Fluoroquinolone Antibiotics Warning For Neuropathy Patients

Today's post from zedie.wordpress.com (see link below) is a very short one but is none the less important for that. Depending on the infection in your body from whatever cause, you may be prescribed antibiotics. Some of these antibiotics are called fluoroquinolones and are notorious for causing neuropathic symptoms. Very often it will be difficult to spot the name fluoroquinolone on the box because the brand and pharmaceutical names will be most prominent. If you already have neuropathy, it may be worth asking your doctor if the antibiotics he/she is prescribing belong to the fluoroquinolone family. If so, it may be worth changing them - there are plenty of alternatives. This short post talks about the American FDA requiring that drug companies place a neuropathy warning on fluoroquinolone packaging. This is of benefit to neuropathy sufferers but also patients who may be at risk of getting neuropathy.

Fluoroquinolone Labels Updated to Reflect Heightened Risk for Peripheral Neuropathy.
Author Zedie: US Virgin Islands August 16th 2013


The FDA is requiring that the labels of fluoroquinolone antibiotics warn of the drugs’ increased risk for peripheral neuropathy.

The risk has been observed with oral and injectable fluoroquinolones, but not topical agents. Patients could experience peripheral neuropathy any time during their treatment, and it could persist for months or years or be permanent.

Patients should contact their healthcare providers if they develop symptoms consistent with peripheral neuropathy in the arms and legs, including pain, burning, numbness, or weakness; change in sensation to touch, pain, or temperature; or change in the sense of body position.

Patients who develop these symptoms should stop taking the antibiotic and receive alternative therapies unless the benefit of the fluoroquinolone outweighs the risk.

Source: FDA MedWatch safety alert

http://zedie.wordpress.com/2013/08/16/fluoroquinolone-labels-updated-to-reflect-heightened-risk-for-peripheral-neuropathy/

Is Inflammation A Chief Cause Of Chronic Pain

Today's post from ufhealth.org (see link below) talks about the effect of inflammation on older pain patients and this includes people living with nerve damage. The link between neuropathy, auto-immune disease and inflammation is often hinted at but rarely confirmed, yet neuropathy is very often the result of inflammation and damage to the nervous system. This article talks about the fact that older people are more prone to and more often suffer from severe inflammation, leading to more and longer lasting pain. It suggests that anti-inflammatory drugs may be the answer but these are rarely on the list of recommended medications for neuropathy patients. It's a chicken and egg question: does the pain cause the inflammation, or the inflammation cause the pain? Inflammation is more often associated with tissue damage than nerve cells but inflammation in the nervous system most definitely can cause chronic pain (ask any shingles sufferer!) An interesting article requiring more research if you're interested. It may also be worthwhile asking your neurologist whether anti-inflammatory drugs such as diclofenac may be of benefit to you, although they do carry the potential for side-effects of their own.

Study shows pain causes older adults to develop more inflammation over a longer period of time 
Published: May 4, 2016 By: Morgan Sherburne 

When older relatives complain about their pains, show a little empathy, because new research suggests that as we age, we may all become more sensitive to pain. A small, preliminary University of Florida Health study has suggested for the first time that inflammation may occur more quickly and at a higher magnitude — and stays around longer — when older adults experience pain versus when younger adults experience pain.

This could mean that older adults could be at risk for developing chronic pain and may benefit from taking anti-inflammatories soon after an injury or procedure, according to the researchers.

Older adults often have a certain level of chronic inflammation in their bodies. But UF researchers found that when they induced pain in older adults, proteins associated with inflammation increased more than they did in younger participants and stayed in the bodies of older adults longer. The researchers also found that anti-inflammatory cytokines, proteins that soothe inflammation, peaked later for older adults than younger adults. Their results were published in a previous issue of Experimental Gerontology.

“Older people go through painful procedures more often, and we wanted to research whether this accumulation of painful procedures or more acute pain episodes that older people encounter is bad,” said Yenisel Cruz-Almeida, Ph.D., MSPH, an assistant professor in the UF College of Medicine’s department of aging and geriatric research who also is affiliated with the UF Institute on Aging. “If you have enough of those in a shorter period of time, does this predispose you to have chronic pain?”

When older adults have this kind of elevated inflammatory response, they’re more likely to have pain generated in the periphery of the body — their tissue and limbs outside of the spinal cord and brain, said the study’s senior author Joseph Riley, Ph.D., director of the pain clinical research unit in the UF Pain Research and Intervention Center of Excellence.

“If older adults are more likely to have these pain messages sent through the spinal cord to the brain, and the nervous system is being adapted to go through these changes, they may become more pain prone,” said Riley, also a professor in the UF College of Dentistry’s department of community dentistry and the UF College of Public Health and Health Professions’ department of clinical and health psychology.While the study does not establish whether accumulation of acute pain predisposes older adults to chronic pain, the researchers say their findings suggest this is a possibility, and it’s the first step in pain research to further understand the relationship between pain and aging. The researchers said the study’s sample size, though small, was more than adequate to demonstrate large differences between the older and younger adults they tested. The differences in inflammation within each group varied very little compared with the overall difference between the two groups, which suggests the populations they sampled were very different and there was little chance of sampling error, Riley said.

Cruz-Almeida and Riley studied eight healthy older adults, whose average age was 68, and nine healthy younger adults, whose average age was 21. None of the participants had illnesses such as diabetes or hypertension. During an initial visit, researchers induced pain in the participants in two ways, either using heat applied to the feet or a cold ice bath.

The first session determined how sensitive the participants were to pain. Determining a tolerable temperature allowed the researchers to recreate the same amount of pain for each participant in the subsequent sessions.

Participants rated their pain on a scale from 1 to 10. The researchers were aiming to induce pain to a Level 4 — a level that created the painful stimuli the researchers needed, but didn’t dissuade the participants from returning for the other visits required in the study.



With a thermode — a device that looks like a microphone with a copper tip — the UF researchers applied heat to the feet of participants in a study that tested the inflammatory response to pain of older adults versus younger adults.To study inflammation in the blood, the scientists inserted a catheter into each participant before inducing pain. That allowed them to collect the participant’s blood before the pain stimulus and then at three, 15, 30, 45, 60 and 90 minutes after the stimulus. These blood samples allowed the researchers to study inflammatory markers in the blood, finding that older adults had higher levels of inflammation when pain was induced than the younger adults.

Riley said activation of the immune system and increased inflammation are not necessarily harmful, but it’s important to understand how the length of time the immune system is activated affects the body.

“We think that the longer you have the immune system activated, having these elevated inflammatory cytokines, the more this activation can alter the homeostasis of the body. Usually an imbalance like that can be associated with autoimmune disorders, which also increase with age,” Cruz-Almeida said. “But the truth is we don’t know what the direct implications would be. We think low-grade inflammation is related to endocrine abnormalities such as diabetes and the development of heart problems. … We need to keep looking and doing future research.”

Riley said immediate implications of the research for patients could be to attack pain quickly with anti-inflammatory medication.

“Early treatment of an injury even with over-the-counter anti-inflammatories may be a good idea,” Riley said. “It’s those first few days of bombarding the central nervous system with pain signals that has a bigger effect (on the body).”
About the Author

Morgan Sherburne

Science writer for UF Health. Morgan writes about the research of faculty physicians in the College of Medicine. She joined the UF Health staff in 2014. A Michigan native, she...Read More

https://ufhealth.org/news/2016/study-shows-pain-causes-older-adults-develop-more-inflammation-over-longer-period-time

Pregnancy And Headaches

15 Weeks Pregnant Baby Bump

WebMD experts and contributors provide answers to your health questions..View the latest health news and explore articles on fitness,t, nutrition, parenting, relationships, medicine, diseases and healthy living at CNN Health..Medical news and health news headlines posted throughout the day, every day.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..Learn about new USPSTF latent TB infection recommendation . Like CDC TB's new Facebook page. See newly released TB Treatment Guidelines. See the Take on Latent .Find a unique combination of doctors' and patients' views at onhealth.com - Owned and Operated by WebMD.Do you really need to eat twice as much food dirung your pregnancy? Of course not! In fact, maintaining a healthy, balancedt is of utmost importance while .

15 Weeks Pregnant Baby Bump

Good Posture During Pregnancy

Medical news and health news headlines posted throughout the day, every day.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.. Do you really need to eat twice as much food dirung your pregnancy? Of course not! In fact, maintaining a healthy, balancedt is of utmost importance .Find a unique combination of doctors' and patients' views at onhealth.com - Owned and Operated by WebMD.WebMD experts and contributors provide answers to your health questions..View the latest health news and explore articles on fitness,t, nutrition, parenting, relationships, medicine, diseases and healthy living at CNN Health..Learn about new USPSTF latent TB infection recommendation . Like CDC TB's new Facebook page. See newly released TB Treatment Guidelines. See the Take on .

HOMOEOPATHIC MEDICINES FOR LIVER SPOTS

Liver spots are flat, brown or black spots that can appear on areas of the skin that are exposed to the sun. They have nothing to do with the liver or liver function

Liver spots are changes in skin color that occur in older skin. The coloring may be due to aging, exposure to the sun or other sources of ultraviolet light, or causes that are not known.

Liver spots are very common after age 40. They occur most often on areas that have had the greatest sun exposure, such as the -Backs of the hands,Face,Forearms,Forehead,Shoulders

Liver spots appear as a patch  or area of skin color change that is:-Flat Light brown to black, Painless

HOMOEOPATHIC REMEDIES

CURARE 30- Spots of yellow brown color

LYCOPODIUM 200- Spots on the face and especially on the abdomen

MEZEREUM 30- This is indicated when the color of the spots is dark brown , blue or black. Spots may be on the chest and arms

NATRUM HYPOSULPH. Q- Use for liverspots- locally and internally. 5 drops in water thrice daily

PLUMBUM MET 30- Liver spots during the period of menopause. They disappear after menopause

HOMOEOPATHIC REMEDIES FOR MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum  is a relatively common viral infection of the skin that results in round, firm, painless bumps ranging in size from a pinhead to a pencil eraser. If the bumps are scratched or injured, the infection can spread to surrounding skin.

Though most common in children, molluscum contagiosum can affect adults as well — particularly those with weakened immune systems. In adults with an otherwise normal immune system, molluscum contagiosum involving the genitals is considered a sexually transmitted infection.

Molluscum contagiosum spreads through direct person-to-person contact and through contact with contaminated objects. The bumps associated with molluscum contagiosum usually disappear within a year without treatment but doctor-assisted removal is also an option.

Causes-The virus that causes molluscum contagiosum spreads easily through:

·         Direct skin-to-skin contact

·         Contact with contaminated objects, such as toys, towels and faucet handles

·         Sexual contact with an affected partner

Scratching or rubbing the bumps spreads the virus to nearby skin

Symptoms--Signs and symptoms of molluscum contagiosum include bumps on the skin that:

·         Are raised, round and flesh colored

·         Are small — typically under about 1/4 inch (smaller than 6 millimeters) in diameter

·         Characteristically have a small indentation (umbilication) or dot at the top near the center

·         Can become red and inflamed

·         May be itchy

·         Can be easily removed by scratching or rubbing, which can spread the virus to adjacent skin

·         Usually appear on the face, neck, armpits, arms and tops of the hands in children

·         May be seen on the genitals, lower abdomen and inner upper thighs in adults if the infection was sexually transmitted

Risk factors--More widespread molluscum contagiosum  infections may occur in people with weakened immune systems and in children who have atopic dermatitis.

Complications--The bumps and the skin around them may become red and inflamed. This is thought to be an immune response to the infection. If scratched, these bumps can become infected. If lesions appear on the eyelids, pinkeye (conjunctivitis) can develop.

HOMOEOPATHIC MEDICINES.  

Homoeopathic medicines are very effective for curing molluscum contagiosm. From my experience the following three medicines are very effective for this condition. These medicines act as a specific for molluscum contagiosm.

CAUSTICUM 1000—Causticum is one of the top remedies for mollcuscum contagiosum. It is considered to be  an almost specific remedy for this condition. It is large, sometimes bleed easily.

CALCAREA CARB 200-Calcarea carb is another top remedy for molluscum contagiosum.It is found mainly on face and hands. The skin is unhealthy and readily ulcerating. Calcarea carb is suitable to fat, flabby persons who sweat profusely, especially head at night. There is a peculiar craving for eggs and undigestabile things like chalk. Calcarea carb persons get cold very easily.

NITRIC ACID 30-Nitric acid is very effective medicine for molluscum contagiosum. They are large, sometimes bleed on washing. Nitric acid is prescribed when splinter like pain is present.

How Do Nerves Work Vid

Today's post is an excellent Youtube animated video description of how nerves work produced by Elliot Krane and Frans Palomares from Ted-Ed. It gives you a visual version of parts of the posts of the last three days and where you may find written information difficult to retain, this video may make it easier. Definitely worth five minutes of your time and a full version can be seen by following the link.




About This Video

At any moment, there is an electrical storm coursing through your body. Discover how chemical reactions create an electric current that drives our responses to everything from hot pans to a mother’s caress.

View full lesson: http://ed.ted.com/lessons/how-do-nerves-work

BUMBLEBEES MAKE FALSE MEMORIES TOO

It's well known that our human memory can fail us. People can be forgetful, and they can sometimes also "remember" things incorrectly, with devastating consequences in the classroom, courtroom, and other areas of life. Now, researchers show for the first time in the Cell Press journal Current Biology on February 26 that bumblebees can be unreliable witnesses too.

The new study is the first to explore false memories in any non-human animals, the researchers say. They now suspect that the phenomenon may be widespread in the animal kingdom.

"We discovered that the memory traces for two stimuli can merge, such that features acquired in distinct bouts of training are combined in the animal's mind," says Lars Chittka of Queen Mary University of London. As a result, "stimuli that have actually never been viewed before, but are a combination of the features presented in training, are chosen during memory recall."

Bumblebees are rather clever animals, which explains why Chittka has been studying learning and memory in the insects for the last 20 years. The bees can remember the patterns, colors, and scents of various kinds of flowers. They can also navigate to those flowers and back home again over long distances.

Most times when people have studied memory in animals, errors in performance have been taken to mean that the animals failed to learn the task or perhaps learned it and then forgot. But Chittka and his colleague Kathryn Hunt wondered: What if animals can experience a more interesting type of memory failure?

To find out, Chittka and Hunt first trained bumblebees to expect a reward when visiting a solid yellow artificial flower followed by one with black-and-white rings or vice versa. During subsequent tests, bees were given a choice between three types of flowers. Two were the yellow and the black-and-white types they'd seen before. The third type of flower had yellow-and-white rings, representing a mixed-up version of the other two. Minutes after the training, the bees showed a clear preference for the flower that most recently rewarded them. Their short-term memory for the flowers was good.

One or three days later, however, something very different happened when the bumblebees' memory was put to the test. At first, the bees showed the same preference displayed in the earlier tests, but as the day wore on, they appeared to grow confused. Half of the time, they began selecting the flower with yellow rings, even though they'd never actually seen that one in training before.

Chittka and Hunt say that the insects' observed merging of long-term memories is similar to the memory conjunction errors humans sometimes make. They don't think those false memories in either bumblebees or humans are simply "bugs in the system," but rather are side effects of an adaptive memory system that is working rather well. In fact, Chittka's team recently found that people who are particularly good at learning rules to classify objects are also especially prone to these false memory illusions.

"There is no question that the ability to extract patterns and commonalities between different events in our environment [is] adaptive," Chittka says. "Indeed, the ability to memorize the overarching principles of a number of different events might help us respond in new situations. But these abilities might come at the expense of remembering every detail correctly."

In bees, with their limited brain capacity, the pressure to "economize" by storing overarching features of a class of objects rather than each individual object might be even more intense. Chittka's lab is now using radar tracking to follow bees and their choices of flowers over a lifetime.

"We are fascinated to learn how lifetime experiences accumulate and are integrated in making day-to-day foraging decisions," he says.

Tdap Vaccine During Pregnancy

Immunization Chart Vaccine And Pregnancy

Updated Recommendations for Use of TetToxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine Tdap in Pregnant Women Advisory Committee on .A preliminary study finds that receipt of the tettoxoid, reduced diphtheria toxoid, and acellular pertussis vaccine in the third trimester of pregnancy did not .What is the Tdap vaccine? The Tdap vaccine offers protection from three serious diseases: tet., diphtheria, and pertussis whooping cough . It's the first booster .Combination vaccines with acellular pertussis. DTap and Tdap are both combined vaccines against diphtheria, tet., and pertussis. The difference is in the dosage .Study Says Tdap Vaccine Safe During Pregnancy. Tet.-diphtheria-pertussis combo shot did not appear to raise risk, even if woman had prior tetshot.Tdap Vaccine What You Need to Know Why get vaccinated? Tet., diphtheria, and pertussis are very serious diseases. Tdap vaccine can protect us from these diseases..Research from JAMA Safety and Immunogenicity of TetDiphtheria and Acellular Pertussis Tdap Immunization During Pregnancy in Mothers and Infants A .Tdap vaccination is both safe and recommended for all pregnant women during every pregnancy, regardless of the timing of their last Tdap immunization..As whooping cough makes a comeback, the CDC encourages the Tdap vaccine for pregnant women..The ACIP has voted to expand the recommendation for the Tdap vaccine to encompass all pregnant women regardless of vaccination history, including repeat .

Immunization Chart Vaccine And Pregnancy

Pregnant Woman Getting Tdap Vaccine

Study Says Tdap Vaccine Safe During Pregnancy. Tet.-diphtheria-pertussis combo shot did not appear to raise risk, even if woman had prior tetshot.As whooping cough makes a comeback, the CDC encourages the Tdap vaccine for pregnant women..Updated Recommendations for Use of TetToxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine Tdap in Pregnant Women Advisory Committee on .Tdap Vaccine What You Need to Know Why get vaccinated? Tet., diphtheria, and pertussis are very serious diseases. Tdap vaccine can protect us from these diseases..Tdap vaccination is both safe and recommended for all pregnant women during every pregnancy, regardless of the timing of their last Tdap immunization..What is the Tdap vaccine? The Tdap vaccine offers protection from three serious diseases: tet., diphtheria, and pertussis whooping cough . It's the first booster .A preliminary study finds that receipt of the tettoxoid, reduced diphtheria toxoid, and acellular pertussis vaccine in the third trimester of pregnancy did not .Research from JAMA Safety and Immunogenicity of TetDiphtheria and Acellular Pertussis Tdap Immunization During Pregnancy in Mothers and Infants A .The ACIP has voted to expand the recommendation for the Tdap vaccine to encompass all pregnant women regardless of vaccination history, including repeat vaccinations .Combination vaccines with acellular pertussis. DTap and Tdap are both combined vaccines against diphtheria, tet., and pertussis. The difference is in the dosage .

Station Pregnancy

Bishop Score Chart

Content provided on this site is for entertainment or informational purposes only and should not be construed as medical or health, safety, legal or financial advice..WebMD experts and contributors provide answers to your health questions..WFMU is not for everyone. Do not take WFMU while pregnant or operating heavy machinery. Side effects include pregnancy or a compulsion to operate heavy machinery..Printables, coloring pages, recipes, crafts, and more from your child's favorite Nickelodeon and Nick Jr. shows..Aldine ISD parents demand answers after MacArthur student struck, killed.Find showtimes, watch trailers, browse photos, track your Watchlist and rate your favorite movies and TV shows on your phone or tablet! IMDb Mobile site.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..AOL Radio is powered by humans! Great radio is all about unexpected connections--the kind that an algorithm can't predict. Pick any station in any of the 30 genres .Get the latest weird news stories from all over the world. Find bizarre and offbeat news about people, nature and unexplained mysteries at ABC News..Guidelines for Safe Work Practices in Human and Animal Medical Diagnostic Laboratories Recommendations of a CDC-convened, Biosafety Blue Ribbon Panel.

Bishop Score Chart

Pregnancy 20 Weeks Pregnant

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..Printables, coloring pages, recipes, crafts, and more from your child's favorite Nickelodeon and Nick Jr. shows..WFMU is not for everyone. Do not take WFMU while pregnant or operating heavy machinery. Side effects include pregnancy or a compulsion to operate heavy .Content provided on this site is for entertainment or informational purposes only and should not be construed as medical or health, safety, legal or financial advice..WebMD experts and contributors provide answers to your health questions..AOL Radio is powered by humans! Great radio is all about unexpected connections--the kind that an algorithm can't predict. Pick any station in any of the 30 genres .Aldine ISD parents demand answers after MacArthur student struck, killed.Get the latest weird news stories from all over the world. Find bizarre and offbeat news about people, nature and unexplained mysteries at ABC News..Guidelines for Safe Work Practices in Human and Animal Medical Diagnostic Laboratories Recommendations of a CDC-convened, Biosafety Blue Ribbon Panel.Find showtimes, watch trailers, browse photos, track your Watchlist and rate your favorite movies and TV shows on your phone or tablet! IMDb Mobile site.

Anti Epileptics For Neuropathy An Australian View

Today's post from nps.org.au (see link below) is a very interesting look at the workings of anti-epileptic drugs in the treatment of neuropathy. It's always interesting to look at how different countries approach the treatment of chronic pain and/or neuropathy. In Australia, it's generally recommended that neuropathy patients are treated with a progressive scale of treatments, beginning with non-drug options and moving on, if necessary, via anti-depressants and anti-epilepsy drugs to opiates. This ties into a general world-wide approach to the disease but the article agrees that neuropathy is hard to treat, whatever you use to control the symptoms. Regarding anti-epileptic drugs, it concludes that the only two that are effective (however limited) are gabapentin and pregabalin. However, once again, this ignores Pfizer's own advice that pregabalin (Lyrica) is not suitable for particular groups of neuropathy sufferers (HIV- and diabetic neuropathy patients for instance) and it does seem strange that that advice from the makers is being overlooked across the world. This may partly be due to that fact that doctors see some successes with neuropathy patients being treated with Pregabalin but that doesn't take into account whether the drug is actually good for you or not. Whatever the issues around pregabalin, this is an interesting article for those already on anti-epileptics, or about to begin using them.

Treating neuropathic pain with anticonvulsants — which ones work?
Published in Health News and Evidence Date published: 10 January 2014

Summary
 
Neuropathic pain is a common form of chronic pain, with an array of drugs available for its treatment, including anticonvulsants.

A recent Cochrane review assessed the evidence around efficacy and safety for 10 anticonvulsant drugs used to treat neuropathic pain and found evidence of efficacy for only 2 — gabapentin and pregabalin.
The study provides support for the use of pregabalin and gabapentin in treatment of neuropathic pain, but was not able to distinguish between the 2 drugs in terms of efficacy for the treatment of painful diabetic neuropathy or postherpetic neuralgia. Nor was the study able to identify patients most likely to benefit from treatment with either drug.
Gabapentin and pregabalin are TGA-approved in Australia for the treatment of neuropathic pain. Currently, pregabalin is PBS subsidised when prescribed for neuropathic pain, and gabapentin is subsidised for this indication only under the RPBS. 

Practice points
Use a comprehensive clinical assessment to determine the cause of pain, its nature and severity, and the effect of the pain on the patient.1
Provide each patient with an individual management plan based on this assessment.1
Use a multidisciplinary approach to management that includes patients in decision making, and consider non-drug treatments first.1,2
Consider the TCA amitriptyline as first line if drug treatment is required.3
Consider next an anticonvulsant such as pregabalin or gabapentin if first line is unsuccessful.3
Conduct early and regular clinical reviews of patients on drug treatment.4
Refer patients whose pain relief is inadequate to a pain specialist, a multidisciplinary pain clinic or a palliative care service.3,5
Chronic pain in Australia

Chronic pain affects 1 in 5 Australian adults,6,7 with incidence increasing with age. Much of the burden of patient management falls on general practitioners.1

Chronic pain is Australia's third most costly health condition after cardiovascular diseases and musculoskeletal conditions.8 The total cost of chronic pain to the Australian economy was reported to be $34 billion in 2007, including $7 billion in health system costs.8

Neuropathic pain

Neuropathic pain is a form of chronic pain, and is difficult to treat effectively.3

Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory system9 and is usually described as burning, painful, cold or electric shocks. These symptoms may occur alongside tingling, pins and needles, numbness or itching.3,10

Causes include nerve damage, which can be followed by changes to the central nervous system.11 This condition can present for months or years, causing significant, disabling, moderate to severe pain.11
Neuropathic pain: Australian guidelines

Australian guidelines recommend that patients with chronic pain, such as neuropathic pain, have an individualised management plan. This plan should be linked to a comprehensive patient assessment to determine the cause of pain, its nature and severity as well as the effect of the pain on the patient.1

There is no generally accepted 'stepwise' approach to treatment of neuropathic pain. Australian guidelines recommend non-drug approaches first.1,5 Many drugs are available for the treatment of neuropathic pain, with TCAs and anticonvulsants the drugs of choice.3,5 However, comparative studies are limited, there is no evidence for differences in the relative efficacies of individual drugs5,11 and these treatments are often associated with adverse events.

Guidelines recommend starting drug therapy for neuropathic pain with a TCA (such as amitriptyline) or an anticonvulsant.3,5 The anticonvulsants gabapentin and pregabalin are recommended by Therapeutic Guidelines as a second-line treatment of neuropathic pain after the TCA amitriptyline.3 The dose of the drugs can be escalated at weekly intervals if tolerated, but it may take several weeks to achieve clinical efficacy.

*TCAs are an established treatment for neuropathic pain but are not approved by the TGA for this indication.
Efficacy and safety of anticonvulsant drugs for neuropathic pain: Cochrane review

The Cochrane Collaboration recently reviewed the efficacy and safety of 10 anticonvulsant drugs for the treatment of neuropathic pain and fibromyalgia.11 This was not a new systematic review of individual studies,11 but compiled data from the 10 previous Cochrane reviews published between 2009 and 201312-21 and comprising 17,955 participants (with at least moderate pain) from 91 studies.11-21

These studies were placebo controlled, double blind, randomised controlled trials. Results were presented for each different drug for 3 different neuropathic pain conditions — painful diabetic neuropathy, postherpetic neuralgia and central neuropathic pain — and for fibromyalgia. This article will focus on the findings related to neuropathic pain.

Evidence of pain reduction for gabapentin and pregabalin only

This Cochrane review reported on efficacy as well as patient impression of improvement, and investigated outcomes including patient-reported pain relief of 50% or more and Patient Global Impression of Change (PGIC).11 Results were reported in terms of whether patients were more likely to achieve the benefit with the treatment than by taking placebo.11

A reduction in pain intensity of 50% or more is considered to be a clinically relevant benefit.3

The Patient Global Impression of Change (PGIC) is a measure of global improvement with treatment where participants rate their improvement from 'very much improved' to 'very much worse' with 'no change' as the mid-point.22

Among the 10 anticonvulsants studied, evidence of pain reduction was only found for gabapentin and pregabalin.11 People taking either of these drugs were more likely to report pain relief of 50% or more for painful diabetic neuropathy and postherpetic neuralgia than those taking placebo†.11 People taking pregabalin for the treatment of central neuropathic pain were also more likely (compared to placebo) to report pain relief of 50% or more†.11

The number of patients who would need to be treated with pregabalin or gabapentin for one patient to see this improvement was estimated to range from 4 to 10 for >=50% reduction in pain.11 Therapeutic Guidelines advises that for pain treatment to be considered to be effective, the number needed to treat for one person to achieve an outcome should be between 2 and 5.3
Further findings

The Cochrane review also found that people taking gabapentin for painful diabetic neuropathy or postherpetic neuralgia were more likely to rate their improvement as 'excellent' or 'very good or excellent' than those people taking placebo*.11

People taking lacosamide or pregabalin for painful diabetic neuropathy were more likely to rate their improvement as 'very good or excellent' than those people taking placebo*.11 The data suggest that the benefit with pregabalin may be dose dependent, as a benefit was seen with the 600mg/day dose but not the 300mg/day dose. Data for other drugs was not presented.11
*These results were statistically significant. The rating of improvement by patients was determined using the PGIC.

Carbamazepine: an accepted treatment for neuropathic pain but insufficient evidence of effect

Carbamazepine is an accepted treatment in Australia for neuropathic pain but is not TGA-approved for this indication.5

This Cochrane review found that evidence of efficacy for carbamazepine was of low quality and consequently likely to be subject to a number of biases that would overestimate efficacy.11 Most studies with carbamazepine were less than 4 weeks' duration, in contrast to studies with other drugs that were of 10-12 weeks or longer.11
Safety

The risk of adverse events in people taking anticonvulsant drugs is high, with CNS adverse events relatively common and often dose dependent, particularly for pregabalin and lacosamide.11 In this Cochrane review, available data showed that only oxcarbazepine statistically significantly increased the risk of a serious adverse event in people taking anticonvulsants for either neuropathic pain or fibromyalgia compared to those taking placebo.11

Limitations of the study

This Cochrane review benefits from, and is also limited by, the fact that the data are taken solely from previous Cochrane reviews. While this ensures that each study included is of a comparative and high standard, it also means that some trials would have been omitted.11 For example, levetiracetam does not feature in a Cochrane review and therefore was not assessed in this study, although it has been tested in other randomised controlled trials.11
Conclusions: pregabalin and gabapentin are the preferred anticonvulsants

While all evidence considered in this Cochrane review was described as 'second tier' or lower due to the potential for biases to overestimate efficacy, the results provide support for current Australian guidelines.3
Treatment best practice and implications for patients
Assess the nature of the pain experience and inform people of realistic outcomes with treatment.23,24
Provide each patient with an individualised management plan based on a comprehensive clinical assessment of their pain.1
The primary treatment goal in most cases is to make the pain tolerable — not usually to eliminate the pain.23
Aim for medium-term drug therapy with a drug holiday after 6 months. Patients who relapse during a drug holiday can resume treatment.
Conduct early and regular clinical reviews.

This Cochrane review supports the use of pregabalin and gabapentin as part of a management plan for neuropathic pain, but is not able to distinguish between their efficacies for treatment of painful diabetic neuropathy or postherpetic neuralgia. Drug therapy is best used as part of a multifaceted, multidisciplinary, active self-management approach to the physical, psychological, social and vocational impacts of neuropathic pain.2

Analgesic failure is common in the treatment of neuropathic pain and there is currently no evidence to inform which patients are most likely to benefit from what drugs and indeed the order in which drugs should be taken to optimise outcomes.11 However, patients who do not respond to one drug may respond to another, even within the same drug class.5 Combination drug therapy may be needed by many patients.24,25 A specific combination of treatments cannot be recommended due to the limited number of studies for any combination therapy, as well as other study factors, such as the limited trial size and duration.25

More information is available from NSW Health.

Refractory, severe neuropathic pain

Assistance from a pain specialist and a multidisciplinary pain service may be required for refractory, severe neuropathic pain, as treatment options are complex.2
Further information
Pregabalin (Lyrica) for neuropathic pain (NPS Medicinewise RADAR: April 2013).26
Information for patients

Patient information leaflet: Key points for patients about chronic pain (Therapeutic Guidelines).

References

1. eTG complete [Internet]. Therapeutic Guidelines: Analgesic. Melbourne: 2012. [Online] (accessed 19 December 2013).
2. Australian Pain Society. Evidence-based recommendations for the pharmacological management of neuropathic pain. Position Statement, June 2008. [Online] (accessed 20 October 2012)
3. eTG complete [Internet]. Therapeutic Guidelines: Neurology. Melbourne: 2011. [Online] (accessed 19 December 2013).
4. National Institute for Clinical Excellence (Nice). Neuropathic Pain: The pharmacological management of neuropathic pain in adults in non-specialist settings. NICE Clinical Guideline 173. Manchester: National Institute for Clinical Excellence, 2013. [Full text]
5. Rossi S e. Australian Medicines Handbook, 2013. Adelaide.
6. Hogg MN, Gibson S, Helou A, et al. Waiting in pain: a systematic investigation into the provision of persistent pain services in Australia. Med J Aust 2012;196:386-90. [PubMed]
7. Blyth FM, March LM, Brnabic AJ, et al. Chronic pain in Australia: a prevalence study. Pain 2001;89:127-34. [PubMed]
8. Access Economics Pty  Ltd. The high price of pain: the economic  impact of persistent pain in Australia. Sydney Deloite Access Economics, 2007 [Full text]
9. Jensen TS, Baron R, Haanpaa M, et al. A new definition of neuropathic pain. Pain 2011;152:2204-5. [PubMed]
10. Votrubec M, Thong I. Neuropathic pain — a management update. Aust Fam Physician 2013;42:92-7. [PubMed]
11. Wiffen PJ, Derry S, Moore RA, et al. Antiepileptic drugs for neuropathic pain and fibromyalgia — an overview of Cochrane reviews. Cochrane Database Syst Rev 2013;11:CD010567. [PubMed]
12. Birse F, Derry S, Moore RA. Phenytoin for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2012;5:CD009485. [PubMed]
13. Corrigan R, Derry S, Wiffen PJ, et al. Clonazepam for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2012;5:CD009486. [PubMed]
14. Gill D, Derry S, Wiffen PJ, et al. Valproic acid and sodium valproate for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2011:CD009183. [PubMed]
15. Hearn L, Derry S, Moore RA. Lacosamide for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2012;2:CD009318. [PubMed]
16. Moore RA, Straube S, Wiffen PJ, et al. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev 2009:CD007076. [PubMed]
17. Moore RA, Wiffen PJ, Derry S, et al. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2011:CD007938. [PubMed]
18. Wiffen PJ, Derry S, Lunn MP, et al. Topiramate for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2013;8:CD008314. [PubMed]
19. Wiffen PJ, Derry S, Moore RA. Lamotrigine for acute and chronic pain. Cochrane Database Syst Rev 2011:CD006044. [PubMed]
20. Wiffen PJ, Derry S, Moore RA, et al. Carbamazepine for acute and chronic pain in adults. Cochrane Database Syst Rev 2011:CD005451. [PubMed]
21. Zhou M, Chen N, He L, et al. Oxcarbazepine for neuropathic pain. Cochrane Database Syst Rev 2013;3:CD007963. [PubMed]
22. Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005;113:9-19. [PubMed]
23. Moulin DE, Clark AJ, Gilron I, et al. Pharmacological management of chronic neuropathic pain - consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag 2007;12:13-21. [PubMed]
24. Dworkin RH, O'Connor AB, Audette J, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc 2010;85:S3-14. [PubMed]
25. Chaparro LE, Wiffen PJ, Moore RA, et al. Combination pharmacotherapy for the treatment of neuropathic pain in adults. Cochrane Database Syst Rev 2012;7:CD008943. [PubMed]
26. National Prescribing Service. Pregabalin (Lyrica) for neuropathic pain. RADAR; April 2013. [Full text]

http://www.nps.org.au/health-professionals/health-news-evidence/latest-issue/treating-neuropathic-pain

Fluoroquinolone Antibiotics And Neuropathy A Report

Today's important post from the Journal of Investigative Medicine at hic.sagepub.com (see link below) is another piece of the jigsaw showing how dangerous fluoroquinolone antibiotics can be for people whether living with, or prone to, nerve damage (neuropathy). It's quite long but worth reading because it's very important to check what sort of antibiotics your doctor is prescribing. Permanent neuropathy from an antibiotic is no joke and is so easily avoided - it's in your own interests to check the label on the box and question your doctor's choice afterwards.
 

Permanent Peripheral Neuropathy
A Case Report on a Rare but Serious Debilitating Side-Effect of Fluoroquinolone Administration
Published July 27, 2014, doi: 10.1177/2324709614545225 Journal of Investigative Medicine High Impact Case Reports April-June 2014 vol. 2 no. 2 2324709614545225

Jacquelyn K. Francis, BA1
Elizabeth Higgins, MD1
1Albany Medical College, Albany, NY, USA
Jacquelyn K. Francis, Albany Medical College, 47 New Scotland AvenueAlbany, NY 12208, USA. Email: francij@mail.amc.edu

Abstract

The health risks and side effects of fluoroquinolone use include the risk of tendon rupture and myasthenia gravis exacerbation, and on August 15, 2013, the Food and Drug Administration updated its warning to include the risk of permanent peripheral neuropathy. We present a case of fluoroquinolone-induced peripheral neuropathy in a patient treated for clinically diagnosed urinary tract infection with ciprofloxacin antibiotic.

Introduction

While there has been success in recent years in decreasing the numbers of unnecessary antibiotic administrations,1 still rampant in medical practice is the inappropriate use of antibiotics. Fluoroquinolones administration is no different. These bactericidal agents are capable of central nervous system (CNS) penetration,2 with an impressive treatment profile that includes an enhanced spectrum of activity, high oral bioavailability, high serum drug concentration that parallels that of intravenous drug administration, and rapid mechanism of action. It is for this reason that physicians favor these drugs for treatment of simple infections, which range from uncomplicated urinary tract infections (UTIs) and gastrointestinal infections to lower respiratory infections and pneumonias. According to established guidelines, however, these antibiotics are recommended as drugs of last resort and for treatment of cases refractory to other safer antibiotic alternatives. Reports in recent years of the adverse drug events of these drugs are on the rise, with not only an overrepresentation of common antibiotic complaints, including diarrhea, nausea, and headache that occur at rates higher than most other antimicrobials on the market,3 but there is also mounting evidence suggesting the potential for long-term adverse peripheral nervous system (PNS) effects from fluoroquinolone usage. The need for physicians to be judicious when prescribing these drugs is therefore paramount.

Case Presentation

A 57-year-old Caucasian female presented to outpatient clinic with complaints of dysuria, polyuria, and urinary urgency. Urinalysis showed 2+ leukocytes and trace blood. Based on her clinical presentation, she was treated for UTI with a ciprofloxacin regimen of 250 mg twice a day for 5 days. Subsequent urine culture showed no evidence of organism, and against advice for reevaluation, she was lost to follow-up. She presented 2 months later reporting whole body burning and alopecia. The burning, she claimed, started 2 or 3 days after completion of the prescribed course of ciprofloxacin. The burning lasted 3 weeks and resolved only to recur, unrelentingly, 3 weeks later. She had been unable to adorn clothing during this time, for she said this triggered whole body burning. At the point wherein she was finally able to wear clothing, she presented to the clinic. Hydration and Epsom salt soaks provided no relief. She reported pain of 10/10. Her past medical history is significant for trigeminal neuralgia, in remission for 12 years. The patient was on no medications at the time of her visit. She has no specific medication allergies, but does get gastrointestinal symptoms with opioids, namely, fentanyl. Physical examination was unremarkable. Vitals at the time that she was seen included the following: blood pressure 132/78 mm Hg, temperature of 97°F, heart rate of 60 beats per minute, respirations of 18. Her body mass index was 17.94, down from 20.3 two months earlier. On detailed neurologic examination, cranial nerves II through XII were intact bilaterally. There was no pronator drift of outstretched arms. There was some muscle wasting in biceps; however, overall tone was normal. Strength was full bilaterally. Reflexes were 2+ and symmetric at the biceps, triceps, knees, and ankles. Plantar responses were flexor. Light touch and pinprick produced pain and paresthesias diffusely in the upper and lower extremities; however, position sense and vibration sense were intact in fingers and toes. Rapid alternating movements and fine finger movements were intact. There was no dysmetria on finger-to-nose and heel-knee-shin. There were no abnormal or extraneous movements. Romberg was absent. The patient’s posture was normal. Gait was steady with normal, though tentative, steps, base, arm swing, and turning. Heel and toe walking were normal. Tandem gait was normal. She had no discernable rash or skin lesions.

Subsequent complete blood work analysis to check for an electrolyte abnormality basis of her complaints was unremarkable. Her complete blood count was normal with a hematocrit of 41%. Her vitamin B12 level was 258 pg/mL, with a normal range of 200 to 900 pg/mL. Her thyroid stimulating hormone level was 2.05, with a normal range of 0.4 to 6.0. Her immunoglobulin levels were normal. Her vitamin D level was 13 nmol/L (optimal >30 nmol/L). Copper level was 98 mg (normal 50-80 mg). Vitamin E was normal at 12.7 µg/mL (normal range = 5.5-17 µg/mL). Vitamin B1 was normal at 5.4 µg/dL (normal range = 2.5-7.5 µg/dL).

Her blood work and further questioning could provide no new medical etiology for her symptoms, and so the patient was subsequently sent for complete neurological workup. Workup included heavy metal toxicity screening to assess for possible heavy metal exposure to lead, mercury, cadmium, and zinc. Electrophysiological studies were also done to assess neuromuscular nerve action potential transmission, a test that could discern a neuromuscular disorder etiology. Three-millimeter skin punch biopsy to assess for small fiber density and possible neurologic process were also done. These tests were all negative. Neurological workup could not determine a unique cause of her symptoms. It was concluded that if her symptoms were neurologic-based, it was, in fact, a multifocal process.

Two years after the initial onset of symptoms, the patient continues to suffer from polyneuropathies chronologically related to ciprofloxacin use. At her most recent visit, she describes constant pain of 7/10 and is unable, she states, to ambulate for more than 2 minutes, without intense shooting pains up and down her lower extremities. She describes “pins and needles” up and down her legs and thighs radiating to her buttocks and feet. She claims that her upper body and abdomen have now been spared of such feelings. She describes severe alopecia and ambulates now with a broad-based gait. She describes being on permanent disability because of her condition. The rest of her physical examination remains unchanged. There are no gross neurological deficits discernible on neurologic examination. The patient remains on amitriptyline 20 mg daily for control of her pain symptoms.

Discussion

Fluoroquinolones are fluorinated quinolones, the only bactericidal agent in the antibiotic class capable of directly inhibiting DNA synthesis. They do this by promoting cleavage of bacterial DNA in the DNA–enzyme complexes of DNA gyrase and topoisomerase IV.2 Generally, gram-negative antibacterial activity correlates with inhibition of DNA gyrase, and gram-positive antibacterial activity corresponds with inhibition of DNA type IV topoisomerase.2,4 With the introduction of these drugs in the 1960s, physicians were able, for the first time, to treat severe gram-negative infections orally.3 The first successful fluorination of part of the quinolone drug in 1986, in the form of norfloxacin, brought with it the capability of crossing the blood–brain barrier and achieving CNS penetration.5 This and the already great treatment profile in the form of enhanced spectrum of activity, high oral bioavailability, high serum drug concentration comparable to intravenous infusion, and rapid mechanism of action added to the popularity of these drugs ultimately resultingin the indiscriminate use of these drugs. The enhanced treatment profile of these drugs came at a price however, with adverse effects so severe that use of many fluoroquinolones since then being restricted or the drugs withdrawn from the market entirely.6,7

One of the challenges of diagnosing a patient with fluoroquinolone-associated peripheral neuropathy is the diffuse, confusing, and delayed array of symptoms that can occur. A 1996 study first brought these adverse effects to light.7 While patients on the fluorinated drugs exhibited less side effects than those associated with first-generation quinolone predecessors, such as nausea and gastrointestinal disturbances, 0.9% to 1.6% experienced adverse reactions relating to the peripheral and central nervous system, including headache, dizziness, drowsiness, agitation, psychosis, and convulsions, as well as peripheral sensory disturbances, symptoms that had never been complained of prior, at least not on any significant scale. Of these patients, 81% had symptoms occurring within 1 week of drug administration, with paresthesia being the mainly reported symptom. Five years later, a 2001 study found that contrary to previous reports suggesting that fluoroquinolone-associated PNS events are mild and short term, 80% of study participants reported severe events that typically involved multiple organ systems, especially the PNS, with symptom onset as early as 24 hours within initiation of treatment. 58% of these cases had symptoms lasting greater than 1 year.8

Another 2001 formal study that sought to assess the prevalence of fluoroquinolone-induced PNS adverse side effects highlighted the severity of these effects. The study concluded that there was a high association between fluoroquinolone antibiotics and severe, long-term adverse PNS and multiple organ system effects that included PNS sensory symptoms (91%), peripheral neuropathy motor symptoms (55%), and CNS effects (75%). Over 80% of the patients surveyed had sequalae stemming from fluoroquinolone use that lasted for greater than 1 year.9 A subset of these patients and their adverse drug events are included in Table 1.


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Table 1.

15 of the 45 Total Reported Cases of Fluoroquinolone-Associated Events in the Literature6.

Despite these seemingly significant numbers and overwhelming reports from patients, physicians continue to prescribe fluoroquinolone antibiotics unsystematically, against US Food and Drug Administration recommendations. The pressures of health care facilities and patients alike to increase patient turnaround and quickly alleviate symptoms may compound this problem 10.

As highlighted in the aforementioned case, the peripheral neuropathy reported with fluoroquinolone administration can be severe, debilitating, and permanent. It is for this reason that physicians need to practice due diligence when prescribing not only antibiotics, but any drug. Physicians also need to practice vigilance in the event of an adverse reaction. They can do this with careful follow-up of patients and ensure that patients are aware of all the side effects that may be associated with their prescribed drug. Patients need to know what to look for and where to go in the event that one of these symptoms become manifest. It is our hope that the updated FDA warning and presentation of this case will encourage physicians to be more conscientious of their treatment selections.

Take Home Points

The FDA recommends that fluoroquinolones be used as a drug of last resort and for treatment of cases refractory to other safer antibiotic alternatives.

The FDA updated their black box warnings on all fluoroquinolones to stress the rapidity of onset and permanence of peripheral neuropathy associated with their use.

Physicians should be aware of the risks and side effects associated with the drugs that are prescribed and be able to inform patients of the risks associated with the use of these drugs.

Physicians should always aim to administer the least broad spectrum antibiotic possible based on known sensitivities and regional resistance patterns.

Article Notes

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

This article is distributed under the terms of the Creative Commons Attribution 3.0 License (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (http://www.uk.sagepub.com/aboutus/openaccess.htm).

References
1.↵
US Food and Drug Administration. FDA drug safety communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection. http://www.fda.gov/Drugs/DrugSafety/ucm365050.htm. Accessed August 15, 2013.
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Scheld M. Quinolone therapy for infections of the central nervous system. Rev Infect Dis. 1989;11(suppl 5):S1194-S1202.
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Turnidge J. Pharmacokinetics and pharmacodynamics of fluoroquinolones. Drugs. 1999;58(suppl 2):29-36.
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Hooper DC,
Wolfson JS. Mechanisms of Quinolone Action and Bacterial Killing. Quinolone Antimicrobial Agents. 2nd ed. Washington, DC: American Society for Microbiology; 1993:53-57.
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Kelentey B,
Kerr M,
Tao Z,
Purushotham KR,
Humphreys-Beher MG,
Zelles T. Inhibition of rat parotid gland growth response induced by chronic isoproterenol following treatment with quinolone antibiotic. Mol Cell Biochem. 1996;165:55-63.
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Cohen JS. Peripheral neuropathy associated with fluoroquinolones. Ann Pharmacother. 2001;35:1540-1547.
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Hedenmalm K,
Spigset O. Peripheral sensory disturbances related to treatment with fluoroquinolones. J Antimicrob Chemother. 1996;37:831-837.
Abstract/FREE Full Text
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Gold L,
Igra H. Levofloxacin-induced tendon rupture: a case report and review of the literature. J Am Board Fam Pract. 2003;16:458-460.
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Mandell L,
Tillotson G. Safety of fluoroquinolones: an update. Can J Infect Dis. 2002;13:54-61.
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Linder JA,
Huang ES,
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Gonzales R,
Stafford RS. Fluoroquinolone prescribing in the United States: 1995 to 2002. Am J Med. 2005;118:259-268.
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http://hic.sagepub.com/content/2/2/2324709614545225.full

Garden remedies for skin care

This entry is a part of the wonderful Herbwifery Blog Party!

Summer Skin Care.....
is all about fresh herbs and delicious fun. Since the gardens and fields are full of surprises now, there are endless ways to treat and care for your skin.
I tend to focus on things that don't attract mosquito's and ticks, since I am outside so much. I don't use sweet stuff like Roses and Jasmine until nighttime when I'll be sleeping indoors.

But many flowers are lovely and do not attract hungry critters. Above, is the start of the explosive, magnificent Monarda flower (M. Didyma) which attracts hummingbirds and heals many ailments. For skin care, I like to make an infusion, cool it, and use it for a facial toner. In fact, most of the following plants, I use this way. I like to make a small jar, since every few days I'll return it to the garden before it turns, and make a fresh one.

Beautiful Basil. Fill a jar with Basil and cover with honey to make a potion to eat and smear on your face. Basil is great for oily, problematic skin, perfect for summer skin care. The basil honey takes only a week to steep, strain and add to tea to drink, or to cosmetic clay for a lovely mask.

This beautiful dark green leaf is of course, the famous Comfrey, full of soothing and mending qualities. I've been using it this past week for my daughter's wrist, which she badly sprained playing Goalie. I macerated it with tinctures of Yarrow, Meadowsweet, and St. Johnswort tincture and oil both. We keep the poultice on for as long as comfortable. The swelling and pain are greatly reduced, and the healing is expedited. By chance there is any hairline fracture, the Comfrey will mend this as well - and as a side note, there is no broken skin. Using comfrey on deep cuts can trap bacteria and lead to infection.

On the lighter side, Comfrey leaf is a super-soother. A cooled infusion is amazing on rashes, red itchy skin, dry skin, or baby's heat rash. A comfrey leaf vinegar is fabulous for moisturizing dry hair as well.

For Poison Ivy, make a big pouch of Comfrey leaf, mugwort leaf, and oats, and add to the bath while filling. The soothing and astringent combination will feel great.

To make a gloriously green healing oil, cut several leaves and place into a double boiler. Gently keep at warm for a couple of hours, being sure not to let it get too hot as to burn the oil. Alternate the stove on and off throughout the day. Let steep overnight, off. Strain in the morning. If you feel you have too much moisture, let stand for a day and pour the oil off, leaving the water behind. If you make the oil using a blender you will have more trouble with water content. If you use a crock pot, be sure to monitor the heat more carefully - they get very hot!


This lovely yellow flower will soon be a crunchy, cooling cucumber. Many garden veggies are great for the skin too! Sliced cukes on the eyes are cliche - but effective for reducing swelling or soothing sunburn. Tomato leaves gave a very pretty aroma, and make a nice toner. Infuse the leaves in part water and part vodka, and add any additional plants you like from the garden, such as Marigold petals, lettuce leaves, kale, strawberry leaves, or carrot tops.




Foot Flowers ...... Summer can be a time for troubled feet if you are hiking through hot sun, wet rivers, and itchy grass. My kayak shoes usually end up with poison ivy on them too, sneaking in through the side holes and making very pesky bumps between my toes.

End an adventurous day with an herbal foot soak. First, make a strong tea, steeping about 1/2 an hour, and make at least a quart of it, with fresh Oregano (shown above), Peppermint, Sage, Rosemary, Lavender, and Marigold or Calendula blossoms. Of course you can be creative with what plants you have available ... leaning towards aromatic and antiseptic herbs. Then, if you want it cold, refrigerate it. If you want it warm, go ahead and pour it into a basin and fill the rest with plain water. If you want, you can add witch hazel extract as well. Grab a good book, a cup of tea to drink, and soak away, as long as you like, but usually at least 20 minutes long.

For foot care on the trail, pack a combination of comfrey root powder, baking soda, kaolin clay or arrowroot powder, and essential oils mixed in if you like.


A salve of Sage and Yarrow are fantastic on the piggies too!

Eyes ..... Rose petals are so perfect for curing red hot eyes, whether from swimming, sun, or computer fatigue. An infusion or distillate applied a few times a day with a cotton ball is a real relief. A rose sitz bath is used also for staunching bleeding in postpartum women, so is helpful to constrict overheated varicose veins during the summer. Rose tinctures effective in helping to prevent spring nosebleeds if taken internally.



Every July, on or around my birthday, I honor this plant of gold and harvest her blossoms and buds. I put them all into jars and fill with olive oil. after 6 weeks I have a blood red oil that heals virtually everything. My son, who has sensitive skin, swears by it for every ailment he has, and won't use anything else because he claims it's the only thing that reliably does not sting. For nerve pain, sunburn, chapped skin, sore muscles, and anything else, St. Johnswort oil or salve is a first-grab remedy.

For days in the sun, I make a squeeze bottle with SJW oil and Lavender hydrosol (since the hydrosol won't go bad like water) and a tad of liquid chlorophyll to shake and apply frequently throughout the day. Since it's liquid and not a cream or salve, it won't melt at the beach. This also makes a perfect daily moisturizer. Add a little geranium essential oil for extra bug-repelling action if you will be gardening or hiking.


More lovely herbs that I like to use during the hot months ..........



Lemon Balm ..... Melissa Off.

Anise Hyssop ..... Agastache Foeniculum

And a few more Recipes :) ....................

Rose-Rosemary Toner:

1/2 pint each fresh rose petals and fresh rosemary sprigs

Add 1 tablespoon each:

Brandy, Honey, and Apple Cider Vinegar

Fill remainder with water or hydrosol of choice.

Let steep in the sun for one day and one night. strain and refrigerate. Use at night to restore moisture and elasticity to the skin, and just because it feels and smells good!

Poison Ivy spray:

2 oz Yarrow/Mugwort infusion

10 drops peppermint essential oil

5 drops German Chamomile essential oil

Shake and spray as often as needed.

Marigold Mask:

Steep fresh Calendula flowers in good honey for 1 week. Strain, and mix equal parts Calendula honey with Green, pink, or white clay, and apply as a mask for 20 minutes.

Herbs & Honey Liquid Soap Infusion:

Place a pint of fresh herbs into a blender. For example, Lemon balm, Peppermint, Sage, Rosemary, and Verbena.

Cover, barely, with liquid castille soap. Do not pour the whole thing in .... just enough to create a maceration. Turn the blender on low to blend.

Transfer to a wide mouth jar. Fill remainder with liquid castille soap and steep for three days.

Strain, and add about 1/3 cup honey and stir. Pour into a big squeeze bottle and enjoy!

Happy Summer!

Sexual Problems for Men with Neuropathy

This is another topic which has been covered before on the blog but recently a 50 year old man from Arkansas mailed and said that despite having both neuropathy and HIV for some years, his doctor had told him that his erectile disfunction was a result of his age and a lifetime of smoking, nothing more. This may perhaps be the case but some doctors need to realise that ED can definitely be a result of neuropathic complaints and not dismiss someone's concerns with a cliche. Losing their potency is a really big deal for many men and having a genuine medical reason for it can perversely, ease the blow. This article is from medicalxpress.com (see link below) and shows the link between ED and neuropathy revealed by the results of Spanish research in this area.

Erectile dysfunction study shows high prevalence of peripheral neuropathy
November 15, 2011

Spanish researchers have uncovered clear links between erectile dysfunction (ED) and peripheral neuropathy, according to a paper in the December issue of the urology journal BJUI.

"Up to now the impact of damaged nerves in the peripheral nervous system on ED has been underestimated" says lead author Dr Consuelo Valles-Antuña, from the Department of Neurophysiology at the Hospital Universitario Central de Asturias in Oviedo.

"However our study of 90 patients shows that men with more severe symptoms of peripheral neuropathy, which can be caused by disease, trauma or illness, had greater self-reported ED and required more aggressive treatment.

"Our findings underline the importance of clinicians carrying out neurophysiological tests on patients with ED, particularly in the pelvic area."

The research team, which included experts on both neurophysiology and urology, studied 90 consecutive patients with sexual problems recruited from the hospital's Department of Andrology.

ED was diagnosed using the five-item version of the International Index of Erectile Dysfunction (IIEF-5) and the occurrence of peripheral neuropathy was predicted using the Neuropathy Symptom Score.

A range of neurophysiology tests were carried out to assess the presence of large and small fibre peripheral neuropathy.

The researchers found that:

•The average age of the men in the study was 54 years of age. Ten per cent were under 40 and only two per cent were over 70.
•No significant correlation between IIEF-5 scores and increasing age was found. In fact, younger patients had lower (worse) IIEF-5 scores, which could be due to higher expectations or a higher number of organic risk factors.
•Just under a third of the patients (30 per cent) had cardiovascular disease, 16 per cent had neurogenic risk factors (relating to the nerves or nervous system) 16 per cent had diabetes and 11 per cent had no risk factors. Just over seven per cent had been diagnosed with mental health issues.
•Patients with more severe symptoms of peripheral neuropathy showed lower (worse) IIEF-5 scores and required more aggressive therapies.
•Neurophysiological exploration confirmed that just under 69 per cent of patients had neurological pathology. Of these, 61 per cent had some type of peripheral neuropathy and eight per cent had myelopathy - problems with their spinal chord.
•Just under 38 per cent of the patients had polyneuropathy, which occurs when a number of the peripheral nerves throughout the body malfunction simultaneously. Of these nine per cent had small fibre neuropathy, damage to the small unmyelinated peripheral nerve fibres, and just over 14 per cent had pudendal neuropathy, affecting the somatic nerve in the pelvic region.
•The findings of the sympathetic skin response tests underlined the importance of checking nerve problems in the pelvic area, as response alterations were much more common in the penis than hand or foot.
•No association between neurophysiological diagnosis and IIEF-5 scores was detected, but a statistical association was found between neuropathy and the Neuropathy Symptom Scores.
."To our knowledge, this is the first study to assess the whole peripheral nerve fibre spectrum in a non-selected group of patients with erectile dysfunction" says Dr Valles-Antuña.

http://medicalxpress.com/news/2011-11-erectile-dysfunction-high-prevalence-peripheral.html