Small Fibre Neuropathy - What Does That Mean?

Today's post comes from the Cleveland Clinical Journal of Medicine (see link below) and discusses in some detail what exactly small fibre neuropathy is. Many people will receive a diagnosis from their doctor telling them that they have small fibre neuropathy but few will receive a full description of precisely what that is. This is mainly due to time constraints on the part of the doctor but is also because it's a pretty complex subject. For most people, hearing that they have a form of neuropathy is enough - they just want to know how it will be treated but as you know, there are many different variants in nerve damage. This article gives you a much better idea of what's involved if you're told that small fibre neuropathy is what you have.
All references and larger, clearer images can be found by following the link to the original page.

Small fiber neuropathy:
A burning problem

1. JINNY TAVEE, MD Neuromuscular Disease Center, Neurological Institute, Cleveland Clinic

1. LAN ZHOU, MD, PhD Director, Cleveland Clinic Cutaneous Nerve Laboratory, Neuromuscular Disease Center, Neurological Institute, Cleveland Clinic

    

Abstract

Small fiber neuropathy is increasingly being recognized as a major cause of painful burning sensations in the feet, especially in the elderly. Although strength remains preserved throughout the course of the disease, the pain and paresthesias are often disabling. Diabetes mellitus is the most common identifiable cause of small fiber neuropathy, and impaired oral glucose tolerance and individual components of the metabolic syndrome are often associated with it. Some cases, however, are idiopathic. Skin biopsy (with an evaluation of the density of intraepidermal nerve fibers) and tests of autonomic nerve function are useful for the diagnosis. Management involves controlling pain and identifying and aggressively treating the underlying cause.

Key points Symptoms of small fiber neuropathy typically start with burning feet and numb toes.

                 

Key points Causes and associated conditions can be found in over 50% of cases. These include glucose dysmetabolism, connective tissue diseases, sarcoidosis, dysthyroidism, vitamin B₁₂ deficiency, paraproteinemia, human immunodeficiency virus infection, celiac disease, neurotoxic drug exposure, and paraneoplastic syndrome.

                 

Key points Findings on routine nerve conduction studies and electromyography are typically normal in this disease.

                 

Key points Management includes aggressively identifying and treating the underlying cause, advising lifestyle modifications, and alleviating pain.

                 

An estimated 15 to 20 million people in the United States over age 40 have some type of peripheral neuropathy. In many, the impairment is purely or predominantly in small nerve fibers, and the clinical presentation consists of pain, burning, tingling, and numbness in a length-dependent or stocking-glove distribution. (“Length” refers to distance from the trunk; distal fibers are affected first.) Symptoms typically begin in the feet and slowly ascend to the distal legs, at which point the hands may also be affected (FIGURE 1).

              

In many of these patients, the findings on neurologic examination, nerve conduction studies, and electromyography are normal, although some may show signs of mild distal sensory loss on physical examination. The lack of objective findings on routine nerve conduction studies and electromyography may lead many physicians to attribute the symptoms to other disorders such as plantar fasciitis, vascular insufficiency, or degenerative lumbosacral spine disease.

              

The past 2 decades have seen the development of specialized tests that have greatly facilitated the diagnosis of small fiber neuropathy; these include skin biopsy to evaluate the density of nerve fibers in the epidermis and studies of autonomic nerve function. Common etiologies have been identified for small fiber neuropathy and can be specifically treated, which is critical for controlling progression of the disease. Pain management is becoming easier with more available options but is still quite challenging.

WHAT IS SMALL FIBER NEUROPATHY?

Small fiber neuropathy is a disorder of the peripheral nerves that primarily or exclusively affects small somatic fibers, autonomic fibers, or both, resulting in sensory changes and autonomic dysfunction when both types are involved (FIGURE 2).

FIGURE 1.

Symptoms are pain, burning, numbness, and autonomic dysfunction (lack of sweating) in the hands and feet in a stocking-glove distribution. Strength is not affected. Tendon reflexes are normal, as are nerve conduction studies.

Peripheral nerve fibers can be classified according to size, which correlates with the degree of myelination.

• Large nerve fibers are heavily myelinated and include A-alpha fibers, which mediate motor strength, and A-beta fibers, which mediate vibratory and touch sensation.
•                        
• Medium-sized fibers, known as A-gamma fibers, are also myelinated and carry information to muscle spindles.
• Small fibers include myelinated A-delta fibers and unmyelinated C fibers, which innervate skin (somatic fibers) and involuntary muscles, including cardiac and smooth muscles (autonomic fibers). Together, they mediate pain, thermal sensation, and autonomic function.

Small fiber neuropathy results from selective impairment of small myelinated A-delta and unmyelinated C fibers.

Sensory symptoms: Pain, burning, tingling, numbness

Damage to or loss of small somatic nerve fibers results in pain, burning, tingling, or numbness that typically affects the limbs in a distal-toproximal gradient. In rare cases, small fiber neuropathy follows a non-length-dependent distribution in which symptoms may be manifested predominantly in the arms, face, or trunk.

                 

Symptoms may be mild initially, with some patients complaining of vague discomfort in one or both feet similar to the sensation of a sock gathering at the end of a shoe. Others report a wooden quality in their feet, numbness in their toes, or a feeling as if they are walking on pebbles, sand, or golf balls. The most bothersome and fairly typical symptom is burning pain in the feet that extends proximally in a stocking-glove distribution and is often accompanied by stabbing or aching pains, electric shock-like or pins-and-needles sensations, or cramping of the feet and calves.

                 

Symptoms are usually worse at night and often affect sleep. Some patients say that their feet have become so exquisitely tender that they cannot bear having the bed sheets touch them, and so they sleep with their feet uncovered. A small number of patients do not have pain but report a feeling of tightness and swelling in their feet (even though the feet appear normal).

                 

Examination often reveals allodynia (perception of nonpainful stimuli as being painful), hyperalgesia (perception of painful stimuli as being more painful than expected), or reduced pinprick and thermal sensation in the affected area. Vibratory sensation can be mildly reduced at the toes. Motor strength, tendon reflexes, and proprioception, however, are preserved because they are functions of large nerve fibers.

Autonomic symptoms

When autonomic fibers are affected, patients may experience dry eyes, dry mouth, orthostatic dizziness, constipation, bladder incontinence, sexual dysfunction, trouble sweating, or red or white skin discoloration. Examination may show orthostatic hypotension and skin changes. The skin over the affected area may appear atrophic, dry, shiny, discolored, or mildly edematous as the result of sudomotor and vasomotor abnormalities.

FIGURE 2

WHAT CAUSES SMALL FIBER NEUROPATHY?

Small fiber neuropathy has been associated with many medical conditions, including glucose dysmetabolism, connective tissue disease, dysthyroidism, vitamin B₁₂ deficiency, paraproteinemia, human immunodeficiency virus (HIV) infection, hepatitis C virus infection, celiac disease, restless legs syndrome, neurotoxic drug exposure, hereditary diseases, and paraneoplastic syndrome. While most of these conditions cause a length-dependent small fiber neuropathy, others (Sjögren disease, celiac disease, and paraneoplastic syndrome) can cause a form of small fiber neuropathy that is not length-dependent.

http://171.66.127.177/content/76/5/297.full

Alpha Lipoic Acid And Possible Thyroid Problems

Today's post comes from the New York Buyers Club blog (see link below) which is almost always a very reliable source of information about vitamins and supplements and Lark Lands, whose work has been used previously on this blog. It talks about potential problems with Alpha Lipoic Acid, one of the most recommended go-to supplements to help with neuropathic symptoms. Usually used in combination with Acetyl-L Carnitine and/or  N-Acetyl-Cysteine, they are co-enzymes which can have a beneficial effect on the nervous system. This article sounds a note of caution concerning higher doses of ALA and potential thyroid problems and advises getting the thyroid monitored (a simple blood test) if  you're taking ALA regularly. The problem here is that the symptoms of thyroid problems are very familiar to many HIV patients as it is (see below) but the blood test should clear up any doubts.

 Alpha lipoic acid: a caution about potential hypothyroidism from Lark Lands

November 20, 2011

NYBC has recently learned from our colleague Lark lands, long known for her expertise in supplementation stategies for people with diabetes and people with HIV, that for, some people, there may be a risk of hypothyroidism in taking alpha lipoic acid, especially at higher doses:

Alpha-lipoic acid (ALA) is a liver protective agent, and has been studied for peripheral neuropathy and lipodystrophy. It may slow HIV replication, and counter HIV-related dementia. ALA is very important in several ways. It easily crosses cell membranes and works as anantioxidant in both lipid (fatty) and aqueous (watery) parts of the body. It is a versatile and powerful antioxidant, both reducing oxidative stress in the body, and indirectly protecting, recycling, or regenerating other major antioxidants.

There is also good evidence that ALA has beneficial effects for those with type 2 diabetes and some of its complications. Its wide-ranging benefits for diabetes, according to recent research, include improved glycemic control, improved insulin sensitivity, as well as reduction of oxidative stress and neuropathy.

Caution

Our colleague Lark Lands, an expert on supplementation for people with diabetes and people with HIV, has drawn our attention to the concern that alpha lipoic acid may produce symptoms of hypothyroidism in some people. Partly due to this concern, NYBC has also reduced ALA in our ThiolNAC, such that 3 tabs/day equals 400mg – below the dosages generally of concern in Lark’s analysis. Symptoms of hypothyroidism may include fatigue, low body temperature, weight gain, hair loss, splitting fingernails, depression, memory problems, muscle weakness, elevated cholesterol, and/or skin that is dry, rough or scaly. NYBC recommends monitoring the thyroid while taking ThiolNAC or ALA by itself.

 Lark Lands notes the following: Although it is not clear what percentage of people this may affect, in some people it appears that alpha-lipoic acid may block the proper conversion of T4, the storage form of thyroid hormone, into T3, the active form. This was first noted in animal research with alpha-lipoic acid, and has since been reported by a number of people known to me. When this occurs, people will develop the symptoms of hypothyroidism (which may include fatigue, low body temperature, weight gain, hair loss, splitting fingernails, depression, memory problems, muscle weakness, elevated cholesterol, and/or skin that is dry, rough or scaly).

For this reason, it is important to monitor the thyroid, first at baseline, before lipoic acid is taken, and then after the first month or two of taking lipoic acid, to see if there have been any adverse effects. If not, it probably means that the thyroid is unlikely to be affected. However, it will still be wise to check the TSH level (a blood test that is an indicator of thyroid function) at least once or twice yearly, or any time that symptoms that could be related to low thyroid appear, as some people have taken 600 mg daily doses for lengthy periods (even up to five years in one case known to me) before TSH levels became elevated outside of the normal healthy range.

It is clear that this problem does not develop in everyone who uses lipoic acid. Some people seem to tolerate doses of 600 mg or even more daily with no problems, while others have developed serious thyroid problems with doses ranging from 500 mg to 1000 mg daily. In the people known to me who have been affected in this way, discontinuing the lipoic acid allowed the thyroid problems to disappear quite quickly. I personally experienced this when taking lipoic acid. My TSH had become seriously elevated, remaining at an abnormally high level for more than a year, and I had developed symptoms of hypothyroidism, including serious fatigue.

Within six weeks of discontinuing the lipoic acid, my symptoms vanished and my TSH returned to normal and stayed there. I had made no other changes of any kind so it is clear to me that the lipoic acid was the problem for me that caused hypothyroidism. Since then, I have so far discovered four other people who developed similar problems while taking it. However, since alpha-lipoic acid is otherwise an excellent supplement, for all the reasons listed above, this does not mean it should be completely written off. Just do monitor the thyroid if you choose to take it!

NYBC’s recommends that if you are on thyroid medication, it may be best to avoid lipoic at high doses (over 400mg/day). 

 http://nybc.wordpress.com/2011/11/20/alpha-lipoic-acid-a-caution-about-potential-hypothyroidism-from-lark-lands/

Neuropathy - A Personal Account

Today's post comes from neuropathyawareness.blogspot.com (see link below) a colleague neuropathy blog and is one person's personal story. This person has no visible connection to HIV but her story will be familiar to very many people suffering from neuropathy. It's not easy taking opioids to try to control the pain: the opioids themselves can have unpleasant side effects and can be addictive and besides that, as this lady says, they still don't remove the pain 100%. The problem is, when all else has failed, modern medicine can offer very few alternatives for reducing the pain.

Living Life with Peripheral Neuropathy

written by Michelle Cornell Monroe, Support for Neuropathy member

Living life with peripheral neuropathy has been a challenge for sure! I never would of thought that my life would revolve around being in chronic pain 24/7. One day I was in great health and the next it was all taken away from me in Jan 2001. Before all this I had never heard of peripheral neuropathy so when I was told that this was my diagnosis and it was permanent with no cure I just about lost it! I remember thinking how can no cure be available and no specific medicine for neuropathy be available? When my neuropathy symptoms first started it came on strong and on a pain scale the pain was a 10 and still is, but controlled with medications/narcotics. So now my life also revolves around being on heavy narcotics and this is someone who never took anything besides a asprin before all this! Even with being on heavy narcotics I still have pain and some days are very bad! I take medicine that is given to cancer patients and still can't get pain control on some days. That is just crazy to me and something has to be changed! We need help spreading the word about PN so a cure can be found. No one should have to live their life in chronic pain!

No one can understand what it's like to live like this unless they have it personally. It takes over your mind and controls everything you do from spending time with family or friends. It follows you everywhere and is always a constant reminder that you have PN. As bad as my life can be with having PN I have found its the little things that can make me happy. Little things like the smell of a flower or watching a new flower grow, enjoying my morning coffee, my fragrant candles, a new recipe etc and best of all being a great mom! I have had time over the years to accept this is the new me and its how it is. Of course I have days that I get depressed, but I try and think tomorrow will be a better day! I'm so glad to have the support from the group called Support for Neuropathy that I joined on facebook. For about 9 out of the 11 years of having PN I had no support and it was very lonely. I have meet many caring and awesome friends in my support group and I'm very thankful to have them all!!

http://neuropathyawareness.blogspot.com/2011/11/living-life-with-peripheral-neuropathy.html

The Frustrations Of The Delayed Neuropathy Diagnosis

Today's post comes originally from the Neuropathy Association via lymeneteurope.org (see link below) which specialises more in Lyme Disease (another cause of neuropathy). The story must be familiar to millions of people. Getting a diagnosis of neuropathy, including the cause, can take a great deal of time and at the end of it many patients ask themselves if it was worth the wait! It's one of those diseases where the patient's own account is generally pretty much conclusive because the symptoms are very specific and treatment (such as it is) can begin more or less straight away. However, once you step onto the medical roundabout, forms have to be filled in and dossiers compiled before treatment can properly begin. Doctors and hospital administrations need patient profiles to justify whatever course of treatment they then offer. The patient meanwhile, needs speedy action to reduce the symptoms and delays raise frustration levels especially if you receive an idiopathic neuropathy diagnosis at the end (no reason for your problems can be found).

National Poll Shows Delayed Diagnosis, Inadequate Pain Care, and Distressing Life Changes Plague Millions With Neuropathy

New York, NY (PRWEB) May 14, 2012
A new national Neuropathy Association poll of peripheral neuropathy patients finds that the majority of respondents experience an extended period of time from symptom onset to diagnosis of their neurological disease, with 57% taking two or more years to receive an accurate diagnosis. In addition to facing delays in receiving a diagnosis that might help prevent disease progression and provide early access to appropriate care and treatment, close to 50% of these patients have been told their neuropathy is “idiopathic” (of an unknown cause). A large majority—70%—of patients experience chronic neuropathic (nerve) pain for which they use multiple therapies, and nearly half say they are challenged in coping with neuropathy’s impact on their overall well-being and quality of life.

“With the potential for millions of Americans to suffer from neuropathy’s progressive chronic pain and disability, the U.S. is currently unprepared to face a major public health crisis if healthcare providers, the media, and public policy officials continue to ignore the inadequacy of medical resources and research funding for neuropathy,” observes Tina Tockarshewsky, president and CEO of The Neuropathy Association.

Peripheral neuropathy, or “nerve damage,” impacts over 20 million Americans (or 1 in 15), making it one of the most common chronic diseases and a leading cause of adult disability. Neuropathy results from injury to the peripheral nerves, disrupting the body’s ability to communicate with its muscles, organs, and tissues. With early diagnosis, it can often be controlled and quality of life restored. If ignored, symptoms can intensify to loss of sensation, weakness, unremitting pain, and/or disability.

The Neuropathy Association’s national survey of 1,922 patients asked about the length of time between symptoms and confirmed neuropathy diagnosis, revealing 57% took two or more years and 43% took less than two years to diagnose.

“While early intervention and treatment can be critical to slowing disease progression, our biggest challenge is many Americans still do not know about neuropathy, are unaware they have it, and do not recognize warning signs. Too often neuropathy is discovered after irreversible nerve damage has occurred.” notes Dr. Thomas H. Brannagan, III, medical advisor for The Neuropathy Association.

While there are over 100 known types of neuropathy, the poll shows 49% of the patients say their neuropathy is “idiopathic” (an unknown cause). At 15%, prediabetic/diabetic neuropathy is the second most common type reported by patients. Other neuropathy types cited include autoimmune-related, hereditary, cancer or chemotherapy-related, entrapment or trauma-related, and neuropathies related to sources such as toxin-induced, nutritional deficiencies, gastro-intestinal disorders, metabolic diseases, or infectious diseases (including Lyme and HIV/AIDS).

“Neuropathy is often misrepresented as only being diabetes-related. We know that diabetic neuropathy typically represents a third of the neuropathy patient community; yet, close to half of the patients receive an idiopathic neuropathy diagnosis. This survey supports the fact that confirming a diagnosis, when possible, requires physicians and patients working in partnership for a thorough evaluation to identify the possible source of the nerve damage,” says Brannagan.

In addition, the survey asked patients about therapeutic management of their neuropathy. Patients say they use a number of therapeutic approaches, with 70% using multiple therapies to address their chronic nerve pain. Nearly half surveyed express that their equally weighted coping challenges pertain to maintaining their overall well-being and their daily interactions.

For 17 years, The Neuropathy Association has been an active national patient advocacy organization working to change perceptions about this progressive, chronic neurological disease. May 14-18, 2012 is the eighth annual Neuropathy Awareness Week, an event launched by the Association to promote greater attention to and prevention of neuropathy as a growing national epidemic.

About The Neuropathy Association

Founded in 1995, The Neuropathy Association is the leading national nonprofit organization providing neuropathy patient support, education, advocacy, and the promotion of research into the causes of and cures for peripheral neuropathies through its nationwide network of members, regional chapters, 15 medical Centers of Excellence, and 150 patient support groups.

Source: The Neuropathy Association

http://www.lymeneteurope.org/forum/viewtopic.php?f=6&t=3823

New Explanation For (Diabetes-Related?) Neuropathic Pain

Today's post from Sciencedaily.com (see link below) brings a dilemma with it. A study has shown that changes in 'dendritic spines' in the brain may play an important part in explaining neuropathic pain in diabetes-related cases! Yet nowhere does it say that this is exclusively a diabetes-related occurence. The article states that the reason why diabetes can cause neuropathy is still a mystery, so there is really no reason to assume that these changes in the nerve endings in the brain only occur in diabetes patients. We need the study to include HIV-related neuropathy and many other forms too, If the dendritic spines are not altered in other forms of neuropathy, then they have some important information but at the moment, to a layman like me, it's just not clear.
 Many people with HIV looking for information on neuropathy, may skip over articles about diabetic neuropathy because they think it doesn't apply. This is generally just not true. Most of the information about diabetic neuropathy applies to all neuropathies; it's just that diabetic neuropathy is by far the most common form amongst the general population. If you ask 99 out of a 100 diabetic neuropathy patients what their symptoms are, you'll find that they are exactly the same as your own. What the researchers mean to say is that they don't really understand the processes behind why neuropathy occurs in most of its forms and tying it to one disease depends on who their target readership is. If there are any experts out there who can explain (in relatively simple terms)  the real differences in disease-based neuropathies, please let us know - very many people are interested.

Unexpected Source for Diabetic Neuropathy Pain

ScienceDaily (May 15, 2012)

Normal dendritic spines — microscopic projections on the receiving branches of nerve cells — are shown at top compared to those of diabetic rat. At bottom, spines after receiving treatment. Yale study suggests that neuropathic pain associated with diabetes may be caused by reshaping of these spines in nerve cells, and might be treated by drugs. (Credit: Image courtesy of Yale University)

Nearly half of all diabetics suffer from neuropathic pain, an intractable, agonizing and still mysterious companion of the disease. Now Yale researchers have identified an unexpected source of the pain and a potential target to alleviate it.

A team of researchers from Yale and the West Haven Veterans Affairs Medical Center describes in the May 15 issue of the Journal of Neuroscience how changes in the structure of dendritic spines -- microscopic projections on the receiving branches of nerve cells -- are associated with pain in laboratory rats with diabetes.

"How diabetes leads to neuropathic pain is still a mystery," said Andrew Tan, an associate research scientist in neurology at the Yale School of Medicine and lead author of the study. "An interesting line of study is based on the idea that neuropathic pain is due to faulty 'rewiring' of pain circuitry."
With a growing number of diabetics, the condition represents a huge unmet medical need. Once neuropathic pain is established, it is a lifelong condition.

"Here we reveal that these dendritic spines, first studied in memory circuit processing, also contribute to the sensation of pain in diabetes," Tan said. A single neuron may contain hundreds to thousands of dendritic spines.

The Yale team led by Tan and senior author Dr. Stephen G. Waxman, the Bridget Marie Flaherty Professor of Neurology, professor of neurobiology and pharmacology,found abnormal dendritic spines were associated with the onset and maintenance of pain. They also found that a drug that interferes with formation of these spines reduced pain in lab animals, suggesting that targeting abnormal spines could be a therapeutic strategy.

Tan said that these dendritic spines in nerve cells seem to store memory of pain, just as they are crucial in memory and learning in the human brain.

"We have identified a single, key molecule that controls structural changes in these spines and hopefully we can develop therapeutic approaches that target that molecule and reduce diabetic pain," Waxman said.

Other authors on the paper are Omar A. Samad, Tanya Z. Fischer, Peng Zhao and Anna-Karin Persson,
The research was funded by the Department of Veterans Affairs.

http://www.sciencedaily.com/releases/2012/05/120515203056.htm

Toxic Neuropathy

Today's post comes from hubpages.com (see link below) and I suspect the original source is again the Neuropathy Association but there is no named author or date. It talks about Toxic neuropathy which is a sort of sub group of the many types of neuropathy and includes conditions like alcoholic neuropathy and neuropathy caused by accidental exposure or ingestion, of poisons and chemicals amongst others. Whether HIV and other medications can be brought under this banner is debatable but the potential toxicity of many drugs may well lead to erosion and degrading of the nervous system. What is certain is that toxic neuropathy always has an external cause.

About Toxic Neuropathy

Toxic neuropathy is one of over 100 different varieties of peripheral neuropathy, a disease or neurologic condition that plays havoc with the peripheral nerves of the human body. When a person is afflicted with peripheral neuropathy, the ability of the body to communicate with its own skin, muscles, joints or internal organs is disrupted, which can cause minor to major problems as well as irritation to downright pain on an ongoing basis.

Neuropathy is often compared to the body’s electrical wiring system breaking down, which can then cause numbness, pain, weakness in the limbs, and loss of coordination, balance, etc. Peripheral neuropathy most often affects the hands and feet, causing loss of sensation or increased sensation that can range from tingling and “pins and needles” feelings to intense pain. Some sufferers of neuropathy describe a “gloves and socks” sensation even when they are not wearing gloves or socks. Peripheral neuropathy’s course is normally variable; it can come and go, slowly progressing over many years, or it can become severe and debilitating quite quickly. However, if diagnosed early, peripheral neuropathy can often be controlled through medications and even diet.

Peripheral neuropathy is a fairly common malady. It’s been estimated that upwards of 20 million Americans suffer from this illness. It can occur at any age, but is more commonamong older adults. A 1999 survey found that 8-9% of Medicare recipients have peripheral neuropathy as their primary or secondary diagnosis! The annual cost to Medicare exceeds $3.5 billion for neuropathic conditions and side effects. It is theorized that peripheral neuropathy has always been present as a human affliction, but has not received much attention. Its extent and importance have not yet been adequately recognized. It is likely to be misdiagnosed, or thought to be a side effect of another disease like diabetes or cancer or kidney failure. The development of new therapies has thusly and unfortunately been slow and underfunded.

When it comes to toxic neuropathy, there are several variables. The peripheral nerves can be destroyed or damaged – leading to the symptoms of neuropathy – by one of three main types of toxicity introduced into the human body. Unlike other forms of neuropathy such as compressive neuropathy – which is due to accidental compression of the nerves by impact or trauma – or diabetic neuropathy – one of the largest forms of neuropathy in terms of causation and caused by the hay-wiring levels of insulin in the body – toxic neuropathy stems from the accidental or intentional exposure to substances that prove harmful to the physical structures of the nervous system. These are the three main exposure elements that tend to create toxic neuropathy in the human body:

· Occupational exposures to chemicals or substances that have a deleterious affect on the nerves of the human body

· Accidental or intentional pharmaceutical ingestions that are above suggested or prescribed levels and which damage the peripheral nerves accordingly as a side effect of ingestion

· The abusive use of alcohol – which it is undetermined at this point as to whether the alcohol itself destroys or damages the nerves OR rather affects the nutritional balance in the body, diluting thiamine and other essential minerals that the nerves need in order to remain healthy…resulting in neuropathy that would need neuropathy care.

Toxic neuropathy can be diagnosed by trained neurologists who consult with patients about their lifestyle choices and habits. Seeking help from trained specialists is advocated, as neuropathy, as has already been stated, is often times misdiagnosed.

http://sweepstakes1.hubpages.com/hub/toxicneuroptahy

NeP - Neuropathic Pain

 Today's post from neurocentre.com (see link below) is another general post about neuropathic pain and another good one for people looking for general information. Many people arrive at the blog, newly affected by neuropathy and may be put off by some of the more specific and scientifically complex posts. All they really want to do is find out what's going on. Every 'general information' post here is different and they all bring a slightly different angle to the subject. For that reason, this article is also useful for seasoned neuropathy sufferers.

What Is Nep?

May 12, 2009 by Neuropathy Trust
 

We all know what toothache or a bad-headache feels like and how glad we are when these painful conditions subside. It’s almost beyond our capability to imagine pain which doesn’t always go away and which might even last for years. Picture someone very close to you, in desperation because of neuropathic pain in the feet, going outside at four o’clock on a winter’s morning and standing on a frozen lawn to lessen the pain and burning sensations. This is a real-life example, by no means extreme, of how this type of pain may affect a person.

In the UK alone such significant suffering is believed to affect at least half a million people today.
Neuropathic pain may be defined as pain arising from a disturbance of function or pathological change in a nerve. The multiple kinds of abnormal pain sensations may suggest that several different changes from the normal healthy state of the nerves has taken place. Some people, for example, may experience severe pain as a result of just light pressure from clothing, air movement, or changes in temperature. Others may even experience spontaneous pain for which no obvious cause can be determined. Such pain may be continuous or may even occur in intermittent bursts.
When tests and examinations are performed on people affected in this way, it is common to also discover different areas of numbness, due to the damaged nerves. There is a growing awareness amongst doctors that our perception of pain is complex and that many different factors are involved. Ideally, how pain is defined and how it is treated should take account of these factors.

Causes of Neuropathic Pain
The term ‘neuropathic pain’ covers a number of different causes and types of pain, examples are:

• Diabetes:
‘Diabetic neuropathy’, at it’s simplest, is most often experienced as pain and/or numbness in the feet and is one of the complications of having diabetes.

• Shingles:
After someone has had chicken pox, the virus (varicella zoster) becomes permanently resident in nerve cells, although this in itself does not cause symptoms. However, in some patients, the virus can become reactivated to cause the acutely painful condition of shingles or herpes zoster. In a small number of patients with shingles the affected nerve can become permanently damaged to give neuropathic pain long after the shingles has resolved. This is known as post herpetic neuralgia.

• Amputation of a limb:
When people have a limb amputated some people may experience ‘phantom limb pain’. They feel pain in the amputated limb, even though the limb is no longer there.
• Cancer:
Neuropathic pain is experienced by some people with cancer as a result of either the tumour or the treatment given.

 • Trigeminal neuralgia:
This is a type of neuropathic pain that occurs in the face. It is due to problems with one of the facial nerves.

• HIV infection:
Having the HIV virus can result in HIV related painful peripheral neuropathy. Some treatments for HIV may also cause the condition.

• Multiple Sclerosis:
Pain can be a symptom of multiple sclerosis because the layer of insulation around the nerve becomes damaged (demyelination).

• Stroke:
Some people who have a stroke develop neuropathic pain.
• Surgery and trauma:
Pain can follow surgery or trauma due to accidental damage to a nerve.

• Drugs:
Some drugs can cause a peripheral neuropathy.

• Back problems:
Some people who have back pain also experience sciatica. Sciatica is the term given to a neuropathic pain down the leg. This is caused by irritation of the sciatic nerve which is the main nerve into the leg.
In some instances is it not always possible to discover the underlying cause and these cases are described as ‘idiopathic’ or ‘cryptogenic’.

http://neurocentre.com/community/?p=21

Distracting Neuropathy Pain - Is It Possible?

Today's post comes from medicalnewstoday.com (see link below) and talks about how performing some sort of activity by using your brain, can provide enough distraction to block pain signals. Most people will probably agree that, turning your mind to something else, can often 'take your mind off' the pain, if only for a short time. Apparently this releases brain-produced opioids which physically interfere with incoming pain signals and the effect is not just psychosomatic. People with severe neuropathy may well be sceptical about how effective this is in reality. Many times, nerve pain is so pervasive, the idea of summoning up the willpower to turn your attention to something else, seems unrealistic. That said, there is nothing wrong with practising and trying to find distractions from pain, especially if you now accept that this can bring on a positive physical response in the brain. Mind over matter may be the cliche that works for you!

Distraction As Pain Relief
Article Date: 19 May 2012 - 0:00 PDT

Mental distractions make pain easier to take, and those pain-relieving effects aren't just in your head, according to a report published online in Current Biology, a Cell Press publication.

The findings based on high-resolution spinal fMRI (functional magnetic resonance imaging) as people experienced painful levels of heat show that mental distractions actually inhibit the response to incoming pain signals at the earliest stage of central pain processing.

"The results demonstrate that this phenomenon is not just a psychological phenomenon, but an active neuronal mechanism reducing the amount of pain signals ascending from the spinal cord to higher-order brain regions," said Christian Sprenger of the University Medical Center Hamburg-Eppendorf.

Those effects involve endogenous opioids, which are naturally produced by the brain and play a key role in the relief of pain, the new evidence shows.

The research group asked participants to complete either a hard or an easy memory task, both requiring them to remember letters, while they simultaneously applied a painful level of heat to their arms.

When study participants were more distracted by the harder of the two memory tasks, they did indeed perceive less pain. What's more, their less painful experience was reflected by lower activity in the spinal cord as observed by fMRI scans. (fMRI is often used to measure changes in brain activity, Sprenger explained, and recent advances have made it possible to extend this tool for use in the spinal cord.)

Sprenger and colleagues then repeated the study again, this time giving participants either a drug called naloxone, which blocks the effects of opioids, or a simple saline infusion. The pain-relieving effects of distraction dropped by 40 percent during the application of the opioid antagonist compared to saline, evidence that endogenous opioids play an essential role.

The findings show just how deeply mental processes can go in altering the experience of pain, and that may have clinical importance.

"Our findings strengthen the role of cognitive-behavioral therapeutic approaches in the treatment of pain diseases, as it could be extrapolated that these approaches might also have the potential to alter the underlying neurobiological mechanisms as early as in the spinal cord," the researchers say.

http://www.medicalnewstoday.com/releases/245546.php 

Is Fibromyalgia A Form Of Neuropathy?

Today's post comes from drbradshook.com (see link below) and shows a blog posting by Carol Ryland (neither are visibly connected to HIV in any way) talking about fibromyalgia. Many people who suspect that they have neuropathic symptoms may well be told that they have fibromyalgia and vice versa. In principle the two are not the same although the pain from both is generally treated in the same way. Peripheral neuropathy often coexists with fibromyalgia as both are considered a connective tissue condition and an auto-immune disorder. Experts are now also beginning to see one as possibly part of the other which for the patient is about as clear as mud. Fybromyalgia is very often linked with chronic fatigue syndrome; whereas neuropathy is generally not (although many neuropathy patients may well beg to differ as they struggle through the day). The answer lies in accurate testing and maybe skin biopsies. Whether this information really helps the patient in the end is the question because the treatment is much the same although establishing the cause of your nerve pain will help your doctor treat you appropriately and tidy up your medical file. 

Fibromyalgia Pain Relief Treatments! Which Ones Are Best for Me? by Carol Ryland

May 11, 2012     

If you hurt all over your body, and often feel exhausted… you’ve gone through countless tests to discover what’s wrong with you and even then, your General Practitioner can not find anything in particular wrong with you… your agony may be a symptom of fibromyalgia. Experiencing tender points on places on places such as your neck, shoulders, back, hips, legs or arms that hurt when touched is a fibromyalgia symptom. Other symptoms, for example difficulty sleeping, morning rigidity, headaches, and issues with thinking and memory, called ‘fibro fog,’ are additional signs that point to a fibromyalgia diagnosis. Over 10,000,000 individuals living in North America today, suffer with the agony of fibromyalgia.
For the fibromyalgia sufferer, discomfort is sometimes felt in your neck, back, shoulders, hands, and pelvic area… but it can be anywhere in the body. Fibromyalgia sufferers also endure general fatigue and sleeping problems. Therefore, it’s easy to see why most sufferers seek fibromyalgia treatments that work for them, with their specific symptoms. Fortunately, there are many fibromyalgia pain relief treatments. If you’re one of 5 to 7 % of the people who suffer from fibromyalgia, the following information may help you to select a treatment that will work for you.

Treatments Utilized for Fibromyalgia Pain Relief…

Many professionals in the medical field and their patients seem to be in agreement that the best fibromyalgia pain relief treatments come in tablet form. There are several medicines that are utilized as pain treatments to relieve the physical discomfort, but you should go to your health practitioner to pinpoint the best therapy plan for your precise condition. Your physician can provide you with a prescription for a stronger medication, since over-the-counter drugs aren’t usually strong enough to relieve the discomfort connected with fibromyalgia. Usually, the medications are the same ones used to relieve the pain of arthritis, although opiods are helpful in dealing with other fibromyalgia symptoms, they are not commonly used for fibromyalgia pain relief because they don’t work. In fact, no pain medication has been approved by the FDA for the relief of fibromyalgia pain.

There are other fibromyalgia pain relief treatments which can be used in combination with the “arthritis medications”. Sufferers may use these alternative strategies together with medicine, or by themselves. Alternative techniques for the treatment of fibromyalgia include: Physical treatments like Acupressure and acupuncture, Massage, Exercise, Chiropractic treatment, Osteopathic manipulation, Occupational therapy, and Biofeedback.

To augment fibromyalgia pain relief medications other medical treatments may be applied like antidepressant’s (Paxil, Prozac), sleep medicines (Lunesta, Ambien), anti-epileptics (Neurontin), and muscle relaxants (Flexeril) can all be utilized for fibromyalgia discomfort alleviation. Many of these medicines relieve symptoms so that you can sleep at night, making it possible to achieve the deep-level sleep required for tissue regeneration… and helping to put other body functions back into balance.

It is your decision as the patient to determine what fibromyalgia pain relief treatment(s) you wish to pursue. But speaking to your physician is recommended to steer you in the right direction and provide quality referrals if needed. Although the primary symptoms of fibromyalgia may never fully vanish, it is nice to know that relief for your discomfort is just a doctor’s visit away… and natural treatments including a healthy “heart-smart” diets and the addition of a nutritional supplement can do wonders in helping you to overcome your fibromyalgia symptoms. There’s no need to live suffering in discomfort a minute longer.

For more information on natural treatments of fibromyalgia symptoms, contact me now by clicking on one of the links below.

http://www.overcomefibro.com/best-fibromyalgia-pain-relief-treatments.html

Carol Ryland is the President of a successful health and wellness business, dedicated to educating and mentoring individuals in the natural treatment of illnesses. Writer of many articles on fibromyalgia and related topics, she is a fibromyalgia survivor with a deep personal understanding of the syndrome and its devastating effects

http://drbradshook.com/

From About.com...

"Is the pain we feel with fibromyalgia and chronic fatigue syndrome a type of neuropathy? It's an idea that's been around for several years but is garnering wider support as researchers find more evidence.

Research just presented at the American Academy of Neurology's annual meeting suggests that many of us with these conditions have small fiber neuropathy -- abnormalities in the small nerve fibers, which are near the surface of your skin a deal with pain and temperature sensation.
Researchers took skin biopsies from 30 people with fibromyalgia, chronic fatigue syndrome, chronic pain syndrome, or a combination of these illnesses, as well as from a control group. Of the people with painful conditions, 13 (43%) had evidence of small fiber neuropathy."

http://chronicfatigue.about.com/b/2010/10/11/small-fiber-neuropathy-in-fibromyalgia-chronic-fatigue-syndrome.htm

Chemotherapy-Induced Neuropathy

You may wonder why today's post from hubpages.com (see link below), talks about dealing with neuropathy caused by cancer treatments. Neither the article, or the author are connected to HIV but it's useful information for those people with HIV, who've unfortunately contracted a form of cancer and then as a result of the chemotherapy course, have also got neuropathy - a triple whammy! It's a fact of life; people with HIV also sometimes get cancer and/or diabetes, both of which can cause neuropathy and the numbers of people with such related diseases may grow as we all survive longer. However, all information on living with neuropathy is relevant - hence this post.

LIFE AFTER LYMPHOMA CANCER / LIVING WITH NEUROPATHY

By j w adams

NEUROPATHY

For some reason, a previous Hub on CIPN { Chemotherapy Induced Peripheral Neuropathy} seemed to pass quite a few regular readers by and at the same time, others who did read it have asked for more details. Hence this Hub, my first since being declared to be in full remission from the T-Cell Cancer, discovered when I had an emergency bowel operation last July and subsequently treated by CHOP Chemotherapy from August 2010 to January 2011. Side effects of Chemotherapy have featured strongly on the 77 or so Hubs that followed the progress of my treatment, amongst them Neuropathy.

CIPN, {see above} , describes damage to the peripheral nervous system from chemotheraputic agents that are neurotoxic. The agents concerned fall into 3 classes as follows: TAXANE , VINCA ALKALOID AND platinum compounds. Put simply, all three cause mild to moderate numbness of of hands and feet as well as tingling as I have often referred to in my own case during treatment by CHOP.. Other symptoms can be burning sensations in hands and feet which are said to increase with increased doses, or cumulative doses. In my case the tingling certainly increased with treatment but subsided when treatments ended in January. However, this has been replaced by weakness in my hands and pain at times in my fingers, palms and wrists. For example, I cannot now release a tightly screwed jar. Others with more severe symptoms can experience much worse failings in hand dexterity and there is a timed test for this involving the slotting of pegs into allotted spaces on a board. Thankfully. I am not at that level currently.

There is no valid treatment for CIPN but the Hospital team state most symptoms will subside in time, though 12 /18 months may elapse or even years in some cases.Very severe CIPN may never go away. As such treatments are to deal with the symptoms themselves and not the cause. These can involve, Steroids for the short term, numbing creams or patches, anti-depressant medicines and for severe cases, opiods or narcotics. I am pleased to say I can get along without any of the above at this time.

Other treatments to relieve the neurophatic pain include electrical nerve stimulation, occupational, physical and relaxation therapies, acupuncture and some I have no idea of including guided imagery, distraction, and biofeedback!

DEALING WITH IT MYSELF.

Dealing with CIPN directly differs from case to case but there are guidelines available for general information and assistance, I list some here: Avoid temperatures that make it feel worse, eg hot/ cold. My symptoms do not like cold! Do not drink alcohol if your symptoms are high as it can make them worse! Is there anything al all that the Medical profession does not say is made worse by alcohol. Happily, my glass of red and gin and tonic do not increase my symptoms I am pleased to report. Also, as neuropathy affects the manipulation of hands/ feet so is mobility of various types a factor to consider. Caution around heat and flames, sharp objects like knives cutters etc is sensible as is ensuring that supports like rails are available to negotiate stairs, bathrooms etc if the feet are affected . Basic common sense is a big key but reminding oneself from time to time to exercise more caution is worthwhile. Ifind Ineed to do this especially in the kitchen when cooking or outside in the garden foer example. By so doing, Iam not barred from achieving what I want to do in most activities.

My own personal way to deal with my own symptoms other than what is quoted above, is to commit to exercise. The general pre-breakfast regime of mobilty and cardio-vascular workouts is now well established and I begin to appreciate the benefits after a month of base work. My wife now joins me, albeit briefly, for the light weight work on the arms which is part also of my own specific programme for neuropathy in my hands. The main part of this however, is to do hand exercises with sponge balls and grips to strengthen my hands. To date, the work is fine but no discernible improvement as yet to symptoms.

Thus, as with most if not all of the possible side effects, I can vouch they exist whilst being thankful that my levels are or have been always low.Life after Lymphoma still requires Positive Mental Attitude and a disciplined sense of self motivation. Neuropathy is just one case but it does serve to remind me that whilst treatment is completed and remission confirmed that their is no immediate cut off line. As my wife constantly reminds me, adhering to a gluten free diet and acting with discipline as outlined above is something not just for today but every future day to win the war and not just the battle.

http://jwadams.hubpages.com/hub/LIFE-AFTER-LYMPHOMA-CANCER