Saturday, 6 February 2016

Suitable Footwear So Essential For Neuropathy Patients

Today's post from footdrkales.com (see link below) is basically an advertisement for a Florida podiatrist, which normally we wouldn't feature on the blog but because the author gives such sensible advice and information, it's worthwhile printing here. If you're one of the majority of neuropathy patients who have foot problems and irritating or painful symptoms, you may assume that you are fully aware of your feet but it's so easy to miss problems until they become serious, especially if one of your symptoms is lack of feeling. It's worthwhile taking the advice in this article on board, after all, your feet have to carry you through the rest of your life.

Choose Footwear Carefully if You Have Neuropathy
Posted on January 29, 2016 by Denise Skerritt



Choosing footwear carefully is important for everyone no matter what age or degree of foot health. But for anyone who suffers from neuropathy, it’s essential that all footwear be sturdy and especially well-fitting.

Neuropathy is damage to the nerves. The peripheral nervous system contains all nerves not located in the brain and spinal cord. These vital nerves carry sensory and muscle nervous signals to those in the brain and spinal cord. Neuropathy in the peripheral nervous system causes numbness and pain in the extremities like the hands and feet.

One of the most common causes of peripheral neuropathy is diabetes. Other causes are infections, traumatic injuries, toxin exposure and metabolic disorders. In addition to loss of sensation, neuropathy also causes tingling, burning, weakness or paralysis.

Patients with Neuropathy Must Guard Their Feet


Because neuropathy interferes with nerve signals, your feet won’t feel cold, heat or pain so you may have an injury without being aware of it.

Always protect your feet! Avoid going barefoot as even a minor sore or cut on the feet can develop an infection and then worsen into an ulcer before being spotted. Also, patients with neuropathy won’t feel the surface beneath their feet properly and so can injure themselves by falling.

Shoes for Neuropathy Must Be Both Protective and Comfortable


If you have neuropathy or diabetes, a visit to Pasco-Hernando Foot and Ankle is a good first step to choosing appropriate footwear. After a comprehensive foot exam, we’ll discuss your neuropathy with you along with any foot or ankle deformities we’ve observed.

When shopping for shoes keep these tips in mind:
Always have both feet measured each time and be sure to shop later in the day when feet are largest.


Shoes should feel comfortable right away – look for extra cushioning and soft, stretchy leather. 


Lace-up shoes are safer and sturdier and stay on your feet better than slip-ons. 


Consider shoes that are made specifically for individuals with diabetes – they are good choices for anyone with neuropathy. These shoes have plenty of room in the toe box and offer both comfort and good protection.


It’s okay for women with neuropathy to wear high heels – but only for short periods. However, if you also have a foot deformity like bunions, or have poor blood circulation, stay away from high heels.


Leave flimsy sandals in the closet – they offer little protection and the straps between the toes can cause blistering or irritation that can go unnoticed.

If You Have Neuropathy Don’t Neglect Your Foot Health


Call Dr. Lawrence J. Kales, board certified foot doctor for a complete foot exam and consultation about your neuropathy today. Reach us at our Hudson office at 727-868-2128 or our Spring Hill office at 352-683-5799, or request an appointment via the website. Dr. Kales has the right experience to help patients with neuropathy with comfortable footwear selection and expert foot care.

http://footdrkales.com/choose-footwear-carefully-if-you-have-neuropathy/

Friday, 5 February 2016

Will HGF Injections Be The Answer For Neuropathy?

Today's post from type2nation.com (see link below) talks about injecting HGF (hepatocyte growth factor - a protein associated with tissue regeneration) to treat neuropathy. Notice, I say neuropathy and not neuropathy symptoms because this is designed to help regenerate nerve growth where damaged and not just the symptoms of nerve pain or tingling. However and this is a big however, in the study, the majority of subjects did not respond to the treatment, which leaves the whole idea open to doubt. The article author suggests that this still shows HGF injections to be potentially useful for neuropathy patients but it seems that many more studies and lots more research may be needed first before this can be assumed.
 

Injections May Combat Diabetic Neuropathy
Published on January 25th, 2016 | by Travis Manni

One common side effect of living with diabetes can be painful diabetic neuropathy, which is nerve damage in the arms, hands, legs, or feet; the condition is caused by chronically high blood sugar levels. There are limited treatment options to deal with diabetic peripheral neuropathy, or the pain it causes.

However, a new multi-center study showed hepatocyte growth factor (HGF) injections helped treat the condition for a good amount of study participants. The study was published in the May 2015 issue of the journal Annals of Clinical and Translational Neuropathy. However, the treatment did not work for the majority of individuals studied, meaning HGF may be a good treatment option, but not necessarily a silver bullet in treating diabetic peripheral neuropathy.

According to the National Center for Biotechnology Information, HGF is a protein in the body that is associated with organ development, tissue regeneration, and wound healing in adults. It also supports the growth and nourishment of neuron cells. In the double-blind Phase II study, 96 individuals were given either a placebo or HGF intramuscular injections in the leg twice over two weeks; the experimental group received either 8 mg (low-dose) or 16 mg (high-dose) of HGF. Participants were asked to record information in a pain and sleep diary.

The low-dose experimental group showed the greatest reduction in pain after three months, according to a MedScape article. In particular, those who were not not already taking other prescription drugs that treat this type of pain reported a statistically significant decrease on the pain measurement scale. Additionally, 48% of those surveyed in the low-dose group reported their pain was either “improved” or “very much improved” after three months; 31% of people in the high-dose group also reported “improved’ or “very much improved” pain levels. Improvement in touch sensitivity was also observed in those treated with HGF.

Researchers hope this form of treatment, which would require only eight injections a year, will eliminate the need for patients experiencing painful diabetic neuropathy to take daily medication. The HGF injections also could be seen as an alternative option for those who do not experience pain relief with currently available prescription drugs. Further study will be needed before the treatment might become available on the market, and researchers expect to conduct a new trial in 2016.

http://www.type2nation.com/treatment/new-injection-treatment-may-combat-diabetic-neuropathy/

Thursday, 4 February 2016

Lessons From A Life With Neuropathy

Today's post from painhq.org (see link below) is an honest, personal story of life with neuropathy. Reading it you may feel that this man's lifestyle has directly contributed to his condition but it's far too easy to criticise from a distance without first looking at our own lives. The story will certainly be recognisable for many neuropathy patients, proving that nothing is as black and white as it seems - sometimes, life just gets in the way. This man uses gabapentin with success but that is his case, that doesn't mean that gabapentin is necessarily the answer for you.

Life with neuropathy
2016

'Old Fart' William's Story
 
I am 72 years old and live alone in a single family bungalow in Peterborough. I eat too much, drink too much, and get too little exercise. I am a retired teacher and have lived alone since my wife died in 2000. I am a fat old fart who lives a fairly circumscribed life - only partly due to my neuropathy. Right now my sciatica is flaring up and is far more debilitating.

My peripheral neuropathy likely dates back to the early to mid ‘90s. I suffered from falling arches, and for some time I ascribed my foot and leg discomfort solely to that issue. It was only in 1997, when the numbness, burning, and occasional stabbing pain was keeping me awake, that I took the problem to my GP.

It is so long ago that I have little or no recollection of the original process of diagnosis. The story is complicated in my mind by my wife suffering a massive brain injury at that time. She was in an automobile accident in Ottawa, in the summer of 1996. She was in an Ottawa hospital until the spring of 1997, and again for several more visits during the next couple of years. She lived at home until her death in January, 2000. Naturally, at the time, my minor problem was peripheral to hers. It was while she was in the hospital (1996 – ’97) that the burning and tingling got so bad that I went to see my GP.  He referred me to a local neurologist who ran some tests and diagnosed peripheral neuropathy. By that time (1998 – ’99) the loss of feeling extended almost to my knees.

The neurologist had no answer as to the origin of the condition. I had been drinking heavily earlier in my life, but had been totally dry for ten years when the condition struck. My GP (at the time) in 1997-9 was convinced that I had diabetes. My blood sugar levels were consistently close to the threshold levels, so he took that leap and declared me diabetic; controlling it with diet and exercise.  It wasn’t until my present GP had me do a glucose test (in 2009) that the diabetes diagnosis was ruled out.

At the beginning I had “pins and needles”, burning on the soles of my feet, numbness or loss of feeling in my feet and lower legs, aching feet and legs (perhaps partly due to the falling arches) and occasional shooting pains or a feeling like a weak electric shock. I do not remember the specifics, but I am sure that the discomfort started in one foot at a time before it came to affect both feet and legs. I have a vague memory of it migrating from one foot to the other over the months.

Finding relief, also known as, gabapentin

Back in 1997 or ‘98 my GP prescribed a common medication used off-licence to treat nerve pain. I have no recollection of which one it was. I just remember him saying that no medication worked for any large percentage of the sufferers, but that particular one was the most efficacious. It might have been an anti-depressant, but the specifics escape me. I just remember that I got every side-effect listed on the fact sheet (dry mouth is one I remember), but it did nothing to ease my nerve pain.

The second medication he prescribed was gabapentin. It was a miracle cure. Within a few days the worst of the symptoms had eased, and after trying different dosages we settled on just 300mg per day. Over the years, I have had to increase the dosage as the pains and discomfort returned. I have never been free of the feeling that something in my feet and legs isn’t right. There is the constant numbness, the decrease in flexibility, and the fairly common occasional tingling sensation. It isn’t pain! For many years, the discomfort was almost forgettable as I went through my daily chores. I loaded my gabapentin into the evening to reduce any chance of pains that would get in the way of my sleep. I don’t think that I ever expected to avoid all of the discomfort of numbness and a bit of tingling. I was happy as long as I could get to sleep every night. I have never suffered from any side-effects related to the gabapentin; or none that I identified.

Currently, I am taking 1500mg of gabapentin daily. It has been my only medication since the late ‘90s, and the only change has been a gradual increase in the dosage over the past 15 or 16 years. I am told that I could probably take and tolerate higher doses and that some patients do take more than my dose.

Life with numbness

From the 1990s, I recognized that I was losing my sense of balance. I avoid ladders. I am far more sedentary than I was in middle age. I rarely travel and, if so, prefer to use my car. At present, I avoid activities which require much walking and standing. I do my own housework (such as it is), but hire people to look after the outside chores. At home, I spend far too much time sitting at the computer – as I am now! I assume that some of the inactivity and lethargy is a result of becoming a fat old fart. I stopped mowing my own lawn over 10 years ago lest I stumble on the uneven surface. For exercise, I walk on a treadmill rather than the sidewalk, as I fear tripping on the uneven surface. For a couple of years before I got a treadmill, I used to walk at 4:00 or 5:00 AM so that I could walk on the residential street which was smoother than the sidewalk.

As some of my foot muscles become dominant and others atrophy, walking becomes more problematic. I drag my heels and walk flat-footed. My feet are no longer flexible, so I describe the sensation as akin to walking with snowshoes. My feet and legs feel “heavy”. It is very tiring. I can’t walk nearly as fast, or as far as I used to. Much beyond a mile is getting to be a trial: not impossible, but not comfortable. My legs ache after any decent walk on my treadmill. Hiking or walking off road is almost impossible. An extended shopping trip can be problematic. Luckily, I detest shopping.

I can feel movement on my skin if a finger is rubbed across my foot or leg, but if touched gently without disturbing the hairs, I often can’t tell if my foot or leg is being touched at all. If I am poked I get no different sensation from a finger than from a needle. Some nerves seem to still work as occasionally I get a sharp pain from stubbing a toe, but most times my only clue that I have stubbed it is the blood welling out from under the nail.

For the past 2 or 3 years I have been noticing a gradual loss of sensation in my fingers. It is just the same numbness and tingling that affects my feet, but less severe as yet. As I do all my own cooking it presents the constant threat of burned fingers. I cook most of my food from fresh ingredients, so I find that my legs often get tired and achy from standing too long in the kitchen preparing vegetables or batch-cooking for my freezer. Perhaps it is the muscle changes in my feet and legs which cause me the most problem; not the occasional bout of neuropathy pain.

My physiotherapist comments that I have retained strength in my arms and legs, but I notice a lack of strength in my hands and a sensitivity in the skin which keeps me from opening jars or bottles. It can hurt to try to grasp an object too tightly. Accidentally hitting my hand on a piece of furniture or door jamb is often remarkably painful; far more so than used to be the case. I am more likely to drop a light object as I no longer sense, say, a sheet of paper in my hand. Simple tasks, such as doing up small buttons, becomes nearly impossible. My wardrobe reflects that new reality; few shirts with buttons and no tight collars. I struggled mightily to rewire a lamp the other day. My fingers were like useless - and senseless - lumps of clay. It is hard to manipulate thin wire with no sense of touch. Picking up small objects is a trial.

My days entail reading the newspaper, normal ablutions, essentials of housework (dusting is avoided at all costs), email contact with a couple of dozen people, internet surfing, walking on my treadmill or doing stretching exercises, watching videos from my PVR or streamed to my TV through my computer, football and occasional soccer matches watched live, daily food preparation, grocery shopping 2 or 3 times a week, occasional appointments and lunches with friends, usually weekly contests over a friend’s snooker table, weekly visits by a female friend. I drive to see my children and grandchildren every few weeks. I have pretty well ceased attending plays and concerts except for the occasional MET in HD performance. That is more due to the lack of a companion rather than the effects of my neuropathy. I have ceased travelling because of my inertia, and mostly the lack of a suitable travel companion. Neuropathy wouldn’t keep me at home were I really keen to take a particular trip. It would just affect the type of trip and the day’s activities – as it does at home. My inertia is only partly the result of my neuropathy.

What pain is like now

I have used gabapentin alone for over 15 years. I have never tried any other medication. I asked my GP about newer and better medications a year or so ago. He said I should stay with what is working rather than weaning me off it and then going through the process of trying to find something better. I was somewhat relieved.

All in all, I view myself as being rather lucky. I found gabapentin pretty early in the process and under normal conditions I can say that I am pain-free. I have discomfort, and my life is circumscribed, but I do not have the constant level of pain common to some sufferers.

My advice for anyone newly diagnosed with neuropathic pain?

  • Seek out whatever medication will render the nerve pain bearable. Once you can limit the pain, everything else is reduced to the level of a really annoying nuisance. 
  • Forget vanity and wear sensible shoes with proper orthotic support to keep you mobile. Work with a physiotherapist to develop a regimen of stretching exercises to help keep you as flexible as possible.
  • Understand that you will have a constant struggle to maintain as much of your lifestyle as possible, to work around your new limitations, and to seek out any treatments or devices which will make life a bit easier. 
  • It isn’t a death sentence so much as a constant set of hurdles which will make life a bit more difficult, but still enjoyable. It’s no walk in the park, but look around at your peers and all of a sudden neuropathy isn’t so bad. There are lots worse conditions to have to cope with.
  • https://www.painhq.org/connect/personal-stories/detail/life-with-neuropathy

Wednesday, 3 February 2016

How Chronic Pain Can Change Your DNA And Genetics

Today's post from sciencedaily.com (see link below) looks at the recent discovery that chronic pain (generally lasting longer than 6 months) can change not only the structure of your DNA but reprograms the way genes work in your immune system. the implications of this are that chronic pain may also change the way other systems in your body work. This may sound very logical to people living with automatic neuropathy (where the body's involuntary functions are affected by nerve damage) but also to people suffering from chronic pain and that includes so many neuropathy patients. It's useful information because future treatments may be gene-targeted and aimed at changing the way our genes respond to pain. Genetic therapies may well be the future of medicine.


Chronic pain changes our immune systems
Date: January 28, 2016 Source: McGill University

Epigenetics may bring us a step closer to better treatments for chronic pain 
 Chronic pain may reprogram the way genes work in the immune system, according to a new study by McGill University researchers published in the journal Scientific Reports.

"We found that chronic pain changes the way DNA is marked not only in the brain but also in T cells, a type of white blood cell essential for immunity," says Moshe Szyf, a professor in the Faculty of Medicine at McGill. "Our findings highlight the devastating impact of chronic pain on other important parts of the body such as the immune system."

Chronic pain -- pain that lasts six months or more -- is one of the most common causes of disability worldwide. Despite enormous efforts to find new therapeutic strategies, however, effective treatments for chronic pain remain elusive.

Using rat models

The all-McGill team examined DNA from brains and white blood cells of rats, using a method that mapped DNA marking by a chemical called a methyl group. "Methyl marks are important for regulating how these genes function," explains co-author Laura Stone, a professor in Dentistry and researcher in the Alan Edwards Centre for Research on Pain. This sort of chemical marking is part of the growing field of epigenetics, which involves modifications that turn genes 'on' or 'off', effectively reprogramming how they work.

"We were surprised by the sheer number of genes that were marked by the chronic pain -- hundreds to thousands of different genes were changed," adds Szyf. "We can now consider the implications that chronic pain might have on other systems in the body that we don't normally associate with pain."

Possible targets for new pain medications

The findings could open new avenues to diagnosing and treating chronic pain in humans, the researchers suggest, as some of the genes found to be marked by chronic pain could also represent new targets for pain medications.

Story Source:


The above post is reprinted from materials provided by McGill University. Note: Materials may be edited for content and length.

Journal Reference:
Renaud Massart, Sergiy Dymov, Magali Millecamps, Matthew Suderman, Stephanie Gregoire, Kevin Koenigs, Sebastian Alvarado, Maral Tajerian, Laura S. Stone, Moshe Szyf. Overlapping signatures of chronic pain in the DNA methylation landscape of prefrontal cortex and peripheral T cells. Scientific Reports, 2016; 6: 19615 DOI: 10.1038/srep19615

McGill University. "Chronic pain changes our immune systems: Epigenetics may bring us a step closer to better treatments for chronic pain." ScienceDaily. ScienceDaily, 28 January 2016. .

http://www.sciencedaily.com/releases/2016/01/160128074319.htm

Tuesday, 2 February 2016

Will Endomorphin Be The Replacement For Opioids For Neuropathy Patients?

Today's post from sciencedaily.com (see link below) follows on from yesterday's post about endomorphin and its potential for chronic pain patients but whereas yesterday's post was from a national newspaper, this one is from the ever-reliable Sciencedaily.com and confirms what you may have read yesterday. If the predictions are correct, then commercially produced endomorphin may replace opioids as the pain killers of choice for those who've tried everything else and as a bonus, will deliver none of the side effects associated with opioids. This is fantastic news for long-term pain patients who not only have to manage their opioid prescriptions properly but have to face the wagging finger of media stigma, however unjust that may be. We still have to wait two years before the first human trials but the eventual benefits may make the wait easier.


New drug could be safer, non-addictive alternative to morphine
 January 28, 2016 Source: Tulane University

The peptide-based drugs, which mimic a natural brain chemical, target the same pain-relieving opioid receptor as morphine

Researchers at Tulane University and Southeast Louisiana Veterans Health Care System have developed a painkiller that is as strong as morphine but isn't likely to be addictive and with fewer side effects, according to a new study in the journal Neuropharmacology.

Using rats, scientists compared several engineered variants of the neurochemical endomorphin, which is found naturally in the body, to morphine to measure their effectiveness and side effects. The peptide-based drugs target the same pain-relieving opioid receptor as morphine.

Opium-based drugs are the leading treatments for severe and chronic pain, but they can be highly addictive. Their abuse results in thousands of overdose deaths in the United States annually. They can cause motor impairment and potentially fatal respiratory depression. Patients also build up tolerance over time, increasing the risk for abuse and overdose.

"These side effects were absent or reduced with the new drug," said lead investigator James Zadina, VA senior research career scientist and professor of medicine, pharmacology and neuroscience at Tulane University School of Medicine. "It's unprecedented for a peptide to deliver such powerful pain relief with so few side effects."

In the study, the new endomorphin drug produced longer pain relief without substantially slowing breathing in rats; a similarly potent dosage of morphine produced significant respiratory depression. Impairment of motor coordination, which can be of particular importance to older adults, was significant after morphine but not with the endomorphin drug.

The new drug produced far less tolerance than morphine and did not produce spinal glial cell activation, an inflammatory effect of morphine known to contribute to tolerance.

Scientists conducted several experiments to test whether the drug would be addictive. One showed that although rats would spend more time in a compartment where they had received morphine, the new drug did not affect this behavior. Another test showed that when the press of a bar produced an infusion of drug, the rats only increased efforts to obtain morphine and not the new drug. The tests are predictive of human drug abuse, Zadina said.

Researchers hope to begin human clinical trials of the new drug within the next two years.

Story Source:

The above post is reprinted from materials provided by Tulane University. Note: Materials may be edited for content and length.


Journal Reference:

James E. Zadina, Mark R. Nilges, Jenny Morgenweck, Xing Zhang, Laszlo Hackler, Melita B. Fasold. Endomorphin analog analgesics with reduced abuse liability, respiratory depression, motor impairment, tolerance, and glial activation relative to morphine. Neuropharmacology, 2016; 105: 215 DOI: 10.1016/j.neuropharm.2015.12.024

Tulane University. "New drug could be safer, non-addictive alternative to morphine: The peptide-based drugs, which mimic a natural brain chemical, target the same pain-relieving opioid receptor as morphine." ScienceDaily. ScienceDaily, 28 January 2016. .

http://www.sciencedaily.com/releases/2016/01/160128155006.htm

Monday, 1 February 2016

Is Endomorphin The 'Super Morphine' That Will End The Need For Opioids?

Today's post from dailymail.co.uk (see link below) could signal the breakthrough all neuropathy patients experiencing chronic pain have been waiting for. It talks about using 'endomorphin' as an alternative to morphine and other opioids but without the side effects! (There will be a follow up post from another source tomorrow.) The endomorphin drugs are peptide-based, and target the same pain-relieving opioid receptor as morphine. Endomorphin is naturally produced in the body but targeted endomorphin drugs may certainly be able to replace opioids in the spectrum of neuropathic pain treatments. It's an old story but it's only at the rat-testing stage at the moment and will be two years before human testing begins but the potential is obvious. More information in tomorrow's post.


Researchers reveal ‘super morphine’ that has all of the painkilling properties but is NOT addictive
By Lisa Ryan For Dailymail.com Published: 29 January 2016 

 A neurochemical has all the painkilling effects of morphine, scientists say
Endomorphin is not addictive and has fewer side effects, a study revealed
And, endomorphin doesn't cause the same respiratory depression
This new drug could offer pain relief without risking opioid addiction

Health officials have frequently warned of the opioid epidemic sweeping America.

There has been a 200 per cent increase in opioid-related deaths since 2000 – with many of those deaths occurring because of prescription painkillers, according to the Centers for Disease Control.

However, scientists may have the answer - a powerful painkiller that isn’t addictive.

Endomorphin – which is found naturally in the body – can be as strong as morphine, but with fewer side effects, according to a study from Tulane University.

Dr James Zadina, a professor of medicine, pharmacology and neuroscience, said: ‘These side effects were absent or reduced with the new drug.

‘It’s unprecedented for a peptide to deliver such powerful pain relief with so few side effects.’

The study, published in the journal Neuropharmacology, tested several engineered variants of the neurochemical endomorphin on rats.

The scientists compared endomorphin to morphine – in an attempt to measure the drugs’ effectiveness and side-effects.

The endomorphin drugs are peptide-based, and target the same pain-relieving opioid receptor as morphine.

Opium-based drugs are the most common treatments for severe and chronic pain – but they can be severely addictive.

Opioid abuse leads to overdose deaths across the world.

Furthermore, the drugs can cause motor impairments and potentially fatal respiratory depression.

And because patients build up tolerance over time – there is a higher risk for abuse and overdose.

The study found the new endomorphin drug offered longer pain relief without substantially slowing the breathing in rats.

A dose of morphine that was similarly potent produced ‘significant respiratory depression,’ the study said.

Additionally, impairment of motor coordination – which is of particular significance to older adults – was higher after morphine.

But, motor coordination wasn’t impaired with the endomorphin drug.

The study found the new drug produced far less tolerance than morphine.

It’s unprecedented for a peptide to deliver such powerful pain relief with so few side effects

It also didn’t produce spinal glial cell activation – which is an inflammatory effect of morphine that can contribute to tolerance.

Several experiments tested whether the drug would be addictive.

One found that while rats would spend more time in a compartment where they received morphine, the new drug didn’t affect that behavior.

Another test found that when the press of a bar produced an infusion of the drug, the rats increased efforts to obtain morphine.

Yet, they did not increase efforts to get the new drug.

Dr Zadina noted that these tests are ‘predictive of human drug abuse.’

The scientists hope to conduct human clinical trials of the new drug within the next two years.

http://www.dailymail.co.uk/health/article-3423555/Researchers-reveal-SUPER-MORPHINE-painkilling-properties-not-addictive.html

Sunday, 31 January 2016

Chronic Pain Patients Treated Shamefully

Today's post from painnewsnetwork.org (see link below) relates expecially to what's going on in the US right now but will be recognisable to many people currently living with neuropathy. More and more these days, we begin to feel that we're nothing more than statistics used to prove one thing or another in the current bureaucracy-obsessed health service and wonder if our doctors are interested in us as people or merely see us as pawns in the drug/insurance company battles and financial negotiations that rule how our health systems operate. This article is both an advertisement for a book (interview with the author) and a comment on how badly chronic pain patients are treated in modern consulting rooms. It hits the nail on the head in several respects and is definitely worth a read.

The Painful Truth: How Patients Are Treated Shamefully  Pain News Network editor Pat Anson August 26, 2015
 

Lynn Webster, MD, is past President of the American Academy of Pain Medicine, vice president of scientific affairs at PRA Health Sciences, and one the world’s leading experts on pain management. He treated people with chronic pain for more than 30 years in the Salt Lake City, Utah area.

Dr. Webster’s new book, “The Painful Truth,” is a collection of stories involving several of his former patients, who struggled with the physical, emotional and financial toll that many chronic pain sufferers experience.

Pain News Network editor Pat Anson recently spoke with Dr. Webster about “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.” The interview has been edited for content and clarity.
 

Anson: Dr. Webster, you’re no longer practicing medicine, but you’re still very involved in the pain community and in research. Why write this book now at this stage of your career?

Webster: It takes a lot of time to write a book, as you can imagine, and it’s taken me four years to get to this point. I think that at this stage in my career I can look back and put together a story about the people who I’ve taken care of for most of my career that I’m not sure I could’ve done in the middle of it. I think that’s given me the ability to look back and reflect and feel the heartache that patients have, and my inability to deliver to them everything that I wanted to deliver to them, because of all of the barriers and obstacles in healthcare.

I’m hoping that my book is going to be a seed that will contribute to a cultural change, a social movement that will bring some dignity and humanity to a large population of our country.

Anson: In your book you said the painful truth is that people in pain are treated shamefully. What did you mean by that?

Webster: When I was growing up on a farm I observed something as a young boy that always puzzled me and that was watching the injured or sick animals. We had all sorts of animals; cows, pigs, sheep, and chickens, and I could see that the injured somehow were always separated from the healthy ones. It wasn’t that the sick separated themselves from the healthy, but the healthy separated themselves from the injured or the ill.

I see that to some degree in people and I wonder if this hasn’t been a biological aspect of survival for man from the beginning. We as humans are better than that; we’re better than we may have been thousands of years ago.

Today, I think that it is shameful that people are stigmatized because they have pain, they’re isolated, and they’re denigrated often. Because of our healthcare system, at least in this country, they’re viewed as addicts, lowlife’s, and druggies. That’s rarely true and it absolutely prevents, it really contributes to the harm that pain sufferers feel towards themselves and their inability to get the type of care they need. I think that it hurts our society in so many different ways, but most importantly the people in pain.

Anson: A lot of your book is dedicated to telling the stories of some of the pain patients that you treated. Virtually every one went through what you just described, where they had trouble getting proper treatment, they had trouble with their jobs, with their families, and with their friends. Is that why you write the book in this way, so that their stories get across the point you’re trying to make?

Webster: Absolutely. It’s less important that a physician tells a story than a patient tells their story. I wanted this book to be felt by the readers, to understand what people in pain experience and the struggles they have.

Anson: You wrote that, “People in pain need to be both treated by medical professionals and supported by all the important people in their lives.” Is that happening?

Webster: No, of course not. There are some patients that have pain who have great support structures in their personal life. For example Alison, she is an individual who had what I thought was the quintessential family support. Were it not for her mother, father and sister, she could’ve gone down the path that too many others take, which would be resignation rather than resilience. It’s one where drugs are used to cope and to escape the pain, physical but also the emotional.



Too many people are separated and too few have the structure of the support system that Alison had. Our healthcare system is abominable. It shamelessly abandons them with limited resources, limited access and actually a labeling of the individual as if they’re a leper; they have a disease that is contagious.

Anson: Is the average physician in U.S. prepared to treat chronic pain?

Webster: No. I think it’s been reported that medical schools average less than 10 hours of education on pain and even less for addiction. Yet this is the number one public health problem in America and it’s not recognized by the CDC like many other disease states have been.

And so very few physicians understand what pain is. In fact, many think that it’s just a symptom and you never die from pain which is categorically wrong. As I write in my book, pain can be as malignant as any cancer and it can be just as devastating. It can take the soul but it also takes the life of some individuals when we ignore it and when we’re unable to provide them the relief that they deserve.

Anson: If you were a young man again in medical school and trying to decide what specialty to go into, knowing what you know today, would you go into pain medicine?

Webster: Without a doubt, there is no hesitancy in this response; I love the field that I’ve been in. As an anesthesiologist I could’ve stayed in the operating room and honestly the compensation of doing that would have been far better than the path that I chose. But the rewards I’ve received from trying to make a difference and the thank you’s that I’ve received will never be matched by any kind of financial or professional recognition in any other areas.

The most rewarding part of life is really to be able to make a difference in someone else’s life. And I think I’ve been able to do that with hundreds, if not thousands of individuals. That actually is the reason for the book. I’m hoping the book is going to make a difference for more people than I could physically touch in my clinic.

Most of the people that I saw as patients were already experiencing a large amount of pain, they’ve been through the mill and many had their chronic pain for years before they came to see me. We are basically going to be taking care of them the rest of their life. We do get to know them, much like a primary care person does to a family they’ve been caring for, and so we get to know them well. They get to know us. We also begin to see the struggles that they have in the system and with the rejection of their families sometimes, their friends, the isolation. And we become the only source that’s grounded, that gives them potential hope. I took that very seriously and I think that’s why it was so rewarding for me.

Anson: You wrote that you’re neither pro-opioid or anti-opioid. What do you mean by that?

Webster: My focus has never been about making opioids available or that they should be used. In fact ten years ago I started the first national campaign about the risk of opioids. My campaign was called Zero Unintentional Overdose Deaths and you can still find that on the Internet. I did a lot of work at trying to understand the potential risks and mitigate those risks so we can prevent people from harm because I knew one day that if we couldn’t prevent people from being harmed from opioids that there would be political response to this that could be very harmful to a large number of people who are not harmed by opioids.

I think the focus should always be about what’s best for a patient and not about whether a drug or a certain treatment is good or bad. All treatments have potential risks and complications, and we need to evaluate whether or not the potential benefit outweighs the potential risk or harm and it has to be patient centered. So my focus has never been about really any treatment, but it’s always been about what’s best for the patient. I’m more anti-pain than I am pro or anti-opioid.

Anson: You prefer a multi-disciplinary approach to pain treatment?

Webster: Yes, it’s been demonstrated that for people with moderate to severe chronic pain, the type that’s not likely to be resolved, it is best managed in a multi-disciplinary, integrative approach. I see the need for more cognitive behavioral therapy. We should always tap into the different treatments that have low risk associated with them before we ever tap into something that has more risk, for example opioids or even interventional treatments we as anesthesiologists and some of the other pain specialists can provide.

Much about pain is really learning how to cope, how to deal with it from day to day and how to manage the stress that’s associated with it because stress augments all pain. And so it’s really important that we use all of the resources that we have to manage the pain and not just a single modality, certainly not opioids or spinal cord stimulators, but look at how we can manage this in a more mindful way, even as clinicians. I use that word intentionally because mindfulness is really what the doctor needs to use as much as the patient in order to optimize the treatment with the lowest risk.

Anson: Has the pendulum swung too far against use of opioids?

Webster: I think there’s too much focus on opioids by almost everyone. And what it has done is it’s forgotten about people. Opioids can cause a great deal of harm, we see way too many people harmed from opioids. But certainly a vast majority of people who have been exposed to opioids are not harmed by them and there are countless number of people, a huge number of individuals who have been on opioids for decades, that believe very strongly that they’ve improved their lives and they could not live without them.

I think the focus is in the wrong place. Our focus should not be on opioids and whether they should or should not be prescribed, but what is the best treatment for the patient? And if opioids are inappropriate as a pain treatment, then I say all of the anti-opioid people as well as the individuals who are interested in helping people with pain should come together and demand that we have more money invested in research so we can replace opioids entirely.

We cannot always know who’s going to have an addiction triggered by exposure. As I pointed out in my book, Rachel just went in for an appendectomy and that initial opioid that she received lead her down a serious, dreadful path because she didn’t have the social support to keep her from taking that path.

I think that the anti-opioid people and those of us who are interested in bringing some dignity and humanity to a large population of people in pain need to come together and insist that we have a Manhattan Project basically and to discover safer and more effective therapies that are not addictive.

Anson: The final version of National Pain Strategy will soon be released, with the goal of advancing pain research, healthcare and education in the U.S. From what you’ve seen and heard so far about it, are they on the right track?

Webster: Yes, I think it’s an important step forward. I think that it brings most importantly the government into the picture, recognizing the need that we do something on a national scale and that alone is a big step forward.

It’s kind of like in my book there are three important words, “I believe you.” This is really the way the government can say, “I believe you.” There is a problem in this country with the way in which we treat pain and the National Pain Strategy is about how they’re going to address that. Having the federal government say I believe you, there is a problem, let’s see if we can change the way pain is treated in this country is a huge step forward.

Anson: Thank you, Doctor Webster.

You can follow Dr. Webster on his blog, and on Twitter @LynnRWebsterMD, Facebook and LinkedIn.

http://www.painnewsnetwork.org/stories/2015/8/25/the-painful-truth-how-pain-patients-are-treated-shamefully

Saturday, 30 January 2016

Maybe Neuropathy Patients Should Put A Sock On It!

Today's post from medicaldaily.com (see link below) is a very useful product but is perhaps not meant for everybody with neuropathic foot and leg pain. If you're prone to foot ulcers and have a significant loss of feeling in your feet, these socks may well be just what you need because of what they can do preventatively. Nobody wants to face amputation due to gangrenous sores but actually relatively few nerve damage patients are at that stage. Most people have limited feeling, confined to toes and the pads of the foot but perversely, there's enough feeling and pain on another level to sense what's going on as you walk. Therefore most people are aware if they have a sore on their foot and if not, they check regularly. However, if you're concerned, talk it over with your doctor and/or podiatrist and see what they say concerning the need for special socks. On the other hand, the best possible shoes are pretty much essential for all neuropathy sufferers.
 
Smart Sock For Diabetic Neuropathy, SenseGO, Helps Patients Manage Symptoms

Jan 27, 2016  By Steve Smith @realsteve_smith


The SenseGo sock helps people with diabetic neuropathy manage their symptoms. Photo: The Hebrew University of Jerusalem

In the United States, up to 70 percent of diabetics suffer from diabetic neuropathy, a type of nerve damage that most often affects the legs and feet. This nerve damage takes its toll on these body parts, affecting how patients feel pain, and increasing risk for injuries. As a result, patients are likely to experience foot ulcers and slow-to-heal cuts and bruises. Going without treatment for these injuries could lead to amputations.

Knowing this, researchers from the Hebrew University of Jerusalem and Hadassah Medical Center created the BioDesign: Medical Innovation Program to develop ways to combat diabetic neuropathy before amputation even becomes a thought. The team’s latest invention is the SenseGO, a machine-washable sock that’s able to detect changes in pressure on a patient’s foot and ultimately prevent foot ulcers.

"This is a classic mobile health approach,” said professor Yaakov Nahmias, director of the BioDesign program, in a press release. “By giving patients and their families the tools they need to prevent the development of ulcers, we can dramatically reduce health care costs related to diabetes."

The SenseGO contains dozens of pressure sensors, which collect information regarding overexertion, incorrect posture, and ill-fitting shoes, among other contributors to foot ulcers. This information is then relayed to a smartphone app, which can warn the patient if there’s too much pressure. SenseGO provides both patients and their physicians with the information they need to “minimize or even eliminate the occurrence of diabetic ulcers,” said Danny Bavli of the Grass Center for Bioengineering in the video.

Roughly 4 to 10 percent of people with diabetes end up with foot ulcers. Although this number seems relatively low, foot ulcers are the number one reason for hospital stays among people with diabetes, despite being painless most of the time, according to the National Library of Medicine (NLM). Some ways to take care of feet when they have an ulcer include debridement — removing dead skin and tissue from the feet to get to the ulcer — taking pressure off the ulcer by wearing special shoes or braces, and wrapping the foot up in dressings that will help to manage the wound. A doctor should be contacted immediately if the ulcer becomes more painful, or if it emits an odor or pus, or becomes more red or firm.

The SenseGO is the latest in a number of other technological advances that aim to improve the lives of diabetes patients. Most recently, Medical Daily reported on the Suggestic app, which offers lifestyle programs for diabetics to manage everything from their nutrition to medications. Researchers have also created temporary tattoos capable of monitoring blood glucose levels. Clearly, the future of diabetes management is bright.

http://www.medicaldaily.com/sensego-diabetic-neuropathy-foot-ulcers-amputations-smartphone-app-machine-371208

Friday, 29 January 2016

The Scandal Of Lyrica, Gabapentin And Cymbalta For Neuropathy Patients

Today's post from ti.ubc.ca (see link below) reinforces the latest evidence that shows that Lyrica, gabapentin and Cymbalta (pregabalin, gabapentin and duloxetine) have very little effect on patients' nerve pain when compared to placebos. It's enough to make you hopping mad (if hopping weren't so painful!) when you realise that very successful pharmaceutical company advertising campaigns have promoted these drugs to the top of doctors' lists when treating neuropathic pain. The patient clearly comes last in the equation and for years now people have been exposed to these drugs and their side-effects without any proven benefits. Time to have a serious discussion with your doctor or specialist, wherein you can ask them how they can justify their prescriptions. The idea that doctors turned to these drugs to prevent a rapid progression towards opioids is just to weak for words.

Benefits and harms of drugs for “neuropathic” pain 
January 19, 2016 Therapeutics  Cochrane reviews

Chronic pain (at times presumed to be “neuropathic” in origin) is a common problem in clinical practice. It is now well recognized that the results of drug treatment are more often disappointing than not.1 Despite this, from 2005-2014 the number of British Columbians prescribed gabapentin increased 1.8 fold, pregabalin 17 fold, and duloxetine 3.6 fold (from 2008). Use of venlafaxine (mostly for depression/anxiety) has remained relatively stable.

Most gabapentin, pregabalin, and duloxetine use in B.C. is for chronic pain, driven partly by concern about problems with long-term opioid therapy. For the same reason, tricyclic antidepressants (amitriptyline, nortriptyline, imipramine, desipramine) are often prescribed for “neuropathic” pain.

In 2009 Therapeutics Letter 75 on gabapentin2 concluded:
Gabapentin reduces neuropathic pain by < 1 point on a 0-10 point scale and benefits about 15% of carefully selected patients (NNT=6-8).
A similar proportion of people suffer harm (NNH=8).
A test of benefit/harm can be made after 1-2 days at a low dose (100-900 mg/day).
Benefit is unlikely to increase with higher doses or longer treatment.

This Letter updates information on gabapentin and critically appraises randomized clinical trials (RCT) assessing the benefits and harms of three other drugs promoted for neuropathic pain: pregabalin, duloxetine, and venlafaxine. It is based primarily on 4 Cochrane reviews.3-6 Like many systematic reviews, these either did not assess risk of bias, or did not fully reflect the implications of the risk of bias in their conclusions. We attempt to demonstrate how appreciation of the biases in RCTs can be incorporated into the conclusions of systematic reviews.


Benefits

Although all pain metrics have limitations7 a 50% or greater reduction from a baseline pain score has been promoted as a more clinically relevant outcome for “neuropathic” pain because it correlates with improvements in comorbidity, function and quality of life.4 Using this outcome across all 4 Cochrane reviews, the mean number of people who must be treated for one to achieve a ≥ 50% reduction in pain (NNT) compared to placebo is about 6. This calculation is based on all doses that were statistically significantly superior to placebo. The evidence is weakest for venlafaxine, but even for gabapentin, pregabalin, and duloxetine, this NNT is likely very optimistic, as we judged the included RCTs to have a high risk of bias.

The greatest potential bias comes from the likelihood that patients and investigators were unblinded by observing drug adverse effects such as somnolence. Loss of blinding has been shown to be associated with a 68% exaggeration of relative benefits for subjective outcomes such as pain.8 In addition almost all RCTs included in the Cochrane reviews were funded by drug manufacturers. A separate Cochrane review demonstrated that industry funded studies lead to “more favourable results and conclusions” than non industry funded studies.9 Accounting for these biases, we suspect the real NNT for benefit from these drugs is at least 10.

An alternative measure of meaningful benefit is the patient’s reported global impression of change (PGIC). PGIC was not reported in any venlafaxine RCT3 and no meaningful difference was found for duloxetine.4 For gabapentin and pregabalin, the estimated NNT for “much or very much improved” PGIC ranges from 6-10.5,6 Like the ≥50% pain score reduction, this is probably overly optimistic.

The evidence of benefit for tricyclic antidepressants for neuropathic pain is weaker and it is not possible to estimate a meaningful NNT.10-13

 
Harms

Withdrawals due to adverse effects compared with placebo were higher with gabapentin, pregabalin, duloxetine and venlafaxine.3-6 Approximately 80% of people receiving these drugs experienced at least one adverse effect. The most common were somnolence, dizziness, and nausea. Anticholinergic effects, such as dry mouth and constipation, were common with duloxetine. The rate of adverse effects reported in Cochrane reviews almost certainly underestimate the real world rates because patients at higher risk (e.g. from impaired kidney function, alcohol use, or with other morbidities) are excluded from RCTs. Furthermore, official product monographs for these drugs report higher rates of adverse effects than do the Cochrane reviews.

The most common adverse effects reported for the tricyclic antidepressants were dry mouth, sedation and constipation.10-13 Likewise official monographs provide a better and higher estimate of the incidence of harms than the systematic reviews. 


To whom do the Cochrane reviews apply?

Patients averaged 50 years of age, had moderate levels of neuropathic pain, and were free of medical conditions other than those being studied (diabetes, fibromyalgia, or post-herpetic neuralgia). RCTs varied with respect to allowed use of other analgesics from acetaminophen only to the use of multiple analgesics including opioids. 


How soon is pain reduced?

In the majority of trials pain reduction compared with placebo was demonstrable within the first week. Very little additional pain reduction occurred after the second week.


Is there evidence that increasing dose improves response?

For gabapentin, pregabalin, duloxetine and venlafaxine, RCTs demonstrated little or no benefit from doses higher than the lowest dose that was superior to placebo.3-6

 
Clinical implications

Evidence from 8 Cochrane reviews should temper expectations regarding the likelihood and magnitude of pain relief from gabapentin, pregabalin, duloxetine, venlafaxine, amitriptyline, nortriptyline, imipramine or desipramine. When initiating a therapeutic trial with one of these drugs in a patient, it is reasonable to start at the lowest recommended dose and assess the patient for benefit and harm at 1 week. If benefit harm ratio is unacceptable, consider stopping the drug. If insufficient but partial pain relief is achieved, increase the dose and reassess within 1 week. If functionally meaningful benefit is still absent, stop the drug and try something else. For patients who achieve clinically meaningful analgesia, use the lowest individualized effective dose to minimize adverse effects. Reassess regularly (e.g. every 2 weeks), as most patients treated with placebo also improve over time.


Conclusions 

 
The evidence base for drug treatment of neuropathic pain is weak, due to the small magnitude of clinically meaningful effects and the high risk of bias in the RCTs.


Probably less than 1 in 10 patients achieve a meaningful reduction in pain.
Most patients experience some adverse side effects like somnolence, dizziness, nausea, dry mouth and constipation.
To identify patients who respond, a therapeutic trial with early assessment is essential. Reassessment of drug utility is needed to detect people with spontaneous remission or placebo response.
Higher doses are unlikely to achieve greater pain reduction, but are more likely to cause harm.


References 

 
Moore A, Derry S, Eccleston C, Kalso E. Expect analgesic failure; pursue analgesic success. BMJ. 346:f2690, 2013.
Therapeutics Initiative. Gabapentin for pain. New evidence from hidden data. Therapeutics Letter. 2009; 75:1-2.
Gallagher HC, Gallagher RM, Butler M, et al. Venlafaxine for neuropathic pain in adults. Cochrane Database of Systematic Reviews, 2015 Issue 8. Art. No.: CD011091. DOI: 10.1002/14651858. CD011091.pub2.
Lunn MPT, Hughes RAC, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD007115. DOI: 10.1002/14651858.CD007115.pub3.
Moore RA, Straube S, Wiffen PJ, et al. Pregabalin for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. NO.: CD007076. DOI: 10.1002/14651858.CD007076.pub2.
Moore RA, Wiffen PJ, Derry S, et al. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews, 2014, Issue 4. Art. No.: CD007938. DOI: 10.1002/14651858.CD007938.pub3.
Ballantyne JC, Sullivan MD. Intensity of Chronic Pain – The Wrong Metric? N Engl J Med 2015;373(22): 2098-9.
Hrobjartsson A, Thomsen AS, Emanuelsson F, et al. Observer bias in randomized clinical trials with measurement scale outcomes: a systematic review of trials with both blinded and nonblinded assessors. CMAJ 2013 Mar 5;185(4):E201-11.
Lundh A, Sismondo S, Lexchin J, et al. Industry sponsorship and research outcome. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: MR000033. DOI:10.1002/14651858.MR000033.pub2.
Moore RA, Derry S, Aldington D, et al. Amitriptyline for neuropathic pain in adults. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD008242. DOI: 10.1002/14651858.CD008242.pub3.
Derry S, Wiffen PJ, Aldington D, Moore RA. Nortriptyline for neuropathic pain in adults. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD011209. DOI: 10.1002/14651858.CD011209.pub2.
Hearn L, Moore RA, Derry S, et al. Desipramine for neuropathic pain in adults. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No.: CD011003. DOI: 10.1002/14651858.CD011003.pub2.
Hearn L, Derry S, Phillips T, et al. Imipramine for neuropathic pain in adults. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD010769. DOI: 10.1002/14651858.CD010769.pub2.
The draft of this Therapeutics Letter was submitted for review to 60 experts and primary care physicians in order to correct any inaccuracies and to ensure that the information is concise and relevant to clinicians.
The Therapeutics Initiative is funded by the BC Ministry of Health through a grant to the University of BC. The Therapeutics Initiative provides evidence-based advice about drug therapy, and is not responsible for formulating or adjudicating provincial drug policies .


http://www.ti.ubc.ca/2016/01/19/96-benefits-and-harms-of-drugs-for-neuropathic-pain/

Thursday, 28 January 2016

Lyrica For Nerve Pain: Yet More Negative Advice

Today's post from vancouversun.com (see link below) is once again bad news for Pfizer, the manufacturers of Lyrica (pregabalin). Regular readers of this blog will know that it's very questionable if Lyrica should ever be taken for neuropathic problems. Pfizer themselves withdrew their own recommendation for Lyrica in these cases two years ago and haven't restored it since and the FDA also have issued negative advice for certain forms of neuropathy. Expensive law suits and side effects lists as long as your arm more or less forced them into taking that decision. Gabapentin and Cymbalta fall into the same category of less than effective drugs for nerve pain, with significant potential side effects. This article points out that new research has shown that most patients taking these drugs simply don't benefit from them...so why take them? Yet these drugs are growing in popularity among doctors and you have to ask why! Pharmaceutical companies however, are masters at persuasion but home doctors especially really need to do their own research.



Common drug for diabetic foot pain isn’t effective, B.C. researchers say 
By Erin Ellis, Vancouver Sun January 20, 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.

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

Wednesday, 27 January 2016

Opioids: It Can Be A Matter Of Semantics For Chronic Pain Sufferers

Today's short post from health.economictimes.indiatimes.com (see link below) has implications for neuropathy patients who have been forced to take opioids in order to control their pain. The current hoo-ha about opioids presents a real danger to patients who genuinely need them because literally nothing else works! This article takes the view that opioid prescription is questionable if there are no ensuing physical function benefits. However, you have to ask whether opioids were ever thought to improve physical function - they're not steroids after all. The point of opioids is that they dampen pain signals and if used properly, they're very effective indeed, so improved physical function is of secondary importance to neuropathy patients - the fact that their pain is reduced to a point where they can live more or less normal lives, is the priority. Physical function improvement can come from other sources. 

Opioids don't guarantee improvement in physical function IANS 24 January 2016

 Patients who were not prescribed any opioids had statistically lower disability and higher physical functioning scores.

People suffering from neuropathic pain complex, chronic pain that usually is accompanied by tissue injury report no improvement in physical functioning after taking opioids that tackle pain, researchers said.

"Even though opioid medications can be a powerful pain killer, it does not necessarily mean improved function will follow," said lead author Geoff Bostick, associate professor at the University of Alberta in Canada.

Patients who were not prescribed any opioids had statistically lower disability and higher physical functioning scores, the findings showed.

Opioids can help people with severe pain be more comfortable, but if they are not facilitating improved physical function, the impact of these medications on quality of life should be questioned, the researchers said in the study published in the journal Pain Medicine.

Stressing the importance of physical function, the researchers suggested that patients who are experiencing chronic pain and are medically cleared for physical activity should find a way to promote movement, even if it is painful.

The study looked at 789 patients across Canada who provided baseline measures of self-reported function, and again at six and 12 months after treatment.

These patients suffered with neuropathic pain from nerve injuries such as diabetic neuropathy and pinched nerves.

http://health.economictimes.indiatimes.com/news/industry/opioids-dont-guarantee-improvement-in-physical-function/50703209

Tuesday, 26 January 2016

Diet And Neuropathy...Again!

Today's post from neverignore.info (see link below) sounds a little 'preachy' in tone and as it goes against most neuropathy patients' need for 'comfort foods' to give us a lift, it may not be well-received. However, preachy it may be but it's an area of our health we can actually exercise some control over. As the article suggests; keep a food diary for a short time (a short time is more than a week by the way!!) and alongside that, keep a diary of how you feel. If it seems that your symptoms are improving then you may be onto a winner. Worth a try? How bad's your pain!!

Neuropathy and Your Diet!
By Lussy January 23, 2016

”Why do I just feel so lousy all the time?”

This is something that unfortunately is becoming more rather than less common in our NeuropathyDR clinics.

You see, there is a tendency now for people not to prepare or consume fresh foods, especially vegetables. Too often, fast food works its way into our diets.

As for people with peripheral neuropathy and chronic pain, this is like pouring gasoline on fire!

The reason for this is that poor food choices raise blood fats and blood sugars. When blood sugar is increased, some of the sugar molecules tend to attach to proteins; proteins like those that help make up our muscles and skin.

This then leads to achiness, stiffness, and quite possibly inflammation. For the peripheral neuropathy sufferer, regardless of the cause this typically poor diet seems to make it worse.

Increased sugar consumption in addition to aggravating your underlying neuropathy, will cause you to gain weight, lose energy and sleep more poorly.

The good news is however when you make deliberate changes to when and how you are eating, you often times will find yourself feeling better than ever!

So, how do we do this without becoming overwhelmed?

The simplest way to do this is to keep a food diary or record for a week. Keep track of everything you consume. You may be shocked at how much sugar is in things like soda, ice cream, and other things that may have become a staple for your diet.

You, like most neuropathy patients probably know you should be eating better.

When neuropathy patients write all this down, changes are much easier for us to help you with.

Always remember, neuropathy is often times a manifestation, or made worse by poor metabolism, secondary to poor diet and lack of enough activity.

Improving both of these can often improve most forms of peripheral neuropathy!

http://neverignore.info/neuropathy-and-your-diet/

Monday, 25 January 2016

NSAID's Like Ibuprofen And Advil Can Be Dangerous: FDA Advice

Today's post from bangordailynews.com (see link below) at first sight, doesn't seem to have a direct link to neuropathy or neuropathy drugs but it is astonishing how many neuropathy patients are not only prescribed nonsteroidal anti-inflammatory drugs, or NSAIDs like ibyprofen, advil and the rest but stay on them for years as prescriptions are not reviewed. Now it's clear that many neuropathy patients also have other conditions (arthritis, reumatism, and other inflammatory diseases) for which NSAID's seem appropriate but they have very little effect on nerve damage pain unless, they too cause severe inflammation. The point is that the FDA have now come out strongly  against these drugs, claiming they are dangerous, not only over the long term but also, in short term courses of treatment. The FDA rarely comes out so strongly one way or the other about existing drugs but when they do, it may be worth taking notice. If you are a neuropathy (or any) patient taking these drugs, it may be time to have a serious discussion with your doctor as to whether these drugs are causing you hidden harm, especially when taken in combination with other neuropathy drugs!!

Why the FDA is warning Americans about ibuprofen
By Dr. Michael Noonan, Special to the BDN Posted July 27, 2015, 

 
Ibuprofen, sold as Motrin and Advil, and other anti-inflammatory drugs are in the news again, and not for a good reason. The U.S. Food and Drug Administration is ramping up its warnings about the risks of these drugs for their role in causing heart attacks and strokes. Some of the other drugs include Celebrex, Aleve, Naprosyn and Toredol. (Aspirin was not included in this recent warning.)

It has been known for some time that these drugs — called nonsteroidal anti-inflammatory drugs, or NSAIDs — have serious side effects and are a major cause of drug-induced injury. They are estimated to cause at least 16,000 deaths per year and send 100,000 people to the emergency room in the U.S. The most common problems they cause are digestive ulcers and associated bleeding. In fact, some doctors give a drug to reduce stomach acid to minimize the stomach-damaging effects of NSAIDs. (Of course, that drug is not without side effects of its own.)

Studies also have shown increased risk of other conditions, including atrial fibrillation, where the heartbeat becomes rapid and weak; kidney damage; and delayed or blocked healing, both of fractures and soft tissue injuries.

The FDA just reversed itself on using “baby aspirin” to prevent heart attacks and strokes, finding that it really doesn’t reduce deaths, but does expose the patient to significant risks.

When using NSAIDs, we are warned not to exceed the dosage, not to take them for too long, or to avoid taking more than one of these drugs at a time. But there is newer evidence, which led to these stronger warnings, showing that even short courses of these drugs at recommended doses can have serious side effects.

Dr. Judy Racoosin, deputy director of the FDA’s Division of Anesthesia, Analgesia, and Addiction Products, said of NSAIDs in the new warning, “There is no period of use shown to be without risk.” She also addressed the fact that while people who already have heart disease may be at more risk, even those without any history of this problem may develop it from taking these drugs.

I have a better idea. Rather than using a drug with the potential for serious side effects, why not use natural treatments? While NSAIDs are used for a lot of conditions, the majority of them are taken for chronic joint and muscle pain. But these problems respond very well to many treatments, including manipulation, massage and acupuncture. For some patients, a simple lifestyle change such as eliminating wheat or soda from the diet makes a big difference. We also use whole food-based supplements and anti-inflammatory herbs with good success.

Many of our patients with chronic pain are able to give up their NSAIDs for one or several of these natural, safe alternative treatments, or at least limit their drug use to an occasional dose if they overdo it, or during rainy weather. (Yes, that does affect pain levels.)

This includes patients who have taken these drugs for decades. It is not uncommon for a patient to be prescribed these drugs by a doctor, and the prescription is never reviewed again, even after many years of taking it. Later, the patient is given another drug to counter the side effects of the anti-inflammatory drug, or undergoes a series of tests to determine why they are developing these new health problems that may all be caused by the NSAIDs. Using natural health care in the first place helps patients avoid this “prescribing cascade” where one drug leads to more and more medical care and declining health.

Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.

http://bangordailynews.com/2015/07/27/health/why-the-fda-is-warning-americans-about-ibuprofen/

Sunday, 24 January 2016

Many Symptoms Of Sjogren's Syndrome Are Neuropathic

Today's post from belmarrahealth.com (see link below) looks at a disease you may have heard of (high-profile sufferers such as Venus Williams - how she continues to play tennis is a wonder!) but have no idea what it entails. Sjogren's syndrome is a particularly nasty neurological condition that is closely linked to neuropathy and displays many familiar neuropathic symptoms. In Sjögren's syndrome, the lymphocytes attack glands whose secretions pass through a duct directly to the outside of the body. It's a typical auto-immune disease that can produce symptoms that range from mild to wild and everything in between and as with many forms of neuropathy, is difficult to treat effectively. This article gives you enough information to increase your understanding of the condition.

Sjögren’s syndrome neurological symptoms include peripheral neuropathy and myelitis
By: Bel Marra Health | Brain Function | Wednesday, January 13,


Sjögren’s syndrome consists of neurological symptoms including peripheral neuropathy and myelitis. In nearly 20 percent of Sjögren’s syndrome cases the condition can affect the nervous system. The main symptoms of Sjögren’s syndrome include dry eyes and dry mouth, but neurological symptoms, too, may occur, the three most common being sensory ganglionopathy (also known as sensory neuronopathy or sensory ataxic neuropathy), painful small fibre neuropathy, and transverse myelitis.

Peripheral neuropathy and Sjögren’s syndrome

Peripheral neuropathy refers to damage caused to the peripheral nerves which can lead to weakness and numbness and commonly occurs in the feet or hands. Below are 10 facts about peripheral neuropathy and Sjögren’s syndrome.

Firstly, peripheral neuropathy is a chronic condition meaning it occurs for life. Reducing pain associated with peripheral neuropathy may take a long time, just like its onset.

Peripheral neuropathy in Sjögren’s syndrome may begin in the feet, hands, thighs, hands, arms, torso, and even the face.

There are a variety of treatments when it comes to peripheral neuropathy that are available and so speaking with your doctor can help you pick the best one. Antidepressants are commonly used to treat peripheral neuropathy but have been found to increase mouth and eye dryness and so they are not commonly used as a first line of treatment in Sjögren’s syndrome patients.

Electrophysiologic tests may be useful in diagnosing neuropathies affecting larger nerves but cannot detect neuropathy in smaller nerves that are not coated in myelin – a nerve insulator.

Biopsy tests can also help diagnose peripheral neuropathy in Sjögren’s syndrome.

Some rare neuropathies can lead to weakness in Sjögren’s syndrome patients and these types can occur suddenly unlike other types which may occur gradually and over time.

Although immunosuppressants may be used to treat some neuropathies there is not enough evidence to support it as a treatment for all.

Frequent pain may raise concern for patients that they are at an increased risk for severe motor weakness but it weakness is not present this most likely will not occur.

Lastly, it is possible to relieve pain but there may be much trial and error when it comes to finding the best form of treatment.


Sjögren’s syndrome and myelitis (inflammation of the spinal cord)

Myelitis is inflammation of the spinal cord. The myelin is an insulator around our nerves which keeps them protected. Myelitis can cause weakness, numbness and difficulty with urination or passing bowel movements. Although myelitis may occur quickly symptoms generally appear gradually and can often be confused with multiple sclerosis.

Appropriate testing can help distinguish between myelitis and multiple sclerosis. Types of diagnostic testing include a spinal tap and MRI of the brain and spinal cord. Proper diagnosis is essential because multiple sclerosis and myelitis in Sjögren’s syndrome require very different modes of treatment. If the two conditions are confused, improper diagnosis can actually lead to flare-ups and worsening of symptoms.


Other types of neuropathy in Sjögren’s syndrome

Aside from the types of neuropathy we already mentioned, there are other types as well which can occur in Sjögren’s syndrome which include:
Autonomic neuropathy: nerve damage occurs to nerves which regulate heartbeat, respiration and gastric motility.
Trigeminal neuralgia and glossopharyngeal neuralgia: numbness or burning of the face.
Mononeuritis multiplex: weakness or clumsiness which may cause weakness or paralysis of different muscles.
Related Reading:

Sjögren’s syndrome, and autoimmune condition, symptoms, diagnosis and treatment

Sjögren’s syndrome is an autoimmune condition, which means the immune system attacks its own healthy cells because it perceives them as a threat. Below is everything you need to know about Sjögren’s syndrome, from symptoms to diagnosis and treat. Continue reading…

Fibromyalgia may be confused with rheumatoid arthritis or lupus

Fibromyalgia is a condition that is easily confused with other health issues, such as rheumatoid arthritis and lupus. For the latest study researchers had participants complete the Revised Fibromyalgia Impact Questionnaire (FIQR) and the Symptom Impact Questionnaire (SIQ). The questionnaires were used to determine specific features that could outline differences between fibromyalgia, rheumatoid arthritis and lupus. Continue reading…

Sources:

http://www.medscape.com/viewarticle/821884
http://info.sjogrens.org/conquering-sjogrens/bid/358138/Peripheral-Neuropathy-and-Sjogren-s
http://www.hopkinssjogrens.org/disease-information/sjogrens-syndrome/neurologic-complications/

http://www.belmarrahealth.com/sjogrens-syndrome-neurological-symptoms-include-peripheral-neuropathy-and-myelitis/