Friday, 29 July 2016

Neuropathy And Fluoroquinolone Antibiotics Don't Mix!

Today's post from (see link below) returns to an old chestnut on this blog that remains relevant because of the increasing numbers of people ending up with nerve damage due to use of fluoroquinolone antibiotics. These really are antibiotics with a sting in the tail and it can be some time before the side effects appear but if you have an infection and are prescribed antibiotics by your doctor, check that they don't belong to the fluoroquinolone group (a list of common brand names appears in the article), especially if you already have, or are prone to neuropathy. There are always alternatives and you should seriously discuss these with your doctor. Further articles on the subject can be found by using the search button to the right of this blog. If in doubt, remember that the American FDA doesn't issue warnings aboiut drugs lightly - they certainly warn you about fluoroquinolones!

FDA warns that fluoroquinolone antibiotics can cause permanent nerve damage 
Posted by: Lori Alton, staff writer in Drug Dangers July 10, 2016

(NaturalHealth365) The U.S. Food and Drug Administration recently came out with a stronger warning against a popular class of drugs called fluoroquinolone antibiotics. Unfortunately, this warning is too late for patients already suffering from permanent side effects caused by this dangerous category of antibiotics.

Sold under the brand names Levaquin, Cipro and Avelox, fluoroquinolone antibiotics are taken by an estimated 26 million Americans each year. The new FDA directive will force manufacturers to provide a stronger warning regarding their use. Keep in mind, when the FDA issues a warning, you know the drug is really toxic and dangerous.
FDA warns: Fluoroquinolone antibiotics offer ‘serious side effects’ which outweigh the benefits

In May, the FDA announced it was requiring manufacturers of these drugs to include a tougher black box warning. Following an advisory committee meeting held in November, the FDA issued the new requirement, warning that the agency now believes the serious side effects associated with fluoroquinolone antibacterial drugs outweigh the benefits for many patients.

That’s strong language coming from an agency that often seems to turn a blind eye toward evidence suggesting serious health risks associated with any pharmaceutical substance. The agency had previously added boxed warnings for fluoroquinolones back in 2008 – specifically for tendon rupture and tendinitis. A second warning came again in 2013 for peripheral neuropathy, a type of permanent nerve damage.

Adverse reactions to fluoroquinolones can lead to permanent damage

While the list of dangerous side effects of Levaquin and other fluoroquinolones is long and varied, these antibiotics are known to be a primary cause of peripheral neuropathy. This condition can lead to nerve damage, with symptoms such as muscle tingling, numbness and muscle weakness. In advanced cases, the condition causes persistent burning pain, muscle wasting, paralysis, respiratory issues, and organ dysfunction – which can lead to organ failure.

But that isn’t the entire story. A number of additional adverse reactions to the drugs have been identified over the years, including diarrhea, nausea, migraines, abnormal liver function, vomiting, skin rash, abdominal pain, and pain in the extremities. Fluoroquinolones have also been linked to cardiovascular problems, including palpitation, ventricular ectopy, atrial flutter, hypertension, angina, cerebral thrombosis, myocardial infarction, and cardiopulmonary arrest.

In addition to an alarming number of problems with the central nervous system, these antibiotics are known to cause gastrointestinal, musculoskeletal, renal and respiratory problems, among others. And, while many of the fluoroquinolones have been removed from the marketplace because of their substantial side effects, Levaquin, Cipro and Avelox remain in use. 

Other treatment options avoid use of antibiotics entirely

While the FDA’s warning recommends patients with bronchitis, uncomplicated urinary tract infections and sinusitis seek out other treatment options, the implication is still that those ‘other options’ should include antibiotics or similar medications. But in addition to risking horrific side effects, the use of any antibiotic puts healthy gastrointestinal microbes in danger, compromising the body’s natural immune system and leaving it open to cancer and other illnesses. Destroying healthy bacteria in the gut also leads to poor nutrient absorption.

But, in reality, there are safer alternatives to antibiotics. Among the most effective (natural) alternative are vitamin C, oregano oil, olive leaves, turmeric, garlic, and ginger. Another natural combatant against illness is to maintain a healthy immune system by maintaining a healthy body.

Never forget: Good health begins with great nutrition. Be sure your diet consists of natural, organic and GMO-free foods, with plenty of green, leafy vegetables for a natural, healthy immune system.

Editor’s note: To learn more about the healing power of vitamin C – read “Reversing disease with the multi-C protocol” by Thomas E. Levy, MD, JD


Thursday, 28 July 2016

Just Saying That Exercise Helps Neuropathy Doesn't Necessarily Make It So

Today's post from (see link below) again promotes exercise as a way of reducing neuropathy symptoms but in this case, the evidence seems a little thin. By testing a group of cancer patients with neuropathy as a side effect, they found that walking and other general exercise prevented the symptoms from worsening, especially in older patients. I would suggest that moderate exercise will help older patients feel generally better anyway than sitting or lying for long periods of time but they'll need to provide much more specific evidence to prove that neuropathic symptoms can be reduced by a graduated walking course. In this case, I would suggest that with this sort of patient, there are far too many variables to come to the conclusion that exercise is more effective in reducing or limiting nerve damage symptoms in older people. That said, there is a general consensus among doctors that regular exercise will improve neuropathy, or at least stop it getting worse but in this case, I feel too much is being assumed from too little data.

Walking and Resistance Training Eases CIPN, Especially Among Older Patients
LAUREN M. GREEN @OncNurseEditor Wednesday, July 20, 2016

Patients undergoing chemotherapy prescribed a formal exercise program experienced less chemotherapy-induced peripheral neuropathy (CIPN), and the finding held true across all chemotherapy regimens tested. The effect was strongest in older patients, according to findings from a nationwide randomized controlled trial reported at the 2016 ASCO Annual Meeting.

CIPN is a highly prevalent and severe side effect of certain chemotherapy types, such as platinums, taxanes, and vinca alkaloids, affecting more than 50% of patients receiving these therapies. Nevertheless, “there are currently no established treatments for CIPN—despite 50 randomized clinical trials—testing the efficacy of drugs to prevent or treat it,” explained lead study author Ian Kleckner, PhD.

Kleckner, a research assistant professor at the University of Rochester Medical Center, and colleagues performed a secondary analysis of a subset of 314 sedentary patients receiving taxane-, vinca alkaloid-, or platinum-based chemotherapy derived from a larger, phase III, national, randomized controlled trial (N = 619).

The majority of patients were women (92%), and 78% had breast cancer. They were randomized to chemotherapy alone or chemotherapy plus exercise. Patients randomized to the EXCAP arm (Exercise for Cancer Patients) which is a personalized, 6-week, home-based, moderate-intensity progressive program, were prescribed a daily walking regimen (eg, steps per day), supplied with pedometers, and also given a set of resistance bands to perform specific exercises.

Walking and resistance exercises were recommended for the control group. They did not receive any formalized support; however, control participants were given the exercise kit at the end of the study.

The investigators used patient self-report of tingling and numbness at baseline and after the intervention, rated on a 0-10 scale with 10 being the worst level of CIPN. In the EXCAP arm, CIPN was reduced compared with controls, with an effect size of 0.26 (P = .06), and the finding was independent of other variables, such as gender, BMI, and cancer stage. However, age was a moderating variable.

“We found that exercise was more effective for older patients,” said Kleckner. “Older patients in the control arm experienced a large increase in CIPN after 6 weeks of chemotherapy, whereas older patients in the experimental exercise arm had a very small, if any, increase in CIPN.”

Kleckner said that based on these findings, he and colleagues hope to expand their research. “What we’d like to do now is design a randomized clinical trial testing exercise against chemotherapy alone, where CIPN is the primary outcome. Only one trial to date has looked at this, and it was very small—60 patients.”

He hopes researchers can identify biomarkers in the brain circuitry or signals of the role inflammation may play to help better identify who is most at risk for CIPN.

Over the next few years, Kleckner would like to see this research continue to “scale up, so we can better learn about the effectiveness of exercise, understand what dose/intensity of exercise is important, what type of exercise, and who responds best to exercise … we’re hoping for an exercise prescription, instead of the generic ‘please exercise.’”

Kleckner I, Kamen CS, Peppone LJ, et al. A URCC NCORP nationwide randomized controlled trial investigating the effect of exercise on chemotherapy-induced peripheral neuropathy in 314 cancer patients. J Clin Oncol. 2016; 34 (suppl; abstr 10000).

Wednesday, 27 July 2016

Possible Supplements For Neuropathy

Today's post from (see link below) may be a recognisable story to many readers and shows how the medication and supplement list builds up as we realise that we need extra support in taming the symptoms of neuropathy. This person is a cancer patient but the post applies to all neuropathy patients, irrespective of the cause. Unfortunately, with advances in science, cancers are being discovered faster and more accurately than ever before. This may, in part, explain the seeming rise in the number of cancer patients across the world but the point is that one of the most unpleasant side effects of cancer treatment is neuropathy and then people are forced onto the treatment mill that we're all acquainted with. The supplement suggestions that this person takes are by no means exclusive but are fairly typical of what most doctors agree are 'recommended' supplements. it is important to remember though, that neuropathy is so complex that while one supplement may work really well for one person, that doesn't mean that that applies to everybody. A sensible combination, after discussion with your doctor and your own research, may be the best answer.

Peripheral Neuropathy after Chemotherapy – Supplements Suggestions 
May 31, 2013 by Rachel - Cha Ching Queen 

Vitamin and Supplement Suggestions for Peripheral Neuropathy after Chemo for Breast Cancer

Chemotherapy has many side effects, some of which can be long-term or even permanent. I was diagnosed with breast cancer in 2009 (read about my breast cancer here). Even though I finished my treatment about 3 1/2 years ago I still have lingering effects from the the chemo. One of the most bothersome is pain in my feet and hands, which as I found out a few days ago, is Peripheral Neuropathy from Chemotherapy most likely caused by the Taxotere.

I have been to many different doctors and tried a variety of homeopathic and pharmaceutical treatments. It’s hard to exactly describe the long-term chemo side-effects pain I have. At first I believed I had arthritis. I am not able to stand for long periods of time. The area around my joints hurt, with the majority of the pain about my big toe joint and the ball of my foot. It feels like I don’t have enough padding on the bottom part of my feet and the bone is hitting the hard floor.

My hands feel somewhat the same, although not quite as bad. I still have a hard time with some fine motor skills such as opening bottles and using a kitchen knife.

During my most recent appointment with the oncologist, she recommended I see a neurologist. My appointment with a neurological oncologist was earlier this week. I was a little nervous about seeing a cancer neurologist. That sounds scary, and I started worrying that maybe something was horribly wrong with my brain.

The neurologist did a ton of tests checking my reflexes, range of motion, vision, sensitivity, and more. He poked a safety pin up and down my feet, legs, hands, and arms. I never realized how bad my neuropathy really was. At the tips of my fingers and toes I could feel a sensation, but it wasn’t until the pin made it’s way further down my toe or finger, that I could really feel the prick. That was interesting.

So, here I am now with a diagnosis of chemo induced peripheral neuropathy. In addition to a few other daily medications, vitamins, and supplements I already take, the neurologist recommended quite a few others as well. Here are the recommended supplements and vitamins my neurologist suggests for peripheral neuropathy after chemotherapy.

Alpha Lipoic Acid 800-600mg BD
Vitamin B12 500mcg QD
Vitamin B6 25-50mg (I’m not taking this extra B6 because I get it in my multi-vitamin) QD
Vitamin B1 50-100mg QD
Gamma Amino Butyric Acid QHS
Phosphotidylserine and Phosphotidylcholine 300-900mg

Then, in addition to this, this is what I take daily to be healthy and help some of my lingering joint pain that was originally diagnosed as Fibromyalgia.
Tums (for Calcium)
Probiotics (digestive issues with occasional IBS attacks)
Alive Multi-Vitamin

Tuesday, 26 July 2016

Are Your Neuropathy Pain Pills Enough, Or Do They Make Things Worse?

Today's post from (see link below) is a call for a more holistic treatment regime for neuropathy from Dr. John Hayes Jr, who has for years, done some excellent work to support neuropathy patients. He asks the question: do we need medications for neuropathy? To which most people's answer would be a resounding 'yes'! However, he makes the argument for a much better-rounded form of treatment that includes diet, lifestyle and alternative therapies because medications just mask the symptoms, they do little to improve the quality of your condition. In that sense, he is completely right but don't be fooled into thinking that you can chuck your pill bottles down the toilet - sometimes the pain is so great, you need those medications just to get through the day. What he is saying is that pills are just not enough and can even lead to a worsening of your symptoms without the back up of a balanced lifestyle and sensible choices. An interesting read.

Neuropathy Treatment Decisions: Should You Take Medications for Neuropathy?
Posted by john on May 14, 2015

The Most Comprehensive and Effective Neuropathy Treatment Approach Goes Beyond Medicating Symptoms and Treats the Root Cause.

There is so much more to effective neuropathy treatment than masking symptoms with medications.

Unfortunately, you would hardly know that’s the case, given how the majority of doctors still approach neuropathy treatment. The truth is that relying on the expertise of a doctor who isn’t specifically trained in neuropathy treatment could end up making your neuropathy symptoms worse, not better.

That’s because so many of the drugs that doctors tend to prescribe for neuropathy symptoms like tingling, numbness, and nerve pain have side effects, some of which will intensify over time.

This “one drug fits all” approach often stems from a lack of understanding about the root cause of neuropathy symptoms.

So-called idiopathic neuropathy, for which there is no known cause, may actually be developed over time due to metabolic syndrome—formerly known as pre-diabetes—a condition that will not be addressed at all by traditional symptom-focused drug therapies for neuropathy.

Or worse, if a doctor ignores the neuropathy and attempts to treat metabolic syndrome using medications for lowering cholesterol or blood pressure, your neuropathy symptoms are likely to get worse in reaction to these drugs.

The most effective approach to neuropathy treatment is a multi-modal approach that begins with substantial lifestyle changes and complementary therapies to support your body’s own natural healing process. Work with a trained neuropathy expert on a treatment plan that includes safe weight loss, a healthy neuropathy diet with no sugars or processed foods, and regular moderate exercise.

When you take the wheel of your own neuropathy treatment plan and consult with an expert trained in the best that neuropathy treatment has to offer, your quality of life will improve for the better.

There is a place for prescription medications. But I truly believe that a comprehensive neuropathy treatment approach that goes beyond drugs and puts YOU in the driver’s seat is the best way to begin healing from neuropathic pain.

Neuropathy Treatment Decisions: Should You Take Medications for Neuropathy? is a post from: #1 in Neuropathy & Chronic Pain Treatment

The post Neuropathy Treatment Decisions: Should You Take Medications for Neuropathy? appeared first on #1 in Neuropathy & Chronic Pain Treatment.

Monday, 25 July 2016

The Nature Of Neuropathic Pain

Today's excellent post from (see link below) looks at the nature of pain and its different sorts. I'm sure that while you've been researching your neuropathy, you've come across terms like 'nociceptive' and 'neuropathic' and have got the gist of what's being said without really understanding what they mean. This article explains why you feel the pain you have and how it relates to the nervous system. Well worth a read and don't forget to click on the 'full size image' links for a better view of the images. Don't forget also, that when it refers to 'diabetic' pain, it refers to all neuropathic pain (it's just that the vast majority of neuropathy sufferers are also diabetics.

The pain drain
David Holmes Nature 535,S2–S3(14 July 2016)doi:10.1038/535S2a Published online 13 July 2016

We can't live without it, but many of us struggle to live with it. Pain has an essential biological function, but too much — or the wrong sort — ruins lives and puts a sizeable dent in economic productivity.

Nociceptive pain

This type of pain is caused by the activation of nociceptors — specialized sensory neuronsthat are stimulated by noxious mechanical, thermal or chemical stimuli. Nociceptors transform these stimuli into electrical signals and relay them to the central nervous system. Nociceptive pain tends to be short-lived and associated with injury. But if it persists beyond 12 weeks, it becomes chronic pain — and its nature can change.

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Neuropathic pain

Unlike nociceptive pain, neuropathic pain is caused by damage to the somatosensory nervous system itself, as a result of trauma or disease. However, there is not always a clear link between disease states and neuropathic pain.

Diabetic neuropathy

Painful diabetic peripheral neuropathy is one of the most common forms of neuropathic pain, with its incidence set to increase as the obesity and diabetes epidemics continue to grow. Neuropathy is caused by metabolic factors as well as by damage to the microvasculature that supplies nerve fibres.

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Neuropathic pain incidence

Definitions of neuropathic pain vary across studies, leading researchers to call for a unified nomenclature. The best evidence on incidence comes from studies of neuropathic pain linked to specific conditions, but even then ranges can vary widely1.

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Price of pain

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Biggest burden

Around 100 million adults in the United States are aff¬ected by chronic pain in a single year. The annual total cost of pain, including direct costs, decreased wages and lost productivity, eclipses that of any other condition2.

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Growing pain

Health-care spending on back problems in the United States more than doubled between 1987 and 2000. Although treatment costs and population increases contributed, most of the $9.5-billion rise was due to an increase in the prevalence of back pain3.

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1. van Hecke, O. et al. Pain 155, 654–662 (2014).
2. Inst. Medicine Relieving Pain in America (National Academy of Sciences, 2011).
3. Thorpe, K. E. et al. Health Affairs (2004).

Author information

Related links

Related links in NPG
Crosstalk between the nociceptive and immune systems in host defence and disease
Pain That Won't Quit
Focus on pain
Nature Insight: Precision Medicine
Related external links
The International Association for the Study of Pain

Sunday, 24 July 2016

Autonomic Neuropathy: The Nerve Damage You Have No Control Over

Today's post from (see link below) talks about autonomic neuropathy, which may be a new term to many people. Basically, it's a form of neuropathy that affects the involuntary functions of the body, breathing, digestion, excretion, sweating, sexual function, etc. You have no control over these functions and when they go wrong thanks to nerve damage, the consequences can make life pretty miserable. Most people begin their neuropathy lives with the well-known symptoms of numbness, tingling, burning etc in the feet and/or hands and for some it stays that way but for others, the damage spreads to the autonomic functions and you begin to notice things going wrong. Your doctor will inevitably try to rule out all other other possible reasons why this is happening and it may be years before you get a proper diagnosis of autonomic neuropathy. The treatment for your pain will remain the same but you may find your medicine chest being expanded to include treatments for dysfunctions elsewhere in your body. I'm sorry, there's no sugar-coated pill to this story: if you have autonomic neuropathy it sucks but there are always ways to improve your situation but you need to take time to research and explore your options. Working with your doctor and not waiting for him or her to provide answers, is the key.

When Autonomic Neuropathy Affects Bodily Functions 
Posted on May 11, 2016 Posted in Staff Pick by Staff Pick

Do any of these symptoms sound familiar? 

Dizziness and fainting when you stand up
Difficulty digesting food and feeling really full when you’ve barely eaten anything
Abnormal perspiration – either sweating excessively or barely at all
Intolerance for exercise – no, not that you just hate it but your heart rate doesn’t adjust as it should
Slow pupil reaction so that your eyes don’t adjust quickly to changes in light
Urinary problems like difficulty starting or inability to completely empty your bladder

If they do, you could have autonomic neuropathy. Especially if you have diabetes, your immune system is compromised by chemotherapy, HIV/AIDS, Parkinson’s disease, lupus, Guillian-Barre or any other chronic medical condition.

You need to see a doctor immediately. A good place to start would be a physician well versed in diagnosing and treating nerve disease and damage, like your local clinician who specializes in our treatment protocol.
What Is Autonomic Neuropathy?

Autonomic neuropathy in itself is not a disease. It’s a type of peripheral neuropathy that affects the nerves that control involuntary body functions like heart rate, blood pressure, digestion and perspiration. The nerves are damaged and don’t function properly leading to a break down of the signals between the brain and the parts of the body affected by the autonomic nervous system like the heart, blood vessels, digestive system and sweat glands.

That can lead to your body being unable to regulate your heart rate or your blood pressure, an inability to properly digest your food, urinary problems, even being unable to sweat in order to cool your body down when you exercise.

Often, autonomic neuropathy is caused by other diseases or medical conditions so if you suffer from: 

Systemic lupus
Parkinson’s disease

Or any number of other chronic illnesses, you stand a much higher risk of developing autonomic neuropathy. Your best course of action is not to wait until you develop symptoms. Begin a course of preventative treatment and monitoring with a clinician to lessen your chances of developing autonomic neuropathy.

How Will The Clinician Diagnose My Autonomic Neuropathy?

If you have diabetes, cancer, HIV/AIDs or any of the other diseases or chronic conditions that can cause autonomic neuropathy, it’s much easier to diagnose autonomic neuropathy. After all, as a specialist in nerve damage and treatment, your clinician is very familiar with your symptoms and the best course of treatment.

If you have symptoms of autonomic neuropathy and don’t have any of the underlying conditions, your diagnosis will be a little tougher but not impossible.

Either way, your clinician will take a very thorough history and physical. Make sure you have a list of all your symptoms, when they began, how severe they are, what helps your symptoms or makes them worse, and any and all medications your currently take (including over the counter medications, herbal supplements or vitamins).

Be honest with your clinician about your diet, alcohol intake, frequency of exercise, history of drug use and smoking. If you don’t tell the truth, you’re not giving your clinician a clear picture of your physical condition. That’s like asking him to drive you from Montreal to Mexico City without a map or a GPS. You may eventually get to where you want to be, but it’s highly unlikely.

Once your history and physical are completed, your clinician will order some tests. Depending upon your actual symptoms and which systems seem to be affected, these tests might include:
Urinalysis and bladder function tests
Thermoregulatory and/or QSART sweat tests
Gastrointestinal tests
Breathing tests
Tilt-table tests (to test your heart rate and blood pressure regulation). Once your tests are completed and your clinician determines you have autonomic neuropathy, it’s time for treatment. 

Treatment and Prognosis

Our clinicians are well versed in treating all types of peripheral neuropathy, including autonomic neuropathy. They adhere to a very specialized treatment protocol that was developed specifically for patients suffering from neuropathy. That’s why their treatments have been so successful – neuropathy in all its forms is what they do.

Autonomic neuropathy is a chronic condition but it can be treated and you can do things to help relieve your symptoms.

Your clinician will work with you and your other physicians to treat your neuropathy and manage your underlying condition. They do this through:

Diet Planning and Nutritional Support
You need to give your body the nutrition it needs to heal.

If you have gastrointestinal issues caused by autonomic neuropathy, you need to make sure you’re getting enough fiber and fluids to help your body function properly.

If you have diabetes, you need to follow a diet specifically designed for diabetics and to control your blood sugar.
If your autonomic neuropathy affects your urinary system, you need to retrain your bladder. You can do this by following a schedule of when to drink and when to empty your bladder to slowly increase your bladder’s capacity.

Individually Designed Exercise Programs
If you experience exercise intolerance or blood pressure problems resulting from autonomic neuropathy, you have to be every careful with your exercise program. Make sure that you don’t overexert yourself, take it slowly. Your clinician can design an exercise program specifically for you that will allow you to exercise but won’t push you beyond what your body is capable of. And, even more importantly, they will continually monitor your progress and adjust your program as needed.

Lifestyle Modifications
If your autonomic neuropathy causes dizziness when you stand up, then do it slowly and in stages. Flex your feet or grip your hands several times before you attempt to stand to increase the flow of blood to your hands and feet. Try just sitting on the side of your bed in the morning for a few minutes before you try to stand.
Change the amount and frequency of your meals if you have digestive problems.

Don’t try to do everything all at once. Decide what really needs to be done each day and do what you can. Autonomic neuropathy is a chronic disorder and living with any chronic condition requires adaptations. Your clinician knows this all too well and will work with you to manage your level of stress and change your daily routines to help you manage your condition and your life.

All of these changes in conjunction with medications, where needed, will make it easier to live with autonomic neuropathy and lessen the chances of serious complications. Early intervention with a NeuropathyDR® clinician is still the best policy if you have any of the underlying conditions that can cause autonomic neuropathy. But if you already have symptoms, start treatment immediately.

About The Author

Dr. John Hayes, Jr. is an Evvy Award Nominee and author of “Living and Practicing by Design” and “Beating Neuropathy-Taking Misery to Miracles in Just 5 Weeks!”. His work on peripheral neuropathy has expanded the specialty of effective neuropathy treatments to physicians, physical therapists and nurses. A free Ebook, CD and information packet on his unique services and trainings can be obtained by registering your information at To book interviews and speaking engagements call 781-754-0599.

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Saturday, 23 July 2016

Killing Nerve Pain With Medical Cannabis

Today's post from (see link below) adds to the growing evidence of the efficiency of marijuana as a pain reliever, especially for nerve pain. It's strange that in North America, the current obsessions of both media and politicians, concern drugs that will relieve people's suffering - needless to say they're against! There are always two sides to every story and drug criminality is the nasty side to both opioids and cannabis but as far as denying patients their rights to live a pain-free life, Americans go overboard in excluding everyone at the same time - from junkies to cancer patients alike. It's long been recognised that cannabis (either smoked or inhaled if your lungs won't take the smoke) will dampen your pain very nicely thank you and it's an artificial, political standpoint that restricts your access to medical marijuana. Luckily, some states in the US have awoken to the fact that the scientists are right and the politicians are wrong but at the moment, with the current opioid hoo-ha, all drugs are bad...abstinence is good. Now it's up to you which side of the fence you come down on but I'm sure that 99% of neuropathy patients with serious, unrelenting pain, would happily get their marijuana from any source if it relieves their suffering. The media has to realise that 99% of chronic pain patients are not faking it...and try to help! yeah, I'm counting the pigs flying across the room too!

Diabetics and Seniors Will Gain From Amendment Two Passing in Florida 

Two studies published by Center for Medicinal Cannabis Research at the University of California San Diego have shown a reduction in diabetic neuropathy pain with inhaled cannabis. The two studies titled “Low-dose vaporized cannabis significantly improves neuropathic pain.” and “Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy.” were published in 2013 and 2015 respectively. The full length journals can be found by clicking the buttons below. Research has also shown that access to medical marijuana for seniors can increase their wellbeing and lower healthcare costs. Despite this, the say No to 2 rhetoric paid for by big pharma has increased.

Study 1 Study 2

"Notice that both links will bring you to the National Institute of Healths website. These are well respected scientists observing strict protocols that have proudly proclaimed This small, short-term, placebo-controlled trial of inhaled cannabis demonstrated a dose-dependent reduction in diabetic peripheral neuropathy pain in patients with treatment-refractory pain. This adds preliminary evidence to support further research on the efficacy of the cannabinoids in neuropathic pain."

This was from the “Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy.” published in 2013 by authors, Wallace MS1, Marcotte TD2, Umlauf A2, Gouaux B2, Atkinson JH3

You can follow the links to see more about studies they have published.

Another quote from the “Low-dose vaporized cannabis significantly improves neuropathic pain.”

"The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (1.29%) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome. In general, the effect sizes on cognitive testing were consistent with this minimal dose. As a result, one might not anticipate a significant impact on daily functioning."

This quote demonstrates that not does cannabis reduce nerve pain, but it does not impair daily functioning. This is another blow to anti-pot organizations such as No on 2 whose anti pot propaganda pieces look like they were produced by the newest content creator on Youtube. Ie: They are JV at best. Anti Florida medical marijuana groups such as the one previously mentioned have cranked up their rhetoric recently. For full disclose the No on 2 CEO is nothing more than a mouthpiece for the federal government. He has been such since being appointed by Reagan and his infamously failed Say no to Drugs Campaign. Ironic how a president so vehemently against drugs would die from something scientific research has shown to help.

With all of the research coming out, why are we still being denied our rights as human beings to safe convenient access to medicine? Marijuana continues to have documented proof of helping nearly all ailments. All one has to do is a google search for cannabis research and take a grain of salt if it goes to the National Institute on Drug Abuse.

This time more research shows a minority group such as diabetics are being denied their rights across the state, country and world. Despite research like this, cities such as Orlando have moved to ban medical marijuana businesses from opening. How long must this lost battle continue to be fought?

It is yet to be determined if a broader, more fair medical marijuana system will make it. Floridians failed to pass it last time. Florida Marijuana is predicting that the amendment will pass due to high young voter turnout for presidential elections. Groups like the Silver Tour are helping to get the elderly educated on medical marijuana and how it can help them save on healthcare and live more fulfilling lives. To quote directly from this article

"Recent studies indicate that the drug is making seniors healthier and helping stem the tide of the opioid epidemic—all while making their health care cheaper."

Floridians have one of the highest rates of diabetes at 11.2% of the population. Many are suffering from the very symptoms that these two studies support. Floridians also have one of the highest elderly rates in the country. The new article from The Atlantic completely destroys most of the mainstream anti marijuana propaganda. We hope that people are beginning to wake up to the truth.

Friday, 22 July 2016

Are Neuropathy Sufferers 'Fear Avoidance Cyclists'?

Today's post from (see link below) is an interesting article that directly applies to the neuropathy sufferer who's movement is impaired by the symptoms of nerve damage. The more your feet, or legs, or hands, or arms or involuntary organs play up, the less inclined you are to put them to the test by moving more than necessary. It's called the 'fear avoidance cycle' and neuropathy patients are classic sufferers. I'm fully aware, I bore you to tears with constant posts about exercise but if you read this article you may come to realise that however painful some form of exercise may seem, your body and mind will thank you for it later. Worth a read to avoid the slippery slope down to inactivity...and even more pain.

A Day Without Pain 
Treating Chronic Pain to Improve Function
A holistic approach to the healing process
Mel Pohl M.D., FASAM Posted Jul 30, 2013

Unlike other injuries, chronic pain is unrelenting, lasts longer than six months, and is characterized by decreased function. The desire to avoid feeling more pain or aggravating the pain one does feel leads patients to avoid movement, which, over time, erodes function. The old “use it or lose it” mantra is definitely applicable here.

It’s understandable that patients with chronic pain fear worsening their pain by moving, but what most people don’t realize is that maintaining mobility is essential if function is to be preserved for the present and the future. Body parts that go unmoved for any length of time eventually become “frozen.” This can happen with the back, the abdomen, the joints (e.g., knees and shoulders), etc. Furthermore, with decreased movement, circulation decreases, scar tissue eventually forms, and pain increases.

The consequences of this are not merely limited to decreased mobility and lingering pain. Avoidance of movement ultimately leads to complete non-function. When people are limited, they may become ashamed of their disability and want to hide, want to do nothing. If I can’t get my shirt on by myself in the morning, why would I want to go out in public and expose any other problems I have to friends and strangers alike? This response to pain, this avoidance, leads to feelings of depression and helplessness that only feed into the cycle of immobility and worsening pain until the patient is entirely non-functioning. This is called the Fear Avoidance Cycle.

Now, some people will try to function around all of this by taking drugs. If I go to a physician or a prescriber and I say that my shoulder or back hurts, what will I be prescribed? Painkillers in the form of opioids (narcotics). Many people who take these medications and as a result feel less pain assume that their treatment is working for them. Successful treatment of chronic pain must include improvement of function as well as reduction of the level of pain.

When people whose only treatment has been medication to reduce the pain come to treatment at my center, I notice that their function is deceased and they are sleepy, less active, and cognitively impaired. This lethargy affects all aspects of their life, from digestion to social interactions. We see people medicated for pain, but their function overall has suffered as a consequence. This is not the proper treatment of chronic pain.

The root of this problem is fear. People need to be supported to walk through their fear of pain. Numerous studies that have proven that if someone is afraid of a certain activity, he or she will avoid that activity, and as a consequence won’t progress in his or her treatment. If we expose the person to the activity with support and gentle movement, the fear slowly diminishes. If fear diminishes, pain does as well, and the person regains mobility and confidence. There is a direct correlation between fear, anxiety, and pain. The solution for Fear Avoidance is increased movement, which will cause some discomfort initially. But it is on a temporary basis because at first patients are breaking up the fibrous tissue that has built up as a result of their inactivity. But with increased mobility we get increased function, and improved self-esteem and lower social isolation. The person overall becomes healthier.

When using medications, it is essential to make sure that the function of the patient improves. Simply taking the pain away and putting someone to bed for 20-plus hours a day is bad pain treatment. Unfortunately that is the cycle that people get into. They can’t sleep because of their pain meds, and then they are given sleeping pills. This makes them anxious during the day, so they are given anti-anxiety pills, and then pills to wake up. The result is that they are over-medicated and they are not living life to the fullest. Their quality of life is diminished. The solution is to decrease or eliminate the use of these medications until overall function improves and life gets better even though there is pain present. It is this delicate balance that defines pain recovery.

Thursday, 21 July 2016

Combining Drugs For Neuropathic Disease Treatment: Why Not?

Today's post from looks at a new treatment for fibromyalgia, which is a chronic and mysterious disease recently found to be linked to neuropathy by the fact that it is stimulated by the central nervous system (brain and spinal cord). It suggests that a combination of pregabalin (Lyrica) and duloxetine (Cymbalta) works very well at reducing the symptoms. The direct link to neuropathy is obvious as both drugs are used singularly to treat neuropathy symptoms. It has also been suggested in the past that combination therapies are the best options for severe neuropathic symptoms but many doctors are reluctant to go down that path because of side effects. The side effects should not be underestimated (especially pregabalin (Lyrica) which has such a bad name yet is still widely prescribed for many neuropathies but the idea of combining treatments is not a bad one and one worthy of consideration in discussion with your doctor or neurologist. Combinations excluding Lyrica may be best, to avoid unpleasant side-effects but surely other options can be considered - there are enough drug treatments to choose from and as they rarely work on their own, a combination which will block pain bearing signals in the sodium channels seems like a logical step forward.

Fibromyalgia: Doubling up to fight pain
Combining two drugs used to treat fibromyalgia safely improves patient outcomes, according to researcher 
Date:July 13, 2016 Source:Queen's University

Queen's University researcher Ian Gilron has uncovered a more effective way of treating fibromyalgia, a medical condition characterized by chronic widespread pain typically accompanied by fatigue, as well as sleep, mood and memory problems.

The results of the trial suggest that combining pregabalin, an anti-seizure drug, with duloxetine, an antidepressant, can safely improve outcomes in fibromyalgia, including not only pain relief, but also physical function and overall quality of life. Until now, these drugs have been proven, individually, to treat fibromyalgia pain.

"Previous evidence supports added benefits with some drug combinations in fibromyalgia," says, Dr. Gilron (Anesthesiology, Biomedical Sciences). "We are very excited to present the first evidence demonstrating superiority of a duloxetine-pregabalin combination over either drug alone."

Fibromyalgia was initially thought to be a musculoskeletal disorder. Research now suggests it's a disorder of the central nervous system -- the brain and spinal cord. Researchers believe that fibromyalgia amplifies painful sensations by affecting the level and activity of brain chemicals responsible for processing pain signals.

"The condition affects about 1.5 to 5 per cent of Canadians -- more than twice as many women as men. It can have a devastating on the lives of patients and their families," explains Dr. Gilron. "Current treatments for fibromyalgia are either ineffective or intolerable for many patients."

This study is the latest in a series of clinical trials -- funded by the Canadian Institutes of Health Research (CIHR) -- that Dr. Gilron and his colleagues have conducted on combination therapies for chronic pain conditions. By identifying and studying promising drug combinations, their research is showing how physicians can make the best use of current treatments available to patients.

"The value of such combination approaches is they typically involve drugs that have been extensively studied and are well known to health-care providers," says Dr. Gilron.

This new research was published in the journal Pain.

Dr. Gilron and his research team at Queen's are members of the SPOR Network on Chronic Pain. The national network, funded under Canada's Strategy for Patient-Oriented Research, directs new research, trains researchers and clinicians, increases access to care for chronic pain sufferers, and speeds up the translation of the most recent research into practice.

Story Source:

The above post is reprinted from materials provided by Queen's University. The original item was written by Anne Craig. Note: Materials may be edited for content and length.

Journal Reference:
Ian Gilron, Luis E. Chaparro, Dongsheng Tu, Ronald R. Holden, Roumen Milev, Tanveer Towheed, Deborah DuMerton-Shore, Sarah Walker. Combination of pregabalin with duloxetine for fibromyalgia. PAIN, 2016; 157 (7): 1532 DOI: 10.1097/j.pain.0000000000000558

Wednesday, 20 July 2016

Nerve Pain (Neuropathy) In 14 Easy Bites

Today's post from (see link below) says it in a nutshell, accompanied by 14 images to illustrate the points. Ideal for you or friends and family who have difficulty understanding what's going on with your disease. Funny how a simple explanation like this can say more than pages and pages of a scientific paper about neuropathy! Well worth a read for patienst and sympathisers (or critics) alike.

Nerve Pain Explained  

Reviewed by Jennifer Robinson, MD on December 07, 2014

How Nerve Pain Feels

People with nerve pain feel it in different ways. For some, it's a stabbing pain in the middle of the night. For others, symptoms can include a chronic prickling, tingling, or burning they feel all day.

Uncontrolled nerve pain can be hard to bear. But with treatment, it can often be adequately controlled.

Understanding Nerve Pain

Pain is supposed to be a warning. When your hand gets too close to a stove, the nerves send a pain signal to the brain -- and you pull back before you burn yourself. But if you have nerve damage, that system isn't working. Damaged nerves may send false signals -- and you feel real pain, often without a cause. Damaged nerves may also result in you not feeling pain when you have an injury.

Nerve Pain Triggers

Some find that certain body positions or activities -- like standing in line or walking -- become painful. Nerve damage may also make your body overly sensitive. Some people may experience pain from bed sheets draped lightly over the body.

Loss of Feeling

Nerve damage may cause loss of sensation or numbness in the fingertips, making it harder to do things with your hands. Knitting, typing, and tying your shoes may become difficult. Many people with nerve damage say that their sense of touch feels dulled, as if they are always wearing gloves.

Nerve Pain and Sleep

Nerve pain is often worse at night. The touch of sheets or the pressure of lying down may be terribly uncomfortable. If you can't sleep because of your nerve pain, make sure to mention it to your doctor. Modifying lifestyle habits or taking medicine could help.

Losing Balance

In addition to dulling your sense of touch, nerve damage can result in muscle weakness or affect your sense of balance. Either of these could lead to falls. Assistive devices -- like braces, canes or walkers -- may help. Physical and occupational therapy may also help

Unseen Injuries

Nerve damage doesn't just cause pain. It may also cause numbness that may prevent you from feeling pain when it matters. People with nerve damage sometimes injure themselves without realizing it. Your doctor may recommend that you check yourself for injuries regularly -- especially your feet.

Nerve Pain Progression

Left untreated, nerve damage may worsen over time. It usually starts in the nerves farthest from the brain and spinal cord -- like those in the feet and hands. Then it may move up into the legs and arms.

However, if you get treatment for the medical condition causing the nerve damage, you may be able to stop the damage -- and even reverse it.

Assessing Your Pain

In many cases, nerve pain may be controlled. Start by getting an assessment at the doctor's office. Be ready to answer questions. How long have you had pain? What does it feel like? How does it affect you? The answers will help your doctor figure out what's causing your pain and how to treat it.

Conditions That Cause Nerve Pain

Many conditions -- such as diabetes, shingles, and cancer -- may cause injury and nerve pain. Some people develop nerve pain for no known reason.

It is important to try to find the underlying cause of your nerve pain, such as uncontrolled diabetes, and seek appropriate treatment for it. It may help ease your pain and stop the progression of damage. But be sure you seek treatment for your pain too.

OTC Treatments for Nerve Pain

Over-the-counter painkillers may be the first treatment your doctor recommends. These may include nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as ibuprofen -- or other analgesics, such as acetaminophen or prescription medicines. Other options include painkilling creams, ointments, oils, gels, or sprays that are used on the skin.

Prescription Drugs for Nerve Pain

There are many prescription medicines that may help with nerve pain. Some are powerful painkillers. Other drug types might help too. Medicines originally used for depression and epilepsy are often prescribed to relieve nerve pain.

Natural Treatments for Nerve Pain

Complementary or alternative treatments may help. For instance, studies have found that acupuncture may ease nerve pain. In some cases, nerve pain is caused or aggravated by a deficiency of vitamin B-12. Taking supplements -- under your doctor's care -- could help.

Taking Control of Your Health

In addition to working with your doctor to find treatment that works, you can take other steps to fight chronic pain. Getting regular exercise, keeping a healthy weight, and improving your diet may help.

Tuesday, 19 July 2016

Opioids To Manage Chronic Pain - Another Perspective

Today's post from (see link below) is a well-balanced and thoughtful look at the current debate about opioid prescription for chronic pain (naturally including neuropathic pain). So many of us have been forced to take opioids to keep our neuropathy symptoms under control; simply because nothing else has worked. It's not as if our doctors have prescribed opioids as a first-line treatment - we've generally been through the mill of other medications and their lack of effectiveness and side-effects and opioids are a last resort treatment but we need them. We're not rabid junkies preying on the helpless to get out fix; we're genuine pain patients who have been left with no choice. The fact that we're now stigmatised as being social pariahs is not our fault and has left us fuming with anger at the hysterical reactions of media and politicians. This article looks at the problem calmly and puts the debate into perspective - worth a read.

Opioids in Pain Management 
Dr Paul Christo MD Posted on July 14, 2016

As we all know, opioids are commonly prescribed for pain. The news has portrayed some scary stories, highlighting celebrity opioid overdoses and stories of addiction. Although opioids have definite risks, they can be quite effective for certain patients with chronic non-cancer pain In patients with cancer pain or those experiencing pain at the end of life, opioids are critical. About 20% of patients going to physician offices with non-cancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription.*

Opioids are powerful painkillers that remain the gold standard for easing postoperative pain. Since the 1990s, more pain specialists and especially primary care doctors have prescribed opioids for patients with persistent pain. Unfortunately, we’ve seen an escalating number of people die from opioid related overdoses. However, opioid related deaths are now beginning to plateau. When examining the literature, there are no studies that compare opioids to other possible treatments with respect to long term outcomes (greater than a year) in pain, function, or quality of life. The Centers for Disease Control (CDC) has responded by recently issuing their opioid prescribing guideline. Their recommendations focus on incorporating non opioid therapies and non-pharmacological therapies (exercise, weight loss, procedures like nerve blocks, and psychological therapies like cognitive behavioral therapy) as therapies for chronic pain instead of opioids.

On the other hand, many of these deaths resulted from combining opioids with alcohol or drugs called benzodiazepines. Some pain experts and patients feel that the “War on Opioids” is hurting patients who need them, saying that the majority of people becoming addicted to opioids are not chronic pain patients. Rather, they are people using opioids non-medically to get “high”, or treat other medical problems like anxiety or depression. As the debate continues, we are seeing more physicians and healthcare providers prescribe fewer opioids primarily due to the FDA’s recommendation to limit the supply, the CDC’s guideline, and fear of media scrutiny. Opioids can produce significant side effects, including constipation, nausea, mental clouding, and respiratory depression, which can sometimes lead to death*. As a patient, it’s important to make sure the prescriber is well versed in opioids as a therapy before initiating them.

Some of the lesser known side effects of opioids include decrease in testosterone and estrogen levels, worsening pain (opioid induced hyperalgesia), and sleep disordered breathing. In fact, there is mounting evidence that long term opioid use for pain can actually produce a chronic pain state, whereby patients find themselves in a vicious cycle of using opioids to treat pain caused by previous opioid use*. Due to the uncommon, but serious risk of respiratory depression and the number of unintentional opioid overdoses, both the American Medical Association and Substance Abuse and Mental Health Administration recommend co-prescribing naloxone to patients at risk who are taking opioids. Naloxone is an opioid antagonist (reversal agent for opioids) and is FDA approved as a nasal spray (Narcan® made by Adapt Pharma) and a subcutaneous or intramuscular injection (Evzio® made by Kaleo). Naloxone is intended to be used by first responders, relatives, or friends of people taking prescribing opioids or using heroin in order to reverse sedation, respiratory depression, and lowered blood pressure.

Pain continues to be a substantial public health problem worldwide. Despite advances, opioids are still needed for pain after trauma or surgery. They are needed for cancer pain, palliative care, and in select situations can be effective for chronic pain. There are an array of options available instead of opioids. For instance, antiepileptic drugs, antidepressants, and NSAIDS can be effective analgesics along with spinal cord stimulation, peripheral nerve stimulation, nerve blocks, pain pumps, psychology, holistic approaches, and integrative therapies. Don’t be afraid to ask about these therapies and to try them. Pain therapies are customized because each person’s pain is unique. A pain treatment that is successful for one patient may not offer than same relief in another. I have spoken about many of these therapies on my radio show, Aches and Gains.

Education is important. Be aware of the side effects of opioids. Keep in contact with your doctor or healthcare provider who can monitor the safe use of opioids if that therapy is chosen.

For more in-depth insight on opioids, listen to my radio show War on Opioids.
* “The Role of Opioids in the Treatment of Chronic Pain”
* “CDC Guideline for Prescribing Opioids for Chronic Pain – United States 2016”

Monday, 18 July 2016

A Simple Start To Your Neuropathy Research

Today's post from (see link below) is useful press-release for those meeting neuropathy for the first time. It gives a simple (though not comprehensive) guide to what's going on with your nerves when neuropathy symptoms appear. Not a bad start but you may wish to explore the disease further and do more of your own research. Nevertheless, we all have to start somewhere and if your doctor's explanation has left you more confused than where you started, this article is a handy guide.

Neuropathy – Key Points, Symptoms, and Conditions to be Lead
July 16, 2016

Neuropathy is a nerve issue typically relating to the peripheral nerves. It can be caused by a variety of underlying medical conditions. In some cases, it can occur with seemingly no cause, termed “idiopathic” neuropathy.

Some key points to note about neuropathy:
People with diabetes are more susceptible to neuropathy. In fact, a part of diabetes care includes regular testing for neuropathy.
There are three types of nerves that can be affected: motor nerves, autonomic nerves, and sensory nerves.
In addition to diabetes, the following can all lead to neuropathy: physical trauma, infection, repeated injuries, metabolic complications, drugs, and metabolic problems can all lead to neuropathy.
In cases where the neuropathy is caused from a toxin, removing exposure to the toxin can prevent the condition from progressing and causing further nerve damage.
The type of symptoms experienced with neuropathy can also vary greatly, depending on the type of nerves that are being affected:
Motor nerves – These types of nerves control power and movement. This type of neuropathy typically causes weakness in the hands, the feet, or both.
Autonomic nerves – These nerves control various systems of the body, including the bladder and gut. This type of neuropathy typically causes changes in the heart rate, sweating, and blood pressure.
Sensory nerves – These nerves are the ones in charge of sensations in and on the body. This neuropathy can cause sensations of tingling, numbness, weakness, or even pain in the hands and feet.
There are various conditions that can lead to neuropathy. While roughly 30% of neuropathy conditions are from unknown causes, the rest are typically attributed to:
Diabetes– This is the most common cause of neuropathy. The reason being is that high blood-sugar damages nerves, so poorly controlled diabetes tends to damage the nerves.
Chronic liver disease
Connective tissue diseases – Rheumatoid arthritis and several other diseases that affect connective tissues can cause neuropathy.
Cancers – Some cancers can lead to neuropathy, such as multiple myeloma and lymphoma.
Vitamin deficiencies – Deficiencies in vitamins folate and B-12.
Toxins – Things such as insecticides or various solvents.
Drugs – Chemotherapy and HIV medication can cause damage to the peripheral nerves.
Excess alcohol consumption – Repeated high levels of blood alcohol can cause nerve damage.
Certain inflammatory issues – Examples include coeliac disease and sarcoidosis.
Chronic kidney disease – The kidneys are responsible for balancing various chemicals in the body, including salt. Imbalances due to the kidneys not functioning properly can lead to peripheral neuropathy.

Diagnosis of neuropathy typically includes questions pertaining to the specific symptoms, general health and medical conditions, family history, medications, alcohol consumption, and the sexual history of the patient. Next is an examination, nerve conduction studies, electromyography, and a skin or nerve biopsy.

Read more at:

Sunday, 17 July 2016

Do We Have To Accept Chronic Neuropathy?

Today's post from (see link below) offers some wise words and advice about 'accepting' the fact that you may be living with chronic pain and by doing so, you somehow wave a magic wand that makes it all okay from that point on. Many self-help sites urge us to accept our chronic condition and that if we don't we're being unrealistic and somehow weak. This article however advises that we should indeed accept the reality of our situation but that doesn't mean giving in to it! Worth a read if you're having trouble resisting throwing bricks at the kids!

Accepting Chronic Pain: Is it Necessary? 
Jennifer Martin, Psy.D Clinical Psychologist PSY 27586 August 3, 2015

As published on Pain News Network ( on March 25, 2015

A patient of mine told me the other day, “I don’t think I will ever be able to accept my chronic pain. It has completely changed my life.”

I think this is something that most people with chronic pain contend with at some point in time; wanting to hold onto hope that their diagnosis isn’t chronic or not wanting to come to the realization that they will have to live with the pain forever.

When most people hear the word “acceptance” they equate it with the notion that they should feel that it’s okay or it’s alright to have a chronic condition. Many people don’t ever feel okay about having to live with pain or an illness for the rest of their lives. It is not something that is easy to get used to and it’s not fair.
Accepting chronic pain does not mean giving into it and it doesn’t mean that you stop looking for treatment.
Accepting chronic pain does not mean accepting a lifetime of suffering.
Accepting chronic pain does not mean you are never allowed to feel angry or sad.

Accepting chronic pain does not mean that you have to give up hope for the future.

When I use the word “acceptance,” I mean accepting the reality of your situation and recognizing that this new reality could be permanent. Those of us with chronic conditions may never like this reality and it may never be okay, but eventually it is necessary to accept it and learn to live life with it. It is the new norm with which we must learn to live.

Acceptance also involves making adaptations and alterations to our lives. We must find new things that bring us joy and we must have hope for the future.
Accepting chronic pain means learning to live again.
Accepting chronic pain means advocating for ourselves and our health so that we can be as healthy as possible.
Accepting chronic pain means learning our limits and learning to cope with feelings of guilt when we have to say “no.”
Accepting chronic pain means being able to look at your diagnosis as something you have, not who you are. Your condition does not define you.
Accepting chronic pain means re-evaluating your role as a husband/wife, mother/father, etc. as well as your life’s goals -- and figuring out how you can maintain these roles and attain your goals with your chronic condition.

For many of us, learning to accept our chronic condition isn’t easy. It is a learning process with a lot of ups and downs. It is something we may resist and something we may think impossible. It is difficult to accept something that has completely changed our lives and possibly the direction we thought our life was going to take.

Why is it necessary to accept your chronic condition?

Once you are diagnosed with a chronic condition, it will be always be with you. The sooner you are able to begin the process of acceptance, the sooner you will be able to learn exactly how to live with it. It is also how you will learn to cope.

Accepting chronic pain means learning to live life in a different way than before your diagnosis. It means learning to pace your activities, educating yourself, taking your medications, advocating for yourself, and surrounding yourself with support. It also means accepting that some aspects of your condition are out of your control.

Chronic pain can be unpredictable. There may be days when you feel in control of your pain and you are able to accomplish everything you would like to. There may also be days when your pain is unbearable, you feel angry about your situation, and all you can do is rest. Accepting your chronic pain means adjusting and adapting to the ways in which your life is different now that you may be living with this kind of unpredictability.

Your life may never go back to what it was prior to your chronic pain. But that doesn’t mean you can’t live a happy, successful, hopeful life with pain. Learning to accept your chronic pain can help you get there.

Saturday, 16 July 2016

The Value Of Medical Marijuana As A Pain Treatment (Vid)

Today's YouTube video is a cautious evaluation of the current thinking regarding medical cannabis as a treatment for chronic pain conditions (including of course, neuropathy). It's cautious because you can sense that the doctor here is weighing up his words carefully, when it comes to a subject that is so sensitive especially in the U.S.A. and by using the search facility to the right of this blog you will find many more articles about the value of medical marijuana for neuropathy patients. Those articles are less 'careful' and go into much more detailed evidence of why marijuana can benefit us in many areas of medicine. The doctor here is right to point out that authorities must do far more research than is presently permitted because otherwise, they are ignoring a potential treatment that will help millions. If they are serious about reducing opioid use then they should also be serious about investigating alternatives.

The Role of Medical Marijuana in Pain Management

Published on 6 Jul 2016

American Academy of Pain Management

Christian Gonzalez, MD, Director of Pain Medicine Aventura Spine Wellness Center, Aventura, Florida, on medical marijuana for pain management: More:

Friday, 15 July 2016

The Nature Of Neuropathic Pain

Today's post from (see link below) is an interesting and informative article looking at what neuropathic pain is and ways to treat it more effectively but more important than that, is the call for better diagnostic tests to establish what sort of neuropathic pain it is. If the testing is improved, then using what is already known about how pain signals in nerves and sodium channels can be blocked, certain current drugs can be re-purposed to better effect. Worth a read and you'll probably learn more than you thought you knew about your condition.

Neuropathy: A name for their pain
Michael Eisenstein Nature (14 July 2016) doi:10.1038/535S10a Published online

  People with neuropathic pain have struggled to find relief with conventional drugs. Researchers are investigating whether more meaningful pain classifications could help.

Two years ago, with little fanfare, neurologist Søren Sindrup reported the results of a successful clinical trial1. On the face of it, it was a modest success story. Instead of coming up with a wonder drug, Sindrup and his team repurposed an existing medication. Nevertheless, some pain researchers consider the trial a potential game-changer — one that marked a turning point in how researchers think about neuropathic pain.

This type of chronic pain arises from damage to the nerves that sense, transmit or process information about environmental stimuli. It can result from numerous initial insults, including spinal cord injury, diabetes and chemotherapy. Patients have generally been grouped on the basis of this initial trauma. But Sindrup, who is at Odense University Hospital in Denmark, and his colleagues took a different approach. They used diagnostic work-ups to cluster patients by their symptoms. This allowed the researchers to home in on a cohort that was more likely to respond to treatment. This is a huge step forward in an area where clinicians have struggled to help their patients. “The drugs we have relieve 50% of pain in somewhere between 1 in 4 and 1 in 7 of the patients we treat,” says Andrew Rice, a pain researcher at Imperial College London. “That's for the best drugs — and that's not very good.”

A growing number of pain researchers think that improvements can be found by analysing symptoms for clues about the underlying nerve damage. Neurologist Giorgio Cruccu of Sapienza University in Rome draws a comparison with another area of neurology. “There is no universal treatment for epilepsy,” he says. Instead, “it depends on the type of seizures”. Pain is a challenging medical target — doctors gain much of their insight from patients' reports rather than from external observations. But clinicians are attempting to devise more-sophisticated diagnostic tools to give the field a quantitative edge — and perhaps usher this patient population into a new era of evidence-based treatment.

Testing your patients
“There were hints in the literature that there are different mechanisms at work.”

Pain is initially recognized through peripheral sensors in the skin known as nociceptors, which react to potential sources of injury such as heat or mechanical trauma. Nociceptors send signals through specialized nerve fibres to the spinal cord, and from there to the brain (see page S2). Disruption to any part of this process can trigger enduring discomfort, although the severity and sensations experienced — burning or shock-like pain, numbness or tingling — can vary widely depending on the nature of the underlying damage. Not all injuries result in the same pain symptoms. For example, people with post-herpetic neuralgia (which can result after an outbreak of shingles) often have spontaneous pain that resembles an electric shock, but some experience allodynia — pain as a result of benign physical contact, such as clothing rubbing against skin. Over the past two decades, clinical researchers have come to appreciate that this variety of symptoms offers a way to understand how pain works. “There were hints in the literature that there are different mechanisms at work across various neuropathic pain entities, where patients have the same 'origin' of pain, but a different pain mechanism,” says Christoph Maier, a pain specialist at University Hospital Bergmannsheil in Bochum, Germany. “Today, we know this idea is correct.”

If these symptoms do represent different underlying mechanisms, that would help to explain why people in the same patient group respond differently to the same drugs — and that might have implications for treatment. “We have tried to develop a classification that is based on symptoms, which may give some indirect clue about the pain mechanism,” says Nadine Attal, a neurologist at Versailles Saint-Quentin-en-Yvelines University in France. Over the past decade, several questionnaires have been developed, including painDETECT and Douleur Neuropathique 4, which help to distinguish pain associated with nerve injury from that brought on by other causes, and the more detailed Neuropathic Pain Symptom Inventory (NPSI), for further subclassification of patients. These can be completed by patients in minutes, and have proved to be a reliable way to assess the nature and intensity of their pain.

Left to right, a whisker-like fibre, pin prick and thermal stimulus are used to test pain sensitivity as part of the quantitative sensory testing protocol.

But questionnaires do not objectively measure pain, nor can they zero in on the factors that trigger it. To provide such insights, Maier and other researchers affiliated with the German Research Network on Neuropathic Pain (DFNS) have devised a standardized battery of assessments known as quantitative sensory testing (QST). The QST protocol includes components such as hot and cold probes, to determine whether pain is triggered by thermal stimuli, and thin, whisker-like filaments that are applied to the skin to assess sensitivity to touch. “If you have somebody with allodynia, that small filament would feel painful,” says Ian Gilron, an anaesthesiologist at Queen's University in Kingston, Canada. QST can help researchers to measure the response of different types of sensory nerve, including both the small fibres that detect painful stimuli and the large ones that transmit information about movement and vibration. Although QST enables clinicians to measure and monitor pain symptoms, it is a labour-intensive process that requires extensive training. Furthermore, the variability in pain response across or even within individuals means that QST is better suited to identifying subgroups in a population than for diagnosing individuals.

Skin biopsies taken from the area of pain can provide a more detailed picture of what is happening at the tissue level. “You can demonstrate the loss of small fibres by directly counting how many free nerve endings can be found in the epidermis,” says Cruccu. He also advocates the use of tests that directly measure how well individual nerves function. Such techniques, says Cruccu, “provide objective measures unpolluted by cognitive biases”. Although this type of neurophysiological testing can reveal the nature of nerve damage, it requires costly, specialized equipment and expertise — and some of the more cutting-edge tools have yet to be validated for clinical use.
In search of subgroups

Researchers are still deciding how to rewrite the diagnostic rule book, but preliminary studies support the idea that a deeper assessment of pain symptoms can lead to more effective care. For example, in Sindrup's clinical trial1, although the team recruited patients with diverse neuropathic traumas, it used QST to identify common characteristics that might predict drug efficacy. The researchers found that people with nerves that had become hyper-responsive to temperature or physical probing — the 'irritable nociceptor' phenotype — were more than three times as likely to have pain relief from the anticonvulsant drug oxcarbazepine as those who had the non-irritable phenotype. This response also makes mechanistic sense: Sindrup and colleagues noted that oxcarbazepine blocks the sodium channel proteins that are responsible for nerve signalling, which could well be hyperactive in patients with irritable nociceptors.

This study is one of the few to select patients up front on the basis of pain characteristics, but others have applied similar techniques retrospectively. By using QST and skin-biopsy data collected during a trial of botulinum toxin A, which inhibits the firing of pain nerves, Attal and her colleagues found that people with both allodynia and a higher density of epidermal pain-sensing fibres were more likely to benefit from this treatment2. And a team led by Didier Bouhassira, a colleague of Attal's at Versailles, is preparing to report a study that re-examined data from 1,200 patients who previously participated in unsuccessful clinical trials for a heavily studied neuropathic pain drug. These findings offer hope for improved patient–drug 'matchmaking', whereby symptom profiles inform smarter trial design and help doctors to prescribe the treatments that are most likely to be effective.

Integrating data sets from multiple diagnostic approaches offers a way to improve this process. One such effort, by neurologist Roy Freeman at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues, analysed QST and NPSI data from past clinical trials to identify four distinct patterns of pain symptoms that seem to correlate in different groups of patients3. These profiles could be developed into 'fingerprints' for specific types of neuropathic injury by, for instance, connecting specific pain triggers such as pressure or cold with manifestations of pain such as stabbing or tingling sensations.

Researchers hope that such correlations will reveal information about the roots of pain pathology. A large European patient registry maintained by the DFNS and the public–private organization the Innovative Medicines Initiative (IMI) is enabling a more thorough hunt for such patterns. “It contains about 4,000 patients,” says Maier, who manages the data set as part of the IMI's Europain project. “It includes somatosensory profiles, clinical data, QST data, microscopy and skin-biopsy data and, in some cases, genetic data.”

Despite having only a handful of trials to serve as proof of concept, several consortia — including the US-based Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) — are planning on using these phenotyping tools in clinical trials. For now, most of the enthusiasm is coming from the academic sector; pharmaceutical companies expect much stronger evidence before taking on the additional cost. There is also the likelihood that more refined testing will shrink the patient population that drug companies can target with new analgesic drugs. “Instead of getting an approval for all of post-herpetic neuralgia, for example, they'd get one just for post-herpetic neuralgia with allodynia,” Rice says.

Nevertheless, according to Cruccu, a growing number of trials now use the quick questionnaires as a cost-effective fail-safe. Even if, overall, a trial seems unsuccessful, the availability of these data could enable a later search for specific subgroups in which efficacy can be demonstrated. Maier says that findings such as those from Sindrup's trial suggest that many 'failures' may be masking successes: small numbers of patients whose positive response to a drug is drowned out by the sea of people whose pain is poorly matched to the therapy being tested.

For now, the diagnostic tools available give only basic signposts for clinicians who treat people with neuropathic pain. But, given the dearth of effective treatments, even modest gains could have an outsized impact — especially once a next generation of analgesics enters the pipeline. “If there was a way to know who was most likely to respond to a drug and really focus on that in a clinical trial,” says Rice, “that would be magic.”



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Demant, D. T. et al. Pain 155, 2263–2273 (2014).
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Attal, N. et al. Lancet Neurol. 15, 555–565 (2016).
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Freeman, R., Baron, R., Bouhassira, D., Cabrera, J. & Emir, B. Pain 155, 367–376 (2014).
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Michael Eisenstein is a freelance science writer based in Philadelphia, Pennsylvania.