Should a Neuropathy Patient use Alternative Therapies?

Unfortunately, HIV patients have historically often clutched at 'alternative therapy' straws when nothing else seems to work but in the early days of the disease, there was little choice. These days, for most people, the medication can keep the virus itself under control but as you know, if you also suffer from neuropathy, you're back to thinking about alternative treatments to compensate for the failings of the conventional drugs. Is it wise to do this? The advice here is to always consult your doctor before trying anything outside the mainstream and hope that they're open-minded enough to be objective. What you need to know is if any particular thing (especially herbal and mineral treatments) will do you harm, or clash with your current medication and that can depend on the individual - qualified advice necessary then.

This article from the US Department of Veterans' Affairs,(see link below) takes an objective look at alternative therapies, explains what they are and gives you some useful advice (and links) to mull over.

Alternative (Complementary) Therapies for HIV/AIDS

Overview

Many people use complementary (sometimes known as alternative) health treatments to go along with the medical care they get from their doctor.

These therapies are called "complementary" therapies because usually they are used alongside the more standard medical care you receive (such as your VA doctor visits and the anti-HIV drugs you might be taking).

They are sometimes called "alternative" because they don't fit into the more mainstream, Western ways of looking at medicine and health care. These therapies may not fit in with what you usually think of as "health care."

Some common complementary therapies include:
Physical (body) therapies, such as yoga, massage, and acupuncture
Relaxation techniques, such as meditation and visualization
Herbal medicine (from plants)

With most complementary therapies, your health is looked at from a holistic (or "whole picture") point of view. Think of your body as working as one big system. From a holistic viewpoint, everything you do--from what you eat to what you drink to how stressed you are--affects your health and well-being.

Do alternative therapies work?

Healthy people use these kinds of therapies to try to make their immune systems stronger and to make themselves feel better in general. People who have diseases or illnesses, such as HIV, use these therapies for the same reasons. They also can use these therapies to help deal with symptoms of the disease or side effects from the medicines that treat the disease.

Many people report positive results from using complementary therapies. In most cases, however, there is not enough research to tell if these treatments really help people with HIV.

If you want to try complementary treatments to help you cope with HIV/AIDS, please remember these things:
Always talk to your VA health care provider before you start any kind of treatment, even if you think it is safe.
Just because something is "natural" (an herb, for example) doesn't mean that it is safe to take. Sometimes these products can interact with your HIV medicines or cause side effects on their own. St. John's-wort, for example, decreases levels of some HIV medications in your blood.
The federal government does not require that herbal remedies and dietary supplements be tested in the same way that standard medicines are tested before they are sold. Many of the treatments out there have not been studied as much as the HIV drugs you are taking. It is always a risk to take something or try something that hasn't been fully studied or researched.
Be careful of treatments that claim to be "miracle cures"--ones that claim to cure HIV/AIDS. There are people out there who may try to trick you into buying an expensive product that doesn't work. Always do your research and ask your VA doctor for help.
Complementary therapies are not substitutes for the treatment and drugs you receive from your VA doctor. Never stop taking your anti-HIV drugs just because you've started another therapy.
The federal government is funding studies of how well some alternative therapies work to treat disease, so keep your eyes open for news about these studies.

Here you can read about some of the more common complementary therapies that people with HIV use. Sometimes these are used alone, but often they are used in combination with one another. For example, some people combine yoga with meditation.

Physical (body) therapies

Physical, or body, therapies include such activities as yoga, massage, and aromatherapy. These types of therapies focus on using a person's body and senses to promote healing and well-being. Here you can learn about examples of these types of therapies.

Yoga

Yoga is a set of exercises that people use to improve their fitness, reduce stress, and increase flexibility.

Yoga can involve breathing exercises, certain stretches and poses, and meditation.
Many people, including people with HIV, use yoga to reduce stress and to become more relaxed and calm. Some people think that yoga helps make them healthier in general, because it can make a person's body stronger.

If you would like to try yoga, talk to your VA health care provider. There are many different types of yoga and various classes you can take. You can also try out yoga by following a program on videotape.

Before you begin any kind of exercise program, always talk with your doctor.

Massage

Many people believe that massage therapy is an excellent way to deal with the stress and side effects that go along with having an illness, including HIV.

During massage therapy, a trained therapist moves and rubs your body tissues (such as your muscles). There are many kinds of massage therapy.

You can try massage therapy for reducing muscle and back pain, headaches, and soreness. Massages also can improve your blood flow (your circulation) and reduce tension. Some people think that massages might even make your immune system stronger.

If you are interested in learning more about massage, you should ask your VA doctor to recommend a trained therapist. Your VA doctor may have a list of trained massage therapists, so if you want to learn more about massage, ask.

Acupuncture

Acupuncture is part of a whole healing system known as traditional Chinese medicine. During acupuncture treatment, tiny needles (about as wide as a hair) are inserted into certain areas of a person's body. Most people say that they don't feel any pain at all from the needles.

Many people with HIV use acupuncture. Some people think that acupuncture can help treat symptoms of HIV and side effects from the medicine, like fatigue and stomach aches.

Some people say that acupuncture can be used to help with neuropathy (body pain caused by nerve damage from HIV or the medicines used to treat HIV).

Others report that acupuncture gives them more energy.

If you are interested in trying it out, ask your VA doctor to recommend an expert. At the end of this guide are links to Web sites where you can read more about the history of acupuncture and how it works.

Aromatherapy

Aromatherapy is based on the idea that certain smells can change the way you feel. The smells used in aromatherapy come from plant oils, and they can be inhaled (breathed in) or used in baths or massages.

People use aromatherapy to help them deal with stress or to help with fatigue. For example, some people report that lavender oil calms them down and helps them sleep better.

You can also ask friends or family if they've tried aromatherapy or know someone who has. At the end of this guide are links to Web sites where you can learn more about aromatherapy.

Please remember! The oils used in aromatherapy can be very strong and even harmful. Always talk with an expert before buying and using these oils yourself.


Relaxation techniques

Relaxation therapies, such as meditation and visualization, focus on how a person's mind and imagination can promote overall health and well-being. In this section, you can read about some examples of how you can use relaxation therapies to reduce stress and relax.

Meditation

Meditation is a certain way of concentrating that allows your mind and body to become very relaxed. Meditation helps people to focus and be quiet.

There are many different forms of meditation. Most involve deep breathing and paying attention to your body and mind.

Sometimes people sit still and close their eyes to meditate. Meditation also can be casual. For instance, you can meditate when you are taking a walk or watching a sunrise.

People with HIV can use meditation to relax. It can help them deal with the stress that comes with any illness. Meditation can help you to calm down and focus if you are feeling overwhelmed.

If you are interested in learning more about meditation, you should ask your VA health care provider for more information. There may be meditation classes you can take. At the end of this guide are links to Web sites where you can learn more.

Visualization

Visualization is another method people use to feel more relaxed and less anxious. People who use visualization imagine that they are in a safe, relaxing place (such as the beach). Most of us use visualization without realizing it--for example, when we daydream or remember a fun, happy time in our lives.

Focusing on a safe, comfortable place can help you to feel less stress, and sometimes it can lessen the pain or side effects from HIV or the medicines you are taking.

You can ask your VA doctor where you can learn more about visualization. There are classes you can take, and there are self-help tapes that you can listen to that lead you through the process. See the links at the end of this guide.


Herbal medicine

Many people, including people with HIV, use Herbal medicines to improve their health. Herbal medicines are substances that come from plants, and they work like standard medicine. They can be taken from all parts of a plant, including the roots, leaves, berries, and flowers.

People with HIV sometimes take these medicines to help deal with side effects from anti-HIV medicines or with symptoms from the illness.

An important note about St. John's wort: St. John's wort has become a popular herbal medicine for treating depression. It interacts with the liver and can change how some drugs work in your body, including some anti-HIV drugs (protease inhibitors and NNRTIs). If you are taking antiviral drugs for your HIV, you should NOT take St. John's wort. Be sure you tell you doctor if you are using St. John's wort. You should also not take St. John's wort if you are taking other antidepressants.


It is important to remember to always use herbs carefully. Learn the proper dosage and use. Don't take too much of anything.
Always ask your doctor before taking anything new. Just because something is "natural" or "non-drug" doesn't mean that it is safe.
Finally, learn about the possible side effects of an herbal therapy. Remember: Some herbs can interfere with your HIV medications.

To learn more about herbs, see the links in the Resources section at the end of this lesson.


Points to remember

In addition to getting mainstream medical care, more and more people are turning to complementary treatments to improve their overall health or to help with specific health problems.

Complementary therapies can include physical therapies (such as yoga and acupuncture), relaxation techniques (such as meditation), and Herbal medicines.

Many people report that these therapies make them feel better and help with symptoms and side effects.

It is important to remember that not all complementary therapies are safe for you. In fact, some therapies (including certain herbs) can be very dangerous because they can interact with your HIV drugs or cause severe side effects.

Always be sure to let your doctor know what medicines you are taking--whether they are prescription or not.


Resources
HerbMed
HerbMed is an interactive, electronic database that contains scientific information about the use of herbs for health. It is provided by the nonprofit Alternative Medicine Foundation, Inc.
National Center for Complementary and Alternative Medicine (NCCAM)
The NCCAM is one of the 27 institutes and centers that make up the National Institutes of Health (NIH). This Web site includes information on specific diseases, treatments, and herbal therapies. Includes a reference on 10 Things To Know About Evaluating Medical Resources on the Web.
New Mexico AIDS InfoNet (part of the New Mexico AIDS Education and Training Center)
Includes several fact sheets on alternative and complementary therapies.
The Yoga Group
Information on yoga for people living with HIV/AIDS. The Web site includes a listing of yoga classes in numerous cities.

http://www.hiv.va.gov/patient/alternative-therapies/single-page.asp

Nervous System Problems and Dementia

A few people (possibly more than a few) are clearly worried by the implications of HIV related problems with the nervous system and have asked if neuropathy is a sign of HIV-associated dementia. It seems difficult to associate the one with the other but as this article from aidsinfonet.org, December 2010, (see link below) shows, neuropathy used to be lumped together, along with other nervous system disorders, under the alarming barrier of HIV-associated dementia. The article gives a balanced and informative view and explains that dementia is pretty much a worst-case scenario on the list of various nerve disorders but is by no means inevitable. Many people without HIV develop the same problems as they get older. It's certainly nice to be learning about problems we can face with old age...for many people twenty five years ago, old age was wishful thinking!

Nervous System Problems and Dementia

WHAT ARE NERVOUS SYSTEM PROBLEMS?

The nervous system has two parts. The brain and spinal cord are the central nervous system (CNS). The nerves and muscles are the peripheral (around the outside) nervous system.

People with HIV disease can have several problems with the nervous system. A common problem is peripheral neuropathy. This can cause damage to nerves controlling sensation. Symptoms may include altered sensation, numbness, tingling, pain, or weakness, especially in the feet and legs. Central nervous system (CNS) problems include depression and problems with sleeping, balance, walking, thinking, and memory.

In the early years of AIDS these were all called “HIV-Associated Dementia.” However, a broader range of problems is showing up at present. This is now called HIV-associated Neurological Disturbances (HAND), which includes less severe symptoms referred to as Minor Cognitive Motor Disorder.

Before combination antiretroviral therapy (ART) was available, about 20% of people with AIDS developed severe dementia. Strong antiretroviral medications (ARVs) have cut the rate of serious dementia. However, with longer survival, more people with AIDS are living with milder neurological problems. These are estimated to affect 40% to 70% of people with HIV. This is true even if people are taking ART.

The body has a mechanism to protect the brain from foreign substances. This is called the blood-brain barrier. It keeps most HIV medications from getting into the brain. However, when the viral load in blood goes down, it also goes down in the brain. It is not known whether using HIV drugs that get into the brain helps reduce symptoms of milder neurological problems. Research studies have had mixed results.

WHAT ARE THE SIGNS OF CNS PROBLEMS?

Some neurologic problems require urgent medical attention. If you have serious headaches, especially with a fever, stiff neck, vomiting, or vision problems, or if you develop new weakness or loss of feeling, you should see your health care provider immediately.

The main symptoms of nervous system problems are with thinking, behavior, and movement.

■ Thinking: memory loss, trouble concentrating, mental slowing, trouble understanding. This can include forgetting telephone numbers that you use a lot, having trouble with simple math like making change at the store, People with CNS problems may have difficulty taking their medications on schedule
■ Behavior: Depression, agitation, lack of caring, irritability
■ Movement: Balance problems, unsteady walking, slower movement, poor coordination, tremor

A physical examination may show reduced reflexes in the ankles, especially when compared to reflexes in the knees.

Magnetic Resonance Imaging (MRI,) a radiologic procedure, may show abnormalities in brain tissue.

WHAT MAKES NERVOUS SYSTEM PROBLEMS WORSE?

Many factors can contribute to nervous system problems. These include severe depression, drug and alcohol use, infection with hepatitis C, inflammation and normal aging.

In addition, CNS problems seem to be more common in people with CD4 cell counts below 200, either currently or when they were at their lowest.

As people with HIV are living longer, aging is also contributing to nervous system problems. Some of the problems of aging may show up faster in people with HIV.

HOW ARE CNS PROBLEMS TREATED?

If the side effects of medications include nervous system problems, they usually go away if you stop taking the drugs. This may take as long as several months.

People with CNS problems may have problems with taking their medications on schedule. They may need extra help remembering to take their medications.

Several other neurological problems are emerging in people, even those taking antiviral medications. This includes conditions related to immune reconstitution inflammatory syndrome (IRIS).

THE BOTTOM LINE

HIV disease can cause a wide range of nervous system problems, from forgetfulness and balance problems to serious dementia. These problems usually don’t show up until the later stages of HIV disease. However, problems with memory can show up even in people with no other symptoms.

The new combination therapies that fight HIV seem to protect the central nervous system against the worst damage from the virus. However, because so many more people with HIV are living longer, and getting older, more nervous system problems are showing up.

Caring for someone with serious nervous system problems is very difficult. Caregivers need to take care of themselves, too, to avoid burnout and depression.

http://www.aidsinfonet.org/fact_sheets/view/505?lang=eng

How Neuropathy affects us all

The rule on this blog is generally, absolutely no advertising however this video from a medical practice in Georgia, USA is so full of useful and accurate information that will hit all the right notes with neuropathy patients, that an exception can definitely be made. As it turns out, the good doctor's promise of a scroll-down text (which could also have been very useful) and a link to the details of his practice and how he proposes to help neuropathy patients at the end of the video, are missing; so the problem of promoting someone's business doesn't arise. I'm not sure why the information at the end isn't there - perhaps it's a YouTube thing but please don't let that put you off watching the video...it's only 4.52 minutes and the man knows how we feel!

How far away is a cure for HIV?

This blog concentrates on HIV in combination with neuropathy and therefore, rarely posts about HIV on its own. However, today's video is of such general interest for all HIV-positive people that for once, straying away from the core topic can be forgiven. You can suffer from neuropathy without having HIV but for most of us, HIV is at the basis of whatever medical problems we have and as such, learning about progress towards a cure can only be of value. The truth is that, for whatever reasons, a cure for HIV is not around the corner; this video helps us understand why.




The following is the text that accompanies the video on YouTube:

What Can We Do Now to Speed Up HIV Cure Research?

After attending a meeting sponsored by several organizations (TAG, AMFAR, Project Inform, the AIDS Policy Project) in Baltimore on April 20-21 this year, I came to the realization that we needed a video that would wake people up to the challenges ahead of us to get to a cure of HIV that is accessible and practical. As most of you know, the case of Timothy Brown (aka The Berlin patient), a person who got cured of HIV and leukemia 5 years ago, has jolted a new energy and hope in the search for the cure. But most people with HIV, policy makers and potential funding sources are not fully aware of this case and what the new movement for a search for a cure are all about. So, I decided to travel around the country to interview key players in advancing this field to make a short video that could serve as a catalyst for awareness and change. This short video, done with a very low budget with the help of my activist friend Greg Fowler, is only part of a longer, more detailed documentary to be finished before World AIDS Day this year, the 30 year anniversary of the first AIDS cases. Please watch it and forward it to your friends. Please follow the suggestions made in that video and become part of the cure! Everyone can do something now to raise awareness and funds not only for research but also for advocacy and education in this important new and expanding area. I hope I can count on you.

--Nelson Vergel

Gene Therapy and Neuropathy

The trend in exploring gene therapy as a means of treating neuropathy is not new but it remains as clear as mud for most people trying to understand how it works, or the theories behind it. This article from NINDS (last modified January, 2007, see link below) looks at a study using a weakened Herpes virus of all things, to deliver a gene to neurons and thus relieve pain.
Unfortunately, the trial was on rats and as they are hardly able to give a running account of how they're feeling, it remains theoretical. At this moment I haven't been able to find any updated information on how the research has developed so if anyone has updated information, please let us know. As always, not everything is easy to understand but you can certainly get a general idea of how and why it works.

Gene Therapy Relieves Neuropathic Pain in Rats

Using a weakened herpes virus to deliver a neurotransmitter-related gene to sensory neurons alleviates pain for up to 6 weeks in rats with chronic pain caused by nerve damage, a new study shows. The findings may lead to the first effective treatment for people affected by this type of "neuropathic" pain.

"Neuropathic pain is very difficult to control," says David J. Fink, M.D., of the University of Michigan and Ann Arbor VA Healthcare System in Ann Arbor, who led the study. "By transferring the gene for GAD, we can substantially reduce this pain in rodents." GAD, or glutamic acid decarboxylase, is the enzyme responsible for synthesizing the neurotransmitter GABA (gamma-aminobutyric acid), which dampens activity in nerve cells. The study was funded in part by the National Institute of Neurological Disorders and Stroke (NINDS) and appeared in the June 2005 issue of Annals of Neurology.*

Pain from damage to sensory nerves in the peripheral nervous system – the vast network that transmits information from other parts of the body to the brain and spinal cord – often occurs as a complication of peripheral neuropathy. This type of pain is common and it is notoriously difficult to treat. Available medications, including opioid drugs, antidepressants, and anticonvulsants, provide only partial relief. As a result, many people with neuropathic pain live with spontaneous burning sensations and pain from stimuli that are normally painless, such as cloth rubbing against the skin.

In the new study, Dr. Fink and his colleagues injected a herpes virus vector either with or without the GAD gene into the hind paws of rats with damaged spinal nerves. Because of pain resulting from the nerve damage, the rats quickly pulled their hind paws away when the paws were touched with a thin hair. They also quickly pulled their paws away from a heat stimulus. These responses are similar to those of people with the enhanced pain and heat sensitivity caused by peripheral neuropathy.

Rats that received the vector containing the GAD gene showed less reaction to the touch and heat stimuli than those that received a viral vector without the gene, the researchers found. The pain reduction began about 1 week after the injection and lasted for 6 weeks before the effect wore off. A second injection of the GAD-containing vector reduced the pain again, however.

In addition to changing the rats' behavioral reactions to the stimuli, the gene therapy reduced the production of three proteins that serve as markers of pain in neurons, the study showed.

The herpes virus has a natural ability to travel from the peripheral nervous system to the sensory nerve centers (called the dorsal root ganglion) in the spinal cord, so vectors created from the herpes virus are particularly well-suited for treatment of nervous system diseases such as peripheral neuropathy. Unlike normal herpes viruses, however, the vectors used in this experiment were unable to replicate, and they stayed in the dorsal root ganglion neurons, where they produced GAD. The presence of GAD increased the levels of GABA in the neurons, modifying sensory transmission from the spinal cord in a way that dulled the pain signals.

Previous studies by Dr. Fink's team and others using herpes vector-mediated gene therapy with different pain-reducing genes, including proenkephalin and glial cell-derived neurotrophic factor, have shown positive effects for treating neuropathic pain, inflammatory pain (including arthritis), and bone pain from cancer. However, the GAD gene therapy used in this study was much more effective for neuropathic pain than the other treatments, Dr. Fink says.

The study supports previous research which showed that neuropathic pain is associated with lower-than-normal amounts of GABA in the spinal cord. While several drugs are available to mimic the effects of GABA, they have significant side effects that limit their use, Dr. Fink says. Gene therapy avoids these problems by increasing GABA levels only in the neurons that control pain sensitivity.

The study did not find any adverse effects of the gene therapy. However, "we can't ask rats how they are feeling," Dr. Fink says. Therefore human studies are needed to ensure that the treatment is safe and that it does not cause subtle side effects.

Dr. Fink and his colleagues are planning a clinical trial of the herpes vector to deliver the proenkephalin gene in patients with pain from metastatic cancer. This study will examine whether the vector is safe to use in humans. If that study goes well, the researchers might then be able to test GAD gene therapy in people with peripheral neuropathy or other types of pain.

The NINDS is a component of the National Institutes of Health within the Department of Health and Human Services and is the nation’s primary supporter of biomedical research on the brain and nervous system.

*Hao S, Mata M, Wolfe D, Glorioso JC, Fink DJ. "Gene transfer of glutamic acid decarboxylase reduces neuropathic pain." Annals of Neurology, June 2005, Vol. 57, No. 6, pp. 914-918.

-By Natalie Frazin, NINDS Office of Communications and Public Liaison

Date Last Modified: Wednesday, January 31, 2007

http://www.ninds.nih.gov/news_and_events/news_articles/news_article_pain_gene_therapy.htm

How does HIV cause Neuropathy?

We read and are often told, that HIV itself can cause neuropathy but in itself, that doesn't tell us much. The doctors will generally tell you that it is strongly suspected that HIV can be a prime cause but suspicion and proof are very different things. Why would HIV cause neuropathy? How could a virus cause nerve damage?
This article from the National Institute of Neurological Disorders and Stroke (see link below) explains how research has uncovered conclusive evidence that the virus can cause neuropathic problems. For that reason alone, it's an important piece of information and you may be able to refer your doctor to it if he or she, expresses doubt (tact required!) Proof may be difficult to establish but where the diagnosis is idiopathic neuropathy, there may also be a direct link to the HIV virus itself.
Remember also that HIV is only one possible cause of neuropathy but is certainly a possibility that can't be ignored.

AIDS Virus Can Infect Neurons

Using modern genetic techniques that can detect single copies of genes inside intact cells, scientists have uncovered the first conclusive evidence that the AIDS virus (HIV) can infect neurons. And using fetal brain tissue cultures, scientists have identified key substances that turn on the AIDS virus in the brain. These and other advances in understanding how HIV attacks and damages the nervous system will be presented by more than 25 leading basic and clinical researchers at the upcoming conference, "Technical Advances in AIDS Research in the Human Nervous System," to be held at the Madison Hotel in Washington, DC on October 4-5, 1993.

"The AIDS virus affects the brain in a variety of subtle ways to cause a multitude of devastating clinical problems," said Eugene Major, Ph.D., conference chair and AIDS coordinator for the intramural program of the National Institute of Neurological Disorders and Stroke (NINDS). "Our understanding of this complex picture has matured dramatically thanks to new findings from innovative technologies to be described at this conference."

The upcoming conference is sponsored by the NINDS with support from the National Institutes of Health's Office of AIDS Research and IGEN, Inc., a biotechnology company based in Rockville, Maryland.

"IGEN is proud to present at this meeting its promising new technology — electrochemiluminescence — that may advance the ability to diagnose HIV and other infectious agents in the central nervous system," said Dr. Richard Massey, the company's president.

Other advances to be presented at the conference include:
a new mouse model that offers insight into brain damage in children with AIDS,
evidence that specific brain cells, called glial cells, may serve as an AIDS virus reservoir, and
identification of toxins secreted by infected cells in the brain that may cause AIDS dementia.
More than half of people who are infected with HIV develop neurological complications during the course of their disease, and some autopsy studies show abnormal changes in brain and nervous tissue in as many as 90 percent of patients. Two common complications are AIDS dementia, which progressively strips away the abilities to learn and remember, and painful damage to the body's nerves called peripheral neuropathy. Both of these complications affect about one in three AIDS patients.

"As ongoing research teaches us more about how the AIDS virus damages vulnerable cells in the brain and nervous system to cause disease, we are also gaining valuable insights into how these cells work together to yield normal brain function," said Patricia A. Grady, Ph.D., acting director of the NINDS.

The NINDS, one of the 17 National Institutes of Health in Bethesda, MD, is the nation's leading supporter of research on disorders of the brain and nervous system. IGEN, Inc. was founded in 1982 to provide products for integrated health care related to cancer and acute infectious disease.

Date Last Modified: Friday, August 07, 2009

http://www.ninds.nih.gov/news_and_events/news_articles/pressrelease_aids_092893.htm

Can Meditation Reduce Neuropathic Pain?

We probably all believe deep down that the more relaxed we are, the better we are able to deal with pain. Or conversely, the more tense we are, the greater the pain will be. Common sense suggests then that relaxation techniques, based around meditation, will help reduce the levels of pain we feel. The problems with this theory are twofold: first we need to really believe in the effectiveness of meditation and secondly, our pain levels need to be low enough to be able to relax, without being anaesthetised because as I'm sure you all know, the concept of neuropathic pain and relaxation... is often a contradiction in terms! This article from Science Daily (see link below) discusses a study on the subject from the University of Manchester. Are you one of the patients who benefits from meditation? Let us know what you think.

Meditation Reduces the Emotional Impact of Pain, Study Finds
ScienceDaily (June 2, 2010)

People who meditate regularly find pain less unpleasant because their brains anticipate the pain less, a new study has found.

Scientists from The University of Manchester recruited individuals into the study who had a diverse range of experience with meditation, spanning anything from months to decades. It was only the more advanced meditators whose anticipation and experience of pain differed from non-meditators.

The type of meditation practised also varied across individuals, but all included 'mindfulness meditation' practices, such as those that form the basis of Mindfulness-Based Cognitive Therapy (MBCT), recommended for recurrent depression by the National Institute for Health and Clinical Excellence (NICE) in 2004.

"Meditation is becoming increasingly popular as a way to treat chronic illness such as the pain caused by arthritis," said Dr Christopher Brown, who conducted the research. "Recently, a mental health charity called for meditation to be routinely available on the NHS to treat depression, which occurs in up to 50% of people with chronic pain. However, scientists have only just started to look into how meditation might reduce the emotional impact of pain."

The study, to be published in the journal Pain, found that particular areas of the brain were less active as meditators anticipated pain, as induced by a laser device. Those with longer meditation experience (up to 35 years) showed the least anticipation of the laser pain.

Dr Brown, who is based in the University's School of Translational Medicine, found that people who meditate also showed unusual activity during anticipation of pain in part of the prefrontal cortex, a brain region known to be involved in controlling attention and thought processes when potential threats are perceived.

He said: "The results of the study confirm how we suspected meditation might affect the brain. Meditation trains the brain to be more present-focused and therefore to spend less time anticipating future negative events. This may be why meditation is effective at reducing the recurrence of depression, which makes chronic pain considerably worse."

Dr Brown said the findings should encourage further research into how the brain is changed by meditation practice. He said: "Although we found that meditators anticipate pain less and find pain less unpleasant, it's not clear precisely how meditation changes brain function over time to produce these effects.

"However, the importance of developing new treatments for chronic pain is clear: 40% of people who suffer from chronic pain report inadequate management of their pain problem."

In the UK, more than 10 million adults consult their GP each year with arthritis and related conditions. The estimated annual direct cost of these conditions to health and social services is £5.7 billion.

Study co-author Professor Anthony Jones said: "One might argue that if a therapy works, then why should we care how it works? But it may be surprising to learn that the mechanisms of action of many current therapies are largely unknown, a fact that hinders the development of new treatments. Understanding how meditation works would help improve this method of treatment and help in the development of new therapies.

"There may also be some types of patient with chronic pain who benefit more from meditation-based therapies than others. If we can find out the mechanism of action of meditation for reducing pain, we may be able to screen patients in the future for deficiencies in that mechanism, allowing us to target the treatment to those people.

http://www.sciencedaily.com/releases/2010/06/100602091315.htm

Neuropathy, HIV and Children

It's easy to forget that children also suffer from HIV-related problems and are therefore also prone to various forms of polyneuropathy. It is perhaps less easy to forget in third world countries where, relatively speaking, far more children become hiv positive and that particular section of the HIV population is tragically far more visible. However, do children suffer from neuropathic problems in the same way as adults? This article from Pediatricsdigest.mobi (see link below) concerns a Brazilian study of HIV- positive children with neuropathy and is very interesting although it's a seemingly quite small study. In our own adult-oriented world, it does no harm to be reminded that there is a large section of our demographic who can't fight for themselves; don't understand what's happening to them and don't have the tools to improve their own situation.
The article is quite long and not all of it is easy to understand but it is fascinating to see how such a study is carried out; something this article outlines very well.

Distal Sensory Polyneuropathy in a Cohort of HIV-Infected Children Over Five Years of Age





Alexandra Prufer de Q. C. Araújo, MD*,
Osvaldo J. M. Nascimento, MD‡,Orlando S. Garcia, MD*

Abstract

Background. Peripheral neuropathy in children with human immunodeficiency virus (HIV) infection has not been systematically studied.

Objectives. To describe the symptoms and signs of peripheral neuropathy in HIV-infected children and to determine their frequency.

Methods. A cross-sectional study was conducted on a convenience sample from a cohort of children older than 5 years of age at the pediatric HIV outpatient clinic of the Federal University of Rio de Janeiro. Those patients were interviewed and examined systematically for peripheral nerve symptoms and signs.

Results. A total of 39 patients were clinically evaluated. Their ages ranged from 5 to 14 years, and 13 patients (34%) had symptoms and signs of peripheral nerve involvement. Distal paresthesia and/or pain plus diminished ankle jerks and/or diminished vibration sense were the most common clinical findings. Symptoms were chronic and fluctuating, and pain was, in general, not severe. Nerve conduction studies primarily revealed axonal changes.

Conclusions. Peripheral neuropathy occurs in one third of HIV-infected children, and, in general, has less severe features than the distal sensory polyneuropathy described in adults. peripheral neuropathy, human immunodeficiency virus, children.

Worldwide, children are still becoming infected with the human immunodeficiency virus (HIV). Although pediatric acquired immunodeficiency syndrome (AIDS) cases have been reported since 1983 and, soon after, many authors started to highlight the central nervous system involvement in the course of the disease, little is known concerning these patients' peripheral nervous system status.

Peripheral neuropathy is common in HIV-infected adults, either related to the disease or to its treatment. It may present as inflammatory demyelinating polyneuropathy, mononeuropathy, mononeuritis multiplex, polyradiculopathy, subclinical neuropathy, or, more frequently, as distal sensory polyneuropathy.

In 1991, Raphael et al reported the case of a 5-year-old boy with AIDS who had developed an inflammatory demyelinating polyneuropathy. In 1997, Floeter et al described the electrophysiologic data of 50 HIV-infected patients under 18 years of age referred for evaluation of suspected neuropathy. A variety of abnormalities were described, including a probable distal sensory axonal neuropathy in 7 of the oldest children. Although biased by referral, this study suggested that at least some children eventually do develop peripheral neuropathy.

The epidemiology of HIV infection is evolving. More children are becoming infected, and attributable to better management strategies, they are surviving longer. The paucity of reports on peripheral neuropathy in HIV-infected children may reflect age-related differences in regenerative capacity or simply the underrecognition of this condition in this population. Our study was conducted to shed light on those questions.

METHODS

A clinical interview and neurologic examination were both performed by one of the authors (A.P.Q.C.A.) on all HIV-infected children older than 5 years of age from a HIV pediatric cohort followed in 1997 at the Institute of Pediatrics of the Federal University Rio de Janeiro, as part of a prospective study. The baseline neurologic evaluation is presented and did not necessarily correspond to the beginning of the clinical features. Verbal ability, which is needed to disclose the presence of subjective symptoms and to make the neurologic examination more reliable, was the reason for selection of this age group. This study was approved by the Review Board of the Institute of Pediatrics of the Federal University Rio de Janeiro, and written and informed consent was obtained from parents or legal guardians.

A structured questionnaire was used to obtain information from the patient regarding symptoms of pain, paresthesia, or weakness. Additional data on developmental milestones and a family history for peripheral neuropathies were obtained from the caretaker.

The physical examination included weight, height, head circumference, higher functions (speech, memory, and attention), cranial nerves, muscular tone, proximal (shoulder abduction and knee extension) and distal (finger extension and big-toe dorsiflexion) strength (using the Medical Research Council scale11), tendon reflexes, plantar response, abdominal reflexes, coordination, light touch, pain, temperature, vibration sense (with a 128-counts/second tuning fork), and blood pressure in the recumbent and standing position.

The medical charts were reviewed for route of acquisition of HIV infection, treatment with neurotoxic drugs, and disease classification (according to the Centers for Disease Control and Prevention [CDC] in 199412).

Nerve conduction studies were performed using a Medelec/TECA Sapphire 2-channel model electromyograph (Medelec, Manor Way, Old Woking, Surrey, England) at a room temperature of 22°C. Median, ulnar, peroneal, and sural nerves on the right side were examined. Miniature bipolar stimulator and recording electrodes were appropriate for pediatric use. A constant current stimulation with duration of 100 microseconds was delivered at 1 pulse/second. Compound muscle action potentials were recorded on the abductor pollicis brevis and extensor digitorum brevis using the belly-tendon configuration, with an orthodromic stimulus. F response was looked for on the peroneal nerve after 20 successive supramaximal stimulations. Sensory nerve action potentials were recorded using an antidromic stimulus. Amplitudes, latencies, and conduction velocities were considered abnormal if outside the range of medium ± 2 standard deviation of the normal age-matched values of this laboratory. The selection of children in our study, based on age, diminished the variability that could have been found in conduction studies if younger children had been included.13 All patients included in the clinical study were also referred for nerve conduction studies.

The patient was considered to have peripheral neuropathy if presenting simultaneously at least 1 symptom (distal pain, paresthesia, hypoesthesia, or weakness) and 1 sign (amyotrophy, hypotonia, weakness, diminished deep tendon reflexes, hypoesthesia, or postural hypotension). Encephalopathy was diagnosed when 1 or more of the following features were present: microcephaly, developmental delay, pyramidal signs, and higher function disorder. A simplification of the HIV-1-associated progressive encephalopathy published guidelines at the time of the study was adopted because of operational issues. Neurotoxic drug exposure was considered if symptoms developed while taking one of the following drugs: dideoxyinosine (ddI), dideoxycytidine, or isoniazid. Disease duration was considered the difference of the date of transfusion to the date of the evaluation if this route, and the same as the age of the patient who had acquired it if transmission had been vertical or undetermined.

There was no attempt, in the present study, to quantify the clinical features, relying either on visual analog scales or on sensory thresholds. These children were not submitted to lumbar puncture or nerve biopsy because of ethical issues.

RESULTS

From the total of 128 patients followed at the HIV pediatric clinic in 1997, 55 were 5 years old or older. During the study, 6 children died, 2 moved to other cities, and 8 did not attend their consultations regularly; therefore, 39 were included in the present study. Their ages ranged from 5 to 14 years old (mean: 8.4). There was a similar distribution in gender (21 males). Most of them had acquired the infection from their mothers (77%), 4 by transfusion (from birth up to 5 years old), and in 5 the route of acquisition could not be determined.

Symptoms related to peripheral nerve dysfunction were found in 22 of 39 children (56%). Pain was the complaint of 13 patients, predominantly distal in the lower limbs. Pain was described as burning in some or as evoked related to walking a longer distance in others. Paresthesia was reported in 15 children, located distally in upper and lower limbs. Those symptoms, although long-lived, did not interfere in daily activities and had a fluctuating course. They had not been described to the pediatricians in previous medical visits, although the symptoms had been present for >1 year in more than one half of those patients.

Neurologic evaluation depicted peripheral nerve abnormalities in 19 patients (49%). Diminished distal vibration sense (10/39) and diminished or abolished tendon reflexes (11/39) were the most common clinical findings. Hypotonia (4/39), distal muscle weakness (3/39), and diminished distal tactile sensation (1/39) were also observed.

This population, based on clinical findings, could be divided into 4 groups: with symptoms, signs, both, or neither. A total of 13 children (34%) had symptoms and signs of peripheral neuropathy. In 8 of the 13 patients, the use of potential neurotoxic drugs was absent before the beginning of the clinical features related to the peripheral nervous system (Table 1). In the remaining 5 patients, the clinical features developed after having been on potential neurotoxic agents (Table 1). Of the 26 children without peripheral neuropathy, 21 were using a combination of antiretroviral drugs that included ddI.

Clinical and Nerve Conduction Features of Patients With Peripheral Neuropathy

Nine of the 13 children with symptoms and signs were submitted to nerve conduction studies. Denial of consent was the primary reason for not performing the test. The sural nerve was the one most commonly involved, with either low amplitudes or small alterations in conduction velocities or latencies. The other common finding was the absence of F response in the peroneal nerve. No conduction block was observed in the studied nerves. In 7 children, the abnormalities occurred in >1 nerve.

Disease duration, presence of undernourishment, or degree of immunodeficiency was not associated with the presence of peripheral neuropathy. Although nonsignificant, peripheral neuropathy had a higher prevalence ratio in the group of children with encephalopathy (1.53; 95% confidence interval: .86–3.4), as well as in those with symptomatic AIDS (1.42; 95% confidence interval: .46–4.53).

DISCUSSION

Peripheral neuropathy occurs in children with AIDS. In this convenience sample of 39 children over 5 years of age, symptoms and signs related to peripheral nerve involvement are present in one third of the cases. The same prevalence has been found in reports of adults with AIDS but few references of clinical features of peripheral neuropathy had been described in pediatric neurologic series. One could explain the lack of peripheral neuropathy in studies of the beginning of the epidemics on the ground of the early mortality of those children. Dying before acquiring adequate language skills would preclude symptoms such as paresthesia or pain from being confirmed. Furthermore, the high prevalence of encephalopathy, with its florid clinical picture in this population, could overshadow the less striking features of peripheral neuropathy.

The predominance of chronic sensory complaints, pain, and paresthesia, bilaterally and distally located, is similar to what has been found in adult series. Nevertheless, in children those symptoms are not severe and they are not referred to their clinicians spontaneously. The findings of diminished ankle jerks and vibration sense are also found in adults. Relying on clinical aspects, one could consider those clinical features attributable to possible HIV-associated predominantly sensory polyneuropathy. There was no attempt, in the present study, to quantify the clinical features, relying on visual analog scales or on sensory thresholds.

It is important to notice that pain, described as burning in the feet that may interfere with walking function, even with a normal peripheral nerve examination, might be attributable to neuropathy with small fiber involvement. In the present study, we found 3 children with those features. Neuropathies with predominantly small fiber involvement are notoriously difficult to diagnose because the conventional neurological examination and the nerve conduction tests are usually normal. Recently, skin biopsy has been developed as a technique useful for detecting the involvement of small unmyelinated fibers in sensory neuropathies. The intraepidermal nerve fiber density in sections of skin, obtained by punch skin biopsy, could potentially diagnose this condition even in children. The density of the nerve fibers may estimate neuropathy severity and would probably be the measurement of choice in the setting of HIV-associated peripheral neuropathy in children. Ethical issues, a previous obstacle for such an invasive procedure, will certainly weaken, justifying its use in future studies.

The nerve conduction studies, performed in 9 of the 13 patients with clinical features of peripheral neuropathy in the present study, confirmed the peripheral nerve involvement and indicated its axonal predominance. Low amplitudes of sural nerve potentials with relative preserved conduction velocities were the most common abnormality in a previous larger nerve conduction study. Unfortunately, a comparison of the absolute results was not possible because of the lack of those values in this previous study. We also found the sural nerve to be one of the most commonly involved nerve.

According to the current case definition for clinical diagnosis of HIV-associated peripheral nervous system disorders, the 13 children described in the present study fulfill 3 of 5 criteria of probable HIV-associated predominantly sensory polyneuropathy. In 8 of the children, the clinical features, primarily the symptoms, had begun before the exposure to neurotoxic drugs, which meets another requirement. Although sensory clinical signs could be thought to be unreliable, they stand as 2 of the 5 criteria used for the definition of HIV-1–associated predominantly sensory polyneuropathy. Indeed, it has been shown that even a screening examination performed by trained nonphysicians is sensitive, compared with a detailed examination by a neurologist.

Many risk factors have been listed for the peripheral neuropathy found in adults with AIDS. A small trend of a higher prevalence for peripheral neuropathy occurring in children with encephalopathy or symptomatic AIDS (CDC classifications B and C) is shown in this study. However, none of the factors presently studied had a significant correlation with the presence of symptoms and signs of peripheral neuropathy in these children, which might have been attributable to a type 2 error. Therefore, larger series as well as prospective studies would be more appropriate to define the true risk factors for the development of this disorder and should be conducted in this age group as well.

CONCLUSION

This study shows that peripheral neuropathy does occur in children with AIDS, indicating a prevalence rate of 34% of a possible predominantly sensory polyneuropathy. Our data, however, point to a less severe clinical picture than the one found in adults. More attention to symptoms and signs in the follow-up of pediatric patients with HIV is needed, particularly now, with a longer life expectancy. Management measures to avoid more harm to the peripheral nervous system, to relieve those children from uncomfortable symptoms, and to try to protect them from developing walking disabilities need to be adopted.

http://www.pediatricsdigest.mobi/content/106/3/e35.full

Neuropathy- Patient Experiences

Every now and then on the Blog it's important to remind ourselves and others how neuropathy affects people in the real world. Several questions have been posted to the blog, as to how neuropathy patients can convince the world around them that they are really in trouble: after all, it's one of those diseases which you can't see just by looking at someone. Seeing someone not respond to the one treatment or the other can also sow the seeds of doubt in people's minds but that's the reality of neuropathy and for many people an extra stress they could do without.

It's all well and good explaining the science and theory behind the disease and the drugs used to treat it but knowing that you're not alone with the way you're feeling, can help enormously. Presenting 'evidence' to family members, workmates and friends is also sometimes necessary - you can see in their eyes that they're wondering exactly how psychosomatic your disease really is and that can be depressing to say the least! Letting them see how others suffer from exactly the same symptoms can be both validating and educative - try showing them some of these short accounts from MedicineNet.com (see link below) and elsewhere on the blog - they'll maybe see you in a different light.

Patient Discussions: Peripheral Neuropathy - Symptoms

Published: June 20
...I have been diagnosed with Peripheral neuropathy and have a Nerve Conduction Velocity Test. It is only in my toes and test showed that it was not a severe case. As I am only 63 sometimes think about the next 20 - 30 years and its' progression although neurologist as said it will be fine! Would taking B12 and Folate be useful as I think what I have is 'idiopathic peripheral neuropathy.

Published: July 15
...I am disabled with peripheral neuropathy; I am on the highest doses of a series of medicine. We started at the lowest dose and each would work for a time and the pain would come back worse. Not just in my feet and legs although this is where it started. Mine is idiopathic neuropathy. For the last 2 months my feet swelled, mostly on the left side. Now they aren't swelling as much but the pain is unbearable and it is difficult to walk. The ankle on the left still swells, a lot of the time it feels like I have wide straps wrapped around the middle of the foot and pain shoots up and down the inside of toes and legs. I am under the care of a neurosurgeon and my family doctor. I just thought you might have some advice, since we seemed to be at the end of the rope.

Published: July 07
...I have peripheral neuropathy as the result of a nerve being compressed during a spinal fusion surgery. It has been a year now, and I still have the pins and needles, bee sting, electric shock and shooting pain sensations in my leg and foot as well as the loss of sensation and hyper sensation of the skin. I currently take 100 mgs of Lyrica three times a day. I will be undergoing a trial using a spinal stimulator that will hopefully lower the level of pain that I have. Then, if it helps, it will be permanently implanted in my spine.

Published: July 16
...I have peripheral neuropathy and have been taking Lyrica (75 mg, three times a day) for three years. I am always tired and depressed because it is not going away. It is most prevalent in the months when I have to wear closed shoes. My family does not understand the pain and anxiety I go through every day. They cannot see it, so they don't believe it. I am currently going to a chiropractor and am hoping that he will align my spine and neck to bring me back to what I was before. He uses manual adjustments with the neck and spine.

Published: July 15
...It began to have problems about 5 years ago, my hands and feet tingling and muscle spasms, they came and went but never stayed long, then a year ago I had problems with my right leg going numb from the thigh down and not being able to stand or walk on it. That lessened and moved to my hands, then to my feet working its way up my legs all the way to my lower back, not in the joints mid muscle with loss of feeling and sensations. Then it went to my hands with weakness and cramping. At times the pain is overwhelming and I get no relief from any of the medications prescribed so far. I want it to end one way or the other.

Published: July 14
...I have pain mostly on my left side of body. It's sharp pain although it has an accompanied sensation which is very disturbing and hard to tolerate. This sensation is like the feeling you get when you scratch your finger nails on a black board. I also get pins and needles along my arms and burning sensation mostly on my palms but at times it is all over including my tongue. When I am depressed, stressed or worried the symptoms seems to increase. This is a problem because I am fatigued from the feeling. I am booked in to see a pain specialist and neurologist in the future but I need something now. Has anybody had same experience symptoms and what helped?

Published: July 14
began to have problems about 5 years ago, my hands and feet tingling and muscle spasms, they came and went but never stayed long, then a year ago I had problems with my right leg going numb from the thigh down and not being able to stand or walk on it. That lessened and moved to my hands, then to my feet working its way up my legs all the way to my lower back, not in the joints mid muscle with loss of feeling and sensations. Then to my hands again with weakness and cramping. At times the pain is overwhelming and I get no relief from any of the medications prescribed so far. I want it to end one way or the other.

Published: July 09
Four years ago I started getting burning feet and lower legs which occurs daily with varying degrees of intensity and is worse at night, often waking me up. I have had extensive tests and no cause could be established. I take Vitamin B complex but this does not seem to help. I am reluctant to take painkillers as I was told they need to be taken continuously. At the time it started I was taking Ciprofloxacin for Prostatitis. Does anyone have similar burning pains and have the found any way to emliminate the symptoms?

http://www.medicinenet.com/peripheral_neuropathy/discussion-188.htm

Rest and the Immune System

Following on from yesterday's post, this short video from Weimar TV talks about how vital it is to get enough rest. HIV patients will relate to any ideas on how to strengthen the immune system but HIV patients who also suffer from neuropathy, which frequently is at its worst at night, will feel somewhat between a rock and a hard place. In this case, we know what we should do but when you can't control your nervous system at night, it's difficult to achieve optimal sleep patterns.

Rest and the Immune System from WeimarTV on Vimeo.

Sleep and Neuropathy

How important is a good night's sleep for neuropathy sufferers? The answer seems obvious doesn't it but are there ways in which we can improve the quality of our sleep and as a result, improve the quality of our waking hours? This extract from an article from The Foundation for Peripheral Neuropathy (see link below) gives lots of very sensible advice, some of which may be useful to you.

Peripheral Neuropathy and Sleep

Sleep is an essential part of living — sleep helps us avoid major health problems and it is essential to our mental and physical performance. It affects our mood and stress and anxiety levels. Unfortunately, sleep disturbance or insomnia is often a side effect of the pain. It is a common complaint among people with living with chronic pain.

It’s no surprise that about 70 percent of pain patients, including those suffering from PN, back pain, headaches, arthritis and fibromyalgia, report they have trouble sleeping according to the Journal of Pain Medicine.

Pain can interfere with sleep due to a combination of issues. The list includes discomfort, reduced activity levels, anxiety, worry, depression and use of medications such as codeine that relieve pain but disturb sleep.

Most experts recommend a range of seven to nine hours of sleep per night for adults, regardless of age or gender. This may seem impossible to people with chronic pain, but there are steps you can take to improve your sleep, which may lead to less pain and lower levels of depression and anxiety. First, talk with your doctor to see if there are medications that may lessen your sleep disturbance. You should also check with your doctor to make sure your current medications aren't causing some of your sleep disturbance.

Beyond medication, there are several things you can do yourself to improve your sleep. Here are some methods to try and help you fall asleep more quickly, help you sleep more deeply, help you stay asleep, and ultimately help keep you healthy.

The following are tips for improving your sleep:

* Reduce your caffeine intake, especially in the afternoons

* Quit smoking

* Limit and/or omit alcohol consumption

* Limit naps to less than one hour, preferably less

* Don’t stay in bed too long—spending time in bed without sleeping leads to more shallow sleep

* Adhere to a regular daily schedule including going to bed and getting up at the same time

* Maintain a regular exercise program. Be sure to complete exercise several hours before bedtime

* Make sure your bed is comfortable. You should have enough room to stretch and turn comfortably. Experiment with different levels of mattress firmness, foam or egg crate toppers, and pillows that provide more support

* Keep your room cool. The temperature of your bedroom also affects sleep. Most people sleep best in a slightly cool room (around 65° F or 18° C) with adequate ventilation. A bedroom that is too hot or too cold can interfere with quality sleep.

* Turn off your TV and Computer, many people use the television to fall asleep or relax at the end of the day. Not only does the light suppress melatonin production, but television can actually stimulate the mind, rather than relaxing it.

* Don't watch the clock – turn your alarm clock around so that it is not facing you

* Keep a notepad and pencil by your bed to write down any thoughts that may wake you up at night so you can put them to rest

* Refrain from taking a hot bath or shower right before bed; the body needs to cool a degree before getting into deep sleep

* Try listening to relaxing soft music or audio books instead, or practicing relaxation exercises.

* Visualize a peaceful, restful place. Close your eyes and imagine a place or activity that is calming and peaceful for you. Concentrate on how relaxed this place or activity makes you feel.

It may take three to four weeks of trying these techniques before you begin to see an improvement in your sleep. During the first two weeks, your sleep may actually worsen before it improves, but improved sleep may lead to less pain intensity and improved mood.

http://www.foundationforpn.org/livingwithperipheralneuropathy/managingpainfulperipheralneuropathy.cfm

How the Brain Controls your Nerve Reactions

As neuropathy patients, we all know that whatever we suffer from, has a lot to do with the brain as the driving force behind the nervous system. However, very few of us understand what goes on there and how it really works.
Our old friend Dr. Erickson, from the Health and Wellness Centre in Denver, gives us his usual high speed explanation of how something operates: in this case the brain and how what happens there affects our nervous system. He may talk quite quickly and you may need to watch it a couple of times to let it all sink in but nobody explains things quite as clearly as he does. He really knows how to talk to the layman patient and you get the feeling that he really wants to make it as simple as possible for us to understand.

More accurate testing for nerve damage

At last they seem to be finding new ways of accurately assessing nerve damage. The EMG's etc are fine for giving a general idea but can't see the damage to the myelin sheath (a biopsy always needed - not good for a living patient) and can therefore be misleading. Luckily, most doctors give the EMG result equal status with the patient's symptoms and story but some patients are still sent away after being told there's apparently nothing wrong, when the numbness, tingling and pain tell them that there quite clearly is. The research in today's post, as highlighted by Sciencedaily.com (see link below) seems a much more promising development in the search for a detailed medical assessment, although it's important to realise that at this stage, it's just research and probably a long way off normal practice.

New Imaging Technique Evaluates Nerve Damage







ScienceDaily (Sep. 14, 2011) — A new imaging technique could help doctors and researchers more accurately assess the extent of nerve damage and healing in a live patient.

Researchers at Laval University in Québec and Harvard Medical School in Boston aimed lasers at rats' damaged sciatic nerves to create images of the individual neurons' insulating sheath called myelin. Physical trauma, repetitive stress, bacterial infections, genetic mutations, and neurodegenerative disorders such as multiple sclerosis can all cause neurons to lose myelin. The loss slows or halts the nerve's transmission of electrical impulses and can result in symptoms such as numbness, pain, or poor muscle control.

Using their images of neurons, the researchers measured the thickness of the myelin at different locations and times after the rats' sciatic nerve was damaged. Two weeks after injury the nerve's myelin covering had thinned considerably, but at four weeks the nerve had begun to heal.

Traditionally, researchers could only obtain such myelin measurements by removing the nerve and slicing it into thin layers, a technique whose destructive nature prevented it from being used to evaluate nerve injuries in living patients. The new imaging method, described in the September issue of the Optical Society's (OSA) open-access journal Biomedical Optics Express, holds promise as a diagnostic tool for doctors treating nerve damage or degenerative diseases, the researchers write.

Story Source: The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Optical Society of America, via EurekAlert!, a service of AAAS.

http://www.sciencedaily.com/releases/2011/09/110913103211.htm

Erythromelalgia and Small Fibre Neuropathy

Today's post concerns another tongue twister of a name for an neurological condition associated with neuropathy. According to the dictionary, Erythromelalgia... is an affection of the feet and occasionally of the hands, characterized by burning pain and tenderness in the soles (or palms) attended with a purplish coloration. After reading this, don't be too worried, it is a relatively seldom seen version of small fibre neuropathy, although if you suffer from it that will be of little consolation. What is surprising is the fact that the symptoms many of us have, (burning feet, redness, sensitivity and sometimes swelling) are very close to the more extreme symptoms of Erythromelalgia. Logic suggests that there may be a link but I'll leave that for you to decide after reading the article which comes from dermnetnz.org (see link below). Certainly the treatment of Erythromelalgia is much the same as for peripheral neuropathy.

What is erythromelalgia?

Erythromelalgia is a condition characterised by intense burning pain, erythema (marked redness), and increased skin temperature, primarily of the feet and hands. The condition is classified into primary and secondary erythromelalgia. It has also been classified into early-onset and late-onset forms. Symptoms of the disease vary markedly between individuals; in some patients there is a continual burning pain while others experience “flare-ups” or bouts of the condition lasting from minutes to days.

Erythromelalgia is also known as ‘erythermalgia’. It may be considered a type of neuropathic pain syndrome (pain related to conditions affecting the nerves themselves), where there is dilation of the small blood vessels that become congested with blood.

What causes erythromelalgia and who gets it?

The actual cause of erythromelalgia is unknown in most cases. Primary erythromelalgia develops spontaneously without any associated underlying disease associated, and is sometimes called ‘idiopathic erythromelalgia’. Secondary erythromelalgia develops secondarily to medical conditions such as neurological diseases (e.g. multiple sclerosis, peripheral neuropathy), autoimmune diseases (e.g. lupus, diabetes mellitus), or more commonly the myeloproliferative disorders. In these disorders the bone marrow produces excessive numbers of cells, e.g. polycythaemia vera (increased red cells), and essential thrombocythaemia (increased platelets). Erythromelalgia presents before the appearance of the myeloproliferative disorder in 85% of cases.

People with early-onset erythromelalgia develop it before they are 25. Although the disease is of unknown origin in most cases, sometimes it can be traced back through generations of a family (Weir-Mitchell disease). This has recently been shown to be due to mutations in a gene called Na(v)1.7., which encodes a sodium channel within certain cells.
Late-onset erythromelalgia occurs most often around 40-60 years of age and is primary in about 60% of cases.
What are the signs and symptoms?

Lower extremities such as the soles of feet and toes are most commonly involved. Rarely does the pain extend up to include the knees. Upper extremity involvement includes the fingers and hands. Often both feet and hands are involved and both sides of the body (bilateral) are affected. It may affect one side of the body (unilateral), particularly in secondary cases. Less frequently, symptoms may also appear in the face, ears and other parts of the body.

The classic description of erythromelalgia is red, painful, warm hands or feet, brought on by warming or hanging the limb downward, and relieved with cooling and elevation.

■ Some patients notice a continual burning while others are troubled with “flare-ups”
■ Flare-ups may last minutes to days and typically occur late in the day and continue through the night
■ Usually attacks begin with an itching sensation, progressing to a more severe pain with a burning sensation
■ During an attack the affected extremity becomes warm, tender, swollen, and appears dusky red and sometimes mottled
■ Pain may be so intense that the patient cannot walk
■ Cooling (with fan or immersion in cold water) and elevating the extremity can relieve symptoms

Symptoms often become so bad that normal functioning and quality of life are greatly affected. Patients avoid warm weather and may even relocate to cooler climates. Many cannot wear socks or closed shoes even in winter. Some patients become virtually housebound by continuous flare-ups and pain.

How is the diagnosis made?

Investigation for underlying causes is essential in all new cases of the disease. Erythromelalgia may be an early sign of polycythaemia or thrombocythaemia, where symptoms may precede diagnosis of the myeloproliferative disorder by 2.5 years. Dramatic relief with aspirin is typical of this type and can be used as an aid to diagnosis.

Diagnosis is based fairly much on the clinical picture, hence is often difficult because of the intermittent nature of the disease. Provided the patient gives a good description of their symptoms, a tentative diagnosis may be made. If in doubt, immersing an affected area in hot water for 10-30 minutes may sometimes provoke an attack.

When no known underlying cause has been found, the erythromelalgia is considered primary.

What treatment is available?

The underlying cause must be treated where possible in secondary erythromelalgia. The treatment of symptoms of both primary and secondary erythromelalgia is through general non-medical measures, drug therapy and surgical intervention.
■ General non-medical measures such as cooling or elevating the extremity may relieve symptoms. Care is needed around cold water immersions, although it will provide temporary relief, it can cause many other serious problems. Frequent immersion into cold water can create a vicious cycle as the changes in temperature may cause reactive flaring. This can also lead to maceration of the skin, non-healing ulcers, infection, gangrene and amputation.
■ Topical treatment with capsaicin cream has been reported with varying results.
■ A variety of oral medications have been used to relieve symptoms, including: ■ Aspirin – promptly relieves symptoms of erythromelalgia involving myeloproliferative disorders
■ Serotonin re-uptake inhibitors – venlafaxine, sertraline, fluoxetine, paroxetine
■ Tricyclic antidepressants – amitriptyline, imipramine
■ Anticonvulsants – gabapentin
■ Calcium antagonists – nifedipine, diltiazem
■ Prostaglandins – misoprostol

■ Intravenous infusions of nitroprusside, lignocaine (lidocaine) and prostaglandin
■ Surgical sympathectomy (a procedure in which the sympathetic nerve fibres are selectively cut)

Patients respond quite variably to drug therapy and no single therapy has proved consistently effective. Spontaneous remissions have also been known to occur.

http://dermnetnz.org/vascular/erythromelalgia.html

What we know about Pain

We think that pain comes from signals being sent back and forth from the area of damage, via neurotransmitters, to the brain (giving some clever dick doctors the right to belittle our experience by telling us it's literally 'between our ears'!). However, what do we really know about pain and how it works? This extract, from an article from the National Institute of Neurological Disorders and Stroke website (see link below) explains clearly what happens when we feel neurological pain. Always handy to know why you're hurting, even if you don't always remember the details.

Seriously though, the most interesting aspect of this article for us, may be the extensive research that is being done into creating synthetic versions of the body's natural defences against pain (I'm backing the Ecuadorian frog!)

A Pain Primer: What Do We Know About Pain?

We may experience pain as a prick, tingle, sting, burn, or ache. Receptors on the skin trigger a series of events, beginning with an electrical impulse that travels from the skin to the spinal cord. The spinal cord acts as a sort of relay center where the pain signal can be blocked, enhanced, or otherwise modified before it is relayed to the brain. One area of the spinal cord in particular, called the dorsal horn, is important in the reception of pain signals.

The most common destination in the brain for pain signals is the thalamus and from there to the cortex, the headquarters for complex thoughts. The thalamus also serves as the brain's storage area for images of the body and plays a key role in relaying messages between the brain and various parts of the body. In people who undergo an amputation, the representation of the amputated limb is stored in the thalamus.

Pain is a complicated process that involves an intricate interplay between a number of important chemicals found naturally in the brain and spinal cord. In general, these chemicals, called neurotransmitters, transmit nerve impulses from one cell to another.

There are many different neurotransmitters in the human body; some play a role in human disease and, in the case of pain, act in various combinations to produce painful sensations in the body. Some chemicals govern mild pain sensations; others control intense or severe pain.

The body's chemicals act in the transmission of pain messages by stimulating neurotransmitter receptors found on the surface of cells; each receptor has a corresponding neurotransmitter. Receptors function much like gates or ports and enable pain messages to pass through and on to neighboring cells. One brain chemical of special interest to neuroscientists is glutamate. During experiments, mice with blocked glutamate receptors show a reduction in their responses to pain. Other important receptors in pain transmission are opiate-like receptors. Morphine and other opioid drugs work by locking on to these opioid receptors, switching on pain-inhibiting pathways or circuits, and thereby blocking pain.

Another type of receptor that responds to painful stimuli is called a nociceptor. Nociceptors are thin nerve fibers in the skin, muscle, and other body tissues, that, when stimulated, carry pain signals to the spinal cord and brain. Normally, nociceptors only respond to strong stimuli such as a pinch. However, when tissues become injured or inflamed, as with a sunburn or infection, they release chemicals that make nociceptors much more sensitive and cause them to transmit pain signals in response to even gentle stimuli such as breeze or a caress. This condition is called allodynia -a state in which pain is produced by innocuous stimuli.

The body's natural painkillers may yet prove to be the most promising pain relievers, pointing to one of the most important new avenues in drug development. The brain may signal the release of painkillers found in the spinal cord, including serotonin, norepinephrine, and opioid-like chemicals. Many pharmaceutical companies are working to synthesize these substances in laboratories as future medications.

Endorphins and enkephalins are other natural painkillers. Endorphins may be responsible for the "feel good" effects experienced by many people after rigorous exercise; they are also implicated in the pleasurable effects of smoking.

Similarly, peptides, compounds that make up proteins in the body, play a role in pain responses. Mice bred experimentally to lack a gene for two peptides called tachykinins-neurokinin A and substance P-have a reduced response to severe pain. When exposed to mild pain, these mice react in the same way as mice that carry the missing gene. But when exposed to more severe pain, the mice exhibit a reduced pain response. This suggests that the two peptides are involved in the production of pain sensations, especially moderate-to-severe pain. Continued research on tachykinins, conducted with support from the NINDS, may pave the way for drugs tailored to treat different severities of pain.

Scientists are working to develop potent pain-killing drugs that act on receptors for the chemical acetylcholine. For example, a type of frog native to Ecuador has been found to have a chemical in its skin called epibatidine, derived from the frog's scientific name, Epipedobates tricolor. Although highly toxic, epibatidine is a potent analgesic and, surprisingly, resembles the chemical nicotine found in cigarettes. Also under development are other less toxic compounds that act on acetylcholine receptors and may prove to be more potent than morphine but without its addictive properties.

The idea of using receptors as gateways for pain drugs is a novel idea, supported by experiments involving substance P. Investigators have been able to isolate a tiny population of neurons, located in the spinal cord, that together form a major portion of the pathway responsible for carrying persistent pain signals to the brain. When animals were given injections of a lethal cocktail containing substance P linked to the chemical saporin, this group of cells, whose sole function is to communicate pain, were killed. Receptors for substance P served as a portal or point of entry for the compound. Within days of the injections, the targeted neurons, located in the outer layer of the spinal cord along its entire length, absorbed the compound and were neutralized. The animals' behavior was completely normal; they no longer exhibited signs of pain following injury or had an exaggerated pain response. Importantly, the animals still responded to acute, that is, normal, pain. This is a critical finding as it is important to retain the body's ability to detect potentially injurious stimuli. The protective, early warning signal that pain provides is essential for normal functioning. If this work can be translated clinically, humans might be able to benefit from similar compounds introduced, for example, through lumbar (spinal) puncture.

Another promising area of research using the body's natural pain-killing abilities is the transplantation of chromaffin cells into the spinal cords of animals bred experimentally to develop arthritis. Chromaffin cells produce several of the body's pain-killing substances and are part of the adrenal medulla, which sits on top of the kidney. Within a week or so, rats receiving these transplants cease to exhibit telltale signs of pain. Scientists, working with support from the NINDS, believe the transplants help the animals recover from pain-related cellular damage. Extensive animal studies will be required to learn if this technique might be of value to humans with severe pain.

One way to control pain outside of the brain, that is, peripherally, is by inhibiting hormones called prostaglandins. Prostaglandins stimulate nerves at the site of injury and cause inflammation and fever. Certain drugs, including NSAIDs, act against such hormones by blocking the enzyme that is required for their synthesis.

Blood vessel walls stretch or dilate during a migraine attack and it is thought that serotonin plays a complicated role in this process. For example, before a migraine headache, serotonin levels fall. Drugs for migraine include the triptans: sumatriptan (Imitrix®), naratriptan (Amerge®), and zolmitriptan (Zomig®). They are called serotonin agonists because they mimic the action of endogenous (natural) serotonin and bind to specific subtypes of serotonin receptors.

Ongoing pain research, much of it supported by the NINDS, continues to reveal at an unprecedented pace fascinating insights into how genetics, the immune system, and the skin contribute to pain responses.

The explosion of knowledge about human genetics is helping scientists who work in the field of drug development. We know, for example, that the pain-killing properties of codeine rely heavily on a liver enzyme, CYP2D6, which helps convert codeine into morphine. A small number of people genetically lack the enzyme CYP2D6; when given codeine, these individuals do not get pain relief. CYP2D6 also helps break down certain other drugs. People who genetically lack CYP2D6 may not be able to cleanse their systems of these drugs and may be vulnerable to drug toxicity. CYP2D6 is currently under investigation for its role in pain.

In his research, the late John C. Liebeskind, a renowned pain expert and a professor of psychology at UCLA, found that pain can kill by delaying healing and causing cancer to spread. In his pioneering research on the immune system and pain, Dr. Liebeskind studied the effects of stress-such as surgery-on the immune system and in particular on cells called natural killer or NK cells. These cells are thought to help protect the body against tumors. In one study conducted with rats, Dr. Liebeskind found that, following experimental surgery, NK cell activity was suppressed, causing the cancer to spread more rapidly. When the animals were treated with morphine, however, they were able to avoid this reaction to stress.

The link between the nervous and immune systems is an important one. Cytokines, a type of protein found in the nervous system, are also part of the body's immune system, the body's shield for fighting off disease. Cytokines can trigger pain by promoting inflammation, even in the absence of injury or damage. Certain types of cytokines have been linked to nervous system injury. After trauma, cytokine levels rise in the brain and spinal cord and at the site in the peripheral nervous system where the injury occurred. Improvements in our understanding of the precise role of cytokines in producing pain, especially pain resulting from injury, may lead to new classes of drugs that can block the action of these substances.

http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm

Alpha Lipoic Acid and Neuropathy

A rather long post today but lots of reliable information is better than none at all, or a brief summary. Alpha Lipoic Acid has been talked about before on the blog but this very well sourced, article from health.howstuffworks.com (see link below) takes a comprehensive and objective look at one of the most commonly recommended supplements to help with neuropathic problems and points out very clearly that nobody knows what the long-term effects of long-term use of ALA actually are. I have taken it myself, along with Acetyl L-Carnitine, over 2 or 3 years but because it is very expensive, I have never taken the high daily doses that are recommended. To be honest, I can't say that I've noticed any significant improvement but (you may recognise this syndrome!) am afraid to stop, in case the condition gets worse. The thinking is, that if I hadn't taken it, the neuropathy might be much worse than it already is...hmmm...desperate much? However, after reading all this information, I may have to reconsider taking Alpha Lipoic Acid, or at least stopping for a while to see if there's any difference. This is not to say that ALA is a bad thing - for many people it has been proved to be beneficial but as always, if you're armed with the facts, you can make much better decisions.

Alpha Lipoic Acid: What You Need to Know
By Richard Winter

Free radicals. It sounds like something they give away at protest rallies. But in your body, they are cells with unpaired electrons that attack other molecules to achieve stability, damaging the DNA of those molecules and spreading disease.

Enter the antioxidant -- compounds the body uses as its defense system to fight free radicals and keep them from setting off chain reactions of cell mutation that can lead to a host of chronic diseases like cancer, heart disease, Alzheimer's and Parkinson's [source: Davis].

One antioxidant getting a lot of attention on the free radical fighting scene is Alpha Lipoic Acid (ALA). Also known as thioctic acid, ALA is naturally produced in the body, as well as absorbed from certain foods we eat, such as red meat, spinach, potatoes, broccoli, yams, carrots, beets and yeast [source: American Cancer Society].

For 20 years, ALA supplements have been used to treat HIV, sciatica, cancer, liver problems, hepatitis, strokes, vascular disease, diabetes, cataracts, glaucoma, multiple sclerosis, burning mouth syndrome and Alzheimer's. Some doctors believe ALA can even help slow the aging process [source: National Toxicology Program].

But because they are not drugs, ALA supplements are not subject to regulation by the Food and Drug Administration. Respected medical journals haven't jumped on the antioxidant bandwagon and more studies are needed to test its effectiveness in humans.
­In the following sections, you'll learn about some of the research surrounding ALA and how this antioxidant works in the body, along with its benefits, side effects, and impact on weight loss and peripheral neuropathy --and numbness in the hands and feet.

First, let's investigate how Alpha Lipoic Acid works in your body.

­AL­A is a fatty acid both produced by the body and absorbed from the foods you eat. When it binds to certain proteins, ALA plays an important role in our metabolism -- namely the Krebs cycle, the body's main process for converting carbohydrates into energy. And unlike other antioxidants, ALA is both water and fat soluble, enabling it to work throughout the body. That's why it's found in varying concentrations in all your muscles and internal organs [source: Larsen].

Your body typically produces enough ALA for its role in creating energy. But when there's an excess in your system, ALA does not bind to protein and acts as an antioxidant. When in this "free" state, ALA deactivates a wide variety of free radicals, such as heavy metals, circulating through your body. It may also help regenerate other antioxidants like Vitamin C and Vitamin E to fight more free radicals [source: Berkeley Wellness Letter].

Because we produce less ALA as we age, some researchers believe that taking a supplement may help slow the aging process. ALA, combined with acetyl-L-carnitine, has been touted as an anti-aging and vitality supplement [source: National Toxicology Program]. To learn more about the benefits of Alpha Lipoic Acid, read on.

Alpha Lipoic Acid Benefits
­
Many of the health benefits attributed to ALA supplements are based on lab testing on animals, primarily rats. Whether humans would experience similar results from ALA's antioxidant powers has not been studied enough to produce definite answers.

Early animal studies suggest that ALA may help in treating Alzheimer's and other diseases that affect the nervous system [source: Larsen]. Additional studies have shown that a combination of antioxidants (including ALA) has helped cancer patients regain their appetite and weight. While early lab experiments suggest that ALA might cause cancer cells to self-destruct, it is unknown if the same effect can be replicated in animals or humans. Researchers are studying ALA as a possible therapy for reducing the side effects of radiation and chemotherapy. Research is also underway to determine if ALA can help prevent nerve damage that may result from some chemotherapy drugs [source: American Cancer Society].

Another potential benefit of ALA is the treatment of diabetes. Although some studies have found that ALA has a positive effect on insulin sensitivity, glucose metabolism and diabetic neuropathy, more research is needed to determine whether ALA supplements provide substantial benefits for type 2 diabetes and its complications [source: National Center for Complimentary and Alternative Medicine].

ALA supplements may also decrease the build up of plaque within the arteries. One study found that ALA reduced heart damage caused by chemotherapy drugs. Another found it beneficial in treating cardiovascular autonomic neuropathy -- a condition characterized by an irregular heartbeat that's common in diabetics [source: Higdon, American Cancer Society].

There are also reports that ALA may have health benefits in relation to cataracts, seizures, kidney damage and liver disease, but additional studies are necessary before any definite conclusion is drawn. In addition, ALA, like just about any other medication or supplement, is not without its side effects. Read on to find out more about ALA's side effects.

Alpha Lipoic Acid Side Effects

­Research has shown that patients can take 300 to 600 milligrams of ALA a day with relatively few side effects, such as skin rashes, stomach aches, nausea, diarrhea and vomiting. However, the jury is still out on the long-term effects of taking ALA supplements. Anyone with pre-existing medical conditions should exercise caution. Children are not advised to take ALA. Pregnant and nursing women should consult their doctors before taking it.

Diabetics who take ALA must monitor their blood sugar levels carefully, because the supplements may lower blood glucose levels [source: National Center for Complimentary and Alternative Medicine].

ALA may also lower levels of thyroid hormone and thyroid-regulating medications (Levothyroxine). Hormone levels should be monitored closely for those taking thyroid hormones and ALA supplements [source: University of Maryland Medical Center]. There is also concern that ALA might interfere with radiation therapy or chemotherapy by making the treatments less effective [source: American Cancer Society].

Unlike prescription drugs, supplements like ALA capsules don't have to be approved by the FDA before they are released on the market. Nor are they tested for their adverse affects when taken with other medication. In 2005, supplements accounted for almost 24,000 calls to U.S. poison control centers [source: American Cancer Society]. That's why it's always best to check with your doctor before taking any herbal remedy.

Read on to learn how ALA may help you lose weight

­If you have a rat with a weight problem, ALA supplements might help get rid of some of that cheese you feed him. But if you're a human looking to slim down for bikini season, you should probably stick with your diet and exercise plan. At this point, ALA hasn't proven its effects on the human body.

Recent studies have shown ALAs can regulate metabolism and inhibit the metabolism of fat in the liver. Unfortunately, those findings are based on lab experiments involving cultured rat liver cells and skeletal muscles -- not bathing beauties [source: Treadwell]. So, there's no indication the same results would occur in humans.

One study conducted at the University of Ulsan College of Medicine in Seoul, Korea, found that ALA decreases the activity of fuel sensors in rats, causing the rodents to eat less and expend more energy, resulting in "profound" weight loss [source: National Center for Biotechnology Information]. But until the same effect is observed in humans, there's probably no point in popping an ALA supplement to achieve weight loss.

The bottom line is further research is necessary concerning ALA's effects on humans in regard to its use for weight loss. In general, it's always best to use extreme caution when taking supplements. And if you do decide to incorporate ALA or any other supplement into your diet, be sure to share that information with your physician.

Next up, learn about ALA's effect on numbness and tingling, or peripheral neuropathy

­Peripheral neuropathy is a condition characterized by pain and numbness in the hands and feet that occurs in patients with diabetes, nerve pressure (from abnormal bone growth or a tumor), vitamin deficiency, kidney or liver disease and alcoholism. Cancer treatment chemicals can also cause it and HIV patients are prone to it [source: Mayo Clinic].

More than 20 percent of diabetic patients develop peripheral neuropathy -- the leading cause of lower limb amputation. Oral and intravenous ALA is approved for use in Germany for treatment of diabetic neuropathy and in the U.S., research has shown that ALA may be helpful in treating nerve damage in diabetics and in cancer patients [source: American Cancer Society].

In a clinical trial, diabetic patients suffering from peripheral neuropathy who were given 200 mg of ALA intravenously for 21 days reported a reduction in pain. A larger study of diabetics with peripheral neuropathy who were injected with 600 mg of ALA a day for three weeks, followed by 12 weeks of oral supplements, also experienced relief [source: Larsen].

A small study in Austria found that more than half of the cancer patients who took ALA after getting the chemotherapy drug oxaliplatin reported an improvement in neuropathy symptoms [source: American Cancer Society]. The National Cancer Institute is currently conducting a phase-3 study on ALA's use in preventing peripheral neuropathy in cancer patients undergoing chemotherapy treatment [source: Higdon, American Cancer Society].

http://health.howstuffworks.com/wellness/natural-medicine/alternative/alpha-lipoic-acid.htm