Monday, 22 May 2017

Why Is Fibromyalgia A Neuropathic Condition?

Today's post from consultqd.clevelandclinic.org (see link below) addresses the on-going confusion surrounding fibromyalgia and its relationship with neuropathy. Fibromyalgia is a painful rheumatic condition characterized by muscular or musculoskeletal pain with stiffness and tenderness at specific points on the body. It's often accompanied by extreme tiredness, sleep problems, memory and mood swings. It's a disease that doctors hate because it's so difficult to pin down and so easy to misdiagnose, even to the point of telling patients that it's all between their ears. Because it's associated with rheumatic and muscular problems, there's a fierce debate as to whether it could ever be linked to nerve damage. This article maintains that it's a neurological problem, caused by a damaged nervous system. Strangely, whatever the cause, the treatment follows very much the same lines as that for neuropathy. Whatever the reasons for and causes of, it's a nasty, painful  condition that has patients at the limit of their tolerance because all the pain seems heightened by extreme sensitivity - sounds much like neuropathy to me!!


Why Fibromyalgia Is Neuropathic 

Mar. 8, 2016 / Pain Management / Education
 
Central sensitization is one explanation

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

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

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

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


Definitions we can agree on

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

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


Fibromyalgia’s link to central sensitization

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

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

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

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

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


What this means for treatment

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

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

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

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

“Pain pathways and centers are in the brain. And we can employ techniques like mindfulness and biofeedback to control pain,” he says. “However, it’s more helpful — and accurate — to consider it a neurogenic disorder.”
 
https://consultqd.clevelandclinic.org/2016/03/why-fibromyalgia-is-neuropathic/

Sunday, 21 May 2017

Two Anti-Depressants For Nerve Pain: How Did They Do?

Today's short post from alert.psychnews.org (see link below) reports that a new study has shown both Duloxetine (Cymbalta and others) and Venlafaxine ( ‎Effexor, Trevilor, Lanvexin, others) to be reasonably effective treatments for nerve pain. Well reasonable in the sense that they performed better than other pills...when compared to placebos. These two serotonin-norepinephrine reuptake inhibitors (anti-depressants) are already widely prescribed for neuropathic pain but as we know, what works for one patient, doesn't necessarily work for others, which leads to patient frustration and difficulties for researchers and studies to come to definitive conclusions. The article also states that pregabalin is FDA approved for neuropathic pain - it's not! The FDA goes as far as to demand that warnings about the side effects be placed on boxes. It's a minefield for patients wondering whether what their doctor has prescribed is a)going to work and b) going to be safe. It is safe to say that almost all drugs prescribed to limit neuropathic pain can have side effects and therefore it's vitally important that you have a serious discussion with your doctor before embarking on a course of drugs. Together you need to weigh up the benefits and risks and even then there's no guarantee that your symptoms will diminish. However, maybe that shouldn't stop you trying - anything is better than that relentless pain...right! But your doctor should monitor your progress on any given drug, with great care and if necessary change the treatment.
 

Duloxetine, Venlafaxine May Be Most Effective at Reducing Diabetic Nerve Pain

Monday, March 27, 2017

The serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine appear to have the best evidence for being effective at reducing nerve pain in people with diabetes, according to a meta-analysis published in Neurology. Duloxetine is FDA-approved for treating pain in diabetic neuropathy, though venlafaxine is not.

The researchers pooled together data from 106 clinical studies published between 2011 and 2015 examining the effectiveness of pharmacologic approaches to improving pain in patients with diabetic peripheral neuropathy. The analysis compared outcomes in patients taking 21 different medications, though the authors were unable to draw conclusions for any head-to-head drug comparisons due to insufficient evidence.

The researchers found moderate evidence to suggest that duloxetine and venlafaxine were more effective at reducing neuropathy-related pain than placebo. Tricyclic antidepressants, botulinum toxin, the opioids tramadol and tapentadol, and the anticonvulsants pregabalin and oxcarbazepine were also found to be more effective than placebo, but the evidence base for these medications was weak.

In contrast, the anticonvulsant gabapentin, mood stabilizer valproate, and capsaicin cream were all found to be no more effective than placebo; these findings run contrary to guidelines for treating diabetic peripheral neuropathy published by the American Academy of Neurology in 2011, which listed all three agents as probably effective.

“Our findings generally support the effectiveness of the three drugs approved by the Food and Drug Administration (FDA) for the treatment of pain in diabetic peripheral neuropathy: duloxetine, pregabalin, and tapentadol,” wrote Julie Waldfogel, Pharm.D., of the Johns Hopkins Hospital and her colleagues. “Additional studies evaluating longer term outcomes are needed to better inform clinical decision-making, patient choice, and clinical practice guidelines.”

http://alert.psychnews.org/2017/03/duloxetine-venlafaxine-may-be-most.html

Saturday, 20 May 2017

Charcot-Marie-Tooth Disease: An Inherited Cause Of Neuropathy

Today's post from cmtausa.org (see link below) clears up a lot of misunderstandings about Charcot-Marie-Tooth Disease, or CMT. Yes it causes neuropathy and yes, once you have a certain diagnosis, the treatment is very much the same as for other neuropathies. The difference is that C.M.T. is inherited and passed down and not brought about by outside sources. It also most frequently affects younger people and is most frequently diagnosed in your twenties. People who do a lot of research about neuropathy (hopefully most of you) will come across references to Charcot-Marie-Tooth Disease and wonder if it has anything to do with their own neuropathic problems. The answer is most likely not but it is wise to look at your own family tree and see if neuropathy is a recurring theme throughout the generations. If that's the case, then there's a strong possibility that your neuropathy is C.M.T. induced. After the diagnosis, you join a much wider family of people living with neuropathy from more than 100 different causes and need to concentrate on reducing the symptoms like everybody else. However, as it's an inherited condition, you may need to investigate the likelihood that you may pass it on to your own children - DNA tests will help in this process.

What is CMT?

 Charcot-Marie-Tooth Association 2017
 
Charcot-Marie-Tooth Disease, or CMT, is a group of inherited disorders that affect the peripheral nerves, which are the nerves outside the brain and spinal cord. There are 90 kinds of CMT. Each kind is caused by a different kind of mutation, and more causes are being discovered every year.

CMT is just one kind of neuropathy (also called peripheral neuropathy), meaning simply that the peripheral nerves are damaged. There are many other causes of neuropathy, including the most common cause—diabetes.

CMT affects about 2.8 million people worldwide, of all races and ethnic groups.

Where Did the Name CMT Come From?


Charcot-Marie-Tooth is named after the three physicians who were the first to describe it in 1886: Jean-Martin Charcot, Pierre Marie and Howard Henry Tooth.



Inherited Disorders

CMT is inherited. It is not contagious, nor is it caused by anything in the environment. The most common forms of CMT are passed down from one generation to the next, meaning that it is dominantly inherited.

Some forms of CMT are recessively inherited—a person may be affected even though his or her parents do not have CMT. In this case, each of the parents harbors a mutation in one of their two copies of a CMT gene. If a child inherits one mutated CMT gene from each of their parents (the chance of this happening is one out of four), the child will develop CMT.

Sometimes the mutation that causes CMT happens spontaneously during the process that produces the eggs or sperm. In these rare cases, a child will have CMT even though neither parent has CMT. If a child has such a spontaneous mutation, he/she may pass that mutation down to his/her offspring.

Symptoms


Some types of CMT cause damage to the covering (myelin sheaths) that surrounds nerve fibers. Other kinds of CMT directly damage the nerves fibers themselves. In both cases, the damaged nerve fibers result in neuropathy. The nerves in the legs and arms, which are the longest, are affected first. Nerve fibers that create movement (called motor fibers) and nerve fibers that transmit sensations (called sensory fibers) are both affected. CMT causes weakness and numbness, usually starting in the feet.

In the most common kinds of CMT, symptoms usually begin before the age of 20 years. They may include:


The foot of a person with CMT. The lack of muscle, a high arch, and claw toes are signs of this genetic disease.
Foot deformity (very high arched feet);
Foot drop (inability to hold foot horizontal);
“Slapping” gait (feet slap on the floor when walking because of foot drop);
Loss of muscle in the lower legs, leading to skinny calves;
Numbness in the feet;
Difficulty with balance;
Later, similar symptoms also may appear in the arms and hands.

CMT almost never affects brain function.

Diagnosis

A diagnosis of CMT is established through a thorough neurological evaluation by an expert in neuropathy, including a complete family history, physical exam, and nerve conduction tests, and appropriate genetic testing.

A physical exam may show:
Difficulty lifting up the foot while walking;
Difficulty with dorsiflexion of the toes and ankles (upward movement, away from the ground) and other foot movements;
Reduced or absent deep tendon reflexes (like the knee-jerk reflex);
Loss of muscle control and atrophy (shrinking of the muscles) in the feet and lower legs (and later the hands).

Genetic testing can provide the exact cause for most people who have CMT.

Prognosis (Expectations)

CMT usually gets worse, slowly, with age; rapid progression is rare, and should motivate a prompt re-evaluation. The problems with weakness, numbness, difficulty with balance, and orthopedic problems can progress to the point of causing disability. Pain can be an issue, either as a direct result of the neuropathy (neuropathic pain) or as consequence of orthopedic problems. Other potential complications include the following:
Progressive inability to walk from weakness, balance problems, and/or orthopedic problems;
Progressive inability to use hands effectively;
Injury to areas of the body that have decreased sensation.

Treatments

There are no known treatments that will stop or slow down the progression of CMT, but the CMTA is funding research to find these treatments.

Physical therapy, occupational therapy, and physical activity may help maintain muscle strength and improve independent functioning.

Orthopedic equipment (such as braces, inserts, or orthopedic shoes) may make it easier to walk.

Orthopedic surgery on the feet can often maintain or even restore function to enable walking.

Family Planning

Most patients can obtain an exact genetic diagnosis. Genetic counseling can inform patients of the chance that they will pass CMT on to their children.

More Answers


The CMTA wants to help you better understand CMT by offering advice from professionals. Click here to find answers to the most frequently asked questions and post questions and concerns that have not yet been addressed—we’ll get you in touch with the right professional.

https://www.cmtausa.org/understanding-cmt/what-is-cmt/

Friday, 19 May 2017

Capsaicin Trials Reveal Moderately Positive Results For Nerve Pain

Today's post from clinicalpainadvisor.com (see link below) reveals the results of recent trials of the capsaicin (chili-based) patch Qutenza in relation to neuropathic pain. Now capsaicin is one of those treatments that regularly returns to the neuropathy forums on the internet but mostly without conclusive results. The results here can also hardly be called 'conclusive' but they do indicate that there is benefit to be had from capsaicin patches, if applied properly. That's the problem: it's a controversial treatment because it carries the risk of potential burn issues and is both tricky to use and needs medical supervision (especially with the 8% versions that are pretty strong). Alternatives include capsaicin creams but they do tend to be messy and less effective than the patches. If you are considering trying capsaicin patches, please talk to your doctor first before ordering them on the internet. Hopefully your insurance will cover them anyway so it's always best to go through the official channels.
 
Capsaicin 8% Patch Effective on Nondiabetic Peripheral Neuropathic Pain
Christin Melton, ELS May 03, 2017 
 
The patch used in the study is approved in the United States for postherpetic neuralgia and in Europe for PNP arising from any etiology.

Results from the ASCEND study recently published in BioMed Central Neurology indicate that an 8% capsaicin patch is effective in relieving peripheral neuropathic pain resulting from a wide range of etiologies.1

Peripheral neuropathic pain (PNP) may arise from several medical conditions and is commonly encountered in clinical practice.2 Conditions including diabetes, cancer and cancer treatments, traumatic nerve injury/entrapment syndromes, and infections such as herpes zoster virus (HZV) or human immunodeficiency virus (HIV) are known etiologies of PNP.1,2 Many patients with PNP are treated with oral nonsteroidal anti-inflammatory drugs (NSAIDs) despite a lack of evidence of their efficacy in relieving neuropathic pain.3 A phase 4 open-label study, ASCEND (Clinicaltrials.gov ID NCT01737294) sought to determine whether a high-dose capsaicin patch (8%; QUTENZA™) was effective on several measures of PNP in a real-world setting.1 The patch used in the study is approved in the United States for postherpetic neuralgia (PHN) and in Europe for PNP arising from any etiology.

ASCEND, which was an observational study conducted from February 2012 to August 2014, included 429 adults from 7 European countries who had non-diabetic PNP, with etiologies including HZV, HIV, back injury or inflammation, cancer, and surgery or trauma. Some participants had newly diagnosed PNP, whereas others had previously received 1 or more treatments for PNP. The patches were prescribed as part of routine clinical practice, with patients receiving up to 4 capsaicin patches per treatment. Patches were applied for 30 minutes to the feet and for 60 minutes at other sites. Subsequent capsaicin treatments could be prescribed every 90 days.

The study's primary end point consisted of follow-up, which was conducted by phone or at the prescribing clinic at weeks 2 and 8. Additional follow-up sessions were conducted at weeks 12, 26, 39, and 52. At each time point, patients were asked to rate their pain intensity over the past 24 hours and over the past 7 days using a 0 to 10 numeric pain rating scale (NPRS). In addition, health-related quality of life (HR-QOL) and perceived changes in health were evaluated.

Between the first capsaicin patch application and follow-up at weeks 2 and 8, mean NPRS scores decreased 26.6% (95% confidence interval (CI: 23.6, 29.62; n = 412). Almost half of patients had at least a 30% reduction in pain at weeks 2 (44.4% reduction; n=183) and 8 (49.1% reduction; n=79). In some patients, pain relief (as indicated by ≥50% reduction in pain scores) occurred as early as the second week after treatment (26.2% of patients; n=108). Improvement was similar in patients with PNP resulting from PHN, neuropathic back pain, postoperative or posttraumatic neuropathic pain, and other causes.

Median time for first re-treatment was 191 days, which was administered to 43.1% of study participants (n=181). In the 16.7% (n=70) of patients who received a third dose, a median of 301 days elapsed between first and second re-treatments. The capsaicin 8% patch showed evidence of long-term effectiveness, with an overall 37% reduction in NPRS scores between baseline and week 52. The investigators noted that “patients in the primary stage of treatment or with short duration of disease had the greatest pain reduction, suggesting that patients with PNP may benefit from early treatment with the capsaicin 8% patch.” Sustained improvement in HR-QOL and in patients' self-perception of health status were also observed. At week 12, 61.0% of patients (n=224/367), indicated their health had improved.

The capsaicin 8% patch was well tolerated. More than 92% of patients completed at least 90% of the suggested patch applications. Only 11% of patients experienced an adverse event, the most common of which were site reactions. The researchers concluded that “the capsaicin 8% patch may benefit patients who have inadequate pain relief from systemic therapies or for those suffering intolerable systematic side effects.” 


Summary and Clinical Applicability

The ASCEND study observed meaningful decreases in pain and improvement in health-related quality of life in patients with PNP with wide-ranging etiologies. In many patients, the capsaicin 8% patch showed long-term effectiveness and good tolerability. In the United States, the capsaicin 8% patch is only approved for PHN. However, the current study indicates that the patch may be an effective option when first-line therapies for PNP are ineffective or not tolerated. 


Limitations and Disclosures

The ASCEND study is limited by the fact that it was an open-label observational study vs a randomized controlled trial.

The study was sponsored by Astellas Pharma Europe Ltd., which manufactures the Qutenza 8% capsaicin patch used in the study.

Several study investigators and individuals who designed the study were Astellas employees. However, the researchers who recruited and treated study participants had no relevant disclosures. Astellas funded the data analyses and medical writing and editing services for the study.


Related Articles

Ketamine for Refractory Neuropathic Pain
Neuropathic Pain Complexity Requires Thoughtful Approach and Combination of Interventions
Central Neuropathic Pain Syndromes
Assessing Biomarker Validity for Neuropathic Pain

Follow @ClinicalPainAdv

 
References
Mankowski C, Poole CD, Ernault E, et al. Effectiveness of the capsaicin 8% patch in the management of peripheral neuropathic pain in European clinical practice: the ASCEND study. BMC Neurol. 2017;17(1):80.
Jay GW, Barkin RL. Neuropathic pain: etiology, pathophysiology, mechanisms, and evaluations. Dis Mon. 2014;60(1):6-47.
Moore RA, Chi CC, WIffen PJ, Derry S, Rice AS. Oral nonsteroidal anti-inflammatory drugs for neuropathic pain. Cochrane Database Syst Rev. 2015;(10):CD010902.


http://www.clinicalpainadvisor.com/neuropathic-pain/capsaicin-patch-for-non-diabetic-peripheral-neuropathic-pain/article/654496/

Thursday, 18 May 2017

Cedric The Entertainer's Family Experiences Of Neuropathy

Today's post from journals.lww.com (see link below) is a personal story about a man's life with neuropathy and as such, makes a change from all the scientific and theoretical articles that reveal the workings of our disease. Sometimes, we just need to know how someone else is dealing with nerve damage. It confirms our own experiences; shows us that we're not alone and inspires us to keep going. In this case, we also have an indirect role-model, in that Cedric the Entertainer talks about his father's experiences with neuropathy. Further than that, the article is also full of useful information about nerve damage and (in this case) diabetes. Always remember; diabetes may be the commonest cause but is only one of more than a hundred. Once you have neuropathy, you'll be sharing experiences both of symptoms and treatments, with millions of others. The cause is not the issue; it's where we go from there that counts.

Touching a Nerve: Diabetic nerve pain sidelined his father for more than a year. Now Cedric the Entertainer is on a mission to educate others about this serious diabetes complication. 
Roberts-Grey, Gina
Neurology Now: August/September 2016 - Volume 12 - Issue 4 - p 18–21
doi: 10.1097/01.NNN.0000490550.78705.00
Features: Cedric the Entertainer

As a stand-up comic, television and film actor, director, musician, and game show host, Cedric Kyles has built a career around making people laugh. Known as Cedric the Entertainer, the 52-year-old Missouri native gained national prominence in 1992 when he appeared on the HBO comedy series Def Comedy Jam. Four years later, he landed his first acting role on The Steve Harvey Show. Since then, he has appeared in dozens of movies, including Barbershop and Barbershop 2: Back in Business, and the animated films Ice Age and Madagascar. He also stars in and is a co-creator and executive producer of TV Land's The Soul Man.



PHOTOGRAPH BY JEMAL ...

Recently, though, he's been using his natural charm, mellifluous voice, and sense of humor to deliver a serious message: If you have diabetes and you experience pins-and-needles pain in your hands or feet, talk to your doctor about it. It could be peripheral neuropathy, a nerve disorder that is a real and treatable condition associated with diabetes.

Cedric signed on to produce “Step On Up,” a series of public service announcements for the American Diabetes Association (ADA), after realizing his father, Kittrell, had been silently enduring debilitating pain in his feet for quite some time. “Our family had no idea it was happening,” says Cedric, who blames his father's stoicism on misguided machismo. “My father is like most men. Our male ego gets in the way. To look strong or macho, we don't talk about our aches and pains. We'd rather sweep health issues under the rug than be vulnerable and admit to someone that something may be wrong,” says Cedric. That's especially true for African American men, he says. “There's a tendency to not want to know about any health problems, and that's dangerous.”

LIVING WITH PAIN


In 2008, Kittrell was diagnosed with type 2 diabetes, a diagnosis he kept secret from his son for eight months, says Cedric. About a year later, Kittrell began experiencing painful tingling sensations in his legs, but he never connected it to diabetes or discussed it with his family or doctor. “We didn't know he was living with such intense symptoms,” says Cedric. “It's amazing that he tolerated what he did for so long without saying something to anyone in the family, his friends, or, perhaps more importantly, to the doctor. He just tried to grin and bear it.”

Like Kittrell, many people with diabetes don't recognize the symptoms of nerve pain or understand that it is a complication of diabetes, says Kamal R. Chémali, MD, a neurologist and director of Sentara Neuromuscular and Autonomic Center in Norfolk, VA. Symptoms can range from numbness or a reduced ability to feel pain or temperature changes to tingling or burning sensations, sharp pains, cramps, muscle weakness, and increased sensitivity to touch. “Although diabetic neuropathy can develop in the hands and arms, it most commonly affects the nerves in the legs and feet and results when chronic high blood sugar damages nerve fibers,” says Dr. Chémali.

A WORLD NARROWS



STEP ON UP Cedric th...

Left untreated, nerve pain can cause infections or create balance problems that may lead to falls and can slowly erode a person's quality of life. Before admitting to his pain, Kittrell gradually withdrew from family functions and activities he enjoyed, including the father-son golf games he and Cedric shared.

“He would still go occasionally, but he started complaining a lot more than was usual for my dad,” says Cedric. Or, he would cancel at the last minute saying his feet hurt.



ACTIVE ENTERTAINER C...

Even when the pair did hit the links, the outings weren't the same, says Cedric. Kittrell couldn't play 18 holes because of pain and numbness in both feet. “He wouldn't say anything, but later I learned he felt like his feet were going to sleep.”

Eventually, the pain became too difficult to bear alone, and Kittrell started talking about it with his family, who encouraged him to discuss his symptoms with his doctor.

DIABETES EDUCATION

“The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and nerves affected,” says Robert G. Smith, MD, PhD, a neurologist at Houston Methodist Neurological Institute. Types of nerve damage include peripheral neuropathy, which affects the extremities; proximal neuropathy, which causes muscle weakness, most commonly in the thighs and hips; autonomic neuropathy, which may affect the digestive system, blood pressure, bladder, and other daily functioning; and focal neuropathy, which tends to affect only one nerve or just a few nerves, most often in the head, torso, arm, or leg.

“It's possible to have just one type or to experience symptoms of several types,” says Dr. Smith. About 60 to 70 percent of people with diabetes have some degree of diabetic nerve pain, according to the National Institute of Neurological Disorders and Stroke. Research published in Diabetes Care, a journal of the American Diabetes Association, says women are 50 percent more likely to experience symptoms than men.

GETTING A DIAGNOSIS


Since nerve pain can't be seen on an x-ray or detected in a blood test, physicians rely on the patient's ability to describe his or her symptoms and a physical examination to check reflexes, muscle strength, and sensitivity to touch, pressure, vibration and/or position changes, says Dr. Smith. “Other routine assessments like blood pressure, heart rate, and weight are also performed to monitor for overall changes.” In addition, the physician would complete a comprehensive foot examination to check circulation and skin tone. “It's recommended that people with diabetes have a comprehensive foot exam once a year to check for neuropathies or assess changes in those already diagnosed with diabetic nerve pain,” says Dr. Smith.

When patients describe limb numbness or pain, a physician might perform tests that record the electrical activity of muscle tissue and nerves, to rule out other conditions such as spine-related nerve damage.

SYMPTOMS AND CONSEQUENCES


Of the four types of diabetic neuropathy, peripheral neuropathy is the most common. It typically affects the feet and legs, but symptoms can spread eventually to the hands and arms, says Dr. Chémali. “The usual sensation is tingling, which patients describe as ‘pins and needles.’ Other sensations include coldness, stiffness, and tightness like a rubber band.”

“Symptoms are often worse at night, when patients are off their feet and resting,” says Dr. Chémali, who adds that depending on the affected nerves, the symptoms can range from mild to disabling. Kittrell experienced pain both at night and when he was standing and walking, says Cedric.

Untreated, the pain and tingling or numbness may manifest as an inability to sense the position of the feet or legs or even weakness of the feet (a footdrop), and patients may start falling, says Dr. Chémali. “In the worst-case scenario, patients may develop gangrene and need a limb amputated,” he adds.

NERVES UNDER STRESS


Experts do not know exactly what causes diabetic peripheral neuropathy. One theory is that injury to the blood vessels supplying the nerves leads to the loss of nerve fiber, says Dr. Chémali. Another is that increased and prolonged exposure to high blood sugar levels leads to the accumulation of sugary proteins in the nerves, which triggers a series of changes that eventually damages nerves from stress and inflammation, he says.

But this complication is not inevitable, says Dr. Chémali. “We don't know what percentage of patients with diabetes will develop peripheral neuropathy, but we do know that early detection of diabetes and tight control of the disease can stabilize and occasionally reverse symptoms in the early stages. Once diabetic neuropathy progresses, it becomes much harder or almost impossible to reverse the symptoms.”

The most effective way to reduce the odds of experiencing this painful complication is to lower your risk of developing type 2 diabetes in the first place, says Dr. Smith. That includes following a healthy diet and getting exercise or some physical activity every day. A regular sleep pattern is also important; studies have demonstrated that adequate sleep promotes a healthy weight, which, in turn, lowers the risk of type 2 diabetes.

TREAT IT RIGHT

Medications used to treat nerve pain include antiseizure drugs and antidepressants. According to the 2011 American Academy of Neurology (AAN) guideline on treatment for painful diabetic neuropathy, strong evidence exists to support the efficacy of pregabalin (Lyrica), the antiseizure drug. Two other antiseizure medications, gabapentin and sodium valproate, are moderately effective, as are the antidepressants amitriptyline, venlafaxine, and duloxetine. In 2004, the US Food and Drug Administration approved duloxetine and pregabalin for nerve pain.

Other treatments rated as moderately effective by the AAN guideline include four opioids (dextromethorphan, morphine sulfate, tramadol, and oxycodone controlled-release), electrical nerve stimulation through the skin, and capsaicin cream, which is made from chili peppers.

Cedric says Kittrell not only takes medication, he also has improved his diet, avoids alcohol, keeps his blood pressure under control, and follows his doctor's recommendations for good foot care—all of which have helped calm his symptoms and regain control of his life.

PROACTIVE STEPS


Cedric recognizes that diabetes and nerve pain could be part of his future—but he's taking steps to prevent that.

Knowing he can't manage a complete lifestyle overhaul, he's sticking to small tweaks, including eating more fruits and vegetables and choosing lean proteins whenever possible. “There are no more middle-of-the-night pancakes after I finish a [stand-up comedy] set. Instead I eat berries, salads, fish, and other sensible foods.”

He also aims for 30 minutes of physical exercise a day. Some days that's simply walking while talking on the phone or rehearsing; other days he's in the gym or on the golf course. “Exercise can come in many forms, but the most important thing I've learned is to get—and stay—moving.”

And he checks his ego at the door.

“This journey with my dad has taught me not only about diabetic nerve pain but also about the importance of men speaking up about any health issue that's bothering them,” says Cedric. “I won't make the mistake of keeping quiet about any health question or problem. My well-being is too important to allow a little pride to get in the way.”

Peripheral Neuropathy Resources

* American Academy of Neurology for a free brochure and video; http://bit.ly/PN-brochure; http://bit.ly/PN-video

* American Chronic Pain Association; http://theacpa.org; 800-533-2331

* American Diabetes Association; http://diabetes.org; 800-342-2383

* National Institute of Diabetes and Digestive Kidney Disease; http://niddk.nih.gov/Pages/default.aspx; 301-496-3583

* National Institute of Neurological Disorders and Stroke; http://ninds.nih.gov; 800-352-9424


Steppin' Up for People with Diabetes


In November 2014, Cedric the Entertainer partnered with the American Diabetes Association (ADA) to produce a series of public service announcements called Step On Up. Cedric has also appeared at a variety of national and local events to educate the more than 29 million Americans living with diabetes about the symptoms of diabetic nerve pain and the importance of talking to their doctors about those symptoms. “It's all about speaking up,” he says.

In November 2014, Cedric appeared at the ADA's “I Decide” to Stop Diabetes Day in Chicago. Last year, he spoke at the association's 2015 diabetes EXPO in Houston and encouraged attendees to take a diabetic nerve pain assessment. He's also appeared on numerous television talk shows, urging people with diabetes and their families to talk to their doctors about symptoms that could be caused by neuropathy.

“This is an important message for everyone, but especially minority communities, because diabetes affects African Americans and Hispanics in greater numbers. They all are at risk of diabetic nerve pain, and I'm glad to be able to use my celebrity to get this message across about not wasting time or letting pride stand in the way of getting yourself checked out.”© 2016 American Academy of Neurology 


 http://journals.lww.com/neurologynow/Pages/ArticleViewer.aspx?year=2016&issue=12040&article=00015&type=Fulltext

Wednesday, 17 May 2017

What Are The Links Between Neuropathy And Back Pain?

Today's post from spine-health.com (see link below) is a useful article that explores the frequent links between neuropathy and back pain. You may have neuropathy, or you may have unrelated back pain but you may also have both, in which case the neuropathy can be caused by the back problems themselves. This article goes into detail (with useful links) as to how and why this happens and is actually the first page of several pages dealing with nerve damage and the spine. Well worth a read if you feel that back pain plays a role in your neuropathic problems.

All About Neuropathy And Chronic Back Pain
By Ralph F. Rashbaum, MD Updated 3/2/2017
 
Neuropathic pain is distinct from other types of pain. If a person breaks a bone, pain signals are carried via nerves from the site of the trauma to the brain. With neuropathic pain, however, pain signals originate in the nerves themselves.
 

Neuropathic pain often occurs as a result of nerve damage or dysfunction.
 




















Read more details on how it affects Spinal Cord and Spinal Nerve Roots
 
How Neuropathic Pain Develops

In many cases, the nerves become damaged or dysfunctional after responding to an injury or trauma, causing hypersensitivity to pain. The nerves then send faulty signals of pain even when the injury has healed. The initial injury can occur in either the peripheral or central nervous system.

See Pain Signals to the Brain from the Spine
Article continues below


Neuropathic pain, or neuropathy, is a chronic condition, meaning it does not go away. Instead, the pain becomes the disease process. The terms sensory peripheral neuropathy and peripheral neuritis are sometimes used to describe neuropathy affecting the peripheral nerves.

See Chronic Pain As a Disease: Why Does It Still Hurt?

An estimated 7 to 10% of people have neuropathic pain.1 This article examines neuropathy and chronic back pain, and how the two conditions are related.

In This Article:

All About Neuropathy And Chronic Back Pain
Understanding Neuropathy Symptoms
Anatomy Of Nerve Pain
Types of Back Pain
Causes of Neuropathic Pain Video
Video: Understanding Different Types of Back Pain

 
When Back Pain Causes Neuropathy

Neuropathy can result from any type of pain that compresses or impinges on a nerve. A herniated disc, for example, could press against a nearby nerve, causing pain. Neuropathic pain originating from the back or spine may include:
Chronic pain radiating down the leg (lumbar radiculopathy, or sciatica)
Chronic pain radiating down the arm (cervical radiculopathy)
Pain following back surgery that starts gradually and persists, commonly called failed back surgery syndrome

See Radiculopathy, Radiculitis and Radicular Pain

Diabetes and regional pain syndrome (RPS), are common causes of neuropathy. Additional causes of include injury, disease, infection, exposure to toxins, and substance abuse. It is not always possible to pinpoint the cause.
Article continues below

Why Early Treatment is Crucial

Early treatment is important, since more aggressive treatment may be needed if symptoms are not addressed soon.

See Treatment Options for Neuropathic Pain

Over time, exposure to significant pain can cause changes to the central nervous system that make the body become more sensitive to even slight touch—a phenomenon known as central sensitization.

See Medications for Neuropathic Pain

As with other types of chronic pain, delays in treatment may also make other health problems more likely. Depression, anxiety, difficulty sleeping, and an inability to work and take part in other activities are some health issues associated with untreated neuropathy.

See Additional Treatments for Neuropathic Pain

References:
Van hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654-62.


http://www.spine-health.com/conditions/chronic-pain/all-about-neuropathy-and-chronic-back-pain

Tuesday, 16 May 2017

How The Brain And Spine Are Not The Only Pain Centres In The Body

Today's very interesting post from sciencealert.com (see link below) allows us to see how far science has developed in understanding neuropathic pain but also how there is still so much to learn. It is now thought that the peripheral nervous system plays a major role in transmitting and controlling pain throughout the body, when it was long thought that the centres of operations were the brain and spine alone. The problem is that they don't yet know how or why this is! It's a fascinating article and well worth a read.

Scientists Discover a Hidden Network of 'Mini Brains' That Could be Responsible for Pain
FIONA MACDONALD 10 APR 2017
 
We might have been wrong about how our bodies feel pain.

Scientists have found evidence of a hidden network of 'mini brains' that could overhaul our understanding of how pain is transmitted throughout the body, and revolutionise the way we design pain medication.

The current assumption is that pain sensations are only interpreted by the central nervous system - the brain and spinal cord. But the new research suggests that the peripheral nervous system plays a much more important role that's been eluding us for centuries.

To be clear, this research has only been done in rats and mice for now, and the results need to be replicated in humans before we think about rewriting the textbooks.

But given the similarities between rodent and human nervous systems, the finding provides a pretty compelling reason to take a closer look at the peripheral nervous system in humans, too. Especially given the ongoing struggle to create effective pain relief for chronic and severe pain.

"We don't yet know how the system works, but the machinery is definitely in place to allow the peripheral system to interpret and modify the tactile information perceived by the brain in terms of interpreting pain, warmth or the solidity of objects," said lead researcher Nikita Gamper from the University of Leeds in the UK.

"Further research is needed to understand exactly how it operates, but we have no reason to believe that the same nerve arrangements would not exist in humans."

The peripheral nervous system is the name given to all the nerves that feed into the central nervous system from around our body.

For those who didn't study anatomy, everything in blue in the image below is the peripheral nervous system, and the yellow/brown - the spinal cord and the brain - is the central nervous system. 





 






























As you can see, the peripheral nervous system is pretty well mapped, but up until now, researchers had assumed that it was little more than a wiring system, shuttling in messages from the rest of the body to the all-overseeing central nervous system.

All the decisions, researchers thought, were made only by the central nervous system - mainly the brain - which then shuttled messages out via the peripheral nervous system to tell the body how to react.

This is part of the 'Gate Control Theory of Pain' which suggests that a simple 'gate' exists between the peripheral and central nervous systems, controlling what information is sent to the central system.

The study now suggests that it's a lot more sensitive than that - the peripheral nervous system could actually be altering signals before they even reach the central nervous system.

"Peripheral nerves have the ability to dial up or down the signal which goes through these gates to the brain," said Gamper. "Importantly, we believe that these gates can be exploited for therapeutic control of pain."

In recent years, some evidence has emerged that the peripheral nervous system might actually play a more complex role in the body, but this is the first solid evidence that it could be interpreting and modulating pain sensations.

The new research looked specifically at the ganglia of the peripheral nervous system, a collection of 'nodules' that were previously thought to only help shuttle messages through the nervous system, not communicate amongst themselves.

After spending five years studying ganglia cells taken from mice and rats in the lab, they found that they could actually exchange information with each other with the help of the signalling molecule GABA - an ability that was previously believed to be restricted to the central nervous system.

More than that, when the researchers stimulated pain signals in rats, they found evidence through this GABA pathway that the ganglia cells were communicating with each other, and regulating and changing the signal they sent on to the central nervous system.

"When our research team looked more closely at the peripheral system, we found the machinery for neuronal communication did exist in the peripheral nervous system's structure. It is as if each sensory nerve has its own 'mini-brain', which to an extent, can interpret incoming information," said Gamper.

"We found the peripheral nervous system has the ability to alter the information sent to the brain, rather than blindly passing everything on to the central nervous system."

While there's a lot more work to be done to understand how this works in the human body, and if this network of 'mini brains' exist at all in humans. If confirmed, it would be a huge deal for researchers working on better painkillers.

Right now, pain relief drugs only target the central nervous system, and the most effective ones have some pretty severe side effects, such as addiction and building up tolerance in patients over time.

If new medication could instead target the peripheral nervous system, it could lead to the development of non-addictive and non-drowsy drugs that are more effective.

"This dramatically changes our understanding of pain medication because in theory it is now possible to target drugs at the peripheral nervous system which could widen the type of treatments available," said one of the team, Xiaona Du from Hebei Medical University in China.

We'll be watching the progress in humans closely.

The research has been published in the Journal of Clinical Investigation.

https://www.sciencealert.com/scientists-discover-a-hidden-network-of-mini-brains-that-could-be-responsible-for-making-us-feel-pain

Monday, 15 May 2017

The Complexity Of How Neuropathy Happens

Today's post from healthcanal.com (see link below) follows on from and is a scientific explanation of yesterday's article by Doctor John Hayes Jr. outlining the effects of metabolic syndrome on nerve damage. It should carry a complexity warning for most readers because the science isn't easy to follow. However, you will get the gist and may have heard of many of the things mentioned (myelin sheaths and Schwann cells for instance). There are articles elsewhere here on the blog which will help explain most of the terms used in this article. To sum up: the research here shows that real progress is being made into finding out exactly how and why neuropathy occurs. Scientists are making great strides in identifying cell structures and functions that cause problems and will be able to use this information to create really effective treatments in the future. Not an easy read but one well worth the effort.

How does neuropathy happen? New research reveals a pathway and a possible therapeutic option By Ellen Goldbaum 05/13/2017 Metabolic Problems / Diabetes 

 


Fluorescence microscopy image of in vitro model of myelin sheath (red) formation by Schwann cells around neuronal axons (green). Cell nuclei are blue. Credit: Keit Men Wong, UB.

UB researchers studying myelination are discovering how metabolic diseases like diabetes may cause neuropathy


BUFFALO, N.Y. —
Diabetic neuropathy is one of the most common complications of diabetes. While not life-threatening, it affects millions in the U.S. and elsewhere, and leads to limb amputations if left unchecked. But the reasons why metabolic disease can lead to neuropathy, which is damage to the peripheral nervous system, have never been well-understood.

Now, in a paper published this week online in Proceedings of the National Academy of Sciences, researchers at the Hunter James Kelly Research Institute (HJKRI) at the University at Buffalo report on research that illuminates what causes some kinds of neuropathy and may reveal potentially powerful therapies.

The UB researchers have discovered an important metabolic pathway that causes neuropathy when hyperactivated in laboratory animals. They also found they could dramatically cure the mice with a drug called rapamycin, which is already on the market as an immunosuppressant and anti-cancer agent.

The research focuses on the way that cells called Schwann cells drive the formation of myelin in the nervous system. Myelin sheaths protect and insulate axons, the long nerve fibers along which impulses travel between neurons, allowing them to function properly.

In particular, the researchers studied a pathway called mammalian target of rapamycin (mTOR), which plays a key role in regulating cell metabolism, growth and division, as well as aging.

“This pathway is dysregulated in patients with diabetes and other diseases that cause neuropathy,” explained Bogdan K. Beirowski, MD, PhD, principal investigator at the HJKRI and assistant professor in the Department of Biochemistry in the Jacobs School of Medicine and Biomedical Sciences at UB.

Damaged axons


“Myelin sheaths deteriorate in a number of neurodegenerative conditions resulting in axon damage,” said Beirowski, “most prominently in peripheral neuropathies such as diabetic neuropathy that is caused by metabolic tissue imbalances.”

Some other diseases are characterized by an inability of myelin sheaths to properly form during development, and researchers are keenly interested in understanding why this happens. Earlier studies suggested that mTOR may be one of the culprits.

The UB scientists found that when hyperactivated, the mTOR pathway, normally responsible for myelin growth, paradoxically resulted in the Schwann cells’ complete failure to form myelin. The result: The mice lost almost all ability to walk.

The researchers found the inability to form myelin was due to overproduction of Schwann cells.

“There are too many Schwann cells for them to function properly,” explained Beirowski. “It’s like a crowded room where no one can move around properly because there isn’t enough space and people bump into each other, causing turmoil.”

However, the application of rapamycin caused the Schwann cells to be healed and rejuvenated, allowing for the formation of healthy, new myelin sheaths.

“Within days with this drug, we were able to completely cure the mice of their neuropathy, even in extensively aged animals,” said Beirowski.

Schwann cell plasticity


The finding provides promising evidence of plasticity in Schwann cells, Beirowski said; that is, the ability to regenerate nerves, critical for reversing myelin damage in so many diseases, from muscular dystrophy and multiple sclerosis to Krabbe’s disease and the Charcot-Marie-Tooth family of neurological diseases.

“Our study has revealed central details in the regulation of myelination by the mTOR pathway in Schwann cells,” said co-author Keit Men Wong, a doctoral candidate in the neuroscience program at UB. “The involvement of this pathway in myelination has been proposed by other scientists, but our work in Dr. Beirowski’s lab for the first time illustrates the relevance of this fascinating molecule for overall Schwann cell development.”

One of the next steps in the research is to determine whether or not the mTOR pathway also is activated in human neuropathies, said Beirowski, who is beginning follow-up studies with Wong and co-author Elisabetta Babetto, PhD, also at the HJKRI.

“We are encouraged by our findings and think that our discoveries could be exploited to regenerate myelin sheaths and nerve structure to help patients with neurological disorders,” he said.

The study was initiated in the laboratory of Jeffrey Milbrandt, MD, PhD, of Washington University in St. Louis, who is co-author on the paper.

Funding for the research was provided by the Muscular Dystrophy Association.

https://www.healthcanal.com/metabolic-problems/diabetes/237679-neuropathy-happen-new-research-reveals-pathway-possible-therapeutic-option.html

Sunday, 14 May 2017

The Difficulties Of Neuropathy Treatment

Today's post from neuropathydr.com (see link below) written by the well-known neuropathy expert, Dr John Hayes Jr, is a short article trying to explain why neuropathy treatment is so difficult. It's a question that baffles both patients and doctors alike because no one patient is the same as another and no one patient responds in the same way to treatment as another. One of his suggestions is that doctors often underestimate the effect of metabolic syndrome on the nervous system. This is a term you may not be aware of but according to the Mayo clinic, 'Metabolic syndrome is a cluster of conditions — increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels — that occur together, increasing your risk of heart disease, stroke and diabetes'... and according to Dr. Hayes, also neuropathy. It may be that one of the chief causes of nerve damage is life-style related then! Now this may be true but considering there are over 100 possible direct causes of nerve damage, this has to be put into context. Metabolic syndrome is by no means the only 'life-style' cause (alcoholic neuropathy for instance). Nevertheless, this article is worth a read and will help increase your understanding of why you have those dreadful symptoms every day.

Why Is Neuropathy Treatment Difficult?
Posted by john on April 24, 2017

Neuropathy treatment can be difficult for some due to the fact that neuropathy is more than one condition.

An understandable question that we get in the clinic day after day is Why is neuropathy treatment so difficult?

As you probably know, a good portion of patients who suffer from some form of chronic intractable pain have peripheral neuropathy. One reason for this includes the fact that we’re living longer. Also, in general, our health habits as so-called modern and developed nations have become worse, not better.

There’s also one major misconception that hampers neuropathy treatment for many and that is misunderstanding that Neuropathy is actually one condition when indeed its many disorders.

Nothing, and I mean nothing can be further from the truth. You see neuropathy rarely occurs without cause. Sometimes the known causes are due to chemotherapy, cigarette smoking, high blood pressure, and other things such as liver and kidney disease.

Sometimes, neuropathy is secondary to known disease processes. One example is Lyme disease.

Most of us know that 60% to 70% of patients who have developed diabetes, ultimately also develop some form of peripheral neuropathy.

About 50% of the time we diagnose neuropathy as being idiopathic. Idiopathic means that we are not one hundred percent sure what caused the patient’s neuropathy. As we have discussed here many times before, at least half the time in idiopathic cases the cause of the neuropathy is due to metabolic syndrome.

Metabolic syndrome is so common now and occurring in younger and younger ages that it is perhaps the most devastating health condition that we as a society must face head-on. Excess sugar and carbohydrate consumption along with decreasing physical activity is having a huge impact on society as a whole.

And too often even otherwise brilliant physicians ignore this as a possible cause of the patient’s underlying health conditions. Everything from neuropathy to heart disease can directly be related to metabolic syndrome.

And that is the reason in which many patients find neuropathy treatment so difficult.

Don’t let this be you! Start today by making stronger and more informed decisions. In a nutshell, do your homework, do your research, and do everything you possibly can advocate for your health and effective neuropathy treatment!

For more information on coping with neuropathy, get your Free E-Book and subscribe to our newsletters at http://neuropathydr.com.

http://neuropathydr.com/neuropathy-treatment-difficult/

Saturday, 13 May 2017

Walkasins May Restore Balance When Walking

Today's post from pr.com (see link below) talks about an interesting development in prosthetics to help improve balance while walking, for people living with neuropathy. As almost all of you with neuropathy problems in the feet will know, balance is a serious issue; leading to unexpected trips and falls and quite often injury. It's immensely frustrating and often alarming to realise that you can't trust or place your feet in the environment in which you move. Numbness, tingling, burning, pain or a combination of all of the above, lead to wrong signals and misplacement and you're constantly watching the ground and your feet to avoid accident. Any technological development such as these Walkasins is therefore extremely interesting. They do initially look a bit 'clunky' and remind you of ankle tracking technology used for criminals but hey...wear long trousers! Reading the article, it seems that the trials were small and the technology is not yet widely available on the market but it's comforting to know that companies are seriously investing in this area and it's been a long time coming.


New Balance Technology Helps Diabetic Man Walk Again
Minneapolis, MN, May 10, 2017 --(PR.com)

 “I put them on, and it was like a miracle,” says neuropathy sufferer and study subject, Mr. Tim Kelley. Walkasins work by restoring sensory signals that are not functioning normally in patients with neuropathy. This immediate restoration of sensory function also impressed Dr. Diane Wrisley of Wingate University. “His brain learned to use the Walkasins immediately," says Wrisley. "He put them on and it was like, ‘Wow! I know where I am in space.’ His improvement is phenomenal.”

 


RxFunction, manufacturer of Walkasins® - the first Wearable Sensory Prosthesis to help improve balance, announced exciting results from an ongoing research study at Wingate University on the long-term benefits of Walkasins use. Walkasins help improve gait and balance in patients who have peripheral neuropathy, a condition that significantly increases the risk of falling due to loss of balance. The Foundation for Peripheral Neuropathy reports an estimated 40 Million Americans have some form of peripheral neuropathy, most commonly due to diabetes or chemotherapy.

Over 40% of diabetic patients develop neuropathy, which negatively affects quality of life and confidence to walk without falling.

“These exciting results have exceeded our expectations and illustrate how Walkasins can significantly improve the lives of millions of patients who experience gait and balance problems due to peripheral neuropathy,” says Dr. Lars Oddsson, co-inventor of the technology and President of RxFunction. “This is a game-changer that can improve health and quality of life and help decrease healthcare costs,” says Dr. Oddsson.

With neuropathy, “you don’t know where your feet are in space,” says Dr. Diane Wrisley, Principal Investigator of the study and Director of Post-Professional Programs for Wingate University’s Department of Physical Therapy. “It’s like you’re walking with bricks on your legs.”

Tim Kelley, a volunteer participant in the research study at Wingate developed diabetes three years ago. Kelley lost his truck driving license, his career of 31 years, as he became unable to drive due to his peripheral neuropathy. Over the next three years, Mr. Kelley lost confidence in his ability to walk and move safely, gained 30 lbs and even used a wheelchair for getting around. He attended physical therapy in the months leading up to the study but had noticed limited improvements.

Mr. Kelley has shown dramatic changes following his participation in the Walkasins study at Wingate University. “I put them on, and it was like a miracle,” Kelley says. Walkasins work by restoring sensory signals that are not functioning normally in patients with neuropathy. This immediate restoration of sensory function also impressed Dr. Wrisley; “His brain learned to use the Walkasins immediately. He put them on and it was like, ‘Wow! I know where I am in space.’ His improvement is phenomenal,” Wrisley says.

Dr. Wrisley has tracked Mr. Kelley’s improvement in gait and balance using standardized measurement tools, the Functional Gait Assessment (FGA) and the Mini Balance Evaluation Systems Test (Mini-BEST). After a month of daily Walkasins use, these measures have continued to improve even further. “We may be maxing out the FGA and Mini-BEST. He almost has perfect scores in them,” Dr. Wrisley said. What this means for Mr. Kelly is that he has gone from using a wheel chair to get around to now where he can walk 2-3 miles with confidence.

Dr. Wrisley has seen Mr. Kelley’s self-confidence improve immensely with Walkasins use as measured by the Activities Specific Balance Confidence scale (validated clinical outcomes measure). Patients with a confidence score below 67% are predictive to have an 84% chance of falling. Mr. Kelley has changed from 24% to 74% (on a zero to 100% scale).

Another measurement of improvement is Mr. Kelley’s increased walking speed which has improved more than 0.5m/s since using Walkasins. Walking speed is an important indicator of overall health and has been termed “the Sixth Vital Sign”; it’s a simple measure that can predict future health status, physical decline, adverse events and even death. Studies have associated increments of 0.1 m/s of walking speed improvements with improved health status, less physical disability, fewer hospitalization days, and a one-year reduction in medical costs of $1,188.

“We’re thrilled to be able to report these results during Peripheral Neuropathy Awareness Week,” says Dan Leach, CEO of RxFunction. “We’re energized by the exuberance shown by our trial patients and are looking forward to helping millions of people who have peripheral neuropathy with the release of Walkasins later this year.”

Interview with Mr. Kelley (trial patient at Wingate University, NC): youtu.be/MEq-nRnsAVU
Once on the market, Walkasins will be available by prescription following an assessment for neuropathy, clinical need, and physical benefit.

About RxFunction Inc.
RxFunction Inc. is a wearable technology company with an initial focus on developing and leading a new business segment within the U.S. medical grade assistive technology marketplace. The Company’s vision is to improve physical ability for social participation and quality of life. Privately held and headquartered in Minneapolis, MN, RxFunction has taken assignment of patented technology developed by Co-founder, Dr. Lars Oddsson, as a research professor at Boston University’s Neuromuscular Research Center, and funded by Edina, MN Investment Bank, Cedar Point Capital, and the NIH’s National Institute on Aging (SBIR Grant AG040865). Walkasins have not been submitted to the FDA for review, and are not available for sale at this time.

Additional information about RxFunction is available at www.rxfunction.com
Press Contact: Dan Leach, dleach@rxfunction.com


http://www.pr.com/press-release/715825

Friday, 12 May 2017

Problems With HIV Drug Side Effects? Try Acupuncture

Today's post from pacificcollege.edu (see link below) is a general article about the benefits of acupuncture for relieving the side effects of HIV combination drugs. It also specifically references neuropathy which may be of interest to regular readers. Many younger people, especially in the West, where HIV drugs have been significantly refined to reduce side effects considerably over the last few years, may well shrug their shoulders here and say that they have no side effect issues from combination therapy. However, the vast majority of people across the world who are living with HIV haven't achieved that luxury yet. They have to remain on older drug combinations because of resistance issues if they change, or non-availability and they may well have been living with side effects for so long that it's become part of their daily lives. In these cases, this article may be of value. It is important to consult a qualified acupuncturist who knows what he/she is doing and although it is relatively inexpensive compared to many therapies, cost may still be an issue. However, if you can afford it and feel you may benefit, why not try acupuncture/acupressure therapy. If you achieve relief from the symptoms, you may well be able to cut out, or reduce, other (non-HIV) drugs used to control pain.

Acupuncture to Ease the Side Effects of AIDS Drugs
No date or author provided

As drug cocktails continue to be used as a course of treatment for those who have HIV and AIDS, more patients are suffering through debilitating side effects that are caused by these medications. Often patients complain of a wide range of symptoms including, night sweats, nausea, vomiting, depression, insomnia, anxiety, peripheral neuropathy, muscle pains, and sinus congestion. However, acupuncture is now being used to alleviate some symptoms brought on by the powerful drugs. These treatments have been shown to boost the immune system and help fight the side effects brought on by HIV and AIDS.

Redge Norton of the San Francisco AIDS Foundation uses acupuncture, massage and nutritional therapy to combat the side effects of the powerful drugs. "It really helped to get my appetite back to normal," said Norton. "And I feel more like myself again."

Acupuncture is commonly thought of as an alternative form of therapy, although its history as a treatment for physical ailments predates the era of laboratory-produced drugs by several thousand years. Practitioners of this ancient tradition choose from a variety of treatment modalities when developing an individual treatment regimen for a patient. In addition to acupuncture, these modalities include therapeutic massage, stress reduction techniques, and the application of heat and herbs that is known as moxabustion.

A significant number of primary care providers have come to recognize that such therapies should not be thought of as alternatives to Western medicine, but rather as complementary therapies - therapies used in conjunction with, not instead of, conventional drug treatments.

Acupuncture may help relieve bloating, cramping, and appetite loss among HIV-infected people taking drug cocktails to keep the virus in check. In 2005 a study was presented at a meeting of the International AIDS Society. This study included 50 HIV-infected men and women taking HIV medications. About half had been diagnosed with full-blown AIDS.

At the start of the study, all of the participants complained that the drugs caused at least two digestive side effects: nearly 80% had gas, more than 40% had bloating, 50% had cramps, nearly 50% had appetite loss, and 10% had actually lost weight

The participants then received six weeks of acupuncture. For three weeks the acupuncture included four sites commonly associated with improvement of digestive symptoms, such as nausea, vomiting, and bowel upset. For another three weeks they received acupuncture at four sites nearby sites not noted for affecting digestive conditions.

The patients were unaware of which type of acupuncture they were receiving at any given time.

But after just three weeks of acupuncture treatments, only 60% had two or more digestive symptoms. Both sets of acupuncture points improved digestive symptoms. However, acupuncture at the sites targeting digestive symptoms was more effective in controlling loss of appetite, abdominal cramps, and bloating.

In addition, among the 20% of people who said they weren't taking their AIDS medications as directed at the start of the study, half reported improvement after acupuncture treatment. This points out, states researcher Elizabeth Sommers, research director of the AIDS Care Project/Pathways to Wellness in Boston, since they feel better after acupuncture, people are more likely to take their drugs properly, resulting in better disease control.

In this study, none of the participants complained of side effects from the acupuncture.


Pain, a frequent symptom in people with HIV disease, appears to be particularly responsive to the effects of acupuncture. While the exact mechanisms by which acupuncture relieves pain remain obscure, there is clinical evidence to show that it does work. Specifically, acupuncture has become a popular treatment for people with peripheral neuropathy, which is a common complaint of people with HIV. Neuropathy, or nerve damage, manifests as pain, tingling, or numbness in the extremities, usually the feet. After acupuncture treatments patients report less tingling and more flexibility in the joints.

Among the many attractive features of acupuncture therapy are its safety and its relatively affordable cost. Convenience is also a consideration: it is not necessary to plan one's life around acupuncture treatments, which is an additional benefit to individuals who must plan their lives around their HIV and AIDS drug therapy schedules.

Among the many attractive features of acupuncture therapy are its safety and its relatively affordable cost. Convenience is also a consideration: it is not necessary to plan one's life around acupuncture treatments, which is an additional benefit to individuals who must plan their lives around their HIV and AIDS drug therapy schedules.

http://www.pacificcollege.edu/news/blog/2014/04/26/acupuncture-ease-side-effects-aids-drugs

Thursday, 11 May 2017

Gabapentin: Good Guy Or Bad Guy For Nerve Pain?

Today's post from peoplespharmacy.com (see link below) is a reminder to neuropathy patients that whatever drugs they take for their symptoms, they may also be subject to potentially dangerous side effects, especially if that drug is prescribed 'off-label' and therefore not FDA or EMA-approved for nerve pain. Pregabalin (Lyrica) is a major case in point but this article concentrates on another very commonly prescribed drug for neuropathy and that is Gabapentin (Neurontin).
Basically, Gabapentin is an anti-seizure (epilepsy) drug that was found to be effective in reducing pain from shingles and post-operative pain. From there, the science suggested that it would block the right signals, in the right channels, from most types of nerve pain too and it became one of the most widely prescribed drugs on the nerve pain list. While some people swear by it, others have found the side effects to be too strong and have found themselves having to wean off its addictive effects over a period of months. This article explains this all in more detail and rightly advises serious discussion with your doctor before starting the drug. Neuropathy patients are long-used to taking drugs meant for other conditions because the theory suggests that they will work for nerve damage pain too but there is almost always a price to pay! More articles about Gabapentin (neurontin) can be found by using the search button here on the blog.

Surprising Gabapentin Side Effects Joe Graedon May 26, 2012 
 
Doctors should be very cautious about prescribing gabapentin off-label, because the side effects can be quite serious.
 

Gabapenin is one of the most commonly prescribed drugs by doctors. At last count over 50 million prescriptions were dispensed annually. It is used for an amazing array of off-label indications. That means physicians are giving it to patients for conditions that the Food and Drug Administration has never approved and for which there may be modest scientific support at best. The reader who asked the question below provides a classic example of just such prescribing. We would not get concerned if this drug was perfectly safe. But gabapentin side effects are not trivial as you will discover in our answer below.

Q. I would like to know your feelings on the regular use of gabapentin for chronic insomnia. As a long time suffer of insomnia, my doctor has prescribed a myriad of drugs. Most recently upwards of 3600 mg of gabapentin at bedtime.

After more than 6 months of use I have noticed that gabapentin is taking a toll on my quality of life. Your thoughts please!


A. Gabapentin (Neurontin) was originally developed as an anti-seizure drug. It was approved by the FDA as an “add-on” treatment for patients with epilepsy in 1993. Although researchers do not completely understand how gabapentin works to control seizures, they think it affects production of a neurochemical in the brain called GABA (gamma-aminobutyric acid). 


The Off-Label Marketing Boondoggle:

Pfizer, the manufacturer of the brand name Neurontin, got into major trouble when it marketed this drug for off-label uses. A company has historically not been allowed to promote a medicine for things that the FDA has not approved. In Pfizer’s case, these unofficial uses for Neurontin included bipolar disorder, alcohol withdrawal, migraines and pain. The company eventually paid $430 million in penalties and admitted to fraudulent promotion.

We mention this because Neurontin is currently available generically as gabapentin. In addition to treating epilepsy, the drug now has official FDA approval for alleviating nerve pain caused by shingles (postherpetic neuralgia). 


Off-Label Prescribing Continues:

Even though gabapentin does not have the FDA’s blessing for treating other kinds of nerve pain (neuropathy), many doctors are using it for this purpose. Some physicians prescribe it to patients with fibromyalgia and migraines as well as to control hot flashes brought on by menopause, even though there is no official blessing from the FDA. This is not illegal. Doctors can prescribe any drug for any reason they see fit. That said, we could find little evidence to suggest that gabapentin would be helpful for insomnia. This is definitely an “off-label” use if ever there was one.

If there were few, if any, side effects associated with gabapentin we would not worry too much about the prescribing of this drug for so many off-label uses. But gabapentin has some potentially worrisome adverse effects. The FDA has issued this warning:

“Antiepileptic drugs (AEDs), including Neurontin [gabapentin], increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.”

The FDA also mentions an “unexpectedly high incidence of pancreatic acinar adenocarcinomas” [cancer] in male rats that received gabapentin. The agency adds the unhelpful caveat that the, “clinical significance of this finding is unknown.” In other words, no one knows whether this animal research means that men will be at higher risk for pancreatic cancer. This is not the sort of thing that the FDA requires drug companies to follow up on because the long-term research needed to detect a cancer signal can be quite challenging and expensive. 


Gabapentin Side Effects:


Dizziness, vertigo
Fatigue and or tiredness
Unsteadiness or incoordination
Abnormal thinking, anxiety, hostility, confusion, amnesia,
Depression, suicidal thoughts, mood changes
Fluid accumulation in feet, edema of face or extremities
Digestive distress, indigestion, loss of appetite, gas, nausea, vomiting, diarrhea
Dry mouth, dental problems, gingivitis
Blurred vision, double vision, unusual eye movements (nystagmus)
Headache
Withdrawal seizures (never stop gabapentin suddenly!)
Blood disorders
Skin rash (alert your M.D. immediately if this occurs!)
Upper respiratory tract infections, fever
High blood pressure
Palpitations
Tremor, jerky movements
Joint pain, joint stiffness, arthritis


Gabapentin Discontinuation Syndrome (aka Withdrawal):

No one should ever discontinue gabapentin abruptly. Like so many medications that affect the central nervous system, sudden withdrawal may lead to unexpected side effects. Some that have been reported include anxiety, insomnia, nausea, pain, sweating and even seizures. Sadly, though, the FDA gives very little guidance to prescribers about how to gradually taper patients off gabapentin.
Stories from Readers:

When you read a long list of gabapentin side effects, like those listed above, your eyes glaze over almost instantly. Drug companies have recognized this, which is why there is so much prescription drug advertising on TV and in magazines. There was a time when the pharmaceutical industry worried about telling patients about such serious side effects as irregular heart rhythms, hypertension or blood disorders. Not any more. They realize that even warnings about heart attacks, strokes or death do not scare people away.

The only way we can help you understand what such side effects are like in real life is to share stories from visitors to this website. Here are just a handful. You can read hundreds more in the comment section at the bottom of this article. 


Sue in Corvallis, Oregon writes about her husband:


“My husband has been on gabapentin for anxiety and depression for over 3 years now. The doctors started him on this to get him off the benzodiazepines he had been on for 20 years.

“While it seemed to help in the beginning, they kept increasing the dose. He is currently on 2700 mg per day (900 mg x 3). That is way too much.

He has changed so much – cries hysterically, has mood swings, goes from insomnia to sleep deprivation. He has tremors, blurred vision and now talks about suicide all the time. He is so discouraged.

“If the FDA has not okayed gabapentin for anxiety and depression why do docs prescribe it? I am ready to complain to the drug company! He and I just want his life back. Lying in bed 85% of the time is not helpful.” 


Susan in Milton, Florida shares a tragic story:


“My boyfriend was prescribed gabapentin for his diabetic neuropathy. I can see now that he became more withdrawn and one evening left the house without my knowledge and went to the hospital where they prescribed sertraline (Zoloft) and counseling the following Monday.

“He committed suicide Saturday morning. If I had been told by his doctor about the side effects of gabapentin I could have done something to prevent his death.”
Lynn in Mobile, Alabama warns about weight gain from gabapentin (she isn’t the only one):


“I have been on gabapentin (800 mg 3 x daily) for about 13 years. It was prescribed for spinal problems and pain problems in general. When I first started gabapentin it worked great. But I experienced a tremendous amount of weight gain, like close to 100 pounds!

“As time has gone on I have noticed my life has changed so much. I have developed random weird thoughts. I never want to go anywhere or do anything except sit in my recliner and watch tv.

“I feel a nervous wreck if it’s been awhile since I have taken my gabapentin. I have an overwhelming feeling sometimes, like a flash in my mind of suicidal thoughts. My mind feels scrambled. It is very hard to explain.

“My pain is so unbearable sometimes that I am afraid to get off gabapentin. I am 44 years old and weighing around 250 pounds! I look horrible and don’t want anyone to see me period.” 


Joanne in England has had trouble getting off gabapentin:


“I had been on gabapentin for about two years for nerve damage from gallbladder surgery. I was on 300 mg 3 times a day. These tabs were a wonder drug and took my pain away almost immediately.

“Now two years later I returned to the doctor and told her I would like to come off this medication as I feel it’s time. For the last few weeks she weaned me off them with a withdrawal chart, which I followed till the last tablet. Just two days after being completely off gabapentin the side effects have hit me: dizziness, headaches, nausea, and I actually fainted, which I have never done before in my life.

“The doctor told me I had come off gabapentin too quickly and to start taking a lower dosage. I started weaning myself off gabapentin gradually again, but still the same symptoms. I have not taken any pills for 5 days and the dizziness and headaches are back. I am not sleeping. I am also having hot sweats in the night and feeling very low in mood. I am not going back on gabapentin! I am going to persevere even with these symptoms and hope I can cope. I feel like I am going around the bend and will never get better.”
The People’s Pharmacy Bottom line:

Gabapentin is an effective treatment for epilepsy and the excruciating pain that sometimes lingers after an attack of shingles. Although it is quite frequently prescribed for off-label uses, the benefit/risk ratio is not clear. The drug has many potentially serious side effects. We are surprised that your doctor prescribed such a heavy-duty drug for insomnia, especially at such a high dose. The “normal” dose of gabapentin for treating epilepsy or shingles pain would be up to 1800 mg daily. Although 3600 mg is sometimes prescribed, it would have to be considered a high dose, especially for an unapproved use.

Since you report that gabapentin is affecting the quality of your life in a negative way, perhaps it is time to talk to your doctor about reconsidering this drug and discussing a VERY gradual withdrawal process. You may need to consult a sleep specialist to help you deal with your chronic insomnia in a more integrative manner.

You may find our recently revised Guide to Getting A Good Night’s Sleep worth consulting.

People with nerve pain may find our one-hour interview with David Casserett, MD, quite fascinating. In it he talks about medical marijuana for “neuropathic” pain. It is titled, “How One Doctor Changed His Mind About Medical Marijuana.”

If you are worried about the psychoactive properties of marijuana, you may find this article about canabidiol (CBD) oil of substantial interest. It may ease nerve pain without causing people to get “high.”

This article was revised: 12/8/2016

https://www.peoplespharmacy.com/2012/05/26/gabapentin-side-effects/