Friday, 9 October 2015

The Safety Of Medical Marijuana As A Pain Killer

Today's post from (see link below) is a recent one looking at the safety of medical marijuana, which if we're honest as neuropathy patients, is what concerns us most. Most people these days have researched enough to realise that the moral, legal and addictive qualities of medical marijuana are not so important; what they're interested in is whether it works as a pain killer for neuropathic symptoms and it quite clearly does for most users. This article assumes that and looks at a study of the drug's safety in comparison with other drugs used to treat neuropathy including opioids. It comes to the conclusion that medical marijuana is a useful addition to the doctor's tool chest when it comes to neuropathy medication. Worth a read.

Medical Marijuana Seems Safe for Chronic Pain
And the drug modestly reduced people's pain scores
By Dennis Thompson HealthDay Reporter WebMD News from HealthDay
WEDNESDAY, Oct. 7, 2015 (HealthDay News)

 Medical marijuana appears mostly safe for treating chronic pain, at least among people with some experience using the drug, a new study suggests.

People who used pot to ease their pain didn't have an increased risk of serious side effects, compared to people with pain who didn't use marijuana, a Canadian research team found.

But, medical marijuana users were more likely to have less-serious side effects, the study authors said. These side effects included headache, nausea, sleepiness and dizziness, the research revealed.

"In terms of a side effect profile, we felt the drug had a reasonably good safety profile, if you compare those effects to other medications," said study lead author Dr. Mark Ware. He is director of clinical research for the Alan Edwards Pain Management Unit at McGill University Health Center in Montreal.

Although this study focused on the safety of medical marijuana, Ware reported that participants also appeared to experience some pain relief through their use of the drug. The researchers also saw improvements in mood and quality of life in the marijuana users.

Findings from the study were reported online recently in the Journal of Pain.

The trial is the first and largest study of the long-term safety of medical marijuana use by patients in chronic pain, Ware said.

The researchers followed 215 adult patients with chronic pain who used medical pot for one year. The researchers compared the marijuana users to a control group of 216 chronic pain patients who didn't use medical marijuana. The study involved seven pain treatment centers across Canada.

The people using pot were given leaf marijuana containing 12.5 percent THC from hospital pharmacies, Ware said. THC is the chemical in marijuana that causes intoxication. People could use pot however they liked -- smoking it, eating it in food, or inhaling it from a vaporizing device.

There was no difference in serious side effects between the two groups, the researchers found.

Marijuana users did have a 73 percent increased risk of minor side effects, the study found.

Mitch Earleywine, chair of NORML, a marijuana legalization advocacy group, said many of these side effects could be reduced by changing the way the pot is used.

"Essentially, people who used vaporized cannabis would have no more adverse events than controls," said Earleywine, who's also a professor of psychology at the State University of New York at Albany.

Ware said he hopes the study will provide valuable information for patients considering medical marijuana for pain treatment.

"This is a paper they should bring to the attention of their physician or health care provider," Ware said. "Anybody who is interested in using cannabis to treat pain should know this information, as it can influence the decision-making process considerably."

Since the study focused on people familiar with marijuana, however, it might not be as useful for patients who've never tried pot before, he added.

"For somebody reading this who's never tried it, the effects they experience might be different," Ware said.

Paul Armentano, deputy director of NORML, said the study provides further evidence that the use of marijuana doesn't deserve to be criminalized.

"These findings, and others like it, are in direct conflict with cannabis' present schedule I status under federal law, a classification that fails to acknowledge the substance's clinical efficacy and acceptable safety profile," he said.

Dr. Jonathann Kuo, an interventional pain management specialist at North Shore University Hospital in Manhasset, N.Y., said medical marijuana has the potential to be a valuable alternative for doctors who specialize in chronic pain management.

"We frequently find that opioids [such as OxyContin, Percocet, Vicodin] are not a good long-term solution for chronic pain," Kuo said. "We'd like to see some more of these long-term safety profiles of medical cannabis, and studies like these are important steps forward in that direction."

However, Kuo said larger follow-up studies looking at pot's safety and effectiveness are needed.

"I'd like to see more definitive studies before prescribing this to my patients in the future," he said.
SOURCES: Mark Ware, M.B.B.S., director, clinical research, Alan Edwards Pain Management Unit, McGill University Health Center, Montreal; Jonathann Kuo, M.D., interventional pain management specialist and attending physician, North Shore University Hospital, Manhasset, and Long Island Jewish Medical Center, New Hyde Park, N.Y.; Mitch Earleywine, Ph.D., professor, psychology, State University of New York at Albany, and chair, NORML; Paul Armentano, deputy director, NORML; Sept. 16, 2015, Journal of Pain, online

Thursday, 8 October 2015

Unscrupulous Methods To Exploit Neuropathy Patients

Today's long post from (see link below) is an example of the sort of practice which swindles desperate patients out of their money, while pretending to cure their neuropathy problems. It is important to say here that not all chiropractors are con-men and that many patients have benefited from chiropractic treatments but it remains a controversial subject because chiropractors are frequently not covered by insurance schemes and thus fall under the banner of private practice. Basically, they can charge you what they want and advertise miraculous cures and that can lead to cases such as this illustrated below but once again, it's people that commit crimes and not the entire chiropractic community. Nevertheless, this long article is worth reading if only as a warning that however desperate you may be to get relief from your neuropathy symptoms, you really need to be careful about which treatment you choose to take on - unfortunately there are people who will prey mercilessly on the desperate and those in pain.

The Straw Protocol: A Chiropractor’s Aggressively Promoted Neuropathy Treatment
Posted by William M. London on February 27, 2015 

Full-page ads promoting free dinner seminars addressing the topic of “Non-surgical, drug-free approach to relief from Peripheral [sic] Neuropathy [sic]” appeared last year on at least nine Sundays in the main news section of the print edition of The Los Angeles Times. The seminars were scheduled at various restaurants in Orange County, Los Angeles County, and Inland Empire.

The Los Angeles Times claims a Sunday circulation of 962,192 and a readership of two million for the Sunday main news section. The cost of full-page ads in the main section of Sundays varies, but I was given a quote of $32,500 by an advertising consultant for the paper.

The ads included on their upper left, in small print, the words “HEALTH TODAY” and on the same line—though perhaps less noticeably—at the far right of the page the word “ADVERTISEMENT.” In a much larger font was the headline:

Do You Suffer from One Of These Seven Symptoms Of This Often Misdiagnosed Problem?

It was followed by this subtitle:

Tens of Millions Suffer And Often Don’t Know Where to Turn

The ads indicated that discussion at the seminars would include:

What REALLY causes Peripheral [sic] Neuropathy [sic]
Three crippling effects of Neuropathy [sic]
Dangers associated with medications
The Straw Protocol, which utilizes proprietary treatment methods and provides outstanding results for people who suffer from Neuropathy

The ads warned that seating at the dinner seminars would be limited and instructed readers to call for a reservation and to provide the RSVP code in the ad (apparently to enable the marketer to keep track of where each caller found out about the seminars). Next to the toll-free number provided in each ad was the name of the advertiser: OPTIMAL HEALTH, and then below it in much smaller, easily overlooked print: Straw Chiropractic. Keeping the print small for the word chiropractic is a clever promotional tactic; many prudent consumers would not be inclined to seek chiropractors for peripheral neuropathy treatment.

I called the advertised phone number, but since I said (honestly) that I didn’t have any of the seven symptoms of neuropathy listed in the ad, I would not be permitted to attend any of the free dinner seminars. (I was disappointed to not qualify for a free dinner since I’m on a tight budget just like many other critics of health pseudoscience who get falsely accused of being paid off by Big Pharma.)

However, the ad offered a second phone number to call in order to obtain more detailed information and answers to common questions about the Straw Protocol without a having to indicate one’s symptoms and attend a seminar. I called the number, 888-858-9291, and left a message with my name and address along with a request that the advertised “Free special report and DVD” be mailed to me. The materials arrived a few days later. 

click to enlarge
The promotional DVD

The title on the label of the DVD is “Our Patients Speak” followed by “The Neuropathy Treatment Center by Optimal Health Straw Chiropractic.” On the left side of the label is the instruction: “Call Today for a FREE Consultation and Evaluation!” (The exclamation mark here is a strong signal of hype.) On the right side of the label, it exclaims “$249 Value!” I guess that’s supposed to be the value of the consultation and evaluation rather than the value of the DVD.

On the bottom of the label is a number to call to find the location to find the nearest location of the Neuropathy Treatment Center. I called and was told there are five locations. Three are in Los Angeles County: Glendale, Placentia, and Gardena. The other locations are in Corona (Inland Empire) and Lake Forest (Orange County). I learned from the website of the practice,, that there is also an “affiliated practice,” Restore Medical Group Greathouse Chiropractic Inc., with locations in San Diego and Sunnyvale.

The DVD plays for just a few minutes and consists of five neuropathy patients expressing satisfaction with treatment from the Neuropathy Treatment Center and dissatisfaction with medications previously prescribed for them from other doctors. Many people can be persuaded to try treatments based on such testimonials, but testimonials regarding clinical benefits are not trustworthy. Consumers often fail to consider that the experiences described in testimonials may poorly represent the experiences of most people who try a new advertised treatment. If the patients actually experienced relief from their neuropathy while they were receiving Straw Protocol treatment, it doesn’t necessarily mean that the relief is attributable to the treatment. And it’s important to recognize that some chiropractors who have solicited testimonials from patients have been found to provide incentives and/or discounts to patients who offer testimonials.

The cover letter for the mailing comes with instructions to watch the enclosed DVD before reading the enclosed special report. Advertisers recognize that this sequence tends to make their messages more persuasive. It’s likely that people tend to be less suspicious of information provided in literature after they have been exposed to relatable role models who appear sincere while offering encouraging stories.

The special report

The tabloid layout of the report reminds me of the many advertising mailers made to look like health newsletters that are sent to people who get on mailing lists of quacks. I wrote about such “Advertising Mailers in Disguise” in 2001 when I served as president of the National Council Against Health Fraud, Inc.

The front cover of the report is made to look official with the words “Optimal Health’s” in the upper left-hand corner, “Summer 2014” in the upper right hand corner, “Natural Health Journal” as a heading, and “Practical Solutions for Optimum Health & Healing” as a sub-heading. The rest of the cover shouts out its hype with lots of bold lettering, enlarged lettering, varied font styles, varied colored lettering, all-caps, italicized lettering, exclamation points, a photo of an older woman along with a quotation that supposedly comes from her, and a concluding sentence in title case. Here’s the text:

A REVOLUTIONARY new way of treating peripheral neuropathy can help you throw away your pills and…

Sleep restfully without tossing & turning or stabbing and shooting pain waking you!
End those weird ‘skin-crawling’ feelings!
No more limitations on your activities!
Regain your good balance!
Live the life you deserve!

“I now have feeling in my feet that I have not felt in over twenty years!!”

Thousands Have Already Experienced This Advanced Method of Treatment and Found Freedom From The Vise-Like Hold Neuropathy Had Over Their Lives!

See Inside [along with a curved arrow as a guide to turn the page]

I suggest that health consumers should be wary of tabloid-style messages telling patients they can have their greatest hopes realized from a supposedly REVOLUTIONARY treatment.

The inside of the report consists of eight pages (page 2 through 9) along with a back cover offering tabloid-style hype similar to what appears on the front cover. Page 2 consists of a letter to the reader that indicates the treatment protocol “has already helped more than 3000 people over the last three years!” In an attempt to overcome any reasonable skepticism, the letter includes this paragraph:

This is neither far-fetched [sic] hope nor over-the-top hype like you’ve seen thrown around by ‘Miracle Pill” hucksters.

Well, I’ll be the judge of that. And so will you if you read on.

Page 3 consists of three testimonials and an introduction to “Dr. Phil Straw, D.C.” (I previously pointed out in my discussion of the supposed experts interviewed in the execrable first part of the video “The Quest for the Cures…Continues” that it’s a bad sign when practitioners are introduced redundantly with “Dr.” before their names and a degree after their names.)

I learned that Dr. Straw is the author of the 2014 book Neuropathy: How to Relieve Foot Numbness, Tingling, Burning, and Cramping Without Drugs or Surgery, he earned his “under-graduate [sic] degree from the University of California Santa Barbara in 1988 and doctor [sic] of Chiropractic in 1995” (from an unidentified institution, but clearly not UCSB), that he’s a “[s]ought-after speaker on peripheral neuropathy and the importance of maintaining optimum health through natural medicine and proper nutrition” (and I would be similarly sought-after if I also offered free dinners with my free seminars), and that he’s the “Creator of THE STRAW PROTOCOL.”

By the way, I am following THE LONDON PROTOCOL in writing about THE STRAW PROTOCOL (and you are supposed to be very impressed indeed by the capital letters in the name of my protocol).

Part of THE LONDON PROTOCOL is to check for disciplinary actions against practitioners who advertise aggressively. I found that, in November 2012, California’s Board of Chiropractic Examiners issued a citation to Philip Arthur Straw for his advertisements and Straw paid his fine in full.

I contacted a staff member serving California’s Board of Chiropractic Examiners and obtained a copy of the citation sent to Dr. Straw, which remains a public record. The section of the letter with the heading “Cause of Citation” reads:

On July 27, 2012 the Board received a complaint from N. F. alleging that the claims made in your advertisements, “Which of These Warning Signs Could Lead to Foot Amputation?” and “Don’t Let Your Neuropathy Put You in a Wheel Chair” are misleading to the public. The advertisements and your response to the Board’s Inquiry were forwarded to a chiropractic expert consultant for review. The Board expert opined that you have used worst-case clinical scenarios as headlines in your advertisements, and in doing so you have engaged in the use of misrepresentations, distortions, sensational or fabulous statements, or which have a tendency to deceive the public. In doing so, you are in violation of CCR section 311 advertisements.

In addition, the Board’s expert opined that your self-appointed designation as a “leading regional authority” and “expert” in such matters is a sensational, distorted statement that has a tendency to deceive the public. The Board expert added that the Board of Chiropractic Examiners does not recognize such expertise, and you have not demonstrated that you possess any diplomate status that might lend truthfulness to such a claim. In doing so, you are in violation of CCR section 311 advertisements.

As mentioned by Los Angeles Times business and consumer columnist David Lazarus in a column published August 25th 2014, the fine was only $500. That slap on the wrist tells you how seriously the Board of Chiropractic Examiners takes CCR section 311. Although the ads from Straw in 2014 didn’t have the same fear-mongering headlines and claims of expertise as the ads mentioned in the 2012 complaint, the claim that the Straw Protocol provides outstanding results should be viewed as a CCR section 311 violation.

Another part of THE LONDON PROTOCOL is to check for publication of clinical research findings in the scholarly literature. A Google Scholar search on “Philip Straw” revealed no such publications. No surprise! I see little reason to consider the Straw Protocol as an “Advanced Method of Treatment” as the ads in 2014 characterized it.

Page 4 of the special report consists of a brief description of peripheral neuropathy in simple language followed by criticisms of the drugs prescribed the medical community to treat peripheral neuropathy. The discussion includes the misleading suggestion that medical doctors treat peripheral neuropathy only to manage symptoms, with drugs and sometimes surgery. It disregards how standard treatment begins with addressing conditions underlying peripheral neuropathies and includes mechanical aids for symptom management. It includes a common medical establishment-bashing trope:

Perhaps the reason you may not have heard of the treatment options available for your peripheral neuropathy (like the method described on the next couple of pages of this report) is because of the stubbornly-held notion that, when it comes to medical treatments that don’t involve a needle or a pharmaceutical company’s pill, the establishment community can be ‘a bit set in their ways.’

Then again, perhaps this is a straw person (or straw establishment community) attack and the popular press has ignored THE STRAW PROTOCOL because it’s just one of the hundreds of non-evidence-based gimmicks for healing promoted by chiropractors. If there was compelling clinical research evidence indicating that the Straw Protocol is safe and the advertising claims made for it are valid, I think we would have heard about it (especially from the Straw-supported Los Angeles Times).

(A fact sheet from the National Institute of Neurological Disorders and Stroke provides a much more informative description of peripheral neuropathy than does Straw’s report. The fact sheet describes the classification, symptoms, causes, diagnostic tests, and treatment, for peripheral neuropathy.)

Pages 5 through 8 include eleven more testimonials, more hype from Dr. Straw, and a description of the four steps of the Straw Protocol (also described on Straw Chiropractic’s website).
Step 1 (Stimulate) of his protocol uses an electronic device that, we are told, has approval for a number of pain indications, but is not a transcutaneous electrical nerve stimulation device. It’s good to be wary of devices that promoters fail to identify by name. When practitioners are secretive about their treatments, they sidestep scrutiny. I’m reminded of a catchphrase of Dana Carvey’s Church Lady character: “How convenient!”
Step 2 (Rejuvenate) is to increase overall circulation by utilizing light emitting diode (LED) therapy. The description of Step 2 also includes a reference to investigations by NASA. Such references are common in the promotion of non-validated health gimmicks.

According to the BlueCross BlueShield of Tennessee Medical Policy Manual’s statement on LED therapy (reviewed most recently on 9/11/14):

Light emitting diode therapy for the treatment of conditions / diseases, including but not limited to diabetic peripheral neuropathy, lymphedema, non-healing wounds, tendonitis, capsulitis, and pain is considered investigational. (Emphasis in original.]

Investigational means not appropriately promoted in free dinner seminars to recruit paying patients. Another key point in the statement:

Scientific evidence in peer review literature is lacking regarding the use, safety, improvement or effectiveness on health outcomes for light emitting diode therapy.
Step 3 (Activate) “uses different frequencies of vibration on different areas of your body which further stimulates new capillary and nerve regeneration.” It would appear that Straw’s patients are shaken (if not stirred), but it isn’t clear that they’re pickin’ up good vibrations, excitations, or healing.

Exposure to some sources of vibration is one of many recognized causes of peripheral neuropathy. That doesn’t mean other sources of vibration provide relief. A review article published in 2015 on whole body vibration (WBV) for rehabilitation of peripheral neuropathies concluded:

The results of this literature search suggest insufficient evidence to assess the effectiveness for the effects of WBV on neuropathic pain, muscle strength and balance in patients with peripheral neuropathies, as there is a clear lack of methodologically high quality research on the subject.

In other words, WBV is a non-validated treatment.
Step 4 (Empower) is described as “truly THE KEY to not only reaching your desired level of pain-free health, but staying there for as long as you like.” It amounts to “nutritional education and proper supplementation” against chronic inflammation.

Inflammation is a complex bodily response to infection and injury that can be either beneficial or harmful. While chronic inflammation appears to play a role in the development of some chronic diseases, it is unclear that any special supposedly anti-inflammatory regimen of foods and dietary supplements can provide clinically-significant relief to peripheral neuropathy patients.

Dietary supplements are frequently tainted with drugs and often do not contain ingredients in doses listed on their labels. Paying more for practitioner-recommended (or -dispensed) supplement formulations provides illusory assurance.

On page 9 of the report is this pitch (bolding in original):

If you call and schedule your appointment for your own exam within 7 days of receiving this package, I will waive the entire $249 fee for you.

It’s followed by an offer of a free copy of Straw’s book at the exam.

I didn’t call within seven days. Soon after I received a letter from Straw Chiropractic renewing the offer for the free exam if I called within two to three days and the book would still be available for me.

click to enlarge

After failing to make the second deadline, I received a second notice which began “Hello…?” followed by a letter beginning with the words: “You’re smart. I can tell.” The letter went on to express surprise that I hadn’t called. The free diagnostic exam offer was still available along with the free book, but “is just not going to be an option for very much longer.” The letter came with a flyer featuring eleven more testimonials.

click to enlarge

click to enlarge

I waited for months to call to find out about costs of the Straw Protocol. The initial free exam and consultation offer was still available.
Costs to patients

Consumers should be wary of high-pressure sales pitches for limited time offers. Practitioners who place full-page newspapers ads need to work hard to get patients into their clinics. They need to recoup their investments in advertising (e.g., newspaper ads) and direct selling (e.g., dinner seminars) and then earn enough from fees charged to patients to make good money.

I reached a sales representative over the phone for Straw Chiropractic and was told that if I were a candidate for the treatment (that I really had peripheral neuropathy and it wasn’t too advanced), it would cost me $500 to $10,000 for five to fifteen weeks of treatment. Insurance doesn’t pay for any of the treatment. The representative wasn’t sure whether the quoted figures include the cost of purchasing dietary supplements.
Advertising in 2015

Thus far in 2015, in some, but not all Sundays, ads of varying sizes for the Straw Protocol have appeared in the main section of The Los Angeles Times. The most recent advertisements (as of this writing), on February 15th and 22nd were smaller than a quarter of a page and included an invitation to call for the free DVD and report. None of the newer ads included invitations to free dinner seminars.

However, I noticed on another page in the main section of the paper a half-page ad for free dinner seminars from the NEUROPATHY RELIEF CENTER of Long Beach Presented by Ballerini Chiropractic. The pitch is very similar to the pitch used by Straw Chiropractic. I will need to investigate further to find out the source of marketing campaigns used by chiropractors to promote peripheral neuropathy treatments services.
Other chiropractors who promoted free dinner seminars

Dr. Straw’s marketing campaign featuring free dinner seminars reminds me of similar recent campaigns by other chiropractors. For example, as I described previously:

[Brandon Lee Babcock, D.C.] pitched a bogus nutritional cure for diabetes. But, as reported December 9th, 2013 by The Salt Lake Tribune, his scheme bilked older adults in Utah of thousands of dollars. To recruit patients, he offered free gourmet dinners where attendees were shown video testimonials and given information about Babcock’s supposed “diabetes breakthrough.” He tricked patients into signing papers that established lines of credit with Chase Health Advance and he maxed out the $6,000 limit when patients tried to withdraw from his services. Some patients testified that Dr. Babcock and his staff misled them into signing up for credit without their knowledge or consent. Others said Babcock refused to provide refunds despite a 30-day opt-out guarantee and a promise of 100% satisfaction.

In 2008, the Utah Department of Occupational and Professional Licensing (DOPL) issued a “non-disciplinary cease-and-desist order” after finding that he advertised treatments for conditions he wasn’t qualified to treat: depression, multiple sclerosis, fibromyalgia, learning problems, attention deficit disorder, allergies, hormone replacement relief, sleep problems and memory loss.

In April 2012, the DOPL suspended Babcock’s chiropractic license by emergency order. In August 2012, West Jordan City revoked Babcock’s business license. The Salt Lake Tribune noted, however, that he continued to lead seminars promoting his program to reverse Type II diabetes.

In October 2013, a jury convicted him of six third-degree felony counts of exploiting a vulnerable adult. In December 2013, he was sentenced to six months in jail.

Colorado-based chiropractors Brandon Credeur, D.C. (a classmate of Brandon Babcock at Parker College of Chiropractic) and his wife Heather Credeur, D.C. also used newspaper advertising to attract diabetics to seminars following free gourmet dinners to promote their “functional endocrinology” treatments to diabetics and people with symptoms of low thyroid function. Jann Bellamy has discussed both Babcock and the Credeurs previously on ScienceBasedMedicine.

A September 2011 complaint from Colorado’s Board of Chiropractic Examiners against Brandon Credeur charged him with violations of the Board’s rules regarding scope of practice; misleading, deceptive, false, or unethical advertising; untrue, deceptive or misleading practices regarding unproven and/or unnecessary services; and record keeping requirements. But instead of losing his chiropractic license, as many of his former patients had hoped, following a hearing in an administrative court room, Credeur’s case ended in a settlement in which he admitted to nothing and agreed to keep better records.

On June 19th, 2013, the Colorado Medical Board sent an order to Brandon and Heather Credeur to cease and desist practicing medicine without a license. That same day, they declared bankruptcy to the dismay of former patients who have sued them to get their money back. A ruling from an administrative law judge is anticipated in response to the Credeur’s challenge to the Medical Board’s order.

The Credeurs remain licensed to practice chiropractic in Colorado.

Candice McCowin, an Irvine, California chiropractor ran newspaper ads claiming breakthrough treatments for diabetes and other chronic illnesses to be discussed at free dinner events. In March 2014, the California Board of Chiropractic Examiners cited the “free diabetic guides” she distributed as misleading ads. As noted in a column by David Lazarus, “McCowin paid a $500 fine and agreed to ensure that future ads ‘not be construed as misleading or deceiving to the public.” Dr. McCowin, I will be looking for your ads.
A few final thoughts

Advertisements that appear in The Los Angeles Times (or any other newspaper) should never be presumed to be trustworthy. The screening processes used by advertising departments of news organizations are typically inadequate to assure that ads are not false or misleading.

The $500 fine for “advertising in a potentially deceptive manner and for portraying himself as a neuropathy expert” that Dr. Straw paid in 2012 was no serious deterrent. I consider recent advertisements by Straw Chiropractic in newspapers and in mailers to patients to be misleading.

The direct selling approach of free dinner seminars and free initial consultations can be seductive. People often respond to acts of apparent kindness and generosity with a sense of obligation to reciprocate. But reciprocation to a sales pitch for a non-validated treatment protocol is unlikely to lead to relief and is likely to be costly.

I don’t expect that licensing boards in California are inclined to take appropriate action to protect consumers from inappropriate advertising of health services. But consumers need to file complaints and they need to let legislators know that they object to practitioners who deceptively advertise health services for financial gain and to licensing boards that fail to adequately protect the public.

William M. London is a professor of public health at California State University, Los Angeles and a co-author of the sixth, seventh, eighth, and ninth (2013) editions of the college textbook Consumer Health: A Guide to Intelligent Decisions. He is one of two North American editors of the journal Focus on Alternative and Complementary Therapies, associate editor of the free weekly e-newsletter Consumer Health Digest, and co-host of the Credential Watch site. Most of his recent writings about extraordinary claims for health products and services can be found at Swift, published by the James Randi Educational Foundation, and the Skeptic Ink Network.

Wednesday, 7 October 2015

What Is Femoral Neuropathy?

Today's post from (see link below) looks at a specific form of neuropathy many people may not have heard of. Femoral neuropathy is the result of damage to the femoral nerve which is a nerve in the thigh that supplies skin on the upper thigh and inner leg, and the muscles that extend the knee. It can affect movement from the hip, via the knee down to the foot, so can be pretty serious. That said, the symptoms will be familiar to most neuropathy patients but the causes may be different. Femoral neuropathy often arises as a result of a compression injury (where a nerve is trapped in an accident) but it can also be caused by many of the reasons that cause most neuropathies. It will take an alert neurologist to diagnose it properly and shows how important the patient's own story is when it comes to diagnosis. An interesting article which may clear up some suspicions on the reader's part and confirm the doubts of others.

What Is Femoral Neuropathy?

Written by Amanda Delgado | Published on 02 October 2015
Medically Reviewed by The Healthline Medical Review Team on 02 October 2015

Part 1 of 8: Overview
What Is Femoral Neuropathy?

Femoral neuropathy, or femoral nerve dysfunction, occurs when you can’t move or feel part of your leg because of damaged nerves, specifically the femoral nerve. This can happen from an injury, prolonged pressure on the nerve, or damage from disease. In most cases, this condition will go away without treatment. However, medications and physical therapy may be necessary if symptoms don’t improve.

Part 2 of 8: Causes
What Causes Femoral Neuropathy?

The femoral nerve is one of the largest nerves in your leg. It’s located near the groin and controls the muscles that help straighten your leg and move your hips. It also provides feeling in the lower part of your leg and the front of your thigh. When this nerve is damaged, it affects your ability to walk and may cause problems with sensation in your leg and foot.

Damage to the femoral nerve can be the result of:

a direct injury
a tumor or other growth blocking or trapping part of your nerve
prolonged pressure on the nerve
a pelvic fracture
radiation to the pelvis
hemorrhage or bleeding into the space behind the abdomen, which is called the retroperitoneal space
a catheter placed into the femoral artery, which is necessary for certain surgical procedures

Diabetes is a common cause of femoral neuropathy. Diabetes can cause widespread nerve damage due to fluctuations in blood sugar and blood pressure. Nerve damage that affects your legs, feet, toes, hands, and arms is known as peripheral neuropathy. Femoral neuropathy falls into this category.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diabetes is the most common reason for peripheral neuropathy in people who have had diabetes for at least 25 years. Peripheral neuropathy that’s caused by diabetes frequently affects the femoral nerve.

Part 3 of 8: Symptoms
Signs of Femoral Neuropathy

This nerve condition can lead to difficulties moving around. Your leg or knee might feel weak, and you may be unable to put pressure on the affected leg.

You might also feel abnormal sensations in your legs. They include:
numbness in any part of the leg
tingling in any part of the leg
dull aching pain in the genital region
lower extremity muscle weakness
difficulty extending the knee
feeling like your leg or knee is going to give out (buckle) on you

Part 4 of 8: Complications
How Serious Is It?

Prolonged pressure placed on the femoral nerve can prevent blood from flowing in the affected area. The decreased blood flow can result in tissue damage.

If your nerve damage is the result of an injury, it may be possible that your femoral vein or artery is also damaged. This could cause dangerous internal bleeding. The femoral artery is a very large artery that lies close to the femoral nerve. Trauma often damages both at the same time. Injury to the artery or bleeding from the artery can cause compression on the nerve.

Additionally, because the femoral nerve provides sensation to a major portion of the leg, injuries can occur due to this loss of sensation. Having weak leg muscles can also make you more prone to falling. Falls are of particular concern in older adults because they can cause hip fractures, which are very serious injuries.

Part 5 of 8: Diagnosis
Diagnosing Femoral Neuropathy

Initial Tests

To diagnose femoral neuropathy and its cause, your doctor will perform a comprehensive physical exam and ask questions about recent injuries or surgeries, as well as questions about your medical history.

To look for weakness, they will test specific muscles that receive sensation from the femoral nerve. Your doctor will probably check your knee reflexes and ask about changes in feeling in the front part of the thigh and the middle part of the leg. The goal of the evaluation is to determine whether the weakness involves only the femoral nerve or if other nerves also contribute.

Additional testing might include:

Nerve Conduction

Nerve conduction checks the speed of electrical impulses in your nerves. An abnormal response, such as a slow time for electrical signals to travel through your nerves, usually indicates damage to the nerve in question.

Electromyography (EMG)

Electromyography (EMG) should be performed after the nerve conduction test to see how well your muscles and nerves are working. This test records the electrical activity present in your muscles when the nerves that lead to them are active. The EMG will determine whether the muscle responds appropriately to stimulation. Certain medical conditions cause muscles to fire on their own, which is an abnormality that an EMG can reveal. Because nerves stimulate and control your muscles, the test can identify problems with both muscles and nerves. 

MRI and CT Scans

An MRI scan can look for tumors, growths, or any other masses in the area of the femoral nerve, which could cause compression on the nerve. MRI scans use radio waves and magnets to produce a detailed image of the part of your body that is being scanned.

A CT scan, using cross-sectional x-rays, can also look for vascular or bone growths.

Part 6 of 8: Treatments
Treatment Options

The first step in treating femoral neuropathy is dealing with the underlying condition or cause. If compression on the nerve is the cause, the goal will be to relieve the compression. Occasionally in mild injuries, such as mild compression or a stretch injury, the problem may resolve spontaneously. For diabetics, bringing blood sugar levels back to normal may alleviate nerve dysfunction. If your nerve doesn’t improve on its own, you’ll need treatment. This usually involves medications and physical therapy.

You might have corticosteroid injections in your leg to reduce inflammation and get rid of any swelling that occurs. Pain medications can help relieve any pain and discomfort. 


Physical therapy can help build up the strength in your leg muscles again. A physical therapist will teach you exercises to strengthen and stretch your muscles. Undergoing physical therapy helps to reduce pain and regain mobility.

You might need to use an orthopedic device, such as a brace, to assist you with walking. Usually, a knee brace is helpful in preventing knee buckling.

Depending on how severe the nerve damage is and how much trouble you’re having moving around, you might also need occupational therapy. This type of therapy helps you learn to do regular tasks like bathing and other self-care activities. These are called “activities of daily living.” Your doctor might also recommend vocational counseling if your condition forces you to find another line of work.

Your doctor might recommend surgery if you have a growth blocking your femoral nerve. Removing the growth will relieve the pressure on your nerve.

Part 7 of 8: Outlook
Long-Term Outlook After Treatment

You might be able to heal fully after you treat the underlying condition. If the treatment isn’t successful or if the femoral nerve damage is severe, you might permanently lose feeling in that part of your leg or the ability to move it.

Part 8 of 8: Prevention
Tips to Prevent Nerve Damage

You can lower your risk of femoral neuropathy caused by diabetes by keeping your blood sugar levels under control. This helps protect your nerves from damage caused by this disease. Preventive measures would be directed at each cause. Talk to your doctor for advice about what preventive measures would be the best for you.

Tuesday, 6 October 2015

Can Vitamin D Supplementation Help With Neuropathy?

Today's post from (see link below) looks at another case control study that suggests that vitamin D supplementation for people with a vitamin deficiency may well help with their neuropathic symptoms. Vitamin D is getting a lot of publicity these days, especially in relation to nerve damage but it's important to first establish if you have a deficiency in vitamin D to begin with. If not, you need to consult your doctor to see whether it's wise to increase your vitamin D intake - too much of any vitamin can be at worst, harmful and at best be a waste of money. The supplements industry will convince you that taking their products can only be good for you but that's only true if you need that supplement to re-establish healthy levels within your body. As this study suggests, vitamin D can certainly help improve neuropathic pain score values but it's always best to get qualified advice and remember, it may take longer than you think to re-establish correct levels in your system - a bottle of vitamin D for 2 weeks may be not be enough. Other posts regarding vitamin D and neuropathy can be found by using the search button to the right of this blog.

Vitamin D and Diabetic Neuropathy
By Michael Rubin, MD Professor of Clinical Neurology, Weill Cornell Medical College
October 1, 2015

Dr. Rubin reports no financial relationships relevant to this field of study.

SYNOPSIS: Vitamin D deficiency may exacerbate the clinical manifestations of diabetic neuropathy, and supplementation with vitamin D3 may be beneficial.

SOURCE: Alamdari A, et al. An inverse association between serum vitamin D levels with the presence and severity of impaired nerve conduction velocity and large fiber peripheral neuropathy in diabetic subjects. Neurol Sci 2015;36:1121-1126.

Skeletal manifestations of vitamin D deficiency include rickets and osteomalacia in children, and osteomalacia in adults. Approximately 3% of the human genome is under vitamin D control, and at least 10 extrarenal tissues express the enzyme 1-alpha-hydroxylase, responsible for converting vitamin D to its active form. Hence, it is not surprising that extraskeletal manifestations may also occur, including muscle weakness, cancer, hypertension, cardiovascular events, schizophrenia and depression, autoimmune disorders, type 1 diabetes, multiple sclerosis, and inflammatory bowel disease. Is there an independent association between vitamin D deficiency and diabetic neuropathy as defined by electrodiagnostic studies?

In this case-control study, patients newly diagnosed with type 2 diabetes were recruited from the Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University, Iran. Exclusionary criteria comprised type 1 diabetes, neuropathy of any cause other than diabetes, cancer, and thyroid, renal, or liver disease. Insulin-requiring diabetics were not included. Nerve conduction studies (NCS) were performed on all patients with neuropathic symptoms of numbness, tingling, or pain, and included the tibial, peroneal, median, and ulnar motor nerves, and median, ulnar, and sural sensory nerves. Statistical analysis comprised the t test for continuous variables, χ2 test for categorical variables, Pearson correlation coefficients, and two multivariate linear regression analyses, with two-sided P value < 0.05 considered significant.

Sixty-two diabetic patients were recruited: 29 with normal NCS and 33 with abnormal NCS. Both groups demonstrated a similar prevalence of retinopathy, microalbuminuria, and hypertension, and comparable HbA1c and creatinine levels. Serum vitamin D level was significantly lower in the abnormal NCS group, and correlated inversely with the degree of NCS abnormality, with lower vitamin D values present in those with more profound NCS abnormalities. For every 1 ng/mL increase in serum vitamin D, the presence and severity of NCS decreased by 2.2% and 3.4%, respectively. Lower vitamin D values correlate with worsening neuropathy in diabetic patients. 


Can vitamin D supplementation improve symptomatic neuropathy in type 2 diabetic patients with vitamin D deficiency? Among 112 such patients enrolled in a prospective, placebo-controlled, clinical trial, 57 were given oral vitamin D3 (50,000 IU weekly for 8 weeks) and 55 received placebo. Exclusionary criteria included B12 deficiency, alcohol abuse, malignancy, autoimmune disease, hyperparathyroidism, and kidney or liver failure. Statistical analysis encompassed the χ2 test, Student t and Mann-Whitney U tests, and the Spearman correlation coefficient, with P < 0.05 considered significant.

 Using nerve conduction studies, a neuropathy symptom score, and a neuropathy disability score to assess the severity of diabetic peripheral neuropathy, vitamin D supplementation both increased serum vitamin D levels and significantly improved neuropathy symptom score values, though not neuropathy disability score nor nerve conduction studies.1 Neuropathic pain, particularly burning discomfort and hyperesthesia, was significantly improved. 

While awaiting confirmation from larger randomized, controlled trials, vitamin D supplementation can be a simple addition to the treatment of painful diabetic peripheral neuropathy.

Shehab D, et al. Prospective evaluation of the effect of short-term oral vitamin D supplementation on peripheral neuropathy in type 2 diabetes mellitus. Med Princ Pract 2015;24:250-256.

Monday, 5 October 2015

Very Readable Description Of Neuropathy Disorders

Today's excellent post from (see link below) gives you an umbrella view of neuropathy but not the usual dry and technical approach that leaves readers' eyelids drooping after a few minutes. This is easy to read and follow and provides lots of very useful information that will help you understand your problem much better. Did you know that the commonest cause of neuropathy world-wide, is not diabetes after all but leprosy? There are millions of people with leprosy-induced neuropathy across the world but because the media concentrates on the developed world and its diseases, diabetes nearly always comes out on top - makes you think eh! Definitely worth a read if you want to learn something about the science of neuropathy without it breaking your brain.

Peripheral Neuropathy 
Gale Encyclopedia of Medicine, 3rd ed. | 2006 | Barrett, Julia
COPYRIGHT 2006 Thomson Gale.

Peripheral Neuropathy

The term peripheral neuropathy encompasses a wide range of disorders in which the nerves outside of the brain and spinal cord—peripheral nerves—have been damaged. Peripheral neuropathy may also be referred to as peripheral neuritis, or if many nerves are involved, the terms polyneuropathy or polyneuritis may be used. 


Peripheral neuropathy is a widespread disorder, and there are many underlying causes. Some of these causes are common, such as diabetes, and others are extremely rare, such as acrylamide poisoning and certain inherited disorders. The most common worldwide cause of peripheral neuropathy is leprosy. Leprosy is caused by the bacterium Mycobacterium leprae, which attacks the peripheral nerves of affected people. According to statistics gathered by the World Health Organization, an estimated 1.15 million people have leprosy worldwide.

Leprosy is extremely rare in the United States, where diabetes is the most commonly known cause of peripheral neuropathy. It has been estimated that more than 17 million people in the United States and Europe have diabetes-related polyneuropathy. Many neuropathies are idiopathic, meaning that no known cause can be found. The most common of the inherited peripheral neuropathies in the United States is Charcot-Marie-Tooth disease, which affects approximately 125,000 persons.

Another of the better known peripheral neuropathies is Guillain-Barré syndrome, which arises from complications associated with viral illnesses, such as cytomegalovirus, Epstein-Barr virus, and human immunodeficiency virus (HIV), or bacterial infection, including Campylobacter jejuni and Lyme disease. The worldwide incidence rate is approximately 1.7 cases per 100,000 people annually. Other well-known causes of peripheral neuropathies include chronic alcoholism, infection of the varicella-zoster virus, botulism, and poliomyelitis. Peripheral neuropathy may develop as a primary symptom, or it may be due to another disease. For example, peripheral neuropathy is only one symptom of diseases such as amyloid neuropathy, certain cancers, or inherited neurologic disorders. Such diseases may affect the peripheral nervous system (PNS) and the central nervous system (CNS), as well as other body tissues.

To understand peripheral neuropathy and its underlying causes, it may be helpful to review the structures and arrangement of the PNS.
Nerve cells and nerves

Nerve cells are the basic building block of the nervous system. In the PNS, nerve cells can be threadlike—their width is microscopic, but their length can be measured in feet. The long, spidery extensions of nerve cells are called axons. When a nerve cell is stimulated, by touch or pain, for example, the message is carried along the axon, and neurotransmitters are released within the cell. Neurotransmitters are chemicals within the nervous system that direct nerve cell communication.

Certain nerve cell axons, such as the ones in the PNS, are covered with a substance called myelin. The myelin sheath may be compared to the plastic coating on electrical wires—it is there both to protect the cells and to prevent interference with the signals being transmitted. Protection is also given by Schwann cells, special cells within the nervous system that wrap around both myelinated and unmyelinated axons. The effect is similar to beads threaded on a necklace.

Nerve cell axons leading to the same areas of the body may be bundled together into nerves. Continuing the comparison to electrical wires, nerves may be compared to an electrical cord—the individual components are coated in their own sheaths and then encased together inside a larger protective covering.
Peripheral nervous system

The nervous system is classified into two parts: the CNS and the PNS. The CNS is made up of the brain and the spinal cord, and the PNS is composed of the nerves that lead to or branch off from the CNS.

The peripheral nerves handle a diverse array of functions in the body. This diversity is reflected in the major divisions of the PNS—the afferent and the efferent divisions. The afferent division is in charge of sending sensory information from the body to the CNS. When afferent nerve cell endings, called receptors, are stimulated, they release neurotransmitters. These neurotransmitters relay a signal to the brain, which interprets it and reacts by releasing other neurotransmitters.

Some of the neurotransmitters released by the brain are directed at the efferent division of the PNS. The efferent nerves control voluntary movements, such as moving the arms and legs, and involuntary movements, such as making the heart pump blood. The nerves controlling voluntary movements are called motor nerves, and the nerves controlling involuntary actions are referred to as autonomic nerves. The afferent and efferent divisions continually interact with each other. For example, if a person were to touch a hot stove, the receptors in the skin would transmit a message of heat and pain through the sensory nerves to the brain. The message would be processed in the brain and a reaction, such as pulling back the hand, would be transmitted via a motor nerve.

When an individual has a peripheral neuropathy, nerves of the PNS have been damaged. Nerve damage can arise from a number of causes, such as disease, physical injury, poisoning, or malnutrition. These agents may affect either afferent or efferent nerves. Depending on the cause of damage, the nerve cell axon, its protective myelin sheath, or both may be injured or destroyed.

There are hundreds of peripheral neuropathies. Reflecting the scope of PNS activity, symptoms may involve sensory, motor, or autonomic functions. To aid in diagnosis and treatment, the symptoms are classified into principal neuropathic syndromes based on the type of affected nerves and how long symptoms have been developing. Acute development refers to symptoms that have appeared within days, and subacute refers to those that have evolved over a number of weeks. Early chronic symptoms are those that take months to a few years to develop, and late chronic symptoms have been present for several years.

The classification system is composed of six principal neuropathic syndromes, which are subdivided into more specific categories. By narrowing down the possible diagnoses in this way, specific medical tests can be used more efficiently and effectively. The six syndromes and a few associated causes are listed below: 

Acute motor paralysis, accompanied by variable problems with sensory and autonomic functions. Neuropathies associated with this syndrome are mainly accompanied by motor nerve problems, but the sensory and autonomic nerves may also be involved. Associated disorders include Guillain-Barré syndrome, diphtheritic polyneuropathy, and porphyritic neuropathy.

Subacute sensorimotor paralysis. The term sensorimotor refers to neuropathies that are mainly characterized by sensory symptoms, but also have a minor component of motor nerve problems. Poisoning with heavy metals (e.g., lead, mercury, and arsenic), chemicals, or drugs are linked to this syndrome.

Diabetes, Lyme disease, and malnutrition are also possible causes.

Chronic sensorimotor paralysis. Physical symptoms may resemble those in the above syndrome, but the time scale of symptom development is extended. This syndrome encompasses neuropathies arising from cancers, diabetes, leprosy, inherited neurologic and metabolic disorders, and hypothyroidism.

Neuropathy associated with mitochondrial diseases. Mitochondria are organelles—structures within cells—responsible for handling a cell's energy requirements. If the mitochondria are damaged or destroyed, the cell's energy requirements are not met and it can die.

Recurrent or relapsing polyneuropathy. This syndrome covers neuropathies that affect several nerves and may come and go, such as Guillain-Barré syndrome, porphyria, and chronic inflammatory demyelinating polyneuropathy.

Mononeuropathy or plexopathy. Nerve damage associated with this syndrome is limited to a single nerve or a few closely associated nerves. Neuropathies related to physical injury to the nerve, such as carpal tunnel syndrome and sciatica, are included in this syndrome. 

Causes and symptoms

Typical symptoms of neuropathy are related to the type of affected nerve. If a sensory nerve is damaged, common symptoms include numbness, tingling in the area, a prickling sensation, or pain. Pain associated with neuropathy can be quite intense and may be described as cutting, stabbing, crushing, or burning. In some cases, a nonpainful stimulus may be perceived as excruciating or pain may be felt even in the absence of a stimulus. Damage to a motor nerve is usually indicated by weakness in the affected area. If the problem with the motor nerve has continued over a length of time, muscle shrinkage (atrophy) or lack of muscle tone may be noticeable. Autonomic nerve damage is most noticeable when an individual stands upright and experiences problems such as light-headedness or changes in blood pressure. Other indicators of autonomic nerve damage are lack of sweat, tears, and saliva; constipation; urinary retention; and impotence. In some cases, heart beat irregularities and respiratory problems can develop.

Symptoms may appear over days, weeks, months, or years. Their duration and the ultimate outcome of the neuropathy are linked to the cause of the nerve damage. Potential causes include diseases, physical injuries, poisoning, and malnutrition or alcohol abuse. In some cases, neuropathy is not the primary disorder, but a symptom of an underlying disease.


Diseases that cause peripheral neuropathies may either be acquired or inherited; in some cases, it is difficult to make that distinction. The diabetes-peripheral neuropathy link has been well established. A typical pattern of diabetes-associated neuropathic symptoms includes sensory effects that first begin in the feet. The associated pain or pins-and-needles, burning, crawling, or prickling sensations form a typical "stocking" distribution in the feet and lower legs. Other diabetic neuropathies affect the autonomic nerves and have potentially fatal cardiovascular complications.

Several other metabolic diseases have a strong association with peripheral neuropathy. Uremia, or chronic kidney failure, carries a 10-90% risk of eventually developing neuropathy, and there may be an association between liver failure and peripheral neuropathy. Accumulation of lipids inside blood vessels (atherosclerosis ) can choke-off blood supply to certain peripheral nerves. Without oxygen and nutrients, the nerves slowly die. Mild polyneuropathy may develop in persons with low thyroid hormone levels. Individuals with abnormally enlarged skeletal extremities (acromegaly), caused by an overabundance of growth hormone, may also develop mild polyneuropathy.

Neuropathy can also result from severe vasculitides, a group of disorders in which blood vessels are inflamed. When the blood vessels are inflamed or damaged, blood supply to the nerve can be affected, injuring the nerve.

Both viral and bacterial infections have been implicated in peripheral neuropathy. Leprosy is caused by the bacteria M. leprae, which directly attack sensory nerves. Other bacterial illness may set the stage for an immune-mediated attack on the nerves. For example, one theory about Guillain-Barré syndrome involves complications following infection with Campylobacter jejuni, a bacterium commonly associated with food poisoning. This bacterium carries a protein that closely resembles components of myelin. The immune system launches an attack against the bacteria; but, according to the theory, the immune system confuses the myelin with the bacteria in some cases and attacks the myelin sheath as well. The underlying cause of neuropathy associated with Lyme disease is unknown; the bacteria may either promote an immune-mediated attack on the nerve or inflict damage directly.

Infection with certain viruses is associated with extremely painful sensory neuropathies. A primary example of such a neuropathy is caused by shingles. After a case of chickenpox, the causative virus, varicella-zoster virus, becomes inactive in sensory nerves. Years later, the virus may be reactivated. Once reactivated, it attacks and destroys axons. Infection with HIV is also associated with peripheral neuropathy, but the type of neuropathy that develops can vary. Some HIV-linked neuropathies are noted for myelin destruction rather than axonal degradation. Also, HIV infection is frequently accompanied by other infections, both bacterial and viral, that are associated with neuropathy.

Several types of peripheral neuropathies are associated with inherited disorders. These inherited disorders may primarily involve the nervous system, or the effects on the nervous system may be secondary to an inherited metabolic disorder. Inherited neuropathies can fall into several of the principal syndromes, because symptoms may be sensory, motor, or autonomic. The inheritance patterns also vary, depending on the specific disorder. The development of inherited disorders is typically drawn out over several years and may herald a degenerative condition—that is, a condition that becomes progressively worse over time. Even among specific disorders, there may be a degree of variability in inheritance patterns and symptoms. For example, Charcot-Marie-Tooth disease is usually inherited as an autosomal dominant disorder, but it can be autosomal recessive or, in rare cases, linked to the X chromosome. Its estimated frequency is approximately one in 2,500 people. Age of onset and sensory nerve involvement can vary between cases. The main symptom is a degeneration of the motor nerves in legs and arms, and resultant muscle atrophy. Other inherited neuropathies have a distinctly metabolic component. For example, in familial amyloid polyneuropathies, protein components that make up the myelin are constructed and deposited incorrectly.

Physical injury

Accidental falls and mishaps during sports and recreational activities are common causes of physical injuries that can result in peripheral neuropathy. The common types of injuries in these situations occur from placing too much pressure on the nerve, exceeding the nerve's capacity to stretch, blocking adequate blood supply of oxygen and nutrients to the nerve, and tearing the nerve. Pain may not always be immediately noticeable, and obvious signs of damage may take a while to develop.

These injuries usually affect one nerve or a group of closely associated nerves. For example, a common injury encountered in contact sports such as football is the "burner," or "stinger," syndrome. Typically, a stinger is caused by overstretching the main nerves that span from the neck into the arm. Immediate symptoms are numbness, tingling, and pain that travels down the arm, lasting only a minute or two. A single incident of a stinger is not dangerous, but recurrences can eventually cause permanent motor and sensory loss. 


The poisons, or toxins, that cause peripheral neuropathy include drugs, industrial chemicals, and environmental toxins. Neuropathy that is caused by drugs usually involves sensory nerves on both sides of the body, particularly in the hands and feet, and pain is a common symptom. Neuropathy is an unusual side effect of medications; therefore, most people can use these drugs safely. A few of the drugs that have been linked with peripheral neuropathy include metronidazole, an antibiotic; phenytoin, an anticonvulsant; and simvastatin, a cholesterol-lowering medication.

Certain industrial chemicals have been shown to be poisonous to nerves (neurotoxic) following work-related exposures. Chemicals such as acrylamide, allyl chloride, and carbon disulfide have all been strongly linked to development of peripheral neuropathy. Organic compounds, such as N-hexane and toluene, are also encountered in work-related settings, as well as in glue-sniffing and solvent abuse. Either route of exposure can produce severe sensorimotor neuropathy that develops rapidly.

Heavy metals are the third group of toxins that cause peripheral neuropathy. Lead, arsenic, thallium, and mercury usually are not toxic in their elemental form, but rather as components in organic or inorganic compounds. The types of metal-induced neuropathies vary widely. Arsenic poisoning may mimic Guillain-Barré syndrome; lead affects motor nerves more than sensory nerves; thallium produces painful sensorimotor neuropathy; and the effects of mercury are seen in both the CNS and PNS. 

Malnutrition and alcohol abuse

Burning, stabbing pains and numbness in the feet, and sometimes in the hands, are distinguishing features of alcoholic neuropathy. The level of alcohol consumption associated with this variety of peripheral neuropathy has been estimated as approximately 3 L of beer or 300 mL of liquor daily for three years. However, it is unclear whether alcohol alone is responsible for the neuropathic symptoms, because chronic alcoholism is strongly associated with malnutrition.

Malnutrition refers to an extreme lack of nutrients in the diet. It is unknown precisely which nutrient deficiencies cause peripheral neuropathies in alcoholics and famine and starvation patients, but it is suspected that the B vitamins have a significant role. For example, thiamine (vitamin B1) deficiency is the cause of beriberi, a neuropathic disease characterized by heart failure and painful polyneuropathy of sensory nerves. Vitamin E deficiency seems to have a role in both CNS and PNS neuropathy. 


Clinical symptoms can indicate peripheral neuropathy, but an exact diagnosis requires a combination of medical history, medical tests, and possibly a process of exclusion. Certain symptoms can suggest a diagnosis, but more information is commonly needed. For example, painful, burning feet may be a symptom of alcohol abuse, diabetes, HIV infection, or an underlying malignant tumor, among other causes. Without further details, effective treatment would be difficult.

During a physical examination, an individual is asked to describe the symptoms very carefully. Detailed information about the location, nature, and duration of symptoms can help exclude some causes or even pinpoint the actual problem. The person's medical history may also provide clues as to the cause, because certain diseases and medications are linked to specific peripheral neuropathies. A medical history should also include information about diseases that run in the family, because some peripheral neuropathies are genetically linked. Information about hobbies, recreational activities, alcohol consumption, and work place activities can uncover possible injuries or exposures to poisonous substances.

The physical examination also includes blood tests, such as those that check levels of glucose and creatinine to detect diabetes and kidney problems, respectively. A blood count is also done to determine levels of different blood cell types. Iron, vitamin B12, and other factors may be measured as well, to rule out malnutrition. More specific tests, such as an assay for heavy metals or poisonous substances, or tests to detect vasculitis, are not typically done unless there is reason to suspect a particular cause.

An individual with neuropathy may be sent to a doctor that specializes in nervous system disorders (neurologist). By considering the results of the physical examination and observations of the referring doctor, the neurologist may be able to narrow down the possible diagnoses. Additional tests, such as nerve conduction studies and electromyography, which tests muscle reactions, can confirm that nerve damage has occurred and may also be able to indicate the nature of the damage. For example, some neuropathies are characterized by destruction of the myelin. This type of damage is shown by slowed nerve conduction. If the axon itself has suffered damage, the nerve conduction may be slowed, but it will also be diminished in strength. Electromyography adds further information by measuring nerve conduction and muscle response, which determines whether the symptoms are due to a neuropathy or to a muscle disorder.

In approximately 10% of peripheral neuropathy cases, a nerve biopsy may be helpful. In this test, a small part of the nerve is surgically removed and examined under a microscope. This procedure is usually the most helpful in confirming a suspected diagnosis, rather than as a diagnostic procedure by itself. 

Treat the cause

Attacking the underlying cause of the neuropathy can prevent further nerve damage and may allow for a better recovery. For example, in cases of bacterial infection such as leprosy or Lyme disease, antibiotics may be given to destroy the infectious bacteria. Viral infections are more difficult to treat, because antibiotics are not effective against them. Neuropathies associated with drugs, chemicals, and toxins are treated in part by stopping exposure to the damaging agent. Chemicals such as ethylenediaminetetraacetic acid (EDTA) are used to help the body concentrate and excrete some toxins. Diabetic neuropathies may be treated by gaining better control of blood sugar levels, but chronic kidney failure may require dialysis or even kidney transplant to prevent or reduce nerve damage. In some cases, such as compression injury or tumors, surgery may be considered to relieve pressure on a nerve.

In a crisis situation, as in the onset of Guillain-Barré syndrome, plasma exchange, intravenous immunoglobulin, and steroids may be given. Intubation, in which a tube is inserted into the trachea to maintain an open airway, and ventilation may be required to support the respiratory system. Treatment may focus more on symptom management than on combating the underlying cause, at least until a definitive diagnosis has been made.
Supportive care and long-term therapy

Some peripheral neuropathies cannot be resolved or require time for resolution. In these cases, long-term monitoring and supportive care is necessary. Medical tests may be repeated to chart the progress of the neuropathy. If autonomic nerve involvement is a concern, regular monitoring of the cardiovascular system may be carried out.

Because pain is associated with many of the neuropathies, a pain management plan may need to be mapped out, especially if the pain becomes chronic. As in any chronic disease, narcotics are best avoided. Agents that may be helpful in neuropathic pain include amitriptyline, carbamazepine, and capsaicin cream. Physical therapy and physician-directed exercises can help maintain or improve function. In cases in which motor nerves are affected, braces and other supportive equipment can aid an individual's ability to move about.

The outcome for peripheral neuropathy depends heavily on the cause. Peripheral neuropathy ranges from a reversible problem to a potentially fatal complication. In the best cases, a damaged nerve regenerates. Nerve cells cannot be replaced if they are killed, but they are capable of recovering from damage. The extent of recovery is tied to the extent of the damage and a person's age and general health status. Recovery can take weeks to years, because neurons grow very slowly. Full recovery may not be possible and it may also not be possible to determine the prognosis at the outset.

If the neuropathy is a degenerative condition, such as Charcot-Marie-Tooth disease, an individual's condition will become worse. There may be periods of time when the disease seems to reach a plateau, but cures have not yet been discovered for many of these degenerative diseases. Therefore, continued symptoms, potentially worsening to disabilities are to be expected.


Afferent— Refers to peripheral nerves that transmit signals to the spinal cord and the brain. These nerves carry out sensory function.

Autonomic— Refers to peripheral nerves that carry signals from the brain and that control involuntary actions in the body, such as the beating of the heart.

Autosomal dominant or autosomal recessive— Refers to the inheritance pattern of a gene on a chromosome other than X or Y. Genes are inherited in pairs—one gene from each parent. However, the inheritance may not be equal, and one gene may overshadow the other in determining the final form of the encoded characteristic. The gene that overshadows the other is called the dominant gene; the overshadowed gene is the recessive one.

Axon— A long, threadlike projection that is part of a nerve cell.

Central nervous system (CNS)— The part of the nervous system that includes the brain and the spinal cord.

Efferent— Refers to peripheral nerves that carry signals away from the brain and spinal cord. These nerves carry out motor and autonomic functions.

Electromyography— A medical test that assesses nerve signals and muscle reactions. It can determine if there is a disorder with the nerve or if the muscle is not capable of responding.

Inheritance pattern— Refers to dominant or recessive inheritance.

Motor— Refers to peripheral nerves that control voluntary movements, such as moving the arms and legs.

Myelin— The protective coating on axons.

Nerve biopsy— A medical test in which a small portion of a damaged nerve is surgically removed and examined under a microscope.

Nerve conduction— The speed and strength of a signal being transmitted by nerve cells. Testing these factors can reveal the nature of nerve injury, such as damage to nerve cells or to the protective myelin sheath.

Neurotransmitter— Chemicals within the nervous system that transmit information from or between nerve cells.

Peripheral nervous system (PNS)— Nerves that are outside of the brain and spinal cord.

Sensory— Refers to peripheral nerves that transmit information from the senses to the brain.

A few peripheral neuropathies are eventually fatal. Fatalities have been associated with some cases of diphtheria, botulism, and others. Some diseases associated with neuropathy may also be fatal, but the ultimate cause of death is not necessarily related to the neuropathy, such as with cancer. 


Peripheral neuropathies are preventable only to the extent that the underlying causes are preventable. Steps that a person can take to prevent potential problems include vaccines against diseases that cause neuropathy, such as polio and diphtheria. Treatment for physical injuries in a timely manner can help prevent permanent or worsening damage to nerves. Precautions when using certain chemicals and drugs are well advised in order to prevent exposure to neurotoxic agents. Control of chronic diseases such as diabetes may also reduce the chances of developing peripheral neuropathy.

Although not a preventive measure, genetic screening can serve as an early warning for potential problems. Genetic screening is available for some inherited conditions, but not all. In some cases, presence of a particular gene may not mean that a person will necessarily develop the disease, because there may be environmental and other components involved. 


American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-2383. 〈〉.

Myelin Project Headquarters. Suite 225, 2001 Pennsylvania Ave., N.W., Washington, D.C. 20006-1850. (202) 452-8994. 〈〉.

Neuropathy Association. 60 E. 42nd St., Suite 942, New York, NY 10165. (800) 247-6968. 〈〉.

Sunday, 4 October 2015

A Chiropractor's View Of Neuropathy

Today's post from (see link below) is written by a chiropractor, prior to inviting you to attend his workshop. In that sense it's an advertisement and this blog very rarely advertises. However, whatever you may think of chiropractors and neuropathy, there is no doubting the truth of what he says and how he describes the problem of neuropathy and for that reason, his post is worth publishing. That is not to say that chiropractors shouldn't be allowed within 100 metres of a neuropathy patient (a view held by many in the medical world) - personally, I believe that if something works for you, then it's worth long as you know what you're doing, go in with your eyes open and understand that it may not be of benefit to you. Then again, that applies to almost all neuropathy treatments - it's the nature of the disease that one man's successful treatment is another man's disaster and waste of money. This short article is however, worth a read.

Neuropathy - Is it Getting on Your Nerves?
by Bryan Ruocco 29/6/2015


Neuropathy is a serious health condition. It can lead to serious health challenges. Remember the nerve system is the very system that carries life and energy from the brain to the body powering all cells, organs and tissues in the body. Peripheral neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord to the rest of the body are damaged or diseased. Damage to these nerves interrupts communication between the brain and other parts of the body and can impair muscle movement, prevent normal sensation in the arms and legs and cause pain.

Neuropathy can be complicated, and is associated with a number of different medical conditions. There are many causes of neuropathy. This includes physical trauma, repetitive injury, infection, metabolic problems and exposure to toxins and some drugs. If you suffer with neuropathy you are not alone. It is estimated that upwards of 20 million Americans suffer from this illness. It is more common than you may think. Neuropathy has an alarming annual cost to Medicare exceeding $3.5 billion.

The term 'neuropathy' covers a wide area and many nerves, but the problem it causes depends on the type of nerves that are affected. There are sensory nerves, motor nerves and autonomic nerves, all serving a different function of the body. When sensory nerves (the nerves that control sensation) are affected, you can experience tingling, pain, numbness, or weakness in the feet and hands. When motor nerves (the nerves that allow power and movement) are affected this can cause weakness in the feet and hands. Lastly, autonomic nerves (the nerves that control the systems of the body eg. gut, bladder, reproductive organs, etc.) may cause changes in the heart rate and blood pressure or sweating. As you can see, damage to the nerve system can cause enormous challenges for the body. One of the most overlooked areas of the human body that causes neuropathy is the spine. Don’t forget the spine houses and protects the spinal cord and nerve roots. The only two parts of your body that are surrounded by bone for protection are your brain and spinal cord. Spinal damage, spinal misalignments, degenerative joint disease, degenerative disc disease, and spinal arthritis, to name a few, can all cause neuropathy.

The most important thing to note is that there are many things you can do naturally that are non-invasive to help with neuropathy. You have options. From diet and blood sugar management to spinal health and hygiene, you have options when it comes to neuropathy. Stop suffering and start learning what natural options are available to you.

I will be hosting a workshop on NEUROPATHY at Panera Bread on July 22, 2015 at 7pm. If you suffer with numbness and tingling in the extremities, muscle weakness and fatigue, sciatica symptoms, carpal tunnel symptoms or anything related to neuropathy, please join us to learn more. It is our mission to educate our community towards superior health and vitality through natural healthcare. Come join us and be our guest and together lets put an end to Neuropathy. We hope to see you there!

Dr. Bryan Ruocco is a local chiropractor and wellness advocate. He owns and operates the Power of LIFE Wellness Center located in the heart of Rocky River.

Bryan Ruocco

Dr. Bryan Ruocco is a local chiropractor and wellness advocate. He owns and operates the Power of LIFE Wellness Center located in the heart of Rocky River. Dr. Ruocco graduated from the prestigious Life Chiropractic College in Marietta, GA. He graduated in the top of his class and received Magna Cum Laude Honors. He has an extreme passion to help other experience exceptional health and is dedicated to serving his community with the latest in non-drug, wellness care. Dr. Ruocco is married to his wife Melissa and have 3 beautiful children who go to school in the local area.

Saturday, 3 October 2015

Just How Is Neuropathy Pain Treated?

Today's post from (see link below) is the second of two consecutive posts written by LtCol Eugene B Richardson. This article is another well-written, comprehensive, clear and easy to understand piece concerning how neuropathic pain is generally treated. The author is also a neuropathy patient and has considerable experience of being on the treatment roundabout. In this way, he's able to cut to the chase and give useful information and advice. Worth a read.

How is Neuropathic Pain Treated?
By LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

FACT: Neuropathic pain does NOT respond to ‘normal’ pain medications.

Pain signals from an external stimulus like a cut or from an internal broken bone are treated with many well-known treatment options for pain.

Pain signals from damaged nerves which send real, but faulty signals to the brain must be treated with other options which currently are limited until research provides more options at the clinical level.

Drug Options

The majority of patients with neuropathic pain are currently treated with two classes of medication.

The anti-depressants and the anti-seizure medications either alone or in combination work for many patients to reduce such pain. Some of these options would include Nortriptyline in the first class and Lyrica in the second class. Speak to your doctor about the options, but recommend that you first consider the anti-depressants as these may have less side effects. Both the anti-depressants and anti-seizure medications reduce neuropathic pain, even if medicine is not totally sure why they work. This information is from the book by Norman Latov, MD PhD of Weill Medical College, Cornell University in his book for patients listed in our RESOURCE tab. (Ref: #4)

Most patients get about 85% relief and a few are lucky with 100% relief, but until there are better medications developed by research, we are fortunately to have these options.

Dr. Latov (Ref: #1) speaks of these and other medications and they do help many neuropathy patients. However, like all medications sometimes the side effects are worse than the symptoms. Each patient must decide if they are worth using if the pain is only at the nuisance level. The dosage and the combinations of these medications must be worked through by the patient with the doctor in a patient doctor partnership of trial and error. As of now, I know of no other way to find what works for you.

Other patients have been prescribed Lidocaine patches for burning pains as noted by Dr. Latov and patients report that these help reduce the burning.

I have found that the burning sensations respond best to compounded topical creams and not to the oral medications. Compounded topical creams are being prescribed more often by doctors and the benefit is the absorption into the blood is limited and it tends to stay concentrated to the area you need it the most according to Neurologist Corey Hunter (Ref: #4). Some of the ingredients physicians use in these compounds includes Lidocaine, Ketamine, Gabapentin, and Amitriptyline, mixed by a compounding pharmacy in percentages as prescribed by the physician.

For patients with an immune mediated neuropathy the use of intravenous immune globulin (IVIg) has been very effective in reducing pain in sensory neuropathies while providing more muscle strength in motor neuropathies and protecting the nerves from more damage. It works! See patient IVIg experience click here:

Ketamine Infusions for Chronic Pain: For information on use and cautions, please see Ketamine Infusions for Chronic Neuropathic Pain.

2015 Update on Promising Research: The Foundation for Peripheral Neuropathy in their E News March 2015, noted in a follow up of reported 2013 research a report published in the Annals of Clinical and Translational Neurology and Science Daily, noted that with “two low dose rounds of non-viral gene therapy called VM 202 patients had significant improvement of their pain that lasted for months!

“Those who received the therapy reported more than 50 percent reduction in their symptoms and virtually no side effects,” said Dr. Jack Kessler, lead author of the study. “Not only did it improve their pain, it also improved their ability to perceive a very, very light touch.

“VM202 contains human hepatocyte growth factor (HGF) gene. Growth factor is a naturally occurring protein in the body that acts on cells, in this case nerve cells – to keep them alive, healthy and functioning. Future study is needed to investigate if the therapy can actually regenerate damaged nerves, reversing the neuropathy.

“Patients with painful diabetic neuropathy have abnormally high levels of glucose in their blood. These high levels of glucose can be toxic.

“We are hoping that the treatment will increase the local production of hepatocyte growth factor to help regenerate nerves and grow new blood vessels and therefore reduce the pain,” said Dr. Senda Ajroud-Driss, associate professor in neurology at Feinberg, an attending physician at Northwestern Memorial Hospital and an author of the study.

“Right now there is no medication that can reverse neuropathy,” Kessler said. “Our goal is to develop a treatment. If we can show with more patients that is a very real phenomenon, then we can show we have not only improved the symptoms of the disease, namely the pain, but we have actually improved function.”

“A future, much larger phase three study will soon be underway. To read the full article Neuropathy: Relief for diabetics with painful condition. ” 

What about muscle cramps?

Muscle cramps are common in neuropathy patients. It is always a good idea to report such muscle cramps to your doctor and determine if it is indeed related to your neuropathy or other conditions. Levels of potassium, calcium, salt, and other substances critical to proper function of muscles may need to be tested to see if they are low.

Other patients have had levels of potassium, calcium, salt, and other substances critical to proper function of muscles tested to see if they are low. Then have the doctor prescribe a supplement at the correct dosage for you.

If you take a diuretic, muscle cramps are common and may require supplements, so speak to your doctor.

Patients have found that eating a banana at night keeps the cramps away, or eating a Tum to increase calcium, or eating salty olives or pickles if your salt levels are low work.

Some neuropathy patients have noted that the drug Venlafaxine resolves restless leg syndrome and the associated leg cramps. Dr. Levine states that this drug changes the levels of serotonin and norepinephrine (two neurochemicals) in the spinal cord and can be effective in patients with neuropathy.
What About Exercise?

Did you know that the wrong type of exercise will force damaged nerves to work and increase the pain! See article at:

How should a neuropathy patient exercise? Consider ordering a copy of the brand new DVD from Matt Hansen the expert as his perspective on exercise for neuropathy is perfect and understands what we can and cannot do. Yet Matt makes it possible for us to exercise WITHOUT the increase in neuropathic pain, keeping muscles as strong and flexible as possible. To see article on DVD click here: When ordering enter the special code NSN 10 and Matt will give 10% of your purchase price back to support the work of the NSN!

If you want a complete discussion of medicines for the treatment of neuropathic pain, read the book by Dr. Latov.

Other options

Dr. Latov in his book and many neuropathy patients have reported reducing pain by the use minerals such as Alpha Lipoic acid (600 to 800 mg) especially pain from diabetic neuropathy. Research suggests that vitamin C is important to protecting nerve cells and the lack of vitamin E can actually cause neuropathy as noted by Dr. Latov.

You see many ads for B supplements in what I call a shotgun approach to the B vitamins. For me it is like shooting a mass of vitamins at an unknown target! We know that a shortage of certain vitamins, especially the E and B vitamins, is known to cause neuropathy. Yet too much B6 can cause it! I like the suggestion of Dr. Latov that the patient have such levels tested (see his book for specific information) to determine any shortage and then treat the identified target rather than using a radium shotgun blast at an unknown target!

Good nutrition is very important for everyone, but it is especially important for neuropathy patients. Why? First good nutrition helps protect and heal the nerves. Secondly, the lack of essential vitamins can cause neuropathy according to Dr. Latov! Neuropathy caused by long term alcohol abuse may be due more too poor nutrition than the alcohol. Read his book.

In the book by Mims Cushing’s, (Ref: #2) patients report that another helpful option is to soak your feet in cold tap water for 15 minutes before going to bed. The cooler water helps by calming the nerves. DO NOT USE FREEZING ICE WATER as with sensory neuropathy this could cause damage to the skin. For those with the sensation of very COLD feet, these patients have found that doing the same with warm tap water (NOT HOT) has a soothing effect.

Acupuncture has been shown to be effective for pain reduction in some patients and this is supported by small studies showing its effectiveness.

Erika Schwartz, M.D. a holistic physician a leading expert on wellness recommends the use of the supplement Curcumin as a great anti-inflammatory that will help relieve pain. She also recommends MSM at 2000 mg per day as helpful for pain.

Again, it is what works for you in treating the strange effects of neuropathic pain from damaged peripheral nerves. 

A Word About PODS (Postural Orthostatic Tachycardia Syndrome)

Do you know how many times over the past 40 years I was sent to the Cardiologist because ‘I was having a heart attack’ only to be told my heart was fine and ask, ‘Why was I here?’ The Tachycardia (silent as I did not feel it), was never understood or recognized. It was often not even related to standing as I has been assumed. Having been diagnosed with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Small Fiber Neuropathy (SFN) and with symptoms of Autonomic Neuropathy, it was a reality for me, but eventually this symptom went away while others were reduced when I began IVIg.

The relationship of the symptoms to Small Fiber Neuropathy was noted in a February/March 2015 Article in Neurology NOW (Ref #6) among other neurological issues. The article notes that there are significant disagreements in the scientific community about what drives POTS or even what symptoms are related to PODS. Symptoms related to PODS in this article include dizziness, lightheadedness, palpitations, near fainting upon standing and unrelated to standing the symptoms noted are fatigue, nausea, autonomic systems, fibromyalgia, and others often connected to several forms of neuropathy.

While prognosis is unpredictable, research in a 2013 large study from the Mayo Clinic presented at the 24th International Symposium on the Autonomic Nervous System noted that 18.2% of patients noted complete resolution of symptoms , while 52.8% reported improved but persistent symptoms two to 10 years after diagnosis.

Several suggestions were made in the Neurology NOW article to alleviate POTS including the simple idea of (1) drinking more water especially with increases in sodium. This simple solution helps expand blood volume and increase blood flow, but it may not work for some people; (2) appropriate exercise (see exercise DVD information noted above) to prevent blood from pooling in the lower extremities and other benefits gained from even low impact exercise.

Until more research confirms what is driving this REAL disorder and the related symptoms, patients just must find ways to cope and live around the illness.
DVD and the Behavioral Sciences

In this regard, remember what I have taught in the DVD “Coping with Chronic Neuropathy”. How you THINK about something, will affect your FEELINGS, which will in turn effect or influence your BEHAVIOR. It you think something is horrible, your feelings will be one of despair and your actions will reflect a sense of defeat. Always try to turn this around to a positive thought, however difficult it may be! It works.

You may also want to find a good psychologist or trained counselor, to explore cognitive therapy as in biofeedback or relaxation techniques, visualization techniques, or a trained specialist in healing arts such as yoga or ta-chi, to find ways to utilize your body’s ability to increase natural chemicals (serotonins) which we know reduce pain. Never underestimate the body’s ability to seek balance and healing.

Soothing music or sounds are a well-known way to relax and improve the body’s response to pain and there are music tapes or even therapists to help. This is why the noise of a water fall or watching a fish tank is so relaxing and healing.

Periods of slow deep breathing together with soft music or other relaxing sounds can be very helpful. Combine this with favorite images such as rain fall, snow showers, waterfall, and fall foliage in the mountains in the fall, or visualizing soft spring rains, baby birds, or whatever and you will be surprised how much it helps. Art therapy is often used to help patients visualize and express how they feel. I have been known to sing while walking my dogs using my power scooter with neighbors looking at me with strange looks, ‘Okay, he is gone’, but who cares.

Pets can offer so much in comfort and care if you are physically able to take care of them and afford them. As we have learned many times with the chronically ill and with veterans who suffer from PTSD pets are often essential for survival. For me they have become my ‘children’ to take care of providing more love and meaning to my daily life. 


Opiates are often used for break through pain and for some are very helpful when there is either a short term need or no other option.

However, my opinion after working with many patients attempting to stop the use of opiates is that patients should try every option carefully before using the opiates. The opiates often require increasing dosages with unwanted side effects that become more of a problem than the symptoms you are trying to address. A day does not go by, when a patient requests help to withdrawing from opiates.

For many patients the opiate drugs will eventually become more of a problem than your symptoms of neuropathy and the body will keep demanding more and more of the drug.

However, this is a very personal decision between you and your doctor, so work with the doctor to discover what does work for you as noted. If your doctor does not work with you on this, find another doctor as every patient is different. I would always tell a patient to get a second opinion regarding opiate use for neuropathic pain.

Remember for neuropathic pain, if you get 85% relief this is probably as good as it is going to get until medical research discovers better options.

Pain Management

A patient went for decades with severe back pain from multiple problems in the spine. Nothing helped. Then they tried the epidural from a Pain Management physician, which is the only thing that helped provide some relief after decades of trying.

This epidural uses Lidocaine and Depomedrol. The patient is sedated when the procedure is done and it is done under a machine that shows the doctor what they are doing on a monitor. It gave the patient 90% relief for the first 3 weeks and then 80% relief. The patient is crippled without this epidural. Unfortunately they need to be repeated and relief is often temporary.
Pain Management can offer many ideas for patients to find some relief from chronic pain including the possible use of spinal cord stimulators, implants, and other such instruments.

How do you communicate pain levels?

(To see article on opening doors with doctors click here.)

One of the most difficult tasks for a neuropathy patient is communicating neuropathic pain or symptom levels to anyone, while the patient fears they are crazy from the strangeness of these symptoms and sensations.

Too many patients in frustration or in a desperate need for relief will state something like, “If 10 is the worst level, than my pain is a 20.” This may communicate your desperation, panic, frustration, or anger, but otherwise is not helpful to the doctor or you.

This is where patient awareness of the pain scale 1 to 10 is very important as you communicate with the doctor, working through the issues of what works and what does not work. This process requires a doctor and patient who LISTEN and HEAR as listening and hearing are two different tasks. You know a doctor is listening if they do not cut you off after you share for 3 seconds and if they can repeat back what you just said!

Remember, if 10 is the level of pain where you pass out and 1 is just a nuisance, then 5 is where your ability to perform daily tasks become very difficult and by 6 impossible. With practice, it will amaze you how skillful you can become in judging your pain or symptom level.

There are times when pain or other symptoms are better expressed in a range over a period of time. Examples would be the burning sensations have been a 2 to 4 or a 4 to 7. This will help you and the doctor see where you are with the medications. But remember, if you get 85% relief from neuropathic pain, this may be as good as it gets with current options. But remember, if you get 80% relief from neuropathic pain, this may be as good as it gets with current options.


#1 Norman Latov, MD, PhD, FAAN Peripheral Neuropathy: When the Numbness, Weakness and Pain Won’t Stop, ANN Press, 2007

#2 Mims Cushing, You Can Cope With Peripheral Neuropathy (Ideas from neuropathy patients), with Dr. Norman Latov, DEMOS Publishing, 2009

#3 Textbook of Peripheral Neuropathy, Peter D Donofrio, MD, Editor, Professor of Neuropathy, Chief of Neuromuscular Section, Vanderbilt University Medical Center, Nashville, TN Published by DEMOS Medical, 2012.

#4 “Journal of the Peripheral Nervous System” published by the Peripheral Nerve Society.

#5 Dr. Corey W. Hunter, MD, Pain Medicine, Ainsworth Institute of Pain Management, New York, NY.

#6 Dr. Sean Levine, MD, FAAN, Professor of Clinical Neurological Surgery and Radiology, NYPH, New York, NY

#7. “Neurology NOW”, February/March 2015, Article: Taking a Stand (on PODS), By Amy Paturel, pages 44 to 47.

About the Author

Col Richardson has suffered with severe neuropathy for over 45 years. A 27 year military veteran and veteran of the Vietnam War, he was diagnosed with a progressive chronic peripheral neuropathy resulting in severe disability. This diagnosis has been confirmed as due to exposure to Agent Orange. It was not until 2010, 42 years after his exposure to Agent Orange, that his diagnosis was recognized by Veterans Affairs as service connected.