Sunday, 30 April 2017

Neuropathy In India

Today's post from India's dailypioneer.com (see link below) gives us a rare glimpse into how other countries view neuropathy and what sort of problems it presents. As you can imagine, in such a vast country as India, neuropathy statistics are alarmingly high but that's not surprising given the population. Nevertheless, the story is the same as it is across the world. It's also worth remembering that new treatments for neuropathy are just as likely to come from India as from any other area of the world - the Indian pharmaceutical industry is booming!


Best foot forward in diabetic neuropathy
Sunday, 23 April 2017 | Dr Mukul Verma |

An estimated 50 per cent of all diabetic patients develop painful diabetic neuropathy in 25 years, writes Dr Mukul Verma

Warmth of a bonfire, freshness of breeze, softness of a cuddly toy — how do we feel all these are sensations? Through the network of nerves that travel throughout the body and convey these feelings to the brain in the form of electrical signals. This relay of information to the brain and back to the sense organs goes on smoothly without a hitch continuously for a lifetime. However, diabetes has the power to collapse this master communication system and blow its circuits out. Prolonged exposure to high glucose levels leads to nerve damage and this is called diabetic neuropathy. It is estimated that about 50 per cent of all diabetic patients develop painful diabetic neuropathy in 25 years.

Diabetic neuropathy can affect nerve fibers throughout the body, but most often, damages nerves in the legs and feet. This is called peripheral diabetic neuropathy. It is more common when blood sugar remains uncontrolled for a long time. Uncontrolled diabetes is rampant in India, in fact 50 to 60 per cent of diabetic patients do not achieve the glycemic target of HbA1c below 7 per cent. With a diabetic population of more than 62 million, the projection for diabetic neuropathy incidence are indeed worrying.

Some common signs of diabetic neuropathy are:
A tingling or burning sensation
Sharp pains
Muscle cramps
Increased sensitivity to touch
Numbness
Reduced ability to feel temperature changes
Muscle weakness
Loss of balance and coordination

The symptoms of peripheral neuropathy depend on the type of nerves that have been damaged. There are three types of peripheral nerves: Motor, sensory, and autonomic. Sometimes all three types of nerves are affected, and this condition is called polyneuropathy. The symptoms vary from patient to patient. Some years ago, I had a 70-year-old patient who complained that his feet “were on fire”. And one 65-year-old had a constant complaint that she was unable to understand where her feet were.

About 10 per cent of diabetic patients experience persistent pain. This is called chronic diabetic neuropathy. The pain typically worsens at night. For some, the pain of diabetic neuropathy may be bearable, for others it may be severe enough to cause sleeplessness, reduce their activity levels, and interfere with their routine.

In a cross-sectional study carried out to assess the burden of diabetic neuropathic pain, about 50 per cent patients reported moderate to severe pain-related interference in activities of daily living. Fifty-seven per cent patients reported an adverse impact on their employment status. Among those currently working, 72 per cent reported reduced productivity, including 22 per cent who reported reduced productivity “most” or “all” of the time.

Diabetic neuropathy pain can cripple the enjoyment of life. Moreover, it can be literally crippling too as it is the leading reason behind diabetic foot ulcer and amputation. This is mainly because the sensory loss associated with diabetic neuropathy can prevent the patient from recognising foot issues like injuries till it is too late.

In India, the awareness about diabetic neuropathy is rather poor. Most diabetics tend to ignore it, thinking that it is a normal part of ageing. However, this is a dangerous trend as it can lead not only to the loss of quality of life but also to the loss of a limb.

I have noted that patients come to specialists like me as a last resort after trying a variety of over-the-counter medications and home remedies. This can do more harm than good as common painkillers are usually ineffective in combating diabetic neuropathy pain. This self-medication may also lead to an unnecessary delay of proper treatment and gastric side-effects.

Awareness about the need to initiate specific protective pain relief medication in diabetic neuropathy is a priority in India today. Early treatment should be sought to prevent the progression of neuropathy and control pain.

Research is going on all over the world to discover therapies to end the agony of neuropathy. A therapy aimed at producing drugs which target the brain immune cells responsible for causing pain is still in its nascent stages. A gene-based therapy, which will induce regeneration of nerves, is also being researched.

But right now, there is no known cure for diabetic neuropathy; it can be only managed better with the help of some prescription medicines, which only a doctor can prescribe. Hence, to be able to put your best foot forward for living well with diabetes neuropathy, it is essential to consult a pain specialist as early as possible and initiate the right treatment.

The writer is a Neurologist, Apollo Hospital, Delhi

http://www.dailypioneer.com/sunday-edition/agenda/miscellany/best-foot-forward-in-diabetic-neuropathy.html

Saturday, 29 April 2017

Writing: A Free Distraction From Chronic Pain

Today's post from paincommunity.org (see link below) talks about a form of therapy that won't reduce the painful symptoms of neuropathy but may serve as a distraction and therefore lessen its impact. Not only that but it may help you put into writing (and therefore words) how long-term neuropathy affects your personality and quality of life. The article urges you to start writing! I don't need to say any more than that but if you do start writing and are looking for an outlet, or an audience, this blog will be happy to publish your work. Let me know that you're intending to write something and I'll provide an email address to which you can send your word file, or whatever. Fiction or non-fiction - it's all good and you may be surprised how much positive energy the simple act of writing can give. If while you're doing it, you don't notice your discomfort as much, then it's a win-win situation.

Writing as a Form of Therapy
by The Pain Community | Apr 21, 2017 | Daily Living
by Guest Blogger – Maria Miguel


All of us encounter stressful and traumatic experiences in our lives. We could be fighting everyday battles of anxiety, depression and other mental health disorders. For me, I find a special comfort in the written word. I can read countless novels and teleport myself into the writer’s worlds. The characters come alive on the pages, and I can visit faraway places conjured up in the minds of the author.

As a writer, I use words to relay emotions and thoughts I can’t exactly form orally. Over the years, writing has been the consistent and most therapeutic method to ease my stress. As someone with obsessive compulsive personality disorder, this is sometimes a challenging task. When I am writing, either about my life or creating my own characters and stories, I am able to work through the best — and worst — times in my life. Through this introspection, I find some of my greatest strength. For me, it’s easier to write about how I am feeling versus talking about every single rumination. Writing allows me to collect my thoughts.

Even if you aren’t a seasoned writer, give it a shot. After all, you don’t have to share your musings with anyone but yourself. Writing can help you assess patterns in your behaviors, increase your sense of self-identity and determine goals and objectives. For example, if you have been struggling with depression, writing about your feelings could help you determine that you are depressed because you are in a failing relationship, don’t enjoy your current job or feel overwhelmingly hopeless because you see the world through a loved one’s sickness.

Here are some tips to use writing as a form of therapy in your own life:

Keep a journal.

Write in this journal as often as needed. I recommend writing every day. It’s OK if your journal writing isn’t structured and is more stream of consciousness. Make your journal an extension of your personality. I write all of my dates in French and tend to purchase journals that are vintage, Parisian or “Wizard of Oz” themed.

Write a letter to yourself or someone else.

If you’re in the midst of letting go of something or someone, writing a “goodbye” letter could work for you. If you weren’t able to say what you wanted to say, then this could be a way to get your feelings out in the open without ever sending the letter or email. You will tell your truths in your internal narrator’s voice, which can be extremely therapeutic. You won’t be bottling up your emotions.

Detail your emotions in poetry.


We all probably had to read and write poetry in high school. For some of us, we didn’t understand the stanzas in front of us; however, poets draw from their own experiences and emotions to pen their poetry. If you feel overwhelmed and don’t know where to start, make a list of images, such as in your bedroom, from your childhood days, from a stressful situation, etc. Then, write a list of senses you experienced associated with these images. Write down your emotions related to the images and senses. After this process, write a poem containing these words and images. You will be able to show yourself — and potential readers — how you are feeling without having to put blatant labels on your emotions.

Be prepared to uncover good and bad memories.


During the writing process, your mind could rediscover thoughts and emotions associated with something bad that happened in your life. For example, if you are writing about lost loves, you may think of a former significant other who wasn’t faithful. You may feel helpless as you write about your parents’ divorce. However, you could also relive the best parts of your life, such as the birth of your child, achieving a goal, traveling to your favorite location and more. Using writing as therapy can help you forgive yourself and others. You can reflect on situations and improve into your best self because you have learned from your successes and mistakes.

Write fiction based on your nonfiction experiences.


Often, when we use writing as therapy, we talk about our personal journeys. Use your own story and craft your own characters. If you are uncomfortable writing about a traumatic experience of your own, have your character experience the event. Writing about specific emotions can help you in the healing process. If you decide to share your writings with someone else — or even a mass audience — the works centered on your experiences and emotions could help others going through the same type of situation. This gives you a new role and gives your writings even more meaning that is greater than you.

To figure out if writing could be therapeutic for you and to find more therapy options, seek out a licensed professional to talk with you about your mental health disorder and its effects and solutions.

Marie Miguel is an avid internet researcher. She is fueled by her determination to answer the many questions she hasn’t been able to find the answer to anywhere else. When she finds these answers she likes to spread the knowledge to others seeking help. She is always looking for outlets to share her information, therefore she occasionally has her content published on different websites and blogs. Even though she doesn’t run one for herself she loves contributing to others.

http://paincommunity.org/writing-form-therapy/

Friday, 28 April 2017

Long Term Opioid Use For Chronic Pain

Today's post from practicalpainmanagement.com (see link below) shows the results of a relatively small-scale study of people using long term opioids for chronic pain. The author points out that despite the current hysteria surrounding opioid treatment for chronic pain, there's no evidence that these pain patients perform any differently than if they use other strong analgesics. The point is that if doctors and patients work together with opioid treatment and there is recurrent and consistent control, there's no reason why opioids can't be as effective (or more) than other pain medications. Patients don't take opioids by choice; they take them because there is literally no alternative and most other options have already been exhausted. Labeling all opioid patients as some sort of menace to society, is grossly unfair, as is denying patients opioid treatment as a result. Of course, we all accept that a minority abuse the system but as usual the media and political lobbies use a sledgehammer to crack a nut and punishes all as a result. Thank goodness there are  sensible commentators out there who see opioids as a tool in the armory against pain - neuropathy patients the world over are grateful that opioids exist but don't let anybody tell you that they enjoy taking them - they're a last resort.
 
Opioid Treatment 10-year Longevity Survey Final Report  
 By Forest Tennant, MD, DrPH
 
Patients in this study were found to be functioning quite well after 10 or more years on generally stable opioid dosages—with the vast majority able to care for themselves and even drive.

About eighteen months ago, I approached the publisher of Practical Pain Management to assist in a survey of long-term, opioid-treated pain patients. Rightly, as any good publisher, he asked why should I go to the time and expense to do a longevity survey? I then presented him my laundry list of reasons for doing the survey. Some explanations of my reasons for doing this survey are given here. Quite frankly this survey was needed, since we simply have little data on opioid long-term treatment.1,2 Also, opioid treatment is constantly under attack, so it seems logical to see if the popularity of this treatment is justified.


Reasons for the Survey

First, recall that we have just finished the “Decade of Pain.” Ushering in this decade were many laws, regulations, and guidelines—promulgated in many states—that encouraged physicians to prescribe opioids without fear of legal reprisal. Did anyone get help this decade? Did this political and humanitarian effort pay off?

Secondly, my own experience in practice was the predominant factor. I started my pain practice in 1975 while serving as a Public Health Physician in East Los Angeles County. Cancer and post-polio patients needed ‘narcotics’ (the common name prior to the more correct usage ‘opioids’) treatment for their severe chronic pain. I’ve now followed some chronic pain patients still taking opioids after 25 to 30 years.1 Also, I was a government consultant in the 1970s on Howard Hughes who managed to survive 30 years with intractable pain after a 1946 plane crash. His average opioid dosage over that time period was about 200 mg of morphine equivalence. But are my patients unusual or simply responsive to an overzealous clinician? Do opioid-treated patients in the hands of other physicians do just as well over a long period?

A little over a year ago there was another reason to do a longevity survey. At that time there was a vitriolic, anti-opioid propaganda campaign being waged. Some prominent academic institutions, pharmaceutical companies, professional organizations, and journals, almost in unison, essentially claimed that opioids shouldn’t be prescribed due to hyperalgesia or other as-yet unnamed complications. Some parties stated that opioids, if prescribed at all, should have a dosage restricted to some arbitrary number such as 200mg of morphine equivalence a day. Some claims fundamentally suggested that pain should only be treated with non-opioids, because opioids actually “cause pain.” Amazingly, some detoxification centers actually advertised for “clients” on the basis that the person’s pain would be cured if the patient spent $10K or $20K to detoxify from opioids. Needless to say, the anti-opioid campaign was hardly backed by bonafide medical management pain practitioners or scientific studies. So what was needed was a simple survey to see if there are long-term opioid-treated patients who are still doing well.


What the Survey Can’t Determine

This survey was not intended or designed to answer some ancillary questions. Not answered is which opioids are superior or could patients have done as well without opioids? Also, it wasn’t intended to determine optimal dosage or complications. The intent was clear and simple: Do some opioid-treated patients improve pain control, function better, and enhance their quality of life over a 10-year period?


Survey Methods

In early 2009, an advertisement was placed in this publication to identify any physician who had a cohort of chronic pain patients they had treated with opioids for 10 or more years and were willing to share outcome data. Three physicians, one each from Kentucky, Louisiana, and California, reported a total of 76 patients who have been treated with opioids for 10 or more years. These, together with the 24 patients treated by this author,1 provide a cohort of 100 patients who have been treated with opioids for 10 or more years and serve as subjects for this survey. Physicians completed a survey questionnaire for each patient that inquired about demographic status, cause of pain, opioids currently used, basic physical functions, activities of daily living, and stability of opioid dosage.


Results and Findings

Patients in this study appeared typical of most chronic pain patients in that they are primarily middle age or older and have degenerative diseases of the spine, joints, or peripheral nerves (see Tables 1 and 2). Most have maintained on one opioid, although some patients required two or three. The majority have been on stable dosages for many years (see Table 3). Despite the longevity of treatment, most function quite well. The vast majority of patients report good function in that they can dress, read, attend social functions, drive, and ambulate without assistance (see Table 4). Almost half (45%) reported they had been on a stable opioid dosage for at least 3 years.





Table 1. Demographics of 10-Year Opioid Patients
Age (Yrs) Range 30-83
Males 61 (61%)
Females 39 (39%)
Length of time in opioid treatment 10 – 35 yrs
Stable opioid dosage without significant escalation 3mos – 31 yrs


Table 2. Causes of Chronic Pain in This Population (N=100)

Spine disease 51
Arthritis 16
Peripheral neuropathy 14
Headache 10
Knee diseases 5
Abdominal adhesions 5
Hip diseases 4
Shoulder/arm diseases 4
Fibromyalgia 4
113*
*Adds up to more than 100 as some patients had more than 1 diagnosis.


Table 3. Opioids Currently Used by These 100 Patients

No. of Opioids Currently Used N(%)
1 62
2 26
3 12
Opioids Currently Used
Hydrocodone 56
Oxycodone 25
Fentanyl 15
Morphine 13
Methadone 8
Propoxyphene 8
Hydromorphone 5
Other 6


Table 4. Activities and Functions in These 10-Year+ Opioid Patients (N=100)
N(%)
Dress without assistance 82
Attend church/social events 89
Read newspapers, books, magazines 97
Gainful employment 25
Care for family 61
Ambulate unassisted 85
Ambulate with cane 5
Drive a car 74

Discussion

Recent epidemiologic studies indicate that about 10 million Americans now take opioid drugs for chronic pain control. This relatively recent and dramatic occurrence has had little outcome study.1,2 The author recently reported 24 Southern California chronic pain patients who were treated with opioids over 10 years and who had positive social, physical, and functional results.1 Outcomes from other patients treated by other physicians in other geographic areas were needed to confirm or deny the positive outcomes found with one physician in one geographic area. As stated above, this survey was not intended and doesn’t imply that there are patients who may have done as well or better if treated differently. Also this survey does not include patients who did not respond to opioids or stopped them due to complications.

This survey doesn’t lay claim to any sophisticated epidemiogic methodology or randomization. All this survey intended to do was meet one fundamental goal: “Are there chronic pain patients in the United States who have taken opioids over 10 years and report less pain, better function and have a better quality of life?” This survey satisfies this simple goal. 


Conclusion

Patients reported here are functioning quite well after 10 or more years in opioid treatment. The vast majority can care for themselves and even drive. Opioid dosages have generally remained stable for long periods without significant escalation. Given the findings here, there is no obvious reason to discourage opioid use or encourage pain patients to cease opioids.


References
1. Tennant F. A 10-year evaluation of chronic pain patients treated with opioids. Heroin Addict Relat Clin Probl. 2009. 11: 31-34.
2. Portenoy RK, Farrar JT, Bakonjam M, et al. Long term use of controlled-release oxycodone for noncancer pain: results of a 3-year registry study. Clin J Pharm. 2007. 23: 287-299.


https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/opioid-treatment-10-year-longevity-survey-final-report

Thursday, 27 April 2017

New Neuropathy Uses For Old Drugs

Today's short post from fiercebiotech.com (see link below) looks at so-called antimuscarinic drugs, currently used in the treatment of a range of conditions from incontinence to ulcers. Researchers have found that these drugs can block receptors which effectively block nerve regeneration, thus extending and increasing the effects of nerve damage. Antimuscarinic drugs block this action and therefore allow nerve regeneration (at least in mice). With me so far? Possibly not but basically it means that nerve receptors that prevent nerves from re-growing after damage (leading to the lifelong pain most of you feel) can be themselves blocked by drugs currently used for other conditions. Nothing new in the neuropathy world here then - most of the drugs we take to dampen our symptoms, are already used for other things and we suffer the side effects as a result. However, this looks promising because if damaged nerves can be allowed to repair themselves, then the symptoms will theoretically reduce considerably. Hope springs eternal!


Peripheral neuropathy could be reversed by FDA-approved class of drugs
by Amirah Al Idrus Jan 19, 2017 

Scientists from the University of Manitoba and UCSD found that a class of already-approved drugs reversed peripheral neuropathy in mouse models.

Treatments for peripheral neuropathy, the numbness and pain most commonly felt in the fingers, arms and legs due to nerve damage, tend to focus on managing pain. But an international team may have found an alternative approach that could potentially reverse symptoms with a class of drugs already in use for other conditions.

Addressing the underlying condition behind neuropathy—such as diabetes—is a major part of alleviating symptoms, but there is no approved treatment that focuses on nerve degeneration. While studying mechanisms involved in neuron growth and regrowth, scientists from UC San Diego and the University of Manitoba, alongside colleagues from St. Boniface Hospital and the National Institute of Diabetes and Digestive and Kidney Diseases, identified a pathway that stunts the outgrowth of neurites, which connect neurons to other neurons.

The activation of muscarinic acetylcholine receptors inhibits the growth of sensory neurons. The team found that blocking this pathway reversed the effects of peripheral neuropathy in mouse models of Type 1 and 2 diabetes, HIV and chemotherapy-induced neuropathy. Their findings were published in the Journal of Clinical Investigation.

The best part? A number of antimuscarinic drugs, such as atropine and pirenzepine, are already approved and on the market for other indications, ranging from incontinence to peptic ulcers. This could lead to a potentially speedy path to clinical use.

Paul Fernyhough of the University of Manitoba and St. Boniface Hospital, Nigel Calcutt of UC San Diego and Lakshmi Kotra of the University of Toronto have cofounded the company WinSanTor to continue working on this approach.

The biotech has exclusively licensed the technology from the researchers and has come up with a repurposed and reformulated version of an already-approved drug, dubbed WST-057. The candidate has prevented and reversed nerve fiber depletion and sensory loss in animal models of peripheral neuropathy, according to a statement.

“An exciting aspect of this work is that these are new uses for old drugs. They have been used in humans for over 20 years with no serious side effects and have an excellent safety profile. We expect Phase 1 trials to progress smoothly with Phase 2 trials arranged and already funded for 2017,” said Fernyhough in a statement.

http://www.fiercebiotech.com/research/peripheral-neuropathy-could-be-reversed-by-fda-approved-class-drugs

Wednesday, 26 April 2017

Neuromodulation And New Advances In Spinal Cord Stimulation

Today's post from healthandwellnessfl.com (see link below) is an example of what modern clinics and practices can offer in the area of pain relief through electrical spinal stimulation. In this case, they call it 'neuromodulation' but in fact that's just a fancy name for spinal cord stimulation, either through implants or sensory pads. It's certainly an area undergoing massive expansion and development at the moment and as the science improves, more and more people are benefiting from such a therapy. However, it's not for everyone and is pretty expensive, so you really need to do two things before embarking on such  a course: a) talk to your doctor, or better still a neurologist and ask his or her advice as to whether this is appropriate for you and b) do as much of your own research as is humanly possible. Some things sound too good to be true and most of them are but spinal cord stimulation is gaining ground with better scientific knowledge, technical advancement and successful results.

Neuromodulation: An Option for Chronic Neuropathic Pain
By Michelle Heine, PA-C, MMS – Ocala Health Neurosurgical Group

The perception of pain is highly complex not only physiologically but the difference of pain perception between individuals is of great variance. Pain originates primarily from noxious stimuli such as touching a hot stove, being involved in a car accident or spilling acid on the skin. These three examples illustrate the first physiologic process of the perception of pain: transduction. Transduction involves thermal, mechanical or chemical threats to the nervous system, which initiate a cascade of microscopic events leading to the awareness of pain.

Most people would agree that pain subsides as the body heals from injury. This is because primary sensory neurons transmit the signal of pain from the noxious stimulus to the brain by a series of action potentials. When the noxious stimulus disappears so does the perception of pain. But what happens when you are left with pain after you have allowed adequate time for your body to heal? Pain without an inciting injury may be the result of damaged peripheral nerves and/or tissues resulting in neuropathic pain.

Damaged primary sensory neurons may become sensitive to the gentlest touch or may even fire without any provocation. This is because injured peripheral nerves may become hyperexcitable leading to out of proportion action potentials traveling to the brain causing pain without a justifiable source. Leaving the patient uncomfortable, frustrated, confused and without hope for relief after exhausting all known resources.

Neuromodulation has been proven effective for treatment of neuropathic pain. Dating back to the 1960s, neurosurgeon C. Norman Shealy was the first to successfully implant a neuromodulation device resulting in liberation from intractable pain. Dr. Shealy’s spinal cord stimulators also known as dorsal column stimulators have significantly advanced since original development. After fifty years of evolution, spinal cord stimulators have become more efficacious, safe and accepted by the chronic pain population.

You may be thinking, how does a spinal cord stimulator work? A series of electrodes either in the form of a paddle or a percutaneous lead is implanted above the spinal cord into the epidural space by a neurosurgeon and is connected to a battery also known as a pulse generator. The electrodes deliver a low dose electrical current, which modulates nerve activity, hence the name neuromodulation.

Before permanent implantation, the patient must first pass a spinal cord stimulator trial. This involves sterile placement of electrodes via percutaneous leads performed by a fellowship-trained anesthesia pain physician, physiatrist or neurosurgeon. The leads are secured to the patient’s back by an adhesive dressing and are connected to an external battery also known as an IPG. Working with the patient’s own clinical specialist, different programs are utilized to provide maximum relief from stimulation. After the trial is complete, the patient will be evaluated for determination of trial success. If the trial is deemed successful, permanent implantation will be scheduled.

The patient generally waits a period of time to heal between the trial and permanent implantation. The surgery is fairly quick and straightforward. A permanent lead will be placed in the epidural space of the thoracic spine and the connecting wires are tunneled underneath the skin to the battery site. Incisions are usually closed with dissolvable sutures and special surgical glue. There is typically no need to have sutures or staples removed after surgery. The spinal cord stimulator will not be turned on until two weeks after surgery to ensure proper scarring of the lead placement. The patient must refrain from bending, lifting greater than ten pounds or twisting six weeks post operatively. After six weeks, the patient is released to full activity without restrictions.

Spinal cord stimulators are easily portable with the controller usually the size of an iPhone. The patient may go about their normal routine without having to stop to take a pill in order to experience adequate pain relief. Thus improving quality of life, functionality and mood.

Neuromodulation is not limited to spinal cord stimulation. Deep brain stimulation known as DBS is FDA-approved to treat essential tremor, Parkinson’s disease and dystonia. Vagal nerve stimulation is used to treat obesity, asthma, seizures, and may even be trialed for heart failure. Sacral nerve stimulation is used to treat incontinence and pelvic ailments. Intrathecal pain pumps are used to deliver low-dose medications directly to the source of pain perception, reducing the need for high-dose oral medications.

Neuromodulation is continually advancing with new technology emerging on a daily basis. Currently, scientists are working on a neuromodulatory system utilizing thought to produce movement via a computer, especially appealing to motor-impaired patients. Neuromodulation offers another chance to those who have failed multiple treatment options who present with neuropathic pain.

Ocala Health Summerfield ER 14193 S US HWY 441 Summerfield, FL 34491

http://healthandwellnessfl.com/neuromodulation-an-option-for-chronic-neuropathic-pain/

Tuesday, 25 April 2017

Can Statins Damage Your Nervous System? (Vid)

Today's post from articles.mercola.com (see link below) returns to a subject not recently covered on this blog but is one that nevertheless shouldn't be ignored by people living with neuropathy or high cholesterol, or both. It has long been known that statin drugs used (effectively it must be said) to reduce cholesterol levels, can damage nerves as a result. Sensible doctors advise their neuropathy patients not to take statins in case their nerve damage worsens but the fact remains that far too many cases of statins causing neuropathy in the first place, should make both doctor and patient seriously question whether those drugs are a sensible option. There are, after all, other ways of reducing cholesterol. This article takes a very definite line and should be a beginning to your research and discussions with doctors, rather than a definitive advice that you must follow. Nevertheless, if you Google 'statins and neuropathy' you will find hundreds of articles, many of which advising against statin use if at all possible. The problem is that it's a very successful drug for pharmaceutical companies - need I say more! An interesting article, definitely worth a read if your doctor is suggesting you start (or continue) taking statins - as with all drugs; there are always side effects. By using the search button here on the blog, you can access other articles on the same subject.


Is Nerve Damage The Rule, Not the Exception With Cholesterol Meds?
By Dr. Mercola
January 25, 2012

Spending on cholesterol-lowering drugs like statins increased by $160 million in 2010, for a total spending of nearly $19 billion in the U.S., the IMS Institute for Healthcare Informatics reported in their Use of Medicines in the United States: Review of 2010.

In all, more than 255 million prescriptions were dispensed for these drugs in 2010, making them the most commonly prescribed type of medication in the United States.

Unfortunately, this excessive use is an artifact of a medical system that regards prescribing pills to lower cholesterol as a valid way to protect one's heart health -- even though the low "target" cholesterol levels have not been proven to be healthy … and cholesterol is actually NOT the underlying culprit in heart disease.

Worse still, these drugs, which are clearly not necessary for the vast majority of people who take them, are proven to cause serious and significant side effects, including, as new research shows, definite nerve damage.


Are You Taking Drugs You Don't Need … and Getting Nerve Damage as a Result?

It must be understood that any time you take a drug there is a risk of side effects.

Oftentimes, these risks are not fully understood, especially when multiple drugs enter the equation, and appear only after a drug has already been taken by millions of people.

Even once a drug has been FDA-approved, you are depending on a limited number of clinical trials to dictate a drug's safety … but it's impossible to predict how a drug will react when introduced into your system, in a real-world setting.

Not to mention, the accuracy of medical research is dubious at best.

In many ways, any time you take a drug YOU are the guinea pig, and unforeseen side effects are the rule, rather than the exception. In terms of statin drugs, side effects are already clearly apparent; at GreenMedInfo.com you can see 304 conditions that may be associated with the use of these drugs, and this is likely only the tip of the iceberg. Among one of the more well-known risks is harm to your muscles and peripheral nervous system with long-term use. Indeed, new research on 42 patients confirmed that:

" … long-term treatment with statins caused a clinically silent but still definite damage to peripheral nerves when the treatment lasts longer than 2 years."


If You Take Statins for Two Years or More, Nerve Damage Appears to be the Rule


What does it mean when you sustain damage to peripheral nerves? As reported by the National Institute of Neurological Disorders and Stroke (NINDS):

"Symptoms are related to the type of affected nerve and may be seen over a period of days, weeks, or years. Muscle weakness is the most common symptom of motor nerve damage. Other symptoms may include painful cramps and fasciculations (uncontrolled muscle twitching visible under the skin), muscle loss, bone degeneration, and changes in the skin, hair, and nails."

At GreenMedInfo.com you can see 88 studies on statin-induced neurotoxicity (nerve damage), with12 studies further statin drugs directly to neuropathy, including chronic peripheral neuropathy. As explained by NINDS:

"Peripheral neuropathy describes damage to the peripheral nervous system, the vast communications network that transmits information from the brain and spinal cord (the central nervous system) to every other part of the body. Peripheral nerves also send sensory information back to the brain and spinal cord, such as a message that the feet are cold or a finger is burned. Damage to the peripheral nervous system interferes with these vital connections. Like static on a telephone line, peripheral neuropathy distorts and sometimes interrupts messages between the brain and the rest of the body.

Because every peripheral nerve has a highly specialized function in a specific part of the body, a wide array of symptoms can occur when nerves are damaged.

Some people may experience temporary numbness, tingling, and pricking sensations (paresthesia), sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. People may become unable to digest food easily, maintain safe levels of blood pressure, sweat normally, or experience normal sexual function. In the most extreme cases, breathing may become difficult or organ failure may occur.

Some forms of neuropathy involve damage to only one nerve and are called mononeuropathies. More often though, multiple nerves affecting all limbs are affected-called polyneuropathy."

One of the more disturbing implications of this finding is that since statins damage the peripheral nerves, it is also highly likely that they damage the central nervous system (which includes the brain), as well. One study published in the journal Pharmacology in 2009, found statin-induced cognitive impairment to be a common occurrence, with 90% reporting improvement after drug discontinuation. There are, in fact, at least 12 studies linking memory problems with statin drug use in the biomedical literature, indicating just how widespread and serious a side effect statin-induced neurological damage really is.


Lower Your Cholesterol and Increase Your Diabetes Risk by Nearly 50%

As mentioned, neurological damage is only one potential risk of statins. They are also being increasingly associated with increased risk of developing diabetes.

Most recently, a study published in the Archives of Internal Medicine revealed statins increase the risk of diabetes for postmenopausal women by 48 percent! Statins appear to provoke diabetes through a few different mechanisms, the primary one being by increasing your insulin levels, which can be extremely harmful to your health. Chronically elevated insulin levels cause inflammation in your body, which is the hallmark of most chronic disease. In fact, elevated insulin levels lead to heart disease, which, ironically, prevention of is the primary reason for taking a statin drug in the first place!

As written on GreenMedInfo:

"The profound irony here is that most of the morbidity and mortality associated with diabetes is due to cardiovascular complications. High blood sugar and its oxidation (glycation) contribute to damage to the blood vessels, particularly the arteries, resulting in endothelial dysfunction and associated neuropathies due to lack of blood flow to the nerves. Statin drugs, which are purported to reduce cardiovascular disease risk through lipid suppression, insofar as they contribute to insulin resistance, elevated blood sugar, and full-blown diabetes, are not only diabetogenic but cardiotoxic, as well."

A separate meta-analysis has also confirmed that statin drugs are indeed associated with increased risk of developing diabetes. The researchers evaluated five different clinical trials that together examined more than 32,000 people. They found that the higher the dosage of statin drugs being taken, the greater the diabetes risk. The "number needed to harm" for intensive-dose statin therapy was 498 for new-onset diabetes -- that's the number of people who need to take the drug in order for one person to develop diabetes.

In even simpler terms, one out of every 498 people who are on a high-dose statin regimen will develop diabetes. (The lower the "number needed to harm," the greater the risk factor is. As a side note, the "number needed to treat" per year for intensive-dose statins was 155 for cardiovascular events. This means that 155 people have to take the drug in order to prevent one person from having a cardiovascular event.)

The following scientific reviews also reached the conclusion that statin use is associated with increased incidence of new-onset diabetes:
A 2010 meta-analysis of 13 statin trials, consisting of 91,140 participants, found that statin therapy was associated with a 9 percent increased risk for incident diabetes. Here, the number needed to harm was 255 over four years, meaning for every 255 people on the drug, one developed diabetes as a result of the drug in that period of time.
In a 2009 study, statin use was associated with a rise of fasting plasma glucose in patients with and without diabetes, independently of other factors such as age, and use of aspirin or angiotensin-converting enzyme inhibitors. The study included data from more than 345,400 patients over a period of two years. On average, statins increased fasting plasma glucose in non-diabetic statin users by 7 mg/dL, and in diabetics, statins increased glucose levels by 39 mg/dL. 


Side Effects Often Don't Show Up Immediately …

Oftentimes statins do not have any immediate side effects, and they are quite effective at lowering cholesterol levels by 50 points or more. This makes it appear as though they're benefiting your health, and health problems that develop later on are frequently misinterpreted as brand new, separate health problems.

Again, the vast majority of people do not need statin drugs, and if you are one of them, taking them is only going to expose you to serious, unnecessary risks!

If your physician is urging you to check your total cholesterol, please be aware that this test will tell you virtually nothing about your risk of heart disease, unless it is 330 or higher. HDL percentage is a far more potent indicator for heart disease risk. Here are the two ratios you should pay attention to:
HDL/Total Cholesterol Ratio: Should ideally be above 24 percent. If below 10 percent, you have a significantly elevated risk for heart disease.
Triglyceride/HDL Ratio: Should be below 2.

To understand why most people don't need a statin drug, you first need to realize that cholesterol is NOT the cause of heart disease. Your body NEEDS cholesterol -- it is important in the production of cell membranes, hormones, vitamin D and bile acids that help you to digest fat. Cholesterol also helps your brain form memories and is vital to your neurological function. For more information about cholesterol, and why conventional advice to reduce your cholesterol to ridiculously low levels is foolhardy, please listen to this interview with Dr. Stephanie Seneff.



Urgent Information: If You Take Statins You Need CoQ10

It's extremely important to understand that taking a statin drug without also taking CoQ10 puts your health in serious jeopardy. Unfortunately, this describes the majority of people who take them in the United States.

CoQ10 is a cofactor (co-enzyme) that is essential for the creation of ATP molecules, primarily in your mitochondria, which you need for cellular energy production. Organs such as your heart have higher energy requirements, and therefore require more CoQ10 to function properly (cardiac muscle cells have up to 200 times more mitochondria, and hence 200 times higher CoQ10 requirements, than skeletal muscle). Statins deplete your body of CoQ10, which can have devastating results.

As your body gets more and more depleted of CoQ10, you may suffer from fatigue, muscle weakness and soreness, and eventually heart failure. Interestingly, heart failure, not heart attacks, is now the leading cause of death due to cardiovascular diseases. Coenzyme Q10 is also very important in the process of neutralizing free radicals. So when your CoQ10 is depleted, you enter a vicious cycle of increased free radicals, loss of cellular energy, and damaged mitochondrial DNA.

If you decide to take a CoQ10 supplement and are over the age of 40, it's important to choose the "reduced" version, called ubiquinol. The reduced form is electron-rich and therefore can donate electrons to quench free radicals, i.e. function as an antioxidant, and is much more absorbable, as nutrients must donate electrons in order to pass through membrane of cells. In other words, ubiquinol is a FAR more effective form -- I personally take 200 mg a day since it has such far-ranging benefits, including compelling studies suggesting improvement in lifespan.


How to Optimize (Not Necessarily Lower) Your Cholesterol Without Drugs

Seventy-five percent of your cholesterol is produced by your liver, which is influenced by your insulin levels. Therefore, if you optimize your insulin level, you will automatically optimize your cholesterol! By modifying your diet and lifestyle in the following ways, you can safely modify your cholesterol without risking your health by taking statin drugs:
Reduce, with the plan of eliminating, grains and sugars in your diet, replacing them with mostly whole, fresh vegetable carbs. Also try to consume a good portion of your food raw.
The average American consumes 50% of their diet as carbs. Most would benefit by lowering their carb intake to 25% and replacing those carbs with high quality fats.
Make sure you are getting enough high quality, animal-based omega 3 fats, such as krill oil.
Other heart-healthy foods include olive oil, palm and coconut oil, organic raw dairy products and eggs, avocados, raw nuts and seeds, and organic grass-fed meats, as described in my nutrition plan.
Exercise daily.
Avoid smoking or drinking alcohol excessively.
Be sure to get plenty of good, restorative sleep.

The goal of the tips above is not to necessarily lower your cholesterol as low as it can go; the goal is to optimize your levels so they're working in the proper balance with your body.

http://articles.mercola.com/sites/articles/archive/2012/01/25/nerve-damage-with-cholesterol-meds.aspx

Monday, 24 April 2017

Can A Foot Massage Apparatus Bring Relief For Neuropathic Feet?

Today's post from foottherapy.net (see link below) is an unashamed advert for foot massagers but it is directed at neuropathy sufferers and is more of a review than an advertisement. In these days when electrical gadgets swamp our discount stores and nerve damage patients are desperately looking for anything that may bring relief to their long-suffering feet, it's important to have some idea of what may be a waste of money and what may actually help. This article reviews a number of foot massage machines and gives an honest appraisal of what they can and can't do. It also warns of potential dangers of such machines, especially to people with extensive numbness, and as such is a useful guide. There are hundreds of these machines on the market, so having an idea of what might be best for you may save you time and money.

Best Foot Massagers for Diabetic Peripheral Neuropathy

April 2017



MedMassager MMF06 11 Speed Foot Massager


Great warranty options to make sure your device will last
Although it doesn’t have a heat option, the increased blood circulation on your feet brought by the strong oscillation makes you feel like you’re being treated with infrared heat.
The oscillation produce a better blood flow not just in your feet but also towards your legs
The variable speed is really useful to adjust intensity
Can be used with your shoes on
More powerful than anything else out there
Built-in arch-bar for toes or heels.

Higher price point
Heavier and bulkier, can get a bit loud
No remote control

This foot massager is best suited to those suffering severe foot/leg pain, serious circulation issues, and pain or cramps resulting from neuropathy or diabetes. The price point is higher than conventional foot massagers used for relaxation but as this is meant for therapeutic use, we think the price tag is more than justified.




Brookstone 839379 Shiatsu Foot Massager with Heat


Brand known for high quality products
Good array of settings and options
Provides deep kneading massage.
Works with air compressions.
Improves circulation.
Available with washable protective covering.
Heating option is available for additional relief.
Easy to store.
Built-in cord is retractable.

May not fit large feet.
Pricey as compared to competitors
Heat function may not be up to the mark.
The massager makes a squishy noise at times and this can put off some users.

Brookstone is well known for providing quality products and often include good warranty programs. The machine will knead and massage the tops and bottoms of the feet, has settings to increase pressure, and has a heat setting that is not overly hot. The Shiatsu Foot Massager is one of the easiest and most convenient massagers available in the market today. It’s a bit pricey, but the results are definitely satisfactory. This is a must-have for anyone who is not on a tight budget.




3Q MG-F18 Foot Massager with Shiatsu, Kneading, Air pressure massage and Heat Function


The foot massager can reach all pressure points of your feet and ankles. This can help improve blood circulation and relive foot pain.
The intensity of the massager can be adjusted in several ways.
The air pressure can be adjusted for light rubbing. This can enable you to get the correct pressure for the massage.
Compressed air enables you to enjoy uninterrupted foot massage.
Heating feature is a valuable addition.
Lightweight and compact. This makes it portable and easy to store.
The cover on the massager makes it easy to clean and maintain.
Affordable price.

The major drawback is that it is slightly smaller than the standard U.S shoe sizing.
The combined air pressure and kneading may be a bit intense for people with sensitive feet.
The sides of the feet and heal are not properly covered in the massage.
It does not have a remote that you can use to operate it easily. The controls are on the massager and you need to access them to operate the device.


Often compared to the more expensive models that are very similar, the 3Q MG-F18 Foot Massager with Heat, Kneading Shiatsu Air Pressure Massager is a less expensive product that offers heating and pressure settings. This model accommodates most foot sizes, but does require looking into for individuals with larger feet. As an added bonus, people who have encountered customer service give stellar reports. The massage settings do not offer the full range of options that some of the more expensive options do, though this may not be an issues for some. Based on the available reviews, the 3Q MG F18 Foot Massager is the best alternative to the more expensive models, and is a quality product that comes with the assurance of exceptional customer service.




uComfy Shiatsu Foot Massager

Different intensity levels.
Multiple functions provide optimum relaxation.
Good heating system.
Easy to clean and maintain.
Lightweight and portable.
Fits large feet.

Ankles and calves are not properly covered in the massage.
No remote control. The controls on the massager can be assessed only by hand and this can be uncomfortable when you are enjoying a good massage.
Not durable.

The uComfy Shiatsu Foot Massager 2.0 has a sleek design and offers many of the same features as the more expensive Brookstone product. This massager will work for the majority of foot sizes, typically up to a size 14 mens. The massage settings include numerous levels of strength and offer a deeper massage than some of the less expensive products on the market. The heat setting is ideal and is not overly hot, lessening the chance for damage due to lack of feeling in the feet. This product does not have a remote control, which can make it difficult to turn on and off for users with limited mobility. The highest setting on the massager can be quite intense, and it is important for users to begin on the lower settings to determine the correct level for them. There are some reports that this product does not continue to work after fairly short periods of time, which can be a major downfall. The uComfy Shiatsu Foot Massager 2.0 is not of the same quality as other products, and may not be the best option for the price.



Homedics Deep Kneading Shiatsu Foot Massager

This device can be easily plugged into any 120V outlet, thus it is portable and can be brought anywhere with ease.
You can use this product anywhere, at home or even in a quiet office as it is superbly quiet.
This device is very light and it weighs only 6.8 pounds, so, you can comfortably use it to massage your aching neck or lower back muscles.

The position of this foot massager cannot be adjusted, some users have to use other materials to support it to be in the best position to get the best massage result.
This product is not recommended to be used by you if you have diabetes or if you have very high arches.
Customers with ticklish or sensitive feet usually found this product as too rough for their preference.

This massager is perfect for anyone who is suffering from terrible aching feet. The 6 rotating massagers can do wonders by massaging all of the pain and tension from your footpad while the heating can rejuvenate you. To add it up, it is light and quiet, thus, you can use it anywhere you want, may it be in the office or at home. The call is yours.


 

Many individuals who suffer from the condition of peripheral neuropathy report that foot massage can provide significant relief from the pain that can be associated with it. Thankfully, there are a variety of at home foot massagers that offer the ability to find relief in the comfort of one’s own home. These massagers are made by a variety of manufacturers, and are available in a wide range of prices to accommodate almost any budget. There are a variety of potential benefits associated with daily foot massage, which can be difficult to do outside of one’s home. This article covers how peripheral neuropathy causes pain and discomfort and the ways in which foot massagers can be beneficial, and also offers reviews of numerous products available on the market from a variety of manufacturers. If you are considering the use of an at home foot massager to address your peripheral neuropathy, you will want to consider the information available here.

What is Diabetic Peripheral Neuropathy?

The National Institutes of Health estimate that a significant number of people have some form of peripheral neuropathy. This condition occurs as the result of damage to the nervous system, which is responsible for transmitting information throughout the body. The term neuropathy refers to damage or disease that occurs within the nervous system, and the term peripheral identifies that the condition is occurring outside of the central nervous system (the brain and spinal cord). There is research and evidence to suggest that massage therapy and the use of at home foot massagers can provide relief from symptoms and promote the general health of the feet.


How Can Foot Massagers Help Relieve Diabetic Peripheral Neuropathy?

Massage therapy is considered to be complimentary or alternative treatments, and is increasingly used as a standard form of treatment for a wide variety of medical conditions including peripheral neuropathy. More research on the effectiveness of massage therapy is necessary, but there is evidence to suggest there are many benefits to forms of massage treatment. Studies suggest massage therapy can be beneficial for a variety of conditions, including various issues related to peripheral neuropathy including paresthesia, nerve pain, joint pain, improved circulation, and enhanced lymph flow through the body.

While the greatest benefits of massage are likely to be experienced when visiting a licensed professional, there are many foot massagers on the market that can provide similar relief. There are numerous options and settings available including; vibration and deep massage, heat therapy, and pressure settings. Vibration and deep massage can help stimulate circulation which promotes the overall health of the foot and reduces discomfort from neuropathy. Pressure may also help improve circulation and can help reduce the nerve pain associated with with peripheral neuropathy. Depending on the severity of the condition, the addition of heat may also provide relief from the symptoms.


Potential Benefits of Foot Massagers

-Increases energy and willingness to engage in exercise and activities

-Relieves stress, and reduces pain

-Improves blood flow and overall circulation

-Improves lymph flow and circulation

-Helps prevent the potential for injury associated with peripheral neuropathy
Common features of the various foot massagers available

–Electric or Self-Massaging: there are electric massagers available with a variety of settings that allow you to relax and rest your feet while being massaged, and there are also massagers that you use through the motions and rotations of your feet which can itself promote use and circulation through motion and light exercise.

–Heating: a common feature of many of the electronic foot massagers may help provide relief and promote circulation and reduce the painful sensations.

–Kneading or Oscillating: massaging action can benefit and stimulate the nerves in the feet, and typically promotes better circulation.

–Applied Pressure: pressure settings may reduce pain and can also promote circulation of blood flow in the feet.

–Position Design: depending on the intended use, the various massagers may work on only the bottoms of the feet, the entire foot, or even parts of the lower legs. Each model allows for different body positioning which may be important depending on an individual’s mobility and comfortable sitting or standing position.


Potential Risks of Massagers for Diabetic Peripheral Neuropathy

Using heat can be dangerous if there is a lack of sensation in the feet, as there is the potential to accidentally burn the skin without immediately noticing. Vigorous or deep massage can also lead to issues related to circulation, particularly for individuals who already have conditions of the circulatory system. If you intend to use an at home massage therapy to help with peripheral neuropathy it is best to consult with your physician or medical provider to ensure the appropriateness of this option for you.

http://www.foottherapy.net/best/treatments/diabetic-peripheral-neuropathy/diabetic-foot-massagers/

Sunday, 23 April 2017

Thyroid Hormone Problems And Nerve Damage

Today's short post from mayoclinic.org (see link below) follows up on an earlier post this week concerning thyroid gland problems and the links with neuropathy. The article rightly points out that neuropathy as a result of thyroid hormone under-production is relatively uncommon but nevertheless with thyroid problems now becoming easier to diagnose, there are more and more cases of nerve damage emerging as a result. As with many forms of neuropathy, damage to the nerves because of hypothyroidism, is often the last link in a whole chain of diagnoses that begins with symptoms of another condition or problem. That it remains relatively rare may be because it is so rarely diagnosed as other illnesses take priority. This article just touches the surface really and if you suspect, or are told that you have thyroid hormone problems, it may be worth talking to the doctor about any other symptoms of neuropathy you may have noticed. That discussion alone may cut corners, get more quickly to the nub of the problem and save a lot of time.

Can hypothyroidism cause peripheral neuropathy and, if so, how is it treated? 
Answers from Todd B. Nippoldt, M.D.  March 29, 2017 

Hypothyroidism — a condition in which your thyroid gland doesn't produce enough thyroid hormone — is an uncommon cause of peripheral neuropathy.

Peripheral neuropathy is damage to your peripheral nerves — the nerves that carry information to and from your brain and spinal cord (central nervous system) and the rest of your body, such as your arms and legs.

Peripheral neuropathy may be caused by severe, long-term, untreated hypothyroidism. Although the association between hypothyroidism and peripheral neuropathy isn't fully understood, it's known that hypothyroidism can cause fluid retention resulting in swollen tissues that exert pressure on peripheral nerves.

One of the more common areas this occurs in is the wrists, because the nerve serving the hands goes through a "tunnel" of soft tissue, which can swell, pressing on the nerve, resulting in carpal tunnel syndrome. The vast majority of carpal tunnel syndrome cases are not due to hypothyroidism, but this would be the most likely area for this to occur with hypothyroidism.

Signs and symptoms of peripheral neuropathy may include pain, a burning sensation, or numbness and tingling in the area affected by the nerve damage. It may also cause muscle weakness or loss of muscle control.

See your doctor if you know or suspect you have hypothyroidism and you're having troubling or painful symptoms in your limbs.


Treatment


Treatment of peripheral neuropathy due to hypothyroidism is directed at managing the underlying hypothyroidism and treating the resulting symptoms. This may include:
Levothyroxine (Synthroid, Unithroid, others), which is a medication for hypothyroidism that often improves the symptoms of neuropathy
Exercising and maintaining a healthy weight, which can help minimize stress on your body as well as strengthen affected limbs

http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/expert-answers/hypothyroidism/faq-20058489

Saturday, 22 April 2017

Neuropathy! Never Heard Of It? Well Now You Have

Today's post from post-gazette.com (see link below) is an excellent newspaper report of the state of neuropathy at the present time. With the use of individual case studies, the article describes neuropathy very accurately (although the statistic of 40 million Americans with neuropathy may be a little far-fetched - the most accepted figure is 20 million but hey, who's counting - one is too many!) Accurate reporting about nerve damage and the pain it brings is hard enough to find so an unbiased report like this is extremely valuable. It allows people living with the disease to feel a little better that they are not alone in feeling how they do and it educates a wider public, most of whom have no clue what neuropathy is. Hopefully it also helps stimulate the medical powers-that-be to work harder in researching the disease and finding an effective treatment. A cure is too much to hope for but an effective treatment of the symptoms must surely be within reach. Definitely worth a read.


Neuropathy affects millions with no guarantees from treatments
David Templeton Pittsburgh Post-Gazette dtempleton@post-gazette.com Sep 13, 2016

Five years ago when Harold Frazier reached 220 pounds and flirted with diabetes, he took to walking 10 miles a day and shed 30 pounds, returning his blood sugar levels to normal.

Problem solved. Or so he thought.

Unexpectedly one day Mr. Frazier, now 63, was unable to lift his foot to the curb. In time, his feet began feeling numb with burning sensations upon awakening each morning and eventual decline in leg and arm function. Today he says he has about 40 percent function of his limbs, forcing his retirement as a maintenance man at the Irwin townhouse complex where he lives.

“Every time I move when I’m asleep I wake up, and I’m lucky to get four hours of sleep a night — and that’s a great night,” Mr. Frazier said, noting he no longer can raise his arms above his head.

“If I am arrested, and they say, ‘Stick ’em up,’ they’ll have to shoot me because I can’t,” he said. “I have lost all the power in my arms.”

Arresting the pain

Mr. Frazier and 40 million other Americans struggle daily with peripheral neuropathy. Initial symptoms typically involve numbness in the feet or hands and may affect other parts of the body such as internal organs. Over time the person can experience sensations of burning, freezing, throbbing or even shooting pain that’s often worse at night, the Foundation for Peripheral Neuropathy reports.

Surprising perhaps is the fact that 70 percent of people with diabetes and up to 40 percent of those who undergo chemotherapy develop painful neuropathy with no cure and limited if any effects from major treatments including Lyrica and Cymbalta, among other drugs.

Alternative treatments exist, each with advocates. But for most people, neuropathy can hinder daily quality of life, preventing activity and exercise, a good night’s sleep and a pain-free existence.

“The pain can be either constant or periodic, but usually the pain is felt equally on both sides of the body — in both hands or in both feet,” according to the foundation website (foundationforpn.org).

Erin Kershaw, chief of the division of endocrinology and metabolism at the University of Pittsburgh and UPMC, said once you develop neuropathy it is difficult to reverse, so prevention is key, especially given that diabetes and alcohol consumption are common but preventable causes.

“Small nerve-fiber burning is extremely uncomfortable,” she said, describing the effects of nerve damage. “It can feel like your feet are on fire all the time,” requiring pain therapies that may have limited impact on reducing pain levels.

Numbness also can result in foot injuries the person may not be aware of due to lack of feeling. This may result in ulceration that’s hard to treat, sometimes leading to amputations. Dr. Kershaw said prescribed drugs do help a substantial number of patients but usually do not eliminate all of the discomfort.

“Neuropathy is a problem that requires more awareness and more research,” she said. “When you see a patient, you are hurting inside because you know the existing therapy is not helping them with pain that’s there every day.”

Cause and effect


About 60 percent of all cases of neuropathy involve diabetes, with chemotherapy-induced neuropathy responsible for about a quarter of all cases and idiopathic neuropathy (where a cause isn’t identified) representing about 10 percent. HIV/​AIDS, repetitive stress, alcohol abuse, inflammatory response, carpel tunnel syndrome, autoimmune diseases and vitamin deficiencies, among others, can cause or contribute to the condition. The American lifestyle and diet also can contribute to and worsen symptoms, studies indicate.

“If nerves are dead, they’re dead,” said Marlene Dodinval, the Foundation for Peripheral Neuropathy’s senior program coordinator. “There is nothing you can do about it.”

The foundation held an international research symposium last week, during which cannabis was discussed as a treatment. It also is working with eight universities nationwide to create a peripheral neuropathy research registry and create a database of patients available for research.

“Neuropathy is an ignored condition,” Ms. Dodinval said. “There is work underway around the world, and more needs to happen.”

The U.S. Food and Drug Administration has approved only pregabalin (Lyrica) and duloxetine (Cymbalta) as treatments for diabetes neuropathy, according to a study update published last month in the American Family Physician journal.

Other nerve-pain and antidepression drugs can serve as second-line drugs with third-line drugs that include opioids. Other treatments include topical creams, sprays and patches including lidocaine, with transcutaneous electrical nerve stimulation providing relief for some, it says.

The update found insufficient evidence to support acupuncture, chiropractic procedures, laser treatments, full-body vibration, electromagnetic field application, and such supplements as alpha lipoic acid, acetyl-l-carnitine and primrose oil. The supplements are championed by some patients with some supportive research.

Ms. Dodinval said some people swear by creams and supplements of capsaicin, an active ingredient in chili peppers.

Relief via support groups

With few effective treatments, Mr. Frazier joined the Pittsburgh Area Peripheral Neuropathy Support Group that meets the third Wednesday of each month April through October at the Brush Creek Evangelical Lutheran Church in Irwin. Members discuss treatments, exchange tips and listen to scheduled speakers.

Bill Wilshire, 70, of North Huntingdon faces his own issue with neuropathy, the exact cause of which is unknown. It began when he kept feeling his socks bunching up under his toes. Pulling up those socks never helped because they weren’t actually bunched up.

Eventually the altered feeling of his toes turned to numbness that affected his balance, eventually jeopardizing his ability to walk. But the retired social studies teacher says he’s one of the lucky ones because he feels numbness but little pain.

Another member, Gerry Getman, 69, of Peters, was undergoing chemotherapy in 2008 for multiple myeloma that’s in remission when he began feeling tingling in his toes and hands. He expected it to go away, as sometimes occurs with chemo-induced neuropathy. But his tingling progressed into pain and burning in his feet, especially at night.

In time, he, too, lost feeling in his legs, reducing his ability to walk without assistance. Now the retired entrepreneur with a doctoral degree in chemistry says he’s 50 percent disabled and controls the discomfort in his arms and legs by keeping his mind occupied.

“I would describe it as fairly severe,” he said. “I have it 24/​7, but it’s always more intense when my mind is not occupied. I actually try to get pretty close to exhausted. I work on the computer until midnight or 1 in the morning so that I can drift off to sleep.

“I think mine has stabilized, and I’ve developed a lifestyle to deal with it quite effectively,” he said. “I mean, you have to. Life goes on.”

David Templeton: dtempleton@post-gazette.com or 412-263-1578.

http://www.post-gazette.com/news/health/2016/09/13/Neuropathy/stories/201609070171?pgpageversion=pgevoke

Friday, 21 April 2017

Can Hypnosis Help With Nerve Pain?

Today's post from painpathways.org (see link below)deals with a question that millions of neuropathy patients must have asked themselves at some point or other, when their medication fails to bring relief. Could hypnotherapy help? Let's face it, nerve damage is universally misunderstood and underestimated; there's no cure and the medications are limited in their effectiveness at best. We've exhausted the supplement and alternative therapy routes and we're bombarded by a media that hounds us as being opium-soaked drug addicts and parts of a world-wide, drug abuse problem. That sort of stress alone could lead us to hypnotherapy, if only to  believe that we still have some self-worth. However, can hypnosis genuinely provide an alternative (or supplementary) pain relief from our jangling nerves? This readable article provides lots of useful information about hypnosis and while it doesn't really go into the scientific evidence, it gives a compelling case for being open-minded (literally!) and giving it a try. of course, for every genuine hypnotherapist, there are a thousand fakers out there who are only to happy to separate you from your hard-earned cash, so get some advice and do your own research as thoroughly as you can. There are hypnotists who work within national health authorities; there are witch doctors and there are well-meaning people who are just about as effective as witch doctors: finding a genuine practitioner may be a minefield but it may also be worth the effort.

Does Hypnosis Work for Pain Management?
by Pain Pathways Magazine | Apr 14, 2017

Mind over matter…a phrase we’ve all heard before. It is typically interpreted to mean that we can use our mind to overcome a situation or even physical condition. For pain sufferers, does this mean that a technique such as hypnosis could help overcome the feeling of pain?

Most of us have preconceived notions of hypnosis and primarily consider it a form of entertainment for the enjoyment of an audience rather than a medical technique. However, hypnosis for pain management has more validity than most people realize – and it may be effective for you.


Origins of hypnosis

Many would be surprised to learn that hypnosis goes back to the biblical age, with evidence of hypnosis dating as early as 1500 BC. During ancient times, mystical practices including “dream temples” and “hypnos” – used by the Egyptians and Greeks – were often a part of the treatment of physical ailments. Over the centuries, hypnosis came and went in various forms and was even used as anesthesia until chloroform began being used in 1831.

By the 20th century, Dr. Milton Erickson’s version of hypnosis was becoming more conventional accepted and used in clinical psychotherapy. Ericksonian hypnosis stressed the importance of the interactive therapeutic relationship and engagement of the patient, rather than a therapist issuing standardized instructions to a passive patient.

As Dr. Erickson was becoming known as world’s leading hypnotherapist, reports describing hypnotic strategies for chronic pain management emerged. In the 1950s, hypnosis reports and the release of biofeedback technology grew in tandem, with the next few decades bringing knowledge about the stress response and its effects on an individual’s physiology. Studies were conducted investigating the effectiveness of both tools in the treatment of chronic pelvic pain, headaches, lower back pain and other pain conditions.


Explaining hypnosis

By definition, hypnosis is a set of techniques designed to enhance concentration, minimize one’s usual distractions and heighten responsiveness to suggestions to alter one’s thoughts, feelings, behavior or physiological state. It not a treatment but rather a procedure that can be used to facilitate other types of therapies and treatments.

Hypnosis involves learning how to use your mind and thoughts to manage emotional distress, unpleasant physical symptoms such as pain and certain behaviors like smoking over overeating.

For pain therapists, hypnosis focuses on the relationship between the mind and body and is considered mainstream. For health professionals in other fields, they may be considered alternative or complementary therapies. Clinical, or medical hypnosis is an altered state of awareness used by licensed therapists to treat psychological or physical problems.
How does hypnosis work?

During hypnosis, the conscious part of the brain is temporarily tuned out as a participant focuses on relaxing and letting go of distracting thoughts. By making his/her mind more concentrated and focused, a participant is able to use it more powerfully. A good analogy is that it’s like using a magnifying glass to focus the rays of the sun and make them more powerful.

So, what is hypnosis like?

When under hypnosis, a person may experience physiologic changes. It’s common for their pulse and respiration to slow down and their alpha brain waves to increase. In this altered state, a person may become more open to specific suggestions and goals offered by the therapist, such as reducing pain. After this suggestion phase, the therapist reinforces continued use of the new behavior or mindset.

For everyone, the experience is a little different. Some people describe their experience as a “trance-like” state. Others may experience it as imagery or the soothing of body sensations. Most people describe hypnosis as pleasant, where they feel focused and absorbed in the experience. They tend to have an acute awareness, but also feel relaxed, comfortable and peaceful.


Hypnosis techniques for pain management

Hypnosis treatment for pain conditions typically consists of 4 stages:


Induction – to focus one’s attention
Deepening – to deepen one’s relaxation of the body
Suggestions – for changes in the client’s experience of pain
Debriefing – to go over what transpired

Beyond taking a participant through these common stages, a therapist may employ varying approaches. They may focus on changing the sensations from pain to something else or on shifting the patient’s attention away from the pain. When underlying dynamics, motivations or unresolved feelings are influencing pain, hypnosis can help the participant unconsciously explore these things and get some resolution for the underlying issues.

Another technique being used for decreasing the sensitivity to pain is hypnoanalgesia. The goal here is to use hypnosis in place of an analgesic in hospitals during surgery to reduce nausea, pain, vomiting and the length of hospital stay. What began as somewhat anecdotal, positive results for hypnoanalgesia has now been supplemented by well-controlled experiments.


Common myths about hypnosis

Hypnosis can’t do everything. There are many myths, misconceptions and misinformation about it – possibly even more than about any other treatment for chronic pain. People have preconceived notions based on stage performers, television and movies and rumors – and these cultural references tend to embellish what it can do.

Hypnosis cannot cure everything. It isn’t dangerous. Participants won’t be asked to do anything against their will. (refer to chart below for common myths and their truths)



Finally, medical hypnosis isn’t generally taught as part of the curriculum of most health care providers. Lack of knowledge of the subject area leads to “superstition”, even within the medical community.


Benefits for pain management

The good news is that research has shown medical hypnosis to be helpful for acute and chronic pain. In 1996, a panel of the National Institutes of Health found hypnosis to be effective in easing cancer pain. More recent studies have demonstrated its effectiveness for pain related to burns, cancer and rheumatoid arthritis and reduction of anxiety associated with surgery. In 2000, a meta-analysis, or study of 18 studies of hypnosis, showed that 75% of clinical and experimental participants with varying types of pain obtained substantial pain relief – supporting the claims of the effectiveness of hypnosis for pain management.

There is growing evidence and established research to suggest that hypnosis:
Has a greater influence on the effects of pain rather than the sensation of pain
May be more effective or at least equivalent to other treatments for acute and chronic pain
Have the potential to save both money and time for patients and clinicians, if the patient responds to hypnosis
May be able to provide analgesia, reduce stress, relieve anxiety, improve sleep, improve mood and reduce the need for opioids
Can enhance the efficacy of other well-established treatments for pain

Good candidates for hypnosis

Some people are better suited to respond to hypnosis than others. And the degree to which people respond varies. There are researchers who believe that people need to possess a “hypnotic trait”, much like other individual traits, that make them more open to hypnotic suggestions. Others believe that all people start off with a sufficient ability to be hypnotized and achieve results and that hypnotic ability can be learned and enhanced through practice.

Hypnosis has been used successfully for people with a variety of pain conditions. The Arthritis Foundation has an entire page on its website dedicated to hypnosis for pain relief of arthritis. Other medical conditions commonly cited as being improved with hypnosis include: 

 
Headaches
Fibromyalgia
Cancer
Burns
Back pain

The American Society of Clinical Hypnosis cites many other illnesses that would make someone a good candidate. Aside from these conditions, many in the field believe that the reality is that candidates with just about any type of chronic or acute pain could see a positive outcome from hypnosis.
Getting started with hypnosis

Once a person has decided to try hypnosis, the American Society of Clinical Hypnosis offers some insights into choosing the right provider. As well, the Societies of Hypnosis provides of list of members in several accredited organizations that the user can search to find a provider based on location, specialty or certification. It’s important to make sure that whichever provider is chosen, the therapist is licensed and has the appropriate certifications.

In addition to meeting with a provider, people interested in the ongoing use of hypnosis may opt to be trained in self-hypnosis. Outside of the treatment setting, participants can learn to practice self-hypnosis or be given audio recordings of their therapy sessions to help with home practice.

And technology can also aid in approaching hypnosis from more of a DIY standpoint. There are several downloadable programs and mobile apps on the market that are designed to help the participant with self-hypnosis, including:


Body Pain Management Hypnosis – a mobile app
Pain Management Self Hypnosis – a downloadable MP3 or CD
Pain Relief Hypnosis – a mobile app 


Final thoughts

Does hypnosis work for pain relief? There is a great deal written about its use and much research into its efficacy. Although not quite mainstream yet, there does seem to be a growing acceptance of hypnosis and a willingness of some medical providers to explore this option with their patients. While not a cure, it may be a pain management tool that could work for you.

https://www.painpathways.org/does-hypnosis-work-for-pain-management/