is no other choice. Basically, the threat of hyperalgesia just means that the patient's pain management needs to be sympathetically structured and monitored, so that he or she never lands in a situation where the need for more analgesic dictates the dosage. There are many opioid and opioid family drugs available - if swapping, changing and monitoring is the answer to opioid dependence than that is the way to go for the safety (and comfort) of the patient. Yet more proof that a holistic approach is the only sensible treatment for severe neuropathy patients.

Long-term use of opioid painkillers such as oxycodone (above) may increase a person’s sensitivity to pain.
By Kelly Servick May. 30, 2016

There’s an unfortunate irony for people who rely on morphine, oxycodone, and other opioid painkillers: The drug that’s supposed to offer you relief can actually make you more sensitive to pain over time. That effect, known as hyperalgesia, could render these medications gradually less effective for chronic pain, leading people to rely on higher and higher doses. A new study in rats—the first to look at the interaction between opioids and nerve injury for months after the painkilling treatment was stopped—paints an especially grim picture. An opioid sets off a chain of immune signals in the spinal cord that amplifies pain rather than dulling it, even after the drug leaves the body, the researchers found. Yet drugs already under development might be able to reverse the effect.

It’s no secret that powerful painkillers have a dark side. Overdose deaths from prescription opioids have roughly quadrupled over 2 decades, in near lockstep with increased prescribing. And many researchers see hyperalgesia as a part of that equation—a force that compels people to take more and more medication, while prolonging exposure to sometimes addictive drugs known to dangerously slow breathing at high doses. Separate from their pain-blocking interaction with receptors in the brain, opioids seem to reshape the nervous system to amplify pain signals, even after the original illness or injury subsides. Animals given opioids become more sensitive to pain, and people already taking opioids before a surgery tend to report more pain afterward.

But how opioids actually interact with pre-existing pain has been poorly studied, says Peter Grace, a neuroscientist at the University of Colorado (CU), Boulder. His team has been trying to trace hyperalgesia to the way opioids affect the immune system. In the new study, he and his collaborators used a rat model meant to mimic chronic nerve pain in people—the kind many might feel from traumatic nerve injury, stroke, or nerve damage caused by diabetes. They sliced into the rats’ thighs and tied a fine thread around a major nerve. The thread swelled over time, causing the nerve to painfully constrict, and then dissolved after about 6 weeks.

Ten days after that injury, half the rats received a 5-day treatment of morphine. Then over about 3 months, the researchers periodically measured the rodents’ threshold of pain by poking their hind paws with stiff nylon hairs of varying thicknesses. (The finer the hair that causes the rat to withdraw its paw, the logic goes, the more sensitive it is to pain.) After 6 weeks, injured rats that had received no morphine withdrew from the same kind of pokes as uninjured control rats. But morphine-treated rats remained sensitive to pokes with much finer hairs. It took them 12 weeks to return to the same pain sensitivity as the control rats, the team reports today in the Proceedings of the National Academy of Sciences. Even after the physical injury had presumably healed, they were in pain.

“Just the primary observation itself, I think, is amazing,” says Vania Apkarian, a neuroscientist at Northwestern University, Chicago, in Illinois, who was not involved in the study. The result “should have a wake-up impact on the field.”

Control rats with no injury also saw their pain tolerance dip if they got morphine, but they returned to their original threshold after about a week. So what made pain sensitivity jump so much more dramatically in the rats with an injury?

The authors propose that the nerve damage and the morphine delivered a kind of one-two punch to cells in the spinal cord called microglia—sentinels of the nervous system that scout for infection. Microglia release inflammatory signaling molecules into the spinal cord, which activate neurons that shoot pain signals up to the brain. Previous studies have shown that opioids make microglia more sensitive to activation. In the new study, the authors found that morphine activates a specific group of signaling proteins in microglia, collectively known as an inflammasome.

That’s not likely to be the only mechanism behind hyperalgesia, Apkarian notes. But in the study, inhibiting microglia—by inserting a gene for a receptor that makes them susceptible to a deactivating drug—reversed the pain-prolonging effect in morphine treated-rats, as did blocking certain proteins in the inflammasome.

Researchers are already exploring drugs that interrupt this pathway to treat pain or improve the performance of opioids. A clinical trial recently launched at Yale University, for example, will test whether an antibiotic that inhibits glial cells prevents the inflammatory effects of opioids. And Linda Watkins, a CU Boulder neuroscientist and senior author on the new study, co-founded a company to develop a chronic pain treatment that blocks one of the signaling proteins in the inflammasome, called toll-like receptor 4.

In the meantime, the finding certainly shouldn’t be the basis for withholding opioids from people in pain, says Catherine Cahill, a neuroscientist at the University of California, Irvine. These drugs also work to block the emotional component of pain in the brain, she notes—a form of relief this study doesn’t account for. And opioids might not prolong pain in humans the way they did in these rats, she says, because the dosing of morphine and its quick cessation likely caused repeated withdrawal that can increase stress and inflammation. Humans usually don’t experience the same withdrawal because they take sustained-release formulations and taper off opioids gradually.

Grace says the field badly needs a human study that systematically tests pain thresholds over time in opioid users. His team is working to confirm the animal findings with pain from other kinds of injury, and in female rats, which weren’t included in this study. In the meantime, he says, “I hope that it’ll get people to really question what the benefit of long-term opioid therapy might be.”

http://www.sciencemag.org/news/2016/05/why-taking-morphine-oxycodone-can-sometimes-make-pain-worse

Monday, 14 August 2017

The Facts About Acupuncture For Nerve Pain Relief

Today's post from foundationforpn.org (see link below) looks once again at the potential of acupuncture to help with neuropathic pain problems. Other articles here on the blog (use the search button) may help you make your mind up when it comes to acupuncture as a nerve pain treatment but this article is a very good start. It's simply explained and fills in some of the knowledge gaps that other articles leave. By answering questions as to how acupuncture works and why, it takes away some of the mystery and that feeling of it being somewhat 'New Age', Chinese and 'hippy', which put many people off considering it as an option. Well worth a read as a stepping stone to finding out more and maybe locating a qualified acupuncturist in your area. Many doctor's practices are now offering acupuncture alongside more conventional forms of medicine and it may be worth your while seeking these out. Do be careful not to be lured by the many high street acupuncture/massage salons that have become a feature in our cities - you need professionals who know what they're doing!!
 

Acupuncture
August 2017

Acupuncture is a method of encouraging the body to promote natural healing and to improve functioning. This is done by inserting needles and applying heat or electrical stimulation at very precise acupuncture points. 


How does acupuncture work?

The classic Chinese explanation is that channels of energy run in regular patterns through the body and over its surface. These energy channels, called meridians, are like rivers flowing through the body to irrigate and nourish the tissues. The improved energy and biochemical balance produced by acupuncture results in stimulating the body’s natural healing abilities, and in promoting physical and emotional well-being.

The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones which influence the body’s own internal regulating system.
Key points:
People use acupuncture for various types of pain. Back pain is the most commonly reported use, followed by joint pain, neck pain, and headache.
Acupuncture is being studied for its efficacy in alleviating many kinds of pain. There are promising findings in some conditions, such as chronic low-back pain and osteoarthritis of the knee; but, for most other conditions, additional research is needed. The National Center for Complementary and Alternative Medicine (NCCAM) sponsors a wide range of acupuncture research.
Acupuncture is generally considered safe when performed correctly.
In traditional Chinese medicine theory, acupuncture regulates the flow of “chi” (vital energy) through the body. Research to test scientific theories about how acupuncture might work to relieve pain is under way.

To relieve their pain, many people take over-the-counter medications—either acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs, including aspirin, naproxen, and ibuprofen). Stronger medications, including NSAIDs in higher dosages and narcotics, are available by prescription only. People may also try non-drug approaches to help relieve their pain. Examples include physical and occupational therapy, cognitive behavioral therapy, self-care techniques, and CAM therapies

While acupuncture is often associated with pain control, in the hands of a well-trained practitioner it has much broader applications. Acupuncture can be effective as the only treatment used, or as the support or adjunct to other medical treatment forms in many medical and surgical disorders. The World Health Organization recognizes the use of acupuncture in the treatment of a wide range of medical problems, including:
Digestive disorders: gastritis and hyperacidity, spastic colon, constipation, diarrhea
Respiratory disorders: sinusitis, sore throat, bronchitis, asthma, recurrent chest infections.
Neurological and muscular disorders: headaches, facial tics, neck pain, rib neuritis, frozen shoulder, tennis elbow, various forms of tendinitis, low back pain, sciatica, osteoarthritis
Urinary, menstrual, and reproductive problems
Acupuncture is particularly useful in resolving physical problems related to tension and stress and emotional conditions 


Does acupuncture hurt?

Acupuncture needles are very thin, and most people feel no pain or very little pain when they are inserted. They often say they feel energized or relaxed after the treatment. However, the needles can cause temporary soreness.

There is evidence that people’s attitudes about acupuncture can affect outcomes. In a 2007 study, researchers analyzed data from four clinical trials of acupuncture for various types of chronic pain. Participants had been asked whether they expected acupuncture to help their pain. In all four trials, those with positive expectations reported significantly greater pain relief.

In addition to studying acupuncture’s efficacy, researchers are looking at potential biomechanisms—that is, how acupuncture might work to relieve pain. There are several theories about these biomechanisms (e.g., acupuncture activates opioid systems in the brain that respond to pain); additional research is still needed to test the theories. Researchers are using neuroimaging techniques such as functional magnetic resonance imaging (fMRI) to look at the effects of acupuncture on various regions of the brain. In 2005, NCCAM sponsored the “Neurobiological Correlates of Acupuncture” conference to discuss research challenges and directions in acupuncture neuroimaging research. Source NIH-National Center for Complementary and Alternative Medicine (NCCAM). 


Side effects and risks

Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Relatively few complications from acupuncture have been reported. Serious adverse events related to acupuncture are rare, but include infections and punctured organs. Additionally, there are fewer adverse effects associated with acupuncture than with many standard drug treatments (such as anti-inflammatory medication and steroid injections) used to manage pain. 


A boost for pain medicine

Acupuncture may provide added pain relief when it’s used along with pain medicine or another therapy, such as massage. Acupuncture can reduce the need for medicine and can improve the quality of life of people with chronic pain. 


When to consider acupuncture

Because acupuncture rarely causes more than mild side effects, it is a potential alternative to pain medications or steroid treatments. It is also considered a “complementary” medicine that can be used along with other treatments. It is best to discuss the use of acupuncture with your health care provider. 


Who shouldn’t use acupuncture

People with bleeding disorders or who take blood thinners may have increased risk of bleeding. Electrical stimulation of the needles can cause problems for people with pacemakers or other electrical devices. Pregnant women should talk with their health care provider before having acupuncture. It’s important not to skip conventional medical care or rely on acupuncture alone to treat diseases or severe pain. 


Acupuncture variations

Several other therapies use a different way of stimulating the acupuncture points. Moxibustion involves the burning of moxa, a bundle of dried mugwort and wormwood leaves, which can then be used to heat the acupuncture needles or warm the skin. Electroacupuncture adds electrical stimulation to the needles. Another recent variation uses laser needles that are placed on (but not in) the skin. 


Acupressure vs. acupuncture

If you are afraid of needles, you may be able to get much of the same effect from acupressure. Acupressure involves pressing or massaging the acupuncture points to stimulate the energy pathways. Scientific comparisons of acupressure and acupuncture are limited, but acupressure has been shown to be effective in reducing nausea and lessening labor pain. 


Choosing a practitioner

It is important to receive treatment from someone who has met standards for education and training in acupuncture. States vary in their licensing requirements. There are national organizations that maintain standards, such as the American Academy of Medical Acupuncture (a physician group) or the American Association of Acupuncture and Oriental Medicine. Make sure that your practitioner uses sterile needles that are thrown away after one use.

The Foundation for Peripheral Neuropathy has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by FPN.

https://www.foundationforpn.org/living-well/integrative-therapies/acupuncture/

Sunday, 13 August 2017

Severe Nerve Pain Treatment: The Trump Factor

Today's post from webmd.com (see link below) may just be an early announcement that the lunatics have taken over the asylum! When Donald Trump announces that “We’re gonna spend a lot of time, a lot of effort, and a lot of money on the opioid crisis;” severe neuropathy patients who rely on sensible opioid prescription to maintain their quality of life with less pain, may well tremble in their boots. We can only hope that Trump has sensible advisers who know what they're talking about and will approach the so-called opioid crisis with pragmatism, sympathy and common sense and not sign up to the political and media hysteria surrounding the subject in the U.S. anno 2017. His record so far suggests that knee-jerk reactions may determine health policy from now on but let's remain optimistic until the facts prove otherwise...and watch as the pigs fly around the room!
 
Trump To Declare Opioid Crisis National Emergency
By Aaron Sheinin
WebMD Article Reviewed by Neha Pathak, MD on August 10, 2017

Aug. 10, 2017 -- President Donald Trump on Thursday said he plans to declare the opioid crisis a national emergency.

Trump, speaking to reporters outside his Bedminster Golf Club in New Jersey, himself declared the crisis an “emergency.”

“We’re gonna spend a lot of time, a lot of effort, and a lot of money on the opioid crisis,” he said.

The president’s remarks come 2 days after Health and Human Services Secretary Tom Price said the administration had no plans to declare a national emergency over opioid use.

“It is a serious problem the likes of which we had never had,” Trump said Thursday. “When I was growing up, they had the LSD and they had certain generations of drugs. There’s never been anything like what’s happened to this country over the last 4 or 5 years.”

The president’s Commission on Combating Drug Addiction and the Opioid Crisis released an interim report that urged Trump to immediately declare a national emergency.

Chaired by New Jersey Gov. Chris Christie, the commission says the opioid crisis is like a “September 11th every three weeks” in terms of the number of Americans dying from overdoses.

More than 33,000 people died in 2015 from opioid overdoses, the CDC says. More than 140 die every day from some kind of drug overdose, the commission’s report says.

A report released this month shows the percentage of drug overdose deaths from synthetic opioids increased from 8% to 18% between 2010 and 2015.

The commission says Trump’s administration should boost the government’s ability to treat people with addictions, grant waivers to all 50 states to allow Medicaid to offer addiction treatment, and provide federal money to pay for medication, like methadone, to treat addictions. 


WebMD Article Reviewed by Neha Pathak, MD on August 10, 2017

http://www.webmd.com/mental-health/addiction/news/20170810/trump-declares-opioid-crisis-national-emergency

Saturday, 12 August 2017

Demyelination And Nerve Damage: Whys And Wherefores

Today's post from medicalnewstoday.com/ (see link below) talks about a common form of neuropathy that is caused by damage to the myelin sheath that normally protects our nerves. You can think of myelin as a sort of insulation, such as that surrounding the wires in our electrical products and systems. That's why, damage to the myelin sheath is so often compared to short circuiting in our homes and in many ways, it's a fairly accurate comparison. Nerve signals need to be able to travel smoothly around our nervous system. If demyelination occurs, the signals are interrupted, or veer off course, or never reach their destination; all leading to the symptoms of neuropathy we're all so familiar with - ranging from diseases such as MS to mild neuropathic symptoms in our feet and hands. Very often damage to the myelin sheath forms the basis of the problem.  Despite the long scientific terms, this article puts it all into perspective and is well worth a read.
 

Demyelination: Causes, symptoms, and treatments By David Railton Reviewed by Christina Chun, MPH Last reviewed Fri 28 July 2017
Demyelinating diseases damage the coatings of nerve cells.

Demyelination occurs when the protective coating of nerve cells, known as myelin, is damaged. When this happens, neurological problems can occur.In this article, we take a look at diseases that cause demyelination, the symptoms that may develop, and what can be done about them.

Contents of this article:

What are demyelinating diseases?
Symptoms
Types
Treatment overview

What are demyelinating diseases?


Many of the nerve fibers in the nervous system are coated with a fatty white substance called myelin. These myelin sheaths allow electrical impulses to be transmitted along the nerve cells quickly and efficiently.

How well these impulses are conducted determines how smoothly and quickly a person can perform everyday movements with little conscious effort.

Some diseases cause damage to these protective myelin sheaths, which may cause problems in the brain, eyes, and spinal cord. These conditions are known as "demyelinating diseases."

Symptoms of demyelinating diseases

Typically, demyelinating diseases can affect:
vision
reflexes and movement
the senses
mood
how often someone needs to use the bathroom

People who experience any of these symptoms may also experience persistent exhaustion that does not appear to have a particular cause.


Visual symptoms

People with a demyelinating disease may experience blurred vision, a loss of vision, "double vision," or they may feel like their vision is swinging back and forth.


Motor symptoms

Some people may also experience weakness in their limbs and the trunk of their body, or have problems balancing. In addition, the muscles might contract, causing stiffness or tightness and interfering with movement and speech.

People may also experience spikes in blood pressure and a rapid heartbeat due to an overreacting nervous system.


Sensory symptoms

Some people may experience numbness, burning, or prickling sensations in their arms, legs, or feet. They may also feel pain when touched lightly.

Some people with a demyelinating disease, such as multiple sclerosis (MS), get a symptom called Lhermitte's sign. This feels like an electric shock that passes down the back of the neck into the spine and then out through the arms and legs.


Symptoms related to the brain

Demyelinating diseases can lead to memory problems, difficulty concentrating, and cognition issues.

People with a demyelinating disease can also experience tremor or incoordination. At times, actions such as swallowing, writing, eating, and walking can become difficult.

Memory, concentration, attention, and processing speed can all be affected by demyelinating diseases.

People with demyelinating diseases commonly experience depression, anxiety, and irritability.


Symptoms affecting the genitourinary system

Demyelinating diseases can affect how often someone needs to use the bathroom. These conditions can make people either incontinent (where they cannot control their bladder or bowels) or constipated (where they cannot empty their bowels regularly and thoroughly).

Infections of the urinary tract can also be more common in people with demyelinating diseases.

The sexual health of individuals with demyelinating diseases may be affected. Men may be unable to get an erection, and both women and men may be unable to orgasm. People with demyelinating diseases may also experience pain during sex.


Types of demyelinating diseases

There are many different types of demyelinating disease. Diagnosis varies from disorder to disorder.

Below is a list of some of these conditions, along with information on possible treatment options.


Multiple sclerosis
Multiple sclerosis is the most common demyelinating disease.

The most common type of demyelinating disease is MS.

The term multiple sclerosis means "many scars." It refers to areas in the brain and spinal cord where myelin has been lost, leaving hardened scars that can appear at different times and in different places.

Unfortunately, there is no cure for MS at present, but many of the symptoms can be managed and treated.

Medications are available to treat relapses of MS and manage symptoms, which are usually taken orally or by injection.

MS is more common among women than men. In fact, about three women to two men have this particular demyelinating disease.

Although MS is not hereditary, some doctors believe that genes can make some people more susceptible to the condition than others.


Optic neuritis

Optic neuritis is another type of demyelinating disease that can arise from MS.

This condition is most common among people aged between 20 and 40. Its most common symptoms are pain with eye movement, vision loss, or loss of color vision.

Optic neuritis is often treated with corticosteroids, although if doctors suspect that MS is causing the problem, they may prescribe MS medications.


Neuromyelitis optica

Neuromyelitis optica, or Devic's disease, occurs when the immune system attacks and destroys myelin, resulting in pain in the spine and limbs and causing bladder and bowel problems.

Neuromyelitis optica can sometimes result in death if a person's breathing becomes affected.

The initial attack of neuromyelitis optica is likely to be treated with corticosteroids.

Drugs that subdue the immune system, called immunosuppressives, may be used to prevent additional attacks.


Transverse myelitis

Transverse myelitis is an inflammation of the spinal cord. This type of demyelinating disease affects sensation and can cause pain and weakness in the arms and legs, as well as causing bladder and bowel problems.

About 1,400 new cases of transverse myelitis are diagnosed each year in the United States.

Similarly to other demyelination diseases, corticosteroids may be prescribed to reduce the inflammation of the spine.

For those people who do not respond to corticosteroids, doctors may recommend plasma exchange therapy. This procedure involves replacing plasma (the fluid in which blood cells and antibodies travel) with special fluids.

Pain medicines such as acetaminophen, ibuprofen, and naproxen can also help with muscle pain.


Acute disseminated encephalomyelitis

Acute disseminated encephalomyelitis (ADEM) is a widespread attack of inflammation in the brain and spinal cord. The inflammation damages myelin and can lead to fever, exhaustion, headache, nausea, and vomiting.

In some severe cases, people may experience seizures, go into a coma, or die. A small fraction of people with this condition develop MS.

Like transverse myelitis, corticosteroids or plasma exchange therapy may be considered to reduce the inflammation that causes ADEM.


Adrenoleukodystrophy and adrenomyeloneuropathy


Adrenoleukodystrophy and adrenomyeloneuropathy are rare, inherited demyelinating diseases that are caused by a gene mutation that usually only affects men. Some women can carry the gene, however, and in some cases, women may develop symptoms.

Symptoms of these conditions vary and span the full range of demyelinating disease symptoms described above.

If people with adrenoleukodystrophy or adrenomyeloneuropathy have low levels of adrenaline and cortisol, then a doctor can prescribe steroids, which can replace the hormones and improve a person's quality of life.

Other treatments for these conditions are currently in clinical trials.

Treatment overview

There are currently no cures available for demyelinating diseases. As a result, treatment tends to focus on reducing and managing symptoms, as well as slowing the progress of the disease.

When demyelination occurs, new myelin can grow. However, the new myelin is not as strong and protective as the old myelin, which means that the transmission of electrical impulses is not as efficient as before.

Researchers are currently looking at what can be done to improve how the body produces new myelin.

For now, people with demyelinating diseases should be sure to speak with their doctor about their treatment options.

http://www.medicalnewstoday.com/articles/318750.php

Friday, 11 August 2017

Chronic Pain Patients Subjected To Media Torture: Time To Fight Back!

Today's excellent post from painnewsnetwork.org (see link below) puts the case for chronic pain patients currently being stigmatised for taking opioids and other strong analgesics - a situation outside their control and unavoidable due to the severity of their condition. The author calls it 'torture', carried out by the 'anti-opioid zealots' and strong as this sounds...she's absolutely right! You will find thousands of stories all across the internet and social media, demonizing patients who continue to take opioids and demonizing the doctors who are just doing what they're supposed to do - initiating best care for their patients. It's a hype driven by the media and politicians who have no clue what they're talking about but are prepared to jump on any populist bandwagon to garner more votes. Luckily, there are enough people prepared to challenge this view and come out in support of the patients themselves. Read this article - it's worth the effort and helps to restore a bit of sanity to the proceedings.

Stop Torturing Chronic Pain Patients
By Kim Miller, Guest Columnist August 02, 2017

Have you heard the stories about people who suffer from unrelenting pain?

These people, who we'll call "patients,” are trying to have a life whereby their pain is controlled enough to participate in some of life's little pleasures, such as cleaning the house, showering and spending time with family, while understanding that being completely pain free is unrealistic.

These patients are often treated as if they're asking for something unreasonable. They are not typical patients, but their anomalies have little place in the medical community, like other patients with chronic conditions such as hypertension or diabetes.

Chronic pain patients are typically required to visit their medical providers once each month if they are being treated with opioids. Along with these regular visits, chronic pain patients are subjected to signed contracts, random drug screens, reports from their state's Prescription Drug Monitoring Program (listing all scheduled medications, dates filled, names of pharmacies and prescribers' names), and random pill counts. Any failure to comply or meet with these specifications can result in the patient being released or "fired" by the medical practice for breaking the pain contract.

Many of these patients have been subjected to abrupt tapering of their opioid medications or had them completely discontinued.

The CDC opioid guidelines, the DEA, misinformed legislators, media hype, and anti-opioid zealots have combined to continually attack the nation's opioid crisis by restricting access to pain medications by legitimate, law abiding patients who are following all of the rules.

This process of restricting medications for patients in need has caused many to suffer needlessly and some to commit suicide. Even patients who have had no negative side effects from opioids -- after taking them for years or even decades -- are now suffering due to no fault of their own.

The worst part of the current situation is that overdose deaths caused by illicit opioids, such as heroin, street-manufactured fentanyl, and fentanyl analogs like carfentenil (elephant tranquilizer) and U-47700, continue to rise. Many media stories, as well as government reports and statements, do not differentiate between prescription opioids and illegal opioids when informing the public about the "opioid epidemic." The misinformed public only hears about opioids causing more deaths, while the picture on the television shows pills in a prescription bottle.

Restricting access to legal opioid medication has no hope whatsoever of curtailing what is an epidemic of non-prescription drugs.

The origins of the opioid crisis may have roots in the overprescribing of opioids, but a growing number of studies have found that opioid medications are no longer involved in the majority of fatal drug overdoses. Deaths categorized as "opioid related" often involve non-prescription opioids like heroin and illicit fentanyl, or benzodiazepines, alcohol, cocaine, methamphetamine and other substances.

The vast and overwhelming evidence points to dangerous substances NOT prescribed by a medical provider, yet we're left with continued restrictions on medications needed by pain patients to have any quality of life.

This dangerous counter-intuitive trend not only deprives patients of pain relief, but is leading to a silent epidemic of suicide in the pain community. It is time to rethink the media and political hype, ditch the CDC guidelines, and stop torturing chronic pain patients.

Kim Miller is the advocacy director of the Kentuckiana Fibromyalgia Support Group and an ambassador with the U.S. Pain Foundation.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

https://www.painnewsnetwork.org/stories/2017/8/2/stop-torturing-chronic-pain-patients