Lyrica Once Again Shown To Be Ineffective

Today's post from vancouversun.com (see link below) will come as no surprise to may neuropathy patients who have been both disappointed by the ineffectiveness of pregabalin (Lyrica) and damaged by its side-effects. The fact is that it rarely works for neuropathic pain. However, because of aggressive marketing, it's the world's number one treatment for nerve pain! To be fair to Pfizer, they did withdraw their own recommendation for Lyrica for many disease-related neuropathies in March 2013 but that was forced by litigation and so much protest that it was inevitable. The FDA's warnings about the drug were that last straw. So why is it still so widely prescribed, despite the inherent dangers of side effects? Who knows! Apparently the marketing goes on and unscrupulous drugs company reps will prioritise getting rid of current supplies as quickly as possible. If you are prescribed Lyrica (pregabalin) for your neuropathic symptoms, please have a serious discussion with your doctor and maybe try to arrange an alternative. This article highlights the dangers if you don't.

Common drug for diabetic foot pain isn’t effective, B.C. researchers say
Erin Ellis, Vancouver Sun 01.18.2016

A report by the Therapeutics Initiative at UBC suggests Lyrica only helps about one in 10 of the people to whom it is prescribed.JB REED / BLOOMBERG NEWS

A pain medication that rarely works as promised had a 17-fold increase in prescriptions over a decade, says the latest research from the Therapeutics Initiative at the University of B.C.

Its report says only about one in 10 patients will gain relief from pregabalin (trade name Lyrica), which is used to treat peripheral neuropathy — usually foot pain caused by diabetes — and other discomfort. Therapeutics Initiative is think-tank that reviews the usefulness of prescribed drugs and offers advice to B.C.’s doctors and pharmacists.

The latest work released Tuesday concludes that pregabalin, and two other painkillers studied, gabapentin and duloxetine (Cymbalta), all have little effect on pain despite extensive marketing campaigns promoting them.

Co-author Dr. Tom Perry, a clinical assistant professor in the department of anesthesiology, pharmacology and therapeutics at UBC, says doctors often tell patients to take these medications in higher doses and for a longer time than the evidence supports. Patients should know within days whether the medications are working for them, he says.

“These drugs are intended to make someone feel better; if you’re not feeling better, why take it?”

Perry and co-author Aaron Tejani, a clinical assistant professor in Pharmaceutical Sciences, looked information on gabapentin, pregabalin and a number of other medications gathered by Cochrane Reviews which evaluate scientific research from around the world. They found expectations of the drugs’ effectiveness far outstripped the evidence and likely drives an increasing number of prescriptions.

In B.C., pregabalin prescriptions rose 17 fold from 2005 through 2014, compared with a 1.8-fold increase in people receiving gabapentin.

Gabapentin is now available as a generic drug, but was formerly trademarked medication called Neurontin manufactured by Pfizer. The pharmaceutical giant agreed to pay $430 million in U.S. fines in 2004 after marketing it for unapproved uses such as migraine headaches and pain.

Combined costs of gabapentin, pregabalin, and duloxetine were over $52 million in British Columbia during 2014, says the Therapeutics Initiative report, of which Pharmacare paid over $13 million, mostly for gabapentin.

Pregabalin, also manufactured by Pfizer for neuropathic pain, is not covered under B.C.’s publicly funded Pharmacare following a recommendation by a national drug advisory committee in 2005. As a result, patients either pay for it out-of-pocket or through private health insurance,

Worse than simply buying a medication that’s not working, Perry says pregabalin is often prescribed to older adults who may become drowsy or lose their balance because of it.

Therapeutics Initiative is funded by the B.C. Ministry of Health through a grant to UBC.

eellis@vancouversun.com

http://www.vancouversun.com/health/common+drug+diabetic+foot+pain+effective+researchers/11662999/story.html

New Cream In Development To Reverse Neuropathy A Big Claim

Today's short post from cardiovascularbusiness.com (see link below) is a version of many other such articles that have suddenly appeared on the internet in the last week, announcing the development of a new trans-dermal ointment to treat neuropathy. It's short because frankly, there's not much to report and yet it has caught the imagination of the neuropathy Net. Basically, a sort of ganglioside (a molecule important in immunology) called GM3 has been found that contributes to neuropathic pain. The theory is that an ointment can be developed to reduce GM3 in the body, thus reducing neuropathy symptoms. The difference between this finding and other developments is that they claim that this can reverse the nerve damage instead of just treating the symptoms. That's a pretty big claim but because it's years away from becoming anything that will appear on doctors' prescription pads, or even human trials, so we can only wait and see. However, we're fairly used to this sort of 'breakthrough' news aren't we? A pinch of salt anyone!

Researchers develop ointment to reverse neuropathy in diabetic patients
Sep 15, 2016 | Katherine Davis

 More than 25 percent of type-2 diabetes patients suffer from neuropathy, a condition that causes numbness and nerve pain in the feet. But new research from Northwestern University has found a way to reverse the condition.

The study, published in Molecular Pain, gives hope to thousands of diabetic patients whom have high levels of GM3, a type of ganglioside that contributes to constant pain in their feet.

"We have such terrible treatments right now for the neuropathy of diabetes," said corresponding author Amy Paller, MD, the Walter J. Hamlin professor of dermatology at Northwestern University Feinberg School of Medicine and director of Northwestern's Skin Disease Research Center in Chicago. "We're basically only treating the pain. This is a novel pathogenesis-based approach that looks at what's causing the neuropathy and reverses that instead of just treating the pain."

After finding that by depleting GM3 through genetic modification prevented the development of neuropathy in mice, the researchers created an ointment to reduce the chemical and the enzyme that makes it.

The scientists compared the appearance and function of the mice’s nerves when they were exposed to ointment to when they weren’t. They tested their pain responses and found that when exposed to the ointment, their pain reactions were no different from mice that had low levels of GM3.

Going forward, the researchers want to further test the ointment on humans in clinical trials to conclude it has the same beneficial effect.

"If the studies look promising in mice, our long-term goal would be to further test safety and advance to human clinical trials to prevent and/or reverse the development of diabetic neuropathy," Paller said.

http://www.cardiovascularbusiness.com/topics/practice-management/quality/researchers-develop-ointment-reverse-neuropathy-diabetic-patients

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/

We Need To Reduce Antibiotic Use And Misuse

Today's post from huffingtonpost.com (see link below) looks at antibiotics and explains why we've got to control their over-prescription, both because of growing resistance, the difficulty in developing new ones, and (in our case) the effect some of them can have on our nervous systems. There is no direct reference to neuropathy but it's a very important topic and certainly relevant to neuropathy sufferers if you look at the damages fluoroquinolone antibiotics can do to your nervous system (see more articles here on the blog). Worth a read.

Stop Killing the Good Guys! Protect Your Child's Microbiome From Antibiotic Overuse
Aviva Romm Practicing Family Physician, Midwife, Herbalist Posted: 01/08/2015

There's no doubt that antibiotics are a good thing. They save lives every day. We can, in part, attribute our longer lifespans, reduction in infant mortality and childhood deaths from life-threatening infections, and the near elimination of childbirth-related maternal deaths from infections in hospitals to antibiotics. As a medical doctor I am grateful to be able to prescribe them for serious bacterial and other appropriate infections, for example Lyme disease. As with many things, however, more is not always better. And this is certainly the case with antibiotics.

The average child in the United States will receive between and 10 and 20 courses of antibiotics by the time he or she is 18 years old. (2) We are so accustomed to antibiotics being prescribed for childhood illnesses that we assume that they are as safe as they are common. But this is far from the truth. We are now learning the hard way that the common overuse of antibiotics, both as medicines and in our foods (they are given to cattle and poultry to keep them "healthy" until they are slaughtered for food; antibiotics also promote growth in these animals by the same mechanisms that their chronic use increases the risk of obesity in humans) is responsible for two major health problems: global antibiotic resistance to serious infections, and damage to the human microbiome.

This growing awareness that antibiotic overuse is dangerous for both public and personal health requires us to drastically and immediately rethink and adjust our antibiotic use. In doing so we can prevent our children from developing life-long chronic illnesses associated with microbiome damage, some of which rival the seriousness of the bacterial infections that used to threaten them, and we can reduce the major global threat of antibiotic resistance we all face.

Antibiotics, Your Child's Microbiome, and Chronic Disease

Antibiotics kill bacteria. The problem is that they not only kill off the bad guys (and as you'll see below, because of antibiotic resistance, they are doing this less effectively!); they kill off the good ones, too. When we give antibiotics to children at a young age or frequently enough, some of the good guys may never fully recover. These good gut flora, and their composite, our microbiome, are essential for more functions that protect and support our health than we'd ever imagined until recently. We now know that microbiome damage directly and significantly increases the risks of our children developing long-term health problems including: food, environmental, and seasonal allergies, eczema, asthma, ulcerative colitis, Crohn's disease, obesity (even when they're not over-eating), diabetes, and cardiovascular disease. (1) (4)

Antibiotics are given to between 30 and 50 percent of all women during pregnancy or labor. (2) Mom's exposure to antibiotics perinatally also negatively affects the breast milk microbiome, which is part of what is supposed to help colonize baby's gut with beneficial flora. (5) Additionally, 34 percent of babies in the U.S. are born by cesarean. These babies miss out on the important inoculation their gut flora is meant to receive through natural exposure to mom's vaginal flora, thus compounding the problem. Our babies thus begin their antibiotic exposure even before birth, and as a result damage to their formative microbial populations begins before they've had a chance to establish their optimal gut flora. If your baby was born by cesarean section, or if you did need to have antibiotics in labor, no need to be worried! Start your baby on a probiotic in the day or so after birth. Data has shown that while we can't necessary restore the native flora baby might have had, we can prevent eczema, allergies, and asthma with early probiotic treatment. (6)

By age 24 months, 69 percent of children in the U.S. have received at least one systemic antibiotic course, though the average is 2.3 courses for ear infections, bronchitis, sore throat, and other common childhood illnesses. Yet according to the Centers for Disease Control, and other official reports, at least 50 percent and as many as 70 percent of the antibiotics prescribed for children for these and other symptoms/conditions are unnecessary and inappropriate. (3)

Reactions to antibiotics are responsible for at least 140,000 hospital visits annually in the US. (3) One in every five emergency department visits due to a medication reaction is due to antibiotics, and in kids under 18 years old they are the most common cause of drug reactions. When a child takes an antibiotic that is not needed, not only is she or he getting no benefit; she or he is exposed to all the risks of harm and the use of that medication adds to antibiotic resistance.Why are antibiotics overprescribed? There are four main reasons:
Doctors think that parents expect an antibiotic prescription when they bring their child in for a sick visit -- and many do -- leading to 50 to 70 percent of the antibiotics that are prescribed. (4)
Doctors are afraid to get sued should an infection that they didn't treat with an antibiotic turn out to be more serious than anticipated.
Doctors don't feel that they have time to explain the problems with antibiotics to parents in the time allocated for a child's sick visit, whereas it is quick and easy to prescribe an antibiotic.
Doctors aren't knowledgeable about alternatives to antibiotics and want to prescribe something they think will help.

The Centers for Disease Control and Prevention (CDC) has been on a several decade-long campaign to get physicians to reduce their antibiotic overprescribing. While there has been about a 20 percent decrease in antibiotic prescribing over the past 20 years as a result, the rates of overprescribing remain shockingly high, according to the CDC and other researchers. (3)

Antibiotic Resistance: A Global Health Threat

We are in the midst of a global health crisis -- antibiotic resistance, which is a direct result over the overprescribing and inappropriate prescribing of antibiotics, and the overuse of antibiotics in the meat industry.

Antibiotic resistance is not something that develops just in the individual -- that is, it's not just that you become resistant to that antibiotic -- it means that the bacteria themselves have learned to outwit the antibiotic so that the antibiotic is no longer effective in treating anyone who is infected with the resistant strain.

Each year in the U.S. alone over 2 million Americans acquire serious infections with bacteria that are now resistant to some or all of the antibiotics that we have to treat those organisms, and at least 23,000 people die each year as a result of antibiotic resistance. (3) Global leaders in public health have declared that these "nightmare bacteria" pose a catastrophic threat to every person in the world!

Five Steps to Preventing Antibiotic Overuse In Your Child
 
Promote health in your children: Preventing recurrent upper respiratory infections including coughs, colds, sore throats is an important and logical step you can take to prevent antibiotic overuse. Less need for them = less use of them! A healthy diet of natural foods with plenty of good quality protein, good quality fats, plenty of fresh vegetables, and low sugar, reduction of chronic stress, playing outside and getting dirty to get exposure to natural probiotics in the soil, and regular hand-washing with soap and water (don't use antibacterial soaps -- these also contribute to antibiotic resistance), along with a multivitamin that contains adequate iron, vitamin D, essential fats, and zinc, all support optimal immunity. The gut can also be nourished and the microflora supported with a probiotic.
Choose organic for your meats and dairy: While it may not be feasible for you to serve your family an entirely organic diet for economic reasons, at least use only antibiotic-free meats and poultry, and organic dairy. These are where the heavy antibiotic exposures come from in the diet -- so it's where you can make your money count most toward reducing antibiotic exposures.
Know your options -- Get Smart: The CDC has a website called Get Smart that is dedicated to preventing antibiotic resistance through preventing antibiotic overuse. You can find information on the primary infections for which antibiotics are overused, how to know when your child really does need an antibiotic, and how to avoid unnecessary use. Included is also information on comfort measures and medical alternatives for common symptoms ranging from cough and sore throat, to fever and ear infections. I don't necessarily agree with all of the CDC's alternative treatment recommendations, particularly the liberal use of Tylenol and ibuprofen, which have their own potentially serious side effects, but the overall information is very useful and also provides solid information to bring to your child's doctor's appointment to share with the pediatrician in case there is disagreement over whether the antibiotic is necessary and appropriate.
Know your rights: Doctors are not infallible nor are we omniscient. And not all doctors are aware of the importance of avoiding antibiotic overprescribing, so some may may insist on the prescription in spite of the CDC's guidelines. If you cannot reach agreement with your pediatrician, you have the right to seek another opinion or to change doctors. You should not be coerced into giving unnecessary antibiotics to your child. If your pediatrician is, however, insistent, find out why -- she may have a different perspective on your child's symptoms and of course the CDC guidelines are just that -- clinical judgment is also important.
Use natural treatments for the symptoms of common childhood illnesses whenever possible.

References
1. Bailey LC et al. Association of antibiotics in infancy with early childhood obesity. JAMA Pediatr 2014 Sep 29
2. Blaser, M. Stop the killing of beneficial bacteria. Nature. Vol 476, 393-94. Aug. 2011.
3. CDC. Antibiotic Resistance Threats in the United States, 2013. US Dept of Health and Human Services, Centers for Disease Control and Prevention.
4. Dooling KL et al. Overprescribing and inappropriate antibiotic selection for children with pharyngitis in the United States, 1997-2010. JAMA Pediatr 2014 Sep 29
5. Williams, F. (2013). Breasts: A natural and unnatural history. New York: W.W. Norton.
6. Osborn DA, Sinn JK. Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev. 2007;17: CD006475.

Aviva Romm, M.D. is a Yale-trained, Board Certified Family Physician, midwife, and herbalist helping extraordinary women live their best lives through optimal health. An award-winning author and the leading international authority on botanical, integrative and functional medicine for women and children, she combines her unique backgrounds to guide women in transforming their health -- and their lives. She is also a leader in the revolution to shift the current medical system into one that respects the healing capacities of the body and nature. Dr. Romm has bridged her interests in traditional medicine with her knowledge of science for over 30 years, specializing in the impact of stress, food and lifestyle on food cravings, weight, immunity, hormone imbalances, and women's chronic health concerns. She also provides comprehensive guidance on natural fertility, pregnancy, and birth, and pediatrics. Dr. Romm practices Functional Medicine for Women and Children at The UltraWellness Center with Dr. Mark Hyman in Lenox, MA. Visit her website www.avivaromm.com for free access to her e-book, Herbal Medicines for Kids: Taking Charge of Your Child's Health... Naturally.

http://www.huffingtonpost.com/aviva-romm/stop-killing-the-good-guy_b_6396546.html?utm_hp_ref=healthy-living

Stocking To Detect Neuropathic Foot Wounds

Today's post from diabetes.co.uk (see link below) talks about a new, prototype product designed to help neuropathy patients who have lost so much feeling from their feet that they become prone to injury, pressure sores and open wounds (without realising it). It's a stocking with inbuilt sensors that monitors unduly high pressures on the foot and alerts the wearer to the problem before it causes physical injury. The problem is that it's currently only a prototype and is probably going to be very expensive but if it gets past the development stage, it could be a very useful tool which will hopefully prevent the nasty injuries loss of feeling in the feet can cause.

New pressure-monitoring device could prevent neuropathy-related injuries
Thu, 14 May 2015

Researchers from Germany have developed a pressure-monitoring stocking that could prevent foot wounds in people with diabetic neuropathy.

The device, which was developed by researchers at the Fraunhofer Institute for Silicate Research ISC in Würzburg, uses integrated sensors to send warnings when pressure on the foot is too high, essentially performing the job of the nerves in the feet.
Neuropathy and foot pressure Diabetic neuropathy is one of the most common diabetic complications. Over time, prolonged exposure to high blood glucose levels damages the nerves in the feet. Diabetic neuropathy is the leading cause of amputation in the UK.

When people develop diabetic neuropathy, they lose the feeling in their feet. This can have a number of damaging effects. One such effect is the inability to notice the amount of pressure being placed on the feet. People without diabetic neuropathy have functioning nerve pathways that automatically redistribute when the person is standing up for a long time.

Over time, excessive weight placed on the feet can lead to the development of pressure sores, which can in turn lead to open wounds or damaged foot tissue.
How does the pressure stocking work? The stocking features 40 dielectric elastomer sensors that measures pressure distribution. The sensors are made from a special silicone film. When pressure builds on the foot - usually because of standing in the same place for a while - the sensors transmit a signal to a wireless electronics unit.

The stocking will cost around £180.
What makes the pressure stocking different? There are several products available to balance out pressure on the foot for people with diabetes, but this one is different, according to Dr. Bernhard Brunner, of the Fraunhofer institute:

"Existing systems on the market measure the pressure distribution only on the bottom of the foot using shoe inserts. Our sensors are attached to the stocking's sole, at the hell, the top of the foot and the ankle, so they can take readings in three dimensions. This is a totally new approach."
Moving forward The device is brand new, and some creases still to be ironed out. Dr. Brunner explained the challenges that face the team going forward:

"With the current prototype, the electronics are attached to the end of the stocking. We're planning to relocate them to a small, button-sized housing that can be detached with a hook-and-loop fastening strip. There's no way around this until a reliable method for cleaning the electronics is developed."

The sensors have to be washable, too. "The first washability tests are in planning, but cleaning using disinfectant is no problem."

The researchers have filed a patent application for the stockings. From May 19 to May 20, the team will be presenting a prototype of the stockings at the SENSOR+TEST 2015 Measurement Fair in Nuremberg.

http://www.diabetes.co.uk/news/2015/may/new-pressure-monitoring-device-could-prevent-neuropathy-related-injuries-97065315.html

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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/

Said The Snail To The Neuropathy Patient

Today's post from npr.org (see link below) will make alarming reading for neuropathy patients who find it difficult enough to walk at any pace at all. However, if true, the lesson is clear. We must all make an effort to walk more often and a little faster if we want to keep our brains active. However painful, maybe we should all push ourselves just a little more to exercise as much as possible - the rest of our body (if not the nerves) will thank us in the end.
 

Slow Walkers May Be On Their Way To Dementia 
by Linton Weeks August 01, 2014

Wait a minute. Weren't we told by Simon and Garfunkel: "Slow down, you move too fast. You've got to make the morning last"?

And by some other philosopher to "stop and smell the roses"?

Now we learn from new research that walking slow can be a bad thing — or at least reveal that you might be slouching toward Alzheimer's.

Published in the medical journal , the study shows that among older people with memory complaints those who walk more slowly are more susceptible to future dementia.

Plodding Points

After examining hundreds of patients, — a neurologist at the Albert Einstein College of Medicine in New York and senior author of the paper — realized that if an older person ambles along at a poky pace, he probably also has some cognitive abnormalities.

Measuring a patient's gait speed with a stopwatch, along with asking a few questions to get a handle on the person's cognitive abilities, can be a useful low-tech test for motoric cognitive risk syndrome, or MCR, Joe says. Certain responses to an MCR test can determine whether someone is in the early stages of the dementia process. Early detection and treatment may help slow or prevent dementia's advance.

Joe says that a slow walking speed is considered to be anything slower than a meter a second, or 2.2 miles per hour. The Neurology report is based on a study of thousands of adults around the world.

Not all dawdlers are destined for dementia, Joe points out. Sometimes people's gaits are slowed down by arthritis or inner ear conditions.

Hurry Up
 
So, we ask Joe, will walking faster help a person ward off dementia? "Epidemiological studies suggest that people who walk regularly have a reduced risk of dementia," he says. "Whether walking faster will reduce risk of dementia needs to be proven — and would be an important next step."

(See what he did there?)

And, he adds, so far there seems to be no correlation between dementia risk and doing other things slowly, such as eating or speaking.

That's beneficial news for aficionados of the Slow Food Movement and for those of us from the American South.

http://www.npr.org/blogs/theprotojournalist/2014/08/01/336830233/slow-walkers-may-be-on-their-way-to-dementia

Strategies To Get Through The Day With Neuropathy

Today's post from psychologytoday.com (see link below) provides some wise words for those people struggling with neuropathy on a daily basis. Sometimes it's the pressure from other people that makes you over-extend and do more than is good for you and sometimes it's the pressure of the relentless symptoms that can make life so miserable that it's difficult to see a way forward. This article may help you form a strategy to deal with all that. It's realistic and not too 'new age' or clichéd and provides some genuinely helpful tips on living with a chronic illness. Worth a read but putting it into action won't be easy.

Pacing: The Chronically Ill Person’s Best Friend
Toni Bernhard J.D. Turning Straw Into Gold Posted Jun 15, 2016

Five effective strategies for pacing when you’re sick or in pain

Pacing refers to spacing out your activities during the day so that you’re able to stay within the limits of what your body can handle without exacerbating your symptoms. Another way to think of it is that pacing is a way to keep you inside your "energy envelope"—the envelope that contains your energy stores for any given day.

First, an admission: Even though pacing may be the single best “treatment” for me, I have a love-hate relationship with it. On the one hand, I love pacing because it keeps my symptoms from flaring. On the other hand, I hate pacing because it keeps me from doing everything I want to do.

To complicate matters, I’m much better at pacing when I’m at my best, as opposed to when I’m at my worst. This means that when I’m feeling intensely sick or in pain, I tend to ignore pacing and overdo things which, of course, only exacerbates my symptoms. Why in the world would I do this? Because doing things distracts me from my symptoms. In other words, activity keeps me from tuning in to how my body feels. Of course, this always backfires. The time comes when my body imposes itself on the situation and tells me in no uncertain terms: “That is enough for now.” Then, when I do give in and lie down to rest, I have to deal with feeling worse due to all that extra activity. When will I learn?

This tendency of mine is the exact opposite way that “pacing failure” is usually described. It’s usually described as overdoing it when you’re feeling good, and then having to pay for it later, often by being confined to bed for a time. This is called the “push and crash cycle.” I can do that too, but in this complicated relationship I have with pacing, I could call my tendency to overdo it when I’m already feeling terrible a “crash and crash cycle”!

I’m pretty sure I’m not alone in doing this.

The odd thing is that I’m generally a very disciplined person, so because pacing takes discipline, you’d think I’d be good at it. But I’m not. I admit that one reason for writing this piece is self-interest: I need to work on my pacing skills and writing about it will inspire me to do so.

Here are some ideas for pacing that have worked for me when I’m being “good” and following them: 

1. Alternating activity with rest.

This is the essence of pacing.

In my experience, the best way to do this is to write out a schedule for the day that incorporates rest in between each activity you want or have to do, be it mental or physical. This way, you’re dividing your activities into manageable chunks of time.

Here’s the secret to success with this: if you don’t stick to your schedule exactly, don’t abandon it. This is a common mistake. When I was teaching, I recommended that students create a schedule during finals period in which they set out what subjects they’d study on any given day and time. Then I gave them this final piece of advice: “Stuff happens that can keep you from sticking precisely to your schedule. Don’t throw it out. Revise it and start from your new spot.”

This approach to scheduling has helped me tremendously since becoming chronically ill. For example, if I put on the schedule for the morning, “10:00-10:30: work on blog post,” but then wind up working until 11:00, I revise the schedule and move on with the day. Simply having that schedule in front of me keeps me from deviating from it too much. Without set time-frames, I’m likely to lose track of time and work for several hours straight; then of course, I have to suffer the consequences. Some people find it helpful to set a timer; when it goes off, they know it’s time to stop the activity and rest for a while. 

2. Slowing down when performing tasks.

I tend to do things quickly. This causes my heart to begin racing and it can even make me dizzy. Slowing down is an excellent way to pace. And so, when I catch myself going faster and faster, for example, when I’m folding laundry or doing the dishes, I consciously tell myself to slow down. Not only do I save energy this way (and so I’m pacing), but I enjoy the task much more.

3. Following the 50% rule.

With this pacing tool, given how you feel on a particular day, you decide what you can comfortably do and then only do 50% of it.

One reason this is a great strategy is that I tend to overestimate what I can comfortably do, so this keeps me safely within my energy envelope. I also recommend that you think of that unexpended 50% as a gift you’re giving yourself to help you feel less sick and in less pain. 

4. Using a metaphor to help allocate available energy.

Many of you are familiar with the “spoon theory” by Christine Miserandino and find it very helpful. Here’s a link to it: The Spoon Theory.

I use a “marbles in a bowl” metaphor because it works better for me. When I wake up in the morning, depending on how I feel, I imagine that I have a certain number of marbles in a bowl. They represent the available energy I have for that day. It might be 50 marbles on a good day…and 10 marbles on a bad day.

Then, before I start an activity, I estimate how many marbles it will use up and subtract that number from my total. When there are no more marbles in my bowl, it’s time to “shut down” for the day. Initially, I had a lot of success with this strategy. Unfortunately, several years ago I stopped doing it. (Note to self: start thinking about marbles again!)

Don’t forget that mental and emotional activity use up marbles too. In fact, stress is a marble gobbler. For this reason, if an unexpected source of stress arises, you may suddenly find your bowl empty. That’s the time to make a commitment to rest as much possible for the remainder of the day.

5. Using a pedometer or a heart rate monitor.

These are inexpensive devices. A pedometer counts the number of steps you take in a day. A heart rate monitor keeps track of how fast your heart is beating. Once you figure out your limits—how many steps you can take or how high your heart rate can become before you feel the energy draining out of you—you keep your eye on the pedometer or the heart-rate monitor; when they get to a certain reading, you know it’s time to rest.

The reason I’m not using either at the moment is that, in my case, I can overdo things without taking a single step, for example, working too hard on my writing even though I’m reclining on the bed. Nevertheless, I know from others that these two devices can be valuable pacing tools.

***

A final word. Expect the unexpected, meaning that no matter how carefully you’ve planned your day for perfect pacing, as John Lennon wrote: “Life is what happens while you’re busy making other plans.” Stuff happens that may keep you from sticking to your pacing goals. When that happens, don’t abandon your pacing plans and don’t blame yourself for getting off-course (that’s a useless waste of your limited energy). Instead, revise your schedule and then try again. In an earlier piece, I referred to this as keeping a “Try Mind.”

https://www.psychologytoday.com/blog/turning-straw-gold/201606/pacing-the-chronically-ill-person-s-best-friend

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Others Concerned About the .ual Transmission of Zika. Anyone not concerned about pregnancy who wants to avoid getting or passing Zika during can use condoms .TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Official U.S. government travel health recommendations provided by the U.S. Centers for Disease Control and Prevention. Disease outbreak alerts, reference material .

The Opioid Row Is Directly Relevant To All Neuropathy Sufferers

Today's post from startribune.com (see link below) is of interest to all neuropathy patients, even if you are only taking paracetamol to reduce your symptoms. It addresses the so-called opioid addiction problem but remember, once you begin serious treatment for your neuropathic pain, you're taking drugs meant for other conditions and they all have potential side effects and potential addiction problems. Most people start for instance, with Amitriptyline (which seldom works when neuropathy takes hold but even this is an antidepressant and can have adverse effects on your health. From that point on, the drugs just get stronger, until after you've exhausted them all, you end up on opioid family medications and remember...this is just to control the pain...it does nothing to help the nerve damage itself. So yes, this article applies directly to you and is worth taking sides on. The point of the article is that although politicians claim this is an 'addiction and criminality' problem, it's not, it's a chronic pain problem for which those drugs are ultimately the only solution. Therefore the article quite rightly aims for a course of treatment that is multi-disciplinary and includes drugs but also many other ways to tackle chronic pain. If you scan down the title list to the right of this blog, you will find many articles relating to non-drug treatments to help you live with chronic pain - they need to be included in any doctor's approach to chronic pain. so that you don't just walk away with a prescription for hard drugs in your hand but have a list of other tools which will reduce the need for those drugs and help cope with chronic pain as well. However, don't be fooled...the drugs are necessary; the pain is real and you're not a junkie for needing them. It's just that you can help yourself in other ways too. Worth a read.

Drop old doctor-centered model for a proactive, self-care approach. 
By James Fricton, Alfred Clavel and Mark Weisberg April 15, 2016

 
Health care and addiction: Instead of opioids, prevent chronic pain

The effort announced by the Obama administration to address the growing opioid abuse problem misses the mark on why people become addicted to opioids. The real reason for the increase in opioid use is not about addiction, but rather about chronic pain.

Thus, the March 27 front-page article (“Taming the pain without the pills”) on an innovative approach to help opioid-addicted patients with chronic pain is important and timely.

While major efforts are underway to prevent most other major health conditions, preventing chronic pain remains an enigma, overlooked by the public, neglected by the health care system and generally ignored by the scientific community. Chronic pain is the “elephant in the room” of health care, and we need to prevent it.

The Institute of Medicine (2011) and the National Pain Strategy (2016) state that chronic pain conditions are the No. 1 reason for the use of opioids, the No. 1 reason for seeking care, the No. 1 cause of disability and the No. 1 driver of health care costs — costing more than cancer, heart disease and diabetes. It costs the United States alone over $700 billion in health care and lost work. This is equivalent to 25 percent of total health care costs and nearly 5 percent of the U.S. total gross national product.

The personal impact in terms of suffering, loss of function, disability, depression, addiction, overdoses and more is incalculable.

The Obama administration strategy suggests that we need to wean thousands of people off these powerfully addictive substances or avoid distributing them in the first place. However, this assumes that people are taking them for nonmedical reasons. In the vast majority of cases, people have been prescribed opioid medications to manage chronic pain.

If we want to reduce opioid addiction and overdoses, we must focus more effort on preventing chronic pain without opioids. Pain conditions in the back, neck, head, face and other areas are caused by physical disorders of the muscles, joints, nerves and other tissues that may begin with an injury or strain and that then may persist due to the lifestyle risk factors that increase sensitization of the nervous system. Repetitive strain, poor sleep, stress, maladaptive postures, emotional problems and other factors can delay recovery. The majority of those with pain over one month in duration still have pain years later despite the use of opioids, pharmaceuticals, implanted devices, surgeries and other innovative treatments.

It’s time we shift the focus to preventing chronic pain. We spend billions on advances in pharmaceuticals, devices, surgeries and other innovative treatments for chronic pain, yet we fail to deliver long-term relief, primarily due to the lack of educating patients in self-management strategies to reduce these risk factors and enhance protective factors.

The Institute of Medicine states that the primary role of the health professional in caring for chronic pain requires guiding, coaching and assisting patients with day-to-day self-management, in addition to evidence-based medical treatments. However, most health professionals lack the time to perform this role and find little support and reimbursement for doing so. They rely on the patient to do so, but this often does not get done. The opioid epidemic is just one of many consequences.

We need to change our health care system. Solving the chronic pain problem requires changing our health care model from a passive model of doctor-centered care to a patient-centered transformative care model. Transformative care brings together evidence-based treatments with self-management training to reduce risk factors and enhance protective factors in each aspect of a person’s life. It helps people shift the balance from illness to health. Embracing patient-centered health care paradigms such as self-responsibility, education, personal motivation, social support, strong provider-patient relationships and long-term change are the key.

We also need to train health professionals and patients on how to prevent chronic pain and opioid addiction. One innovative example of this is the massive open online course (MOOC) titled “Preventing Chronic Pain: A Human Systems Approach” (www.coursera.org/course/chronicpain). This course provides free online education to help those who want to prevent chronic pain and opioid addiction. Course evaluations found 93 percent believed that the course made a difference in their lives and that 85 percent of health providers believe that it made a difference in their patient care. As one participant stated, “Absolutely fascinating and enlightening. This information should be part of every health care educational program!”

Patients and health care professionals can shift the balance from a passive, dependent role to one of being empowered, engaged and well-trained to not only prevent their chronic pain, addiction and disability but also to enhance health and well-being. Ultimately, this will best prevent the opioid problem, improve the quality of health care and significantly reduce health care costs. The “elephant in the room” will finally get addressed. Why not support this?

Dr. James Fricton is a professor and specialist with the HealthPartners Institute for Education and Research, the Minnesota Head and Neck Pain Clinic and the University of Minnesota. Dr. Alfred Clavel is a neurologist with the Minnesota Head and Neck Pain Clinic and department chair in pain management at HealthPartners. Dr. Mark Weisberg is a clinical psychologist with the Minnesota Head and Neck Pain Clinic and the University of Minnesota.

http://www.startribune.com/health-care-and-addiction-x2009-x2009-instead-of-opioids-prevent-chronic-pain/375905321/

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/

Sleep Deprivation Can Lead To More Pain And Weakness

Today's post from brainlessblogger.blogspot.nl (see link below) looks at the effects of impaired sleep patterns on fibromyalgia patients. Fibromyalgia is also a neurological condition closely linked to other forms of neuropathy and many neuropathy patients are well aware that their problems getting quality sleep have an on-going effect on the rest of their lives. The article looks at studies that suggest that short-term sleep deprivation can lead to an increase in adrenalin production and the patient actually feeling better ('running on adrenalin'). However, long-term sleep impairment does lead to an increase in pain due to fatigue and a build up of over-worked neural activity. Neuropathy patients are often kept awake, or wakened, by the pain or tingling itself, leading to a vicious circle of symptoms that reduce the quality of life considerably. The conclusion is that good sleep is essential - no surprise there but if lack of quality sleep is a problem for you, it's worthwhile getting expert advice to achieve as much undisturbed sleep as is possible in your case.

sleep duration and fibromyalgia pain intensity
Tuesday, January 12, 2016

Insomnia, sleep disorders and impaired sleep have always been considered significant factors in regards to fibromyalgia syndrome and even explored as a cause to the syndrome. It is during deep sleep that people produce significant amounts of growth hormone which repair and maintain muscles. Therefore lack of deep sleep and interrupted sleep, which are predominate features with FM, have long been considered factors in pain intensity along with lack of overall time sleeping. Lack of sleep, therefore, must relate to pain levels. A recent study in the Journal of Pain, 2012, suggests this is not necessarily the case.


The Study


74 people with FM were asked to be a part of the University of Florida study and were observed over a 14 day time period. Given the small test group and time frame of the study we have to take these results with a grain of salt. In the study set up FM patients had a sleep diary where they would record how their sleep went and they also were to rate their pain levels every evening.

"For this study, a research team from the University of Florida hypothesized that decreased total sleep time would predict higher clinical pain in a sample of patients with fibromyalgia…Results of the analysis showed that four sleep measures evaluated in the study failed to significantly predict clinical pain. The authors noted that the effects of impaired sleep, such as fatigue and inactivity, may play more significant roles in clinical pain than measures of sleep duration or insomnia. Sciencedaily.com"

Why the results are surprising

These results are surprising because we would expect the opposite. Historically other studies have shown disruptive sleep patterns in people with chronic pain conditions will produce increased pain. Lack of sleep is in fact a factor that can produce pain in healthy people as well. Given the majority of FM patients have disrupted sleep one would expect the results to show decreased duration of sleep would increase pain the next day.

Why we cannot draw firm conclusions

The study is only of 74 people so this is not a large study and we cannot draw any conclusions from one small study. Secondly, the duration of the study itself was short, only over a span of two weeks, which given the nature of chronic pain and sleep disorders is hardly significant. A few days of less sleep can get someone, who regularly gets disrupted sleep, into a sleep deprivation state running on adrenaline. For the short term this will actually make them function fairly well on a pain basis. They will be in 'fight or flight' mode and not feel as much pain, or at least, not right away. However, accumulated sleep deprivation will cause the pain to build up such that we often see with FM the morning muscle pain being severe in the morning and becoming less severe as the day goes on. Ironically, also with short, disrupted sleep someone with FM may feel very alert in the morning because they have not actually gotten much sleep. They do not feel the pain from being in one position for a long period of time so there is no muscle aches from that. The lack of sleep, initially, makes them feel alert, energized and with no morning stiffness and pain. Whereas, longer durations of sleep are often still of poor quality leaving someone with FM still feeling groggy. They will often wake up with morning stiffness and pain from laying in one position for too long if they have managed to be asleep for any length of time. It is not necessarily duration that is a factor but quality. Therefore, it is not necessarily the case that decreasing the total sleep time would increase the pain the next day with someone with FM. Ten hours of poor quality sleep where the person woke up frequently and spent very little time in deep sleep cannot be compared to five solid good hours of sleep. Ten hours of poor quality sleep may leave the person feeling groggy, stiff and sore, while the five hours of restorative sleep may leave them feeling alert and well rested.

Nevertheless, FM patients suffer from poor quality sleep and, at times, other sleep disorders such as restless leg syndrome (RLS) or sleep apnea. Whether the duration of their sleep affects intensity or not certainly lack of sleep affects fatigue, mood and likely even overall health. It is vital with FM to try and maintain healthy sleep habits and a regular sleep cycle. Quality of sleep is just as important as quantity of sleep.

http://brainlessblogger.blogspot.com/2016/01/sleep-duration-and-fibromyalgia-pain.html

Is Intravenous Immune Globulin The Answer To Neuropathy Problems

Today's post from kiich.sharedby.co (see link below) is a St Louis Post Despatch, letters-to-the-doctor example, which asks the question whether Intravenous immune globulin is the answer to the neuropathy patient's problem. It's a specific question relating to a specific case but if it's  got you curious as to what IVIG is, then you may want to research further to see if it's a possibility for you.

IVIG is primarily for autoimmune neuropathy 
Dr. K Roach November 06, 2014 12:00 am 
Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital.Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, Fla. 32853-6475

Dear Dr. Roach • My brother has been treated for peripheral neuropathy for the past 10 years. He turns 60 in October. After an MRI found a left parietal tumor, he was seen by a prominent neurosurgeon who felt that the tumor had been there since birth and is not connected to the symptoms of pain and decreased sensation in his feet and hands. He is not diabetic, has no cardiovascular problems and does not use alcohol. Basically, all tests come back normal. For now, they just monitor the tumor.

My brother resisted taking any narcotics until three years ago and is now on a long-acting narcotic twice a day. The physicians seem to think this is a genetic/autoimmune problem, and my brother is less inclined to keep searching for help.

My question is: Would a trial of IVIG infusion therapy be reasonable? I don’t know if his bloodwork supports checking his immune status, but I am not sure that the results necessarily would reflect the problem. I have read of IVIG use for some neuropathies, but before I try to get my brother to see a neurologist again, I would like to know if this is a possible therapy to try. — M.S.

Answer • Peripheral neuropathy is one of the most frequent topics I get questions about, but it is very difficult to answer the questions, because there are many different kinds of peripheral neuropathies (“peripheral” means the part of the nervous system outside the brain and spinal cord, while “neuropathy” simply means that something is wrong with the nerve).

In general, peripheral neuropathies can be broken down into several categories. Diabetes is the most prevalent one I see, but those caused by prolonged alcohol use and HIV are other common types. Some are indeed autoimmune, such as Guillain-Barre. Other toxins besides alcohol, especially chemotherapy, may cause symptoms in the peripheral nerves. There are genetic or hereditary causes that are relatively rare. Other important causes include infection, especially Lyme disease; hypothyroidism; vitamin deficiencies; and amyloidosis. One cause I see rarely is called paraneoplastic, associated with an existing tumor. That is one way the tumor in the parietal area of the brain could possibly cause the neuropathy.

If the underlying condition can be treated, it should be, but it sounds in your brother’s case that despite looking, his doctors haven’t been able to find a cause. About 1/4 of cases of peripheral neuropathy fall into the idiopathic, or unexplained, category. Intravenous immune globulin is used primarily for the autoimmune types of neuropathy. Only his neurologist can say if it’s right for him.

When the underlying condition can’t be treated, then we rely on medications to ease symptoms. While opiates are sometimes needed, most experts try to avoid them, because the body can get used to them over time. Probably the most effective medications for neuropathies are antidepressants (the older tricyclic antidepressants, such as amitriptyline) and seizure medicines, such as gabapentin (Neurontin) and pregabalin (Lyrica). I always recommend physical therapy, because movement prevents weakness and may improve symptoms.

http://kiich.sharedby.co/de4d996b4c7488eb/?web=50fca7&dst=http%3A//www.stltoday.com/lifestyles/health-med-fit/health/to-your-good-health/ivig-is-primarily-for-autoimmune-neuropathy/article_c72824f0-b93e-5e9e-a0ab-8d16292332f1.html

To Cane Or Not To Cane For Neuropathy

Today's article from neuropathy.org (see link below) examines a problem that many people living with long-term neuropathy eventually have to face and that is whether to take advantage of walking aids like canes. It's very often a matter of pride. You don't want to be seen needing a walking cane and you put it off as long as possible while running the constant risk of misstepping or losing your balance. Most people who invest in a cane see the benefits immediately. It's like having a third leg that helps to stabilise you whilst walking and before you know it you forget that people may be looking at you differently. Certainly the benefits can outweigh what you may see as stigma.

Coming Around to Using a Cane
By Elizabeth Byleen June 2013

"The amazing thing about the cane is that it is teaching me to walk differently. With the cane, I have loosened up. My stride has become longer and more relaxed. It takes less effort to walk, so I walk more. I have become physically stronger. This new strength and my more relaxed gait carry over even when I’m not using the cane."

Support Your #1 Cause: The Fight
Against Neuropathy!

My inherited peripheral neuropathy has me walking in my father’s footsteps. Just like him, it’s difficult to stay on my half of the sidewalk. In fact, as I walk to work, many people don’t pass me on the sidewalk, but walk out in the street around me. My gait is unpredictable; I wobble and weave, and my balance is a problem. My proprioception (or perception of knowing where I am in space) is off, especially when I’m in low light. But just like my dad, I keep moving. I’m ambulatory, and that feels great.

Several years ago, when I lost my balance and fell in my bedroom— pushing my hand through a glass window and bruising my face on the nightstand—a friend suggested I use a cane at night. “Oh, not me! Not even in the privacy of my own home,” I said to myself. A few years later, when my doctor suggested a cane, I was insulted, even though I careened off a wall as I left his office. A cane was a symbol of giving up and admitting defeat. I was in my early fifties, and not willing to send out that message.

The summer after my doctor suggested a cane, I stopped in to visit with my 90-year old neighbor, Hazel, who was sitting on her front porch. Rather exhausted after a long walk, I shared with Hazel that I was discouraged by how I walked; in fact, two people along the way had asked me if I was okay. She offered to let me borrow one of her canes for a while and see how it worked for me. Out of politeness, I said I would.

On the short walk home, even though the cane was not the correct height, I noticed immediately how helpful it was. I didn’t lean into it, but with just a light touch, I got more feedback about where I was, making it much easier to navigate. That week, my daughter and I took long walks in the evenings. I walked straighter and taller. I was more confident, and I didn’t obsess about every crack in the sidewalk that might trip me up.

The amazing thing about the cane is that it is teaching me to walk differently. Because of the fear of falling, the fear of running into people, and the fear of being perceived as drunk or somehow not quite right, over the years I had developed a real tightness to my walk. I tensed everything up: my mind, my shoulders, my arms, my hips, and my legs. With the cane, I have loosened up. My stride has become longer and more relaxed. It takes less effort to walk, so I walk more. I have become physically stronger. This new strength and my more relaxed gait carry over even when I’m not using the cane.

Our resistance can be so fierce. While I once thought a cane was only a symbol of my decline, it’s proving to be a very helpful tool, especially in crowds, unfamiliar places, and over long distances. Having that extra point of contact—basically acting as a tripod—provides me much more stability. An unexpected benefit is that my cane sends a quick visual signal to others to give me more space and time to maneuver. I had to overcome incredible resistance to eventually arrive at something that works so well for me.

http://www.neuropathy.org/site/News2?page=NewsArticle&id=8393

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/