ANTIVIRAL THERAPY BENEFITS HIV INFECTED STIMULANT USERS

New clinical research from UC San Francisco shows that 341 HIV-infected men who reported using stimulants such as methamphetamine or cocaine derived life-saving benefits from being on antiretroviral therapy that were comparable to those of HIV-infected men who do not use stimulants.

That said, those who reported using stimulants at more than half of at least two study visits did have modestly increased chances of progressing to AIDS or dying after starting antiretroviral therapy compared to non-users. The data was collected between 1996 and 2012.

"Patients with HIV who use stimulants and other substances often experience difficulties with accessing antiretroviral therapy, partially due to the concerns of healthcare providers that they will not be able take their medications as directed. Findings from this study demonstrate that many stimulant users take their antiretroviral therapy at levels sufficient to avoid negative clinical outcomes. When we look at overall mortality, antiretroviral therapy leads to similar clinical benefits for both stimulant users and non-users, notwithstanding stimulant use," said the study's primary investigator, Adam W. Carrico, PhD., UCSF assistant professor of nursing.

The research is available starting in October online ahead of print in the Journal of Acquired Immune Deficiency Syndromes. The study included 1,313 HIV-infected men who have sex with men within the Multicenter AIDS Cohort Study, an ongoing nationwide prospective study of HIV infection among men who have sex with men in the U.S.

"If we are to achieve the goals of the President's National HIV/AIDS Strategy and UNAIDS to end the HIV/AIDS epidemic, we will need to treat HIV-positive active substance users for their HIV while encouraging them to stop or reduce their substance use. Programs integrating substance abuse services with HIV clinical care may both improve health outcomes for patients and reduce new infections," said Carrico.

The UCSF Division of HIV/AIDS at San Francisco General Hospital has created an integrated care delivery system that could serve as a model for other clinics, added Carrico. The HIV primary care clinic utilizes a patient centered team care approach that includes substance abuse services for stimulant and opioid users, along with mental health services, all located onsite. STOP, the "stimulant treatment outpatient program," within the clinic provides outpatient substance abuse and mental health treatment integrated with patients' primary medical care.

"The pattern of use varies and the real issue is whether patients can take their antiretrovirals as prescribed. We find that some patients are able to start taking antiretrovirals very reliably before they are able to decrease or stop their stimulant use, which often requires more complex behavioral, emotional, interpersonal and environmental changes. Being in an HIV primary care setting allows us to engage stimulant users even if they are not ready to go to specialty substance abuse programs or support groups," said Valerie Gruber, PhD, STOP director and UCSF professor of psychiatry.

Gene Therapy Offers New Hope For Treatment Of Peripheral Neuropathy

ScienceDaily (June 1, 2007) (so not exactly new!)

— Researchers from the University of Pittsburgh School of Medicine report that they have successfully used gene therapy to block the pain response in an animal model of neuropathic pain, a type of chronic pain in people for which there are few effective treatments.



Neuropathic pain is the result of damage to nerve fibers caused by injuries or diseases, such as diabetes and cancer. These damaged nerve fibers continue to send signals to pain centers in the brain even after the surrounding tissue has healed. Unfortunately, neuropathic pain often responds poorly to standard pain treatments and occasionally may get worse instead of better over time. For some people, it leads to serious, long-term disability and dependence on pain medications that have a variety of unwanted side effects, including addiction.

The Pitt research team, led by Joseph Glorioso, III, Ph.D., chair of the department of biochemistry and molecular genetics, University of Pittsburgh School of Medicine, used a genetically engineered herpes simplex virus (HSV) to deliver the gene for part of the human glycine receptor (GlyR), a receptor found primarily on the surface of nerve cells in the spinal cord and the lower brain but not in the nerves in the limbs, to the paws of rats. A group of control rats received only the HSV vector without the inserted gene.

After the delivery of the therapeutic gene or empty vector (for the control group), the researchers injected the same paws of each rat with formalin, an irritant known to simulate the symptoms of a peripheral neuropathic pain at the site of injection. Following formalin injection, the rats were then given an injection of glycine to activate the GlyR receptor.

Both control and GlyR-HSV-infected rats showed a typical pain response to formalin. However, the application of glycine eliminated the pain response in GlyR-HSV infected animals, while it had no effect on animals infected with vector only. This alleviation of the pain response in GlyR-HSV-treated mice was reversed by the subsequent addition of low concentrations of strychnine, a strong GlyR-specific inhibitor, or antagonist.

According to Dr. Glorioso, these findings suggest that HSV-directed expression of GlyR in peripheral neurons and subsequent selective activation by glycine has the potential to be used therapeutically not only for neuropathic pain management but a variety of pain syndromes.

"The inability to effectively manage neuropathic pain associated with injuries and illnesses is a growing national and international problem. Gene therapy offers a more targeted, less toxic approach for effectively managing this condition. It also is our hope that targeted transgene delivery of GlyR may have even broader implications for managing a number of chronic pain syndromes, including pain resulting from shingles, arthritis and cancer," explained Dr. Glorioso.

These findings are being presented at the 10th annual meeting of the American Society of Gene Therapy, being held May 30 to June 3 at the Washington State Convention & Trade Center, Seattle.

In addition to Dr. Glorioso, others involved in the study included Michael Cascio, Ph.D., James Goss, Ph.D., David Krisky, M.D., Ph.D., and Rahul Scrinivasin, M.D., Ph.D., all with the department of molecular genetics and biochemistry, University of Pittsburgh School of Medicine.

Progress In Gene Therapy For Neuropathic Pain

Today's post from mybestlife.com (see link below) talks about the advances in gene therapy in trying to combat neuropathic pain. Scientists have identified a part of the brain (amygdala) responsibile for emotional responses to pain and to put it simply, are hoping that by injecting it with a selected virus this will block seretonin receptors responsible for pain signals. This is in response to decades of treatments using various drugs which have had limited or virtually no success. Gene therapy may well be the future in this field and the researchers have been awarded a substantial 5 year grant to investigate the possibilities. The article may seem to be a little complex but it's important to at least have some idea of the direction research is going. As always, the future is a long way off in terms of effective and inexpensive treatment but they have to start somewhere!

Gene therapy at center of UTMB effort to eliminate neuropathic pain
16th September 2013

University of Texas Medical Branch at Galveston researchers have been awarded a five-year, $1.8 million grant by the National Institute of Neurological Disorders and Stroke to apply the techniques of gene therapy to the problem of neuropathic pain — that is, pain that arises from a malfunction in the nervous system.

Neuropathic pain is a daily reality for millions of Americans, manifesting itself in a variety of life-impairing ways. Someone suffering from neuropathic pain might feel intense discomfort in response to a light touch, for example, or suddenly feel as though he or she were freezing in response to a small decrease in temperature. Caused by either accidental or disease-induced nerve damage, this kind of pain has proven very difficult to treat.

“Patients in neuropathic pain are willing to do almost anything to get relief,” said Dr. Volker Neugebauer, the co-principal investigator on the grant. “They’re in torment, often in really desperate situations.”

To make matters worse, long-term neuropathic pain often causes depression, acting through emotional mechanisms in the brain meant to underscore the importance of pain signals. Depression further increases the perception of pain, creating a vicious cycle of increasing pain and depression. And while conventional pain medicines can block the pain signal, they are usually successful for only a limited time only; eventually the pain returns when the nervous system compensates for the blockade.

Neugebauer and his UTMB colleague and co-principal investigator Thomas Green believe that a better anti-neuropathic pain strategy is to target higher brain regions and prevent the abnormal generation of persistent emotions. They focus on the amygdala, a structure best known for its role in emotional responses, including anxiety and depression and — in Neugebauer’s previous work — for its connection to pain regulation. Neugebauer and Green hypothesize that stopping abnormal activity in the amygdala by a particular type of receptor for the neurotransmitter serotonin will enable the successful treatment of neuropathic pain.

Although increased serotonin activity in the brain is generally thought of as a good thing — it’s the mechanism used by many antidepressant drugs — activation of the serotonin 2C receptor in the amygdala can cause problems, according to Neugebauer. “In neuropathic pain we see that this receptor is activated on cells that regulate output from the amygdala to brain areas where responses to potentially harmful situations are generated,” Neugebauer said. “This activity should be turned off when such response is no longer needed or useful, but these serotonin 2C receptors continue to drive amygdala output, creating a chronic pain state.”

In experiments with laboratory rats in which neuropathic pain behavior has been induced by nerve damage, Neugebauer and Green plan to investigate the possibility of “re-normalizing” the amygdala by injecting it with specially designed viruses containing genetic material that blocks cells’ generation of serotonin 2C receptors.

“The viruses that we’re using are adeno-associated viruses, very common vectors that about 80 percent of the people in our society have been exposed to,” Green said. “We’ve modified them so that they can’t replicate, and inserted a gene that instructs the amygdala cells to make small pieces of RNA that interfere with the production of serotonin 2C receptors.”

According to Green, who has been working with similar gene-therapy techniques for more than 10 years, the viral injections produce permanent effects in the brain and no off-target effects. The researchers plan to test the rats’ response to the treatment with a variety of behavioral experiments that will examine both its effect on chronic pain behavior and behaviors associated with depression.

In addition to the behavioral investigation, the project will include electrophysiological studies of amygdala activity, in an effort to further define the “circuitry” of this key pain and emotion center. It will also examine the inconsistent results achieved when chronic pain is treated with selective serotonin reuptake inhibitor antidepressants, attempting to determine whether serotonin 2C receptor activity might be responsible.

“SSRIs increase serotonin, and most of the serotonin receptors produce good effects,” Neugebauer said. “But increasing serotonin also means you’re hitting the 2C receptor as well, perhaps mediating undesirable effects. We want to take that out and then see if increasing serotonin produces consistently good effects.”

For more information
The University of Texas Medical Branch
http://www.utmb.edu/

http://www.mybestlife.com/health/News-2013-Sep/20130916-neuropathic-pain-study.htm

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New And Exciting Stem Cell Therapy For Neuropathy

Today's post from painnewsnetwork.org (see link below) is another article proclaiming the latest 'breakthrough' in neuropathy treatment. Don't worry, it's not a lurid advertisement from yet another questionable neuropathy clinic but shows the results of new research on stem-cell therapy. If you read it, you may justifiably get excited at the prospect of a pain-free existence thanks to bone marrow cell injections but this sort of treatment on humans is a long way off and as such can be frustrating information for many neuropathy patients. Nevertheless, the field of stem-cell therapy is beginning to show multiple promising results and as such makes interesting reading and gives hope for the future.

‘Amazing’ New Stem Cell Treatment for Neuropathy
By Pat Anson, Editor July 13, 2015

Researchers at Duke University say an experimental stem cell therapy being tested on animals shows great potential to provide long-lasting pain relief for people suffering from diabetic neuropathy or other types of nerve damage.

In a study published in the Journal of Clinical Investigation, researchers said mice injected with a type of stem cell known as bone marrow stromal cells (BMSCs) were much less sensitive to nerve pain.

"This analgesic effect was amazing," said Ru-Rong Ji, PhD, a professor of anesthesiology and neurobiology in the Duke School of Medicine. "Normally, if you give an analgesic, you see pain relief for a few hours, at most a few days. But with bone marrow stem cells, after a single injection we saw pain relief over four to five weeks."

BMSCs are known to produce an array of healing factors and can be coaxed into forming other types of cells in the body. They are already being used to treat people with serious burns, inflammatory bowel disease, heart damage and stroke.

"Based on these new results, we have the know-how and we can further engineer and improve the cells to maximize their beneficial effects," said Ji.

Researchers injected the mice with stem cells through a lumbar puncture, infusing them into the fluid that bathes the spinal cord.

The picture on the right shows how the injected stem cells (in red) migrated to the site of the nerve injury and were still present four weeks after treatment.

A molecule emitted from the injured nerve cells -- which has previously been linked to neuropathic pain – is believed to act as a “homing signal” and attract the stem cells.

Researchers measured levels of anti-inflammatory molecules in the mice and found that one in particular, TGF-β1, was present in higher amounts in the spinal fluid of the stem cell-treated animals.

TGF-β1 is a protein that is secreted by immune cells and is common throughout the body. Research has shown that people with chronic pain have too little TGF-β1.

Injecting TGF-β1 directly into spinal cord fluid provides pain relief, but only for a few hours, according to Ji. By contrast, bone marrow stromal cells stay on site for as much as three months after the infusion.

Ji’s research team is working to identify stem cells that produce more TGF-β1, as well as other types of pain relieving molecules. In addition to diabetic neuropathy, researchers believe stem cell therapy could also be used to treat pain from chemotherapy, surgical amputation, lower back pain and spinal cord injuries.

Nearly 26 million people in the United States have diabetes and about half have some form of neuropathy, according to the American Diabetes Association. Diabetic peripheral neuropathy causes nerves to send out abnormal signals. Patients feel pain or loss of feeling in their toes, feet, legs, hands and arms. It may also include a persistent burning, tingling or prickling sensation. The condition can lead to injuries, chronic foot ulcers and even amputations.

Another recent animal study by researchers in the U.S. and South Korea found that diabetic rats given intramuscular injections of bone marrow stromal cells experienced both angiogenesis (blood vessel growth) and a restoration of the myelin sheath -- a protective covering over nerve cells damaged by neuropathy.

"Currently, the only treatment options available for DN (diabetic neuropathy) are palliative in nature, or are directed at slowing the progression of the disease by tightly controlling blood sugar levels," said Dr. John Sladek, Jr., Professor of Neurology, Pediatrics, and Neuroscience, Department of Neurology at the University of Colorado School of Medicine.

"This study offers new insight into the benefits of cell therapy as a possible treatment option for a disease that significantly diminishes quality of life for diabetic patients.”

The study is being published in the journal Cell Transplantation.

http://www.painnewsnetwork.org/stories/2015/7/12/amazing-stem-cell-treatment-for-neuropathy

Magnetic Therapy an option for Neuropathy

Today's short post from Discovery: fit&health (see link below) reinforces the need for people with neuropathic pain to consider carefully, if a treatment is going to help or not. Many clinics offer therapies and treatments involving magnets and make extravagent claims as to their success rate. These can be expensive and may well work for some but many medical experts would disagree. The conclusion of this article is that more research is needed but in the meantime, you need to get advice from your own doctors before parting with your hard-earned cash.

Magnet Therapy and Diabetic Neuropathy

Magnets have used for centuries in China, India, and Egypt for their alleged healing powers. In the late 1800s, American advertisements offered magnetic belts and insoles as a cure for sleeplessness, hysteria, and indigestion. Such claims continue today, yet exactly how or if they work remains unknown.

One theory suggests that magnets can work with the body's own magnetism, similar to a magnetic resonance imaging (MRI) procedure. An MRI scanner creates a strong magnetic field, which causes the atoms within body tissues to shift. Based on that premise, it would seem possible for therapeutic magnets to heal damaged nerves.

Some researchers believe the magnets increase blood flow, "nourishing" a painful area, helping it heal, while others say magnets "repolarize" nerve impulses, changing the perception of pain.

Whatever the reason, magnetic insoles, mattress pads, pillows, bracelets, Belts, and even hairbrushes are a $5 billion industry worldwide, thanks to consumers who swear by them as a safe, noninvasive therapy for all types of chronic pain from tendonitis to migraine headaches.

Mainstream medicine, however, isn't buying it. For every study that shows the potential benefits of using magnets, it seems there's another that shows none at all. One of the more compelling studies appeared in the American Journal of Pain Management in January 1999. In it, Dr. Michael Weintraub, a neurologist at New York Medical College in Valhalla, N.Y., studied the effects of magnets on diabetic and nondiabetic patients with chronic foot pain.

His results showed 90 percent of the diabetics found magnetic footpad insoles significantly reduced chronic foot pain. While the numbers look impressive, critics say the study was too small to mean much. Meanwhile, another study done at the Veterans Affairs Hospital in Prescott, Ariz., published in the March 2000 Journal of the American Medical Association, found that adults with long-term back pain got absolutely no significant pain reduction from magnet therapy.

Despite the controversy, most experts agree the therapy warrants more research. In fact, the National Center for Complementary and Alternative Medicine at the National Institutes of Health believes the potential of magnetic healing worthwhile enough that it funded two ongoing studies on magnets and pain.

http://health.howstuffworks.com/medicine/tests-treatment/magnet-therapy-and-diabetic-neuropathy.htm

Combination Drug Therapy For Neuropathy Pain

Today's post from painnewsnetwork.org (see link below) reinforces an article from last week on the blog concerning using a combination drug therapy to better relieve neuropathic pain. It talks about two drugs (the anti-depressant, nortryptiline and morphine) which are currently two of the individual treatments in the range of drugs used to suppress neuropathic symptoms. Using them in combination seems to work more effectively than single drug treatment according to UK researchers. They are also relatively cheap (important in today's climate) but do carry the risk of side effects and that needs to be discussed and monitored by your doctor. Apart from that, the nature of neuropathy is that patients react so differently to different drug treatments - there's no one drug which doctors can truthfully say works for all. So it's entirely possible that this combination will not work for you, just the same as the individual drugs may not work for you. That said, the idea of combining drugs with carefully controlled and safe dosages, seems logical on all points but if your doctor suggests this to you, make sure you discuss all possible outcomes and ensure that he or she will monitor the situation very carefully - these drugs are not M&Ms. One final point, some doctors prescribe morphine and the anti-convulsant, gabapentin (neurontin) combinations too.

Two Drug Combo Relieves Neuropathy PainBy Pat Anson, Editor April 08, 2015

British researchers say a combination of two widely used drugs – an antidepressant and an opioid – can significantly relieve pain and other symptoms caused by neuropathy.

In a study published in the journal PAIN, researchers at Queens University say combining the painkiller morphine with the antidepressant nortriptyline relieved chronic neuropathic pain in nearly 90 percent of patients – significantly better than when either drug is used alone.

"Morphine and nortriptyline are excellent candidates for pain management because of the extensive research conducted on them, their low cost, and widespread availability all over the world," said Ian Gilron, MD, a professor in Queen's School of Medicine and anesthesiologist at Kingston General Hospital.

"Current neuropathic pain treatments are ineffective or intolerable for many sufferers so this new evidence supporting the morphine-nortriptyline combination is important news for patients."

Nortriptyline, an antidepressant sold under the brand names Aventyl and Pamelor, is already being used to treat pain in the arms and legs caused by multiple sclerosis. Morphine has long been used to treat both acute and chronic pain.

Neuropathic pain is characterized by tingling or burning sensations that develop as result of nerve damage caused by conditions such as shingles, diabetes, amputation, inflammation, and cancer. About 8% of adults worldwide suffer from neuropathy. Many drugs used to treat neuropathic pain, such as Neurontin and Lyrica, often don’t work or have unpleasant side effects.

In the double-blind, randomized study, 52 neuropathy patients were given a choice of trying every one of three treatments: morphine alone, nortriptyline alone, and a combination of the two drugs over six-week treatment periods. Patients were asked to record their pain levels and side effects during each treatment.

The average daily pain before treatment was 5.6, measured using a rating scale from 0-10. Average daily pain dropped to 2.6 when patients received the two drug combination. Patients taking nortriptyline and morphine alone rated their pain at 3.1 and 3.4, respectively.

Researchers said that common side effects for both drugs, which include constipation and dry mouth, did not worsen with the combined treatment.

"It's important to remember that we don't want to completely eliminate patients' ability to sense pain as it's a warning system for us, but we do want to find the right balance of pain relief and drug side effects," said Gilron

Nortriptyline and morphine are currently not available in a combined formulation. According to the Mayo Clinic, using the two drugs together is usually not recommended because they both cause sedation.

http://www.painnewsnetwork.org/stories/2015/4/8/two-drug-combo-relieves-neuropathy-pain

TALK THERAPY NOT MEDICATION BEST FOR SOCIAL ANXIETY DISORDER

While antidepressants are the most commonly used treatment for social anxiety disorder, new research suggests that cognitive behavioral therapy (CBT) is more effective and, unlike medication, can have lasting effects long after treatment has stopped.

Social anxiety disorder is a psychiatric condition characterized by intense fear and avoidance of social situations and affects up to 13 percent of Americans and Europeans. Most people never receive treatment for the disorder. For those who do, medication is the more accessible treatment because there is a shortage of trained psychotherapists.

The findings of the study, a network meta-analysis that collected and analyzed data from 101 clinical trials comparing multiple types of medication and talk therapy, are published online Sept. 26 in The Lancet Psychiatry.

"Social anxiety is more than just shyness," says study leader Evan Mayo-Wilson, DPhil, a research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. "People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction. The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering."

The research was a collaboration between the Johns Hopkins Bloomberg School of Public Health, Oxford University and University College in London, where Mayo-Wilson formerly worked.

For the study, Mayo-Wilson and his colleagues analyzed data from 13,164 participants in 101 clinical trials. The participants all had severe and longstanding social anxiety. Approximately 9,000 received medication or a placebo pill, and more than 4,000 received a psychological intervention. Few of the trials looked at combining medication with talk therapy, and there was no evidence that combined therapy was better than talk therapy alone.

The data compared several different types of talk therapy and found individual CBT was the most effective. CBT is a form of treatment that focuses on relationships between thoughts, feelings and behaviors. It helps people challenge irrational fears and overcome their avoidance of social situations, Mayo-Wilson says.

For people who don't want talk therapy, or who lack access to CBT, the most commonly used antidepressants -- selective serotonin reuptake inhibitors (SSRIs) -- are effective, the researchers found. But they caution that medication can be associated with serious adverse events, that it doesn't work at all for many people, and that improvements in symptoms do not last after people stop taking the pills.

The researchers acknowledge that medication remains important but say it should be used as a second-line therapy for people who do not respond to or do not want psychological therapy. The group's analysis has already led to new treatment guidelines guidance in the U.K. and, Mayo-Wilson says, it could have a significant impact on policymaking and the organization of care in the U.S.

Social anxiety disorder typically begins in adolescence or early adulthood, and it can severely impair a person's daily functioning by impeding the formation of relationships, by negatively affecting performance at work or school, and by reducing overall quality of life. Because it strikes people at critical times in their social and educational development, social anxiety disorder can have important and lasting consequences.

"Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce healthcare costs," Mayo-Wilson says. "The healthcare system does not treat mental health equitably, but meeting demand isn't simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff."

Is Light Therapy A Realistic Option For Neuropathic Pain

Today's post from townsendletter.com (see link below) presents the case for light therapy as a potential treatment for neuropathic pain and related problems. it does this by illustrating three study cases with different forms of neuropathy. Now the problem with light therapy is that mainstream medicine is by no means firmly in favour; some regarding it as another alternative treatment based on expensive equipment and carried out at expensive clinics. After all, if it were as effective as is claimed, the whole of mainstream neurology would be performing it across the world but that doesn't exclude the possibility that it will work for many people living with nerve pain. You have to make your own mind up and investigate further as thoroughly as possible. Talking it over with regular doctors and specialists is advised, with the expectation that they will probably not be in favour. If that's the case, then you need to ask them why. Their answers, plus your own research should give you a better perspective as to whether this may be something for you to try.

A Breakthrough in Using Light Therapy to Treat Neuropathies
by Len Saputo, MD From the Townsend Letter November 2015

This article describes the successful treatment using light therapy of three patients with peripheral neuropathy. The etiology of neuropathy for each of these patients was different, as were the patients themselves in age, sex, and general condition. All of the patients were significantly disabled and had previously undergone extensive conventional treatment without significant relief.

I have used light therapy to treat over 2000 patients with a variety of painful health conditions since 1999, when I first met Maurice Bales, who had extensive experience with the development and manufacturing of infrared light devices, beginning in the 1970s with his work at NASA and the Lawrence Livermore Lab. Maurice trained me to treat a wide range of painful conditions that included neuropathy, neck and back pain, TMJ disorders, headaches, fractures, and sports injuries. I have found that if something hurts, chances are that treatment with light will help.

Despite its remarkable effectiveness, safety profile, and affordability, light therapy remains for the most part underappreciated and underused. This lack of utilization of light therapies is not just by mainstream medicine but also by the alternative and integrative medical communities. This situation exists despite the fact that more than 70,000 peer-reviewed articles have been published on light therapy and listed on PubMed going back to 1899. Since then light therapy has been documented to relieve pain, increase circulation, reduce inflammation, speed up wound healing by an average of 40%, increase lymphatic drainage, attract stem cells, and stimulate mitochondrial production of ATP – among other things.1-15 This sounds a bit like Star-Trek medicine!

I have selected three case histories that demonstrate the range of peripheral neuropathies that can be treated using light therapy.

Case #1: Chemotherapy-Induced Peripheral Neuropathy

J. K. is a 69-year-old female referred by her oncologist for treatment of advanced peripheral neuropathy caused by chemotherapy. She was diagnosed in 2010 with colon cancer and was treated with surgery, chemotherapy, and radiation. She felt well and remained in remission until December 2014, at which time she was found to have stage IV disease based on diagnosing metastases to her lungs. She was started on chemotherapy with Erbitux.

Her cancer responded to this treatment, but within a few months she developed progressively worsening numbness in her hands and feet. By June 2015, she had such dense numbness that she could not feel the accelerator or brake in her car and was unable to button her clothing. She became depressed because she was for the most part confined to her home. Her oncologist referred her to me for treatment of her neuropathy because it had become so severe that chemotherapy had to be discontinued.

She was treated with 11 15-minute light treatments to her feet, legs, and hands from July 29, 2015, through August 20, 2015. She regained enough sensation in her fingers and feet that she can now drive, walk normally, and button her clothing without assistance. She is now much more active socially and is back on her chemotherapy treatment. She remains in remission and is enjoying life once again.
 
Pre-Tx Plantar Feet



Post-Tx Plantar Feet



Pretreatment thermographic image of soles of feet show lack of circulation as blue and green colors. Posttreatment shows significantly increased circulation as red and orange.

Case #2: Trauma-Induced Neuropathy

T. S. is a 39-year-old woman who was in a tornado three years ago, when a large uprooted tree fell on her geodesic dome and crashed her to the ground. Ever since that event, she could not raise her arms above her neck; has been walking with a wide-based gait to maintain her balance; has been weak in both legs; tires easily; and developed numbness, burning pain, and tingling in her feet and lower legs.

Her podiatrist referred her to me to treat her peripheral neuropathy with light therapy.

The patient's examination revealed dense numbness extending from the bottoms of her feet to the midcalf. She had normal pedal pulses and no Babinski sign, but her knee and ankle reflexes were absent. Her lumbar spine had very significant bilateral pain to direct pressure from L3 to S1. The range of motion of her neck was restricted to 45 degrees bilaterally and there was moderate tenderness to palpation in the suboccipital portion of her neck. She also suffered from both lumbar disc disease and neuropathy.

She received seven treatments on her feet, low back, neck, and TMJ with light from July 15 through August 21, 2015. The patient reported, "Photonic stimulation has been a miracle for me. I no longer have pain when I stand or walk, and am able to straighten my knees. I walk with balance and at a normal speed, which I never imagined I would be able to do again. I am dreaming of getting a bike and returning to yoga and dance."

Posterior pre_Tx




Posterior post-Tx



Pretreatment image shows inflammation in orange and red from a posterior radiculopathy. The posttreatment image shows a reduction in inflammation and more symmetrical pattern of heat distrubution. (The white spot is an artifact of the BioPhoton treatment.)

Case #3: Diabetic Neuropathy

R. S. is a 56-year-old male with a history of type 2 diabetes, hypertension, obesity, hyperlipidemia, and being a "wine connoisseur." He was referred by his chiropractor for treatment of his neuropathy with infrared light. His symptoms began in 2008 and included numbness and mild burning nighttime pain that had been progressive and assumed to be caused by type 2 diabetes. It is noteworthy that he was being treated with glipizide, amlopidine, hydrochlorothiazide, pravastatin, and nortriptyline, all of which have an association, albeit weak, with peripheral neuropathy. Odds are that the most likely cause in this case was a combination of diabetes and alcohol.

He was treated from January 2014 through June 2015 with 31 infrared light therapy treatments to his feet. The combination of gradually reducing his alcohol consumption and employing light treatments had a major effect on improving his neuropathy symptoms. At the present time has no pain and only mild numbness in his feet. His gait is normal. In addition to using light therapy, we have successfully focused on improving his lifestyle factors including stress, insomnia, diet, exercise, weight management, and reduction in alcohol consumption. Because of his compliance we have been able to discontinue all of his medications.

Pain management has become a very sophisticated discipline that tends to be complicated and often associated with challenging side effects. Light therapy is another story, because it is simple, effective, safe, and affordable. In contrast, in mainstream clinical practice, it is typical for patients with severe pain to be treated with a polypharmacy that usually includes drugs for pain, anxiety, depression, insomnia, and a wide range of additional drugs to manage their side effects. Many people take 10 or more drugs and, not unexpectedly, simply cannot function very well. These are often those patients who come to my office!

For some neuropathies, light treatment alone is sufficient to relieve even the most severe pain. I have been able to wean more than a thousand patients off their medications. For other painful conditions, it can be helpful to use an integrative team approach that can include chiropractic, Chinese medicine, bodywork, imagery, psychotherapy, pulsed electromagnetic field therapy, and so on.

I have found that the safest and most effective way to use light therapy is to use the right device under the guidance of infrared imaging in real time. The Bales Thermal Image Processor (TIP) that we employ is a high-resolution infrared camera which is highly stable and sensitive. It allows us to use light devices that can deliver the right wavelengths with enough power that we usually get impressive clinical improvement in just a single 15-minute office visit. This approach also allows patients to observe their infrared images in real time and see for themselves the impressive changes that occur during a treatment. So patients get great clinical results not only from the effects of light itself, but also from the effects of visualizing how the treatment changes the thermal patterns on their skin.

We have learned that with certain conditions, it is critical to follow the thermal effects of light during treatment so that we visualize what we're doing and also minimize any chance of making symptoms worse. This is especially important in people with fibromyalgia and other forms of neuropathic pain such as complex regional pain syndromes, shingles, certain vascular headaches, and several other conditions.

There are hundreds of light therapy devices available, greatly varying in their respective prices, mechanisms, and efficacy. The device that I began using in 1999 was the Bales Scientific Photonic Stimulator, in conjunction with the Bales TIP camera. When its inventor, Bales, worked for NASA and the Lawrence Livermore Labs, he was developing equipment used for the space shuttle. Starting in 1985, he began to adapt his work to the medical field, creating his thermographic camera in 1990 and the Photonic Stimulator, which was approved by the FDA as a medical device to treat pain in 1997. Bales has made dozens of incremental improvements to photonic stimulators over the past two decades. What is especially noteworthy about the three cases I discuss in this article is that I used a revolutionary new model introduced only this year, now called the BioPhoton 100. This device is significantly more powerful than its predecessors, offers variable wavelengths and frequencies, is considerably smaller, and costs less.



BioPhoton

Photonic Stimulator

Here are some of the specific differences:

Power: Output power has been increased from 0.250 watts to 8.9 watts. Output power is a very important factor for permeation depth. While lower-powered devices may benefit cells at the superficial level, they fail to penetrate deeper tissue, which is often the root problem of a chronic disease. The BioPhoton can target tissues deep within the body and penetrate the skull to reach the brain. More power equates to more photon energy being transmitted to the cells, which also reduces the duration and number of treatments.

Spectrum wavelengths: The previous model had a fixed wavelength of 850 to 880 nm, while the BioPhoton 100 has mixed-spectrum blue light at wavelengths from 450 nm and red and far-infrared light up to 940 nm. Blue light only penetrates superficial tissues but can treat cutaneous conditions such as traumatic injuries such as burns, cuts, contusions, and even infections such as MRSA.16-18 Increasing the power of blue light can deliver substantial amounts to the deeper tissues. It should be noted that blue light has greater ability than red or infrared in releasing nitric oxide to cause vasodilation.19,20 Infrared wavelengths include 850 nm and 940 nm and have the actions mentioned earlier.

Modulation (waveform) options: The BioPhoton 100 Professional model can accept external input from other devices. This provides the practitioner with the ability to replicate other frequency protocols that can be customized to meet individual treatment goals. These protocols may include square, triangular, sine, or audio waveforms at varied frequencies. It has been theorized that different waveforms are beneficial in the treatment of various diseases.

Smaller size and lower price: The size of the device has gone from 14.5² × 10² × 6² down to 5.5² × 2.5² × 2.75.² The price of the original Photonic Stimulator was $9320 (in today's dollars), while models of the BioPhoton 100 range from $2200 to $7000. These improvements make it possible for practitioners to devise a treatment protocol and then rent the device to patients to use in their homes for a specified period. This allows for daily use, which equates to faster healing, and more satisfied patients. Home treatment allows for more regular treatments at a lower cost while freeing up more time for other patients.

I believe that the BioPhoton 100 is a significant breakthrough not just in light therapy in particular but in medicine in general. We are now involved in research in conjunction with the National Institutes of Health at UCSF. Light therapy often provides superior results than do conventional treatments for a variety of illnesses and is completely noninvasive and, used correctly, free of side effects. The clinical applications of photon therapy are expanding at the speed of light!

I'm even more enthusiastic today than when I was first introduced to light therapy by Maurice Bales. It has been very rewarding to see the surprised look on the faces of so many of my patients after just a short 15-minute treatment. Because the word spreads fast when there's an effective, quick, safe, and affordable solution to managing painful conditions, I've had to devote more than half of my practice to light treatment. The vast majority of my patients come to me through word of mouth from other patients. I encourage my medical brethren to see how they might incorporate light therapy into their practices. They will not only be able to help a lot of patients who don't need to suffer, but can also make it a profitable undertaking.

BioPhoton

Light Emitter



Len Saputo, MD, is a graduate of Duke University Medical School and board certified in internal medicine. He was in private practice in affiliation with John Muir Medical Center in the San Francisco Bay Area for more than 30 years. His approach to healing has evolved from mainstream medicine into "Health Medicine" – an integrative, holistic, person-centered, and preventive style of practice. drlen@doctorsaputo.com

Notes

1. Branco K, Naeser MA. Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies--an open protocol study. J Altern Complement Med. 1999;5:5–26.

2. Irvine J, Chong SL, Amirjani N, Chan KM. Double-blind randomized controlled trial of low-level laser therapy in carpal tunnel syndrome. Muscle Nerve. 2004; 30:182–187.

3. Weintraub MI. Noninvasive laser neurolysis in carpal tunnel syndrome. Muscle Nerve. 1997;20:1029–1031.

4. Ehrreich SJ, Furchgott RF. Relaxation of mammalian smooth muscles by visible and ultraviolet radiation. Nature. 1968;218:682–684.

5. Chaudhry H, Lynch M, Schomacker K, Birngruber R, Gregory K, Kochevar I. Relaxation of vascular smooth muscle induced by low-power laser radiation. Photochem Photobiol. 1993;58:661–669.

6. Mittermayr R, Osipov A, Piskernik C, et al. Blue laser light increases perfusion of a skin flap via release of nitric oxide from hemoglobin. Mol Med. 2007;13:22–29; Passarella S. He-Ne laser irradiation of isolated mitochondria. J Photochem Photobiol B. 1989;3:642–643.

7. Alves ACA, Vieira R, Leal-Junior ECP, et al. Effect of low-level laser therapy on the expression of inflammatory mediators and on neutrophils and macrophages in acute joint inflammation. Arthritis Res Ther. 2013;15:R116. doi:10.1186/ar4296.

8. Whelan HT, Smits RL Jr, Buchman EV, et al. Effect of NASA light-emitting diode irradiation on wound healing. J Clin Laser Med Surg. 2001 Dec;19(6):305–314. Review PMID: 11776448.

9. Chaves ME, de Araujo AR, Piancastelli ACC, Pinotti M. Effects of low-power light therapy on wound healing: Laser vs LED. An Bras Dermatol. 2014 Jul–Aug;89(4):616–623. doi:10.1590/abd1806-4841.20142519.

10. Pereira AN, Eduardo Cde P, Matson E, Marques MM. Effect of low-power laser irradiation on cell growth and procollagen synthesis of cultured fibroblasts. Lasers Surg Med. 2002;31:263–267.

11. Shimotoyodome MD. Effects of IR light on lymph flow. Lasers Surg Med. 2001;29(5):442–447.

12. Hou J, Zhang H, Yuan X, Li J, Wei Y, Hu S. In vitro effects of low-level laser irradiation for bone marrow mesenchymal stem cells: Proliferation, growth factors secretion and myogenic differentiation. Lasers Surg Med. December 2008;40(10):726–733. doi:10.1002/lsm.20709.

13. Pastore D, Greco M, Passarella S. Specific helium-neon laser sensitivity of the purified cytochrome c oxidase. Int J Radiat Biol. 2000;76:863–870.

14. Yu W, Naim JO, McGowan M, Ippolito K, Lanzafame RJ. Photomodulation of oxidative metabolism and electron chain enzymes in rat liver mitochondria. Photochem Photobiol. 1997;66:866–871.

15. Passarella S. He-Ne laser irradiation of isolated mitochondria. J Photochem Photobiol B. 1989;3:642–643.

16. Kim SW et al. In vitro bactericidal effects of 625, 525, and 425 nm wavelength light-emitting diode irradiation. Photomed Laser Surg. November 2013;31(11):554–562. doi:10,1089/pho.2012.3343.

17. Dai T et al. Blue light eliminates community-acquired methicillin-resistant Staphylococcus aureus in infected mouse skin abrasions. Photomed Laser Surg. November 2013;331(11):531–538. doi:10.1089/pho.2012.3365.

18. Bumah VV et al. Wavelength and bacterial density influence the bactericidal effect of blue light on methicillin-resistant Staphylococcus aureus (MRSA). Photomed Laser Surg. November 2013;31(11):547–553. doi:10.1089/pho.2012.3461.

19. Chaudhry H, Lynch M, Schomacker K, Birngruber R, Gregory K, Kochevar I. Relaxation of vascular smooth muscle induced by low-power laser radiation. Photochem Photobiol. 1993;58:661–669.

20. Mittermayr R, Osipov A, Piskernik C, et al. Blue laser light increases perfusion of a skin flap via release of nitric oxide from hemoglobin. Mol Med. 2007;13:22–29.

http://www.townsendletter.com/Nov2015/break1115.html

Snake therapy

Only in America!
I've tried to write a suitable introduction to this video...I can't...over to you!

New Gene Therapy Relieves Neuropathic Pain Vid

Today's post from emaxhealth.com (see link below) looks at a new finding in the field of genetic therapies. Gene therapy seems to be one of the growth areas as far as nerve damage treatment in the future is concerned and each new story seems to offer genuine hope for the future. This article concerns VM202, a non-viral gene therapy that contains human hepatocyte growth factor (HGF). This is a growth factor that keeps nerves healthy and able to function. In this latest research, patients have responded extremely well to just two treatments and have achieved long-lasting pain relief. It's a fascinating story which you don't need to fully understand to appreciate that this may be an exciting development for the future.

Gene therapy offers new hope for diabetic neuropathy
By Kathleen Blanchard G+ 2015-03-06

Diabetes can lead to nerve damage known as neuropathy that is painful, permanent, irreversible and progressive. The most common symptoms of peripheral neuropathy that occurs in the extremities is a feeling of numbness and tingling and sharp, stabbing pain, especially in the feet. Researchers at Northwestern University have uncovered a new way to help diabetics get relief from diabetic neuropathy.

Researchers for the study that included 84 patients found patients with diabetes who were given two low dose rounds of a non-viral gene therapy called VM202 reported pain relief for more than a year.

Rather than just treating symptoms of diabetic neuropathy, the gene therapy actually helps the body heal.

Diabetes nerve damage can make it difficult to sense injury, making it easy to injure fragile skin. A simple foot injury for some with diabetes can mean slower wound healing, greater risk of infection, risk for chronic foot ulcers, amputation, increased medical costs, and decreased quality of life.

The non-viral gene therapy helped patients experience sensation with just a light touch.

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

How the therapy works

The researchers explain VM202 contains a gene known as human hepatocyte growth factor (HGF) that is responsible to keeping nerve fibers healthy and functioning.

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Dr. Senda Ajroud-Driss, an author of the study said the hope is that the therapy will stimulate new blood vessel growth and nerve regeneration to reduce pain and heal the body.

Medications used to treat diabetic neuropathy can be expensive. Some have side effects that are intolerable including dizziness and mood changes.

Injections to treat the condition were administered twice during a two-week period for the study. The gene therapy is administered into the back of the calf muscle and lower leg. The study group received either the therapy or a placebo for comparison.

The finding is published in the Annals of Clinical and Translational Neurology.



The researchers are planning a phase III study in the near future. “Our goal is to develop a treatment. If we can show with more patients that this is a very real phenomenon, then we can show we have not only improved the symptoms of the disease, namely the pain, but we have actually improved function." The study offers new hope for treating diabetic neuropathy that affects 2 to twenty-five percent of people diagnosed with diabetes. Gene therapy used in the research had no side effects and resulted in a 50 percent reduction of symptoms.

http://www.emaxhealth.com/1020/new-hope-treating-diabetic-neuropathy