HOMOEOPATHIC REMEDIES FOR DIABETES INCLUDING DIABETIC FOOT AND DIABETIC NEPHROPATHY

Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel.

If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered.

Causes --To understand diabetes, first you must understand how glucose is normally processed in the body.

How insulin works

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

·        The pancreas secretes insulin into the bloodstream.

·        The insulin circulates, enabling sugar to enter your cells.

·        Insulin lowers the amount of sugar in your bloodstream.

·        As your blood sugar level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

·        Glucose comes from two major sources: food and your liver.

·        Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.

·        Your liver stores and makes glucose.

·        When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

Causes of type 1 diabetes

·        The exact cause of type 1 diabetes is unknown. What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.

·        Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear.

Causes of prediabetes and type 2 diabetes

·        In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream.

·        Exactly why this happens is uncertain, although it's believed that genetic and environmental factors play a role in the development of type 2 diabetes. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

Causes of gestational diabetes

·        During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin.

·        Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

Symptoms--Some of the signs and symptoms of type 1 and type 2 diabetes are:

·        Increased thirst

·        Frequent urination

·        Extreme hunger

·        Unexplained weight loss

·        Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin)

·        Fatigue

·        Irritability

·        Blurred vision

·        Slow-healing sores

·        Frequent infections, such as gums or skin infections and vaginal infections

Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40.

HOMOEOPATHIC REMEDIES

Homoeopathic remedies are very safe for treating diabetes and its complications without any side effects . Some of the important remedies are given below-Along with the following remedies consider the constitutional drug for a permanent cure.

ABROMA AUGUSTA Q - Abroma Augusta is the top Homeopathic medicine to treat Diabetes Mellitus. Its use is highly recommended in those patients who are losing flesh and suffer from extreme weakness due to Diabetes Mellitus. The patients who can greatly benefit from this Homeopathic medicine have an increased thirst with dryness of mouth. They also have an increased appetite and the urination is very frequent day and night. Excessive weakness is felt after urination. Homeopathic medicine Abroma Augusta is also of great help in treating sleeplessness in a person with Diabetes. Another sphere in which this Homeopathic remedy yields good results is skin complaints like boils and carbuncles in a diabetic patient. Burning sensation in the whole body is a prominent general symptom that can be found in persons requiring Abroma Augusta

CEPHALANDRA INDICA Q- A specific remedy for diabetes. Dryness of mouth. Great thirst for large quantities of cold water

PHOSPHORUS 200--Phosphorus is a Homeopathic medicine of great help for treating Diabetes Mellitus, though its use depends completely on the constitutional symptoms of the patient. Homeopathic medicine Phosphorus is a remedy of great help for weakness of vision in a diabetic patient

RHUS AROMATICA Q- Rhus aromatic is an effective remedy for diabetes. Passing large quantities of urine of low specific gravity

SYZYGIUM JAMBOLANUM Q-Syzygium Jambolanum is among the best Homeopathic remedies for the treatment of Diabetes Mellitus. It acts promptly and efficiently in decreasing the sugar levels. Excessive thirst and excessive urination are always present in the patient. Homeopathic medicine Syzygium Jambolanum also gives wonderful results in treatment of long-standing ulcers in a diabetic patient

PHASEOLUS 3X—Diabetes with heart disease

PHOSPHORIC ACID Q-Phosphoric Acid is an excellent Homeopathic remedy for extreme weakness, either mental or physical, in a diabetic patient. Such patients feel exhausted all the time. They have a weak memory and are forgetful. Some sort of history of grief may be found in patients requiring this Homeopathic medicine. For numbness of feet in patients of Diabetes Mellitus, Phosphoric Acid is the best Homeopathic remedy

MEMORDICA CHARANTIA Q- An excellent specific remedy for diabetes.

GYMNEMA SYLVESTRE Q--Gymnema Sylvestre is a Homeopathic medicine of great help for patients of Diabetes Mellitus who are losing weight with weakness and exhaustion. In such patients, this Homeopathic remedy works as a tonic resulting in improvement of overall health. With Homeopathic medicine Gymnema Sylvestre,the patient puts on weight and feels energeti

URANIUM NITRICUM 3X- Diabetes with weakness and losing flesh

DIABETIC FOOT

SECALE COR 30- An excellent remedy for diabetic gangrene . Dry gangrene of toe. Dusky blue tinge. Skin feels cold to touch yet covering not tolerated. Warmth aggravatio

ARSENICUM ALBUM 30- Diabetic gangrene. Burning and soreness , relieved by warmth. Fetid smell from the wound. Restlessness

APIS MELLIFICA 30-Spreading cellulitis with burning stinging pain. Sensitive. Blebs are seen

ANTIMONIUM CRUDUM 30- Callosities are seen. Dry gangrene

CARBO VEGETABIS 30- Carbuncles and boils becomes gangrenous. Wet , purple and icy cold gangrene.Moist gangrene. There is great prostration

HEPAR SULPH 30- Blebs are seen. Very sensitive to touch

LACHESIS 200- Bluish purple surroundings around gangrene. Traumatic

RHUS TOX 30- Spreading cellulitis

SULPHURIC ACID-30- Blue and purple surroundings of the gangrene. Bleeding under the skin

THIOSINAMINUM 30-Specific for callosities. Dry gangrene

TARENTULA CUB 30- Painful and inflamed abscess with a tendency to gangrene

ECHINACEA Q- Emitting a foul smell from gangrene . 5 drops in a little of water every 2 hours . Externally wash with a Echinacea lotion. It act as a cleaning and antiseptic agent.

DIABETES NEPHROPATHY

LYCOPODIUM CLAVATUM 30—Lycopodium is an effective remedy for diabetic nephropathy. Urine scanty , cries before urinating, red sand in urine, must strain, suppressed or retained. Urine milky and turbid. Sometimes haematuria . Urine is burning and hot. The right kidney is mainly affected. The patient experiences impotency.The patient likes warm food and drink, also there is intense craving for sweets.

SERUM ANGUILLAE 6X—Serum Anguilae is one of the best remedies for diabetes nephropathy. It is very effective in acute nephritis. Kidney failure. It is prescribed when hypertension and oliguria without oedema is present. Urine contains albumin.

ARALIA HISPIDA 30-Aralia hispida is found to be effective for diabetes nephropathy. There is dropsy of renal origin. Urinary tract infection is present. Urine is scanty leading to complete suppression of urine. Renal diseases with constipation.

AMPELOPSIS QUINQUEFOLIA 30- Ampelopsis quinquefolia is another effective remedy for diabetes nephropathy. There is uraemia or uremic coma. Vomiting, purging, tenesmus , cold sweat and collapse are the leading symptoms. 

CUPRUM ARSENITUM 3x-Cuprum ars is also a very effective remedy for diabetes nephropathy. There is kidney inefficiency and uremia. The urine smell like garlic. Urine of high specific gravity increased, acetones and diacetic acid.

CUPRUM ACETICUM 3X- In Cuprum aceticum the tongue is pale , coated with lot of mucus. Anemia. Pulse rapid. The patient is chilly. Breathlessness with dry cough. Cannot eat or drink without retching.

ARSENICUM ALBUM- 30-Arsenic alb. Is also an effective remedy for diabetes nephropathy. Urine is scanty, burning when urinating. Albuminuria. Epithelial cells, cylindrical clots of fibrin and globules of pus and blood in urine. Feeling weakness in abdomen after urination. Retention of urine. Urine black as if mixed with dung.

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Chest Pain During Pregnancy

Chest Pain Heart

Live a healthier life with TODAY's health tips and find the latest news for personal wellness, fitness,t and relationships..Whether you're looking to lose weight or just want a way to get rid of that nasty cold, eHow has all the answers you're looking for..TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Prepare for Your Procedure. Get the facts on what to expect during your procedure as well as your recovery..Diabetes Scandals For Feet Diabetes Scandals For Feet :: what is the cause of type 1 diabetes - The 3 Step Trick that Reverses Diabetes Permanently in As .Chest pain can be caused by anything from muscle pain to a heart and should never be ignored..Chest pain angina . Taking L-carnitine by mouth seems to improve exercise tolerance in people with chest pain. Taking L-carnitine along with standard treatment also .

Chest Pain Heart

Right Rib X Ray Technique

Chest pain can be caused by anything from muscle pain to a heart and should never be ignored..Prepare for Your Procedure. Get the facts on what to expect during your procedure as well as your recovery..TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Whether you're looking to lose weight or just want a way to get rid of that nasty cold, eHow has all the answers you're looking for..Chest pain angina . Taking L-carnitine by mouth seems to improve exercise tolerance in people with chest pain. Taking L-carnitine along with standard treatment also .Live a healthier life with TODAY's health tips and find the latest news for personal wellness, fitness,t and relationships..Diabetes Scandals For Feet Diabetes Scandals For Feet :: what is the cause of type 1 diabetes - The 3 Step Trick that Reverses Diabetes Permanently in As .

Pregnancy After Tummy Tuck

How To Get Flat Stomach After Pregnancy

How To Get Flat Stomach After Pregnancy

Kelly Rowland And Her Baby

Sleep Deprivation And Neuropathy

Today's post from beating-diabetes.com (see link below) is aimed at diabetics with neuropathy but applies to all of us living with nerve problems. It talks about a problem that millions of people with neuropathic symptoms have and that is sleep deprivation. You don't need telling how important a good night's rest is for your general health and feeling of well-being and if the symptoms of neuropathy regularly disrupt your sleep it can affect your whole life, leading to all sorts of problems during the waking hours. This article gives some very helpful advice as to how to tackle the problem. The solution doesn't always lie with prescription sleeping pills; there may be other ways of improving what can seem an insurmountable problem. Lack of sleep is a vastly underrated aspect of living with neuropathy and all good advice is welcome.
 

Diabetic Neuropathy and Sleep
Written By: Paul - May• 11•14

Diabetic neuropathy can develop into a nagging intrusiveness that will undermine you ability to enjoy a good night’s sleep. And lack of sleep will exacerbate the painful symptoms of neuropathy. What can you do about it?

Peripheral neuropathy is damage to the nerves in the feet and legs. When it is caused by long-term diabetes it is called diabetic neuropathy.

This nerve damage can cause a loss of feeling in the feet or symptoms such as tingling, numbness, burning, and pain. These symptoms come and go and can be quite intensive and disturbing from time to time.

It is permanent, so once it’s happened you cannot improve it by controlling your diabetes better. However, you can allay the symptoms (and prevent the damage getting worse) through a change in diet and exercise.
Sleep disturbances

As it can be very intrusive, neuropathy can disturb your sleep in a number of ways.

The pain and weird sensations (especially in the legs) of neuropathy can make it hard to fall asleep.

Many people find themselves focusing on their pain during the evening when daytime distractions are at a minimum which makes it more difficult to get to asleep. The pain can also kick in during the night and wake you up.

Neuropathy has been linked with sleep apnoea syndrome, ie pauses in breathing during sleep.

A meta-analysis published online in late 2013 by three Japanese researchers indicates that patients with diabetic neuropathy are twice as likely to have apnoea compared to diabetic patients who do not have neuropathy. This, however, does not mean that neuropathy is a cause of sleep apnoea.

The relationship between neuropathy and sleep is a two-way street. While neuropathy can cause your sleep to be disturbed, sleep that is disturbed (for other reasons) can make the symptoms of neuropathy worse.

In addition, being deprived of sleep can lower your pain threshold and your ability to tolerate pain, which makes your neuropathic pain feel worse.
Overcoming the effects of neuropathy on sleep

There are several things you can do to overcome the intrusiveness of neuropathy:

[1] You can use medicines, both over-the-counter and prescription medications. However these can cause drowsiness during the day, as well as other side affects and can cause dependency.

[2] You can try non-pharmacological treatments such as cognitive behavioural therapy, relaxation techniques, stress management, and acupuncture.

[3] You can follow the tips below for getting a good night’s sleep. This is probably the best thing you can do.
Getting a good night’s sleep despite your neuropathy

There are several things you can do to get a good night’s sleep. You may find some or all of the following useful: 

Keep your blood glucose under control using diet and, if necessary, medications.

Get some exercise every day.

Go to bed at about the same time each night so you adhere to a regular sleep/wake schedule.

Make sure your bed is large and comfortable with a good mattress and supportive pillows.

Elevate the bed sheets so that they are not in direct contact with your legs and feet. You can do this using wire frames to create a tunnel for your feet under the blankets.

Ensure your room is cool (18 degrees Centigrade) and well ventilated.
Sleep in the dark in a noise free room (or use a blindfold and/or ear plugs).

Develop a bedtime ritual (eg, taking a warm bath, reading light material).

Limit or eliminate caffeine four to six hours before bed and minimize daytime use.

Avoid smoking, especially near bedtime or if you awake in the middle of the night.

Avoid alcohol and heavy meals before going to bed.

Turn off your TV, smartphone, iPad, and computer a few hours before your bedtime.

Adopt relaxation techniques to help induce sleep such as setting an hour aside before bedtime to relax and unwind. Try meditation or deep breathing exercise.

http://beating-diabetes.com/index.php/diabetic-neuropathy-and-sleep/

Neuropathic Pain For Health Professionals

Today's post from journals.lww.com (see link below) written for Nursing magazine, is a comprehensive article about neuropathy, its causes and treatments for health professionals. It's often interesting to read about how professionals are taught to approach the disease. We can then better understand the reasons for their decisions on our behalf. It also can give us some insights that the doctors don't tell us, either because they don't have time, or because they consider the subject matter too complex for the patient to understand. Definitely worth a read on a day when you don't have to rush off to work. The reference links referred to by the numbers throughout the article can be followed in the original article (see link below).

Living with the nightmare of neuropathic pain
D'Arcy, Yvonne MS, CRNP, CNS Nursing 2014

PATIENTS LIVING WITH a neuropathic pain syndrome will tell you that this vicious pain can ruin quality of life and spoil dreams. Some neuropathic pain, such as that from diabetic neuropathy, has a gradual onset, but other types, such as complex regional pain syndrome (CRPS), can develop suddenly. Some patients with neuropathic pain who have difficulty getting a diagnosis can experience increased pain and anxiety from the uncertainty of their pain condition.

To get a better understanding of this pain, let's look at a patient who had an accident that resulted in a neuropathic pain syndrome that changed her life.
 
Meet the patient

Mrs. S, age 65, is a retired teacher who went to bed one night free from pain. During the night, she got up to use the bathroom without turning on the light and ran into a table leg quite hard, injuring her right foot. Because the pain was so severe, her husband drove her to the ED. There she rated her pain as an 8 on a pain intensity rating scale of 0 (no pain) to 10 (worst pain imaginable).

The healthcare provider (HCP) obtained an X-ray of her foot, which revealed no fractures. Believing that Mrs. S had only soft-tissue damage, the HCP prescribed an opioid-acetaminophen combination medication for moderate pain, and told her to elevate, ice, and rest her foot for several days.

Although Mrs. S very diligently rested her foot, used ice packs, and took her medications as needed, the pain didn't resolve. In fact, it increased and became constant. Over the next 6 weeks, Mrs. S was evaluated by many HCPs, but none could give her a concrete diagnosis. Her pain was 7/10 at best and none of the pain medications she'd been given significantly relieved it; instead, they just made her sleepy. Because she had trouble putting weight on her foot, she started to use crutches. Her foot often felt cold, so she tried to put a sock on for warmth, but she couldn't stand the pressure it put on her foot.

Her husband was concerned about her unrelieved pain, loss of function, and lack of sleep due to pain. At 3 months, Mrs. S was referred to the local pain management specialist, who diagnosed her with CRPS, a neuropathic pain syndrome where the injury is located in the peripheral nerves but can also include changes in the central nervous system.1 (See Focusing on CRPS.)

When Mrs. S asked about treatment, she was told the pain would most likely persist and that the best approach was to try medications designed to treat neuropathic pain to help reduce it. At this point, she broke into tears and told the specialist, “This can't be! I just retired after teaching for 30 years. I planned to travel the world and now I'm in constant pain. How could this have happened to me?”

What we know about neuropathic pain

Neuropathic pain is chronic pain caused by damage in the peripheral or central nervous system. It's been defined as pain that's the direct consequence of a lesion or disease affecting the somatosensory system.2 (See The language of pain.)

This distinct type of pain encompasses a wide variety of neuropathic pain conditions. Unlike acute pain, it has absolutely no protective function and doesn't require any nociceptive input; that is, it exists independent of a stimulus. In contrast, nociceptive pain results from damage to tissue that's nonneural, such as surgical tissue damage or a tissue injury. Nociceptive pain is caused by activation of thermoreceptors, chemoreceptors, and mechanoreceptors, depending on whether the pain is caused by burns or muscle or tendon damage.3

Clinically, a patient such as Mrs. S doesn't have to move or walk on her affected foot to have pain. This type of pain persists without any pressure or sensory input.

Sorting out neuropathic pain

Of the many different types of neuropathic pain, some are caused by chronic diseases such as diabetes or HIV infection. Others, such as postmastectomy pain syndrome, result from surgery or treatments such as chemotherapy. Overall, neuropathic pain is thought to affect 1,765,000 people in the United States, not including those with back pain neuropathy.4 (See Sorting out common neuropathic pain conditions.)

Neuropathic pain has many sources and causes. For example, the continued inflammatory process of osteoarthritis may create neuropathic pain. Fibromyalgia is now considered a disease caused by dysregulation of pain inhibition pathways and amplification of central pain.5
 
Pathophysiology: Getting to the root

Generation of neuropathic pain involves both the peripheral nervous system and the central nervous system, and both the ascending and descending neural pathways. It's maladaptive: Neuropathic pain promotes abnormal functioning of nerves in one or both systems leading to a difficult-to-treat chronic pain condition.6 As the nerves change function, a phenomenon called neural plasticity occurs. These changes are responsible for heightened pain sensitivity and unpredictable, sudden pain exacerbations.

If the source of the neuropathic pain is in the periphery, continued pain stimuli from the peripheral nerve injury create sensitization that over time creates abnormal neural activity along the afferent nerve pathways leading to the central nervous system.7 This sensitization causes the release of what's commonly called an “inflammatory soup” of pain-promoting substances such as cytokines, tumor necrosis factors, bradykinin, and substance P. This in turn leads to hypersensitivity of the nerves, allowing them to crosstalk with each other, release pain-facilitating substances, activate higher level pain-generating functions such as N-methyl-D-aspartate receptors, and fire faster.

Sodium channels on nerve fibers play a part in the creation of neuropathic pain. In normal neural functioning, nerve depolarization occurs when the stimulus reaches the activation point and the nerve is forced to fire. When neuropathic pain is created, more primary and secondary sodium channels are activated, allowing for an ectopic neural discharge.4

Pain that originates from the central nervous system is even more difficult to manage. Pain that's centrally controlled can be created by a continued barrage of pain stimuli to the peripheral neurons, causing central neurons to become hyperexcitable. This hyperexcitability has been transferred to the central nervous system through the synaptic junction between the two nervous systems. As a result of this central sensitivity, synaptic connectivity reorganizes, causing lower activation thresholds and increased responses to stimuli.8

Additionally, collateral neurons may sprout and create larger fields of effect with the ability to crosstalk with each other and recruit additional neurons for pain creation. This phenomenon, called wind-up, causes an increased response to painful stimuli.6 Meanwhile, the descending pathway inhibition potential used to block pain is adversely affected, letting more pain reach the patient.

This explains the pain that Mrs. S is continuing to have. Continual pain stimuli from the periphery have created central sensitization and the wind-up effect has been created related to neuronal plasticity. Because the pain had continued at high levels for so long, the central nervous system pain-facilitating process was activated, which will make her pain much harder to manage.
 
Signs and symptoms

When assessing neuropathic pain, the nurse must ask the patient to describe the pain. Aside from the numeric pain intensity scale, the descriptors the patient uses are the best means of identifying the pain. If the patient uses words such as burning, shooting, electric, painful numbness, or tingling, the pain has a neuropathic source. After a mastectomy, some patients complain of strange painful sensations or painful pruritus in the ipsilateral axilla or upper arm. This is also classified as neuropathic pain.

Using fiber wisps for sensation testing or alcohol to create a cool sensation and touching the painful areas can determine just how large an area is affected. Ask patients if they experience hyperalgesia, increased pain from a stimulus that's normally painful, such as a pinprick, or allodynia, a painful response to a stimulus that isn't normally painful, such as touch from clothes or bedsheets.6 Assess for other signs of neuropathic pain. Other common types of neuropathic pain include paresthesia, an abnormal sensation that isn't unpleasant, such as numbness or tingling, and dysesthesia, an unpleasant sensation such as painful pruritus or feeling as though bugs are crawling under the skin.6

In the acute phase, patients who are developing CRPS after an injury continue to report high-intensity pain despite escalating doses of opioids. As the condition develops, besides allodynia, patients report edema, skin discoloration due to changes in blood flow, temperature differences between the affected and nonaffected extremity, changes in hair and nail growth, weakness, and tremor.9

Mrs. S is having difficulty with severe pain and she can't put any pressure on her foot. She has allodynia, and she's started to use descriptors indicative of CRPS, such as painful coldness.
 
Treatment options

One of the best ways to manage neuropathic pain is to use a stepwise approach. To adequately assess and diagnose a patient with neuropathic pain, the HCP will need to perform a focused physical exam. If possible, the HCP will identify the source, make a diagnosis, and examine any contributing comorbidities such as diabetes. Remember that the patient may not understand that pain descriptors may be the key to adequate management.

Besides explaining the diagnosis to the patient and discussing treatment options, the HCP will set realistic achievable goals. Many patients with neuropathic pain have seen multiple HCPs with no success; receiving a diagnosis may end the uncertainty that these patients have experienced and give them some hope for reducing the pain. Although complementary techniques such as relaxation or yoga may be beneficial for adjunct pain relief, the mainstay is pharmacologic management.

Stepping up to medications

Using the stepwise approach to treatment includes using first-line medications with the highest level of evidence for success in controlling neuropathic pain. (See Lining upmedications for neuropathic pain.)

After patients begin drug therapy, nurses need to reassess the efficacy of the therapeutic regimen. If the first medication chosen doesn't provide pain relief or increase functionality, the HCP may try titrating the dose upward. If that doesn't provide adequate pain relief, the HCP may consider combining two first-line medications.

If careful drug choices in the first-line category don't provide adequate pain relief, trialing second-line options may be a way of optimizing pain relief. As always, adding nonpharmacologic therapies, such as yoga, pool therapy, or meditation, can help with pain relief and relaxation.

For Mrs. S, our patient with CRPS, using one or more first-line therapies should provide some level of pain relief. Her current medication is an opioid, which is a second-line option. Using first-line medications either alone or in conjunction with the opioid may optimize her pain relief, and a consultation with physical medicine and rehabilitation professionals to work on increasing functionality is highly recommended. Mrs. S may never be pain free—that isn't a reasonable goal for her—but she should be able to move to a higher level of physical activity and perhaps begin to take short trips to see some of the places she's been dreaming about.

New options on the horizon

Research evidence supports the use of some antiepileptic drugs for certain types of neuropathic pain such as painful diabetic neuropathy. However, lacosamide, an antiepileptic drug, was trialed for managing neuropathic pain and fibromyalgia but failed to show significant benefit. The FDA has declined to approve its use for neuropathic pain.10 Another therapy that produced better outcomes is topical application of high-dose capsaicin, 8% patch, which is thought to produce desensitization. It's indicated for a particularly difficult-to-treat neuropathic pain syndrome called postherpetic neuralgia. In six studies involving 2,073 patients, a small number of participants with postherpetic neuralgia and HIV neuropathy with high pain levels benefited.11 Pain relief lasted for up to 12 weeks. In studies, 11 or 12 patients had to be treated to get 1 positive outcome of reduced pain (this is known as numbers needed to treat and is considered high).11 However, some patients did benefit, and their pain was significantly reduced.

Although single medications used alone can positively affect neuropathic pain, combination therapy demonstrates superior pain relief. Some agents caused problematic sedation.12 Unfortunately, there weren't enough comparative or replication studies to identify particular combinations of drugs that had improved pain relief. In a meta-analysis with 386 patients, gabapentin plus an opioid was superior to gabapentin alone, according to a modest but clinically significant finding.12

One of the most exciting ideas for managing neuropathic pain is attempting to use molecular approaches. Chromaffin cells release a combination of pain-reducing neuroactive compounds, including catecholamines and opioid peptides.13 Encapsulating the cells and implanting them in the subarachnoid space has relieved pain in both animal and human studies.13

In these cell transplantation studies, encapsulated cells with permeable membranes turn into cellular pumps that create and dispense analgesic compounds.13 Future research targets include astrocyte cells that are genetically modified to secrete enkephalin and genetically engineered cells designed to secrete gamma-aminobutyric acid, a pain inhibitory substance.13 Patients thought to be good candidates for study include those with low back pain and knee pain; these can have neuropathic elements. Understanding the pathways and physiology of neuropathic pain transmission can help researchers look for ways to use these specialized cells to reduce pain right at the source of pain generation.

Other options for managing neuropathic pain include using autologous bone marrow-derived progenitor cells to repair damaged neurons in patients with diabetic peripheral neuropathy and gene transplants applied to peripheral nerves, injected into dorsal root ganglia, or introduced into the intrathecal space of the spine via lumbar puncture or injected directly into the brain.13 Gene transplants have been tested only in animals using the herpes simplex virus.13

Stem cell transplantation also provides promise for pain research. Mesenchymal stem cells can be harvested from bone marrow, are fairly stable, and can, once transplanted, migrate to injured tissue and have immunosuppressive characteristics.14 They can also differentiate into astrocytes and neurons and migrate to injured neuronal areas to mediate functional recovery.14 Although many of the finer points of the process are yet to be discovered, studies of mice have shown that the transplanted stem cells relocated themselves into key areas for neuropathic pain generation in the brain.14

Although many new management options are still being studied in animals, they hold promise for human use in the future. Researchers are attacking the pain process from many different directions and using the known pain pathophysiology to direct the therapy to targets that may yield good results.

In the foreseeable future, patients like Mrs. S won't be limited to medications or interventions for intractable pain syndromes such as spinal cord stimulators. Instead, they'll have options that include stem cell transplants for nerve repair or genetically engineered cells that will enhance the production of pain-reducing substances. Using these new techniques will help many patients leave the nightmare of neuropathic pain behind and fulfill their dreams.

Focusing on CRPS

CRPS, or complex regional pain syndrome, was formerly called causalgia or reflex sympathetic dystrophy.3 It's usually the result of a crush injury or repeated tissue trauma. Continuing pain or abnormal sensation is out of proportion to the event that initiated it. At some time, the patient experiences edema, skin blood flow changes, or abnormal sudomotor activity in the region of pain. No other condition is identified that could explain the pain or dysfunction.15

The International Association for the Study of Pain defines two types of CRPS:

CRPS I, which doesn't require the presence of a nerve lesion.
CRPS II, which includes the presence of a nerve lesion.
Although the true cause of CRPS hasn't been determined, the most accepted rationales include the following:
enhanced peripheral neurogenic inflammation
sympathetic nervous system dysfunction
structural reorganization in the central nervous system.

Source: Fechir M, Geber C, Birklein F. Evolving understandings about complex regional pain syndrome and its treatment. Curr Pain Headache Rep. 2008;12(3):186–191.


The language of pain

Allodynia: painful response to a stimulus that isn't normally painful, such as touch from clothes or bed sheets.
Crosstalk: new communication, or neural sprouts, between nerves that don't normally synapse with one another.
Dysesthesia: an unpleasant sensation, such as painful pruritus or feeling as though bugs are crawling under the skin.
Hyperalgesia: increased pain from a stimulus that's normally painful.
Neural plasticity: continued noxious stimuli and inflammation causing an elevation of nociceptive input from the periphery to the central nervous system, which then creates an increased response at the cortical level to change its somatotopic organization for the painful site, inducing central sensitization.
Neuropathic pain: chronic pain caused by damage in the peripheral or central nervous system that's the direct consequence of a lesion or disease affecting the somatosensory system.
Nociceptive pain: pain that results from nonneural damage to tissue.
Paresthesia: an abnormal sensation that isn't unpleasant, such as numbness or tingling.
Wind-up: an increased response to painful stimuli. Add, on a new line as source format:

Source: Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113–130.

Sorting out common neuropathic pain conditions

Peripheral syndromes and U.S. patients affected

Painful diabetic neuropathy; 600,000
Postherpetic neuralgia; 500,000
Cancer associated; 200,000
HIV associated; 100,000
Phantom limb pain; 50,000

Central syndromes and U.S. patients affected
 
Spinal cord injury; 120,000
CRPS I and II; 100,000
Poststroke; 30,000

Source: Irving GA. Contemporary assessment and management of neuropathic pain. Neurology. 2005;64(12 suppl 3):S21-S27.

http://journals.lww.com/nursing/Fulltext/2014/06000/Living_with_the_nightmare_of_neuropathic_pain.12.aspx

ANTIBIOTICS GIVE RISE TO NEW COMMUNITIES OF HARMFUL BACTERIA

Most people have taken an antibiotic to treat a bacterial infection. Now researchers from the University of North Carolina at Chapel Hill and the University of San Diego, La Jolla, reveal that the way we often think about antibiotics -- as straightforward killing machines -- needs to be revised.

 The work, led by Elizabeth Shank, an assistant professor of biology in the UNC-Chapel Hill College of Arts and Sciences as well as microbiology and immunology in the UNC-Chapel Hill School of Medicine, and Rachel Bleich, a graduate student in the UNC-Chapel Hill Eshelman School of Pharmacy, not only adds a new dimension to how we treat infections, but also might change our understanding of why bacteria produce antibiotics in the first place.

"For a long time we've thought that bacteria make antibiotics for the same reasons that we love them -- because they kill other bacteria," said Shank, whose work appears in the February 23 Early Edition of the Proceedings of the National Academy of Sciences. "However, we've also known that antibiotics can sometimes have pesky side-effects, like stimulating biofilm formation."

Shank and her team now show that this side-effect -- the production of biofilms -- is not a side-effect after all, suggesting that bacteria may have evolved to produce antibiotics in order to produce biofilms and not only for their killing abilities.

Biofilms are communities of bacteria that form on surfaces, a phenomenon dentists usually refer to as plaque. Biofilms are everywhere. In many cases, biofilms can be beneficial, such as when they protect plant roots from pathogens. But they can also harm, for instance when they form on medical catheters or feeding tubes in patients, causing disease.

"It was never that surprising that many bacteria form biofilms in response to antibiotics: it helps them survive an attack. But it's always been thought that this was a general stress response, a kind of non-specific side-effect of antibiotics. Our findings indicate that this isn't true. We've discovered an antibiotic that very specifically activates biofilm formation, and does so in a way that has nothing to do with its ability to kill."

Shank and her team previously reported that the soil bacterium Bacillus cereus could stimulate the bacterium Bacillus subtilis to form a biofilm in response to an unknown secreted signal. B. subtilis is found in soil and the gastrointestinal tract of humans.

Using imaging mass spectrometry, they subsequently identified the signaling compound that induced biofilm production as thiocillin, a member of a class of antibiotics called thiazolyl peptide antibiotics, which are produced by a range of bacteria.

At that point, Shank and her colleagues knew thiocillin had two very specific and different functions, but they didn't know why -- and wanted to know how it worked. That's when they modified thiocillin's structure in a way that eliminated thiocillin's antibiotic activity, but did not halt biofilm production.

"That suggests that antibiotics can independently and simultaneously induce potentially dangerous biofilm formation in other bacteria and that these activities may be acting through specific signaling pathways," said Shank. "It has generated further discussion about the evolution of antibiotic activity, and the fact that some antibiotics being used therapeutically may induce biofilm formation in a strong and specific way, which has broad implications for human health."

Weight Bearing Exercise Can Be Dangerous For Neuropathy Patients

Today's post from huffingtonpost.com (see link below) looks at the problems that certain forms of exercise may bring the neuropathy patient who has lost most of the feeling in their feet. These problems are not to be underestimated but it's important to say here that the vast majority of neuropathy patients have some feeling in their feet, despite the numbness that can affect the toes and pads of the foot. These patients are unlikely to step on a nail and not feel something. That said, many people living with neuropathy feel very little and this can certainly lead to serious accidents. When this is the case, load-bearing exercises can be more dangerous than helpful. Nevertheless the article recommends exercise as being essential, as long as this is controlled and the feet are carefully and regularly monitored. The article is aimed at diabetic neuropathy patients but applies to all people living with neuropathy and foot problems.

Type 2 Diabetes and Peripheral Neuropathy: To Walk or Not to Walk?
 
Milt Bedingfield Posted: 05/11/2015 

It is now well known that engaging in light to moderate physical activity on a regular basis is of significant value for most people that have either Type 1 or Type 2 diabetes. In fact the American Diabetes Association recommends that people with diabetes should get a minimum of 150 minutes of light to moderate exercise per week including aerobic and resistance training.

What the ADA says...

It has also been recommended that people with peripheral diabetic neuropathy that have reduced or absent feeling in their feet should not engage in any form of weight bearing exercise activity. The American Diabetes Association recommends that people with diabetes-related peripheral neuropathy should limit the amount of weight-bearing physical activity they perform due to their increased risk of foot ulcers and amputation (1, 2). This is based on the fact that with peripheral neuropathy there is either a decreased ability or total inability in the feet to feel pain or discomfort.

As an example, standing barefoot on hot asphalt maybe in a parking lot in the middle of the summer would be very uncomfortable for someone with normal sensation in their feet, however go unnoticed for someone with peripheral neuropathy. Similarly, the person with peripheral neuropathy may develop a painful nickel-sized blister after walking too far or when wearing new shoes and not even feel it. Without daily inspection of the ankles and feet (which a lot of people do not do) this blister could go unnoticed for days resulting in a potentially infected, slow to heal, or non-healing wound. In the worst case this could lead to an amputation. All of this is the result of losing what is called the protective sensation in the feet.

In the absence of peripheral neuropathy whenever there is insult to the foot or feet such as a blister, a cut or scrape or stepping on a small piece of glass or nail, there would be pain which would cause you to notice the injury and hopefully treat the wound accordingly.

There are also painful stages of neuropathy that can precede lack of sensation which are characterized by frequent but intermittent pain in the feet throughout the day, having pain only in the evening while in bed to constant pain. This stage of neuropathy can result in changing the way you walk, that is your stride length, which part of your feet you strike the ground with first and ultimately what part of your feet support your body weight.

Because of everything I have just mentioned above this leads to the unfortunately recommendation that discourages walking for a great many people with diabetes.

To Walk or Not to Walk?

So where does that leave us? Exercise is arguably the best treatment there is, particularly in controlling Type 2 diabetes, and preventing diabetes related complications, such as peripheral neuropathy, however once you have peripheral neuropathy in your feet you should avoid doing any weight bearing exercise.

I have wrestled with the dilemma for years about how to guide my patients that would benefit immensely from starting to exercise or increasing their exercise however have various stages of neuropathy.

According to the Centers for Disease Control and Prevention, from 2000-2002, approximately 60 percent of lower-extremity amputations in the United States were diabetes-related, with the majority of those amputations being preceded by a foot ulcer (3). Almost all diabetic foot ulcers occur in those people that have lost feeling in their feet due to diabetic peripheral neuropathy (4, 5).

On the other hand poorly controlled blood glucose control contributes greatly to peripheral neuropathy.

Eight-year cardiovascular mortality is 34 percent lower among people with diabetes who walk two hours per week compared with non-walkers (6).

Feet First Randomized Controlled Trial

The Feet First Randomized Controlled Trial was designed to look at the effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy. The study, conducted over a 12-month period by Lemaster and colleagues, showed that participants in the Feet First intervention group achieved a modest increase in activity, with no increase in foot lesions, compared with those in the control group. The group also recommended additional research be conducted in this area to investigate the current guidelines and close supervision for patients with diabetes and peripheral neuropathy (7).

Tuttle and colleagues found that people with Type 2 diabetes and peripheral neuropathy experienced no negative consequences when performing moderate-intensity, weight-bearing exercise in their study (2).

Dr. Sheri Colberg reports in her article "Exercising with Peripheral Neuropathy" that recent descriptive studies suggest that patients with a lack of feeling in their feet who participate in daily weight-bearing activity are at decreased risk of foot ulceration compared with those who are less active (8, 9), especially if their daily routine is very similar with little variation from day to day regarding their physical activity (9, 10).

As a result of the above information, I am going to continue evaluating each of my class participants on a case by case basis, however, for those patients with peripheral neuropathy that I believe will be prudent in checking their feet and following the recommended foot care guidelines and stand to gain significant benefit from performing some weight bearing exercise, I will be more likely to recommend it to them.

References:

1. Singh, N., D. G. Armstrong, and B. A. Lipsky: Preventing foot ulcers in patients with diabetes. JAMA 293 (2):217-228, 2005

2. Tuttle, L. J., M. K. Hastings, and M. J. Mueller: A moderate-intensity weight-bearing exercise program for a person with Type 2 diabetes and peripheral neuropathy. Phys Ther 92 (1):133-141, 2012

3. Centers for Disease Control and Prevention. History of foot ulcer among persons with diabetes -- United States, 2000-2002. MMWR. 2003;52:1098-1102. Medline

4. Pham H, Armstrong DG, Harvey C, et al. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care. 2000;23:606-611.

5. Reiber GE, Smith DG, Wallace C, et al. Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. JAMA. 2002;287:2552-2558. CrossRefMedline

6. Gregg EW, Gerzoff RB, Caspersen CJ, et al. Relationship of walking to mortality among US adults with diabetes. Arch Intern Med. 2003;163:1440-1447. CrossRefMedline

7. Lemaster, J. W., M. J. Mueller, G. E. Reiber, D. R. Mehr, R. W. Madsen, and V. S. Conn: Effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: feet first randomized controlled trial. Phys Ther 88 (11):1385-1398, 2008

8. Richerson, S., and K. Rosendale: Does tai chi improve plantar sensory ability? A pilot study. Diabetes Tech Ther 9(3):276-286, 2007

9. Ko, S. U., S. Stenholm, C. W. Chia, E. M. Simonsick, and L. Ferrucci: Gait pattern alterations in older adults associated with type 2 diabetes in the absence of peripheral neuropathy--results from the Baltimore Longitudinal Study of Aging. Gait Posture 34 (4):548-552, 2011

10. Kanade, R. V., R. W. van Deursen, K. Harding, and P. Price: Walking performance in people with diabetic neuropathy: benefits and threats. Diabetologia 49 (8):1747-1754, 2006

http://www.huffingtonpost.com/milt-bedingfield/post_9394_b_7188266.html

Zantac Pregnancy

Ranitidine Zantac

Zantac official prescribing information for healthcare professionals. Includes: indications, dosage, adverse reactions, pharmacology and more..All about Zantac 75 during pregnancy, breastfeeding and trying to conceive TTC . Is it safe for use?.ZANTAC 25 EFFERdose Tablets for oral administration is an effervescent formulation of ranitidine that must be dissolved in water before use. Each individual tablet .Learn about Zantac Ranitidine Hcl may treat, uses, dosage, side effects, drug interactions, warnings, patient labeling, reviews, and related medications..ZANTAC SYRUP Ranitidine drug information product resources from MPR including dosage information, educational materials, patient assistance..Find patient medical information for Zantac oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings..Pictures of Zantac Ranitidine Hcl , drug imprint information, side effects for the patient..Ranitidine, sold under the trade name Zantac among others, is a medication that decreases stomach acid production. It is commonly used in treatment of peptic ulcer .Zantac ranitidine is used to treat and prevent ulcers in the stomach and intestines. Includes Zantac side effects, interactions and indications..The common antacid medication Zantac and the generic equivalent, ranitidine can significantly increase blood alcohol levels and impair driving ability .

Ranitidine Zantac

Zantac 150 Mg Tablet

All about Zantac 75 during pregnancy, breastfeeding and trying to conceive TTC . Is it safe for use?.Learn about Zantac Ranitidine Hcl may treat, uses, dosage, side effects, drug interactions, warnings, patient labeling, reviews, and related medications..Zantac official prescribing information for healthcare professionals. Includes: indications, dosage, adverse reactions, pharmacology and more..Zantac ranitidine is used to treat and prevent ulcers in the stomach and intestines. Includes Zantac side effects, interactions and indications..Find patient medical information for Zantac oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings..Ranitidine, sold under the trade name Zantac among others, is a medication that decreases stomach acid production. It is commonly used in treatment of peptic ulcer . The common antacid medication Zantac and the generic equivalent, ranitidine can significantly increase blood alcohol levels and impair driving ability .ZANTAC 25 EFFERdose Tablets for oral administration is an effervescent formulation of ranitidine that must be dissolved in water before use. Each individual tablet .ZANTAC SYRUP Ranitidine drug information product resources from MPR including dosage information, educational materials, patient assistance..Pictures of Zantac Ranitidine Hcl , drug imprint information, side effects for the patient..

Duloxetine Cymbalta Reviews For Neuropathy

Today's post from the always reliable Drugs.com (see link below) talks about user reviews of Duloxetine (Cymbalta, Ariclaim, Xeristar, Yentreve, Duzela), which is an antidepressant drug used to treat neuropathy. It's a somewhat controversial drug due to the potential side effects which many people just can't take.The reviews are not extensive and not really up to date, which is why this post asks for your input. Drugs.com is always a trustworthy source for information about any drugs you may take and is worth adding to your favourites, especially when you are taking multiple drugs for different conditions.
If you are taking Duloxetine/Cymbalta, or have taken it in the past, please share your experiences for the benefit of others, especially in comparison with other anticonvulsant or antidepressant drugs prescribed for neuropathy.

User Reviews for Duloxetine
Also known as: Cymbalta

The following information is NOT intended to endorse drugs or recommend therapy. While these reviews might be helpful, they are not a substitute for the expertise, skill, knowledge and judgement of healthcare practitioners in patient care.
Learn more about Duloxetine.

Compare all 38 medications used in the treatment of Diabetic Peripheral Neuropathy.

Reviews for Duloxetine to treat Diabetic Peripheral Neuropathy


Review by Anonymous (taken for less than 1 month):January 25, 2013 11:21 AM User Rating: 8.0

Cymbalta (duloxetine): I’m a Type 1 Diabetic for 39 years. Had VERY painful muscle spasms/seizing and twitching. I tried various supplements which "should" have helped but no improvement. I started Neurontin at 1,800mg/day and I had terrible swelling plus gained 18 lbs in 6 months (and my eating habits actually got better while on it). The 1,800mg of Neurontin no longer controlled the muscle spasms. I started Cymbalta, 30 mg before bed, and had significant reduction in pain the first morning. I did notice a very strong headache that first day. I had only 3-4 muscle spasms that first day as well....Wow!! Second day...almost NO pain in the morning and only a dull headache with much weaker muscle spasms. Side effects: Crazy dreams, difficulty sleeping, headache.

Review by Anonymous (taken for 1 to 2 years): September 14, 2012 

User Rating: 9.0

Cymbalta (duloxetine): I was not sure how well it worked at first. Then I was unable to get it for awhile, and was in a lot of pain, trouble getting through the day. I just wanted to sleep. Once back in my system I noticed the difference. This helps my depression, back pain, and the neuropathy.

Review by Anonymous:August 12, 2012 10:37 AMUser Rating: 1.0

Cymbalta (duloxetine): Did not work for me. I had nausea, abdominal & stomach pain, loss of appetite. I lost 5 lbs. in less than a week.


Review by Tonywwk1:March 23, 2012 4:51 PMUser Rating: 8.0

duloxetine: I have severe Diabetic Neuropathy to both feet, and Neurotin seemed rather ineffective. The pain was a combination of burning, needles and pins sensation, and severe knife stabbing sensations intermittently to both feet. I started taking Cymbalta over a year ago, and it has significantly reduced the sensations and pain, making them tolerable. I initially noticed a loss of appetite, which was a blessing in disguise for me, and I lost 25 pounds before the anorexia disappeared. I have several severe disorders which require close monitoring of my blood, but overall, Cymbalta has been a God send to me.

Review by Sewanhaka100: February 18, 2012 1:23 AM

Cymbalta (duloxetine): I started on 30mg Cymbalta daily with a little foot pain improvement - as this was still not enough my doctor put me on 60mg daily. I am so happy and relieved to be able to actually "walk" again and function like a normal person. I was crawling to the bathroom at night before for 8 months I was in pure agony. I have been on Cymbalta for 5 weeks and so far great results! Thank you Eli Lilly and my doctor.

Review by Anonymous: September 6, 2010 7:28 PMUser Rating: 8.0

Cymbalta (duloxetine): Cymbalta lessens the burning pain in my feet that used to wake me up and keep me awake at night. It often relieves burning pain almost completely.

Review by kathygirl: August 6, 2010 10:50 AM 

User Rating: 3.0

Cymbalta (duloxetine): I was very unsteady on my feet, at first some of the pain was resolved, but it didn't work. Even though my feet were NOT swollen they felt that way, very tight feeling. It felt like I was walking on balloons, terrible feeling and I was afraid to walk with that unsteadiness. Didn't work for me, since then, I have been on many different medications. Neurontin, didn't help, amitriptiline, didn't help, Lyrica, didn't help. I am on nortriptyline now with a pain patch. The fentanyl patch really helps, but I don't want to stay on this forever, so trying different medications. I am only supposed to leave the pain patch on 3 days, and found with the new medication, nortriptyline, I can go 5 days. So I am hopeful here.

Review by Anonymous: February 1, 2010 1:25 PM
User Rating: 8.0

Cymbalta (duloxetine): I have peripheral neuropathy and very bad pain in my back. Cymbalta made a huge improvement in my pain level. The doctor started me gradually to lessen the nausea. I have worked up to 30 mg. twice a day for a total of 60 mg. I have been taking it for 3 months and still find the pain level, and my frame of mind, much improved. I do have slight nausea occasionally, and dry mouth. The excessive sweating has gone away.

Review by Jo.Nigle: October 27, 2009 5:22 AM 

User Rating: 9.0

Cymbalta (duloxetine): Cymbalta was the first drug that actually improved the diabetic neuropathy pain I was experiencing in my legs, feet, arms and hands. For the first time, I was able to sleep through the night without waking in tears from the pain. I was so happy my doctor put me on this drug in conjunction with Neurontin. The pain almost disappeared! Approximately 6-8 weeks later, I noticed that the neuropathy pain started back up again despite continuing on the medicines. I too, had insomnia making it difficult, at best, to be alert, focused or have any energy the following day. To this day, I still have some insomnia and an increase in the neuropathy symptoms; BUT Cymbalta 60mg & Neurontin 600mg are the BEST drugs so far in lessening the pain.

Review by TerryinAlaska: October 20, 2009 6:45 PM 

User Rating: 3.0

Cymbalta (duloxetine): It was like a wonder drug at first. Then, even though I went up to the maximum dose of 60 mg, I can no longer tell I am even taking it. I stop it - then start it back up - still no help. It's just no good anymore.

Review by Tomasue: September 4, 2009 5:38 PM 

Cymbalta (duloxetine): I was only able to take this for about 3 days. It made me so unsteady on my feet that falling was a great threat. I also spoke, looked and felt like a "drunken sailor". Totally uncoordinated and 'out of it'. It did nothing for my neuropathy.

Review by KimberDawn38: July 25, 2009 5:09 AM 

User Rating: 10

Cymbalta (duloxetine): I've tried many, many different medicines for my nerve pain. Finally after being put on Cymbalta for my depression, I noticed that my nerve pain was not near as bad as it was before. I'm overwhelmed with my results. Almost to tears, of joy, instead of tears of pain! Thank you!

Review by HAPPYKAT: June 26, 2009 11:24 PMUser Rating: 10

Cymbalta (duloxetine): Works great on my nerve pains, due to diabetes.

Review by Anonymous: June 11, 2009 4:10 PM

Cymbalta (duloxetine): Cymbalta worked for my neuropathy for about 6 weeks then suddenly stopped working. I was very sad that is stopped. I did experience very bad insomnia but other than that I didn't have any major side effects.

Review by Anonymous: June 9, 2009 3:43 PMUser Rating: 1.0

Cymbalta (duloxetine): Debilitating side effects after only 2 hours with only one 60mg pill. Extreme sweating, fatigue, difficulty swallowing and walking. Next came the nausea and intense insomnia. Had to call in sick to work the next day due to lack of sleep and weakness. Didn't get out of bed until 3 pm.

Review by hemaro: April 6, 2009 7:01 PM

User Rating: 9.0

Cymbalta (duloxetine): Cymbalta has been a lifesaver for my Diabetic Neuropathy. In just a few days the pain and discomfort went away. The only problem I am facing with Cymbalta is insomnia even in combination with Xanax 4mg and Vistaril 150mg.

Review by Anonymous: February 25, 2009 9:25 PM
User Rating: 9.0

Cymbalta (duloxetine): Caused me to have serotonin syndrome.
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