Wednesday, 4 May 2016

Are You Strong Enough To Change Your Diet To Reduce Your Pain?

Today's challenging post from health.clevelandclinic.org (see link below) looks at what they call 'elimination diets' for reducing chronic inflammatory pain. Now given that neuropathy probably falls into this category, what are the chances that if you change your diet, your symptoms will improve? Promising, according to some and a waste of time, according to others but the biggest question is: can you change your diet in any of the ways described below? Think giving up smoking or drinking and you're pretty much appreciating the challenge here and remember...there are no guarantees that it will work. However, it is worth considering, even if you only half believe but always make a doctor's appointment first to check whether cutting out certain foodstuffs may actually harm you rather than help. The biggest advantage is that no chemical drugs are involved. Worth a read to get you thinking.

Should You Switch to an Elimination Diet to Fight Chronic Pain?
Pain management specialist answers 7 key questions April 14, 2016 / By Chronic Conditions Team

People rave about elimination diets for easing chronic pain, but do they work? Experts say, sometimes they do help. In many cases, it’s worth a visit to your doctor to see if an elimination diet could be right for you.

Pain management specialist Hong Shen, MD, suggests discussing an elimination diet with your doctor if you have:


Neck pain
Back pain
Fibromyalgia or any chronic pain condition
Complex regional pain syndrome (serious pain that develops and lingers after an injury)

Here, she answers common questions about how elimination diets work. 


1. How can an elimination diet relieve pain?

Inflammation is the root cause of chronic pain. Some foods are highly inflammatory, especially sugar, hydrogenated oil and highly processed food.

Many patients can develop sensitivity to gluten, dairy, corn and soy. Those foods can trigger your body’s immune response and cause pain, so eliminating the problematic foods can sometimes ease your pain.


2. What foods are usually eliminated?

The first foods Dr. Shen recommends that you eliminate include gluten, dairy, sugar, packaged foods and processed foods. If you’re still having pain, you may also need to eliminate corn, eggs, shellfish, beef, pork, coffee, tea and chocolate.

“Not everyone needs to eliminate all of these foods,” says Dr. Shen. “It just depends on what you’re eating on a regular basis.”

RELATED: 7 Simple Swaps That Will Transform Your Diet

 
3. How long should you eliminate these foods?

It depends on the type of problem you’re having.

If you’re on a strict elimination diet that includes avoiding all or most of the problematic foods, Dr. Shen recommends that you restrict them for between four and six weeks. If you’re on a diet that’s free of gluten, dairy or sugar, you can stay on it indefinitely.

RELATED: Gluten-Free Diets — The Straight Skinny

 
4. How do you determine which food is causing the problem?

“The elimination diet serves both diagnostic and treatment purposes,” Dr. Shen says. “I will have my patients eliminate certain foods for four to six weeks, or, ideally, eight weeks.”

After eight weeks, if all your symptoms resolve, you can start reintroducing one food at a time and try it for three days. Dr. Shen recommends eating a significant amount of the targeted food at least twice in those three days.

If you develop discomfort, stop the new food until the symptoms completely disappear again. Then reintroduce the food a second time. If the same symptoms reappear, you stop it again and reintroduce a different food.

“From this test, you can find which food gives you pain,” she says.

RELATED: New Dietary Guidelines Target Added Sugars, Healthy Eating Patterns

 
5. How effective are elimination diets?

According to Dr. Shen, 30 to 40 percent of patients put on elimination diets get better just from changing their diets alone. Sometimes the changes are gradual. Other times, they’re more dramatic.

“You can have headaches for your entire life, then be pain-free after four to six weeks on an elimination diet,” she says.

In one study, 246 fibromyalgia patients followed either a gluten-free or dairy-free diet.

“Many responded to treatment, although some quicker than others,” says Dr. Shen. “The results of the study were similar to the 30 to 40 percent success rate we see at Cleveland Clinic.”

How effective an elimination diet will be for you will depend on your condition. And everyone is different, so it also depends on how well your body responds.


6. Are elimination diets used along with other treatments?

Treating pain is often complicated, Dr. Shen says, so it must be addressed on an individual basis. Doctors sometimes recommend other treatments as well, including:


Pain medications
Mind-body medicine (using your mind to influence your body)
Guided imagery (a technique that focuses on mental images to help relieve pain)
Hypnosis
Meditation
Yoga
Reiki (a healing technique in which touch channels energy to activate the natural healing processes of your body)
Acupuncture
Chiropractic medicine
Massage
Herbal supplements
Addressing other nutritional issues (e.g., potential deficits)


7. Why should I see a doctor before beginning an elimination diet?

In some instances, eliminating certain foods affects treatments for other health conditions.

“If you’re on diabetic medications, blood pressure medications or blood thinners (e.g., Coumadin), you may need to have your medication adjusted, depending on what you’re eliminating,” Dr. Shen says.

If you have food sensitivities, even healthy foods may trigger symptoms. Treating chronic pain requires a multi-level approach. “It’s not just diet alone,” she says.

Stress reduction is also important, as is exercise and getting a good night’s sleep.

RELATED: 7 Health Foods That Can Ruin Your Diet

https://health.clevelandclinic.org/2016/04/switch-elimination-diet-fight-chronic-pain/

Tuesday, 3 May 2016

Cell Toxins That Cause Neuropathy

Today's post from source.wustl.edu (see link below) attempts (successfully) to put some very complex information into words that we as lay readers can pretty much understand. It talks about the toxins produced by Schwann cells which 'leak' out onto adjacent axons and damage them, causing the nerve pain we feel with neuropathy. However, these toxins have been called into action by the mitochondria (energy generators of the cells) which have been damaged themselves and no longer produce the energy needed to make nerve cells work normally. With me so far? Probably not but this article explains the whole process and teaches us how nerves and their complex structures actually work. Finding drugs to block this toxin production is the aim. Have a read. You might surprise yourself how quickly you form a picture of what's going on with neuropathy.
 

New clues to causes of peripheral nerve damage
By Caroline Arbanas March 6, 2013

Anyone whose hand or foot has “fallen asleep” has an idea of the numbness and tingling often experienced by people with peripheral nerve damage. The condition also can cause a range of other symptoms, including unrelenting pain, stinging, burning, itching and sensitivity to touch.

Although peripheral neuropathies afflict some 20 million Americans, their underlying causes are not completely understood. Much research has focused on the breakdown of cellular energy factories in nerve cells as a contributing factor.

Now, new research at Washington University School of Medicine in St. Louis points to a more central role in damage to energy factories in other cells: Schwann cells, which grow alongside neurons and enable nerve signals to travel from the spinal cord to the tips of the fingers and toes.

The finding may lead to new therapeutic strategies to more effectively treat symptoms of this highly variable disorder, the scientists reported March 6 in the journal Neuron.

“We found that a toxic substance builds up in Schwann cells that have disabled energy factories, leading to the same kind of nerve damage seen in patients with neuropathies,” said senior author Jeffrey Milbrandt, MD, PhD, the James S. McDonnell Professor of Genetics and head of the Department of Genetics. “Now, we’re evaluating whether drugs can block the buildup of that toxin, which could lead to a new treatment for the condition.”

The most common cause of peripheral neuropathy is diabetes, which accounts for about half of all cases. The condition also can occur in cancer patients treated with chemotherapy, which can damage nerves.

In the body, Schwann cells wrap tightly around nerve axons, the fibers that relay nerve signals. Graduate student and first author Andreu Viader and colleagues in Milbrandt’s lab studied Schwann cells in mice with genetically disabled mitochondria, or cellular energy factories. Under normal conditions, these mitochondria produce fuel and intermediates of energy metabolism that allow nerve cells to function.

The researchers showed that the crippled mitochondria activated a stress response in the Schwann cells. Instead of synthesizing fatty acids, a key component of Schwann cells, the cells burned fatty acids for fuel.





Over time, inefficient burning of fatty acids by the crippled mitochondria leads to a build up of acylcarnitines, a toxic substance, in the Schwann cells. The researchers found levels of acylcarnitines up to 100-fold higher in these mutant Schwann cells than in healthy Schwann cells.

And the bad news doesn’t end there. Eventually, the toxin leaks out of the Schwann cells and onto the nerve axons. Studying neurons in petri dishes, the researchers showed that acylcarnitines damage nerve axons and disrupt the ability of nerves to relay signals.

“The toxin leaking out of the Schwann cells and onto the adjacent nerve axons causes damage that results in pain, numbness, tingling and other symptoms,” Milbrandt said. “We think that is a likely mechanism to explain the degeneration of axons that is known to occur in peripheral neuropathies.”

The new research suggests that drugs that inhibit the buildup of acylcarnitines may block axonal degeneration. Milbrandt and his team now are evaluating the drugs in mice with disabled Schwann cells to see if they can slow or alleviate the decay of axons. The research is supported by the National Institutes of Health (NIH) Neuroscience Blueprint Center Core Grant (P30 NS057105), the HOPE Center for Neurological Disorders and the National Institutes of Health (AG13730 and PPG 2P01 HL057278).

Viader A, Sasaki Y, Kim S, Strickland A, Workman CS, Yang K, Cross RW, Milbrandt J. Aberrant Schwann cell lipid metabolism linked to mitochondrial deficits leads to axon degeneration and neuropathy. Neuron. March 6, 2013.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

https://source.wustl.edu/2013/03/new-clues-to-causes-of-peripheral-nerve-damage/

Monday, 2 May 2016

The Opioid Row Is Directly Relevant To All Neuropathy Sufferers

Today's post from startribune.com (see link below) is of interest to all neuropathy patients, even if you are only taking paracetamol to reduce your symptoms. It addresses the so-called opioid addiction problem but remember, once you begin serious treatment for your neuropathic pain, you're taking drugs meant for other conditions and they all have potential side effects and potential addiction problems. Most people start for instance, with Amitriptyline (which seldom works when neuropathy takes hold but even this is an antidepressant and can have adverse effects on your health. From that point on, the drugs just get stronger, until after you've exhausted them all, you end up on opioid family medications and remember...this is just to control the pain...it does nothing to help the nerve damage itself. So yes, this article applies directly to you and is worth taking sides on. The point of the article is that although politicians claim this is an 'addiction and criminality' problem, it's not, it's a chronic pain problem for which those drugs are ultimately the only solution. Therefore the article quite rightly aims for a course of treatment that is multi-disciplinary and includes drugs but also many other ways to tackle chronic pain. If you scan down the title list to the right of this blog, you will find many articles relating to non-drug treatments to help you live with chronic pain - they need to be included in any doctor's approach to chronic pain. so that you don't just walk away with a prescription for hard drugs in your hand but have a list of other tools which will reduce the need for those drugs and help cope with chronic pain as well. However, don't be fooled...the drugs are necessary; the pain is real and you're not a junkie for needing them. It's just that you can help yourself in other ways too. Worth a read.


Drop old doctor-centered model for a proactive, self-care approach. 
By James Fricton, Alfred Clavel and Mark Weisberg
April 15, 2016

 
Health care and addiction: Instead of opioids, prevent chronic pain


The effort announced by the Obama administration to address the growing opioid abuse problem misses the mark on why people become addicted to opioids. The real reason for the increase in opioid use is not about addiction, but rather about chronic pain.

Thus, the March 27 front-page article (“Taming the pain without the pills”) on an innovative approach to help opioid-addicted patients with chronic pain is important and timely.

While major efforts are underway to prevent most other major health conditions, preventing chronic pain remains an enigma, overlooked by the public, neglected by the health care system and generally ignored by the scientific community. Chronic pain is the “elephant in the room” of health care, and we need to prevent it.

The Institute of Medicine (2011) and the National Pain Strategy (2016) state that chronic pain conditions are the No. 1 reason for the use of opioids, the No. 1 reason for seeking care, the No. 1 cause of disability and the No. 1 driver of health care costs — costing more than cancer, heart disease and diabetes. It costs the United States alone over $700 billion in health care and lost work. This is equivalent to 25 percent of total health care costs and nearly 5 percent of the U.S. total gross national product.

The personal impact in terms of suffering, loss of function, disability, depression, addiction, overdoses and more is incalculable.

The Obama administration strategy suggests that we need to wean thousands of people off these powerfully addictive substances or avoid distributing them in the first place. However, this assumes that people are taking them for nonmedical reasons. In the vast majority of cases, people have been prescribed opioid medications to manage chronic pain.

If we want to reduce opioid addiction and overdoses, we must focus more effort on preventing chronic pain without opioids. Pain conditions in the back, neck, head, face and other areas are caused by physical disorders of the muscles, joints, nerves and other tissues that may begin with an injury or strain and that then may persist due to the lifestyle risk factors that increase sensitization of the nervous system. Repetitive strain, poor sleep, stress, maladaptive postures, emotional problems and other factors can delay recovery. The majority of those with pain over one month in duration still have pain years later despite the use of opioids, pharmaceuticals, implanted devices, surgeries and other innovative treatments.

It’s time we shift the focus to preventing chronic pain. We spend billions on advances in pharmaceuticals, devices, surgeries and other innovative treatments for chronic pain, yet we fail to deliver long-term relief, primarily due to the lack of educating patients in self-management strategies to reduce these risk factors and enhance protective factors.

The Institute of Medicine states that the primary role of the health professional in caring for chronic pain requires guiding, coaching and assisting patients with day-to-day self-management, in addition to evidence-based medical treatments. However, most health professionals lack the time to perform this role and find little support and reimbursement for doing so. They rely on the patient to do so, but this often does not get done. The opioid epidemic is just one of many consequences.

We need to change our health care system. Solving the chronic pain problem requires changing our health care model from a passive model of doctor-centered care to a patient-centered transformative care model. Transformative care brings together evidence-based treatments with self-management training to reduce risk factors and enhance protective factors in each aspect of a person’s life. It helps people shift the balance from illness to health. Embracing patient-centered health care paradigms such as self-responsibility, education, personal motivation, social support, strong provider-patient relationships and long-term change are the key.

We also need to train health professionals and patients on how to prevent chronic pain and opioid addiction. One innovative example of this is the massive open online course (MOOC) titled “Preventing Chronic Pain: A Human Systems Approach” (www.coursera.org/course/chronicpain). This course provides free online education to help those who want to prevent chronic pain and opioid addiction. Course evaluations found 93 percent believed that the course made a difference in their lives and that 85 percent of health providers believe that it made a difference in their patient care. As one participant stated, “Absolutely fascinating and enlightening. This information should be part of every health care educational program!”

Patients and health care professionals can shift the balance from a passive, dependent role to one of being empowered, engaged and well-trained to not only prevent their chronic pain, addiction and disability but also to enhance health and well-being. Ultimately, this will best prevent the opioid problem, improve the quality of health care and significantly reduce health care costs. The “elephant in the room” will finally get addressed. Why not support this?

Dr. James Fricton is a professor and specialist with the HealthPartners Institute for Education and Research, the Minnesota Head and Neck Pain Clinic and the University of Minnesota. Dr. Alfred Clavel is a neurologist with the Minnesota Head and Neck Pain Clinic and department chair in pain management at HealthPartners. Dr. Mark Weisberg is a clinical psychologist with the Minnesota Head and Neck Pain Clinic and the University of Minnesota.

http://www.startribune.com/health-care-and-addiction-x2009-x2009-instead-of-opioids-prevent-chronic-pain/375905321/

Sunday, 1 May 2016

Weightless In Water: Exercises For Neuropathy Patients

Today's short post from moveforwardpt.com (see link below) is a useful article for neuropathy patients who know they must exercise but find the very idea too painful to contemplate. Exercise does help with our symptoms...we all know it but drumming up the courage to begin and then maintain an exercise regime just seems a torture too far for most of us. Have you perhaps thought about exercising in water? Even for non-swimmers and people who find the bath an intimidating depth, this article shows you the way to exercise relatively painlessly in a weightless environment. You don't have to do every exercise but try as many as possible and if you're worried about kids sniggering at you...f*** 'em...they're going to be suffering from something one day too! It makes sense...give it a read and then maybe give it a try...you'll be amazed how much better you feel afterwards and how helpful it is for our over-stretched nerves.
 

10 Exercises To Do In the Pool
Authored by Julie A. Mulcahy, PT, MPT 2016

Pool (aquatic) exercise provides many benefits, including an ideal environment to exercise throughout the year. The buoyancy of the water supports a portion of your body weight making it easier to move in the water and improve your flexibility. The water also provides resistance to movements, which helps to strengthen muscles. Pool exercises can also improve agility, balance, and cardiovascular fitness. Many types of conditions greatly benefit from pool exercise, including arthritis, fibromyalgia, back pain, joint replacements, neurological, and balance conditions. The pool environment also reduces the risk of falls when compared to exercise on land.


Preparing for the Pool

Before starting any pool exercise program, always check with your physical therapist or physician to make sure pool exercises are right for you. Here are some tips to get you started:
Water shoes will help to provide traction on the pool floor.
Water level can be waist or chest high.
Use a Styrofoam noodle or floatation belt/vest to keep you afloat in deeper water.
Slower movements in the water will provide less resistance than faster movements.
You can use webbed water gloves, Styrofoam weights, inflated balls, or kickboards for increased resistance.
Never push your body through pain during any exercise.
Although you will not sweat with pool exercises, it is still important to drink plenty of water. 


10 Excellent Exercises for the Pool

1. Water walking or jogging: Start with forward and backward walking in chest or waist high water. Walk about 10-20 steps forward, and then walk backward. Increase speed to make it more difficult. Also, increase intensity by jogging gently in place. Alternate jogging for 30 seconds with walking in place for 30 seconds. Continue for 5 minutes.

2. Forward and side lunges: Standing near a pool wall for support, if necessary, take an oversized lunge step in a forward direction. Do not let the forward knee advance past the toes. Return to the starting position and repeat with the other leg. For a side lunge, face the pool wall and take an oversized step to the side. Keep toes facing forward. Repeat on the other side. Try 3 sets of 10 lunge steps. For variation, lunge walk in a forward or sideways direction instead of staying in place.

3. One leg balance: Stand on 1 leg while raising the other knee to hip level. Place a pool noodle under the raised leg, so the noodle forms a “U” with your foot in the center of the U. Hold as long as you can up to 30 seconds and switch legs. Try 1-2 sets of 5 on each leg.

4. Sidestepping Face the pool wall. Take sideways steps with your body and toes facing the wall. Take 10-20 steps in 1 direction and then return. Repeat twice in each direction.

5. Hip kickers at pool wall: Stand with the pool wall to one side of your body for support. Move 1 leg in a forward direction with the knee straight, like you are kicking. Return to start. Then move the same leg to the side, and return to the start position. Lastly, move that same leg behind you. Repeat 3 sets of 10 and switch the kicking leg.

6. Pool planks: Hold the noodle in front of you. Lean forward into a plank position. The noodle will be submerged under the water, and your elbows should be straight downward toward the pool floor. Your feet should still be on the pool floor. Hold as long as comfortable, 15-60 seconds depending on your core strength. Repeat 3-5 times.

7. Deep water bicycle: In deeper water, loop 1-2 noodles around the back of your body and rest your arms on top of the noodle for support in the water. Move your legs as if you are riding a bicycle. Continue for 3-5 minutes.

8. Arm raises: Using arm paddles or webbed gloves for added resistance, hold arms at your sides. Bend your elbows to 90 degrees. Raise and lower elbows and arms toward the water surface, while the elbows remain bent to 90 degrees. Repeat for 3 sets of 10.

9. Push ups: While standing in the pool by the pool side, place arms shoulder width apart on pool edge. Press weight through your hands and raise your body up and half way out of the water, keeping elbows slightly bent. Hold 3 seconds and slowly lower back into pool. (Easier variation: Wall push up on side of pool: place hands on edge of pool shoulder width apart, bend elbows, and lean chest toward the pool wall.)

10. Standing knee lift: Stand against the pool wall with both feet on the floor. Lift 1 knee up like you are marching in place. While the knee is lifted even with your hip, straighten your knee. Continue to bend and straighten your knee 10 times, and then repeat on the other leg. Complete 3 sets of 10 on each leg. For more of a challenge, try this exercise without standing against the pool wall.

Learn more about aquatic physical therapy.

http://www.moveforwardpt.com/Resources/Detail/top-10-exercises-to-do-in-pool

Saturday, 30 April 2016

Using Supplements To Relieve Neuropathy Symptoms

Today's post from dana-farber.org (see link below) is the sort of post that often leaves you with more questions than answers. It's aimed at cancer patients who have suffered nerve damage as a result of the treatment but in principle applies to all neuropathy patients with the same symptoms. It suggests (rather half-heartedly) a few supplement options, as well as acupuncture as means of relieving the discomfort and pain but concentrating on vitamin B6 is not really helpful because B12 can be just as effective in helping nerve damage symptoms. However, this is generally only because the cause of the neuropathy has reduced the body's vitamin B levels to very low levels and that needs to be checked first. After checking your vitamin levels (including vitamins D and E) you should consult your doctor before your dietitian and do your own research to see what else may be added to the armoury. The references to glutamine and alpha lipoic acid are useful but by no means exclusive. There is more evidence to suggest that alpha lipoic acid should be taken in combination with acetyl L-carnitine to provide the necessary co-enzyme balance to work and other supplements such as Q-10 may help. Apart from that, recent studies have shown that alpha lipoic acid may actually increase tumour growth in certain cancer patients (esp. breast cancer) In short, there's nothing wrong with this post but it gives too little information for what it's trying to achieve. It is so important to consult the specialists (including dietitians) and do more of your own research (hundreds of articles here on this blog) before committing to self-help treatments but it may well be worth your while doing so (if your budget can take it!).


Alleviating Peripheral Neuropathy Symptoms
Posted in: Coping with Cancer, Health and Wellness

Ask the Nutritionist

 
Q: I have been told that B vitamins may help with peripheral neuropathy resulting from chemotherapy. What dose of these vitamins is safe and are there other nutritional supplements that can help?

J.M., Richmond, California


A: Peripheral neuropathy, a side effect of certain chemotherapy drugs, causes numbness and tingling in the hands and feet. The exact mechanism of this chemotherapy-induced neuropathy is unknown. Supplementation may help alleviate symptoms of neuropathy.

Vitamin B6 is known to help diabetic neuropathy and may help manage chemotherapy-induced neuropathy symptoms when taken in a safe dose. Taking 50 to 100 mg of B6 daily is safe and may be effective. If you are taking a multivitamin and/or B Complex, check the amount of B6 so that you do not go above 100 mg total per day.

Glutamine has been suggested to help chemotherapy-induced neuropathy, especially from Taxol. Taking 30g/day, as 15 grams twice daily, of Pure L-Glutamine Powder is considered safe for cancer patients. Try to find a powder without other "fillers" in the ingredient list.

Alpha-Lipoic-Acid (ALA) seems to reduce symptoms of peripheral neuropathy in diabetic patients, and may help with symptoms of chemotherapy-induced neuropathy. Taking 300 mg twice daily or 600 mg daily is considered a safe dose. Symptom improvement is seen within 3-5 weeks. ALA is an antioxidant, and when used in combination with radiation treatment, may reduce effectiveness of the cancer therapy. ALA can be used for up to 4 weeks safely. For long-term use, speak with your physician and dietitian.

Acupuncture is an alternative therapy to oral supplementation. Emerging evidence supports acupuncture as effective in reducing chronic pain associated with cancer.

When considering supplementation, it is important to meet with a Registered Dietitian for an individualized dietary supplement plan.

http://www.dana-farber.org/Health-Library/Alleviating-Peripheral-Neuropathy-Symptoms.aspx

Friday, 29 April 2016

Opioids Versus Non-Opioids For Neuropathic Pain: Debunk The Myth

Today's excellent post from painnewsnetwork.org is a sensible look at the whole issue of prescribing opioids vs non-opioid medications for chronic pain (and especially chronic nerve pain) patients. It debunks the myth that chronic pain patients, willingly or unwillingly are on a rapid path to becoming junkies and/or criminals and its most important quote may well be: “Does the CDC really believe that a pain patient on long term opiates hasn't already tried everything else possible?” The crux of the matter is this: do we abandon chronic pain patients to a life of misery because we have a moral, or political issue with the very drugs that will relieve them of that pain? They have already been through the medication mill of trying this and that before all parties reach the conclusion that there's simply nothing else that will tackle their pain. Do you seriously think that neuropathy pain patients unanimously shout: 'Oh goodie...we can begin taking opioids...yippee'!! The powers that be need to tackle the criminal problem behind commercial abuse before taking criminal actions to inflict further pain on long-suffering patients!


Patients Say Non-Opioid Therapies Often Don’t Work  
By Pat Anson, EditorOctober 15, 2015

Pain treatments recommended by the Centers for Disease Control and Prevention (CDC) as alternatives to opioids often do not work and are usually not covered by insurance, according to a large survey of pain patients. Many also believe the CDC’s opioid prescribing guidelines discriminate against pain patients.

Over 2,000 acute and chronic pain patients in the U.S. participated in the online survey by Pain News Network and the Power of Pain Foundation. Most said they currently take an opioid pain medication.

When asked if they think pain patients are being discriminated against by the CDC guidelines and other government regulations, 95% said they “agree” or “strongly agree.” Only 2% said they disagree or strongly disagree.

The draft guidelines released last month by the CDC recommend “non-pharmacological therapy” and “non-opioid” pain relievers as preferred treatments for chronic non-cancer pain. Smaller doses and quantities of opioids are recommended for patients in acute or chronic pain. A complete list of the guidelines can be found here.

“Many non-pharmacologic therapies, including exercise therapy, weight loss, and psychological therapies such as CBT (cognitive behavioral therapy) can ameliorate chronic pain," the CDC states in internal briefing documents obtain by PNN.

“Several nonopioid pharmacologic therapies (including acetaminophen, NSAIDs, and selected antidepressants and anticonvulsants) are effective for chronic pain. In particular, acetaminophen and NSAIDs can be useful for arthritis and low back pain, and antidepressants such as tricyclics and SNRIs as well as selected anticonvulsants are effective in neuropathic pain conditions and in fibromyalgia.”

Most patients who were surveyed said they had already tried many of these non-opioid treatments and had mixed results, at best.

“Does the CDC really believe that a pain patient on long term opiates hasn't already tried everything else possible?” asked one patient.

“The CDC says don't do something but comes up with NO viable, realistic alternatives. Tylenol, etc., are unrealistic. Exercise is unrealistic when you are in too much pain to move! “ said another patient.

“Anti-anxiety meds are just as addictive. Over the counter pain medicines are not strong enough to cover the pain in a patient with chronic pain. And there are hundreds of pain patients who can't take NSAIDs because of an allergic reaction. Same thing with steroids,” wrote another.

When asked if exercise, weight loss or cognitive behavioral therapy had helped relieve their pain, only about a third of the patients surveyed said they “helped a lot” or “helped a little.” Nearly two-thirds said they “did not help at all.”

Over half said non-opioid medications such as Lyrica, Cymbalta, Neurontin, anti-depressants and anti-anxiety medications “did not help at all.”

Over the counter pain relievers such as acetaminophen and NSAIDs were even less helpful. Three out of four patients said they “did not help at all.”

“We must be mindful of the treatment options that the CDC guidelines stress over opioids,” said Barby Ingle, president of the Power of Pain Foundation. “For instance in my case, taking NSAIDS for an extended period (a little over 1 year) caused internal bleeding and ulcers which lead to being hospitalized, a surgical procedure, and months of home nursing and physical therapy that could have been avoided.

“It is important to include a multi-disciplinary approach to care. We have to use non-pharmacological treatments and non-opioid medications in conjunction with more traditional treatments. Using chiropractic care, nutrition, good dental health, better posture, meditation, aqua therapy, etc., can go a long way in the management of chronic pain conditions.”

But the survey found that many of those treatments are simply out of reach for pain patients because they’re not covered by insurance.

When asked if their health insurance covered non-pharmacological treatments such as acupuncture, massage and chiropractic therapy, only 7% said their insurance covered most or all of those therapies.

About a third said their insurance “covers only some and for a limited number of treatments” and over half said their insurance does not cover those treatments. About 4% do not have health insurance.

“I tried acupuncture and massage, paying out of my pocket, but neither helped. In fact, they hurt. I tried Lyrica, Savella, and Cymbalta. No luck. I do warm water aerobics three days a week WHEN I CAN TAKE MY OPIATES FIRST,” wrote one patient.

Although the CDC didn’t even raise the subject of medical marijuana in its guidelines, many patients volunteered that they were using marijuana for pain relief and that it worked for them.

“Alternative medicine is needed. I am a huge advocate of medicinal marijuana, in addition to opioids to treat my disease,” wrote a patient who suffers from CRPS (Chronic Regional Pain Syndrome).

“If cannabis was legal and accessible, it would greatly lessen the need for prescription pain medication,” said another patient.

“I should be able to get the proper medical marijuana legally. I have tried it from a friend and it helps tremendously. However, I will not purchase it because it is illegal. I pray every day I can get it someday,” said a patient who suffers from lupus, arthritis and other chronic conditions.

The survey found patients were evenly divided on whether they should be required to submit to urine drugs tests for both prescribed medications and illegal drugs.

"In order to receive my monthly pain medication, I must submit to a urine screen and a pill count each and every month. I must (whether they work or not) agree to have steroid injections every few months. While I don't have any problem to submitting to urine screenings or pill counts, I do not like having injections that provide no help. I am trapped playing this game,” said a patient.

“99.9% of pain patients are responsible adults but are treated like toddlers who need constant supervision. Pain patients are sicker, fatter, and poorer because they are pumped full of chemicals and steroids. Forced to be experimental guinea pigs or forced to suffer if they say NO,” said another patient.

"As both a chronic pain patient and a provider I get to view this issue from multiple perspectives. Of course opioids aren't the first line treatment for chronic pain, and when they are used they shouldn't be the only treatment. They are one part of a larger toolkit for managing chronic pain," wrote a registered nurse practitioner.

"There are many fortunate people who are able to manage their pain without medication, or even recover from pain completely using some of the wonderful new interventions we now have available. But there are large numbers of patients out there who have tried all the other medications and dietary changes and injections and PT (physical therapy) modalities and mindfulness. And they are still left with pain that only responds to opiates."

For a complete look at all of the survey result, visit the "CDC Survey Results" tab at the top of this page or click here.

http://www.painnewsnetwork.org/stories/2015/10/14/patients-say-non-opioid-therapies-often-dont-work
 

Thursday, 28 April 2016

Why Neuropathic Pain Hurts (Vid)

Today's YouTube video is a Ted Talk video about why pain hurts and this applies to neuropathic pain too. In fact, you'll learn more about how your nervous system responds to and delivers pain signals than from a host of text-only articles. There's a good chance you'll have a giggle too (something never to be turned down) because this guy is funny and knows how to engage an audience. If he can engage an audience of neuropathic patients (that's you, the readers), he's a freaking genius! he may use the word 'groovy' a bit too much but you'll forgive him. Give it a try, you're going to learn something about your brain and the nervous system for sure. Definitely worth 15 minutes of your time.

TEDxAdelaide - Lorimer Moseley - Why Things Hurt


TEDx Talks Uploaded on 21 Nov 2011 Why do we hurt?

Do we actually experience pain, or is it merely illusion?

In this video, Lorimer Moseley explores these questions, and position the pain that we feel as our bodies' way of protecting us from damaging tissues further. He also looks at what this might mean for those who suffer from chronic pain.




https://www.youtube.com/watch?v=gwd-wLdIHjs#t=8s

Wednesday, 27 April 2016

Neuropathy: When A Picture Says It Better

Have you ever wished you just had the right image to send to someone who'd just sent you yet another e-mail asking how you are and noting how well you looked the last time they saw you? You need the image that says more than a thousand words right? Now neuropathy is not normally a laughing matter but there are a few 'lighter' images out there you might want to send, without any explanatory text, or long explanations. Given the choice between strangling your well-meaning friends, or firing a humour-bullet...one of these may fit the bill. If you know of more...let us know..they just might make someone's day a tiny bit better.



I've Got Neuropathy...Deal With It!
Dave R April 2016




















 
www.neuropathyandhiv.blogspot.com

Tuesday, 26 April 2016

Why Does Neuropathy Make Us So Damned Tired?

Today's post from neuropathyjournal.org (see link below) tries to explain why many people living with neuropathy (especially autonomic neuropathy) become progressively more tired as the years go on. There's no easy answer and there can also be many other reasons why fatigue and weakness start to affect our lives so strongly but for many people, along with degradation of nerve fibres, comes muscle and mental fatigue and it can be very difficult to live with. LtCol Richardson does a good job of explaining the process but also offers some helpful tips to help us cope with and improve our tiredness levels. Worth a read.

Fatigue in Peripheral Neuropathy 
By LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS9

Unfortunately fatigue is a central part of many neuropathies and especially the immune mediated neuropathies. It is central to many other chronic illnesses that affect the body’s immune system. The causes are often complex and many.

Dr. Scott Berman, in his book Coping with Chronic Neuropathy notes in chapter VIII “Dealing with Fatigue and Insomnia” that this symptom is one of the most difficult and challenging for the neuropathy patient. Dr. Berman is a Psychiatrist, a member of the Board of Directors of the NSN and a Medical Advisor. Scott lives with untreatable CIDP.

He notes:

…that in one study looking at fatigue in autoimmune neuropathy 80% of 113 patients had severe fatigue. The fatigue was independent of motor or sensory symptoms and was rated as one of the top three most disabling symptoms. (“Fatigue in Immune-Mediated Polyneuropathies,” Neurology 53: 8 November 1999, I.S.J. Merkies, et al).

For decades in living with untreated Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Autonomic Neuropathy (AN) and Progressive Polyneuropathy due to exposure to Agent Orange in Vietnam, I can attest to the facts noted above. While other major symptoms respond to treatment with Immune Globulin (IVIg), the symptom of severe fatigue continues as one of the symptoms that responds only temporarily to the infusions followed by several days of total fatigue following infusion and then with some lessening until the next infusion.

Dr. Norman Latov in his book “Coping with Peripheral Neuropathy”, states what I have heard other neurologists share, that the fatigue we feel, first appearing as weakness, increases as the weakness (or damage) of motor nerves expands. At this point with only a few muscles doing the whole job of lifting a leg or arm or carrying on autonomic functions, the body becomes weak and eventually extreme fatigue occurs. Think of a young child who tires easily because the muscles and nerves are not fully developed and only a few underdeveloped nerves or muscles are doing the job of moving!

On the other hand, to state the obvious, pain in some neuropathies does not help us sleep. Neuropathy patients must seek medical help in finding medications or other options which works for them. The medical practitioners have increased their knowledge in recognizing the reality of neuropathic pain. These strange symptoms from damaged peripheral nerves are present in sensory neuropathies. It is become less common for these patients to be told that it is all in their ‘head’ and are finally getting the help they need.

Impact on family and friends:

Families and friends, as we all have learned, may not understand this reality since we “look so good” and may even believe/suggest that you are just lazy or unmotivated or worse. The best thing you can do for them is to have them watch the DVD Coping with Chronic Neuropathy which will be an education about the impact of any neuropathy on our lives.

Educating yourself about neuropathy:

At any rate, fatigue is something we struggle with every day and often regulates/determines our daily activities.

While fatigue in neuropathy and other chronic illnesses is not fully understood by the experts, from a practical standpoint, here is what I have learned to do or not do in coping with fatigue. If you have found other things that help, send us a message and we will add it to the list.

1. DO NOT think negatively about fatigue, thus feeling guilty about your fatigue. Go take a nap! (See DVD “Coping with Chronic Neuropathy”).

2. Learn when your “fatigue” periods occur, as these often establish a pattern at certain times of the day. Then go lay down and stop moaning about it, as it is what it is until it isn’t.

3. I have learned that you do not even have to actually “sleep”, but just allowing your body to rest/stop for an hour takes care of the exhaustion as the body recovers. But whatever works for you, do it without guilt or apology.

4. For nighttime, have a standard bedtime routine in preparing for sleep that tells your body that it is time to sleep.

5. Do not eat a large meal just before bedtime or take a stimulant that keeps you awake or might interfere with sound sleep (i.e. caffeine, for some alcohol).

6. Do consider drinking a glass of milk as for many this encourages the body to sleep.

7. Do consider one of those special recordings of quiet music or rain falling or similar if it helps.

8. Do consider using a ticking clock if that helps. As a child in the 40s I got my best sleep on the floor in front of the big radio in the living room listening to Dragnet or was it the Lone Ranger, maybe the Big Story. Today most TV programs have the same effect, sleep! Pun intended.

9. Muscle spasms and/or restless leg can make sleeping difficult and rob you of needed sleep. Speak to your doctor and have tests done for calcium, salt, potassium levels and other deficiencies which can make it difficult for muscles to work properly. This is especially true if you are on a diuretic which can empty your body of needed minerals. Getting up and having a glass of orange juice worked for my mother and works for me. If the lack of something is not the problem, have the doctor find out what may be causing these muscle problems. There are also medications to help prevent these muscle spasms and cramps for they are very common in neuropathy.

10. I have found that if I wake up with my mind creating solutions to an issue or writing poetry (happens) and not able to sleep, I go to another room or go do some work on my computer (write out the solution or poetry) until I begin to feel sleepy again. It works for me.

11. For some insomnia is a real curse. There are medications that one can use as Dr. Scott Berman mentions in his book, so speak to your doctor. Frankly, I would work on natural solutions first and be creative to see what works for you. But if ALL else fails these medications may help and be a heaven sent blessing.

12. My Nurse told me that many patients with this effect of a chronic illness, take Folic Acid and it is known to help. So you many want to speak to your doctor in this regard.

13. Dr. Erika Schwartz, M.D. (national leading expert on wellness) suggests that patients with extreme fatigue have the physician check your basal metabolic rate and your thyroid function. Low thyroid is a common cause of fatigue. So speak to your doctor in this regard.

14. So what do you do or not do that helps? Send it to us and we will enter it here!

DISCLAIMER: The information in this article and on the website or the links or in the guidance provided is intended to be educational and informative and not medically prescriptive or diagnostic. All patients are encouraged to consult with their own medical doctor when considering any this information.

Copyright – 2014-2015 Network for Neuropathy Support, Inc., 501c3, dba as Neuropathy Support Network. This article or its contents may be reprinted or published for educational purposes as long as the printing or publishing is not for profit and acknowledgement is granted the author.

https://neuropathyjournal.org/fatigue-in-peripheral-neuropathy/

Monday, 25 April 2016

Lyrica Once Again Shown To Be Ineffective

Today's post from vancouversun.com (see link below) will come as no surprise to may neuropathy patients who have been both disappointed by the ineffectiveness of pregabalin (Lyrica) and damaged by its side-effects. The fact is that it rarely works for neuropathic pain. However, because of aggressive marketing, it's the world's number one treatment for nerve pain! To be fair to Pfizer, they did withdraw their own recommendation for Lyrica for many disease-related neuropathies in March 2013 but that was forced by litigation and so much protest that it was inevitable. The FDA's warnings about the drug were that last straw. So why is it still so widely prescribed, despite the inherent dangers of side effects? Who knows! Apparently the marketing goes on and unscrupulous drugs company reps will prioritise getting rid of current supplies as quickly as possible. If you are prescribed Lyrica (pregabalin) for your neuropathic symptoms, please have a serious discussion with your doctor and maybe try to arrange an alternative. This article highlights the dangers if you don't.


Common drug for diabetic foot pain isn’t effective, B.C. researchers say
Erin Ellis, Vancouver Sun 01.18.2016

A report by the Therapeutics Initiative at UBC suggests Lyrica only helps about one in 10 of the people to whom it is prescribed.JB REED / BLOOMBERG NEWS

A pain medication that rarely works as promised had a 17-fold increase in prescriptions over a decade, says the latest research from the Therapeutics Initiative at the University of B.C.

Its report says only about one in 10 patients will gain relief from pregabalin (trade name Lyrica), which is used to treat peripheral neuropathy — usually foot pain caused by diabetes — and other discomfort. Therapeutics Initiative is think-tank that reviews the usefulness of prescribed drugs and offers advice to B.C.’s doctors and pharmacists.

The latest work released Tuesday concludes that pregabalin, and two other painkillers studied, gabapentin and duloxetine (Cymbalta), all have little effect on pain despite extensive marketing campaigns promoting them.

Co-author Dr. Tom Perry, a clinical assistant professor in the department of anesthesiology, pharmacology and therapeutics at UBC, says doctors often tell patients to take these medications in higher doses and for a longer time than the evidence supports. Patients should know within days whether the medications are working for them, he says.

“These drugs are intended to make someone feel better; if you’re not feeling better, why take it?”

Perry and co-author Aaron Tejani, a clinical assistant professor in Pharmaceutical Sciences, looked information on gabapentin, pregabalin and a number of other medications gathered by Cochrane Reviews which evaluate scientific research from around the world. They found expectations of the drugs’ effectiveness far outstripped the evidence and likely drives an increasing number of prescriptions.

In B.C., pregabalin prescriptions rose 17 fold from 2005 through 2014, compared with a 1.8-fold increase in people receiving gabapentin.

Gabapentin is now available as a generic drug, but was formerly trademarked medication called Neurontin manufactured by Pfizer. The pharmaceutical giant agreed to pay $430 million in U.S. fines in 2004 after marketing it for unapproved uses such as migraine headaches and pain.

Combined costs of gabapentin, pregabalin, and duloxetine were over $52 million in British Columbia during 2014, says the Therapeutics Initiative report, of which Pharmacare paid over $13 million, mostly for gabapentin.

Pregabalin, also manufactured by Pfizer for neuropathic pain, is not covered under B.C.’s publicly funded Pharmacare following a recommendation by a national drug advisory committee in 2005. As a result, patients either pay for it out-of-pocket or through private health insurance,

Worse than simply buying a medication that’s not working, Perry says pregabalin is often prescribed to older adults who may become drowsy or lose their balance because of it.

Therapeutics Initiative is funded by the B.C. Ministry of Health through a grant to UBC.

eellis@vancouversun.com

http://www.vancouversun.com/health/common+drug+diabetic+foot+pain+effective+researchers/11662999/story.html

Sunday, 24 April 2016

Fibromyalgia Vs Neuropathy: The Argument Goes On

Today's post from consultqd.clevelandclinic.org (see link below) highlights something that has seemed pretty obvious to both neuropathy and fibromyalgia patients for a long time - both conditions are neurological in origin and both are treated by much the same medications, with the same lack of success. Basically, fibromyalgia is a rheumatic condition characterized by muscular or musculoskeletal pain with stiffness and localized sensitivity and tenderness at specific points on the body. Patients have highly sensitised nerves that display strange sensations including severe pain. No difference with neuropathy there then. The point is that for many years, doctors have refused to put the two conditions together because it was assumed that the problems were solidly muscular or rheumatic in nature; or, even worse, psychosomatic! However, just as with neuropathy, the pain and other sensations can only be experienced through nerves and neural pathways, so how can it not be neuropathic too? This article tries to both legitimise fibromyalgia and prove that neural dysfunction is a key element. Why is this important to the average neuropathy patient? Well because the symptoms can be so similar in terms of what the patient actually feels, that he or she just doesn't understand the diagnosis he or she is given. There are so many forms of neuropathy, why shouldn't fibromyalgia be one of them!


Why Fibromyalgia Is Neuropathic:
Central sensitization is one explanation

Mar. 8, 2016 / Pain Management 

The etiology of fibromyalgia is still largely unknown, but it isn’t as controversial as it used to be.

A decade ago, the chronic rheumatic disease was most often attributed to muscle and ligament problems. Some declared it a psychogenic disorder. (Some still do.) More recently, however, studies have linked fibromyalgia with malfunctioning neurotransmitters, neurochemical imbalances and other neuropathic conditions.

“Today, it’s more widely accepted that fibromyalgia is primarily a neurogenic disease,” says Philippe Berenger, MD, a pain management specialist at Cleveland Clinic. “It still doesn’t explain the disease, but it’s a step forward.”

Dr. Berenger bolstered this belief in a presentation at Cleveland Clinic’s 18th Annual Pain Management Symposium in San Diego in March.
Definitions we can agree on

In 1994, the International Association for the Study of Pain (IASP) defined neuropathic pain as “initiated or caused by a primary lesion or dysfunction of the nervous system.” In 2008, the IASP’s Neuropathic Pain Special Interest Group tweaked the definition to include “disease of the somatosensory nervous system.”

“Fibromyalgia fits these definitions,” says Dr. Berenger. “Although the condition has no anatomically definable lesions, it is marked by altered neurological function in the spinal cord and brain. It can, therefore, be considered a dysfunction of the central inhibitory process of pain control.”
Fibromyalgia’s link to central sensitization

It’s clear that fibromyalgia has mechanisms and pathways associated with central sensitization, he notes. The condition follows similar pathways as other neuropathic pain syndromes, such as complex regional pain syndrome, interstitial cystitis and irritable bowel syndrome.

“All nerves in fibromyalgia patients are more sensitive than they should be — including the brain and spinal cord,” says Dr. Berenger. “Many patients have difficulty with concentration or have hypersensitivity to light, odors or sounds. Some have additional neuropathic pain syndromes or struggle with autonomic dysfunction, such as vasovagal symptoms.”

Central sensitization has been demonstrated in animals and humans by using various triggers (e.g., mustard oil, heat, hypertonic saline injection) to activate nociceptors in skin, viscera or muscle. Sensitization presents as:
Tactile allodynia
Hyperalgesia
Enhanced pressure and thermal sensitivity
Spreading to neighboring nonstimulated sites and remote regions

Increased excitability of spinal cord neurons can cause a series of events:
Increased duration (spontaneous firing) and a growing area of response
Abnormal neuro-anatomical reorganization (new connections between A-beta, A-delta and C fibers, which spread and involve multiple dermatomes)
Diffuse symptoms — which can outlast the stimuli (long-term potentiation)
Newer evidence supports neurogenic claim

In 2014, researchers discovered through skin biopsy that patients with fibromyalgia had lower epidermal nerve fiber density than patients without fibromyalgia. Small fiber neuropathy, therefore, is likely another contributing factor in fibromyalgia pain — and yet more evidence that the condition has neurogenic roots, notes Dr. Berenger.
What this means for treatment

“Most of the drugs used today to treat fibromyalgia — like antidepressants and antiepileptics — are already focused on neurological targets,” says Dr. Berenger.

However, considering fibromyalgia as a central sensitization disorder opens up a larger array of treatment options, he says. Agents active on the central nervous system include:
Sodium channel blockers
Calcium channel blockers
Serotonin-norepinephrine reuptake inhibitors (SNRI)
NMDA receptor antagonists
Nerve growth factor (NGF) inhibitors

Low-dose naltrexone is another treatment option on the horizon. One 2013 study found that the drug significantly reduced pain and improved mood and general satisfaction in people with fibromyalgia. Other studies have reported similar positive responses to the drug.
“It’s all in the mind”

Saying that fibromyalgia is “all in the mind” isn’t entirely wrong, concludes Dr. Berenger.

“Pain pathways and centers are in the brain. And we can employ techniques like mindfulness and biofeedback to control pain,” he says. “However, it’s more helpful — and accurate — to consider it a neurogenic disorder.”

https://consultqd.clevelandclinic.org/2016/03/why-fibromyalgia-is-neuropathic/

Saturday, 23 April 2016

Intra-Muscular Vitamin D Injections Reduce Neuropathy Symptoms

Today's post from vitamindcouncil.org (see link below) makes some remarkable claims about the benefits of a single, high-dosage injection of vitamin D for neuropathy patients. The results were seen after some weeks and had no effect on the disability of a patient but definitely on the severity of their symptoms. Personally, I find it an encouraging research but it definitely needs some significant follow-up to confirm its conclusions. The injections were intra-muscular and therefore administered by a doctor or medical professional, which may be a good thing, to dissuade people from rushing to the supplement store to swallow 600,000 IU of vitamin D in pill form in one go! Vitamin D supplementation has been a buzz therapy among the neuropathy communities for some time now but most doctors will agree that vitamin D supplementation is only really necessary if there is proven vitamin D deficiency. The word has it that it is certainly beneficial for nerve health but you need to do more of your own research and consult with a trusted medical professional before embarking on a self-help course of vitamin D. Most articles place an emphasis on diabetes-related neuropathy patients but as we all know by now, that's only because the vast majority of neuropathy sufferers come from the diabetic community. Most information regarding neuropathy applies to the condition irrespective of its cause. More articles can be found by using the search button to the right of this blog.

Research finds vitamin D to be a safe and effective treatment for painful diabetic neuropathy
Posted on April 11, 2016 by Amber Tovey

A new study published in the journal BMJ Open Diabetes Research and Care discovered that treatment with a single intramuscular dose of 600,000 IU of vitamin D in patients with painful diabetic neuropathy caused significant reductions in symptoms.

Diabetic neuropathy is a type of nerve disorder that can occur if a person has diabetes. High blood sugar can injure nerves throughout the body, but diabetic neuropathy most commonly affects nerves in the legs and feet. It often causes pain and numbness in the extremities, but may also cause problems in the gastrointestinal tract, urinary tract, blood vessels and heart.

Approximately 21% of the population is affected by painful diabetic neuropathy. Treatments for diabetic neuropathy are limited. The therapeutic effectiveness for all medications is at best near 50% pain relief. In addition, most of the medications are accompanied by unwanted side effects. This has left the medical community searching for new treatments.

A previous study suggested vitamin D supplementation may help treat diabetic neuropathy. The researchers found that weekly vitamin D supplementation of 50,000 IU for 8 weeks reduced symptoms but not disability. In an effort to confirm the treatment effect of vitamin D on diabetic neuropathy, researchers recently conducted a prospective open-labeled trial in Pakistan.

A total of 143 patients with type 1 or type 2 diabetes were included in the study. All patients received a single intramuscular dose of 600,000 IU of vitamin D3.


Pain was assessed using three different questionnaires: The Douleur Neuropathique 4 (DN4), total McGill pain and Short Form McGill Pain Questionnaire (SFMPQ). The researchers wanted to compare pain severity before and after the administration of the vitamin D injection. Here is what they found:
Average vitamin D levels increased from 31.7 ng/ml at baseline to 46.2 ng/ml at week 20.
Total McGill pain score, DN4 and SFMPQ significantly decreased after vitamin D administration (p is less than 0.001).

The researchers concluded,

“The administration of 600 000 IU of vitamin D results in a modest but significant increase in 25(OH)D levels measured at 20 weeks. This improvement in 25(OH)D levels was associated with an improvement in several independent measures of PDN, which became significant approximately 10 weeks after administration of vitamin D.”

The researchers noted that the average vitamin D levels of the patients at baseline was much higher than previous studies, indicating that a proportion had likely received vitamin D supplementation from their primary physician previously. This shows vitamin D supplementation has become a more widely accepted practice for diabetic patients.

Future studies should follow a randomized controlled trial design and use a daily dosage regimen.

Citation

Tovey, A.; Cannell, JJ. Research finds vitamin D to be a safe and effective treatment for painful diabetic neuropathy. The Vitamin D Council Blog ; Newsletter, 2016.

https://www.vitamindcouncil.org/blog/research-finds-vitamin-d-to-be-a-safe-and-effective-treatment-for-painful-diabetic-neuropathy/

Friday, 22 April 2016

New Findings Reveal More Damage To Nerves Than Thought

Today's post from medicalxpress.com (see link below) may look as though it's primarily aimed at people already with diabetes or at the so-called pre-diabetes stage (high blood sugar) but if you read further, it applies to most people living with 'classic' neuropathy and its symptoms, irrespective of the cause. Previously it was thought that because the symptoms in the feet and lower legs are so predominant, that is where the initial damage to motor nerves is happening...at least at first. However, new research has shown that in fact there is visible damage/degredation along the entire length of sensory nerves, rather than just at the ends of the longest nerves first. The nerve deterioration is therefore happening along both large and small fibre nerve lengths. The professor here likens the small fibre neuropathy (characterised by burning and tingling in most cases) to a 'canary in a coal mine'...a warning of worse things to come. These findings may seem a somewhat far-from-our-bed-show but the fact is that current neuropathy testing methods won't show this up...perhaps leading to the huge number of 'idiopathic' ('we haven't a clue why this has happened') neuropathy diagnoses.

Small nerve fibers defy neuropathy conventions
April 11, 2016

Results of a small study of people with tingling pain in their hands and feet have added to evidence that so-called prediabetes is more damaging to motor nerves than once believed, in a report on the study published online in JAMA Neurology on April 11.

Johns Hopkins neurologists say the study of patients with small fiber neuropathy showed unexpected deterioration over the entire length of sensory nerve fibers, rather than just at the longest ends first, which the investigators say defies the conventional wisdom of how nerves were thought to deteriorate.

Over the three-year course of the study of the 62 participants, 13 of them with prediabetes, the investigators found that generalized damage occurs in those with prediabetes, and that the precursor condition may be less benign than most clinicians appreciate.

"I liken small fiber neuropathy to the canary in the coal mine," says senior author Michael Polydefkis, M.D., professor of neurology at the Johns Hopkins University School of Medicine and director of the Cutaneous Nerve Lab. "It signals the beginning of nerve deterioration that with time involves other types of nerve fibers and becomes more apparent and dramatically affects people's quality of life. The results of this new study add urgency to the need for more screening of those with the condition and faster intervention."

Small diameter nerve fibers reach out to the surface of the skin, and their damage is often marked by development of burning pain in the feet. But routine nerve tests, like nerve conduction, and routine examinations often fail to identify nerve damage because those measurements mostly assess injury to large diameter nerve fibers. The most common cause of small fiber neuropathy is diabetes, Polydefkis notes, but it can also be caused by lupus, HIV, Lyme disease, celiac disease or alcoholism.

In an effort to measure damage more accurately in small nerve fibers in people with small fiber neuropathy symptoms, Polydefkis and his team took small samples of skin—the size of a large freckle—from 52 patients diagnosed with small fiber neuropathy and from 10 healthy controls. Of the 52 patients enrolled in the study with small fiber neuropathy, 13 were considered to have prediabetes, 14 had type 2 diabetes, and 25 had normal blood sugar and an unknown cause of neuropathy. The participants ranged in age from their mid-40s to late 60s, and just less than half were female. Skin samples were taken from the ankle, the lower thigh near the knee and the upper thigh. Three years later, samples from the same area in the same group were taken for comparison.

Microscopic analysis of the skin samples was done to determine the density of small nerve fibers over time. According to the lead author of the study, Mohammad Khoshnoodi, M.D., assistant professor of neurology at Johns Hopkins, a lower density of fibers indicates more nerve damage.

Initially, he says, all patients with small fiber neuropathy had fewer nerve fibers at the test site on the ankle compared to the upper thigh, demonstrating more nerve damage the further down the leg measured. After three years, all three groups of those with small fiber neuropathy lost nerve fibers at the site tested in the ankle. But what surprised the researchers was that nerve fibers were lost at similar rates from the lower and upper thigh sites as well, a phenomenon that would not have been expected if the longest nerve fibers were the most vulnerable.

"We are all taught in medical school that the longest nerves degrade first, and we show that this isn't always the case," says Khoshnoodi.

Patients with prediabetes or diabetes had at least 50 percent fewer small nerve fibers in their ankles initially than those participants with an unknown cause for their small fiber neuropathy, indicating these patients started the study with more damage to their small nerve fibers.

The patients with prediabetes continued to have worsening damage to their small nerve fibers over the course of the study; they lost about 10 percent of their nerve fiber density each year at all sites tested along the leg. Patients with diabetes also lost similar rates of nerve fibers along the three sites of the leg.

"I expected that people with diabetes would do worse, but I didn't really expect people with prediabetes to experience a similar rate of degradation of their small nerve fibers," says Polydefkis.

Khoshnoodi cautions that the study was small, and that other factors in addition to high blood sugar, such as smoking, high blood pressure and high cholesterol, may also have contributed to the decline. Future studies that address these risk factors will need to be performed to determine if prediabetes is as debilitating to nerves as full-blown diabetes.

According to the National Institute of Neurological Disorders and Stroke, an estimated 20 million people in the U.S. have some form of peripheral neuropathy. About 50 percent of people with diabetes have neuropathy.

Explore further: Researchers uncover source of mystery pain

Journal reference: Archives of Neurology

Provided by: Johns Hopkins University School of Medicine

http://medicalxpress.com/news/2016-04-small-nerve-fibers-defy-neuropathy.html