Saturday, 13 February 2016

Valuable Resources For Pain Patients

Today's post from (see link below) is basically a list of resources and websites designed to provide information for people living with all forms of pain, chronic or otherwise. Given that neuropathy is a painful disease (even milder forms are uncomfortable) this resource may help you understand what you're going through and provide access to much needed information that your doctor may not have time to give to you. Worth a glance and maybe a click or two, for all pain patients.

Provided by the American Pain Society; February 2016

Disclaimer: The views expressed on these websites do not necessarily reflect that of the American Pain Society or its members. All views portrayed are exclusively held by the individual websites and/or their guests.

People with Pain

Clinical Centers Guide
A guide to APS award winning Clinical Centers of Excellence.

Pain Matters
Created by Teva Pharmaceuticals to provide information for healthcare professionals and people affected by chronic pain as they maneuver through the complexities of pain care and management.

Aches and Gains®
The first national radio talk show to highlight pain management and those who suffer from a variety of debilitating medical conditions. Celebrity and expert guests share their own stories of success with host Dr. Christo. Aches and Gains® airs every Saturday on Sirius XM’s FamilyTalk 131, 5-6 pm EST.

U.S. Pain FoundationAn organization created by people with pain for people with pain.

American Chronic Pain AssociationAn association that offers peer support and education in pain management.

The National Pain FoundationA Global Pain Initiative.

International Association for the Study of Pain (IASP) - News
IASP link to "Going to the doctor for back pain can be a slippery slope", by Jill U. Adams. The Washington Post, May 2014.

IASP - Fact SheetsIASP Fact Sheets on Acute Pain. Global Year Against Acute Pain. October 2010-October 2011.

Created by the Pain Research Forum, this is designed to inform patients and the general public on the latest pain research and chronic pain findings to encourage conversation and support. 

Pain Researchers

Cutting Edge - COPCs Research Advances
An e-newsletter from the Chronic Pain Research Alliance designed to provide up to date information on recent basic science and clinical pain research for all members of the pain community.

Clinical Centers Guide
A guide to APS award winning Clinical Centers of Excellence

Pain Research Forum (PRF)An international pain research community.

PRF - PapersAn international pain research community. The Papers of the Week is now sponsored by APS.

PRF - Funding OpportunitiesFind the latest funding opportunities available for pain researchers.

IASP - Fact SheetsIASP Fact Sheets on Acute Pain. Global Year Against Acute Pain. October 2010-October 2011.

PRF - NewsA Rational Approach to Pharmacotherapy for Neuropathic Pain. By Pat McCaffrey. Pain Research Forum, October 2014.
Pain Clinicians

Clinical Centers Guide
A guide to APS award winning Clinical Centers of Excellence

IASP Pain Clinical Updates PDFAn update on fibromyalgia syndrome. Pain. Clinical Updates. IASP, June 2008.

Back pain
IASP - NewsletterAn update on back pain. Pain. Clinical Updates. IASP, August 2010.

IASP - NewsIASP link to "Going to the doctor for back pain can be a slippery slope", by Jill U. Adams. The Washington Post, May 2014.

Acute pain
IASP - Fact Sheets
IASP Fact Sheets on Acute Pain. Global Year Against Acute Pain. October 2010-October 2011.

IASP - Pain Clinical UpdatesWhy does pain hurt? Pain. Clinical Updates. IASP, July 2009.

IASP - Pain Clinical UpdatesAcute pain and immune impairment. Pain. Clinical Updates. IASP, March 2005.

Chronic Pain

Pain Matters
Created by Teva Pharmaceuticals to provide information for healthcare professionals and people affected by chronic pain as they maneuver through the complexities of pain care and management.

IASP - Pain Clinical UpdatesChronic pain after surgery or injury. Pain. Clinical Updates. IASP, January 2011.

PRF - NewsA Rational Approach to Pharmacotherapy for Neuropathic Pain. By Pat McCaffrey. Pain Research Forum, October 2014.

The National Pain FoundationA Global Pain Initiative.

Opioid Prescribing and Urine Drug Screening Interpretation
My Top Care is a site designed for clinicians, pharmacists or patients interested in better understanding issues surrounding opioid prescribing and drug screening.

Friday, 12 February 2016

Why Must Genuine Patients Suffer In The So-Called War On Drugs?

Today's post from (see link below) is a very sensible appraisal of the current pain medication-abuse hysteria that is sweeping North America. Yes we have addiction (a large problem) with all the social problems that come with it but we also have more people living with chronic pain than ever before. If you have severe neuropathy for instance, can you imagine not having the necessary drugs to control the symptoms? Yet that is a scenario that may well turn out to be reality for many neuropathy sufferers, if the political drug abuse buttons continue to be pushed in the way they are. This article rightly points out that the genuine patients are inevitably going to suffer unless a pragmatic and sensible approach is taken. Well worth a read!

Pain Patients Ignored in Reaction to Super Bowl Ad 
By Nicole Hemmenway, Guest Columnist
February 09, 2016
While the issue of pain medication and addiction has been a hot topic in the media and government for quite some time, a TV commercial shown during the Super Bowl seemed to add more fuel to the fire.

Initially, I thought these conversations would be beneficial to those of us – like myself – who deal with pain. I believed that in 2016 we had come a far way from judging people with disabilities, and that the patient voice would finally be heard for positive, proactive, and bipartisan change to occur.

I was wrong. Sadly, the focus has not been on the patient. Instead, media coverage (and a White House press conference) has chosen to only address the high rate of opioid overdose.

There is scrutiny from the public, those running our nation and the media that such an ad, designed by multiple patient advocacy groups to raise awareness about a serious issue (opioid induced constipation), is seen as a way to further stem the opioid epidemic. The ad became an excuse for politicians and high-profile individuals to push an agenda that only stigmatizes the pain patient more. To my dismay, the patient voice wasn’t only lost in the rhetoric, it was obsolete.

I am angry. Very angry. We have two very serious problems happening in America right now: addiction and the pandemic of pain. In 2011, the Institute of Medicine reported that over 100 million Americans live with some type of pain brought on from a chronic condition, illness or injury. This is a staggering number that will only grow higher, and not enough is being done to help these Americans.

My issue is that it appears most people only want to state how terrible pain medications are, and how they are the reason we have such a high addiction and overdose rate. The only discussion to “fix” the crisis is to limit access to treatment. Repeatedly, I hear the answer is to deny legitimate people living with pain access to the treatments their providers deem beneficial for them. That is not a solution. This doesn’t solve or even curtail the problem. In my mind, I see it as a cop-out; a loosely fit Band-Aid if you will.

Let me be clear. I am not pro-drugs. In fact, the high doses of medications I was prescribed nearly took my life a decade ago. Thankfully, I was able to try countless treatment options and found my answer in a non-invasive electrical stimulation device, as well as diet change, light therapy, acupuncture, upper cervical care and exercise.

I live in the San Francisco Bay area. Because of where I reside, I have access to every possible complementary therapy. I can try active release technique, reiki, healing touch and hot mineral springs. There are wonderful interdisciplinary programs nearby. Anything that may help me move past my pain is available. Yet the downside is that nearly none of these treatments are covered by insurance.

So while I have access to them – unlike rural areas, where finding a complementary practitioner is impossible – I also have to pay out-of-pocket. And they are not cheap!

The cost of my health insurance – like millions of others who need it – is obscene. For my family, our monthly premium is $827.34 (my husband’s employer contributes an additional $225). Our deductible is $9,000, with an out-of-pocket max of $13,000 for the year. This is the reality for most Americans. With that, how is it feasible for Americans living with pain to afford additional treatments? It is not.

The actual problem is not being addressed, and I would love to be given the opportunity to talk with White House Chief of Staff Denis McDonough, Senator Ron Wyden or Dr. Andrew Kolodny about the real issue. I believe most people taking pain medications want to lower their dose or even not need them. But there has to be other treatment options in place to help control the pain. What are we offering now? Nothing, really.

That is the problem, and this is where I hoped the discussion surrounding the Super Bowl, pain care in America and addiction would have went this past week. Unfortunately, it did not. As a society, we keep missing opportunities to really advance the issue of healthcare and pain care. There is a serious pandemic called chronic pain that is widely misunderstood and inadequately treated.

Right now, the public persona sees those with pain as “junkies” (thanks Bill Maher for adding to the misperception). I take huge offense to that. We are not junkies or addicts. We are people following legitimate treatments our providers believe will help us. And even with that, many cannot receive the medications or care they need and deserve.

This, in my mind, is injustice. It is time to stop shaming a quarter of our population for having pain. They are just trying to find answers so they can return to a better quality of life.

So I leave you all with these questions to ask yourselves. When will the voices of those with pain be considered a priority to America? How can we make sure those with pain have access to ALL forms of care? What can we do to begin working together so we find a balanced approach to pain management?

There will be a solution, as soon as we start asking the right questions. To start, America needs to care for those of us with invisible illnesses. Our voices must be part of the discussion, which sadly, they have not been. Let us do our part to change this now.

Nicole Hemmenway is vice-president of U.S. Pain Foundation, a non-profit patient advocacy group. Nicole is also the author of No, It Is NOT In My Head: The Journey of a Chronic Pain Survivor from Wheelchair to Marathon.

Pain News Network invites other readers to share their stories with us. Send them to:

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

Thursday, 11 February 2016

New Drugs To Be Targeted At Pain Receptors Deep In The Nerve Cell

Today's post from (see link below) may at first sight seem a little difficult to understand but basically, when the body experiences pain, there are pain receptors on the surface of nerve cells that identify it and transmit the information further and let you feel that pain. If the pain is extreme, sometimes these pain receptors retreat to the nucleus of the cell, as if it's 'safer' there. Pain relieving drugs are designed to block the pain signals in the receptors at the surface of the cell but if the receptors have migrated to the nucleus then the drugs don't have any effect. This knowledge enables researchers to design pain-relieving drugs that can penetrate the nerve cell to the nucleus and thus block the signals from reaching the receptors. They can then 'safely' return to the surface of the cell. At least that's the theory and although it may seem like double-dutch to most of us, sometimes it's interesting to know in which direction the scientists are going.

Location may be key to effectively controlling pain
Date:February 3, 2016 Source:McGill University
In real estate, location is key. It now seems the same concept holds true when it comes to stopping pain. New research published in Nature Communications indicates that the location of receptors that transmit pain signals is important in how big or small a pain signal will be -- and therefore how effectively drugs can block those signals.

Blocking pain receptors in the nucleus of spinal nerve cells could more effectively control pain than interfering with the same type of receptors located on cell surfaces. The scientists also found that when spinal nerve cells encounter a painful stimulus, some of the receptors will migrate from the cell surface into the nucleus.

A team of researchers led by McGill University's Director of Anesthesia Research Terence Coderre and Karen O'Malley at Washington University in St. Louis, found that rats treated with investigational drugs to block the activity of the receptors in the nucleus soon began behaving in ways that led them to believe the animals had gotten relief from neuropathic pain. According to Prof. Coderre, "drugs that penetrate the spinal nerve cells to block receptors at the nucleus were effective at relieving pain, while those that don't penetrate the nerve cells were not. Rats with nerve injuries had less spontaneous pain and less pain hypersensitivity after blocking receptors at the nucleus, while the pain sensitivity of normal rats was not affected."

Location is key
Scientists have been studying glutamate receptors in the pain pathway for decades. What's new, Coderre explained, is that these most recent experiments -- in cell cultures and rats -- demonstrate that the location of the receptor in the cell has a major effect on the cell's ability to transmit pain signals.

The researchers focused mainly on nerve cells in the spinal cord, an important area for transmitting pain signals coming from all parts of the body.

"We'll now focus our research at determining what events cause the glutamate receptors to migrate to the nucleus, and how to produce drugs that more specifically block glutamate receptors only at the nucleus," added Coderre.

Story Source:

The above post is reprinted from materials provided by McGill University. The original item was written by Cynthia Lee. Note: Materials may be edited for content and length.

Journal Reference:
Kathleen Vincent, Virginia M. Cornea, Yuh-Jiin I. Jong, André Laferrière, Naresh Kumar, Aiste Mickeviciute, Jollee S. T. Fung, Pouya Bandegi, Alfredo Ribeiro-da-Silva, Karen L. O’Malley, Terence J. Coderre. Intracellular mGluR5 plays a critical role in neuropathic pain. Nature Communications, 2016; 7: 10604 DOI: 10.1038/NCOMMS10604

Wednesday, 10 February 2016

MRI Scan Can Prove Whether Chronic Pain Drugs Work Or Not

Today's post from (see link below) looks at the possibility of using an MRI scan to measure the effectiveness of new drugs meant to reduce chronic pain. The MRI measures the nerve cells in the brain's response to pain signals and can see very quickly if they respond positively. Apparently one of the problems with new drugs is that it takes so long to prove effectiveness or not. By using a non-invasive MRI scan, gathering that evidence (from the behaviour of the brain's neurological response,) will be both quicker and more accurate, thus reducing the amount of time patients have to wait for proven new drugs for chronic pain.

Functional MRI may help identify new, effective painkillers for chronic pain sufferers 
Date:February 4, 2016 Source:American Society of Anesthesiologists

New research may allow new, more effective and safer pain medications to reach patients who suffer from chronic pain sooner. According to a recent study published in Anesthesiology, the official medical journal of the American Society of Anesthesiologists (ASA), using functional magnetic resonance imaging (FMRI), to measure the brain's neural response to pain, may be a viable tool for evaluating the effectiveness of new pain medications during the early stages of human drug development -- providing the needed objective evidence to prevent the premature discarding of potentially beneficial therapies.

"Many potential pain relieving drugs identified in preclinical research fail to reach the market because of a lack of early objective evidence that shows whether a drug is effectively reaching target pain receptors in the body and regulating chronic pain mechanisms," said Vishvarani Wanigasekera, M.D., study lead author and clinical post-doctoral research fellow, Nuffield Division of Anaesthetics, University of Oxford, England. "We have used noninvasive FMRI to successfully obtain such evidence that we hope can help to prevent the premature discarding of potentially effective pain relievers, as well as avoid exposing patients to ineffective ones."

Currently, patient reported pain relief is the primary outcome measure used in human drug development studies to assess whether a pain relieving medication is effective. However, due to their subjective and context-dependent nature, self-reported pain perception and relief is subject to many influences, in addition to the actual pain relieving effectiveness of the drug. Early drug development studies typically involve a small sample size. When subjective pain reports are used as the sole outcome measure in these studies, researchers can easily miss effective compounds that might work well in the population at large.

In the double-blind, randomized study, researchers induced a phenomenon called central sensitization and some symptom-like features of neuropathic pain, a complex chronic pain condition, on three separate occasions in 24 healthy volunteers by applying capsaicin cream, a topical irritant often used to produce similar characteristics of neuropathic pain in an experimental setting, on the subjects' skin. Prior to capsaicin cream application, subjects either received a single dose of gabapentin, which is considered effective and a first line treatment for neuropathic pain; ibuprofen, which is generally not considered an effective treatment for the condition; or a placebo. Researchers then assessed the effect the drugs or placebo had on the brain's neural response to pain using FMRI in addition to patient reported pain relief.

They found in the absence of behavioral measures distinguishing which drug was most effective at low subject numbers, the imaging responses were clear. Pain relevant neural activity was significantly reduced in the subjects who received gabapentin, even with extremely low subject numbers, highlighting the potential for FMRI to make a drug's effect clear in small cohorts.

The authors acknowledge that the mechanisms and neural activity involved in the expression of pain in neuropathic patients is not exactly the same as in the healthy subjects with capsaicin cream-induced pain. However, similar studies in early human drug development can determine whether a drug has the ability to affect relevant neural activity in the brain.

"There is a clear need for more effective, safer pain relievers," said Dr. Wanigasekera. "Chronic pain is a very common condition. Even the most effective pain medications currently available only provide adequate pain relief, defined as a 50 percent reduction in pain, in one out of four patients, while some drugs, such as opioids, have significant side effects, including dependence and overuse. We believe that neuroimaging techniques, such as FMRI, can provide objective evidence that can be used as outcome measures in early drug development to enhance the efficiency of the drug development process."

Story Source:

The above post is reprinted from materials provided by American Society of Anesthesiologists. Note: Materials may be edited for content and length.

Journal Reference:

Vishvarani Wanigasekera, Melvin Mezue, Jesper Andersson, Yazhuo Kong, Irene Tracey. Disambiguating Pharmacodynamic Efficacy from Behavior with Neuroimaging. Anesthesiology, 2016; 124 (1): 159 DOI: 10.1097/ALN.0000000000000924

Tuesday, 9 February 2016

Opioids Were Never Intended To Improve Function; Just Relieve Pain

Today's post from (see link below) is an ever-so-subtle addition to the current media-inspired movement that claims all things 'opioid' are bad. It addresses opioids and neuropathic pain directly and comes to negative conclusions based on the study results that show that opioids produce little improvement in function in people who take them. However, opioids don't address the disease and are not meant to be 'cures'. Don't these people realise that opioids are never meant to improve function - they're meant to reduce pain and in that respect, they are very successful. Of course, reduced pain can enable people to function better but only because their pain is gone, not because the original illness has been addressed. Of course the media realise this full well! Inventing negative effects that were never claimed to be benefits of opioid use in the first place, is a sort of negative publicity that's used in politics all the time. The fact is that if you are taking opioids for neuropathic pain, you have tried everything else and nothing works, leaving you with opioids that generally do the job. Of course they have to be controlled and monitored and the patient has to take some responsibility to make sure that the potential for addiction is minimised but good doctors should be monitoring you to within an inch of your life to make sure you're not entering any sort of spiral. Opioids have been used for pain control since the dawn of time but like everything in this modern world, we always seem to need a sledgehammer to crack a nut!

How Effective Are Opioids in Neuropathic Pain? 
Steve Duffy January 26, 2016

Improved function may not necessarily follow opioid treatment.

A new study suggests that opioid prescriptions for patients with neuropathic pain, may not improve their physical function or disability. In fact, results from the study — conducted by the University of Alberta and published in Pain Medicine — indicate that opioid use could be harmful when it comes to physical recovery for patients with neuropathic pain.

"We studied patients with neuropathic pain from nerve injuries such as diabetic neuropathy and pinched nerves, and the ones who weren't prescribed any opioids had statistically lower disability and higher physical functioning scores," said Geoff Bostick, PhD, lead author of the study.

TRENDING ON CPA: ACA Supports Proposed Guideline for Prescribing Opioids to Patients With Chronic Pain

The study sample included 789 patients with neuropathic pain across Canada. Patients gave self-reported measures of physical function (pain disability index) and a medical outcomes study short form-12 physical function (PCSS-12), at the beginning of the study, then again at 6 months and 12 months after treatment began. Analysis of covariance models was created to examine the association between opioid therapy and both physical functioning outcomes with adjustment for confounding.

Results showed that patients prescribed opioid treatment did not report greater physical functioning or lower disability than patients who were not prescribed opioids — even after the results were adjusted for disease severity. The improvements in disability and physical functioning scores from baseline and 12 months for all groups were "modest and may not be clinically significant," authors reported.

They asserted that while opioids are a powerful painkiller, the results of the study testify that improved function does not necessarily follow opioid treatment.

In addition, they highlighted the association between opioid prescription and a patient's quality of life, considering that the treatment may not be aiding the patient's functionality. They call for further research to analyze this correlation.

For those who have chronic pain but are medically cleared for physical activity, a graded approach to recovery is suggested, according to Dr. Bostick. "I tell patients to walk until they are at 50% of their tolerance — walk and stop before the pain gets too bad. Each week, walking time is gradually increased. Over time, this tolerance will slowly increase and so will physical function."

Bostick G, Toth C, Carr E et al. Physical Functioning and Opioid use in Patients with Neuropathic Pain. Pain Med. 2015;16(7):1361-1368. doi:10.1111/pme.12702.
This article originally appeared on MPR.

Monday, 8 February 2016

Covering The Basics About Neuropathy

Today's post from (see link below) is a short, general information article about neuropathy, specifically designed for those new to the disease, or family and friends who want to know more about what's so clearly affecting someone in their circle. For that reason, it's short and concise and you will need to do much more research from now on but it does cover the basics and will be helpful to those wanting a quick explanation of what's going on. Definitely worth a read; if not for yourself, maybe for someone you know.

Aging column: What you should know about neuropathy
Judson Haims February 1, 2016

Neuropathy in its simplest definition is nerve disease or damage. It is a relatively common condition and is not isolated to any particular part of the body. Injury, infection, exposure to toxins and alcohol/drugs can all contribute to neuropathy.

Neuropathy affects:

• Sensory nerves, which control sensation. Effects of this type of neuropathy often include impaired sense of touch, reflex and balance.

• Motor nerves, which govern movement. These nerves, if affected, contribute to issues of muscle twitching, weakness and atrophy.

• Autonomic nerves, which influence internal organs. Bladder control, blood pressure, digestion and sweating abnormalities are associated with this type of disorder.


The central nervous system (CNS) is contained within the brain and spinal cord. Neuropathy occurring within the CNS is often associated with spinal cord injury, scaring of tissue surrounding nerves, alcohol abuse and Parkinson’s.

The peripheral nervous system is the largest nervous system of the human body. The nerves that run through our arms, hands, fingers, legs feet and toes are peripheral nerves — they transmit sensory information back to the CNS of the brain and spinal cord.

While neuropathy can commonly occur in your central nervous system, it more often affects the peripheral system.

According to the National Institutes of Health, “An estimated 20 million people in the United States have some form of peripheral neuropathy, a condition that develops as a result of damage to the peripheral nervous system — the vast communications network that transmits information between the central nervous system (the brain and spinal cord) and every other part of the body. Symptoms can range from numbness or tingling, to pricking sensations (paresthesia) or muscle weakness.

“Areas of the body may become abnormally sensitive, leading to an exaggeratedly intense or distorted experience of touch (allodynia). In such cases, pain may occur in response to a stimulus that does not normally provoke pain. Severe symptoms may include burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. Damage to nerves that supply internal organs may impair digestion, sweating, sexual function and urination. In the most extreme cases, breathing may become difficult, or organ failure may occur.”


In the United States, the most common cause of peripheral neuropathy is diabetes. According to the American Diabetes Association, 60 to 70 percent of people with diabetes will develop neuropathy.

Peripheral neuropathy is often difficult to diagnose. Because it can affect many different parts of the body, it is sometimes hard to determine the specific cause of symptoms. Often, medical professionals will start by running blood tests, physical exams, reviewing medical history and examining family neurological diseases.

Further testing may include nerve and skin biopsies, nerve function tests, and CT/MRI imaging. An electromyogram (EMG) study may also be suggested. EMG studies are used to evaluate and measure the electrical activity of muscles at rest and during contraction. Nerve conduction studies measure the ability of sensor y and motor nerves and how well they send electrical signals.


Although people with diabetes often experience neuropathy issues, one of the best steps to taking an active role in minimizing your exposure to peripheral neuropathy is keeping your blood sugar levels under control. This requires constant monitoring by anyone that may have neuropathy concerns however, for those with diagnosed diabetes the A1C test should be taken at least twice a year.

Maintaining good foot care plays a very important part in minimizing risks of neuropathy. Properly trimming toenails, wearing dry and clean socks, wiggling your toes, moving your ankles up and down multiple times a day, and wearing shoes that are comfortable and fit well may assist in mitigating many foot problems.

Great information about peripheral neuropathy can be found at the Foundation for Peripheral Neuropathy, the American Diabetes Association, and the Brain Resources and Information Network division of the National Institute of Neurological Disorders and Stroke.

If you have experienced loss of sensitivity in your hands and/or feet, or have noticed balance concerns, a visit to your doctor may be a good idea.

Judson Haims is the owner of Visiting Angels Home Care in Garfield County. His contact information is,, 970-328-5526.

Sunday, 7 February 2016

Downward Facing Dog For Neuropathy?

Today's post from (see link below) talks about Yoga for neuropathy. When even fully fit people can struggle to master even basic yoga positions, the idea that it can be of benefit to neuropathy patients may seem a little far-fetched (or even downright impossible). However, this short article gives you three yoga poses that may well help with the symptoms. Clearly explained, if you're still not sure what you're supposed to do, look them up on Google images and all will become clear. Worth a try? What have you got to lose?

Yoga For People With Neuropathy 
By Jacqueline Marshall, Jun 11, 2015

Do not let pictures of yoga experts with their bodies twisted into bizarre, compact shapes fool you.

Even people with stiff muscles, creaky joints, problems with balance, tingling, or numbness can perform yoga asanas or poses.

Most poses can be altered to suit anyone’s flexibility and strength level, and many help relieve the distressing symptoms of peripheral neuropathy. The yoga video series by Peggy Cappy called Yoga For the Rest of Us is an excellent way to get gentle, effective yoga instruction—modified for health issues.
Three Poses for Neuropathy

Here are three yoga postures that can diminish neuropathy symptoms, calm the nervous system, and increase mental focus.

Knee To Chest

This pose strengthens muscles that might have been weakened by neuropathy, and massages the abdominal organs.
Lie on your back, legs outstretched, arms at your sides, toes pointing up.
Bring the right knee to your chest and grasp its shin with both hands, or the forearms.
Slowly lift your head, bringing the forehead to the knee; hold this position several moments, and keep breathing.
Lower your head and leg back to the floor; repeat with the left leg.
Repeat the exercise two to four times.

Gentle Toe Stretch

Try this pose to relieve numbness and tingling in the feet. It increases foot circulation and toe flexibility.
Sit on the floor in a cross-leg position.
Thread your left hand fingers between the left toes, and right hand fingers between the right toes.
Spread your fingers apart to give the toes a gentle stretch.
Hold the toe stretch for a few moments - continue to breath - then relax your fingers.
Repeat several times.

Downward Facing Dog

Inverting the body strengthens core muscles, stimulates the endocrine system, and soothes the central nervous system. It may relieve joint pain or stiffness, and ease the numbness of neuropathy.
Start on your hands and knees, wrists directly under the shoulders, knees directly below the hips, bottoms of the toes on the mat or rug.
Press with the palms and lift your knees off the floor; slowly straighten the legs until your body forms the outline of an “A.” (If you cannot straighten your legs, it is okay to keep them bent.)
Imagine your hips and thighs are being pulled backward from the top of the thighs.
Continue breathing, gaze between the legs or toward your abdomen, and hold this position as long as you comfortably can.
Slowly bend your knees and come back to the starting position.

Talk to your doctor before starting a new exercise regimen such a yoga, especially if you have been a long-time couch potato, or have back, neck, and joint problems. You should feel a stretch when doing yoga poses, but never push yourself to the point of pain.

Source: Molecular Lab USA

Saturday, 6 February 2016

Suitable Footwear So Essential For Neuropathy Patients

Today's post from (see link below) is basically an advertisement for a Florida podiatrist, which normally we wouldn't feature on the blog but because the author gives such sensible advice and information, it's worthwhile printing here. If you're one of the majority of neuropathy patients who have foot problems and irritating or painful symptoms, you may assume that you are fully aware of your feet but it's so easy to miss problems until they become serious, especially if one of your symptoms is lack of feeling. It's worthwhile taking the advice in this article on board, after all, your feet have to carry you through the rest of your life.

Choose Footwear Carefully if You Have Neuropathy
Posted on January 29, 2016 by Denise Skerritt

Choosing footwear carefully is important for everyone no matter what age or degree of foot health. But for anyone who suffers from neuropathy, it’s essential that all footwear be sturdy and especially well-fitting.

Neuropathy is damage to the nerves. The peripheral nervous system contains all nerves not located in the brain and spinal cord. These vital nerves carry sensory and muscle nervous signals to those in the brain and spinal cord. Neuropathy in the peripheral nervous system causes numbness and pain in the extremities like the hands and feet.

One of the most common causes of peripheral neuropathy is diabetes. Other causes are infections, traumatic injuries, toxin exposure and metabolic disorders. In addition to loss of sensation, neuropathy also causes tingling, burning, weakness or paralysis.

Patients with Neuropathy Must Guard Their Feet

Because neuropathy interferes with nerve signals, your feet won’t feel cold, heat or pain so you may have an injury without being aware of it.

Always protect your feet! Avoid going barefoot as even a minor sore or cut on the feet can develop an infection and then worsen into an ulcer before being spotted. Also, patients with neuropathy won’t feel the surface beneath their feet properly and so can injure themselves by falling.

Shoes for Neuropathy Must Be Both Protective and Comfortable

If you have neuropathy or diabetes, a visit to Pasco-Hernando Foot and Ankle is a good first step to choosing appropriate footwear. After a comprehensive foot exam, we’ll discuss your neuropathy with you along with any foot or ankle deformities we’ve observed.

When shopping for shoes keep these tips in mind:
Always have both feet measured each time and be sure to shop later in the day when feet are largest.

Shoes should feel comfortable right away – look for extra cushioning and soft, stretchy leather. 

Lace-up shoes are safer and sturdier and stay on your feet better than slip-ons. 

Consider shoes that are made specifically for individuals with diabetes – they are good choices for anyone with neuropathy. These shoes have plenty of room in the toe box and offer both comfort and good protection.

It’s okay for women with neuropathy to wear high heels – but only for short periods. However, if you also have a foot deformity like bunions, or have poor blood circulation, stay away from high heels.

Leave flimsy sandals in the closet – they offer little protection and the straps between the toes can cause blistering or irritation that can go unnoticed.

If You Have Neuropathy Don’t Neglect Your Foot Health

Call Dr. Lawrence J. Kales, board certified foot doctor for a complete foot exam and consultation about your neuropathy today. Reach us at our Hudson office at 727-868-2128 or our Spring Hill office at 352-683-5799, or request an appointment via the website. Dr. Kales has the right experience to help patients with neuropathy with comfortable footwear selection and expert foot care.

Friday, 5 February 2016

Will HGF Injections Be The Answer For Neuropathy?

Today's post from (see link below) talks about injecting HGF (hepatocyte growth factor - a protein associated with tissue regeneration) to treat neuropathy. Notice, I say neuropathy and not neuropathy symptoms because this is designed to help regenerate nerve growth where damaged and not just the symptoms of nerve pain or tingling. However and this is a big however, in the study, the majority of subjects did not respond to the treatment, which leaves the whole idea open to doubt. The article author suggests that this still shows HGF injections to be potentially useful for neuropathy patients but it seems that many more studies and lots more research may be needed first before this can be assumed.

Injections May Combat Diabetic Neuropathy
Published on January 25th, 2016 | by Travis Manni

One common side effect of living with diabetes can be painful diabetic neuropathy, which is nerve damage in the arms, hands, legs, or feet; the condition is caused by chronically high blood sugar levels. There are limited treatment options to deal with diabetic peripheral neuropathy, or the pain it causes.

However, a new multi-center study showed hepatocyte growth factor (HGF) injections helped treat the condition for a good amount of study participants. The study was published in the May 2015 issue of the journal Annals of Clinical and Translational Neuropathy. However, the treatment did not work for the majority of individuals studied, meaning HGF may be a good treatment option, but not necessarily a silver bullet in treating diabetic peripheral neuropathy.

According to the National Center for Biotechnology Information, HGF is a protein in the body that is associated with organ development, tissue regeneration, and wound healing in adults. It also supports the growth and nourishment of neuron cells. In the double-blind Phase II study, 96 individuals were given either a placebo or HGF intramuscular injections in the leg twice over two weeks; the experimental group received either 8 mg (low-dose) or 16 mg (high-dose) of HGF. Participants were asked to record information in a pain and sleep diary.

The low-dose experimental group showed the greatest reduction in pain after three months, according to a MedScape article. In particular, those who were not not already taking other prescription drugs that treat this type of pain reported a statistically significant decrease on the pain measurement scale. Additionally, 48% of those surveyed in the low-dose group reported their pain was either “improved” or “very much improved” after three months; 31% of people in the high-dose group also reported “improved’ or “very much improved” pain levels. Improvement in touch sensitivity was also observed in those treated with HGF.

Researchers hope this form of treatment, which would require only eight injections a year, will eliminate the need for patients experiencing painful diabetic neuropathy to take daily medication. The HGF injections also could be seen as an alternative option for those who do not experience pain relief with currently available prescription drugs. Further study will be needed before the treatment might become available on the market, and researchers expect to conduct a new trial in 2016.

Thursday, 4 February 2016

Lessons From A Life With Neuropathy

Today's post from (see link below) is an honest, personal story of life with neuropathy. Reading it you may feel that this man's lifestyle has directly contributed to his condition but it's far too easy to criticise from a distance without first looking at our own lives. The story will certainly be recognisable for many neuropathy patients, proving that nothing is as black and white as it seems - sometimes, life just gets in the way. This man uses gabapentin with success but that is his case, that doesn't mean that gabapentin is necessarily the answer for you.

Life with neuropathy

'Old Fart' William's Story
I am 72 years old and live alone in a single family bungalow in Peterborough. I eat too much, drink too much, and get too little exercise. I am a retired teacher and have lived alone since my wife died in 2000. I am a fat old fart who lives a fairly circumscribed life - only partly due to my neuropathy. Right now my sciatica is flaring up and is far more debilitating.

My peripheral neuropathy likely dates back to the early to mid ‘90s. I suffered from falling arches, and for some time I ascribed my foot and leg discomfort solely to that issue. It was only in 1997, when the numbness, burning, and occasional stabbing pain was keeping me awake, that I took the problem to my GP.

It is so long ago that I have little or no recollection of the original process of diagnosis. The story is complicated in my mind by my wife suffering a massive brain injury at that time. She was in an automobile accident in Ottawa, in the summer of 1996. She was in an Ottawa hospital until the spring of 1997, and again for several more visits during the next couple of years. She lived at home until her death in January, 2000. Naturally, at the time, my minor problem was peripheral to hers. It was while she was in the hospital (1996 – ’97) that the burning and tingling got so bad that I went to see my GP.  He referred me to a local neurologist who ran some tests and diagnosed peripheral neuropathy. By that time (1998 – ’99) the loss of feeling extended almost to my knees.

The neurologist had no answer as to the origin of the condition. I had been drinking heavily earlier in my life, but had been totally dry for ten years when the condition struck. My GP (at the time) in 1997-9 was convinced that I had diabetes. My blood sugar levels were consistently close to the threshold levels, so he took that leap and declared me diabetic; controlling it with diet and exercise.  It wasn’t until my present GP had me do a glucose test (in 2009) that the diabetes diagnosis was ruled out.

At the beginning I had “pins and needles”, burning on the soles of my feet, numbness or loss of feeling in my feet and lower legs, aching feet and legs (perhaps partly due to the falling arches) and occasional shooting pains or a feeling like a weak electric shock. I do not remember the specifics, but I am sure that the discomfort started in one foot at a time before it came to affect both feet and legs. I have a vague memory of it migrating from one foot to the other over the months.

Finding relief, also known as, gabapentin

Back in 1997 or ‘98 my GP prescribed a common medication used off-licence to treat nerve pain. I have no recollection of which one it was. I just remember him saying that no medication worked for any large percentage of the sufferers, but that particular one was the most efficacious. It might have been an anti-depressant, but the specifics escape me. I just remember that I got every side-effect listed on the fact sheet (dry mouth is one I remember), but it did nothing to ease my nerve pain.

The second medication he prescribed was gabapentin. It was a miracle cure. Within a few days the worst of the symptoms had eased, and after trying different dosages we settled on just 300mg per day. Over the years, I have had to increase the dosage as the pains and discomfort returned. I have never been free of the feeling that something in my feet and legs isn’t right. There is the constant numbness, the decrease in flexibility, and the fairly common occasional tingling sensation. It isn’t pain! For many years, the discomfort was almost forgettable as I went through my daily chores. I loaded my gabapentin into the evening to reduce any chance of pains that would get in the way of my sleep. I don’t think that I ever expected to avoid all of the discomfort of numbness and a bit of tingling. I was happy as long as I could get to sleep every night. I have never suffered from any side-effects related to the gabapentin; or none that I identified.

Currently, I am taking 1500mg of gabapentin daily. It has been my only medication since the late ‘90s, and the only change has been a gradual increase in the dosage over the past 15 or 16 years. I am told that I could probably take and tolerate higher doses and that some patients do take more than my dose.

Life with numbness

From the 1990s, I recognized that I was losing my sense of balance. I avoid ladders. I am far more sedentary than I was in middle age. I rarely travel and, if so, prefer to use my car. At present, I avoid activities which require much walking and standing. I do my own housework (such as it is), but hire people to look after the outside chores. At home, I spend far too much time sitting at the computer – as I am now! I assume that some of the inactivity and lethargy is a result of becoming a fat old fart. I stopped mowing my own lawn over 10 years ago lest I stumble on the uneven surface. For exercise, I walk on a treadmill rather than the sidewalk, as I fear tripping on the uneven surface. For a couple of years before I got a treadmill, I used to walk at 4:00 or 5:00 AM so that I could walk on the residential street which was smoother than the sidewalk.

As some of my foot muscles become dominant and others atrophy, walking becomes more problematic. I drag my heels and walk flat-footed. My feet are no longer flexible, so I describe the sensation as akin to walking with snowshoes. My feet and legs feel “heavy”. It is very tiring. I can’t walk nearly as fast, or as far as I used to. Much beyond a mile is getting to be a trial: not impossible, but not comfortable. My legs ache after any decent walk on my treadmill. Hiking or walking off road is almost impossible. An extended shopping trip can be problematic. Luckily, I detest shopping.

I can feel movement on my skin if a finger is rubbed across my foot or leg, but if touched gently without disturbing the hairs, I often can’t tell if my foot or leg is being touched at all. If I am poked I get no different sensation from a finger than from a needle. Some nerves seem to still work as occasionally I get a sharp pain from stubbing a toe, but most times my only clue that I have stubbed it is the blood welling out from under the nail.

For the past 2 or 3 years I have been noticing a gradual loss of sensation in my fingers. It is just the same numbness and tingling that affects my feet, but less severe as yet. As I do all my own cooking it presents the constant threat of burned fingers. I cook most of my food from fresh ingredients, so I find that my legs often get tired and achy from standing too long in the kitchen preparing vegetables or batch-cooking for my freezer. Perhaps it is the muscle changes in my feet and legs which cause me the most problem; not the occasional bout of neuropathy pain.

My physiotherapist comments that I have retained strength in my arms and legs, but I notice a lack of strength in my hands and a sensitivity in the skin which keeps me from opening jars or bottles. It can hurt to try to grasp an object too tightly. Accidentally hitting my hand on a piece of furniture or door jamb is often remarkably painful; far more so than used to be the case. I am more likely to drop a light object as I no longer sense, say, a sheet of paper in my hand. Simple tasks, such as doing up small buttons, becomes nearly impossible. My wardrobe reflects that new reality; few shirts with buttons and no tight collars. I struggled mightily to rewire a lamp the other day. My fingers were like useless - and senseless - lumps of clay. It is hard to manipulate thin wire with no sense of touch. Picking up small objects is a trial.

My days entail reading the newspaper, normal ablutions, essentials of housework (dusting is avoided at all costs), email contact with a couple of dozen people, internet surfing, walking on my treadmill or doing stretching exercises, watching videos from my PVR or streamed to my TV through my computer, football and occasional soccer matches watched live, daily food preparation, grocery shopping 2 or 3 times a week, occasional appointments and lunches with friends, usually weekly contests over a friend’s snooker table, weekly visits by a female friend. I drive to see my children and grandchildren every few weeks. I have pretty well ceased attending plays and concerts except for the occasional MET in HD performance. That is more due to the lack of a companion rather than the effects of my neuropathy. I have ceased travelling because of my inertia, and mostly the lack of a suitable travel companion. Neuropathy wouldn’t keep me at home were I really keen to take a particular trip. It would just affect the type of trip and the day’s activities – as it does at home. My inertia is only partly the result of my neuropathy.

What pain is like now

I have used gabapentin alone for over 15 years. I have never tried any other medication. I asked my GP about newer and better medications a year or so ago. He said I should stay with what is working rather than weaning me off it and then going through the process of trying to find something better. I was somewhat relieved.

All in all, I view myself as being rather lucky. I found gabapentin pretty early in the process and under normal conditions I can say that I am pain-free. I have discomfort, and my life is circumscribed, but I do not have the constant level of pain common to some sufferers.

My advice for anyone newly diagnosed with neuropathic pain?

  • Seek out whatever medication will render the nerve pain bearable. Once you can limit the pain, everything else is reduced to the level of a really annoying nuisance. 
  • Forget vanity and wear sensible shoes with proper orthotic support to keep you mobile. Work with a physiotherapist to develop a regimen of stretching exercises to help keep you as flexible as possible.
  • Understand that you will have a constant struggle to maintain as much of your lifestyle as possible, to work around your new limitations, and to seek out any treatments or devices which will make life a bit easier. 
  • It isn’t a death sentence so much as a constant set of hurdles which will make life a bit more difficult, but still enjoyable. It’s no walk in the park, but look around at your peers and all of a sudden neuropathy isn’t so bad. There are lots worse conditions to have to cope with.

Wednesday, 3 February 2016

How Chronic Pain Can Change Your DNA And Genetics

Today's post from (see link below) looks at the recent discovery that chronic pain (generally lasting longer than 6 months) can change not only the structure of your DNA but reprograms the way genes work in your immune system. the implications of this are that chronic pain may also change the way other systems in your body work. This may sound very logical to people living with automatic neuropathy (where the body's involuntary functions are affected by nerve damage) but also to people suffering from chronic pain and that includes so many neuropathy patients. It's useful information because future treatments may be gene-targeted and aimed at changing the way our genes respond to pain. Genetic therapies may well be the future of medicine.

Chronic pain changes our immune systems
Date: January 28, 2016 Source: McGill University

Epigenetics may bring us a step closer to better treatments for chronic pain 
 Chronic pain may reprogram the way genes work in the immune system, according to a new study by McGill University researchers published in the journal Scientific Reports.

"We found that chronic pain changes the way DNA is marked not only in the brain but also in T cells, a type of white blood cell essential for immunity," says Moshe Szyf, a professor in the Faculty of Medicine at McGill. "Our findings highlight the devastating impact of chronic pain on other important parts of the body such as the immune system."

Chronic pain -- pain that lasts six months or more -- is one of the most common causes of disability worldwide. Despite enormous efforts to find new therapeutic strategies, however, effective treatments for chronic pain remain elusive.

Using rat models

The all-McGill team examined DNA from brains and white blood cells of rats, using a method that mapped DNA marking by a chemical called a methyl group. "Methyl marks are important for regulating how these genes function," explains co-author Laura Stone, a professor in Dentistry and researcher in the Alan Edwards Centre for Research on Pain. This sort of chemical marking is part of the growing field of epigenetics, which involves modifications that turn genes 'on' or 'off', effectively reprogramming how they work.

"We were surprised by the sheer number of genes that were marked by the chronic pain -- hundreds to thousands of different genes were changed," adds Szyf. "We can now consider the implications that chronic pain might have on other systems in the body that we don't normally associate with pain."

Possible targets for new pain medications

The findings could open new avenues to diagnosing and treating chronic pain in humans, the researchers suggest, as some of the genes found to be marked by chronic pain could also represent new targets for pain medications.

Story Source:

The above post is reprinted from materials provided by McGill University. Note: Materials may be edited for content and length.

Journal Reference:
Renaud Massart, Sergiy Dymov, Magali Millecamps, Matthew Suderman, Stephanie Gregoire, Kevin Koenigs, Sebastian Alvarado, Maral Tajerian, Laura S. Stone, Moshe Szyf. Overlapping signatures of chronic pain in the DNA methylation landscape of prefrontal cortex and peripheral T cells. Scientific Reports, 2016; 6: 19615 DOI: 10.1038/srep19615

McGill University. "Chronic pain changes our immune systems: Epigenetics may bring us a step closer to better treatments for chronic pain." ScienceDaily. ScienceDaily, 28 January 2016. .

Tuesday, 2 February 2016

Will Endomorphin Be The Replacement For Opioids For Neuropathy Patients?

Today's post from (see link below) follows on from yesterday's post about endomorphin and its potential for chronic pain patients but whereas yesterday's post was from a national newspaper, this one is from the ever-reliable and confirms what you may have read yesterday. If the predictions are correct, then commercially produced endomorphin may replace opioids as the pain killers of choice for those who've tried everything else and as a bonus, will deliver none of the side effects associated with opioids. This is fantastic news for long-term pain patients who not only have to manage their opioid prescriptions properly but have to face the wagging finger of media stigma, however unjust that may be. We still have to wait two years before the first human trials but the eventual benefits may make the wait easier.

New drug could be safer, non-addictive alternative to morphine
 January 28, 2016 Source: Tulane University

The peptide-based drugs, which mimic a natural brain chemical, target the same pain-relieving opioid receptor as morphine

Researchers at Tulane University and Southeast Louisiana Veterans Health Care System have developed a painkiller that is as strong as morphine but isn't likely to be addictive and with fewer side effects, according to a new study in the journal Neuropharmacology.

Using rats, scientists compared several engineered variants of the neurochemical endomorphin, which is found naturally in the body, to morphine to measure their effectiveness and side effects. The peptide-based drugs target the same pain-relieving opioid receptor as morphine.

Opium-based drugs are the leading treatments for severe and chronic pain, but they can be highly addictive. Their abuse results in thousands of overdose deaths in the United States annually. They can cause motor impairment and potentially fatal respiratory depression. Patients also build up tolerance over time, increasing the risk for abuse and overdose.

"These side effects were absent or reduced with the new drug," said lead investigator James Zadina, VA senior research career scientist and professor of medicine, pharmacology and neuroscience at Tulane University School of Medicine. "It's unprecedented for a peptide to deliver such powerful pain relief with so few side effects."

In the study, the new endomorphin drug produced longer pain relief without substantially slowing breathing in rats; a similarly potent dosage of morphine produced significant respiratory depression. Impairment of motor coordination, which can be of particular importance to older adults, was significant after morphine but not with the endomorphin drug.

The new drug produced far less tolerance than morphine and did not produce spinal glial cell activation, an inflammatory effect of morphine known to contribute to tolerance.

Scientists conducted several experiments to test whether the drug would be addictive. One showed that although rats would spend more time in a compartment where they had received morphine, the new drug did not affect this behavior. Another test showed that when the press of a bar produced an infusion of drug, the rats only increased efforts to obtain morphine and not the new drug. The tests are predictive of human drug abuse, Zadina said.

Researchers hope to begin human clinical trials of the new drug within the next two years.

Story Source:

The above post is reprinted from materials provided by Tulane University. Note: Materials may be edited for content and length.

Journal Reference:

James E. Zadina, Mark R. Nilges, Jenny Morgenweck, Xing Zhang, Laszlo Hackler, Melita B. Fasold. Endomorphin analog analgesics with reduced abuse liability, respiratory depression, motor impairment, tolerance, and glial activation relative to morphine. Neuropharmacology, 2016; 105: 215 DOI: 10.1016/j.neuropharm.2015.12.024

Tulane University. "New drug could be safer, non-addictive alternative to morphine: The peptide-based drugs, which mimic a natural brain chemical, target the same pain-relieving opioid receptor as morphine." ScienceDaily. ScienceDaily, 28 January 2016. .

Monday, 1 February 2016

Is Endomorphin The 'Super Morphine' That Will End The Need For Opioids?

Today's post from (see link below) could signal the breakthrough all neuropathy patients experiencing chronic pain have been waiting for. It talks about using 'endomorphin' as an alternative to morphine and other opioids but without the side effects! (There will be a follow up post from another source tomorrow.) The endomorphin drugs are peptide-based, and target the same pain-relieving opioid receptor as morphine. Endomorphin is naturally produced in the body but targeted endomorphin drugs may certainly be able to replace opioids in the spectrum of neuropathic pain treatments. It's an old story but it's only at the rat-testing stage at the moment and will be two years before human testing begins but the potential is obvious. More information in tomorrow's post.

Researchers reveal ‘super morphine’ that has all of the painkilling properties but is NOT addictive
By Lisa Ryan For Published: 29 January 2016 

 A neurochemical has all the painkilling effects of morphine, scientists say
Endomorphin is not addictive and has fewer side effects, a study revealed
And, endomorphin doesn't cause the same respiratory depression
This new drug could offer pain relief without risking opioid addiction

Health officials have frequently warned of the opioid epidemic sweeping America.

There has been a 200 per cent increase in opioid-related deaths since 2000 – with many of those deaths occurring because of prescription painkillers, according to the Centers for Disease Control.

However, scientists may have the answer - a powerful painkiller that isn’t addictive.

Endomorphin – which is found naturally in the body – can be as strong as morphine, but with fewer side effects, according to a study from Tulane University.

Dr James Zadina, a professor of medicine, pharmacology and neuroscience, said: ‘These side effects were absent or reduced with the new drug.

‘It’s unprecedented for a peptide to deliver such powerful pain relief with so few side effects.’

The study, published in the journal Neuropharmacology, tested several engineered variants of the neurochemical endomorphin on rats.

The scientists compared endomorphin to morphine – in an attempt to measure the drugs’ effectiveness and side-effects.

The endomorphin drugs are peptide-based, and target the same pain-relieving opioid receptor as morphine.

Opium-based drugs are the most common treatments for severe and chronic pain – but they can be severely addictive.

Opioid abuse leads to overdose deaths across the world.

Furthermore, the drugs can cause motor impairments and potentially fatal respiratory depression.

And because patients build up tolerance over time – there is a higher risk for abuse and overdose.

The study found the new endomorphin drug offered longer pain relief without substantially slowing the breathing in rats.

A dose of morphine that was similarly potent produced ‘significant respiratory depression,’ the study said.

Additionally, impairment of motor coordination – which is of particular significance to older adults – was higher after morphine.

But, motor coordination wasn’t impaired with the endomorphin drug.

The study found the new drug produced far less tolerance than morphine.

It’s unprecedented for a peptide to deliver such powerful pain relief with so few side effects

It also didn’t produce spinal glial cell activation – which is an inflammatory effect of morphine that can contribute to tolerance.

Several experiments tested whether the drug would be addictive.

One found that while rats would spend more time in a compartment where they received morphine, the new drug didn’t affect that behavior.

Another test found that when the press of a bar produced an infusion of the drug, the rats increased efforts to obtain morphine.

Yet, they did not increase efforts to get the new drug.

Dr Zadina noted that these tests are ‘predictive of human drug abuse.’

The scientists hope to conduct human clinical trials of the new drug within the next two years.

Sunday, 31 January 2016

Chronic Pain Patients Treated Shamefully

Today's post from (see link below) relates expecially to what's going on in the US right now but will be recognisable to many people currently living with neuropathy. More and more these days, we begin to feel that we're nothing more than statistics used to prove one thing or another in the current bureaucracy-obsessed health service and wonder if our doctors are interested in us as people or merely see us as pawns in the drug/insurance company battles and financial negotiations that rule how our health systems operate. This article is both an advertisement for a book (interview with the author) and a comment on how badly chronic pain patients are treated in modern consulting rooms. It hits the nail on the head in several respects and is definitely worth a read.

The Painful Truth: How Patients Are Treated Shamefully  Pain News Network editor Pat Anson August 26, 2015

Lynn Webster, MD, is past President of the American Academy of Pain Medicine, vice president of scientific affairs at PRA Health Sciences, and one the world’s leading experts on pain management. He treated people with chronic pain for more than 30 years in the Salt Lake City, Utah area.

Dr. Webster’s new book, “The Painful Truth,” is a collection of stories involving several of his former patients, who struggled with the physical, emotional and financial toll that many chronic pain sufferers experience.

Pain News Network editor Pat Anson recently spoke with Dr. Webster about “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.” The interview has been edited for content and clarity.

Anson: Dr. Webster, you’re no longer practicing medicine, but you’re still very involved in the pain community and in research. Why write this book now at this stage of your career?

Webster: It takes a lot of time to write a book, as you can imagine, and it’s taken me four years to get to this point. I think that at this stage in my career I can look back and put together a story about the people who I’ve taken care of for most of my career that I’m not sure I could’ve done in the middle of it. I think that’s given me the ability to look back and reflect and feel the heartache that patients have, and my inability to deliver to them everything that I wanted to deliver to them, because of all of the barriers and obstacles in healthcare.

I’m hoping that my book is going to be a seed that will contribute to a cultural change, a social movement that will bring some dignity and humanity to a large population of our country.

Anson: In your book you said the painful truth is that people in pain are treated shamefully. What did you mean by that?

Webster: When I was growing up on a farm I observed something as a young boy that always puzzled me and that was watching the injured or sick animals. We had all sorts of animals; cows, pigs, sheep, and chickens, and I could see that the injured somehow were always separated from the healthy ones. It wasn’t that the sick separated themselves from the healthy, but the healthy separated themselves from the injured or the ill.

I see that to some degree in people and I wonder if this hasn’t been a biological aspect of survival for man from the beginning. We as humans are better than that; we’re better than we may have been thousands of years ago.

Today, I think that it is shameful that people are stigmatized because they have pain, they’re isolated, and they’re denigrated often. Because of our healthcare system, at least in this country, they’re viewed as addicts, lowlife’s, and druggies. That’s rarely true and it absolutely prevents, it really contributes to the harm that pain sufferers feel towards themselves and their inability to get the type of care they need. I think that it hurts our society in so many different ways, but most importantly the people in pain.

Anson: A lot of your book is dedicated to telling the stories of some of the pain patients that you treated. Virtually every one went through what you just described, where they had trouble getting proper treatment, they had trouble with their jobs, with their families, and with their friends. Is that why you write the book in this way, so that their stories get across the point you’re trying to make?

Webster: Absolutely. It’s less important that a physician tells a story than a patient tells their story. I wanted this book to be felt by the readers, to understand what people in pain experience and the struggles they have.

Anson: You wrote that, “People in pain need to be both treated by medical professionals and supported by all the important people in their lives.” Is that happening?

Webster: No, of course not. There are some patients that have pain who have great support structures in their personal life. For example Alison, she is an individual who had what I thought was the quintessential family support. Were it not for her mother, father and sister, she could’ve gone down the path that too many others take, which would be resignation rather than resilience. It’s one where drugs are used to cope and to escape the pain, physical but also the emotional.

Too many people are separated and too few have the structure of the support system that Alison had. Our healthcare system is abominable. It shamelessly abandons them with limited resources, limited access and actually a labeling of the individual as if they’re a leper; they have a disease that is contagious.

Anson: Is the average physician in U.S. prepared to treat chronic pain?

Webster: No. I think it’s been reported that medical schools average less than 10 hours of education on pain and even less for addiction. Yet this is the number one public health problem in America and it’s not recognized by the CDC like many other disease states have been.

And so very few physicians understand what pain is. In fact, many think that it’s just a symptom and you never die from pain which is categorically wrong. As I write in my book, pain can be as malignant as any cancer and it can be just as devastating. It can take the soul but it also takes the life of some individuals when we ignore it and when we’re unable to provide them the relief that they deserve.

Anson: If you were a young man again in medical school and trying to decide what specialty to go into, knowing what you know today, would you go into pain medicine?

Webster: Without a doubt, there is no hesitancy in this response; I love the field that I’ve been in. As an anesthesiologist I could’ve stayed in the operating room and honestly the compensation of doing that would have been far better than the path that I chose. But the rewards I’ve received from trying to make a difference and the thank you’s that I’ve received will never be matched by any kind of financial or professional recognition in any other areas.

The most rewarding part of life is really to be able to make a difference in someone else’s life. And I think I’ve been able to do that with hundreds, if not thousands of individuals. That actually is the reason for the book. I’m hoping the book is going to make a difference for more people than I could physically touch in my clinic.

Most of the people that I saw as patients were already experiencing a large amount of pain, they’ve been through the mill and many had their chronic pain for years before they came to see me. We are basically going to be taking care of them the rest of their life. We do get to know them, much like a primary care person does to a family they’ve been caring for, and so we get to know them well. They get to know us. We also begin to see the struggles that they have in the system and with the rejection of their families sometimes, their friends, the isolation. And we become the only source that’s grounded, that gives them potential hope. I took that very seriously and I think that’s why it was so rewarding for me.

Anson: You wrote that you’re neither pro-opioid or anti-opioid. What do you mean by that?

Webster: My focus has never been about making opioids available or that they should be used. In fact ten years ago I started the first national campaign about the risk of opioids. My campaign was called Zero Unintentional Overdose Deaths and you can still find that on the Internet. I did a lot of work at trying to understand the potential risks and mitigate those risks so we can prevent people from harm because I knew one day that if we couldn’t prevent people from being harmed from opioids that there would be political response to this that could be very harmful to a large number of people who are not harmed by opioids.

I think the focus should always be about what’s best for a patient and not about whether a drug or a certain treatment is good or bad. All treatments have potential risks and complications, and we need to evaluate whether or not the potential benefit outweighs the potential risk or harm and it has to be patient centered. So my focus has never been about really any treatment, but it’s always been about what’s best for the patient. I’m more anti-pain than I am pro or anti-opioid.

Anson: You prefer a multi-disciplinary approach to pain treatment?

Webster: Yes, it’s been demonstrated that for people with moderate to severe chronic pain, the type that’s not likely to be resolved, it is best managed in a multi-disciplinary, integrative approach. I see the need for more cognitive behavioral therapy. We should always tap into the different treatments that have low risk associated with them before we ever tap into something that has more risk, for example opioids or even interventional treatments we as anesthesiologists and some of the other pain specialists can provide.

Much about pain is really learning how to cope, how to deal with it from day to day and how to manage the stress that’s associated with it because stress augments all pain. And so it’s really important that we use all of the resources that we have to manage the pain and not just a single modality, certainly not opioids or spinal cord stimulators, but look at how we can manage this in a more mindful way, even as clinicians. I use that word intentionally because mindfulness is really what the doctor needs to use as much as the patient in order to optimize the treatment with the lowest risk.

Anson: Has the pendulum swung too far against use of opioids?

Webster: I think there’s too much focus on opioids by almost everyone. And what it has done is it’s forgotten about people. Opioids can cause a great deal of harm, we see way too many people harmed from opioids. But certainly a vast majority of people who have been exposed to opioids are not harmed by them and there are countless number of people, a huge number of individuals who have been on opioids for decades, that believe very strongly that they’ve improved their lives and they could not live without them.

I think the focus is in the wrong place. Our focus should not be on opioids and whether they should or should not be prescribed, but what is the best treatment for the patient? And if opioids are inappropriate as a pain treatment, then I say all of the anti-opioid people as well as the individuals who are interested in helping people with pain should come together and demand that we have more money invested in research so we can replace opioids entirely.

We cannot always know who’s going to have an addiction triggered by exposure. As I pointed out in my book, Rachel just went in for an appendectomy and that initial opioid that she received lead her down a serious, dreadful path because she didn’t have the social support to keep her from taking that path.

I think that the anti-opioid people and those of us who are interested in bringing some dignity and humanity to a large population of people in pain need to come together and insist that we have a Manhattan Project basically and to discover safer and more effective therapies that are not addictive.

Anson: The final version of National Pain Strategy will soon be released, with the goal of advancing pain research, healthcare and education in the U.S. From what you’ve seen and heard so far about it, are they on the right track?

Webster: Yes, I think it’s an important step forward. I think that it brings most importantly the government into the picture, recognizing the need that we do something on a national scale and that alone is a big step forward.

It’s kind of like in my book there are three important words, “I believe you.” This is really the way the government can say, “I believe you.” There is a problem in this country with the way in which we treat pain and the National Pain Strategy is about how they’re going to address that. Having the federal government say I believe you, there is a problem, let’s see if we can change the way pain is treated in this country is a huge step forward.

Anson: Thank you, Doctor Webster.

You can follow Dr. Webster on his blog, and on Twitter @LynnRWebsterMD, Facebook and LinkedIn.