How the Brain Controls your Nerve Reactions

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

SINGLE DOSE OF ANTIDEPRESSANT CHANGES THE BRAIN

A single dose of antidepressant is enough to produce dramatic changes in the functional architecture of the human brain. Brain scans taken of people before and after an acute dose of a commonly prescribed SSRI (serotonin reuptake inhibitor) reveal changes in connectivity within three hours, say researchers who report their observations in the Cell Press journal Current Biology on September 18.

"We were not expecting the SSRI to have such a prominent effect on such a short timescale or for the resulting signal to encompass the entire brain," says Julia Sacher of the Max Planck Institute for Human Cognitive and Brain Sciences.

While SSRIs are among the most widely studied and prescribed form of antidepressants worldwide, it's still not entirely clear how they work. The drugs are believed to change brain connectivity in important ways, but those effects had generally been thought to take place over a period of weeks, not hours.

The new findings show that changes begin to take place right away. Sacher says what they are seeing in medication-free individuals who had never taken antidepressants before may be an early marker of brain reorganization.

Study participants let their minds wander for about 15 minutes in a brain scanner that measures the oxygenation of blood flow in the brain. The researchers characterized three-dimensional images of each individual's brain by measuring the number of connections between small blocks known as voxels (comparable to the pixels in an image) and the change in those connections with a single dose of escitalopram (trade name Lexapro).

Their whole-brain network analysis shows that one dose of the SSRI reduces the level of intrinsic connectivity in most parts of the brain. However, Sacher and her colleagues observed an increase in connectivity within two brain regions, specifically the cerebellum and thalamus.

The researchers say the new findings represent an essential first step toward clinical studies in patients suffering from depression. They also plan to compare the functional connectivity signature of brains in recovery and those of patients who fail to respond after weeks of SSRI treatment.

Understanding the differences between the brains of individuals who respond to SSRIs and those who don't "could help to better predict who will benefit from this kind of antidepressant versus some other form of therapy," Sacher says. "The hope that we have is that ultimately our work will help to guide better treatment decisions and tailor individualized therapy for patients suffering from depression."

Con Artists In The Neuropathy World

Today's post from watchdog.org (see link below) is an interesting one for all neuropathy patients who may be seduced by the claims of various individuals and commercial clinics to be able to cure neuropathy. In this case, a chiropractor ended up behind bars for giving and charging for unnecessary nerve block injections. The problem is that neuropathy treatments are a huge grey area for desperate patients. When regular treatments have little or no effect, people are tempted by the headlines of both alternative practitioners, as well as chiropractors (who in many countries are seen as perfectly legitimate). The dilemma arises when clinics use treatments that are not officially approved but do seem to work for some people and this covers the whole spectrum from herbal supplements to injections, electrical stimulation and the rest. So what do you do when faced by what seem to be promising and credible adverts. The first thing is to avoid clinics that claim to be able to cure neuropathy - they can't - at best they may be able to help relieve some of the symptoms. Secondly, you should both consult your own doctor and do as much of your own background checking and research as possible. Even then, you run the risk of being ripped off and your health put at risk. However, if a treatment doesn't work for you, it may not be the fault of the doctor or clinician - that's just the nature of neuropathy - what works for some is useless for others and that's why malafide con-artists find it so easy to work in the field. It's just the same with cancer, where exaggerated claims can be a waste of time or a danger to your health. In the end, 'let the buyer beware' - not everybody is fake but fakes do exist. Best get as much considered advice from the regular medical world as possible.

Striking a Nerve
By Larry Benson / February 13, 2015

Medicare does not pay for experimental or investigational procedures, treatments or alternative medicine. According to an article published by The Kansas City Star, a former chiropractor from Missouri was aware of that stipulation within Medicare policy, but nonetheless billed the government benefits program for more than $3 million in experimental procedures performed on patients with neuropathy.

According to the story, the former owner of a chiropractic office in Kansas City performed nerve block injections that were not medically necessary to many of his clinic’s patients, who happened to be Medicare beneficiaries. (That’s certainly convenient.) Over a three-year period of time, the former chiropractor received $879,582 for the unneeded services.

Further research revealed that the chiropractor’s clinic provided the nerve blocking procedure during a time when Medicare had no specific coverage guidelines for neuropathy treatments. Apparently, he didn’t investigate whether or not Medicare considered the treatment to be necessary for patients with neuropathy and billed Medicare even though the procedure was not supported by medical research. (Well, he had some nerve.)

The 59-year-old pleaded guilty to one count of health care fraud. He was sentenced to 15 months in federal prison for his fraudulent claims and surrendered his license to practice.

This former chiropractor’s illegal actions definitely struck a nerve with the government and probably his patients, as well. (Let’s hope he didn’t endanger any lives with the unnecessary treatment.) While neuropathy can cause the loss of sensation, it appears that this fraudster is going to feel the full effects of the painful reality that he is now considered a criminal.

http://watchdog.org/199838/striking-a-nerve/

The Speeds Of Nerve Signals

Another interesting post from sciencedaily.com (see link below) talks about how an old theory about how nerve signals are transmitted and how fast they travel has proven to be true. It shows how damage to the protective layer (myelin sheath) can interrupt and affect this basic function and people with many forms of neuropathy know what the results of this can be.

How Nerve Signals Are Sent Around the Body at Varying Speeds as Electrical Impulses

ScienceDaily (Oct. 11, 2012)

Scientists have proved a 60-year-old theory about how nerve signals are sent around the body at varying speeds as electrical impulses.

Researchers tested how these signals are transmitted through nerve fibres, which enables us to move and recognise sensations such as touch and smell.

The findings from the University of Edinburgh have validated an idea first proposed by Nobel laureate Sir Andrew Huxley.

It has been known for many years that an insulating layer -- known as myelin -- which surrounds nerve fibres is crucial in determining how quickly these signals are sent.

This insulating myelin is interrupted at regular intervals along the nerve by gaps called nodes.
Scientists, whose work was funded by the Wellcome Trust, have now proved that the longer the distance between nodes, the quicker the nerve fibres send signals down the nerves.

The theory that the distance between these gaps might affect the speed of electrical signals was first proposed by Sir Andrew Huxley, who won the Nobel Prize in 1963 for his work on electrical signalling in the nervous system, and who died earlier this year.

The study, published in the journal Current Biology, will help provide insight into what happens in people with nerve damage. It will also shed light on how nerves develop before and after birth.
Professor Peter Brophy, Director of the University of Edinburgh's Centre for Neuroregeneration, said: "The study gives us greater insight into how the central and peripheral nervous systems work and what happens after nerves become injured. We know that peripheral nerves have the capacity to repair, but shorter lengths of insulation around the nerve fibres after repair affect the speed with which impulses are sent around the body."

The researchers found that when the myelin reached a certain length, the speed with which nerves impulses were conducted reached a peak.

The study, carried out in mice, also confirmed that a protein -- periaxin -- plays a key role in regulating the length of myelin layers around nerve fibres.

http://www.sciencedaily.com/releases/2012/10/121011124440.htm

Is Turmeric curcuma The Wonder Spice

Today's post from seattleorganicrestaurants.com (see link below) doesn't seem to have medical or scientific authorship but does refer to its sources. The reason I say that is because it makes some astonishing claims for the healing powers of Turmuric (Curcuma depending on where you live). Now even if only a tenth of these are bordering on the truth, it still comes over as a wonder-spice. Turmeric has long been advanced as a help for nerve pain and its symptoms (see other posts via the search button on this blog), so any lengthy article about the spice is certainly worth a look for neuropathy patients. I suggest you read it and then make your own minds up (maybe after also discussing it with a health professional or a qualified herbalist). You do slightly wonder why India and south east Asia in general isn't the healthiest place in the world, considering how much turmeric is used in their diet...but then again, look at the populations, that may be evidence enough😏

Studies show that turmeric can be as effective as 14 pharmaceutical drugs
Seattle Organic Restaurants 2016

Turmeric and saffron are the two prominent spices used in South Asian and Middle Eastern dishes including Persians and Indians. Persian saffron and turmeric are very well-known because of their unique quality and taste. For thousands of centuries, curcumin known as turmeric has been used for its healing and medicinal properties. Based on an informative article written by greenmedinfo.com, turmeric is as effective and if not even better than 14 different pharmaceutical drugs in the market.

Here are some of the scientific studies about the health benefits of turmeric:



1. Lowering the level of bad cholesterol and improving heart health -- Alternative drugs: Lipitor and atorvastatin

A 2004 study published in the journal Atherosclerosis shows that turmeric can reduce the level of bad cholesterol and fight the plaque buildup in the arteries which is an important factor in developing heart diseases. Another 2008 study published in the journal Drugs in R & D shows that turmeric extract is as beneficial as the drugs used for inflammation and type 2 diabetics.

Besides lowering the bad cholesterol levels and fighting plaque buildup in the arteries, turmeric can improve the cardiovascular health. A study published in 2012 discovered that both exercise and curcumin supplements can significantly improve the cardiovascular health. In conclusion, turmeric can be as effective as conventional drugs such as Lipitor and atorvastatin (for lowering cholesterol and improving heart health), without having the side effects.

2. Great anti-inflammatory -- Alternative drugs: Corticosteroids and steroid

Inflammation is the root of many chronic diseases including cancer, arthritis, dementia and heart disease. Poor eating habits and high intake of omega 6 versus omega 3 is the leading cause of chronic inflammation. Studies show that turmeric is a great source of anti-inflammatory.

A study published in the journal Phytotherapy Research showed that the powerful antioxidants in turmeric can be as effective as steroid in treatment of chronic anterior uveitis (an inflammatory eye disease). Another study published in Critical Care Medicine showed that turmeric is as effective as corticosteroid drug known as dexamethasone and can provide relief for inflamed areas of the body.

Also a study published in the journal Oncogene discovered that curcumin is as effective as other anti-inflammatory drugs that can kill cancer cells such as aspirin, ibuprofen, sulindac, phenylbutazone, naproxen, indomethacin, diclofenac, dexamethasone, celecoxib, and tamoxifen.

3. Improving depression and suppressing negative thoughts -- Alternative drugs: Prozac/Fluoxetine, Imipramine

A study published in 2011 in the journal Acta Poloniae Pharmaceutica showed that turmeric can be as effective as anti-depressant drugs for improving depression and reducing negative thoughts, without having the side effects of anti-depressant drugs.

4. Blood thinner -- Alternative drug: Aspirin:

A study published in the journal Arzneimittelforschung discovered that curcumin has anti-platelet and prostacyclin modulating effects of aspirin and can help to reduce the risk of heart attack or stroke without having the side effects of aspirin.



5. Destroying cancer cells -- Alternative drug: Chemotherapy

Studies show that turmeric can destroy and kill cancer cells. In 2007, a study published in the International Journal of Cancer showed that curcumin is as effective as oxaliplatin drug for treating colorectal cancer.

In another study published in the journal Breast Cancer Research and Treatment, researchers discovered that turmeric can target the cancer cells while leaving healthy cells unharmed. Also, another study published by researchers at University of Texas shows that turmeric is very effective in killing cancer cells and leaving healthy cells unharmed.

6. Diabetes -- Alternative drugs: Diabetes drugs such as Metformin

A 2009 study published in the journal Biochemitry and Biophysical Research showed that curcumin can be 500 times to 100,000 times (in the form known as tetrahydrocurcuminoids(THC)) more effective than diabetic drugs such as metformin. The researchers also concluded that turmeric can suppress glucose production in the liver and help diabetic patients.

7. Alzheimer's Disease or dementia: Alternative drugs: Memantine and Diclofenac

In a study published in Annals of Indian Academy of Neurology, the researchers discovered that taking one-quarter of a teaspoon of turmeric extract or powder daily can improve the symptoms of Alzheimer's and dementia.

According to the researchers, curcumin is a powerful antioxidant and anti-inflammatory that can improve the cognitive functions in patients with AD. The authors suggest that “a growing body of evidence indicates that oxidative stress, free radicals, beta amyloid, cerebral deregulation caused by bio-metal toxicity and abnormal inflammatory reactions contribute to the key event in Alzheimer's disease pathology. Due to various effects of curcumin, such as decreased Beta-amyloid plaques, delayed degradation of neurons, metal-chelation, anti-inflammatory, antioxidant and decreased microglia formation, the overall memory in patients with AD has improved”.

8. Protecting the brain damage due to heavy alcohol consumption:

In a study at PanjabUniversity Institute of Pharmaceutical Sciences, the researchers found out that the potent antioxidant and anti-inflammatory molecule in turmeric known as curcumin can fight against chronic alcohol-induced cognitive dysfunction.

9. Anti-aging properties:

Studies show that the curcumin and its active metabolite, tetrahydrocurcumin (THC) could significantly increase the lifespan of three microorganisms including roundworms, Fruit flies and mice. According to the authors of the study, “given the long and established history of turmeric as a spice and herbal medicine, its demonstrated chemopreventive and therapeutic potential, and its pharmacological safety in model systems, curcumin, the bioactive extract of turmeric, promises a great future in human clinical studies designed to prevent and/or delay age-related diseases”.

10. Regenerating liver tissues:

In a study published in the Journal of the Medical Association of Thailand, the researchers discovered that primary polyphenol in turmeric, can repair and even regenerate the liver tissues of diabetic rats.

In conclusion, the studies show that the active compound in turmeric known as curcumin is as effective (in some cases even more potent) as pharmaceutical drugs. According to greenmedinfo.com, turmeric can be even more effective than the following lists of medical conditions and drugs:

· NSAIDs (non-steroidal anti-inflammatory drugs)

· Hydrocortisone (for inflammation)

· Prednisone (for inflammation)

· Corticosteroids (uveitis)

· Memantine and Diclofenac (for memory)

· Atorvastain (for inflammation-mediated endothelial dysfunction)

· Dexamethasone (lung transplantation or injury)

· Fluoxetine [Prozac] and imipramine [Tofranil] (depression)

· Acetylsalicylic acid (Thrombosis and Arthritis)

· Quinidine (myocardial ischemia)

· Oxaliplatin (Colorectal Cancer)

· Metformin (Gluconeogenesis/Blood Sugar

Sources:

http://www.greenmedinfo.com/blog/turmeric-may-repair-and-regenerate-diabetic-liver-function

http://sciencealerts.com/

http://www.seattleorganicrestaurants.com/vegan-whole-food/turmeric-curcumin-as-effective-as-pharmaceutical-drugs.php

The War On Illegal Medications

Today's post from the always excellent pain-topics.org (see link below) talks about the world-wide closing down of internet medication sales sites thanks to an FDA and Interpol initiative. It's especially important for people living with neuropathy, who have searched for treatments and 'cures' across the Net because they're just not available via the normal system. Desperation does that to people but it's important to know that the amount of fake medicines via online sites is staggering. Buying drugs in this manner can really put your health at risk; either because the drugs are worthless, or are too strong and remember, many of these internet pharmacies are run by unscrupulous people who are just after your money. For people with severe neuropathy, the temptation to order strong pain killers online because of the new restrictions via chemists and doctors can be very strong but it is very dangerous.

FDA Trounces Illegal Online Pharmacies
Posted by SB. Leavitt, MA, PhDFriday, June 28, 2013


According to a news release [here], the U.S. Food and Drug Administration (FDA), in partnership with international regulatory and law enforcement agencies from 99 participating countries, took action against more than 9,600 websites that illegally sell potentially dangerous, unapproved prescription medicines to consumers. These actions include the issuance of regulatory warnings, and seizure of offending websites and more than $41-million worth of illegal medicines worldwide.

The action occurred as part of the 6th annual International Internet Week of Action (IIWA), a global cooperative effort to combat the online sale and distribution of potentially counterfeit and illegal medical products. As part of this year’s international effort — called “Operation Pangea VI” — the FDA’s Office of Criminal Investigations, in coordination with the United States Attorney's Office for the District of Colorado, seized and shut down 1,677 illegal pharmacy websites during June 18-25, 2013.

Many of those websites appeared to be operating as a part of an organized criminal network that falsely purported its websites to be “Canadian Pharmacies.” These websites displayed fake licenses and certifications to convince U.S. consumers to purchase drugs they advertised as “brand name” and “FDA approved.” The drugs confiscated as part of Operation Pangea were not from Canada, and were neither brand name nor FDA approved. These websites also used certain major U.S. pharmacy retailer names to trick consumers into believing an affiliation existed with these retailers.

The FDA’s Office of Criminal Investigations Cybercrime Investigations Unit banner is now displayed on seized websites to help consumers identify them as illegal. Here are some examples:
> http://www.canadianhealthandcaremall.com/
> http://www.walgreens-store.com
> http://www.c-v-s-pharmacy.com

During Operation Pangea VI, the largest Internet-based action of its kind, the FDA targeted websites selling unapproved and potentially dangerous prescription medicines that could pose significant public health risks. Products purchased from the websites targeted during Operation Pangea also bypassed existing safety controls required by the FDA, and the protections provided when used under a doctor’s care.

The goal of Pangea VI, which involved law enforcement, customs, and regulatory authorities from 99 countries, was to identify the makers and distributors of illegal drug products and medical devices and remove those products from the supply chain. Some of the medicines that were sold illegally by the targeted websites included: Avandaryl (glimepiride and rosiglitazone), “Generic Celebrex,” “Levitra Super Force” and “Viagra Super Force,” Clozaril (clozapine), and many others sold as pain relievers, sleep aids, hormone replacement therapies, antidepressants, etc.

In addition to health risks, these illegitimate pharmacies pose non-health-related risks to consumers, including credit card fraud, identity theft, or computer viruses. The FDA encourages consumers to report suspected criminal activity at www.fda.gov/oci. The FDA provides consumers with information to identify an illegal pharmacy website and advice on how to find a safe online pharmacy through BeSafeRx: Know Your Online Pharmacy, plus there is important information for consumers in this regard at Pain-Topics.org [here].

COMMENTARY: The above news release tells the story — and, we would add, “Bravo!” It is time that the worldwide plague of illegitimate online pharmacies is recognized as a form of international terrorism — a growing threat to public health and safety.

Of particular concern for the pain field, the spate of alleged analgesics — including bogus opioids in many cases — proffered by these unscrupulous website operators can be harmful to unwary consumers and it also floods communities with illicit drugs that may be misused and abused. Since the origins of these fugitive drugs are often unknown, they may be erroneously assumed to be diverted from legitimate prescribing and distribution channels; thus tarnishing the reputations of law-abiding prescribers, pharmacies, and wholesalers — as well as patients with pain.

Taking action against nearly 10,000 felonious websites worldwide, as happened this month, sounds impressive; yet, this is a proverbial “drop in the bucket,” since a single offending operation may have hundreds of interconnected sites. It is unfortunate that government funds and resources must be dedicated to chasing down and trouncing these online operations, but it is tax-payer money well spent. The FDA should be commended for these actions in helping to safeguard the public and, in particular, the pain community.

http://updates.pain-topics.org/2013/06/fda-trounces-illegal-online-pharmacies.html

Looking in the mirror

I think lots of us can identify with much of this post from PERIPHERAL NEUROPATHY NEWS – L A
A publication of the Neuropathy Support Group of Los Angeles
Vol. 10 April 2010

The President’s Corner

It seemed to me that my 55-year-old daughter had been
growing. The past few years when I visit her in Arizona, she
seems to be my height, and I’ve been 5’5’’ all my life.
Wrong! My new doctor’s nurse measured me on my first
visit, and I’m now 5’2’’, my daughter’s height. I saw it with
my own eyes.
It’s not bad enough that I’ve shrunk; my feet are now 1½”
longer than they used to be.
All things considered though, I guess those are small
things to get upset about—that, along with a lot of other
minor irritations. Compare them to neuropathy.
With neuropathy, we hurt, drop and knock over things,
lose our balance and fall, feel drugged out on medications—
then we hurt and have withdrawal when we forget them.
Our toes and fingers tingle—then we burn them without
knowing it, or they’re freezing. That’s just to mention a few.
I guess and inch or two here or there (or everywhere) are
small potatoes. Probably, in the annals of time, so is
neuropathy. We can’t cure it or fix it any more than we can
grow taller or lose a few inches off our feet. But, damn it, it
hurts, it keeps us awake, and we’re afraid. But, sometimes I
think the worse part is that nobody besides people with
neuropathy understands all of that.
I have some confessions to make. What I’m about to say
is probably isolated to me, so don’t get your shorts in bunch,
this is me I’m talking about. But, I confess that I’ve been
known to dwell on my condition; I’ve been short with people
because they don’t seem to be aware that I hurt; I’ve
refused help from friends and those close to me when they
have tried to be sensitive; I’ve worried at night about the
future—being alone, not being able to drive, you name it;
and the worst of all, I’ve exaggerated sometimes to get
sympathy.
What do I say to myself? What can I say? I say, “Don’t do
that.” And guess what? It works! USUALLY.
Hey, good news—I’ve got it! I just figured something out!
I didn’t really shrink 3’’, 1½ of those inches just went south
(among other things) and made my feet longer. Boy, I’m
glad to at least have that settled.
I’m still working on where the other 1½ inches are that
I’m still missing! More than you really want to know? I
promise, I won’t bring it up again…..Velda

The Drawbacks Of Current Neuropathy Treatment

Today's post from hospitalnews.com (see link below) takes a look at the current hit and miss state of neuropathic pain treatment from a Canadian point of view and looks more closely at Gabapentin as one of the options. Conclusions are that the jury's out on gabapentin and other medications prescribed to reduce neuropathic symptoms have limited success and also bring the danger of side effects with them. Nothing new here then but it is interesting to have our suspicions confirmed regarding the effectiveness of current neuropathy treatment.

Neuropathy: What a pain
Dr. Janice Mann September 1, 2015

No one wishes to experience pain. But fortunately when those everyday aches and pains arise, we have over-the-counter medications readily available to help us out. (For a recent review on what the evidence has to say about over-the-counter pain medications, check out the Ask Julie column at Vox with Canada’s own Julia Belluz: http://www.vox.com/2015/8/17/9165189/best-painkiller-tylenol-aspirin-advil).

But what if you are experiencing pain that isn’t likely to get better with these over-the-counter medications? Patients with neuropathic pain find themselves in this category. Neuropathic pain — or as it is sometimes called, neuropathy — is a type of chronic pain that results from damage to the nervous system. Neuropathic pain can be peripheral, resulting from damage to the peripheral nerves (nerves in your arms, legs, hands, and feet for example) or central, resulting from damage to the brain or spinal cord. Common causes of peripheral neuropathy include diabetes and postherpetic neuralgia (nerve pain following shingles). Causes of central neuropathy can include spinal cord injury and multiple sclerosis.

Neuropathic pain is notoriously difficult to treat and may involve both pharmacological and physical therapies. Although painkillers — both over-the-counter and prescription — may be tried, they are not always successful in treating the pain, and in the case of opioids can lead to abuse and addiction. Other classes of medication, not typically used for pain, can be helpful in the treatment of neuropathic pain. These include antidepressant medications and medications normally used to prevent seizures, called anticonvulsant drugs.

Gabapentin, an anticonvulsant originally developed for the treatment of epilepsy, is sometimes used off label to treat neuropathic pain. It is thought to work by inhibiting the transmission of nerve signals in the brain. While gabapentin has been viewed by some health care professionals as a promising option for the treatment of neuropathic pain, others are concerned about the potential for abuse (at high doses it may be associated with sedative and dissociative or psychedelic effects).

Because of the uncertainty of the role of gabapentin in the treatment of neuropathic pain, decision-makers in the Canadian health care system turned to the Rapid Response service at CADTH — an independent, evidence-based agency that finds, assesses, and summarizes the research on drugs, medical devices, and procedures — to find out what the evidence says.

When CADTH searched for the evidence on gabapentin and neuropathic pain, they found 19 relevant publications — nine systematic reviews, two randomized controlled trials, six non-randomized studies, and two guidelines. Overall, the evidence suggests that gabapentin is effective in the treatment of neuropathic pain. A greater reduction in neuropathic pain was found with gabapentin compared with placebo (no active drug) in adults who have a variety of conditions, including diabetic peripheral neuropathy and postherpetic pain. For short-term treatment of painful diabetic neuropathy and postherpetic neuralgia, gabapentin may be as effective as two classes of antidepressants known as tricyclic antidepressants and serotonin norepinephrine reuptake inhibitors, and another drug for seizures called pregabalin — but these findings are based on indirect evidence (evidence on each drug individually rather than evidence that directly compares the drugs with one another). The evidence for gabapentin for other types of neuropathic pain is limited.

The number of adverse events was higher in patients taking gabapentin compared with patients taking placebo (side effects reported include somnolence, dizziness, peripheral edema, and gait disturbances); but, overall, serious adverse events were few and comparable between the two groups. Gabapentin may be used as a recreational drug, but there is an absence of high-quality evidence on the prevalence and risk of misuse among patients prescribed the drug to manage neuropathic pain.

No Canadian evidence-based clinical practice guidelines were identified, but UK guidelines support the use of gabapentin as one of the first-line treatment options for the management of neuropathic pain. US guidelines recommend gabapentin as an option for diabetic neuropathy.

Knowing the evidence on gabapentin for the treatment of neuropathic pain can help to guide decisions about its use — as well as identify areas where more research is needed. As more evidence on gabapentin and neuropathic pain becomes available, further reviews may be necessary to ensure policy and clinical practice is in keeping with the latest evidence.

If you’d like more information about the CADTH Rapid Response service, please visit www.cadth.ca/RapidResponse. If you’d like to see what other drugs, devices, or procedures have been covered by the Rapid Response service at CADTH, visit www.cadth.ca/RapidResponseReports. Here you’ll find all of the freely available reports listed chronologically as they are completed. To learn more about CADTH, visit www.cadth.ca , follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Officer in your region: https://www.cadth.ca/contact-us/liaison-officers.

Dr. Janice Mann is a Knowledge Mobilization Officer at The Canadian Agency for Drugs and Technologies in Health.

http://hospitalnews.com/neuropathy-what-a-pain/

Peripheral Neuropathy – the sting in the tail

Another personal account today from the Aidsmap.com site (see link below). It pretty much speaks for itself and possibly reflects aspects of your own experience with neuropathy and HIV.

Peripheral Neuropathy –
the sting in the tail
by Dave

"I felt as though I was walking on bare bones!"

To begin: It is estimated that between 30% and 40% of HIV patients will develop neuropathy. In the United States alone, there are 20 million sufferers (from all sources, not just HIV). It’s one of those diseases that is so un-cool, it barely makes a ripple in the public consciousness and yet if you know someone with mono, peripheral, or autonomic neuropathy, you’ll know how much it has changed their lives.

Becoming an HIV statistic was bad enough but despite all the problems with the various medication regimes and side-effects and assorted crises here and there, I eventually learned to live with it and put it in a file alongside the arthritis and lung problems which had affected me at an earlier age. Okay, I thought, enough is enough; although there are always people much worse off than yourself, I figured I already had my fair share of life-changing health problems. Not so apparently because then, almost unannounced, neuropathy arrived in my dossier.

It started off, like for so many people, with tingling in the toes, then loss of feeling in the toes and feet, then confusingly dull pain in the same places, especially in the soles of my feet. I felt as though I was walking on bare bones. It didn’t happen quickly, over a couple of years actually and although I mentioned it to my HIV doctor, I didn’t make a big deal of it and nor did he. Then gradually, it began to affect my calves and other functions in my body but because the joint problems from the arthritis muddied the waters, it was some time before someone attached the ‘peripheral neuropathy’ label and the treatment roundabout began.

To keep it short, I tried everything, from amytriptiline to capsaicin (chilli-pepper cream) and nothing worked without bringing its own side-effects along to make my life that bit more miserable. The pain and lack of energy got so bad that I found myself staying at home for days on end (thank God for my roof terrace!) My social life disappeared in the mist and my real friends couldn’t take the whining over something they couldn’t grasp anymore – which I really understand but doesn’t make it any easier.

The HIV specialist is sympathetic; he’s seen it before and knows how neuropathy can take over your life, yet strangely enough the neurologist was less sympathetic. He threw out the diagnosis, ‘Yes, you’ve got peripheral neuropathy but because the EMG tests don’t show much, there’s nothing I can do; you’ll just have to learn to live with it...’ and then just as casually, washed his hands and threw me back to the HIV specialist. What he failed to tell me was that the nerve tests very infrequently show the results in glorious technicolour – it’s called idiopathic neuropathy and is very common. My rheumatologist saw no connection between the neuropathy and his field and I had to go to Germany to arrange costly MRIs of my spine to show how joint degeneration and subsequent nerve entrapment can very much have a bearing on your neuropathic status. Ho hum, the medical treadmill can be very wearing, especially when you’re ill.

In the end, the HIV specialist put me on oxycontin because the pain was just too much to live any sort of normal life and that’s pretty much where I stand now. The problem is that oxycontin, just like almost every other form of neuropathy treatment, has side-effects. In this case, an hour before my next pill, I’m sweating and almost crawling up the wall with pain...because the oxycontin says so! I refuse to up the dosage because I don’t want to be completely dependent on a morphine derivative.

Last year I decided that I needed to take control of what was happening to me and if that was not possible, then I needed to know what was going on and why. I trawled the internet and came up with hundreds of sites about neuropathy but they were either rip-off commercial sites, trying in devious ways to sell you something; or they were so basic they weren’t worth reading; or they were directed at diabetics or cancer sufferers (who also suffer in vast numbers from neuropathy) but there were very few sites directed specifically at HIV patients with neuropathy. So to help myself, I did the research both to improve my own knowledge and to act as a distraction from the nagging discomfort and created both a website and a blog. The intention is to provide HIV patients with a readable source of information both about the disease and the options you have in dealing with it. Certain neuropathy treatments don’t work in the same way for HIV as for diabetes patients for instance. Because I live in Amsterdam, the website is in both English and Dutch but the blog is English-language only (http://www.neuropathyandhiv.nl/neuropathiehiv_002.htm) and (www.neuropathyandhiv.blogspot.com).

A final twist in the tail is that strangely enough, most studies have come to the conclusion that almost nothing helps with nerve repair, (not just masking the pain), apart from capsaicin, or smoked marijuana! In my case, the laws of the land aren’t the problem; the fact that I gave up smoking four years ago because of my lung problems, is! Damn! Just when pleasure became legal again!

http://aidsmap.com/Peripheral-neuropathy-the-sting-in-the-tail/page/2053211/

The Very Picky Herbalist

So,

maybe I'm pitta-vata aggravated today. Perhaps. I've been in the sun a lot more lately, and there's not running river water near enough to the farm area, though it is near enough to visit for lunch, thank heavens.

I've begun week 3 of the Farm to Pharmacy program at the Goldthread Herb Farm and Apothecary, (which, for the most part, is going amazingly well, just to preface) but after being a bit too sun-blazed I have earned myself a spell to rant. Here goes.

I'm learning a lot about myself even though I'm only in week 3, and I think I do not like some of it. I do not like weeding, (how can I "weed" chamomile out of mint? Or sweet annie out of echinacea? or ...)  nor much of the physical movements of gardening. My mind likes, it, but my body not. I do not like harvesting with a bunch of chatty people. I do not like eating tepid lunches, and I don't like drinking cold demulcents in the morning. I do not like tincture ratios because I never understand them, and I don't like it when people tease me.

I DO like quiet, rhythmic, intimate harvesting. I like to touch, taste, feel and listen to the resin, the yellow ray flowers, and to a new plant friend introducing themselves to me for the first time. I like to listen wholly. I like the enormous fragrant peach tree branches I got to bring home. I like the new plants I'm getting to know, and being outside more. I like eating slowly by the water, with my feet in the current, and I still love harvesting plants and making medicine more than anything. I like the brain input on the body systems too, that rocks. I love listening to people make herb honey for the first time. I love taking all the extra garlic scapes home to pickle them.

So there is my version of Kiva's what herbalists really want (and don't want) post ;) entitled: The Very Picky Herbalist.

I probably could find more things I'm feeling pissed off about - but that would just be the heat talking :) I'll let it be, and instead, take you on a tour of my new plant friends, and some medicine making miscellany ...........

Inula

Lavender and Echinacea

Clary Sage

Grindelia 

Yerba mansa

Yarrow flower medicine

Reishi mushroom

Herbal infused ghee

Lady's Slipper Ring treasures

ready to go

ready to nourish

Shatawari

Licorice

German Chamomile & Chocolate Mint

Lavender

Lavender, more and more

Little leaf Linden tree

Poppy

California Poppy

A finale of Chamomile....

Wormwood punctuations.

Love,

Ananda

The problem with Statins

You have probably heard of Statins. Statin drugs work by blocking a key enzyme in the production of cholesterol. Cholesterol is a natural product of the liver and in the right amounts does not pose a problem to the body. The body, however, sometimes produces too much cholesterol and that is often caused by poor dietary choices (you know what you eat!).

Statin drugs block the enzyme linked to the liver’s cholesterol production, thus inhibiting the liver’s ability to produce LDL. Your LDL cholesterol levels will often be measured in a standard HIV blood test and you may have heard that LDL levels should be lower and HDL cholesterol levels should be higher. Statin drugs can achieve this for people with cholesterol problems. Studies have also shown that statin drugs can help the body reabsorb cholesterol that has accumulated on the artery walls.

As HIV patients we have to be more aware of our cholesterol levels than most. HIV patients are at a higher risk for cardiovascular disease in part due to lipid abnormalities that can occur with the use of certain antiretroviral therapies so Statin drugs may be prescribed to help maintain healthy cholesterol levels.

However... Statins themselves can cause Neuropathy!

Time to talk to the doctor again, if you are advised to take these drugs. If you don't already have neuropathy, there isn't too much risk until you begin to show symptoms but if you already have neuropathic problems, it's important to discuss the consequences of statin use with your doctor. It's also important to realise that statins can have other side effects too; especially muscle pain or weakness. Sometimes just one more side effect can be one too many for the long-suffering HIV patient. Always ask - there may be an alternative available.

The following article is from Science Daily: http://www.sciencedaily.com/releases/2002/05/020514075710.htm
from the American Academy of Neurology.

Statin Drugs May Increase Risk Of Peripheral Neuropathy

Statin drugs can increase the risk of developing peripheral neuropathy, according to a study published in the May 14 issue of Neurology, the scientific journal of the American Academy of Neurology.

Peripheral neuropathy results from damage to the peripheral nerves and causes weakness, numbness and pain in the hands and feet. Statin drugs are prescribed for millions of Americans to lower cholesterol.

People taking statins were 14 times more likely to develop peripheral neuropathy than people who were not taking statins, according to the Danish study. However, the overall risk of developing neuropathy is rare, said study author David Gaist, MD, PhD, of the University of Southern Denmark in Odense

"The positive benefits of statins, particularly on reducing the risk of heart disease, far outweigh the potential risk of developing neuropathy," Gaist said. "These findings shouldn't affect doctor or patient decisions to start using statins. But if people who take statins develop neuropathy symptoms, they should talk with their doctor, who may reconsider the use of statins."

For the population-based study, the researchers used a patient registry to identify all of the first-time cases of peripheral neuropathy with no known cause (such as diabetes) in Funen County, Denmark, over a five-year period. Each case was matched to 25 people of the same age and sex with no neuropathy as a control group. The use of statins was then determined for each group.

They identified 166 cases of first-time neuropathy with no known cause. Of those, 35 had a definite diagnosis, 54 were probable cases and 77 were possible cases. Nine of the people with neuropathy had taken statins. They had taken statins for an average of 2.8 years.

For those with a definite diagnosis of neuropathy, the statin users' risk of developing neuropathy was 16 times higher than for the control group. When all cases of neuropathy were taken into account, the statin users' risk of developing neuropathy was four times higher than the control group's risk. Taking statins for longer periods of time and taking higher doses of them increased the risk of developing neuropathy.

Statins lower levels of low-density lipoprotein (LDL) cholesterol by blocking the production of a liver enzyme used by the body to make cholesterol.

For more information about the American Academy of Neurology, visit its web site at http://www.aan.com.

FIRST EBOLA CASE DIAGNOSED IN THE US

The Centers for Disease Control and Prevention (CDC) confirmed today, through laboratory tests, the first case of Ebola to be diagnosed in the United States in a person who had traveled to Dallas, Texas from Liberia. The patient did not have symptoms when leaving West Africa, but developed symptoms approximately four days after arriving in the U.S. on Sept. 20.

The person fell ill on Sept. 24 and sought medical care at Texas Health Presbyterian Hospital of Dallas on Sept. 26. After developing symptoms consistent with Ebola, he was admitted to hospital on Sept. 28. Based on the person's travel history and symptoms, CDC recommended testing for Ebola. The medical facility isolated the patient and sent specimens for testing at CDC and at a Texas lab participating in the CDC's Laboratory Response Network. CDC and the Texas Health Department reported the laboratory test results to the medical center to inform the patient. Local public health officials have begun identifying close contacts of the person for further daily monitoring for 21 days after exposure. A CDC team was dispatched to Dallas this morning.

"Ebola can be scary. But there's all the difference in the world between the U.S. and parts of Africa where Ebola is spreading. The United States has a strong health care system and public health professionals who will make sure this case does not threaten our communities," said CDC Director, Dr. Tom Frieden, M.D., M.P.H. "While it is not impossible that there could be additional cases associated with this patient in the coming weeks, I have no doubt that we will contain this."

The ill person did not exhibit symptoms of Ebola during the flights from West Africa and CDC does not recommend that people on the same commercial airline flights undergo monitoring, as Ebola is only contagious if the person is experiencing active symptoms. The person reported developing symptoms several days after the return flight. Anyone concerned about possible exposure may call CDC-Info at 800-CDC-INFO for more information.

CDC recognizes that even a single case of Ebola diagnosed in the United States raises concerns. Knowing the possibility exists, medical and public health professionals across the country have been preparing to respond. CDC and public health officials in Texas are taking precautions to identify people who have had close personal contact with the ill person and health care professionals have been reminded to use meticulous infection control at all times.

We do know how to stop Ebola's further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases such as Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the U.S.

CDC has been anticipating and preparing for a case of Ebola in the United States. We have been:

Enhancing surveillance and laboratory testing capacity in states to detect cases

Developing guidance and tools for health departments to conduct public health investigations

Providing recommendations for healthcare infection control and other measures to prevent disease spread

Providing guidance for flight crews, Emergency Medical Services units at airports, and Customs and Border Protection officers about reporting ill travelers to CDC

Disseminating up-to-date information to the general public, international travelers, and public health partners

The data health officials have seen in the past few decades since Ebola was discovered indicates that it is not spread through casual contact or through the air. Ebola is spread through direct contact with bodily fluids of a sick person or exposure to objects such as needles that have been contaminated. The illness has an average 8-10 day incubation period (although it ranges from 2 to 21 days); CDC recommends monitoring exposed people for symptoms a complete 21 days. People are not contagious after exposure unless they develop symptoms.

The Difficulties Of Neuropathy Treatment

Today's post from neuropathydr.com (see link below) written by the well-known neuropathy expert, Dr John Hayes Jr, is a short article trying to explain why neuropathy treatment is so difficult. It's a question that baffles both patients and doctors alike because no one patient is the same as another and no one patient responds in the same way to treatment as another. One of his suggestions is that doctors often underestimate the effect of metabolic syndrome on the nervous system. This is a term you may not be aware of but according to the Mayo clinic, 'Metabolic syndrome is a cluster of conditions — increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels — that occur together, increasing your risk of heart disease, stroke and diabetes'... and according to Dr. Hayes, also neuropathy. It may be that one of the chief causes of nerve damage is life-style related then! Now this may be true but considering there are over 100 possible direct causes of nerve damage, this has to be put into context. Metabolic syndrome is by no means the only 'life-style' cause (alcoholic neuropathy for instance). Nevertheless, this article is worth a read and will help increase your understanding of why you have those dreadful symptoms every day.

Why Is Neuropathy Treatment Difficult?
Posted by john on April 24, 2017

Neuropathy treatment can be difficult for some due to the fact that neuropathy is more than one condition.

An understandable question that we get in the clinic day after day is Why is neuropathy treatment so difficult?

As you probably know, a good portion of patients who suffer from some form of chronic intractable pain have peripheral neuropathy. One reason for this includes the fact that we’re living longer. Also, in general, our health habits as so-called modern and developed nations have become worse, not better.

There’s also one major misconception that hampers neuropathy treatment for many and that is misunderstanding that Neuropathy is actually one condition when indeed its many disorders.

Nothing, and I mean nothing can be further from the truth. You see neuropathy rarely occurs without cause. Sometimes the known causes are due to chemotherapy, cigarette smoking, high blood pressure, and other things such as liver and kidney disease.

Sometimes, neuropathy is secondary to known disease processes. One example is Lyme disease.

Most of us know that 60% to 70% of patients who have developed diabetes, ultimately also develop some form of peripheral neuropathy.

About 50% of the time we diagnose neuropathy as being idiopathic. Idiopathic means that we are not one hundred percent sure what caused the patient’s neuropathy. As we have discussed here many times before, at least half the time in idiopathic cases the cause of the neuropathy is due to metabolic syndrome.

Metabolic syndrome is so common now and occurring in younger and younger ages that it is perhaps the most devastating health condition that we as a society must face head-on. Excess sugar and carbohydrate consumption along with decreasing physical activity is having a huge impact on society as a whole.

And too often even otherwise brilliant physicians ignore this as a possible cause of the patient’s underlying health conditions. Everything from neuropathy to heart disease can directly be related to metabolic syndrome.

And that is the reason in which many patients find neuropathy treatment so difficult.

Don’t let this be you! Start today by making stronger and more informed decisions. In a nutshell, do your homework, do your research, and do everything you possibly can advocate for your health and effective neuropathy treatment!

For more information on coping with neuropathy, get your Free E-Book and subscribe to our newsletters at http://neuropathydr.com.

http://neuropathydr.com/neuropathy-treatment-difficult/

Cedric The Entertainers Family Experiences Of Neuropathy

Today's post from journals.lww.com (see link below) is a personal story about a man's life with neuropathy and as such, makes a change from all the scientific and theoretical articles that reveal the workings of our disease. Sometimes, we just need to know how someone else is dealing with nerve damage. It confirms our own experiences; shows us that we're not alone and inspires us to keep going. In this case, we also have an indirect role-model, in that Cedric the Entertainer talks about his father's experiences with neuropathy. Further than that, the article is also full of useful information about nerve damage and (in this case) diabetes. Always remember; diabetes may be the commonest cause but is only one of more than a hundred. Once you have neuropathy, you'll be sharing experiences both of symptoms and treatments, with millions of others. The cause is not the issue; it's where we go from there that counts.

Touching a Nerve: Diabetic nerve pain sidelined his father for more than a year. Now Cedric the Entertainer is on a mission to educate others about this serious diabetes complication. 
Roberts-Grey, Gina
Neurology Now: August/September 2016 - Volume 12 - Issue 4 - p 18–21
doi: 10.1097/01.NNN.0000490550.78705.00 Features: Cedric the Entertainer

As a stand-up comic, television and film actor, director, musician, and game show host, Cedric Kyles has built a career around making people laugh. Known as Cedric the Entertainer, the 52-year-old Missouri native gained national prominence in 1992 when he appeared on the HBO comedy series Def Comedy Jam. Four years later, he landed his first acting role on The Steve Harvey Show. Since then, he has appeared in dozens of movies, including Barbershop and Barbershop 2: Back in Business, and the animated films Ice Age and Madagascar. He also stars in and is a co-creator and executive producer of TV Land's The Soul Man.



PHOTOGRAPH BY JEMAL ...

Recently, though, he's been using his natural charm, mellifluous voice, and sense of humor to deliver a serious message: If you have diabetes and you experience pins-and-needles pain in your hands or feet, talk to your doctor about it. It could be peripheral neuropathy, a nerve disorder that is a real and treatable condition associated with diabetes.

Cedric signed on to produce “Step On Up,” a series of public service announcements for the American Diabetes Association (ADA), after realizing his father, Kittrell, had been silently enduring debilitating pain in his feet for quite some time. “Our family had no idea it was happening,” says Cedric, who blames his father's stoicism on misguided machismo. “My father is like most men. Our male ego gets in the way. To look strong or macho, we don't talk about our aches and pains. We'd rather sweep health issues under the rug than be vulnerable and admit to someone that something may be wrong,” says Cedric. That's especially true for African American men, he says. “There's a tendency to not want to know about any health problems, and that's dangerous.”

LIVING WITH PAIN

In 2008, Kittrell was diagnosed with type 2 diabetes, a diagnosis he kept secret from his son for eight months, says Cedric. About a year later, Kittrell began experiencing painful tingling sensations in his legs, but he never connected it to diabetes or discussed it with his family or doctor. “We didn't know he was living with such intense symptoms,” says Cedric. “It's amazing that he tolerated what he did for so long without saying something to anyone in the family, his friends, or, perhaps more importantly, to the doctor. He just tried to grin and bear it.”

Like Kittrell, many people with diabetes don't recognize the symptoms of nerve pain or understand that it is a complication of diabetes, says Kamal R. Chémali, MD, a neurologist and director of Sentara Neuromuscular and Autonomic Center in Norfolk, VA. Symptoms can range from numbness or a reduced ability to feel pain or temperature changes to tingling or burning sensations, sharp pains, cramps, muscle weakness, and increased sensitivity to touch. “Although diabetic neuropathy can develop in the hands and arms, it most commonly affects the nerves in the legs and feet and results when chronic high blood sugar damages nerve fibers,” says Dr. Chémali.

A WORLD NARROWS



STEP ON UP Cedric th...

Left untreated, nerve pain can cause infections or create balance problems that may lead to falls and can slowly erode a person's quality of life. Before admitting to his pain, Kittrell gradually withdrew from family functions and activities he enjoyed, including the father-son golf games he and Cedric shared.

“He would still go occasionally, but he started complaining a lot more than was usual for my dad,” says Cedric. Or, he would cancel at the last minute saying his feet hurt.



ACTIVE ENTERTAINER C...

Even when the pair did hit the links, the outings weren't the same, says Cedric. Kittrell couldn't play 18 holes because of pain and numbness in both feet. “He wouldn't say anything, but later I learned he felt like his feet were going to sleep.”

Eventually, the pain became too difficult to bear alone, and Kittrell started talking about it with his family, who encouraged him to discuss his symptoms with his doctor.

DIABETES EDUCATION

“The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and nerves affected,” says Robert G. Smith, MD, PhD, a neurologist at Houston Methodist Neurological Institute. Types of nerve damage include peripheral neuropathy, which affects the extremities; proximal neuropathy, which causes muscle weakness, most commonly in the thighs and hips; autonomic neuropathy, which may affect the digestive system, blood pressure, bladder, and other daily functioning; and focal neuropathy, which tends to affect only one nerve or just a few nerves, most often in the head, torso, arm, or leg.

“It's possible to have just one type or to experience symptoms of several types,” says Dr. Smith. About 60 to 70 percent of people with diabetes have some degree of diabetic nerve pain, according to the National Institute of Neurological Disorders and Stroke. Research published in Diabetes Care, a journal of the American Diabetes Association, says women are 50 percent more likely to experience symptoms than men.

GETTING A DIAGNOSIS

Since nerve pain can't be seen on an x-ray or detected in a blood test, physicians rely on the patient's ability to describe his or her symptoms and a physical examination to check reflexes, muscle strength, and sensitivity to touch, pressure, vibration and/or position changes, says Dr. Smith. “Other routine assessments like blood pressure, heart rate, and weight are also performed to monitor for overall changes.” In addition, the physician would complete a comprehensive foot examination to check circulation and skin tone. “It's recommended that people with diabetes have a comprehensive foot exam once a year to check for neuropathies or assess changes in those already diagnosed with diabetic nerve pain,” says Dr. Smith.

When patients describe limb numbness or pain, a physician might perform tests that record the electrical activity of muscle tissue and nerves, to rule out other conditions such as spine-related nerve damage.

SYMPTOMS AND CONSEQUENCES

Of the four types of diabetic neuropathy, peripheral neuropathy is the most common. It typically affects the feet and legs, but symptoms can spread eventually to the hands and arms, says Dr. Chémali. “The usual sensation is tingling, which patients describe as ‘pins and needles.’ Other sensations include coldness, stiffness, and tightness like a rubber band.”

“Symptoms are often worse at night, when patients are off their feet and resting,” says Dr. Chémali, who adds that depending on the affected nerves, the symptoms can range from mild to disabling. Kittrell experienced pain both at night and when he was standing and walking, says Cedric.

Untreated, the pain and tingling or numbness may manifest as an inability to sense the position of the feet or legs or even weakness of the feet (a footdrop), and patients may start falling, says Dr. Chémali. “In the worst-case scenario, patients may develop gangrene and need a limb amputated,” he adds.

NERVES UNDER STRESS

Experts do not know exactly what causes diabetic peripheral neuropathy. One theory is that injury to the blood vessels supplying the nerves leads to the loss of nerve fiber, says Dr. Chémali. Another is that increased and prolonged exposure to high blood sugar levels leads to the accumulation of sugary proteins in the nerves, which triggers a series of changes that eventually damages nerves from stress and inflammation, he says.

But this complication is not inevitable, says Dr. Chémali. “We don't know what percentage of patients with diabetes will develop peripheral neuropathy, but we do know that early detection of diabetes and tight control of the disease can stabilize and occasionally reverse symptoms in the early stages. Once diabetic neuropathy progresses, it becomes much harder or almost impossible to reverse the symptoms.”

The most effective way to reduce the odds of experiencing this painful complication is to lower your risk of developing type 2 diabetes in the first place, says Dr. Smith. That includes following a healthy diet and getting exercise or some physical activity every day. A regular sleep pattern is also important; studies have demonstrated that adequate sleep promotes a healthy weight, which, in turn, lowers the risk of type 2 diabetes.

TREAT IT RIGHT

Medications used to treat nerve pain include antiseizure drugs and antidepressants. According to the 2011 American Academy of Neurology (AAN) guideline on treatment for painful diabetic neuropathy, strong evidence exists to support the efficacy of pregabalin (Lyrica), the antiseizure drug. Two other antiseizure medications, gabapentin and sodium valproate, are moderately effective, as are the antidepressants amitriptyline, venlafaxine, and duloxetine. In 2004, the US Food and Drug Administration approved duloxetine and pregabalin for nerve pain.

Other treatments rated as moderately effective by the AAN guideline include four opioids (dextromethorphan, morphine sulfate, tramadol, and oxycodone controlled-release), electrical nerve stimulation through the skin, and capsaicin cream, which is made from chili peppers.

Cedric says Kittrell not only takes medication, he also has improved his diet, avoids alcohol, keeps his blood pressure under control, and follows his doctor's recommendations for good foot care—all of which have helped calm his symptoms and regain control of his life.

PROACTIVE STEPS

Cedric recognizes that diabetes and nerve pain could be part of his future—but he's taking steps to prevent that.

Knowing he can't manage a complete lifestyle overhaul, he's sticking to small tweaks, including eating more fruits and vegetables and choosing lean proteins whenever possible. “There are no more middle-of-the-night pancakes after I finish a [stand-up comedy] set. Instead I eat berries, salads, fish, and other sensible foods.”

He also aims for 30 minutes of physical exercise a day. Some days that's simply walking while talking on the phone or rehearsing; other days he's in the gym or on the golf course. “Exercise can come in many forms, but the most important thing I've learned is to get—and stay—moving.”

And he checks his ego at the door.

“This journey with my dad has taught me not only about diabetic nerve pain but also about the importance of men speaking up about any health issue that's bothering them,” says Cedric. “I won't make the mistake of keeping quiet about any health question or problem. My well-being is too important to allow a little pride to get in the way.”

Peripheral Neuropathy Resources

* American Academy of Neurology for a free brochure and video; http://bit.ly/PN-brochure; http://bit.ly/PN-video

* American Chronic Pain Association; http://theacpa.org; 800-533-2331

* American Diabetes Association; http://diabetes.org; 800-342-2383

* National Institute of Diabetes and Digestive Kidney Disease; http://niddk.nih.gov/Pages/default.aspx; 301-496-3583

* National Institute of Neurological Disorders and Stroke; http://ninds.nih.gov; 800-352-9424


Steppin' Up for People with Diabetes

In November 2014, Cedric the Entertainer partnered with the American Diabetes Association (ADA) to produce a series of public service announcements called Step On Up. Cedric has also appeared at a variety of national and local events to educate the more than 29 million Americans living with diabetes about the symptoms of diabetic nerve pain and the importance of talking to their doctors about those symptoms. “It's all about speaking up,” he says.

In November 2014, Cedric appeared at the ADA's “I Decide” to Stop Diabetes Day in Chicago. Last year, he spoke at the association's 2015 diabetes EXPO in Houston and encouraged attendees to take a diabetic nerve pain assessment. He's also appeared on numerous television talk shows, urging people with diabetes and their families to talk to their doctors about symptoms that could be caused by neuropathy.

“This is an important message for everyone, but especially minority communities, because diabetes affects African Americans and Hispanics in greater numbers. They all are at risk of diabetic nerve pain, and I'm glad to be able to use my celebrity to get this message across about not wasting time or letting pride stand in the way of getting yourself checked out.”© 2016 American Academy of Neurology 

 http://journals.lww.com/neurologynow/Pages/ArticleViewer.aspx?year=2016&issue=12040&article=00015&type=Fulltext