How the Brain Controls your Nerve Reactions

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

Alcohol And Nerve Damage Not To Be Underestimated

Today's post from diabetic2.tophealthychoices.com (see link below) looks at a widely underestimated cause of nerve damage and neuropathic complications and that is alcohol. Most people are well aware of the results of over-indulging in alcohol but may not be aware what it can do to your nervous system and neurological functions. This article looks at what it is, what the symptoms are and how it is treated, with the conclusion that like most forms of neuropathy, there is no cure. Once the damage is done, you're left with trying to control the symptoms. It also goes without saying that if you already have neuropathy, alcohol may help you temporarily forget but will only worsen the condition in the long run. Everything in moderation folks!

 Alcoholic Neuropathy – Symptoms, Causes and Treatment
17 Jul, 2015

As Dr. Siwek mentions in this week’s episode of the Pain Channel, April is Alcohol Awareness Month. When we think of alcohol awareness, the first things that pop into our minds are drunk driving, designated drivers, and sobriety tests, right? Popular culture has taught us to correlate drinking with driving consequences. But Alcohol Awareness Month is truly about the health consequences associated with alcoholism such as neurologic complications, vitamin deficiencies, liver disease, and much more.

Neurologic complications of alcohol abuse may also result from nutritional deficiency, because alcoholics tend to eat poorly and may become depleted of thiamine or other vitamins important for nervous system function. Persons who are intoxicated are also at higher risk for head injury or for compression injuries of the peripheral nerves. Sudden changes in blood chemistry, especially sodium, related to alcohol abuse may cause central pontine myelinolysis, a condition of the brainstem in which nerves lose their myelin coating. Liver disease complicating alcoholic cirrhosis may cause dementia, delirium, and movement disorder. _Healthline.com

What is Alcoholic Neuropathy?

Alcoholic neuropathy, also known as alcoholic polyneuropathy, is the direct result of overconsumption of alcohol over extended periods of time. Unfortunately, alcoholics to not eat right, nor exercise, so their bodies slowly become deficient in several nutritional areas. There is a continual debate over whether it is the alcohol itself, or malnutrition that accompanies alcoholism, which is the root cause of alcoholic neuropathy.

The causes of alcoholic neuropathy are extensive, from irregular lifestyles leading to missed meals and poor diets, to a complete loss of appetite, alcoholic gastritis, constant vomiting, and damaging of the lining of the gastrointestinal system. All of these symptoms cause nutritional deficiencies, and when the lining of the gastrointestinal system becomes compromised, the body is not able to absorb the proper nutrients.

Alcohol consumption in extremes can also increase the toxins within a person’s body such as ethanol and acetaldehyde, which many believe are directly linked to alcoholic neuropathy.

What are the Symptoms of Alcoholic Neuropathy?

In most cases, alcoholic neuropathy sets gradually into the body so that the individual does not realize they have this condition until it is deeply rooted within their system. While weight loss is an early warning sign, it is also a side effect of heavy drinking, so most individuals with alcohol conditions do not realize what their body is trying to tell them. Painful paralysis and motor loss is the first symptom that individuals tend to truly take notice of. According to Alcoholism-Solutions.com, the following is a list of possible symptoms of alcoholic neuropathy:

Normal symptoms can include:

loss of sensation
tingling in the feet/hands
weak ankles
weakened muscles and a burning feeling in the feet.

Gastrointestinal symptoms can include:

loose bowel movements
feelings of nausea, possibly vomiting and constipation.

Men may experience:

the inability to hold liquid (incontinence)
and even impotence in some cases.

In severe occurrences of alcoholic neuropathy:

the autonomic nerves are damaged
autonomic functions are involuntary, like the heart beat and respiration.

Because this chronic condition effects the brain and nerves, pain can be intense and constant, sharp and quick, or dull and prolonged, and cramping may occur in muscles without warning.

Treatment of Alcohol Neuropathy

Most pain doctors in Arizona will tell you that there is no known cure for alcohol neuropathy, but there are successful pain management and treatment methods to help patients get back into life. At this point, when a patient has been diagnosed with alcohol neuropathy, a pain doctor’s best intention is to control the pain. Once that damage has been done from this chronic condition, unfortunately it cannot be undone. However, the pain can be controlled.

Obtaining from alcohol consumption will be the pain doctor’s first course of treatment. Whether it’s through counseling, Alcoholic’s Anonymous meetings, or in-house psychological evaluations, kicking the habit is the first step. This will be the toughest step for anyone living with alcohol neuropathy.

Next, your pain doctor will want to manage your nutritional intake through medication and a strict diet. Using a multidisciplinary team of industry experts, your pain doctor will no doubt sit you down with a nutritionist to determine the best course to get you back on track with a healthy diet. Multivitamins are also a key aspect in nourishing your body.

Physical therapy is usually called for in cases of alcohol neuropathy due to the great damage that has been done to the nerves. Since motor loss is a symptom of this chronic condition, your pain doctor will want to bring blood flow and life back into the affected areas of your body. One of the best ways to do this is through exercise and physical therapy.

Most individuals who abuse alcohol are also at great risk for abusing pain medication while going through pain management treatment, which is always a concern for pain doctors in Arizona. According to NYTimes Health, the least amount of medication needed to reduce symptoms is advised, to reduce dependence and other side effects of chronic use.

Common medications may include over-the-counter analgesics such as aspirin, ibuprofen, or acetaminophen to reduce pain. Stabbing pains may respond to tricyclic antidepressants or anticonvulsant medications such as phenytoin, gabapentin, or carbamazepine.

While it’s deemed impossible to reverse the damage already done to the body’s nerves, pain doctors can help patients living with alcoholic neuropathy reduce and control pain and get back into life. Of course, the best way to prevent this chronic condition is to respect your alcohol intake, but if you are suffering from this debilitating condition speak immediately to an Arizona pain specialist about your options at http://www.ThePainCenter.com.

http://diabetic2.tophealthychoices.com/alcoholic-neuropathy-symptoms-causes-and-treatment-96/

A New Alternative To Opiates For Nerve Pain

Today's post from consultqd.clevelandclinic.org (see link below) talks about a new advance in stem cell therapy concerning mesenchymal stem cells (MSC). These have been shown to reduce nerve pain and if they are injected directly into the vein, they have also been shown to reduce the side effects and addictiveness of opioids. Of course it's not as simple as this but these wonder cells apparently also can travel to the site of nerve injury and repair nerve cells on the spot. It may all seem a bit sci-fi and magical but it is true and reveals the huge potential of stem-cell therapy for all sorts of medical issues in the future. The fact that mesenchymal stem cells (MSC) directly apply to neuropathy problems makes it an exciting development for nerve pain patients across the world. Now we have to find the money in state budgets to develop the science and insurance companies who will pay for the treatment - don't hold your breath.

 Stem Cell Therapy for Neuropathic Pain: New Findings Show Promise
Animal studies demonstrate effectiveness

Aug. 10, 2016 / Pain Management / Research

Stem cell research at Cleveland Clinic could pave the way for an entirely new approach to chronic pain treatment that reduces medicine’s current reliance on opioid therapy for intractable pain. The modality also shows promise as a tool to reverse opioid tolerance (OT) and opioid-induced hyperalgesia (OIH), particularly problematic side effects of opioid therapy. Jianguo Cheng, MD, PhD, and his colleagues at Cleveland Clinic have developed patented methods of attenuating opioid tolerance.

Animal studies by Dr. Cheng and his colleagues have demonstrated the effectiveness of mesenchymal stem cell (MSC) transplantation in reducing hyperalgesia due to nerve injury. The group’s work has shown MSC transplantation’s effectiveness in reducing pain induced by sciatic nerve injury in rats and mice. MSC transplantation significantly reduced pain sensitivity evaluated by foot withdrawal thresholds in animals in response to thermal or mechanical stimulation. These cells produced immune modulatory and anti-inflammatory effects, promoted sensory nerve repair, and showed strong analgesic properties that could provide a safer and more effective alternative to current treatment modalities, in the management of neuropathic pain, says Dr. Cheng, Professor of Anesthesiology and Director of the Cleveland Clinic Multidisciplinary Pain Medicine Fellowship Program.

Pain medicine researchers are searching for an alternative to opioid therapy because neuropathic pain often does not respond to morphine and other opioids. Opioid analgesics can also lead to a variety of complications, ranging from itching and constipation to dependence, addiction, respiratory depression and death.

About 30 percent of neuropathy cases are caused by nerve damage associated with diabetes. However, hundreds of diseases are linked to neuropathic pain. Sources of neuropathic pain include alcoholism, amputation (which can result in phantom pain), some chemotherapy drugs (for example, Cisplatin®, Paclitaxel®, Vincristine®), radiation therapy, complex regional pain syndrome type II, trigeminal neuralgia, shingles, spinal stenosis, and central nervous system disorders, such as Parkinson disease and multiple sclerosis.

Recent research by Dr. Cheng and his group has yielded new discoveries that bode well for MSC transplantation as a potential future treatment modality. One investigation compared the analgesic effects of MSC derived from bone marrow with MSC derived from adipose tissue. Adipose-derived cells were found to be as efficacious as bone marrow-derived cells in reducing neuropathic pain in rats. The finding suggests that stem cell therapy could offer a practical option because stem cells from adipose tissue are relatively easy to obtain.

Recent investigations by Dr. Cheng and his colleagues comparing the analgesic effectiveness of intrathecal versus intravenous methods of MSC transplantation show both methods to be equally effective. The finding has important implications because intravenous transplantation of MSC could offer a safer and more expeditious route of delivery than intrathecal transplantation.

“We originally thought that stem cells would have to be introduced intrathecally in order to reduce pain, and that stem cells introduced intravenously would pass through the lungs and fail to produce analgesia,” says Dr. Cheng. “The finding that intravenous transplantation is as effective as intrathecal transplantation is encouraging.”

Dr. Cheng’s group has also discovered that MSCs can be found in the area surrounding the injured nerve following MSC transplantation. “For reasons we do not yet fully understand, these cells have the ability to migrate to the injury site to promote repair of the injured nerve fibers,” Dr. Cheng says. “The cells can sense the injury’s location and travel to it.”

Although many questions must be answered before it can be known whether stem cell therapy is safe and effective for humans, some small patient studies show potential, Dr. Cheng says. According to one observational study in Australia, MSC transplantation reduced pain in patients suffering from trigeminal neuralgia, a particularly difficult condition to treat. “Though the findings are preliminary, the study provides some evidence that what we have learned in the laboratory can be translated to clinical use,” Dr. Cheng says.

Dr. Cheng’s team has achieved analgesia with MSC transplantation from rats to mice, providing early evidence that stem cells’ anti-inflammatory and immuno-modulatory properties can be transferred between species. An important pre-clinical study will be to see whether the transplantation of human stem cells to animals also can produce analgesic and anti-tolerance effects, Dr. Cheng says.

Dr. Cheng’s team presented research at the 2016 annual meeting of the American Academy of Pain Medicine showing MSC’s potential to reverse opioid tolerance and opioid-induced hyperalgesia, problems that can compromise the safety and efficacy of opioid therapy. Intravenous transplantation of bone marrow-derived MSC significantly attenuated OT and OIH in animals whether the transplantation was performed seven days before or 14 days after the initiation of daily morphine injections. These data demonstrate that MSC transplantation can not only prevent the development of OT and OIH but can also reverse it.

https://consultqd.clevelandclinic.org/2016/08/stem-cell-therapy-neuropathic-pain-new-findings-show-promise/

Sleep Apnea And Nerve Damage

Today's post from mdedge.com (see link below) is a very interesting one, discussing (via a case study), the link between neuropathy and sleep apnea. Many people living with neuropathy also have troubles breathing regularly at night (apnoea) and it has long been suspected that there is a strong link between the two. In this case, the patient eventually responded extremely well to apnea treatment, in that her neuropathy symptoms were also massively reduced. It must be said here, that sleep apnea treatment is no easy option and many patients struggle to adapt to the equipment necessary but the reward re your nerve problems may make it worthwhile sticking it out. Worth a read if you are a smoker, or someone who has sleep apnea problems plus nerve damage.

Peripheral neuropathy linked to obstructive sleep apnea?
J Fam Pract. 2013 October;62(10):577-578 Author(s): Schmidt S, MD, PhD Rodrigues A, MD Lupi Me, MD Wong F, DDS, MS
Siegfried Schmidt, MD, PhD; Anthony Rodrigues, MD; Maria Elisa Lupi, MD; Fong Wong, DDS, MS
Department of Community Health and Family Medicine, College of Medicine (Drs. Schmidt and Lupi), Department of Restorative Dental Sciences, College of Dentistry (Dr. Wong), University of Florida, Gainesville; Department of Child Neurology, Floating Hospital for Children at Tufts Medical Center and Tufts University School of Medicine, Boston, Mass (Dr. Rodrigues)
Fwong@dental.ufl.edu

The authors reported no potential conflict of interest relevant to this article.

OSA may not be the first thing that comes to mind when examining a patient with peripheral neuropathy, but treating the sleep disorder can produce surprising benefits.
 
CASE A 57-year-old white woman presented with symptoms of bilateral “stocking-like numbness” and the sensation of “wearing socks for a few weeks” but denied any injury, previous chemotherapy, or diabetes. Her medical history was positive for untreated obstructive sleep apnea (OSA), obesity (body mass index, 36 kg/m2), osteoarthritis in various joints, impaired fasting glucose with normal glycosylated hemoglobin (HbA1c), hypertension, gastroesophageal reflux disease, hypothyroidism, hypercholesterolemia, and osteoporosis.

Our initial examination revealed decreased sensation to light palpation and pin prick over the distal portion of her lower extremities in a stocking-like fashion. Proprioception was decreased at the distal joint of the big toe. Her deep tendon reflex pattern was symmetric with 2+ at the knees, ankles, and toes. The rest of her lower extremity exam was within normal limits and there were no obvious vascular abnormalities.

Given the suspicion of peripheral neuropathy, the patient underwent laboratory tests and a nerve conduction study. Vitamin B12, vitamin B1, methylmalonic acid (MMA), thyroid function, thyroid peroxidase (TPO), serum protein electrophoresis (SPEP), rapid plasma reagin (RPR), sedimentation rate, vitamin D, complete blood count, and chemistry profile 24 were all negative. The antinuclear antibody test revealed a homogenous 1:80 titer with a negative nuclear deoxyribonucleic acid. Her fasting glucose had been elevated between 107 to 117 mg/dL in the last 5 years but HbA1c was normal (5.8%). The patient had not been diagnosed with diabetes and her latest glucose values had been stable.

However, electromyography and a nerve conduction study were abnormal, with electrophysiological evidence of mild axonal polyneuropathy. During the month prior to her presentation, she had developed burning pain in addition to the numbness/stocking sensation. Pregabalin, gabapentin, duloxetine, celecoxib, hydrocodone, methadone, and other medications were ineffective. Eventually the foot pain became so severe—she described it as “walking on tacks”—that she was unable to walk.

Our team decided to do a nerve block to relieve the pain. Initially she underwent right and later left peroneal and posterior tibial nerve blocks, which gave her immediate relief that lasted about 2 months.

Relief from the pain, but what about the OSA symptoms?

In the meantime, our patient developed increasing OSA symptoms, including snoring, nonrestorative sleep, daytime somnolence, and fatigue. (To learn more about OSA, see “Obstructive sleep apnea: A diagnostic and treatment guide” on page 565.)

Her history of mild-to-moderate OSA dated back 2 years, and included an apnea-hypopnea index (AHI) of 20 events per hour and 133 episodes of oxygen desaturation with a low O2 desaturation of 83%. The patient had never been treated, however, because she felt that she couldn’t tolerate the continuous positive airway pressure (CPAP) mask.

The patient finally agreed to a CPAP titration study. Her AHI improved from 20 to less than 2 events per hour; the oxygen desaturation dropped from 133 to 104 episodes; and the lowest O2 desaturation went from 83% to 85%.

When we initially started CPAP, our patient did not tolerate it very well. However, after consulting with our sleep clinic, she was placed on bilevel positive airway pressure, which she did tolerate. Surprisingly, she also noticed immediate improvement of the neuropathic foot pain; after a few weeks it resolved completely.

Still no foot pain…We continue to follow the patient’s progress and, after 3 years, she remains free of foot pain. Her initial numbness remains, however. She has not After starting CPAP, the patient noticed immediate improvement of the neuropathic foot pain; after a few weeks, it resolved completely. developed diabetes, with similar fasting sugar levels and an HbA1c of 5.4%. She is not taking any medication for neuropathic pain, but remains on methadone for unrelated severe intractable osteoarthritic pain of the lumbar spine, bilateral knee joints, and left hip.

The link between sleep apnea and neuropathy

Our case report suggests that clinicians should consider OSA as a cause of neuropathic pain. A recent review of the literature supports the relationship between the 2 conditions.

The prevalence of neuropathy in the general population is 2.4%, rising to 8% with advancing age.1 Many different types of peripheral neuropathy have been described; they have different symptoms and characteristics, depending on the specific part of the nervous system that is affected.2

The literature reveals a strong association between OSA and peripheral neuropathy and sight-threatening retinopathy.3 One study found that nearly 60% of patients with diabetes and OSA also have peripheral neuropathy.4 Another report found that OSA is an independent risk factor for axonal damage of peripheral nerves.5 Furthermore, a case-control study revealed that the impaired neural function is at least partly reversible with treatment for sleep apnea.4 Finally, Tahrani et al6 have found that “neuropathy prevalence was higher in patients with OSA than those without” (60% vs 27%; P<.001), which supports our case finding.

The specific mechanism linking OSA and neuropathy remains elusive, but the evidence suggests that peripheral nervous tissue is affected by chronic endoneural hypoxia in this patient population.7 In patients with OSA, 2 types of nerve dysfunction are apparent: ischemia-related axonal degeneration and resistance to ischemic nerve failure.8

An approach worth considering. While nerve blocks did provide some relief for our patient, they are not a long-term solution. To our knowledge, this case report is the first one published in the United States describing resolution of neuropathic pain by treatment of OSA. This approach is certainly worth considering in patients who have not responded to more traditional therapy.

Correspondence
Fong Wong, DDS, MS, Associate Professor, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, 1395 Center Drive, PO Box 100435, Gainesville, FL 32610; Fwong@dental.ufl.edu

http://www.mdedge.com/jfponline/article/77872/neurology/peripheral-neuropathy-linked-obstructive-sleep-apnea

How Capsaicin Works To Reduce Nerve Pain

Today's post from the-scientist.com (see link below) takes a look at a neuropathy treatment that seems to have both dropped off the neuropathy news vine and lost favour this last year or so and that is, the use of capsaicin to help control neuropathic pain. Capsaicin, extracted from chili peppers, has long been used as a topical treatment for neuropathy patients. However, its relative difficulty of use and potential for burning, means that it's not the most popular treatment for the patients themselves. However, capsaicin (along with marijuana) is actually one of the very few non-drug treatments that has been proved to work. This article helps us understand exactly how capsaicin works in reducing nerve pain - definitely worth a read. Remember, when all else has failed (especially damaging and powerful drugs originally designed for other purposes) it may be worth giving capsaicin a try again. The patches and cream need good advice and sometimes expert help with application but they may give you quite a bit of the relief you need.

How Hot Peppers Can Ease Pain  By Anna Azvolinsky | February 11, 2015

 Researchers uncover one way capsaicin—the spicy compound found in chili peppers—provides pain relief.

Capsaicin—a substance in chili pepper plants that makes them spicy hot—exerts its pain-attenuating effects by triggering a signaling cascade that results in the inactivation of mechano-sensitive transmembrane channels in neurons, according to a study published this week (February 10) in Science Signaling.

Initially causing a burning hot sensation, the compound is used as a topical pain medication because, when applied regularly, results in numbness to local tissue. Despite being widely used, researchers have previously not known how capsaicin exerts its pain-killing effects.

The initial pain-dulling sensation occurs when capsaicin activates heat-sensing transient receptor potential vanilloid 1 (TRPV1) ion channels on sensory neurons. Prolonged stimulation with the compound results in desensitization of these neurons. “This is one of the underlying mechanisms of capsaicin’s numbing effect, but TRPV1 is a heat sensor, so how it affects mechanical pain was not known,” said Tibor Rohacs, an associate professor of pharmacology and physiology at Rutgers New Jersey Medical School, who led the study.

Rohacs and his colleagues uncovered a link between the heat-stimulating function of capsaicin and its ability to relieve mechanical pain including neuralgia (pain from damaged nerves), neuropathy, and muscle and joint pain. Capsaicin’s activation of TRPV1 ion channels in turns inhibits mechanical force-sensing ion channels called Piezo1 and 2 by depleting phospholipid signaling molecules, phosphoinositides, in the cell membrane.

“What is unique in this study is how one kind of channel regulates the activity of another,” said Tamas Balla, a signal transduction researcher at the National Institutes of Health who previously collaborated with Rohacs but was not part of the current study. “I believe that this is the first example of ion channel cross-talk mediated by phospholipids,” Balla added.

“The work is very thorough and cutting-edge,” Mario Rebecchi, an anesthesiology and biophysics researcher at Stony Brook University in New York, told The Scientist in an e-mail.

Dorsal root ganglion (DRG) neurons perceive pain and are often used to study mechanically stimulated ion channels, also found in peripheral neurons of the skin. Using DRG neurons isolated from mice, Rohacs and his colleagues first found capsaicin able to inhibit mechanically activated currents in these cells. The researchers then expressed TRPV1 along with either the mechanically stimulated Piezo 1 or 2 ion channel in human embryonic kidney cells. The expression of TRPV1 was necessary for capsaicin to inhibit the activity of the Piezo channels. “What was really striking was that the inhibition [of the Piezo mechnosensitive channels] was almost 100 percent,” said Rohacs.

TRPV1 activation increases intracellular calcium ion levels, which then activate phospholipase C (PLC) enzymes to break down phosphoinositides. Adding two of the most abundant types of phosphoinositides into the solution of DRG neurons in vitro resulted in less inhibition of Piezo ion channel signaling, suggesting that these lipids are required to relay the signal from TRPV1 to the mechanically stimulated Piezo channels.

To show that the depletion of phosphoinositides inhibits the Piezo ion channels, and that other calcium-signaling dependent pathways are not involved, the team bypassed PLC signaling by expressing a phosphatase that also breaks down the membrane phosphoinositides but does not result in downstream signaling effects. This direct depletion of phosphoinositides also resulted in the block of Piezo channel activity. Further in vitro experiments showed that it is the PLC delta isoform that is necessary to dampen the mechanically stimulated ion channels (rather than the beta version). Typically, PLC beta signals through G protein-coupled receptors while PLC delta signals by activating calcium ions.

“This work links how a chemical stimulus can indirectly influence a mechanical process, at least at the cellular level,” Philip Gottlieb, a biophysics researcher at the University of Buffalo in New York who was not involved in the work, told The Scientist in an e-mail. “The supposition is that mechanically induced pain can be affected by a chemical that is known to activate the TRPV1 [ion channel yet appears] unrelated to the mechanically induced response.”

The capsaicin mechanism likely involves other signaling pathways, but inhibition of Piezo channels makes sense in the context of reducing pain, said Rohacs. Another pain modality modified by capsaicin is thermal pain, Rebecchi noted.

Still, to Rebecchi’s mind, “it is a huge leap to go from channel activities in an artificial heterologous expression model in vitro to sensation of pain.” Gottleib agreed: “There remain many questions including how this will play out in animal models.”

One question is how inflammation is coordinated with pain perception and sensitivity. Balla said he would like to see how this pain-perceiving neuronal pathway interacts with inflammatory signaling molecules like bradykinin, an inflammation-mediating peptide that indirectly activates TRPV1 ion channels. This would help researchers better “understand the key players acting in concert in pain perception,” said Balla.

I. Borbiro et al., “Activation of TRPV1 channels inhibits mechanosensitive Piezo channel activity by depleting membrane phosphoinositides,” Science Signaling, doi: 10.1126/scisignal.2005667, 2015.

http://www.the-scientist.com/?articles.view/articleNo/42153/title/How-Hot-Peppers-Can-Ease-Pain/

Nerve Biopsy For Neuropathy

Today's post from foundationforpn.org (see link below) appears here because two readers have recently asked me what a nerve biopsy involves and whether it's necessary or not. Neurologists will generally perform a nerve biopsy if they are running a very thorough series of diagnostic tests for neuropathy. However, it's expensive and slightly invasive, so many doctors will avoid it unless they feel it's completely necessary. The patient's own story, symptoms and medical history, plus a number of other tests will often be enough to reach a conclusion about neuropathy - a nerve biopsy will only confirm if the nerve damage is based on demyelation (damage to the protective layer surround the nerve) or axonal damage (damage to the axon in the nerve cell). Nevertheless nerve biopsies are quite frequently carried out and it's helpful to know what that involves - this short article does just that.

Nerve / Skin / Muscle / Tissue Biopsy  
No author: no date

Biopsies are small samples of nerves, skin, muscle or other tissues that are removed from the body. The samples are examined to identify and diagnose various disorders.
What is it?

A biopsy is a minor surgical procedure which involves making a small incision to remove a sample of nerve, skin, muscle or tissue for examination.
Why should I do it?

A nerve biopsy may help distinguish between demyelination (damage to the myelin sheath covering the nerve) and axon degeneration (destruction of the axonal portion of the nerve cell). It may also help identify an inflammatory neuropathy or confirm specific diagnoses.

A nerve biopsy is invasive and is useful only in certain circumstances.

A skin biopsy is helpful to distinguish certain disorders that might affect the small nerve fibers, as may be the case with painful sensory axonal neuropathies.

A muscle or other tissue biopsy is used to diagnose and identify damage caused to muscles and organs as a result of various disorders such as Charcot-Marie-Tooth disease, sarcoidosis and amyloidosis.
How is a nerve biopsy performed?

A nerve, skin, muscle or other tissue biopsy usually is a simple outpatient procedure. For a nerve biopsy, a local anesthetic is used to numb the area. The surgeon makes a small incision and removes a portion of the nerve, usually from the ankle or the calf. The sample is then examined for abnormalities under a microscope.

A skin, muscle or other tissue biopsy is performed much the same way, except that the surgeon removes skin, muscle, or other tissue instead of nerve.
How will it feel?

Because a local anesthetic is used, discomfort during the procedure is usually minimal. The anesthetic may burn or sting when first injected. After the procedure, the area may feel tender or sore for a few days. An area of the skin may remain permanently numb after the biopsy.

https://www.foundationforpn.org/livingwithperipheralneuropathy/evaluation/neurologicaltests/index.cfm

Large Scale Studies Essential For Opiates And Nerve Pain

Today's post from cochrane.org (see link below) follows on from yesterday's post, in that it looks at studies and clinical trials of the effectiveness of morphine on neuropathic pain. It's conclusions, that there is little evidence that morphine helps with neuropathic pain, are (as they themselves point out) a little misleading because the studies it examines, are just too small to reflect accurate results. The whole point of the article is to call for much larger studies on the effectiveness of morphine and other opioids on nerve pain. Why there seems to be a reluctance to carry out these studies is mystifying in the current climate of hostility towards opioids but one thing is sure: large scale examination of the true effect of these drugs is not only essential...it's urgent!
 

Morphine for neuropathic pain in adults
Published: 22 May 2017 Authors: Cooper TE, Chen J, Wiffen PJ, Derry S, Carr DB, Aldington D, Cole P, Moore R Primary Review Group: Pain, Palliative and Supportive Care Group

Bottom line

There is very low quality evidence that morphine taken by mouth has any important effect on pain in people with moderate or severe neuropathic pain.

Background

Neuropathic pain comes from damaged nerves. It is different from pain messages that are carried along healthy nerves from damaged tissue (a fall or cut, or arthritic knee). Neuropathic pain is often treated by different medicines (drugs) to those used for pain from damaged tissue, which we often think of as painkillers. Medicines that are sometimes used to treat depression or epilepsy can be effective in some people with neuropathic pain. Opioid painkillers are sometimes used to treat neuropathic pain.

Opioid painkillers are drugs like morphine. Morphine is derived from plants or synthesised by chemists. Morphine is widely available for use as a painkiller, usually given by mouth.

Our definition of a good result was someone with a high level of pain relief and able to keep taking the medicine without side effects making them want to stop.

Study characteristics

In February 2017, we searched for clinical trials in which morphine was used to treat neuropathic pain in adults. Five studies satisfied the inclusion criteria, randomising 236 participants to treatment with morphine, placebo, or other drugs. Studies lasted four to seven weeks. Few studies reported beneficial outcomes that would be regarded as clinically relevant.

Key results

Four small studies reported that pain was reduced by between a quarter and a third in some people. This level of pain reduction was experienced by 6 in 10 participants with morphine and 4 in 10 with placebo. Between 1 and 2 in 10 participants withdrew from treatment with both morphine and placebo, but the reasons were not given. Side effects were poorly reported, but were more common with morphine than with placebo, and included drowsiness, dizziness, constipation, feeling sick, dry mouth, and decreased appetite.

Quality of the evidence

The evidence was of very low quality. This means that the research did not provide a reliable indication of the likely effect, and the likelihood that the effect will be substantially different is very high. Small studies like those in this review tend to overestimate results of treatment compared to the effects found in larger, better designed studies. There were other problems that might lead to over-optimistic results. The very low quality evidence and the lack of any important benefit mean that we need new, longer-lasting, large trials before we will know if morphine is useful for the treatment of neuropathic pain.

Authors' conclusions:

There was insufficient evidence to support or refute the suggestion that morphine has any efficacy in any neuropathic pain condition. 

Background:

Neuropathic pain, which is caused by a lesion or disease affecting the somatosensory system, may be central or peripheral in origin. Neuropathic pain often includes symptoms such as burning or shooting sensations, abnormal sensitivity to normally painless stimuli, or an increased sensitivity to normally painful stimuli. Neuropathic pain is a common symptom in many diseases of the nervous system. Opioid drugs, including morphine, are commonly used to treat neuropathic pain. Most reviews have examined all opioids together. This review sought evidence specifically for morphine; other opioids are considered in separate reviews.

Objectives:

To assess the analgesic efficacy and adverse events of morphine for chronic neuropathic pain in adults.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase for randomised controlled trials from inception to February 2017. We also searched the reference lists of retrieved studies and reviews, and online clinical trial registries. 

Selection criteria:

We included randomised, double-blind trials of two weeks' duration or longer, comparing morphine (any route of administration) with placebo or another active treatment for neuropathic pain, with participant-reported pain assessment. 

Data collection and analysis:

Two review authors independently extracted data and assessed trial quality and potential bias. Primary outcomes were participants with substantial pain relief (at least 50% pain relief over baseline or very much improved on Patient Global Impression of Change scale (PGIC)), or moderate pain relief (at least 30% pain relief over baseline or much or very much improved on PGIC). Where pooled analysis was possible, we used dichotomous data to calculate risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or harmful outcome (NNH). We assessed the quality of the evidence using GRADE and created 'Summary of findings' tables. 

Main results:

We identified five randomised, double-blind, cross-over studies with treatment periods of four to seven weeks, involving 236 participants in suitably characterised neuropathic pain; 152 (64%) participants completed all treatment periods. Oral morphine was titrated to maximum daily doses of 90 mg to 180 mg or the maximum tolerated dose, and then maintained for the remainder of the study. Participants had experienced moderate or severe neuropathic pain for at least three months. Included studies involved people with painful diabetic neuropathy, chemotherapy-induced peripheral neuropathy, postherpetic neuralgia criteria, phantom limb or postamputation pain, and lumbar radiculopathy. Exclusions were typically people with other significant comorbidity or pain from other causes.

Overall, we judged the studies to be at low risk of bias, but there were concerns over small study size and the imputation method used for participants who withdrew from the studies, both of which could lead to overestimation of treatment benefits and underestimation of harm.

There was insufficient or no evidence for the primary outcomes of interest for efficacy or harm. Four studies reported an approximation of moderate pain improvement (any pain-related outcome indicating some improvement) comparing morphine with placebo in different types of neuropathic pain. We pooled these data in an exploratory analysis. Moderate improvement was experienced by 63% (87/138) of participants with morphine and 36% (45/125) with placebo; the risk difference (RD) was 0.27 (95% confidence interval (CI) 0.16 to 0.38, fixed-effects analysis) and the NNT 3.7 (2.6 to 6.5). We assessed the quality of the evidence as very low because of the small number of events; available information did not provide a reliable indication of the likely effect, and the likelihood that the effect will be substantially different was very high. A similar exploratory analysis for substantial pain relief on three studies (177 participants) showed no difference between morphine and placebo.

All-cause withdrawals in four studies occurred in 16% (24/152) of participants with morphine and 12% (16/137) with placebo. The RD was 0.04 (-0.04 to 0.12, random-effects analysis). Adverse events were inconsistently reported, more common with morphine than with placebo, and typical of opioids. There were two serious adverse events, one with morphine, and one with a combination of morphine and nortriptyline. No deaths were reported. These outcomes were assessed as very low quality because of the limited number of participants and events.

http://www.cochrane.org/CD011669/SYMPT_morphine-neuropathic-pain-adults

How To Identify And Manage Nerve Damage Symptoms

Today's post from littlethings.com (see link below) is yet another list of things to do to identify and help with neuropathy. (Why do we all love lists so much...one of the features of the 21st century!?) Despite the many self-help lists on the internet, this is a very useful one, especially for people new to neuropathy, who have difficulty understanding all the medical science their doctor has thrown at them. It explains simply what neuropathy is and how it can affect you and goes on to provide several ideas for learning to manage the disease. Many experienced neuropathy sufferers will be aware of most of what's said here but equally, many will benefit from the clear description and practical ideas. It's at least a starting point for further research.

Neuropathy: 12 Ways To Identify And Manage This Painful Disease
Laura Caseley 2016

Aches and pains are part of life. Everyone experiences a twinge here and a pang there, but what happens when it becomes all too frequent and severe, to the point where it’s getting in the way of your life?

However, if your aches, pains, and stiffness cause extreme changes in your body — like excess sweating, loss of bladder control, and high blood pressure — you might be suffering from neuropathy, a little-known but complex disease of the nervous system.

Neuropathy comes in many forms and can affect either just one nerve — in which case it’s called mononeuropathy — or several —and then it’s called polyneuropathy.

It can come on slowly over many years, or start all of a sudden. It can also come as a result of treatment for another condition, in which case it’s called peripheral neuropathy.

Anything that affects your nerves is serious business, because your nerves control, well, everything.

Not only to they allow us to experience the world via the sense of touch, but they also control organs and prompt the body to respond involuntarily to temperature and other factors. When a nerve is upset, it can cause pain in everything from your legs to your teeth.

If you’re concerned that something might be amiss with your nerves, check out the symptoms of neuropathy below. And if you think you might have it, see the ways you can soothe it at home.

Typically, people with neuropathy will have to take medical steps with the help of a doctor or specialist, but these at-home tips can be used alongside medical therapies — with a doctor’s permission, of course.

What Is Neuropathy?

Neuropathy is a disease of the nerves that impairs motion, gland or organ function, and sensation. In total, it affects some 24 million Americans.

Common causes include heavy alcohol consumption, immune system diseases, traumatic injury, celiac disease, hypothyroidism, radiation and chemotherapy, and viral infections.

About 30% of cases are also associated with diabetes. Certain classes of antibiotics can also be causes, and sometimes, neuropathy can also be congenital.

Neuropathy can take several forms, but there are some common symptoms.

The best way to determine exactly which nerves are effected is to to talk to a doctor or neurologist.

How Can I Tell If I Have Neuropathy?

Symptom #1: Numbness Of Limbs

Neuropathy, particularly peripheral neuropathy, is often characterized by a feeling of numbness or heaviness in the limbs, making them hard to move.

Numbness may also appear in other parts of the body, but it’s most commonly felt in the arms and legs.

Symptom #2: Muscle Weakness

Lifting things and even moving around becomes increasingly difficult with neuropathy, which makes the muscles feel weak and tired.

Some people also experience tremors.

Symptom #3: Difficulty With Coordination

As the muscles become increasingly numb and weak, it can start to effect motor skills.

Depending on which nerves the neuropathy is affecting, this can make fine motor functions like writing difficult, and can even affect walking and balance.

Symptom #4: Stabbing Or Burning Pain

Tingling, stabbing, burning, or pins-and-needles pain is also very common with neuropathy, as nerves misfire in your body.

Some people also develop allodynia, in which even light touches to the skin result in sharp pains.

Symptom #5: Bowel And Bladder Problems

If the autonomic nervous system is affected, it can also lead to issues with the bowels and bladder, typically constipation and difficulty urinating.

If you suspect you might have neuropathy, be sure to talk to your doctor. He or she can create a management plan to help your symptoms.

How Can I Manage Neuropathy?

Remedy #1: Avoid Gluten, Refined Sugars, And Trans Fats

After speaking to your doctor and getting their professional opinion, you can try managing your symptoms with a few simple life changes.

There’s a correlation between celiac and neuropathy, and many people with neuropathy seem to have some level of gluten sensitivity, so try cutting it out of your diet.

Gluten, along with refined sugars, can cause inflammation in the digestive system and increase blood sugar, which can cause damage to nerves.

This is also especially true for cases in which diabetes is involved.

Alcohol should also be avoided.

Remedy #2: Spice Up Your Meals

Cayenne pepper is a great additive anyway, but even better if you have neuropathy.

It has a high content of capsaicin, the compound that makes things spicy. Capsaicin is also a natural pain reliever and improves circulation throughout the body.

You can add a sprinkle to your meals, and if you don’t like spicy food, you can also take capsaicin as a supplement.

Remedy #3: Take A Hot Shower

Just like the heat from capsaicin helps from the inside, heat from a hot shower will help with pain from the outside.

It feels great, and it also helps improve circulation and to relax muscles. A hot bath works, too.

Remedy #4: Take Care Of Your Feet

Numbness or diminished feeling in the feet can be especially dangerous, because you can injure them without even realizing it.

Neuropathy is very common in the feet, and so if you’re dealing with it, your feet will need extra attention.

Wear comfy socks and shoes and make sure your tootsies are clean and free of any cuts, and keep your toenails short and cut straight across.

Remedy #5: Try Acupuncture Or Chiropractic Care

In addition to a your regular doctor, visiting a chiropractor or acupuncturist can also help soothe the aches and pains.

These treatments can help improve circulation, which gets oxygen and nutrients to the affected nerves, helping them function better.

Remedy #6: Take Your Vitamins

Getting the right vitamins, especially your B vitamins, is very important when it comes to neuropathy.

You can take these as supplements (just don’t take more than 50 mgs of B-6 per day), or stock up on B-rich foods like beans, lean meats, nuts, and fruits and vegetables.

Remember, be sure to speak to your doctor before beginning any new supplement or dietary plan.

Have you ever suffered from nerve issues? What was the remedy that helped you the most?

Let us know in the comments, and SHARE this important information with everyone you know!

http://www.littlethings.com/guide-to-neuropathy/

Medical Cannabis For Nerve Pain What Doctors Must Decide

Today's post from journalofethics.ama-assn.org (see link below) is an advisory article for doctors considering whether to prescribe medical cannabis for their neuropathic patients in severe pain. The article comes from 2013 and you probably don't need reminding that the case for medical marijuana use for chronic pain has become significantly stronger since then. It's an interesting and well-balanced article that will give us an insight into what considerations doctors must take before prescribing it but may also give you a little more confidence in deciding whether its a safe and/or desirable option in your own particular case. Worth a read.
 

Medicinal Cannabis and Painful Sensory Neuropathy
Igor Grant, MD Virtual Mentor. May 2013, Volume 15,

Painful peripheral neuropathy comprises multiple symptoms that can severely erode quality of life. These include allodynia (pain evoked by light stimuli that are not normally pain-evoking) and various abnormal sensations termed dysesthesias (e.g., electric shock sensations, “pins and needles,” sensations of coldness or heat, numbness, and other types of uncomfortable and painful sensations). Common causes of peripheral neuropathy include diabetes, HIV/AIDS, spinal cord injuries, multiple sclerosis, and certain drugs and toxins. Commonly prescribed treatments come from drugs of the tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressant classes, anticonvulsants, opioids, and certain topical agents. Many patients receive only partial benefit from such treatments, and some either do not benefit or cannot tolerate these medications. The need for additional treatment modalities is evident.

Animal studies and anecdotal human evidence have for some time pointed to the possibility that cannabis may be effective in the treatment of painful peripheral neuropathy [1]. Recently, the Center for Medicinal Cannabis Research (CMCR) at the University of California [2] completed five placebo-controlled phase II clinical trials with smoked or inhaled cannabis [3-7]. Another study reported from Canada [8]. Patients included people with HIV neuropathy and other neuropathic conditions, and one study focused on a human model of neuropathic pain. Overall, the efficacy of cannabis was comparable to that of traditional agents, somewhat less than that of the tricyclics, but better than SSRIs and anticonvulsants, and comparable to gabapentin (see figure 1).




Figure 1. Common analgesics for neuropathic pain.

*to achieve a 30% reduction in pain.

Number needed to treat (NNT) = 1/(E-P), where E is the proportion improved in experimental condition and P is the proportion improved on placebo. Example: If 60% “improve” (according to a given definition) in the experimental condition, while 30% “improve” in the placebo condition, then NNT = 1/(.6-.3) = 3.3. Data adapted from Abrams et al. [3] and Ellis et al. [4].

The concentrations of tetrahydrocannabinol (THC) in these studies ranged from 2 to 9 percent, with a typical concentration of 4 percent resulting in good efficacy. Side effects were modest and included light-headedness, mild difficulties in concentration and memory, tachycardia, and fatigue. Serious side effects (e.g., severe anxiety, paranoia, psychotic symptoms) were not observed. Mild cognitive changes resolved within several hours of drug administration.

While these were short-term trials with limited numbers of cases, the data suggest, on balance, that cannabis may represent a reasonable alternative or adjunct to treatment of patients with serious painful peripheral neuropathy for whom other remedies have not provided fully satisfactory results. Because oral administration of cannabinoids (e.g., as dronabinol, marketed as Marinol) can result in inconsistent blood levels due to variations in absorption and first-pass metabolism effects, inhalational (or potentially sublingual spray, e.g., nabiximols, marketed as Sativex) administration remains preferred to oral administration.

Cannabis as a smoked cigarette, while demonstrating efficacy, poses a number of challenges, inasmuch as it remains illegal under federal law, even though it is permitted in an increasing number of jurisdictions on physician recommendation. Figure 2 provides a schematic approach for physician decision making in jurisdictions where medicinal cannabis is permitted [9]. See figure 2 



This decision tree suggests key points that a physician should consider in making a determination. In the case of a patient assumed to have persistent neuropathic pain, the first determination to be made is that the patient’s signs and symptoms are indeed consistent with a diagnosis of neuropathy. Assuming a patient does not respond favorably to or cannot tolerate more standard treatments (e.g., antidepressants, anticonvulsants) and is willing to consider medicinal cannabis, the physician proceeds to compare risk and benefit. Among these considerations is whether the patient has a history of substance abuse or a serious psychiatric disorder that might be exacerbated by medicinal cannabis. Even the presence of such a risk does not necessarily preclude the use of medicinal cannabis; rather, coordination with appropriate substance abuse and psychiatric resources is necessary, and, based on that consultation, a risk-benefit ratio can be formulated. In patients for whom the ratio appears favorable, the physician should discuss modes of cannabis administration including oral, smoked, or vaporized. Once risks and benefits are evaluated and discussed with the patient, cannabis treatment may commence as with other psychotropic medications, with attention being paid to side effects as well as efficacy. Attention must also be paid to possible misuse and diversion, which can then trigger a decision to discontinue the treatment.

In summary, there is increasing evidence that cannabis may represent a useful alternative or adjunct in the management of painful peripheral neuropathy, a condition that can markedly affect life quality. Our society should be able to find ways to separate the medical benefits of making a treatment available to improve lives when indicated from broader social policy on recreational use, marijuana legalization, and unsubstantiated fears that medicinal cannabis will lead to widespread cannabis addiction [10-12].

References
Joy JE, Watson Jr SJ, Benson JA, eds. Marijuana and Medicine: Assessing the Science Base. Washington, DC: National Academies Press; 1999.
Center for Medicinal Cannabis Research. http://www.cmcr.ucsd.edu.
Abrams DI, Jay CA, Shade SB, et al. Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial. Neurology. 2007;68(7):515-521.
Ellis RJ, Toperoff W, Vaida F, et al. Smoked medicinal cannabis for neuropathic pain in hiv: a randomized, crossover clinical trial. Neuropsychopharmacology. 2009;34(3):672-680.
Wallace M, Schulteis G, Atkinson JH, et al. Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology. 2007;107(5):785-796.
Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low-dose vaporized cannabis significantly improves neuropathic pain. J Pain. 2013;14(2):136-148.
Wilsey B, Marcotte T, Tsodikov A, et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain. 2008;9(6):506-521.
Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ. 2010;182(14):E694-E701.
Grant I, Atkinson JH, Gouaux B, Wilsey B. Medical marijuana: clearing away the smoke. Open Neurology J. 2012;6:18-25.
Kleber HD, DuPont RL. Physicians and medical marijuana. Am J Psychiatry. 2012;169(6):564-568.
Harper S, Strumpf EC, Kaufman JS. Do medical marijuana laws increase marijuana use? Replication study and extension. Ann Epidemiol. 2012;22(3):207-212.
Grant I, Atkinson JH, Gouaux B. Research on medical marijuana. Am J Psychiatry. 2012;169(10):1119-1120.

Igor Grant, MD, is a professor and executive vice chair of the Department of Psychiatry and director of the HIV Neurobehavioral Research Program (HNRP) at the University of California, San Diego School of Medicine. Dr. Grant is the founding editor of the Journal of the International Neuropsychological Society and founding co-editor of the journal AIDS and Behavior.

http://journalofethics.ama-assn.org/2013/05/oped1-1305.html

Mercury Can Cause Nerve Damage Vid

Today's post from docotrrainey.com (see link below) is an interesting one, including a video, about the potential for mercury causing neuropathy. Now you may not immediately think that you're in any danger of absorbing mercury into your system but dental fillings, chemical wastes, pesticides and even vaccines can introduce mercury into your body. Amongst other toxic effects, mercury can attack your nervous system and cause significant nerve damage. There are ways to neutralize any mercury in your system, by eating foods rich in sulfur (see list in the article). An interesting read but remember you have to look at everything you read in perspective and look at your own personal circumstances to see if there's a risk.
 

Mercury Toxicity – Beware! It can deteriorate your neurons. 

According to the Environmental Protection Agency (EPA), Mercury can destroy your digestive system, cause mood swings, irritability, muscle weakness, skin rashes, memory loss, central nervous system damage, and the list goes on. This list does not list all the damage that Mercury can cause to the body, but it gives you a brief overview and can be viewed here: http://www.epa.gov/hg/effects.htm

Please view this week’s video about Mercury. If you are unable to view the video, the text can be viewed below in its entirety. When you are done, be sure to watch the video from Calgary University by clicking here http://www.youtube.com/watch?v=BtFsy0rQsak . This video is the coolest in cutting edge medical technology. 

 


Transcript:
Hello, I’m Dr. Ian Rainey with your weekly health tip. This week we are going to talk about Mercury, not to be confused with the planet. Mercury is an element. In fact, it is one of the most toxic substances on Earth and it has many negative effects on the body. Because of this, it has become what many call the great mimicker of many health conditions. It can damage the immune system and the reproductive system. It can also inhibit neurological and cardiovascular health. This video will provide information about the sources of mercury exposure, potential health effects, how to eliminate Mercury and ways to reduce your exposure to mercury.

Sources of mercury include: dental amalgam fillings, hazardous waste, vaccines, pesticides, shellfish, and coal burning power plants

Here are some the things you should know about mercury toxicity.

Mercury is known to denervate nerve fibers. This works in a similar fashion to the way the multiple sclerosis. Essentially, it makes it so the nerves cannot do their job.

Mercury can leak into the blood brain barrier. Not many things can. That is what makes it so toxic and difficult to remove. Once this happens the nerves lose their ability to conduct information and create visual responses.

Mercury can cause depression. It does this by binding to the hormones that make you happy, such as serotonin.

Mercury can cause hearing loss.

Mercury can change your emotions. It does this by decreasing norepinephrine and dopamine activity. This will make you lose excitement and joy for life.

Mercury can cause peripheral neuropathy autoimmunity, recurring sinus problems, prostate issues and gum infection.

Mercury is also at the root of many undiagnosed patients who have chronic fatigue and fibromyalgia. One of the most common ways that a patient presents with Mercury toxicity is with a terrible burning sensation and pain that seems to migrate to different areas.

All of these symptoms resemble nerve damage. But the medical community looks for nerve damage with things like EMG’s, nerve conduction tests and MRI’s. You are never going to find any mercury toxicity with these tests.

As a result, out of confusion and an inability to find the solution, health professionals begin diagnosing things like erythromelalgia, fibromyalgia, idiopathic pain syndrome and neurosis.

Out of this confusion came an answer. We now are able to test for mercury toxicity in the body with a simple urine test. I do offer this test for patients who exhibit many of the signs of mercury toxicity.

So now you may be wondering what you can do to reduce the mercury load on your body. You should eat foods that are high in sulfur. This would include things like kale, horseradish, collards, cilantro, watercress, cabbage and broccoli. You should also include foods that have cysteine. This includes oats, chicken and red peppers because they contain metallothionein. Metallothionin is a natural chelator that will help eliminate mercury from the body. Even chlorophyll is a natural chelator! So don’t forget to eat your green veggies.

If you can’t seem to stomach all of these foods, there are special vitamins and supplements that combine the best of all natural chelators to help you eliminate the mercury in your body. Those are available at my office or at the Good Earth.

I want to thank Joe Buishas and and Dr. Ron Grisanti for providing material, as well as the University of Calgary for the video explaining how Mercury causes nerve damage to the brain. Please watch this extra video if you have the time. It is amazing to see how Mercury actually destroys your nervous system. http://www.youtube.com/watch?v=BtFsy0rQsak

http://www.doctorrainey.com/weekly-health-tip/mercury-toxicity-beware-deteriorate-neurons/

Research Into Nerve Pain Patience Is A Virtue

 Today's post from foundationforpn.org/ (see link below) tries to remove the feeling that many people living with neuropathy have, that there is very little research and thus very little progress being made in the medical field of neuropathy. This blog agrees and frequently tries to highlight new research studies, however medically complex for the reader, to show that there is a great deal of work being done behind the scenes. The problem is that the time spans between ideas, research, study, tests and evaluations and products on the pharmacists' shelves for patients can be enormous. This is frustrating for current patients but it is surely better to know what's going on and be aware of the fact that much is being done, than be kept in the dark and have the feeling that the medical world is ignoring our plight; even if it means waiting years for concrete results.
 

International Research on Peripheral Neuropathy

foundationforpn.org/ March 7, 2016

It is not unusual for peripheral neuropathy patients, their caregivers and loved ones to be heard wishing for research on PN that may bring hope for better treatments or even a cure. Many people share the perception that little or no research is occurring on peripheral neuropathy leaving them frustrated and sometimes even angry.

In fact, research is happening all over the world. ClinicalTrials.gov is a Web-based resource that provides patients, their family members, health care professionals, researchers, and the public with easy access to information on publicly and privately supported clinical studies on a wide range of diseases and conditions. The Web site is maintained by the National Library of Medicine (NLM) at the National Institutes of Health (NIH). As March 1, 2016, ClinicalTrials.gov identified 1745 studies related to peripheral neuropathy since it first started collecting data in 2007.* 561 studies listed there are still active. The map above shows that 46% of the research is taking place in the U.S. but 29% is also taking place across Europe.

The Foundation for Peripheral Neuropathy uniquely supports PN research through the Peripheral Neuropathy Research Registry (PNRR). Currently, limited data exist to define characteristics of peripheral neuropathy patients with neuropathic pain. In a groundbreaking step to learn more about PN and to find a cure for the debilitating condition, the Foundation for Peripheral Neuropathy launched the first ever national Peripheral Neuropathy Research Registry (PNRR) focused on Diabetic, Chemotherapy-Induced, HIV/AIDS and Idiopathic neuropathies. The data in the PNRR aims to help researchers access detailed genotypic and phenotypic history and neurological examination information about people with painful and non-painful peripheral neuropathies. This Research Registry will facilitate both basic and clinical research studies that are expected to improve understandings of the etiology and pathogenesis of PN. Ultimately, the major goal of the Registry is to improve the ability to diagnose, treat and prevent peripheral neuropathy.

* The ClinicalTrials.gov results database was launched in September 2008 to implement Section 801 of the Food and Drug Administration Amendments Act of 2007 (FDAAA), which requires the submission of “basic results” for certain clinical trials, generally no later than 1 year after their Completion Date. The submission of adverse event information was optional when the results database was first released but was required beginning in September 2009. Results information for registered and completed studies is submitted by the study sponsor or principal investigator in a standard, tabular format without discussions or conclusions. The information is considered summary information and does not include patient-level data.

For more information on how clinical trials work and for featured clinical trials visit the Clinical Trials page on our website

 

 https://www.foundationforpn.org/2016/03/07/5016/

Anti Epilepsy Drugs Control Nerve Pain

Today's post from mayoclinic.org (see link below) is very useful for those already taking anti-epilepsy drugs for their neuropathy, or those for whom that may become an option in the future. Many people are confused and more than a little alarmed as to why they're being given anti-seizure drugs for nerve damage. This article explains the reasoning behind prescribing those drugs for neuropathy. As you look through the list below, you'll probably recognise some of the drugs from your other research into the disease. The fact is, nobody is totally certain why anti-seizure drugs work for nerve pain (in some cases, not all and side-effects are an issue!) but it's clear that they block pain signals sufficiently to be effective. Worth a read.
 

Anti-seizure medications: Relief from nerve pain By Mayo Clinic Staff

 Anti-seizure drugs often are used to help control the type of pain caused by damaged nerves.

Anti-seizure medications were originally designed to treat people with epilepsy. But the nerve-calming qualities of some of these medications can also help quiet the burning, stabbing or shooting pain often caused by nerve damage. 

Why does it hurt?

Nerves can be damaged by many things, including injury, surgery, disease or exposure to toxins. The damaged nerves are activated inappropriately and send pain signals that don't serve a useful purpose. This type of pain can be debilitating and difficult to control.

Nerve damage (neuropathy) can be caused by many conditions, including:
Diabetes. High blood sugar levels, common in diabetes, can damage nerves throughout your body. The first symptom generally is numbness and pain in your hands and feet (diabetic neuropathy).
Shingles. Anyone who has had chickenpox is at risk of shingles, a rash of blisters that can be painful or itchy. A condition called postherpetic neuralgia occurs if shingles pain persists after the rash disappears.
Because the risk of shingles increases with age, everyone age 50 and older should receive the varicella-zoster virus vaccine (Zostavax), which can help prevent this painful condition.

Chemotherapy. Some chemotherapy drugs can damage nerves, causing pain and numbness that generally begin in the tips of your toes and fingers (neuropathy).
Herniated disk. Nerve damage can occur if a herniated disk in your spine squeezes a nerve passing through your vertebrae too tightly.
Fibromyalgia. Fibromyalgia is a chronic condition that causes pain and tenderness throughout your body. 

How do anti-seizure drugs help?

The exact mechanism of action isn't fully understood, but anti-seizure medications appear to interfere with the overactive transmission of pain signals sent from damaged nerves.

Some anti-seizure drugs work particularly well for certain conditions. Carbamazepine (Carbatrol, Tegretol) is widely prescribed for trigeminal neuralgia, a condition that causes searing facial pain that feels like an electric shock.

It's important to note that the Food and Drug Administration has issued a warning that all anti-seizure medications are associated with a slightly increased risk of suicidal thoughts or actions. Talk to a doctor or counselor promptly if you feel depressed or suicidal.
 
Newer anti-seizure drugs may have fewer side effects

More recent research supports the use of the anticonvulsants gabapentin (Neurontin) or pregabalin (Lyrica) to help relieve pain caused by damaged nerves.

Both gabapentin and pregabalin are particularly effective in the treatment of postherpetic neuralgia, diabetic neuropathy and pain caused by a spinal cord injury. Pregabalin also may be used to treat fibromyalgia.

Because these drugs have few side effects and are usually well tolerated, they are often the first medications to try for neuropathic pain. You may experience side effects, such as drowsiness, dizziness, confusion or swelling in the feet and legs. These side effects are limited by starting with a low dosage and slowly increasing it.

Medications from other drug classes with distinct mechanisms of pain relief (such as antidepressants) may be used in combination with anti-seizure class medications if anti-seizure medications fail to control your pain. 

Side effects limit use of older anticonvulsants

Anti-seizure drugs have been used to treat nerve pain for many years, but their use was limited by the severity of side effects they produce.

Older anti-seizure drugs include:
Carbamazepine (Carbatrol, Tegretol)
Oxcarbazepine (Trileptal)
Phenytoin (Dilantin)
Valproic acid (Depakene)

Side effects may include:
Liver damage
Nausea
Vomiting
Double vision
Loss of coordination
Drowsiness
Headache

If you take an older anticonvulsant, you generally need regular follow-up visits so that your doctor can monitor for side effects. These older drugs often have more side effects than do the newer anticonvulsants, and the evidence supporting use of the older anticonvulsants for neuropathic pain is sparse at times. As a result, older drugs may be recommended only when the newer medications prove ineffective. 

Research continues

As scientists learn more about the way anti-seizure drugs work, this information will be useful in determining which drugs may work best for different types of nerve pain. Pain caused by nerve damage can be disabling, but anti-seizure drugs sometimes provide relief.

http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/in-depth/pain-medications/art-20045004

What They Dont Tell You About Nerve Pain

Today's excellent post from healthperfection.co (see link below) is the article you wish you'd read when you first found out you had neuropathy. It would have saved months of personal research, visits to the doctor, trial and error treatments and unpleasant surprises. For that reason, it's recommended reading for all people living with neuropathy. For the 'experts' you may learn something you didn't already know and for the 'beginners', you certainly will learn something you didn't already know. Worth a read.

11 THINGS DOCTORS DON’T TELL YOU ABOUT NEUROPATHY
By admin On March 5, 2016 In Health News

Have you ever learned a piece of valuable new information about neuropathy and thought to yourself, “I wish I would’ve known that when I was first diagnosed.” If you’re anything like me, this is a somewhat frequent occurrence. The reality is that while a lot has been (and is being) discovered about neuropathy in the scientific and medical communities, our understanding of it is an evolving process. Compared to a decade or two ago, we know considerably more now than we did – but even so, there is much that is yet to be fully understood about this silent but painful nerve condition.

As I look back on all I’ve learned about neuropathy over the years – from causes to treatments and everything in between – there is a lot I wish I’d been told about sooner. As with any battle against a chronic condition – knowledge is power. The more you know about your neuropathy – including its potential causes and the steps you can take to most effectively treat it and prevent it from spreading – the better your chances are of reducing your neuropathy related symptoms and preventing further nerve damage.

With that said, here are 11 things I wish I’d known about neuropathy when I was first diagnosed:

There are many potential causes – including medications

Some of the known causes of neuropathy include diabetes, chemotherapy, exposure to toxins, surgery, injury or trauma, vitamin B12 deficiency, excessive amounts of vitamin B6, autoimmune diseases, nutritional imbalances, excessive alcohol consumption and even medications. Knowing the cause of your neuropathy is one of the most important factors in determining how to treat it.

MORE: 7 Potential Causes of Your Neuropathy

In some cases, the cause of neuropathy will remain a mystery even after thorough testing and investigation. This is referred to as idiopathic neuropathy, meaning the cause is unknown. In most cases, however, doctors should be able to arrive at a cause (or number of causes).


Some Causes Are Reversible

One of the dreaded realities we often associated with neuropathy is that the damage is irreversible – that you’re stuck with the pain, tingling or numbness forever. While in many cases the damage and symptoms may last indefinitely, there are cases in which the damage may be reversible. This largely depends on the cause of your neuropathy and how quickly you catch it and take steps to reverse it (obviously, the earlier the better).

Among the causes in which damage has the potential to be stopped and even reversed are diabetes, vitamin B12 deficiencies, nutritional deficiencies, heavy alcohol consumption and medications. Of course, to have any hope of stopping or reversing the damage one must determine the cause of the damage and take immediate steps to remedy the problem.

For those with diabetes or nutritional deficiencies, managing blood sugar and improving diet is key to reversing the damage. Those with vitamin B12 deficiencies should work with their doctor to determine ways to eliminate the deficiency through diet or supplementation. Finally, those with neuropathy caused by alcohol or medications should restrict or eliminate the use of the substance causing the damage. 

Nerve Damage Can Spread If Underlying Cause Isn’t Addressed

The peripheral nervous system is comprised of nerves running from the brain and spinal chord to other parts of the body. Damage to the peripheral nerves typically manifests itself first in our extremities – usually the hands or feet. What many neuropathy patients don’t realize is that over time these symptoms can spread to other parts of the body – including the arms, ankles, legs and more – if the underlying cause isn’t addressed. This is why both early detection and treatment are so critical. 

Look Out For Early Indicators of Peripheral Neuropathy

The earlier you can catch neuropathy the better your chances of preventing the symptoms from spreading. Some of the early signs of neuropathy to watch out for include:

Gradual numbness or tingling sensations in the feet or hands (which may spread into the legs and arms)
Sharp, stabbing pains
Intense burning pain
Extreme sensitivity to touch
Loss of balance or coordination
Muscle weakness, loss of motor skills
Restless Leg Syndrome (RLS)
Neuropathy Can Affect Muscle Control

Within the peripheral nervous system there are three types of nerves: motor, autonomic and sensory. While the most recognizable symptoms of neuropathy are related to the sensory nerves (i.e. pain, tingling and numbness) – nerve damage can manifest itself in other ways as well. When neuropathy damages the motor nerves, it disrupts the nerves ability to relay messages from the brain and spinal cord to various muscle groups. This can result in difficulties such as loss of balance, difficulty walking, loss of dexterity, cramps or spasms, muscle weakness and loss of muscle control. 

Neuropathy Can Affect Autonomic Functions

Another group of nerves that can be affected my neuropathy is the autonomic nerves. The autonomic nervous system is a division of the peripheral nervous system that influences various internal organs such as the heart, stomach, liver, adrenal gland and more. Damage to the autonomic nerves disrupts the signals sent from the brain and spinal cord to these various organs – sometimes resulting in a disruption to the involuntary functions these organs are involved in.

Here are the most common organs affected by damage to the autonomic nerves and the symptoms generally associated with them:


Pain Medications Only Mask the Pain

There are a number of prescription medications available to help cope with neuropathic pain. These medications have been a lifesaver for many sufferers (myself included) as they help take the edge off the pain and make it more manageable. Unfortunately, their purpose is simply to help mask the pain rather than help correct the underlying problem. In addition, there can be negative side effects associated with any prescription medication – so one must be aware of the risks.

Understanding that these prescription medications would not necessarily stop or reverse my nerve damage – but merely mask the symptoms – helped me to recognize the importance of trying various approaches to help address the underlying causes of my neuropathy.

Natural Herbs & Supplements May Help

While prescription medications typically only mask the symptoms, nutritional supplements and herbs may help both relieve symptoms and address underlying causes. By addressing underlying causes or problems, they may help to slow or even stop the nerve damage from spreading. Some of the best supplements and herbs for nerve pain include:
Vitamin B12
Vitamin D
Magnesium
Alpha Lipoic Acid
CoQ10
Acetyl-l-carnitine

Vitamin B12 is especially important for nerve health. It helps build up and support the myelin sheath – a protective coating around the nerves that shelters them from damage and infection. Studies have shown that high doses of vitamin B12 can promote nerve regeneration of damaged nerves.

MORE: Top 10 Herbs & Supplements for Nerve Pain
 
Alternative Therapies Can Help (but be patient)

Like a lot of people, I was hesitant about alternative therapies and skeptical about the promised results. However, alternative therapies have proven to be very beneficial in both helping me to manage my pain as well as improving my overall health. That said – there is no miracle therapy or treatment that is going to relieve my nerve pain overnight. I’ve found that with alternative approaches, the results are gradual – but they tend to be lasting results.

Alternative therapies for neuropathy range from low-impact exercises like yoga or tai chi to ancient practices like acupuncture. Here is a good list of popular approaches you may want to explore if you are suffering from neuropathy:
Acupuncture
Massage
Yoga
Tai Chi
Walking or stationary bike
Biofeedback
TENS therapy (Transcutaneous electrical nerve stimulation)

MORE: 10 Little Known Ways to Relieve Nerve Pain
 
Diet Could Be Helping or Hurting Nerve Pain

Something else I wish I’d known was the impact that diet can have on the symptoms of neuropathy. There are certain foods that can aggravate nerve pain as well as ones that can help boost nerve health. Knowing which foods or ingredients fall into which category can make a big difference!

Among the foods that can make neuropathy worse are casein-based products (commonly found in dairy products), artificial sweeteners, gluten, added sugars and refined grains. When consumed excessively, alcohol can also harm the nerves and block the absorption of essential vitamins like B12.

MORE: 4 Nutrient Deficiencies That Are Killing Your Nerves

Foods that promote healthier nerves include ones rich in B-complex vitamins such as B12 & B2. Other important vitamins and nutrients for strong nerves include vitamin D, vitamin E, Magnesium and Zinc.

Joining a Neuropathy Support Group Can Help

They say that experience is the mother of all wisdom, so what better way to learn about neuropathy than to join others who have been living with it for years? Joining a support group or online forum can give you insights into living with neuropathy that you might not find elsewhere. They are also safe environments to ask questions and learn what experience others have had with various medications, treatments and therapies.

To find a support group near you, the Neuropathy Support Network has a usefulsupport group search tool. In addition to local support groups, there are a handful of online support groups or forums. For finding information and support online, check out these 10 Resources Every Neuropathy Sufferer Should Bookmark.

Life with neuropathy can be painful, overwhelming and frustrating. As with anything, the more experience one has the more wisdom and insight he or she will gain into how to better cope with the hand that has been dealt. For me, the process has been gradual and frustrating (of course) – but I’ve learned many things that have resulted in small yet meaningful changes to make the road a little smoother. What things do you wish you had known about neuropathy when you were first diagnosed?

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