Sunday, 5 July 2015

Neuropathy And Lack Of Sleep

Today's post from (see link below) takes a look at the influence of chronic pain on sleep quality. To long-suffering neuropathy sufferers, broken sleep patterns are a no-brainer - of course they stem from the pain and discomfort. However, this article asks the chicken and egg question as to whether pain disrupts sleep, or sleep problems make the pain worse but sensibly concludes that pain is the root of lack of sleep, when the two are concurrent. It's important to mention here that sleep apnoea is often linked to neuropathy and vice versa but sleep apnoea is a distinct condition on its own and can be caused by a number of reasons outside nerve damage. The article also offers some tips for improving your night rest and as such is worth a read.

Sleep and chronic pain news
May 25, 2015 by Kerima

Sleep impairments are a stronger and more reliable predictor of pain than pain is of sleep impairments.

Insomnia is an important topic for pain management and I found three good sources today. Check out the info graphic below and read on for tips and helpful info.
Pain and sleep: a preventable cycle

“When pain becomes a problem, it can be a vicious cycle. If someone experiences poor sleep due to pain one night, he or she is likely to experience more problems the next night and so on. It gets worse and worse every night.

Also we know that pain triggers poor sleep. For instance, someone experiencing lower back pain may experience several intense microarousals (a change in the sleep state to a lighter stage of sleep) per each hour of sleep, which lead to awakenings… Pain is a serious intrusion to sleep. Pain is frequently associated with insomnia and these coexisting problems can be difficult to treat. One problem can exacerbate the other.”

“Those with acute or chronic pain are more likely to have sleep problems impact their daily lives. Among people who’ve had sleep difficulties in the past week, more than half of those with chronic pain say those difficulties interfered with their work. That drops to 23 percent of those without pain. People with pain are also far more apt than others to report that lack of sleep interferes with their mood, activities, relationships and enjoyment of life overall.

People with pain also feel less control over their sleep, worry more about lack of sleep affecting their health and exhibit greater sleep sensitivity. They’re more likely than others to say environmental factors make it more difficult for them to get a good night’s sleep. These factors include noise, light, temperature and their mattresses alike, suggesting that taking greater care of the bedroom environment may be particularly helpful to pain sufferers.

While both chronic and acute pain relate to lost sleep, the survey indicates that chronic pain is an especially powerful problem. Indeed, nearly one in four people with chronic pain, 23 percent, say they’ve been diagnosed with a sleep disorder by a doctor, compared with just 6 percent of all others..”

Both quotes are from the National Sleep Foundation.

The good news is… people with chronic pain who said they were motivated to make sure they had enough time for sleep, and who had a bedtime routine did sleep more.” 

Sleep, pain and exercise

“ Sleep deprivation causes various physiologic and behavioral changes in the body. It has been shown that total sleep deprivation (2013) or sleep deprivation of a specific stage of sleep … cause hyperalgesia (exaggerated sensitivity to pain). In addition, people who sleep less than 6 hours or more than 9 hours seem to have increased frequency of self-reported pain” “A recent review … (2013) points to the fact that sleep impairments are a stronger and more reliable predictor of pain than pain is of sleep impairments.” “Physical exercise is able to improve sleep patterns in healthy individuals… Particularly in insomnia patients, regular exercise leads to benefits over time, being comparable to pharmacotherapy and behavior therapy (2015). Pilates, for example, improves muscle flexibility and strength and also improves life quality and has been shown to be able to improve sleep quality” Yoga and other exercise was also mentioned in this article by Marcele Siegler, physiotherapist, and her colleagues.
Research and tips for better sleep

Finally a few notes from an interview with my favorite sleep specialist Gregg Jacobson on Huffington Post. Read my review of his book here. The information below has helped me normalize and not feel upset about night-time awakening, and has probably prevented me from having insomnia.

According to Jaboson,”prior to … (night-time lighting), humans likely went to sleep soon after dusk and awakened at dawn in longer sleep periods that consisted of alternating bouts of sleep and wakefulness. This non-continuous sleep pattern is characteristic of virtually all mammals and is also the pattern we experience early and late in life. It is only in adult life, and the last 350 years of human history, that a more consolidated nocturnal sleep pattern is apparent. However, many adults still experience polyphasic sleep in the form of insomnia, and regular intervals of waking are still experienced in normal sleepers today, as evidenced by six to 12 brief awakenings per night (which most of us don’t recall, for they are too short). Evidently, this polyphasic sleep pattern lies dormant in our physiology, met an evolutionary need, and therefore may be adaptive rather than a sleep disorder.”

Jacobson has found that CBT cognitive-behavioral interventions can work as well or better than sleeping pills. Here are some of his suggestions.

Negative, distorted thoughts and beliefs about insomnia such as “I must get eight hours of sleep” or “I did not sleep a wink last night.”
Going to bed too early or sleeping too late and spending excessive time in bed.
Irregular arising times.
Trying to control sleep rather than letting it happen.
Lying awake in bed, frustrated and tense.
Using the bed and bedroom for activities other than sleep.
Use of electronic devices before bedtime.

You can find more information and an affordable online course (pdf and guided relaxations –I have not tried it, but I found the book the best on the market) at Gregg Jacob’s website.

Saturday, 4 July 2015

Why Isn't Neuropathy Better Known?

Today's post from (see link below) asks the question why so many Americans suffer in silence with neuropathy but the same question can be applied across the world. You can safely bet that 9 out of 10 people on the street will never have heard of it, let alone pronounce it, yet it is so widespread - how's this possible? You get the feeling that we need a sort of advertising organisation on the scale of Saatchi and Saatchi, to promote awareness of neuropathy and the fact that it's one of those diseases that's actually growing instead of decreasing. Modern lifestyles, diets and choices are contributing to this growth and yet there's nothing about neuropathy that makes it sexy for the media. Maybe we need highly visible role models! What do you think?
Why 42 Million Americans Suffer in Silence with Peripheral Neuropathy
July 2015 (no author mentioned)

Imagine that your feet feel like they are asleep while simultaneously on fire, all the while 10,000 pins and needles are poking at them. Your toes and balls of your feet are numb to your touch, and over time this feeling is progressing in your legs and hands too. What if this feeling were chronic and never went away, causing misery both day and night? This is what 42 million Americans are dealing with everyday, it is a condition called “Peripheral Neuropathy” or PN.

President Clinton famously once said “I feel your pain”, and well, unfortunately I do too. you see, I have Peripheral Neuropathy, the condition listed above, and fortunately at this point I just have these awkward feelings in my feet but my fear is that over time it will spread into my legs and my hands and eventually become debilitating.

I had never heard of Peripheral Neuropathy until I started researching the nature of my symptoms. Consider that 42 Million Americans suffer from some form of peripheral neuropathy whether very light beginning stage symptoms or late stage debilitating symptoms. That is 14% of the American population. But hold on, that seems like a very high number for a condition that most people don’t even know how to pronounce let alone have heard of. Well the fact is that about half of the 14% or 7% (21 million Americans) just have a very mild form of PN that may manifest itself in just a few numb, tingly toes. Because of this the PN subject does not pay much attention to the symptoms to the degree that they don’t even mention it to their doctor during the official start of their symptoms. Given that, it means there are 21 Million Americans that suffer from much more sever symptoms of PN some of them debilitating to the degree that it affects mobility. Still, I am at a loss to understand why more people do not know about this condition. Several people I have talked to recently have never heard of it let alone pronounce it. With a world population of 7 billion people, more than 500 million people may have this condition today around the world. This is one of those conditions that can really make your life miserable. I know it sounds morose and negative but we suffer in silence, not really sharing our pain and frustration with anyone other than our doctor and close family most of the time. But I think it is time to elevate awareness.

Over time as Peripheral Neuropathy progresses it can become crippling and debilitating. Sure there are drugs that will relieve the pain and discomfort to some degree, often not much more than by a factor of 20%. That is partially due to the fact that many of these drugs were designed to control epileptic seizures that in essence slow down the rate at which the mind perceives pain so that sensation is also slowed and thus abated. The side effects inhibit the thought process of the brain and make people feel like they are zombies. Because of these irritating side effects we have no choice but to look for other alternative treatments.

Let’s first go on the hunt for the primary root cause of this condition. Although there are many contributing factors that cause Peripheral Neuropathy to develop, the leading cause is high glucose or blood sugar levels. You don’t have to be diabetic to be considered having high glucose levels anymore, pre-diabetics are also on the list. Higher than normal glucose levels damage the micro veins and arteries starting with those which are furthest from the heart and have the least amount of circulation, that means your feet and hands. Pre-diabetics and diabetics alike are predisposed to impairing the micro veins and arteries in their extremities.

Once the micro veins and arteries are damaged they no longer can supply oxygen to the nerves in the extremities which ultimately means that the nerve cells begin to die. As these nerve cells die they essentially create intermittent signals of sensation to the brain which are felt as pins and needles, burning, numbness and the occasional shooting of lightening pain in the feet and hands.

Diabetes is growing by leaps and bounds in the United States and many of the western cultures around the world. Fine, but how did we get here? Well it boils down to the fact that in order to provide foods that are fast and economical, our society has opted to consume processed foods over whole foods. Processed foods are foods that contain highly refined ingredients like white rice, bleached flour, white sugar or any unnatural form of food and more important they are extremely high in carbohydrates and low in fibre. Carbohydrates are what you have to keep at reasonable levels in your body because carbohydrates are converted to glucose by your body. Too much glucose in your body ultimately leads to glucose intolerance by your cells which is diabetes. Whole foods are those that are whole and cooked in the home like roast chicken with broccoli or green beans. And no, green beans are not whole if they are from a can because they often add salt and preservatives to the broth. Fresh green beans and other fresh produce from the grocer are what we need to be consuming.

The American fast food diet has been killing us and it is taking its toll, causing us to develop various miserable conditions ultimately related to our diet like Peripheral Neuropathy.

Our first lady, Michelle Obama, has been spreading the word to help our young generation have an appreciation for whole fresh foods and I think she is doing a great job by growing veggies in the White House back yard. What we are really facing here is a very influential processed food industry and lobby that does not want to behave in a way that will promote a healthy lifestyle.

If you really want to make a change with yourself and those companies that are supplying us currently with unhealthy processed foods, then you really need to consider making a change by reducing your carbohydrate intake by preparing your own whole foods. I know that we can’t always do that every single day and there are food deserts in America where it is very challenging. Let’s learn how to read food labels properly so that we really understand what we are about to put in our families bodies. Yes, there are actually good healthy foods that come in paper or plastic packages but you have to read the nutrition information to make sure that you are getting what you want and is right for you.

So now you understand that our love of excessive carbohydrates is what has lead most of us to develop the condition of Peripheral Neuropathy. Now that we know what to do to prevent it, what are we going to do about the millions of people that already have it or are in the process of developing it? Drug companies have medications available that will relieve the discomfort to some degree but you would have to weigh the benefits with the side effects, particularly the ongoing drowsiness and “the zombie lifestyle” you will experience. That is not to say that drugs will not work for some as it likely will be just right for some but a complete flop for others.

Those with PN (Peripheral Neuropathy) need to be on an exploratory quest to 1) stop the symptoms from spreading and 2) relieve the pain and discomfort.

There are many products and services available to those with PN. First and foremost, get as much information from various sources as possible. This will help guide the PN sufferer to make better decisions about treatment options.

Also PN sufferers need to open the lines of communication. The more interest around this topic the more likely that big money will be looking for a real cure. PN sufferers need to start local interest groups that meet regularly on the topic. There are great organization like the Foundation for Peripheral Neuropathy and the Peripheral Neuropathy Association that a PN sufferer or loved one can take part in.

Friday, 3 July 2015

A Short But Useful Description Of Neuropathy

Today's post from (see link below) is another general description of neuropathy for those new to the disease or still unsure what it entails. There are many others on this blog (see list to the right of the blog) but that's no reason not to include good, clear and well-written descriptions of the disease that plagues our lives because almost every neuropathy summary contains something you didn't know or hadn't fully understood. This one for instance, gives a good description of how different sorts of nerves can be affected by neuropathy and what happens when they are. Worth a read...even for the long-suffering and cynical.

Neuropathy just one of the many things we treat

August 17, 2014

Peripheral neuropathy is a condition in which nerves of the peripheral nervous system are damaged. This peripheral nervous system is a network of nerves that transmits information from the body to and from the central nervous system (brain and spinal cord).


The symptoms of peripheral neuropathy depend on the nerve that has been damaged. If sensory nerves which send information to the brain about sensations like pain and touch are destroyed, the symptoms include pain, numbness, tingling, pricking and burning sensations.

If motor nerves which control the conscious movement of muscles are affected, the symptoms of the neuropathy include muscle weakness, painful cramps and fasciculations which are uncontrollable muscle twitches. The muscle may also become paralyzed and cause inability to grasp things or walk.

If autonomic nerves which regulate automatic activities like digesting food are damaged the symptoms include inability to digest food properly, diarrhea, constipation and stool incontinence. Other symptoms of autonomic neuropathy include inability to sweat normally which can lead to heat intolerance, irregular beating of the heart and failure to maintain normal blood pressure levels which can cause dizziness and fainting spells. 


The causes of peripheral neuropathy are either inherited or acquired. Inherited forms are caused by inborn errors in the genetic code or changes in the genes which are known as genetic mutations. Examples of inherited polyneuropathies include Charcot Marie Tooth disease which is characterized by numbness, weakness and wasting of the leg muscles with resultant gait (walking) abnormalities.

Acquired peripheral neuropathies can be caused by physical trauma which can stretch, crush or cut the nerves. This trauma is usually from automobile accidents and sports related activities.

Toxins like arsenic, lead, thallium and mercury can also damage the nerves. Some medications like those used to treat cancer and seizures can also cause peripheral neuropathy. Alcoholism and nutritional deficiencies like thiamine and B12 deficiency are other causes of this condition.

Systemic diseases which affect the entire body can also cause peripheral neuropathy. Examples include diabetes mellitus, kidney failure, liver disease and hormonal imbalances like hypothyroidism which is caused by underproduction of hormones by the thyroid gland.

Microorganisms can also attack the nerves and cause peripheral neuropathy. Examples include the human immunodeficiency virus (HIV) and the herpes zoster virus which causes shingles. Bacteria like those which cause leprosy and Lyme diseases can also affect the nerves.


Peripheral neuropathy is diagnosed on the basis of symptoms in addition to exam findings. If both are consistent with neuropathy, a nerve conduction study must be performed by a board certified neurologist and his/her neurodiagnostic technician to confirm the diagnosis. Many other conditions can mimic neuropathy, and often, more than one diagnosis is responsible for the symptoms if severe.


The treatment of peripheral neuropathy depends on the cause. Those which are inherited do not have a cure while the management of acquired neuropathies begins with treating their underlying cause. Therefore if the patient has a systemic disease like diabetes, it must be well controlled. Nutritional deficiencies must also be corrected and exposure to nerve toxins avoided. FDA approved medical vitamins are now approved for the treatment of neuropathy.

After the underlying cause has been managed symptomatic treatment is given for the symptoms being experienced by the patient. Pain medications specifically for neuropathy are therefore prescribed for those in pain and muscle relaxants for those experiencing muscle spasms. This, however, is a double edged sword. Once the pain is covered up, it is difficult to determine the progression of neuropathy until it is too late. Yearly, or twice yearly nerve conduction studies are very important to document the benefit of treatment, or change treatment course if worsening of the neuropathy is noted.

Supportive measures used to treat peripheral neuropathies include following a physician-supervised exercise program which includes both active and passive forms of exercise to improve muscle strength and prevent wasting.

The surgical treatment of peripheral neuropathy is reserved for those with symptoms caused by compression of the nerves by tumors, swollen blood vessels or slipped disks.

The treatment of peripheral neuropathy is important since if left untreated the condition progresses as the nerve damage continues. Some patients however may experience periods of relief which are followed by relapses. The result of not treating the neuropathy is that the patient’s physical and emotional well-being as well as their quality of life deteriorates.

The current research on peripheral neuropathy by St. George’s University of London reveals that loss of sensation in the feet can be a predictor of cardiovascular events like heart attacks and strokes in patients with diabetes.

Thursday, 2 July 2015

Will 'Quell' Be The Device That Actually Works For Neuropathy Patients?

Today's post from (see link below) looks like an advert for a new product, something which this blog tries to avoid but at the same time, if something comes on the market, it is our duty to inform people who may or may not benefit and ask for user reactions and experiences. After all, it's not as if neuropathy is overwhelmed with health devices that actually work is it? Take a read and make up your own minds, then do your own research and discuss it with your doctor or neurologist. One of these days, one of these products may well turn out to be a eureka moment but in the meantime, always maintain a healthy dose of scepticism!

Got Neuropathy? Quell Offers “World’s First Pain Relief Wearable”

Written by Amy Tenderich | Published on 01 July 2015

Amongst the current flurry of wearable sensors and mHealth apps that appear to be so many elaborate toys, a new system called Quell stands out. It seems to have real potential to change lives… for many people with diabetes and beyond.

Quell is a first-of-its-kind, drug-free option for reducing the pain of neuropathy, sciatica, and other chronic pain through neural pulses — delivered by a band wrapped just below the knee, with a companion app that allows users to change settings and track sessions via a smartphone or iPad.

Its makers boast that it is “clinically proven to start relieving chronic pain in as little as 15 minutes… (with) FDA cleared prescription-strength technology that works with your own body by stimulating your nerves and blocking pain signals in your body.”

Approved by FDA last summer, Quell is just being launched now, following a highly successful Spring Indiegogo crowdfunding campaign. It was debuted to the diabetes world in a decent-sized booth at the ADA Scientific Sessions in Boston a few weeks ago. The big expo signs touting “Wearable Pain Relief Technology” were hard to ignore. I spent about 40 minutes in the booth myself, talking with their experts and getting a demo of this insipid-looking Velcro band that’s creating such a stir.

Check out their marketing video here.

My first thought was that for many of our friends in the Diabetic Community who suffer from the pain of neuropathy, Quell could certainly be a boon!

From Calf to Brain

I learned that the device, made by a startup called NeuroMetrix in the Boston area, was developed in collaboration with the renowned design firm IDEO. Users simply wrap it around their upper calf, just below the knee, and turn it on for intermittent sessions of up to 60 minutes, followed by a rest period of another hour (more than 60 minutes at a time can cause overstimulation), we’re told.

The first time you use it, you calibrate the unit by testing different vibration intensity levels and pressing when you feel stimulation (user tip: the unit needs to be held upright while you do this). The companion app remembers your settings and tracks your sessions, for your own records and to share with a doctor, if desired.

Quell works by stimulating nerves in your upper calf with neural pulses, that trigger a pain relief response in your central nervous system that blocks pain signals in your body. So it helps treat pain in the back, legs, or feet –- the pain does not have to be located at or even near the spot on your leg where the unit is worn.

“A Huge Difference”

“There’s been a ton of excitement around this because there really are so few options for treating chronic pain. Some patients are on three to five different medications, which can be addictive or have other unwanted effects,” said Alyssa Fenoglio, NeuroMetrix Director of Marketing.

Indeed, the Quell Indiegogo campaign (“The World’s First Pain Relief Wearable!”) launched in March raised $100,000 in just 1.5 days, and over $387,000 in one month, Fenoglio says. As part of that, the company pre-sold nearly 2,000 units at an introductory discount of $199 per device.

The company’s been collecting user testimonials, with dozens of people saying things like “it makes a huge difference” and “I’m getting my life back” by being able to enjoy many activities again.

"It elevates your inherent pain-modulating chemicals — at a molecular level, it's what painkillers do synthetically. But you can essentially cause a similar effect without any of the downsides by electrically stimulating to induce your brain to produce these chemicals," CEO of NeuroMetrix Shai Gozani told Fast Company recently.

The use of electrical stimulation to fight pain has apparently been around since the 1970s. But NeuroMetrix has developed a novel, convenient way to deliver its benefits.

NeuroMetrix itself began as a spinoff of the Harvard-MIT Division of Health Sciences and Technology in 1996, and has “spent nearly two decades of designing, building and marketing medical devices that stimulate nerves and analyze nerve response for diagnostic and therapeutic purposes.” Its Board of Directors includes Nancy Katz, who some may recognize as a diabetes expert who serves as VP of Consumer Marketing and Market Development at Medtronic.

Supply and Demand

Quell likely will not be covered by insurance, but it can be purchased using FSA debit cards. You can obtain Quell through selected physician’s offices (they’re expanding that network) or by purchasing it directly from the company online. The price is $249 for the device, plus $30 for a package of two replacement electrode strips, which need to be changed out every two weeks because sweat and oil from the skin wear them out, Fenoglio says.

OK, so if used regularly, the cost adds up to a little over $600 for the first year, and then ca. $360 in following years, which is less than the annual cost of prescription pain relief meds like Lyrica and Cymbalta — but without the side effects of weight gain, foot swelling, drowsiness and more. Not to mention potential negative drug interactions and long-term effects.

The Quell companion app is free to download and lets users track the number of sessions per day (time and intensity), change settings, and get alerts, such as when they are nearing the point of overstimulation or when it’s time to change the electrode strip.

The app also includes an accelerometer that can track activity and sleep (Quell has FDA clearance for nighttime use), so users could track the correlation of decreased pain with better sleep and more exercise over time, for example. With users’ permission, the company also plans to use data from the app to study Quell’s performance.

Got Neuropathy?

Seriously, who wouldn’t be interested in a non-invasive, drug-free, relatively affordable and easy-to-use wearable to reduce chronic pain?

My hope is that NeuroMetrix gets connected with efforts like the Diabetes Hope Conference, where people with diabetes meet online to discuss living well with complications like painful neuropathy. Because this is one Internet of Things/Health Wearable Gadget that the Diabetes Community ought to take seriously, IMHO.

Wednesday, 1 July 2015

Tackling Neuropathic Pain With Alternative Treatments

Today's post from (see link below) looks at some of the alternative treatments for neuropathic discomfort; whether supplements or homoeopathic and you are advised to make up your own mind as to whether you take these recommendations seriously or not. Actually, this is not negative advice: many neurologists recommend exactly the same things, especially in cases where chemical medications are not helping. There is the cost of course and you shouldn't expect miraculous results after two or three weeks - you're probably in for the long haul with alternative treatments but that is no reason to reject them out of hand. Many people have benefited from trying one or more of these options but always remember, with neuropathy, what works for one doesn't work for all - it's a question of trying things out until you find relief...or not! Remember too - the word 'diabetic' in the title does not exclude you if you have neuropathy caused by something else - neuropathy symptoms are pretty much universal.

Soothe Diabetic Foot Pain And Peripheral Neuropathy With Effective Home Remedies and Alternative Treatments 
Posted by JB Bardot Tuesday, June 23, 2015

Peripheral or diabetic neuropathy affects 60-70 percent of all diabetics with stabbing, burning pain in the hands, feet and especially the toes, according to Additionally, many non-diabetics are affected with painful neuropathies of no known cause. Initially experienced as numbness, and tingling of the affected parts, neuropathies often develop into feelings of having hot or icy needles stabbing sensitive flesh. Pharmaceutical medicines may or may not help manage pain, and often produce unwanted side effects. Fortunately, there is a more natural, multi-disciplinary approach to pain management using a variety of home remedies, herbs, supplements, homeopathic remedies, and lifestyle adjustments.

Herbs, supplements and homeopathic remedies

• Topical applications of cayenne pepper mixed with olive or coconut oil relieves neuropathy pain for some people. Capsicum, the active ingredient in cayenne, may feel hot to the skin initially; however, it binds to the body’s pain receptors, fooling the neural pathways and lessening pain over a period of time.

• Omega 3 fatty acids in the form of fish oil supplements provide healthy fats that soothe nerves, helping to relieve pain and inflammation from peripheral neuropathy. Omega 3 fatty acids are also found in flax seeds and oil, borage oil and Evening primrose oil.

• Homeopathic remedies are effective at providing relief from peripheral neuropathies for many people. Remedies such as Plumbum Met, Phosphoric Acid, Phosphorous, Zincum Met, Pulsatilla, Graphites, Lachesis, Gelsemium, Baryta Carb, Causticum, Zincum Phos, Agaricus, Mercurius, Sulphur, Cuprum Met, and Rhus Tox. This list is not exhaustive. Consult a homeopath for the correct remedy based on your individual case.

• Acupuncture and Traditional Chinese Medicine (TCM) reduce stress hormones which can be the cause of some neuropathies. Treatment eventually leads to the reduction of inflammation and pain.

• Lecithin, a fat emulsifier, will reduce diabetic neuropathy pain by working to protect the liver and pancreas from the effects of eating oils high in trans fats and hydrogenated fats. Lecithin is found naturally in the body and is important in the production and transmission of energy. The myelin sheaths that cover nerves are made primarily from lecithin. Most lecithin is made from eggs or soy and it’s important to use a product that’s organic and labeled non-GMO.

• High doses of the B vitamin, Inositol added to one’s diet has been shown to reduce pain and the frequency of peripheral neuropathies. Additionally, increase doses of vitamin B-complex — especially B-6 and B-12 — to help calm and repair damaged nerves and provide pain relief.

• Alpha Lipoic Acid (ALA) works to regenerate nerves damaged by diabetes and other causes. ALA is a sulfur-containing compound found naturally in the body. Some studies suggest that this antioxidant may actually improve circulation, enhance the action of insulin and reduce oxidative stress, thus preventing neuropathies.

• Keep your body alkaline by drinking a pH drink from 1 to 3 times daily. Mix 2 Tbs. fresh lime or lemon juice with 1/2 tsp. baking soda. Allow all foaming and fizzing to go flat. Add 10 – 12 oz. water and drink all at once.

• Manage pain and frequency of attacks by keeping glucose levels stable, suggests pain specialist Dr. Robert Gerwin, of Johns Hopkins University. There are a number of ways to maintain blood sugar. Eat foods lower on the glycemic index scale and avoid those whose numbers are high. Take a daily supplement consisting of cinnamon and chromium to lower glucose levels and help prevent diabetic neuropathies.

Lifestyle adjustments

• Wear well-fitting shoes, with large toe boxes.

• Protect hands and feet in winter with warm socks, gloves and shoes that keep feet dry.

• Sit with legs uncrossed to encourage good circulation.

• Stop smoking cigarettes. Smoking causes the blood vessels to constrict, worsening circulation and aggravating neuropathy pain.

See also:

Herbs, Home Remedies and Foods that Reduce Swelling

Home care solutions provide gout pain relief for painful feet

(Photo credit: Gwenllian Evans Flicker)

Tuesday, 30 June 2015

Surviving HIV Carries A Price Tag

Today's well-written post from (see link below) are personal accounts of people who have been lucky enough to survive many years with HIV and progress into old age. Thanks to improvements in HIV medication, there are many more people in exactly the same situation but this doesn't mean that they can live wholly healthy lives - unfortunately, there is often a price to pay for surviving with HIV. These stories includes fibromyalgia and neuropathy as health problems many people with HIV have to live with and there's a certain irony to the fact that the majority of the pills they take, are for conditions other than HIV. Definitely worth a read.

As people with HIV live longer, aging presents challenges
Lolly Bowean Chicago Tribune (TNS) 9:02 PM, Jun 27, 2015

CHICAGO — It’s been 30 years since Greg Sanchez was diagnosed with HIV, the human immunodeficiency virus that causes AIDS, and he keeps his more than two dozen bottles of pills and other medications on his wooden nightstand so he can get to them easily.

But he takes only a single pill for HIV. The rest of his prescriptions, a crowd of white-topped orange plastic bottles, are to treat the many ailments and conditions that he says are a result of aging with the virus, along with years of taking the sometimes toxic medications to treat it.

At 50, Sanchez has coronary artery disease, fibromyalgia and arthritis, among other illnesses. He suffers chronic pain in his knees and back and walks with a cane because of vertigo and neuropathy. Advancing bone disease has left him in need of hip surgery.

“I’m grateful to still be alive, but my body is probably about 20 years older than I actually am,” said Sanchez, who lives in an apartment in Chicago’s Rogers Park neighborhood filled with plants and photographs of loved ones. “I’m going to the doctors constantly. Sometimes it’s hard to put my finger on if it is the HIV, or if it’s just getting older.

“Sometimes I feel like an old man.”

In the decades since HIV emerged, it has evolved from a diagnosis with an almost certain death sentence to a chronic illness, one that medical advances have made manageable and less urgent. Now, those diagnosed while relatively young have lived into middle age and even longer with the disease. In some cases, they have lived with HIV for more than a quarter-century.

As these long-term survivors get older, though, some are finding their bodies wearing out, their internal organs battered by potent and sometimes toxic medications, the devastatingly permanent conditions that come with aging leaving their mark a lot faster.

Statistics suggest that more and more HIV and AIDS patients will experience aging that way, and that the urgency over the disease’s killing prowess will give way to how it slowly takes a different toll on its patients. According to the Centers for Disease Control and Prevention, 26 percent of the estimated 1.2 million people living with HIV in 2011 were 55 or older. In 2013, 27 percent of the estimated 26,688 new AIDS diagnoses were in people 50 and older.

Those demographic changes are forcing a new conversation among health care professionals about how patients manage HIV and the other illnesses that come with growing older. Indeed, this is the first group to live so long with the virus, offering a first glimpse of what it is like to grow old with the disease, as well as a first test for doctors for how to treat it.

Some in that group are men like Sanchez, who was diagnosed in 1985, when the condition was far more deadly. The rest may have contracted the disease later in life. Either way, the inflammation HIV causes makes the body work harder and show symptoms of aging faster.

Few studies have examined age-related health problems among HIV patients and how to slow what looks like an accelerated aging process. One study at the University of California, Los Angeles suggests that HIV-positive blood samples showed signs of aging 14 years faster than the blood of healthy individuals. But researchers examining those samples still have more work to do to determine why, said Tammy Rickabaugh, an assistant researcher with the project at the school’s AIDS Institute and Center for AIDS Research.

“We definitely see from studies that HIV-infected people tend to have clinical conditions earlier: frailty, diabetes, high blood pressure,” she said. “What’s difficult to tease out is how much of that is because of the virus and how much of that is from drug treatment. We know the drugs have some effects.”

At the Howard Brown Health Center, on Chicago’s North Side, doctors and other health care providers have begun counseling young HIV patients on heart disease, diabetes, kidney and liver disease and cancers and are testing them for those conditions earlier. They advise them that if they overcome HIV, other issues are likely to arise, said Dr. Magda Houlberg, a chief clinical officer, internal medicine physician and geriatric expert at Howard Brown.

“Some patients are exhausted because they have experienced chronic illness for so long and now they are growing old,” Houlberg said. “They think, ‘Wow, this doesn’t go away. I have all these other new things and I can only expect more things to come.’”

Roy Ferguson, 63, has lived with HIV for 18 years.

Three times, he was near death with pneumonia. In 2011, he went to the Hines VA Hospital thinking he would die, he said. Instead, he made it through the crisis.

“Then it became clear that I was going to live, not die,” he said. “I thought, ‘Now what do I do with myself?’ “

Ferguson worked for years as a field service technician installing equipment until he was downsized. He has emerged as an activist pushing for better access to medication and research for people infected with HIV. These days, he sticks with a disciplined two-hour workout regimen of pushups, squats and bench presses and can be obsessive about his diet. To keep an upbeat disposition, he works with HIV-positive military veterans and volunteers with the AIDS Foundation of Chicago.

Unlike Sanchez, he takes only five pills a day, three of them to manage HIV.

“It helps to think of the benefits of aging, instead of giving in to fear,” he said. “Now I’m prepared to live.”

It’s not just the physical problems that make aging with HIV a challenge. There is also a psychological toll: the guilt from having survived when so many others died. There is a fatigue, too, that can set in from dealing with so many ailments and taking so much medication.

Then there are those who didn’t financially prepare because they didn’t expect to live long enough to retire. Others find themselves debt-ridden from medical bills.

Even as an educator on HIV and aging who talks about the issue often, Brian Bongner said it’s different living through it. He was diagnosed in 1987, took medications that possibly damaged his organs and watched dozens of his friends succumb to AIDS-related illnesses.

“I was told three different times by doctors that I would not go home from the hospital,” he said. “I was told I would never see 23.”

Now, at 47, he finds purpose in teaching about the condition.

“You feel isolated,” Bongner said at a recent training session, speaking to leaders from agencies that work with HIV-positive clients. “You don’t want your friends to see you sick. You don’t want to go to the doctor and be told you’re dying from something else. Your organs are already damaged by HIV, then there’s the medication to treat it, then there’s the aging. At one point we didn’t have an aging HIV-positive population. Now we have 85-year-olds coming through the door.”

Sanchez tries to strategize to overcome his limitations. He has a home health aide who helps him with cooking and other basic tasks. He records reminders of things he has to do and sets his phone alarm so he won’t forget when to take his medications.

“I try to take the bulk of my meds at night so I’m better during the day,” he said. “I have to gauge my energy level.”

Sanchez was only 19 when he learned he was HIV positive. The first thing he did was cash out his life insurance policy, thinking it would never mature. It took him seven years and nearly dying to come to terms with it and begin taking medication.

But while he pushes to rehabilitate, he lives from one health crisis to another. Some weeks, he is at the doctor’s office two to three times. He keeps handy a neat, typewritten list of all his ailments and medications so he can let doctors know what he’s taking.

He often reads about men his age who also have HIV but who are more robust and active.

But that’s not his life.

He misses out on music festivals because he can’t stand for long periods of time. Going to dinner is arduous because of his diet restrictions. Alcohol doesn’t mix well with his medications. His aches and pains make being social tough.

He spends a lot of time alone.

“They show pictures of men climbing mountains, running marathons and conquering the world,” he said of some of the magazines he reads. “I feel I’m not represented. Our community wants us to be a certain way, and when we’re not, we are isolated.”

Monday, 29 June 2015

Stem Cell Injections For Nerve Pain

Today's post from (see link below) could potentially be as important an announcement as any other so-called neuropathy breakthroughs of the last few years. if only it were as simple as the title suggests. One of the major causes of nerve pain is the disintegration or degeneration of the myelin protective sheath around nerves. As with electrical wiring, if the insulation material is damaged (in this case, myelin), the live wire is exposed, causing short-outs etc. Finding something that can repair myelin at the point of damage, would be a major discovery in the fight against neuropathic pain and other symptoms. This article suggests that they may have found exactly that and by simply injecting certain cells extracted from bone marrow, the myelin sheath can be restored, thus blocking off the cause of pain. Whoopee! However, now come the disclaimers! As always with this sort of news, we discover that the research is only at the lab animal testing stage and that this particular form of stem cell therapy is closer to theory than practical application. This means that once more hopes are raised but the reality is that we're still years away from practical treatments. Okay, we'd rather hear about good news in the research field than be kept in the dark but there should always be a subtitle in heavy print, warning the neuropathy patient that they shouldn't start planning to restore their full and busy lives just yet. It's the nature of the beast!

Stem cell injections improve diabetic neuropathy in animal models 
Public Release: 23-Jun-2015 Putnam Valley, NY. (June 23, 2015)

 Bone-marrow-derived mesenchymal cells promote blood vessel growth and re-myelination of peripheral nerves
Cell Transplantation Center of Excellence for Aging and Brain Repair

 - Diabetic neuropathy (DN) is a condition in which perpetually high blood sugar causes nerve damage, resulting in a myriad of symptoms such as numbness, reduced ability to detect painful stimuli, muscle weakness, pain, and muscle spasms. DN affects up to 60 percent of patients with diabetes, is often the cause of foot ulcers, and can ultimately result in amputations. There is no curative therapy for DN, but a recent study carried out by a team of researchers in the U.S. and Korea has found that laboratory animals modeled with DN can experience both angiogenesis (blood vessel growth) and nerve re-myelination following injections of mesenchymal stem cells derived from bone marrow (BM-MSCs).

Their study will be published in a future issue of Cell Transplantation and is currently freely available on-line as an unedited early e-pub at:

The researchers used mesenchymal stem cells, which can be easily isolated from a variety of sources, such as adipose (fat) tissues, tendons, peripheral blood, umbilical cord blood, and bone marrow. MSCs derived from bone marrow (BM-MSCs) have been among the most successfully transplanted cells, offering therapeutic benefits for a wide range of conditions, from serious burns to cardiovascular diseases, including heart attack and stroke.

In this study, laboratory rats modeled with diabetes were randomly assigned to BM-MSC or saline injection groups 12 weeks after the induction of diabetes. The non-diabetic control group of rats was age- and sex-matched. DN was confirmed by latency in nerve conduction velocity tests.

"We investigated whether local transplantation of BM-MSCs could attenuate or reverse experimental DN by modulating angiogenesis and restoring myelin, the electrically insulating substance surrounding nerves that is reduced by DN," said study co-author Dr. Young-sup Yoon, Professor at the Department of Medicine, Division of Cardiology at Emory University School of Medicine. "In this study we have provided the first evidence that intramuscular injected BM-MSCs migrate to nerves and can play a therapeutic role."

According to the researchers, their findings indicate that intramuscular injection of MSCs resulted in an increase of multiple angiogenic and neurotrophic factors associated with blood vessel growth and subsequently aided the survival of diabetic nerves, suggesting that BM-MSC transplantation restored both the myelin sheath and nerve cells in diabetic sciatic nerves.

"We identified several new mechanisms by which MSCs can improve DN," said the researchers. "First, we demonstrated that numerous engraftments migrated to and survived in the diabetic nerves. Second, we demonstrated a robust increase in vascularity. Third, we found the first evidence that MSCs can directly modulate re-myelination and axonal regeneration."

The researchers concluded that DN, for which there is no other therapeutic option, can be an "initial target for cell therapy" and that transplantation of BM- MSCs "represents a novel therapeutic option for treating DN."

"Currently, the only treatment options available for DN are palliative (focused on alleviating pain) in nature, or are directed at slowing the progression of the disease by tightly controlling blood sugar levels, "says Dr. John R. Sladek, Jr., Professor of Neurology, Pediatrics, and Neuroscience, Department of Neurology at the University of Colorado School of Medicine. "This study offers new insight into the benefits of cell therapy as a possible treatment option for a disease that significantly diminishes quality of life for diabetic patients. Safety and efficacy for human application must be evaluated to further determine the feasibility of BM-MSC transplantation for treatment of DN."

Contact: Dr. Young-sup Yoon, Professor of Medicine, Department of Medicine, Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, WMB 3009, Atlanta, GA 30322, USA.
Phone: 404-727-8176
Fax: 404-727-3988

Citation: Han, J. W.; Choi, D.; Lee, M. Y.; Huh, Y. H.; Yoon, Y-S. Bone marrow-derived mesenchymal stem cells improve diabetic neuropathy by direct modulation of both angiogenesis and myelination in peripheral nerves. Cell Transplant. Appeared or available on-line: May 13, 2015.

The Coeditors-in-chief for CELL TRANSPLANTATION are at the Diabetes Research Institute, University of Miami Miller School of Medicine and Center for Neuropsychiatry, China Medical University Hospital, TaiChung, Taiwan. Contact, Camillo Ricordi, MD at or Shinn-Zong Lin, MD, PhD at or David Eve, PhD or Samantha Portis, MS, at

News release by Florida Science Communications

Sunday, 28 June 2015

Neuropathy Caused By Necessary Medications (Personal Story)

Today's post from (see link below) is a personal account of having neuropathy as a result of cancer drug treatment but will resonate with many neuropathy patients. He makes a very good point, that many people encounter neuropathy as a result of the drugs they have been taking for other conditions and it's ironic that most neuropathy treatments also involve drugs used to treat other conditions. He points out that his doctors shrug their shoulders as if to say, well it's par for the course, which only highlights the importance of finding new treatments as quickly as possible. Science is busy doing just that and there certainly seems to be a new wave of interest in finding solutions for nerve damage but in the meantime, patients need the patience of a saint while they wait in discomfort and pain.

Living with and tackling PERIPHERAL NEUROPATHY 
Posted on May 28, 2015 by frankobserver

Peripheral neuropathy is caused when there has been damage to the nerves of the peripheral nervous system causing a loss of touch sensation or a loss of motor function in certain parts of the body; whilst this can be predominantly to the hands and feet, many different parts of the body can be affected..

Whilst diabetes and shingles (Herpes Zoster) are two common causes of peripheral neuropathy, there are several other major illnesses, diseases and treatments that can be the basis of it. 

I’ve had the neuropathy for well over six years to some degree although the severity has diminished somewhat in recent times.

It first appeared during the chemotherapy that followed my operation for cancer. The treatment was called “Folfox” and it was administered at the Drogheda Oncology Unit in County Louth during 2009. The staff and the treatment I received was excellent and for many, one can argue that peripheral neuropathy is a small price to pay but it is still frustrating!

By no means am I unusual in that I have developed peripheral neuropathy, in fact, it appears to be fairly common, especially after Folfox chemotherapy. For some it lasts six or twelve months and then goes away; for others it seems that the damage may be permanent.
When one asks someone in the medical profession “what one can do to resolve this problem”, it is normally met by a “shrug of the shoulders” It seems that, despite their incredible skills, they are technically stumped on this one. However, the medical profession make wonderful advances and there are indications that the instances of peripheral neuropathy, caused by treatment, can and will be reduced for future patients.

Accordingly, when the Folfox treatment is administered now in Ireland, there is an additional drug which can help reduce the instances of peripheral neuropathy in patients. It is considered that Xaliproden reduces neuropathy caused by FOLFOX and seriously reduces the risk of same associated with oxaliplatin which is incorporated in Folfox; this is great news for patients and for people recovering from colorectal cancer; however, the drug has to be administered at the time of ones chemotherapy – it is not practical after the treatment has been completed apparently.

My peripheral neuropathy was caused by Folfox Chemotherapy and there has been little I can do to relieve the symptoms; additionally the amount of numbness to the toes & feet can differ considerably for those affected. But for all people with peripheral neuropathy, it seems the amount of pain can vary considerably from patient to patient, and depending on the parts of the body most affected.

So for large numbers of people, the nerve damage that leads to peripheral neuropathy is caused by the drugs that have been administered to treat other diseases and not necessarily from the illness itself.

Tackling this problem is difficult but from my own experience I have found that vitamin B6 in doses of 100mg per day can assist and reduce the numbness but it remains a significant problem even now. Squeezing a tennis ball helps the hands and fingers as does exercising the toes (standing on tip toes, moving them as much as possible and massage) but it’s a gradual process.
Peripheral neuropathy caused by chemotherapy may be ‘a small price to pay’ especially if chemotherapy has helped to save your life!! But ‘non-cancer’ patients may experience problems following exposure to other toxins, some heavy metals and organophosphate pesticides. Lupus & rheumatoid arthritis can also be causes of peripheral neuropathy .There are also hereditary diseases such as Charcot-Marie-Tooth disease. Syphilis patients too can experience this and HIV can cause peripheral neuropathy as can the necessary treatment for same. 

There are many sites that discuss this issue but the best place to start is probably with your own doctor or GP. My own experiences are covered in a log that I made at the time of my treatment. Please visit COLON CANCER – MY EXPERIENCES.
Good luck and best wishes to all.

Saturday, 27 June 2015

Quinolone Antibiotics And Neuropathy

Today's post from (see link below) is yet another story of the damage caused by quinolone antibiotics - in this case, severe neuropathy. Despite FDA warnings and case studies from all across the world, doctors are still widely prescribing this family of antibiotics but the damage they can cause to existing and potential neuropathy patients, speaks for itself. If your doctor proposes prescribing fluoroquinolones for your infection, please don't just accept it but start a serious discussion with him or her to see whether they are in fact the right sort of antibiotic for you. There are alternatives but remember, once you have nerve damage you can't turn the clock back. For the sake of a serious discussion, you could save yourself years of misery. Other articles on this subject can be found by using the search button to the right of this page.

Busy Mom Tells Harrowing Story of Quinolone Peripheral Neuropathy 
By Amanda Antell June 16, 2015

Quinolone antibiotics are some of the most commonly prescribed medications in the United States, designed to treat all varieties of infections. Unfortunately, these famous drugs have been linked to several severe side effects like blindness and nerve damage.

In one of the most recent examples of these cases, a young mother that was prescribed Levaquin was diagnosed with peripheral neuropathy soon after. Not even 40 years old, this mother now struggles to walk and must undergo intense physical therapy several times a week; she complains that she will lose strength in her legs if she does not do this.

It all started last summer when the young mom, Shannon, had been diagnosed with a sinus infection and was prescribed Levaquin to treat it. Soon after starting the medication, Shannon started feeling a burning-like pain in her legs, along with her feet and eyes. After three months and four doctors, she was finally diagnosed with peripheral neuropathy. Her doctor had come to this conclusion based on the correlation between her symptoms and her Levaquin prescription.

The doctors involved in the case stated that they were not surprised by this incident, as they had read many similar cases from different cities. One of the diagnostic doctors, Dr. Charles Bennett, is one of the chairs of a drug safety watchdog agency at the University of South Carolina. He had recently petitioned for the FDA to add new black box warnings for Levaquin.

The FDA already required recent label updates for quinolone drugs regarding the side effects of tendon rupture, muscle weakness, and nerve damage. However Dr. Bennett insists that stronger warnings need to be attached to quinolone drugs, like Levaquin, because statistics show that 1,200 people have died from these side effects with nearly 100,000 injuries.

When Shannon learned that she was suffering nerve damage allegedly caused by her antibiotic, she was devastated, but feels lucky that her condition was not serious enough to be life-threatening. Currently, Shannon is trying to stay positive and is hoping that her nerves will regenerate themselves so she can resume her life. Family members state that they find it difficult to watch her struggle, and wish that the drug companies had provided stronger warnings and conducted sufficient research.

Levaquin’s manufacturing company, Johnson & Johnson, had emailed a statement to WCNC regarding Shannon’s case. The company insisted that Levaquin is a highly important medication that has been used to treat bacterial infections for more than 20 years, and has proven to have more benefits than risks when evaluated. Many patients disagree with this sentiment, after being left with permanent nerve damage, blindness, or other physical scarring.
Overview of Quinolone Peripheral Neuropathy

The concern of quinolone peripheral neuropathy became rampant when the FDA issued a public warning in August 2013 that stated that serious nerve damage could occur when taking a quinolone antibiotic. The agency warned that nerve damage could be permanent and can occur as soon as a week after starting the medication. A year later, in August 2014, a study published in Neurology found that quinolone injections or oral tablets could double the risk of peripheral neuropathy, as well as permanent nerve damage. The medications included in the FDA’s warning are Levaquin (levofloxacin), Cipro (ciprofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin), and Factive (gemifloxacin).

Peripheral neuropathy occurs when nerves that connect the brain and spinal cord, otherwise known as the central nervous system, somehow become disrupted. These nerves are vital in sending signals between the brain and the rest of the body, so any interferences can impair muscle movement, cause severe pain, and prevent sensation signals from reaching the arms and legs. Currently, it is unknown as to what causes peripheral neuropathy but doctors believe that quinolones somehow cause the nerves to cross signals with each other.

Doctors warn that this condition is fast and aggressive, resulting in permanent nerve damage in some cases. Numerous patients have filed legal action against Johnson & Johnson and other quinolone manufacturing companies for failing to protect them against the dangers of their products.

Friday, 26 June 2015

Anaesthetics And The Treatment Of Neuropathy

Today's post from (see link below) is a general assessment of neuropathy treatment at the moment, from the American Society of Anaesthesiologists and looks particularly at anaesthetics as pain killers, including such drugs as ketamine. The problem is that there are no definite conclusions here. Ketamine is seen as a promising analgesic agent for neuropathy sufferers but there's little discussion of opioids in general and no mention of methadone for instance, which is proving very successful in nerve pain cases. Nevertheless, this does look at neuropathy treatment from the point of view of anaesthesiologists and as such gives us another angle on the subject.

Causes of Neuropathic Pain Guide Treatments
Timothy Lubenow, M.D., Philip Peng, M.B.B.S., and Jianguo Cheng, M.D., Ph.D. 2014

Neuropathic pain is one of the most complex and difficult management challenges physician anesthesiologists face. Hundreds of distinct neuropathic pain syndromes have been documented and many are refractory to multiple treatments.

“Neuropathic pain affects 18 percent of the general U.S. population,” said Jianguo Cheng, M.D., Ph.D., Professor and Director of the Pain Medicine Fellowship Program at the Cleveland Clinic in Cleveland. “It is a major part of our practice and very resource-intensive. Medical costs for neuropathic pain patients are threefold higher compared with matched control subjects.”

Neuropathic pain is caused by a lesion or insult in the peripheral or central nervous system. The resulting plasticity in the peripheral and central nervous system leads to sensitization and hyperexcitability of neurons in the dorsal root ganglion, the spinal cord and the brain. The result is hyperalgesia, allodynia and spontaneous pain.

Causes include post-surgical, post-traumatic or post-herpetic neuralgia, diabetic neuropathy, HIV neuropathy, hypothyroidism, toxic exposures, lesions of the central nervous system, complex regional pain syndromes and more.

“Treatment of neuropathic pain has two goals,” said Timothy Lubenow, M.D., Professor of Anesthesiology, Rush University Medical Center, Chicago. “We want to alleviate or eliminate the cause of the underlying disease and to relieve symptoms.”

Treating the underlying cause is vital to long-term control, he said. For example, it is virtually impossible to successfully treat diabetic neuropathy until the underlying diabetes is brought under control.

Step therapy is standard for treating neuropathic pain, Dr. Lubenow said. Most patients can be treated with drug therapy, typically combinations of agents with different mechanisms of action. Multiple medical societies have issued guidelines for neuropathic pain, most with somewhat different recommendations. There are a wealth of anecdotal reports and open-label studies, and a dearth of strong evidence.

“When the evidence is soft, it is more open to interpretation and opinion,” he said. “You want a drug or a combination of drugs that are useful in alleviating pain, but you also want to minimize side effects.”

Pregabalin, gabapentin and duloxetine appear as preferred agents in most guidelines, Dr. Lubenow said. Other agents frequently recommended include sodium valproate, oxycarbazepine, venlafaxine, amitriptyline, dextromethorphan tramadol, morphine, oxycodone and capsaicin.

For patients with recalcitrant pain, spinal cord stimulation and intravenous infusion may be viable alternatives.

There are data supporting the use of I.V. lidocaine, bisphosphonates, phentolamine and immunoglobulin, said Philip Peng, M.B.B.S., Professor of Anesthesiology and Pain Management at Toronto Western Hospital, University of Toronto. But the duration of analgesia tends to be short, and severe adverse events are common.

Ketamine is one of the most promising I.V. agents for neuropathic pain, he said. Most studies use 50 mg or less infused over 30 minutes to two hours and the analgesic effect lasts less than two days. Trials using larger doses over longer infusion periods show much greater effect.

A study using anesthetic doses infused over five days showed significant pain relief up to six months following treatment, but there were significant psychotropic effects, muscle weakness and infections. Later trials using lower doses showed less severe adverse events but also less analgesia.

Early data from a Toronto Western Hospital trial using six-hour outpatient infusions for five days showed slightly more non-responders than responders, Dr. Peng reported. But responders showed greater than 50 percent pain relief up to three months after treatment.

“Responders tend to have less pain by the end of the second day,” he said. “At this point, we have no good tool for predicting responders. We are hoping for more robust data as the protocol progresses.”

Thursday, 25 June 2015

The Mystery Of Neuropathy

Today's post from (see link below) is a reader-friendly description of neuropathy and how it affects us. Less focussed on the science but more on how we feel when we have neuropathic symptoms. Relating it to other systems which we're more aware of, is always useful - it helps put neuropathy in a meaningful context in people's minds and especially reassures them that they're not alone in feeling as they do. It includes the very sensible statement that the best neuropathy diagnosis is obtained by listening to the patient's testimony but can be followed up by certain diagnostic tests - if only most doctors agreed with that order of events!

Peripheral neuropathy’s cause remains mystery for millions of Americans
By Premier Health
Monday, June 22, 2015

A person’s brain and spinal cord serve as the mainframe from which important messages are sent throughout the body via the peripheral nervous system.

The peripheral nervous system helps the body’s internal organs function properly and provides important signals regarding its response to the outside environment such as when a person’s feet are hot or their hands are cold. Trauma, infections, disease and injury can all cause damage to the peripheral nervous system and when this happens, a person may notice the feelings they have taken for granted all these years have become distorted or are suddenly gone.

This condition, known as peripheral neuropathy, causes numbness and tingling in a person’s extremities, and in extreme cases, can limit a person’s mobility and affect their ability to breathe. According to the National Institute of Neurological Disorders and Stroke (NINDS), peripheral neuropathy affects more than 20 million Americans, and for a significant number of individuals the cause of the disease is unknown.

“Peripheral neuropathy distorts the messages that travel from the brain and spinal cord to the outlying parts of the body including hands, feet and sometimes a person’s face,” said Christopher Scheiner, MD, PhD, a neurologist with the Clinical Neuroscience Institute. As the NINDS describes it, the disease is much like static on a telephone line, interrupting messages that should be carried throughout a person’s body, but which never properly reach their destination.

Dr. Scheiner said in most cases, symptoms of peripheral neuropathy happen gradually. As a result, individuals may dismiss symptoms until the disorder progresses to a point where they can no longer deny their existence. Carpal tunnel syndrome, where the median nerve in the wrist is damaged, is one of the better known peripheral neuropathies where this is often played out, Dr. Scheiner said.

“People may attribute the loss of sensation in their hands simply to their positioning on the steering wheel,” Dr. Scheiner said. “However, they will begin to notice that it is happening more often and becoming more painful. But it is when they do something outside of their normal routine such as holding a paintbrush for five minutes that they realize something is wrong.”

Peripheral neuropathy is best diagnosed through a clinical exam in which a neurologist will ask a series of questions about a patient’s symptoms. A physician’s diagnosis can then be supported through additional testing. One common test that is done is an electrodiagnostic test called an electromyography (EMG). An EMG delivers electricity through a small shock to the areas of the body where a patient is having symptoms. This enables a doctor to determine any damage to the nerves in that area.

Dr. Scheiner said it’s important to be evaluated for peripheral neuropathy because in some cases it could signal an underlying health issue that needs immediate attention. The most common form of peripheral neuropathy is diabetes. Up to 70 percent of diabetics have the disorder, according to the Foundation for Peripheral Neuropathy. In some cases, diabetes may be discovered through the presence of peripheral neuropathy, he said.

HIV/AIDS patients and those taking certain chemotherapy drugs also experience the disorder. According to the Foundation for Peripheral Neuropathy, the disorders affect up to 40 percent of chemotherapy patients and a third of all HIV/AIDs patients.

The disorder can sometimes be cured when an underlying health issue is brought under control. In some cases, peripheral neuropathy can cause a person pain and when this happens medication can be prescribed to help alleviate it.

“These medications help to turn off the nerves that are causing pain,” Dr. Scheiner said. “They are different than what a patient would receive from an over-the-counter medication like Tylenol, but still allow a patient to function without the sensation that they are being controlled by a substance.”

Premier Health Specialists is one of the largest groups of specialty care practices in Southwest Ohio. More than 130 physicians serve patients in a variety of specialties such as bariatric, breast care, burn and wound, cardiology, cardiothoracic surgery, cardiovascular-thoracic surgery, general surgery, gynecologic oncology, hand and reconstructive surgery, infectious diseases, maternal-fetal medicine, neurosciences, obstetrics and gynecology, orthopedic surgery, orthopedic spine surgery, ophthalmology, palliative care, physiatry, plastic surgery, podiatry, psychology, pulmonology, sports medicine and urology. Premier Health Specialists is part of Premier Health, which includes Miami Valley Hospital, Good Samaritan Hospital Dayton, Atrium Medical Center and Upper Valley Medical Center. For more information, visit

Wednesday, 24 June 2015

Neuropathy: An HIV-Related Pain Problem

Today's post from (see link below) looks at the remarkably high incidence of neuropathy associated with HIV infection. The article mentions a figure of 30% of all people living with HIV, also contracting neuropathy but you will find many experts quoting figures of up to 45% and 50%. Neuropathy can arise from the virus itself attacking the nervous system; or long-term HIV drug use, or any of the other 100 causes that affect the rest of the population. Whatever the accuracy of the statistics, it is clearly a problem for HIV patients and one that is widely underestimated and often poorly treated. Worth a read.
Peripheral Neuropathy and HIV-Associated Nerve Pain 
Pain Medicine Specialist, Dr. Paul Christo 2015
Most people in the U.S. are aware that HIV (human immunodeficiency virus) causes AIDS, but many might not know that the condition itself and medications associated with HIV/AIDS can end up causing severe pain for those who suffer from it. According to AVERT, a UK-based HIV and AIDS charity, neuropathic pain affects approximately 30 percent of people with AIDS.

Like other serious health issues, such as cancer and diabetes, HIV can cause damage to the peripheral nerves of the body. Symptoms are usually felt in both feet or both hands and can progress up the body in a “stocking and glove” pattern. Minor everyday injuries like a paper cut or sunburn injure these nerves in healthy people. However with a condition like HIV, this nerve damage can lead to burning pain, numbness, or even paralysis. Patients may also feel numbness, tightness, or clumsiness. According to The Peripheral Nerve Center at Johns Hopkins, peripheral neuropathy is one of the most frequent neurological complications of an HIV infection.

On a past episode of Aches and Gains, I spoke with Hotchkiss Brain Institute neurologist and neuroscientist, Dr. Douglas Zochodne. He is a pioneer in the field of nerve regeneration whose work centers around stimulating nerve re-growth in an effort to restore sensory and motor function, as well as ease pain. It’s the work of Dr. Zochodne and other medical pioneers that may give patients who suffer from neuropathic pain of various types some relief and the ability to live a fuller life.

GBS is a condition that can be associated with HIV (and Lupus); it attacks the nervous system and can cause painful, stinging, needle-like sensations along with numbness and weakness. GBS is also referred to as Chronic Acute Inflammatory Demyelinating Polyneuropathy (CIDP) and Landry’s Ascending Paralysis. The cause of GBS/CIDP is unknown, but those with HIV-associated GBS are typically treated similarly to other GBS patients.

Treatment of HIV/AIDS-associated neuropathy varies greatly depending on the level and type of pain. Often, doctors use medicines like gabapentin (Neurontin), pregabalin (lyrica), or duloxetine (cymbalta) and see pain improvement. Peripheral neuropathy caused by certain medications is often treated by reducing the dosage of the drug or completely eliminating it. Though in some cases the damage may be permanent, many patients start to feel less neuropathic pain within a few weeks or months after stopping the medication.

The month of June features two annual observances of HIV/AIDS awareness: National Caribbean-American HIV/AIDS Awareness Day on June 8 and National HIV Testing Day on June 27. For more information on HIV/AIDS neuropathy, visit The Foundation for Peripheral Neuropathy website.

Learn more about nerve pain by listening to podcasts from previous Aches and Gains episodes:
The Mystery of Chronic Inflammatory Demyelinating Polyneuropathy (CIPD)
The Miracle of Nerve Restoration
Painful Diabetic Neuropathy

Each week on Aches and Gains radio show, I outline a new pain source, what causes it, who can be affected, and most importantly, how it can be treated or managed. Visit the radio show page for a complete list of podcasts for past episodes. Tune into Aches and Gains every Saturday at 5 p.m. and 5:30 p.m. on SiriusXM Family Talk Radio Channel 131.

Tuesday, 23 June 2015

New Discovery Curbs Nerve Pain Without Drug Side Effects

Today's post from (see link below) is one of those complex technical ones that often leave us scratching our heads to wonder how it could possible affect our own personal situations. However, if you take a little time to read it, you should get the gist of what it's saying and what the implications are. It starts off with a neuropathy-patient-friendly call for treatments that work well on people and not just laboratory mice. We are so used to the newest developments being announced at the rodent-testing stage, that we lose faith that they will ever be translated to human treatment. This article tries to show that the gulf between lab-rats and humans in this case, is not so large after all. Worth a read.

Potent approach shows promise for chronic pain
Inhibitor discovered through human, mouse genetic studies curbs pain without narcotic side effects 

Date:June 17, 2015 Source:Boston Children's Hospital

Non-narcotic treatments for chronic pain that work well in people, not just mice, are sorely needed. Drawing from human pain genetics, an international team led by Boston Children's Hospital demonstrates a way to break the cycle of pain hypersensitivity without the development of addiction, tolerance or side effects.

Their findings, reported June 17 in the journal Neuron, could lead to treatments for chronic pain conditions caused by nerve damage, such as diabetic peripheral neuropathy (DPN) and post-herpetic neuralgia (PHN), as well as chronic inflammation, like rheumatoid arthritis. Current treatments provide meaningful pain relief in only about 15 percent of patients.

"Most pain medications that have been tested in the past decade have failed in phase II human trials despite performing well in animal models," notes Clifford Woolf, MD, PhD, director of Boston Children's F.M. Kirby Neurobiology Center and a co-senior investigator on the study with Michael Costigan, PhD. "Here, we used human genetic findings to guide our search from the beginning."

In 2006, Costigan, Woolf and colleagues showed in Nature Medicine that people with variants of the gene for GTP cyclohydrolase (GCH1)--about 2 percent of the population--are at markedly lower risk for chronic pain. GCH1 is needed to synthesize the protein tetrahydrobiopterin (BH4), and people with GCH1 variants produce less BH4 after nerve injury. This suggested that BH4 regulates pain sensitivity.

"We wanted to use pharmacologic means to get the same effect as the gene variant," says Alban Latremoliere, PhD, also of Boston Children's Kirby Center, who led the current study along with Woolf and Costigan.

In a "reverse engineering" approach, the researchers modeled the human biology in mice. They first showed that mice with severed sensory nerves produce excessive BH4, churned out both by the injured nerve cells themselves and by macrophages--immune cells that infiltrate damaged nerves and inflamed tissue. Mice engineered to make excess BH4 had heightened pain sensitivity even when they were uninjured, suggesting that BH4 is sufficient to produce pain. On the flip side, mice that were genetically unable to produce BH4 in their sensory nerves had decreased pain hypersensitivity after peripheral nerve injury.

"We then asked, if we could reduce production of BH4 using a drug, could we bring about reduction of pain?" says Latremoliere.

The answer was yes. The researchers blocked BH4 production using a specifically designed drug that targets sepiapterin reductase (SPR), a key enzyme that makes BH4. The drug reduced the pain hypersensitivity induced by the nerve injury (or accompanying inflammation) but did not affect nociceptive pain--the protective pain sensation that helps us avoid injury.

Fine-tuning pain relief

Because BH4 is active all over the body, with important roles in the brain and blood vessels, the goal of any treatment would be to dial down excessive BH4 production, but not eliminate it entirely. Latremoliere and colleagues showed that blocking SPR still allowed minimal BH4 production through a separate pathway and reduced pain without causing neural or cardiovascular side effects.

"Our findings suggest that SPR inhibition is a viable approach to reducing clinical pain hypersensitivity," says Woolf. "They also show that human genetics can lead us to novel disease pathways that we can probe mechanistically in animal models, leading us to the most suitable targets for human drug development."

Story Source:

The above post is reprinted from materials provided by Boston Children's Hospital. Note: Materials may be edited for content and length.

Journal Reference:
Clifford J. Woolf et al. Reduction of Neuropathic and Inflammatory Pain through Inhibition of the Tetrahydrobiopterin Pathway. Neuron, June 2015 DOI: 10.1016/j.neuron.2015.05.033

Monday, 22 June 2015

Are Tens Units Any Good For Neuropathy?

Today's post from (see link below) reflects the varying opinions about the benefits of electrical nerve stimulation machines such as Tens, for people with nerve damage. As a result, this article can only be seen as one person's opinion and the best advice would be to consult as many people as possible (including your doctor) and do your own research before  starting using such appliances. That said, if numbers are to be believed, thousands of people across the world do get some benefit from using Tens and others but that can be said from almost all given neuropathy treatments. Do all the research you can but remember, as with all neuropathy treatments, what works for some doesn't work for others - it remains a minefield.

Using Electrical Nerve Stimulation Machine for Diabetic Neuropathy Should Be Considered  

No visible author 18 Jun, 2015

 The most common forms of electro-analgesia is the Tens machine. There has been several clinical reports and ongoing research with regards to the use of Tens machines for certain medical conditions such as arthritic pain, myofacial, lower back pain, bladder incontinence, visceral pain, post operative pain and neurogenic pain. Due to these studies being inconclusive, the question as to whether the Tens are more effective than a placebo in combating pain is still unresolved. The mechanisms currently proposed with regards to the Neuro modulation that Tens produces include pain control, restoration of input afferent, and presynaptic inhibition in the dorsal horn of the spinal cord and direct inhibition of an abnormal excited nerve.

Studies revealed that the electrical stimulation reduces pain via nociceptive inhibition in the horn of the spines dorsum horn at a presynaptic level and in turn limits its central transmission and that the electrical nerve stimulation machine on the skin myelinated nerve fibres and the electrical stimuli activates a low threshold. With low frequency Tens a marked increase in met-enkephalin and beta endorphins were noted and also demonstrated antinociceptive reversal effects by naloxone. Through micro opioid receptors the effects were postulated. However, naloxone was not reversed with high frequency Tens analgesia, implicating a dynorphin binding receptor that is naloxone resistant. Increased levels of dynorphin A were revealed in cerebral spinal fluid samples. Pain in interpreted when painful peripheral stimulation occurs as the C fibres carry the information which causes the T cells to open the gate which in turn the cortex and thalamus receive the pain transmission centrally. This theory explains the gate control theory, as the gate is usually closed. A range of both positive and negative outcomes have been noted in a wide range of medical conditions when using the Tens machine. Due to several trials and studies conducted there has been an overall consensus in favour of the use of Tens. Around 70 to 80% of patients experience initial pain relief provided by Tens, and around 20 to 30% success rate decreased after a few months of using Tens. In order to establish the full benefits, the Tens should be applied for at least an hour.

The stimulus preferences differ, and studies revealed that 57% of patients that used the Tens machine daily most definitely benefited as well as displayed different stimuli to particular pulse patterns and frequencies and were found to be adjusting their stimulators in subsequent treatment sessions. Tens has also proved positive for mild levels of pain post operative and post traumatic and proved ineffective for acute pain and tension headaches. However, Tens proved positive for painful diabetic neuropathy and treatment using Tens should be considered for this disorder.