Sunday, 4 October 2015

A Chiropractor's View Of Neuropathy

Today's post from (see link below) is written by a chiropractor, prior to inviting you to attend his workshop. In that sense it's an advertisement and this blog very rarely advertises. However, whatever you may think of chiropractors and neuropathy, there is no doubting the truth of what he says and how he describes the problem of neuropathy and for that reason, his post is worth publishing. That is not to say that chiropractors shouldn't be allowed within 100 metres of a neuropathy patient (a view held by many in the medical world) - personally, I believe that if something works for you, then it's worth long as you know what you're doing, go in with your eyes open and understand that it may not be of benefit to you. Then again, that applies to almost all neuropathy treatments - it's the nature of the disease that one man's successful treatment is another man's disaster and waste of money. This short article is however, worth a read.

Neuropathy - Is it Getting on Your Nerves?
by Bryan Ruocco 29/6/2015


Neuropathy is a serious health condition. It can lead to serious health challenges. Remember the nerve system is the very system that carries life and energy from the brain to the body powering all cells, organs and tissues in the body. Peripheral neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord to the rest of the body are damaged or diseased. Damage to these nerves interrupts communication between the brain and other parts of the body and can impair muscle movement, prevent normal sensation in the arms and legs and cause pain.

Neuropathy can be complicated, and is associated with a number of different medical conditions. There are many causes of neuropathy. This includes physical trauma, repetitive injury, infection, metabolic problems and exposure to toxins and some drugs. If you suffer with neuropathy you are not alone. It is estimated that upwards of 20 million Americans suffer from this illness. It is more common than you may think. Neuropathy has an alarming annual cost to Medicare exceeding $3.5 billion.

The term 'neuropathy' covers a wide area and many nerves, but the problem it causes depends on the type of nerves that are affected. There are sensory nerves, motor nerves and autonomic nerves, all serving a different function of the body. When sensory nerves (the nerves that control sensation) are affected, you can experience tingling, pain, numbness, or weakness in the feet and hands. When motor nerves (the nerves that allow power and movement) are affected this can cause weakness in the feet and hands. Lastly, autonomic nerves (the nerves that control the systems of the body eg. gut, bladder, reproductive organs, etc.) may cause changes in the heart rate and blood pressure or sweating. As you can see, damage to the nerve system can cause enormous challenges for the body. One of the most overlooked areas of the human body that causes neuropathy is the spine. Don’t forget the spine houses and protects the spinal cord and nerve roots. The only two parts of your body that are surrounded by bone for protection are your brain and spinal cord. Spinal damage, spinal misalignments, degenerative joint disease, degenerative disc disease, and spinal arthritis, to name a few, can all cause neuropathy.

The most important thing to note is that there are many things you can do naturally that are non-invasive to help with neuropathy. You have options. From diet and blood sugar management to spinal health and hygiene, you have options when it comes to neuropathy. Stop suffering and start learning what natural options are available to you.

I will be hosting a workshop on NEUROPATHY at Panera Bread on July 22, 2015 at 7pm. If you suffer with numbness and tingling in the extremities, muscle weakness and fatigue, sciatica symptoms, carpal tunnel symptoms or anything related to neuropathy, please join us to learn more. It is our mission to educate our community towards superior health and vitality through natural healthcare. Come join us and be our guest and together lets put an end to Neuropathy. We hope to see you there!

Dr. Bryan Ruocco is a local chiropractor and wellness advocate. He owns and operates the Power of LIFE Wellness Center located in the heart of Rocky River.

Bryan Ruocco

Dr. Bryan Ruocco is a local chiropractor and wellness advocate. He owns and operates the Power of LIFE Wellness Center located in the heart of Rocky River. Dr. Ruocco graduated from the prestigious Life Chiropractic College in Marietta, GA. He graduated in the top of his class and received Magna Cum Laude Honors. He has an extreme passion to help other experience exceptional health and is dedicated to serving his community with the latest in non-drug, wellness care. Dr. Ruocco is married to his wife Melissa and have 3 beautiful children who go to school in the local area.

Saturday, 3 October 2015

Just How Is Neuropathy Pain Treated?

Today's post from (see link below) is the second of two consecutive posts written by LtCol Eugene B Richardson. This article is another well-written, comprehensive, clear and easy to understand piece concerning how neuropathic pain is generally treated. The author is also a neuropathy patient and has considerable experience of being on the treatment roundabout. In this way, he's able to cut to the chase and give useful information and advice. Worth a read.

How is Neuropathic Pain Treated?
By LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

FACT: Neuropathic pain does NOT respond to ‘normal’ pain medications.

Pain signals from an external stimulus like a cut or from an internal broken bone are treated with many well-known treatment options for pain.

Pain signals from damaged nerves which send real, but faulty signals to the brain must be treated with other options which currently are limited until research provides more options at the clinical level.

Drug Options

The majority of patients with neuropathic pain are currently treated with two classes of medication.

The anti-depressants and the anti-seizure medications either alone or in combination work for many patients to reduce such pain. Some of these options would include Nortriptyline in the first class and Lyrica in the second class. Speak to your doctor about the options, but recommend that you first consider the anti-depressants as these may have less side effects. Both the anti-depressants and anti-seizure medications reduce neuropathic pain, even if medicine is not totally sure why they work. This information is from the book by Norman Latov, MD PhD of Weill Medical College, Cornell University in his book for patients listed in our RESOURCE tab. (Ref: #4)

Most patients get about 85% relief and a few are lucky with 100% relief, but until there are better medications developed by research, we are fortunately to have these options.

Dr. Latov (Ref: #1) speaks of these and other medications and they do help many neuropathy patients. However, like all medications sometimes the side effects are worse than the symptoms. Each patient must decide if they are worth using if the pain is only at the nuisance level. The dosage and the combinations of these medications must be worked through by the patient with the doctor in a patient doctor partnership of trial and error. As of now, I know of no other way to find what works for you.

Other patients have been prescribed Lidocaine patches for burning pains as noted by Dr. Latov and patients report that these help reduce the burning.

I have found that the burning sensations respond best to compounded topical creams and not to the oral medications. Compounded topical creams are being prescribed more often by doctors and the benefit is the absorption into the blood is limited and it tends to stay concentrated to the area you need it the most according to Neurologist Corey Hunter (Ref: #4). Some of the ingredients physicians use in these compounds includes Lidocaine, Ketamine, Gabapentin, and Amitriptyline, mixed by a compounding pharmacy in percentages as prescribed by the physician.

For patients with an immune mediated neuropathy the use of intravenous immune globulin (IVIg) has been very effective in reducing pain in sensory neuropathies while providing more muscle strength in motor neuropathies and protecting the nerves from more damage. It works! See patient IVIg experience click here:

Ketamine Infusions for Chronic Pain: For information on use and cautions, please see Ketamine Infusions for Chronic Neuropathic Pain.

2015 Update on Promising Research: The Foundation for Peripheral Neuropathy in their E News March 2015, noted in a follow up of reported 2013 research a report published in the Annals of Clinical and Translational Neurology and Science Daily, noted that with “two low dose rounds of non-viral gene therapy called VM 202 patients had significant improvement of their pain that lasted for months!

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

“VM202 contains human hepatocyte growth factor (HGF) gene. Growth factor is a naturally occurring protein in the body that acts on cells, in this case nerve cells – to keep them alive, healthy and functioning. Future study is needed to investigate if the therapy can actually regenerate damaged nerves, reversing the neuropathy.

“Patients with painful diabetic neuropathy have abnormally high levels of glucose in their blood. These high levels of glucose can be toxic.

“We are hoping that the treatment will increase the local production of hepatocyte growth factor to help regenerate nerves and grow new blood vessels and therefore reduce the pain,” said Dr. Senda Ajroud-Driss, associate professor in neurology at Feinberg, an attending physician at Northwestern Memorial Hospital and an author of the study.

“Right now there is no medication that can reverse neuropathy,” Kessler said. “Our goal is to develop a treatment. If we can show with more patients that is a very real phenomenon, then we can show we have not only improved the symptoms of the disease, namely the pain, but we have actually improved function.”

“A future, much larger phase three study will soon be underway. To read the full article Neuropathy: Relief for diabetics with painful condition. ” 

What about muscle cramps?

Muscle cramps are common in neuropathy patients. It is always a good idea to report such muscle cramps to your doctor and determine if it is indeed related to your neuropathy or other conditions. Levels of potassium, calcium, salt, and other substances critical to proper function of muscles may need to be tested to see if they are low.

Other patients have had levels of potassium, calcium, salt, and other substances critical to proper function of muscles tested to see if they are low. Then have the doctor prescribe a supplement at the correct dosage for you.

If you take a diuretic, muscle cramps are common and may require supplements, so speak to your doctor.

Patients have found that eating a banana at night keeps the cramps away, or eating a Tum to increase calcium, or eating salty olives or pickles if your salt levels are low work.

Some neuropathy patients have noted that the drug Venlafaxine resolves restless leg syndrome and the associated leg cramps. Dr. Levine states that this drug changes the levels of serotonin and norepinephrine (two neurochemicals) in the spinal cord and can be effective in patients with neuropathy.
What About Exercise?

Did you know that the wrong type of exercise will force damaged nerves to work and increase the pain! See article at:

How should a neuropathy patient exercise? Consider ordering a copy of the brand new DVD from Matt Hansen the expert as his perspective on exercise for neuropathy is perfect and understands what we can and cannot do. Yet Matt makes it possible for us to exercise WITHOUT the increase in neuropathic pain, keeping muscles as strong and flexible as possible. To see article on DVD click here: When ordering enter the special code NSN 10 and Matt will give 10% of your purchase price back to support the work of the NSN!

If you want a complete discussion of medicines for the treatment of neuropathic pain, read the book by Dr. Latov.

Other options

Dr. Latov in his book and many neuropathy patients have reported reducing pain by the use minerals such as Alpha Lipoic acid (600 to 800 mg) especially pain from diabetic neuropathy. Research suggests that vitamin C is important to protecting nerve cells and the lack of vitamin E can actually cause neuropathy as noted by Dr. Latov.

You see many ads for B supplements in what I call a shotgun approach to the B vitamins. For me it is like shooting a mass of vitamins at an unknown target! We know that a shortage of certain vitamins, especially the E and B vitamins, is known to cause neuropathy. Yet too much B6 can cause it! I like the suggestion of Dr. Latov that the patient have such levels tested (see his book for specific information) to determine any shortage and then treat the identified target rather than using a radium shotgun blast at an unknown target!

Good nutrition is very important for everyone, but it is especially important for neuropathy patients. Why? First good nutrition helps protect and heal the nerves. Secondly, the lack of essential vitamins can cause neuropathy according to Dr. Latov! Neuropathy caused by long term alcohol abuse may be due more too poor nutrition than the alcohol. Read his book.

In the book by Mims Cushing’s, (Ref: #2) patients report that another helpful option is to soak your feet in cold tap water for 15 minutes before going to bed. The cooler water helps by calming the nerves. DO NOT USE FREEZING ICE WATER as with sensory neuropathy this could cause damage to the skin. For those with the sensation of very COLD feet, these patients have found that doing the same with warm tap water (NOT HOT) has a soothing effect.

Acupuncture has been shown to be effective for pain reduction in some patients and this is supported by small studies showing its effectiveness.

Erika Schwartz, M.D. a holistic physician a leading expert on wellness recommends the use of the supplement Curcumin as a great anti-inflammatory that will help relieve pain. She also recommends MSM at 2000 mg per day as helpful for pain.

Again, it is what works for you in treating the strange effects of neuropathic pain from damaged peripheral nerves. 

A Word About PODS (Postural Orthostatic Tachycardia Syndrome)

Do you know how many times over the past 40 years I was sent to the Cardiologist because ‘I was having a heart attack’ only to be told my heart was fine and ask, ‘Why was I here?’ The Tachycardia (silent as I did not feel it), was never understood or recognized. It was often not even related to standing as I has been assumed. Having been diagnosed with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Small Fiber Neuropathy (SFN) and with symptoms of Autonomic Neuropathy, it was a reality for me, but eventually this symptom went away while others were reduced when I began IVIg.

The relationship of the symptoms to Small Fiber Neuropathy was noted in a February/March 2015 Article in Neurology NOW (Ref #6) among other neurological issues. The article notes that there are significant disagreements in the scientific community about what drives POTS or even what symptoms are related to PODS. Symptoms related to PODS in this article include dizziness, lightheadedness, palpitations, near fainting upon standing and unrelated to standing the symptoms noted are fatigue, nausea, autonomic systems, fibromyalgia, and others often connected to several forms of neuropathy.

While prognosis is unpredictable, research in a 2013 large study from the Mayo Clinic presented at the 24th International Symposium on the Autonomic Nervous System noted that 18.2% of patients noted complete resolution of symptoms , while 52.8% reported improved but persistent symptoms two to 10 years after diagnosis.

Several suggestions were made in the Neurology NOW article to alleviate POTS including the simple idea of (1) drinking more water especially with increases in sodium. This simple solution helps expand blood volume and increase blood flow, but it may not work for some people; (2) appropriate exercise (see exercise DVD information noted above) to prevent blood from pooling in the lower extremities and other benefits gained from even low impact exercise.

Until more research confirms what is driving this REAL disorder and the related symptoms, patients just must find ways to cope and live around the illness.
DVD and the Behavioral Sciences

In this regard, remember what I have taught in the DVD “Coping with Chronic Neuropathy”. How you THINK about something, will affect your FEELINGS, which will in turn effect or influence your BEHAVIOR. It you think something is horrible, your feelings will be one of despair and your actions will reflect a sense of defeat. Always try to turn this around to a positive thought, however difficult it may be! It works.

You may also want to find a good psychologist or trained counselor, to explore cognitive therapy as in biofeedback or relaxation techniques, visualization techniques, or a trained specialist in healing arts such as yoga or ta-chi, to find ways to utilize your body’s ability to increase natural chemicals (serotonins) which we know reduce pain. Never underestimate the body’s ability to seek balance and healing.

Soothing music or sounds are a well-known way to relax and improve the body’s response to pain and there are music tapes or even therapists to help. This is why the noise of a water fall or watching a fish tank is so relaxing and healing.

Periods of slow deep breathing together with soft music or other relaxing sounds can be very helpful. Combine this with favorite images such as rain fall, snow showers, waterfall, and fall foliage in the mountains in the fall, or visualizing soft spring rains, baby birds, or whatever and you will be surprised how much it helps. Art therapy is often used to help patients visualize and express how they feel. I have been known to sing while walking my dogs using my power scooter with neighbors looking at me with strange looks, ‘Okay, he is gone’, but who cares.

Pets can offer so much in comfort and care if you are physically able to take care of them and afford them. As we have learned many times with the chronically ill and with veterans who suffer from PTSD pets are often essential for survival. For me they have become my ‘children’ to take care of providing more love and meaning to my daily life. 


Opiates are often used for break through pain and for some are very helpful when there is either a short term need or no other option.

However, my opinion after working with many patients attempting to stop the use of opiates is that patients should try every option carefully before using the opiates. The opiates often require increasing dosages with unwanted side effects that become more of a problem than the symptoms you are trying to address. A day does not go by, when a patient requests help to withdrawing from opiates.

For many patients the opiate drugs will eventually become more of a problem than your symptoms of neuropathy and the body will keep demanding more and more of the drug.

However, this is a very personal decision between you and your doctor, so work with the doctor to discover what does work for you as noted. If your doctor does not work with you on this, find another doctor as every patient is different. I would always tell a patient to get a second opinion regarding opiate use for neuropathic pain.

Remember for neuropathic pain, if you get 85% relief this is probably as good as it is going to get until medical research discovers better options.

Pain Management

A patient went for decades with severe back pain from multiple problems in the spine. Nothing helped. Then they tried the epidural from a Pain Management physician, which is the only thing that helped provide some relief after decades of trying.

This epidural uses Lidocaine and Depomedrol. The patient is sedated when the procedure is done and it is done under a machine that shows the doctor what they are doing on a monitor. It gave the patient 90% relief for the first 3 weeks and then 80% relief. The patient is crippled without this epidural. Unfortunately they need to be repeated and relief is often temporary.
Pain Management can offer many ideas for patients to find some relief from chronic pain including the possible use of spinal cord stimulators, implants, and other such instruments.

How do you communicate pain levels?

(To see article on opening doors with doctors click here.)

One of the most difficult tasks for a neuropathy patient is communicating neuropathic pain or symptom levels to anyone, while the patient fears they are crazy from the strangeness of these symptoms and sensations.

Too many patients in frustration or in a desperate need for relief will state something like, “If 10 is the worst level, than my pain is a 20.” This may communicate your desperation, panic, frustration, or anger, but otherwise is not helpful to the doctor or you.

This is where patient awareness of the pain scale 1 to 10 is very important as you communicate with the doctor, working through the issues of what works and what does not work. This process requires a doctor and patient who LISTEN and HEAR as listening and hearing are two different tasks. You know a doctor is listening if they do not cut you off after you share for 3 seconds and if they can repeat back what you just said!

Remember, if 10 is the level of pain where you pass out and 1 is just a nuisance, then 5 is where your ability to perform daily tasks become very difficult and by 6 impossible. With practice, it will amaze you how skillful you can become in judging your pain or symptom level.

There are times when pain or other symptoms are better expressed in a range over a period of time. Examples would be the burning sensations have been a 2 to 4 or a 4 to 7. This will help you and the doctor see where you are with the medications. But remember, if you get 85% relief from neuropathic pain, this may be as good as it gets with current options. But remember, if you get 80% relief from neuropathic pain, this may be as good as it gets with current options.


#1 Norman Latov, MD, PhD, FAAN Peripheral Neuropathy: When the Numbness, Weakness and Pain Won’t Stop, ANN Press, 2007

#2 Mims Cushing, You Can Cope With Peripheral Neuropathy (Ideas from neuropathy patients), with Dr. Norman Latov, DEMOS Publishing, 2009

#3 Textbook of Peripheral Neuropathy, Peter D Donofrio, MD, Editor, Professor of Neuropathy, Chief of Neuromuscular Section, Vanderbilt University Medical Center, Nashville, TN Published by DEMOS Medical, 2012.

#4 “Journal of the Peripheral Nervous System” published by the Peripheral Nerve Society.

#5 Dr. Corey W. Hunter, MD, Pain Medicine, Ainsworth Institute of Pain Management, New York, NY.

#6 Dr. Sean Levine, MD, FAAN, Professor of Clinical Neurological Surgery and Radiology, NYPH, New York, NY

#7. “Neurology NOW”, February/March 2015, Article: Taking a Stand (on PODS), By Amy Paturel, pages 44 to 47.

About the Author

Col Richardson has suffered with severe neuropathy for over 45 years. A 27 year military veteran and veteran of the Vietnam War, he was diagnosed with a progressive chronic peripheral neuropathy resulting in severe disability. This diagnosis has been confirmed as due to exposure to Agent Orange. It was not until 2010, 42 years after his exposure to Agent Orange, that his diagnosis was recognized by Veterans Affairs as service connected.

Friday, 2 October 2015

Just What Is Neuropathy Pain?

Today's post from (see link below) is the first of two posts written by LtCol Eugene B Richardson, whose work has been featured before on this blog. In today's post, he provides you with a great deal of basic information about neuropathic pain but does it in a way that's easy to follow and remember. It helps that he too is a patient, so he knows what you're feeling and how confusing the whole medical story concerning nerve damage can be. The second article (about how neuropathy is treated) will appear tomorrow. Worth a read.

What is Neuropathic Pain?
By LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

The physical cause of neuropathic pain is damaged peripheral nerves and as one medical expert notes, may also be due to the attempt of damaged nerves to fire across damaged sections of the peripheral nerve. See: References #1 to #3

It is illegal to torture prisoners in our country. So why do neuropathy patients too often live with a torture known as ‘neuropathic pain’ caused by Peripheral Neuropathy?

Somatization Disorders

Somatization disorder is a long-term (chronic) condition in which a person has physical symptoms that involve more than one part of the body, but no physical cause can be found.

This concept cost me my military career in the 1970’s and 80’s. It sets up the neuropathy patient while they seek help for the horror of neuropathic pain. It is important to understand that the pain and other symptoms of patients with this disorder are real and are not created or faked on purpose (malingering). It is time to stop calling patient’s crazy and ignoring this pain or the other symptoms of a neuropathy.

In 2015 we finally have a growing understanding of neuropathic pain yet with limited medication options, sometimes treatment fails the patient. In the last two decades medicine has come a long way in increasing clinical training of doctors in the diagnosis and treatment of the neuropathies and for this many patients are very grateful. On the other hand, neuropathy patients have many resources today that were not available to them just a few years ago, so the patients have little excuse in teaching themselves so that they are informed advocates who have learned ways to help the doctor and themselves with this chronic condition. 


Doctors now know to test for large fiber damage and if they find no recordable damage, that this does not rule out neuropathy, only damage. These tests measure damage and do not diagnose or rule out neuropathy.

The patient can have symptoms and neuropathic pain for years before damage will show in these tests.

Doctors now know that testing for small fiber neuropathy must be done using a (skin biopsy) for this is the only test to show small fiber damage..

After I was diagnosed with an immune mediated neuropathy, doctor after doctor, asked, ‘Why did they not do the spinal tap?”, but today doctors know that this can be, along with other tests and information a helpful test in confirming an immune mediated neuropathy.
Severity of pain

Dr. Norman Latov, MD, PhD of Cornell University notes that while for some patients neuropathic pain is a nuisance, but for millions of other patients, they are in fact living with constant torture at one level or another with untreated conditions that do many times lead to severe disabilities at a greater cost to society.

Neuropathic pain can involve a wide variety of strange sensations, such as violent sudden electric shocks, stabbing, shooting, burning, tingling, pins and needles, severe muscle cramps, bone pain, sense of strange numbness, cement legs, heavy legs, strange feelings of socks on the feet or gloves on the hands, severe skin pain due to touch, no feeling on touch, digestive problems, urinary problems, problems with lack of sweating, and the list goes on, in addition to other known symptoms of neuropathy?

While only a well trained doctor can determine the cause of your symptoms, you may have peripheral neuropathy and you are experiencing neuropathic pain from damaged nerves sending inappropriate but real signals to the brain.

Like many types of neurological pain, neuropathic pain does remit and relapse making it sometimes difficult to understand both for the doctor and the patient.

Unfortunately, doctors and patients note that these neuropathic symptoms are often worse at night. Experts theorize that this may be due to the brains relaxed state and the fact the brain is not ‘busy’ processing other data. This is why pain is sometimes perceived to be worse at night, as the brain is not as busy working on other information.

Did you know that research has shown that patients with ‘tightly wrapped” neurons in the brain will experience more intense pain than other patients! Ref: #4

While not completely understood, often how a patient experiences neuropathic pain and symptoms is related to their genetic makeup, physical and emotional resources or inappropriate exercise or physical activity in which damaged nerves are forced to work. 


Did you know that the wrong type of exercise (click to see article) will force damaged nerves to work and increase the pain!

How should a neuropathy patient exercise? Consider ordering a copy of the brand new DVD from Matt Hansen the expert as his perspective on exercise for neuropathy is perfect and understands what we can and cannot do. Yet Matt makes it possible for us to exercise WITHOUT the increase in neuropathic pain, keeping muscles as strong and flexible as possible. To see article on (click on link) Exercise for Neuropathy DVD: When ordering enter the special code NSN 10 and Matt will give 10% of your purchase price back to support the work of the NSN!
We are making progress in Medicine when it comes to understanding neuropathic pain!

In decades past, some doctors did not understand the strange manifestations of neuropathic pain and would dismiss the patient.

Today, that is not the case as medicine has grown in its understanding of neuropathic pain and patients are become better at describing the level of pain or symptoms so that the doctor understands their condition and how to treat them.

Many great doctors now report in books and medical journals, especially Dr. Norman Latov in his book for patients and “The Journal of the Peripheral Nervous System” (Ref #3). Since the decades of the 60’s to the 90’’s, we have made great strides toward understanding and attempts to treat neuropathic pain.

One of the most critical aspect beyond the treatment of neuropathic pain, is the absolute requirement for the patient and physician to establish a partnership in which they work together to find out what may work among the options for each individual patient.

Patient systems are different and each patient must be seen as unique when it comes to discovering what works and what does not work for each patient presenting with neuropathic pain. 


Conversely, it is not enough to treat these symptoms of a neuropathy.

Doctors are become better at conducting the testing necessary in attempts to no only look for a cause, but to identify the TYPE of the neuropathy.

If the cause is unknown, the worst possible diagnosis is a diagnosis of ‘Idiopathic’ Neuropathy. (click on link to read article)

For many doctors now tell us, the use of differential diagnosis (subtle differences between neuropathies) may point to a possible cause. (See Refs: 1 & 3) Thus the other important goal is to identify the type of neuropathy as according to Dr. Norman Latov and other experts, this often points to a suggested cause!

To see How Neuropathic Pain is treated.


#1 Norman Latov, MD, PhD, FAAN Peripheral Neuropathy: When the Numbness, Weakness and Pain Won’t Stop, ANN Press, 2007

#2 Mims Cushing, You Can Cope With Peripheral Neuropathy (Ideas from neuropathy patients), with Dr. Norman Latov, DEMOS Publishing, 2009

#3 Textbook of Peripheral Neuropathy, Peter D Donofrio, MD, Editor, Professor of Neuropathy, Chief of Neuromuscular Section, Vanderbilt University Medical Center, Nashville, TN Published by DEMOS Medical, 2012.

#4 “Journal of the Peripheral Nervous System” published by the Peripheral Nerve Society.

About the Author

Col Richardson has suffered with severe neuropathy for over 45 years. A 27 year military veteran and veteran of the Vietnam War, he was diagnosed with a progressive chronic peripheral neuropathy resulting in severe disability. This diagnosis has been confirmed as due to exposure to Agent Orange. It was not until 2010, 42 years after his exposure to Agent Orange, that his diagnosis was recognized by Veterans Affairs as service connected.

Thursday, 1 October 2015

The Causes Of Neuropathy

Today's post is another useful neuropathy article from (see link below). In this case it looks at the causes of neuropathy; something which your doctors may have trouble explaining to you and certainly something that is difficult to confirm. Even if you have HIV and diabetes and drink more than you should (some of the commonest neuropathy causes) your particular neuropathy could still be caused by something else, so perhaps it's not surprising that doctors and neurologists have problems establishing causes. It's also entirely possible that your neuropathy may be idiopathic (no known cause), which muddies the waters considerably. However, the causes of neuropathy and nerve damage are known - it may just be difficult attaching one to your individual case. This article looks at those causes and you can be more or less sure that your problems arise from one of the ones mentioned here.

What causes peripheral neuropathy?
Last updated August 5, 2014

Peripheral neuropathy may be either inherited or acquired. Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, and vascular and metabolic disorders. Acquired peripheral neuropathies are grouped into three broad categories: those caused by systemic disease, those caused by trauma from external agents, and those caused by infections or autoimmune disorders affecting nerve tissue. One example of an acquired peripheral neuropathy is trigeminal neuralgia (also known as tic douloureux), in which damage to the trigeminal nerve (the large nerve of the head and face) causes episodic attacks of excruciating, lightning-like pain on one side of the face. In some cases, the cause is an earlier viral infection, pressure on the nerve from a tumor or swollen blood vessel, or, infrequently, multiple sclerosis. In many cases, however, a specific cause cannot be identified. Doctors usually refer to neuropathies with no known cause as idiopathic neuropathies.

Physical injury (trauma)
is the most common cause of injury to a nerve. Injury or sudden trauma, such as from automobile accidents, falls, and sports-related activities, can cause nerves to be partially or completely severed, crushed, compressed, or stretched, sometimes so forcefully that they are partially or completely detached from the spinal cord. Less dramatic traumas also can cause serious nerve damage. Broken or dislocated bones can exert damaging pressure on neighboring nerves, and slipped disks between vertebrae can compress nerve fibers where they emerge from the spinal cord.

Systemic diseases
— disorders that affect the entire body —often cause peripheral neuropathy. These disorders may include: Metabolic and endocrine disorders. Nerve tissues are highly vulnerable to damage from diseases that impair the body's ability to transform nutrients into energy, process waste products, or manufacture the substances that make up living tissue. Diabetes mellitus, characterized by chronically high blood glucose levels, is a leading cause of peripheral neuropathy in the United States. About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage.

Kidney disorders can lead to abnormally high amounts of toxic substances in the blood that can severely damage nerve tissue. A majority of patients who require dialysis because of kidney failure develop polyneuropathy. Some liver diseases also lead to neuropathies as a result of chemical imbalances.

Hormonal imbalances
can disturb normal metabolic processes and cause neuropathies. For example, an underproduction of thyroid hormones slows metabolism, leading to fluid retention and swollen tissues that can exert pressure on peripheral nerves. Overproduction of growth hormone can lead to acromegaly, a condition characterized by the abnormal enlargement of many parts of the skeleton, including the joints. Nerves running through these affected joints often become entrapped.

Vitamin deficiencies and alcoholism
can cause widespread damage to nerve tissue. Vitamins E, B1, B6, B12, and niacin are essential to healthy nerve function. Thiamine deficiency, in particular, is common among people with alcoholism because they often also have poor dietary habits. Thiamine deficiency can cause a painful neuropathy of the extremities. Some researchers believe that excessive alcohol consumption may, in itself, contribute directly to nerve damage, a condition referred to as alcoholic neuropathy.

Vascular damage and blood diseases
can decrease oxygen supply to the peripheral nerves and quickly lead to serious damage to or death of nerve tissues, much as a sudden lack of oxygen to the brain can cause a stroke. Diabetes frequently leads to blood vessel constriction. Various forms of vasculitis (blood vessel inflammation) frequently cause vessel walls to harden, thicken, and develop scar tissue, decreasing their diameter and impeding blood flow. This category of nerve damage, in which isolated nerves in different areas are damaged, is called mononeuropathy multiplex or multifocal mononeuropathy.

Connective tissue disorders and chronic inflammation can cause direct and indirect nerve damage. When the multiple layers of protective tissue surrounding nerves become inflamed, the inflammation can spread directly into nerve fibers. Chronic inflammation also leads to the progressive destruction of connective tissue, making nerve fibers more vulnerable to compression injuries and infections. Joints can become inflamed and swollen and entrap nerves, causing pain.

Cancers and benign tumors
can infiltrate or exert damaging pressure on nerve fibers. Tumors also can arise directly from nerve tissue cells. Widespread polyneuropathy is often associated with the neurofibromatoses, genetic diseases in which multiple benign tumors grow on nerve tissue. Neuromas, benign masses of overgrown nerve tissue that can develop after any penetrating injury that severs nerve fibers, generate very intense pain signals and sometimes engulf neighboring nerves, leading to further damage and even greater pain. Neuroma formation can be one element of a more widespread neuropathic pain condition called complex regional pain syndrome or reflex sympathetic dystrophy syndrome, which can be caused by traumatic injuries or surgical trauma. Paraneoplastic syndromes, a group of rare degenerative disorders that are triggered by a person's immune system response to a cancerous tumor, also can indirectly cause widespread nerve damage.

Repetitive stress frequently leads to entrapment neuropathies, a special category of compression injury. Cumulative damage can result from repetitive, forceful, awkward activities that require flexing of any group of joints for prolonged periods. The resulting irritation may cause ligaments, tendons, and muscles to become inflamed and swollen, constricting the narrow passageways through which some nerves pass. These injuries become more frequent during pregnancy, probably because weight gain and fluid retention also constrict nerve passageways.

Toxins can also cause peripheral nerve damage. People who are exposed to heavy metals (arsenic, lead, mercury, thallium), industrial drugs, or environmental toxins frequently develop neuropathy. Certain anticancer drugs, anticonvulsants, antiviral agents, and antibiotics have side effects that can include peripheral nerve damage, thus limiting their long-term use.

Infections and autoimmune disorders can cause peripheral neuropathy. Viruses and bacteria that can attack nerve tissues include herpes varicella-zoster (shingles), Epstein-Barr virus, cytomegalovirus, and herpes simplex-members of the large family of human herpes viruses. These viruses severely damage sensory nerves, causing attacks of sharp, lightning-like pain. Postherpetic neuralgia often occurs after an attack of shingles and can be particularly painful.

The human immunodeficiency virus (HIV), which causes AIDS, also causes extensive damage to the central and peripheral nervous systems. The virus can cause several different forms of neuropathy, each strongly associated with a specific stage of active immunodeficiency disease. A rapidly progressive, painful polyneuropathy affecting the feet and hands is often the first clinically apparent sign of HIV infection.

Lyme disease, diphtheria, and leprosy are bacterial diseases characterized by extensive peripheral nerve damage. Diphtheria and leprosy are now rare in the United States, but Lyme disease is on the rise. It can cause a wide range of neuropathic disorders, including a rapidly developing, painful polyneuropathy, often within a few weeks after initial infection by a tick bite.

Viral and bacterial infection
s can also cause indirect nerve damage by provoking conditions referred to as autoimmune disorders, in which specialized cells and antibodies of the immune system attack the body's own tissues. These attacks typically cause destruction of the nerve's myelin sheath or axon (the long fiber that extends out from the main nerve cell body).

Some neuropathies are caused by inflammation resulting from immune system activities rather than from direct damage by infectious organisms. Inflammatory neuropathies can develop quickly or slowly, and chronic forms can exhibit a pattern of alternating remission and relapse. Acute inflammatory demyelinating neuropathy, better known as Guillain-Barré syndrome, can damage motor, sensory, and autonomic nerve fibers. Most people recover from this syndrome although severe cases can be life threatening. Chronic inflammatory demyelinating polyneuropathy (CIDP), generally less dangerous, usually damages sensory and motor nerves, leaving autonomic nerves intact. Multifocal motor neuropathy is a form of inflammatory neuropathy that affects motor nerves exclusively; it may be chronic or acute.

Inherited forms
of peripheral neuropathy are caused by inborn mistakes in the genetic code or by new genetic mutations. Some genetic errors lead to mild neuropathies with symptoms that begin in early adulthood and result in little, if any, significant impairment. More severe hereditary neuropathies often appear in infancy or childhood.

The most common inherited neuropathies are a group of disorders collectively referred to as Charcot-Marie-Tooth disease. These neuropathies result from flaws in genes responsible for manufacturing neurons or the myelin sheath. Hallmarks of typical Charcot-Marie-Tooth disease include extreme weakening and wasting of muscles in the lower legs and feet, gait abnormalities, loss of tendon reflexes, and numbness in the lower limbs.

Wednesday, 30 September 2015

Common Testing Tools For Neuropathy

Today's post from (see link below) is another article highlighting the commonest diagnosis/testing tools with regard to neuropathy. This is especially useful for people who have been told they probably have neuropathy but must undergo certain tests to establish that. Hopefully, your doctor will listen carefully to your story and conclude that there's enough evidence to diagnose nerve damage but many doctors (and insurance companies) require more than that - scientific proof. Unfortunately, even these tests can't prove neuropathy 100% but they are an accepted part of the process you go through. By the way, you're entitled to ask your doctor why you're having certain tests and not others. That may be perfectly reasonable but you deserve an explanation as to why.

How is neuropathic pain diagnosed?
Last updated August 5, 2014
Diagnosing neuropathy is often difficult because the symptoms are highly variable. A thorough neurological examination is usually required and involves taking an extensive patient history (including the patient’s symptoms, work environment, social habits, exposure to any toxins, history of alcoholism, risk of HIV or other infectious disease, and family history of neurological disease), performing tests that may identify the cause of the neuropathic disorder, and conducting tests to determine the extent and type of nerve damage.

A general physical examination and related tests may reveal the presence of a systemic disease causing nerve damage. Blood tests can detect diabetes, vitamin deficiencies, liver or kidney dysfunction, other metabolic disorders, and signs of abnormal immune system activity. An examination of cerebrospinal fluid that surrounds the brain and spinal cord can reveal abnormal antibodies associated with neuropathy. More specialized tests may reveal other blood or cardiovascular diseases, connective tissue disorders, or malignancies. Tests of muscle strength, as well as evidence of cramps or fasciculations, indicate motor fiber involvement. Evaluation of a patient’s ability to register vibration, light touch, body position, temperature, and pain reveals sensory nerve damage and may indicate whether small or large sensory nerve fibers are affected.

Based on the results of the neurological exam, physical exam, patient history, and any previous screening or testing, additional testing may be ordered to help determine the nature and extent of the neuropathy.

Computed tomography, or CT scan,
is a noninvasive, painless process used to produce rapid, clear two-dimensional images of organs, bones, and tissues. X-rays are passed through the body at various angles and are detected by a computerized scanner. The data is processed and displayed as cross-sectional images, or "slices," of the internal structure of the body or organ. Neurological CT scans can detect bone and vascular irregularities, certain brain tumors and cysts, herniated disks, encephalitis, spinal stenosis (narrowing of the spinal canal), and other disorders.

Magnetic resonance imaging (MRI)
can examine muscle quality and size, detect any fatty replacement of muscle tissue, and determine whether a nerve fiber has sustained compression damage. The MRI equipment creates a strong magnetic field around the body. Radio waves are then passed through the body to trigger a resonance signal that can be detected at different angles within the body. A computer processes this resonance into either a three-dimensional picture or a two-dimensional "slice" of the scanned area.

Electromyography (EMG) involves inserting a fine needle into a muscle to compare the amount of electrical activity present when muscles are at rest and when they contract. EMG tests can help differentiate between muscle and nerve disorders.

Nerve conduction velocity (NCV) tests can precisely measure the degree of damage in larger nerve fibers, revealing whether symptoms are being caused by degeneration of the myelin sheath or the axon. During this test, a probe electrically stimulates a nerve fiber, which responds by generating its own electrical impulse. An electrode placed further along the nerve’s pathway measures the speed of impulse transmission along the axon. Slow transmission rates and impulse blockage tend to indicate damage to the myelin sheath, while a reduction in the strength of impulses is a sign of axonal degeneration.

Nerve biopsy involves removing and examining a sample of nerve tissue, most often from the lower leg. Although this test can provide valuable information about the degree of nerve damage, it is an invasive procedure that is difficult to perform and may itself cause neuropathic side effects. Many experts do not believe that a biopsy is always needed for diagnosis.

Skin biopsy
is a test in which doctors remove a thin skin sample and examine nerve fiber endings. This test offers some unique advantages over NCV tests and nerve biopsy. Unlike NCV, it can reveal damage present in smaller fibers; in contrast to conventional nerve biopsy, skin biopsy is less invasive, has fewer side effects, and is easier to perform.

Tuesday, 29 September 2015

Less Painful Neuropathy Exercise Suggestions

Today's short post from (see link below) suggests three forms of exercise which may help relieve the symptoms of neuropathy. It's a somewhat simplistic article but for those who realise they should be exercising but hate the idea of a gym, or painful resistance exercises, these three options may seem like viable options.

Three Neuropathy-Friendly Exercises to Try 
These Exercises Provide Pain-Free Health Benefits
By Ginger Vieira

Neuropathy can present a variety of challenges, because in neuropathy, the nerve-endings of your feet, toes, and fingers can cause a burning sensation that is sometimes very painful. Meanwhile, people with diabetes are encouraged to exercise regularly to help lower blood sugars — but exercise might be one of the last things you want to do when the bottom of your feet are burning and tingling!

Fortunately, not all exercises require repetitive movement or impact on your feet. Here are three types of exercise you can participate in fully without exacerbating your neuropathy:

Even if you're not the most agile fish in the sea, joining a water aerobics class or even simply treading water for 15 t0 20 minutes several days a week can exercise your heart and lower blood sugars. It's also great for building and maintaining lean muscle mass. If neuropathy is keeping you off your feet, it's definitely time for a pool membership! Bonus: Look for a place with an outdoor pool for summer activity; swimming in the sunshine might make you even more likely to work out.

Tai Chi. While walking can be a great way to de-stress and unwind at the end of a day, it can be pretty painful with neuropathy. Instead, you can find some of those same gentle benefits from a Tai Chi class! There will be no repetitive impact on your feet, it encourages de-stressing and mindfulness and you'll be surprised to hear that this gentle form of exercise can definitely get your heart-rate up and even get you to sweat a little. Give it a try!

Cardio Machines. While many aspects of a typical gym workout might not be suitable for a person dealing with burning feet and fingers, cardio machines such as a spin bike, reclined bike, elliptical, and cross-trainer (very similar to the elliptical) provide incredible ways to get your heart-rate up without any major impact on your feet or gripping of your hands.

Diabetic neuropathy does not have to leave you stranded at home on the couch. In order to prevent further progression of your neuropathy, exercise and lower blood sugars are crucial. Dip your toes in the water (so to speak) of one of these types of exercise, and find one you enjoy!

Monday, 28 September 2015

Neuropathy Resources For The Neuropathy Patient

Today's post from (see link below) is a very long but useful Canadian list of world-wide resources for people living with neuropathy. Books, videos, websites, there's something for everyone here and the site as a whole (produced by DeGroote Pain HQ) may well be something you wish to get involved with and help develop. Certainly worth browsing through and maybe visiting the site's home page. 
Resources: Rate and review resources on neuropathic pain. Share your thoughts on books, websites and more.

McMaster University

Pain-QuILT is a web- and mobile-based solution to transform the assessment and tracking of pain s...

Neuropathic Pain: Causes, Management and Unders...
Cory Toth, Dwight Moulin

January 2014 book for professionals written by an international team of experts in the field and ...

Miniatlas Neuropathic Pain

App for iPhone and iPad designed for physicians with images related to neuropathic pain.

Nociceptors - An Introduction to Pain
Armando Hasudungan

Detailed YouTube video with illustrated overview of pain pathways.

Pain: Nerves on Fire. Changing Neuropathic Pain
Jay Tracy

Accessible, user-friendly book described as a 'compassionate, educational book'.

PAIN - It's Not All in Your Head : The Tests Do...
Jay Tracy

Pain - It's Not All in Your Head : The Tests Don't Show Everything can help you to understand wha...

Peripheral Neuropathy & Neuropathic Pain: Into ...
Gerard Said

Given the almost explosive increase in diabetes predicted over the coming years and the high inci...

Managing Chronic Pain: A Cognitive-Behavioral T...
John D. Otis

By presenting the basic, proven-effective CBT methods used in each treatment this guide can be us...

Managing Pain Before It Manages You, Third Edition
Margaret A. Caudill MD PhD MPH

Straightforward, hands-on guide provides detailed information plus step-by-step techniques, activ...

The Mindfulness Solution to Pain: Step-by-Step ...
Dr. Jackie Gardner-Nix

This book offers a new treatment approach, mindfulness-based chronic pain management, that helps ...

Neuropathic Pain
Michael Bennett

Pocketbook covering the basics of diagnosis and management of neuropathic pain.

The Pain Chronicles: Cures, Myths, Mysteries, P...
Melanie Thernstrom

An overview of the cultural perception of pain throughout the ages, mixed with the author's perso...

PAINS Project
The Pain Action Alliance to Implement a National Strategy (PAINS)

PAINS is an American consortium of leaders working in professional societies, patient advocacy or...

The Pain Community

The Pain Community’s overarching goal is to improve the overall health, wellbeing and quality of ...

Pain Concern

Pain Concern provides information to people in pain throughout the UK. They have also worked with...

Neuropathic Pain

An overview of neuropathic pain, it's causes and treatments. Some information is specific to the UK.

Neuropathic Pain

An overview of neuropathic pain, it's causes, mechanisms and treatments.

Peripheral neuropathy

An overview of peripheral neuropathy, including: symptoms, causes, risk factors, complications, t...

The Nerve Damage of Diabetes

An overview of diabetic neuropathy, it's causes, it's prevalence and causes.

Peripheral Nerve Disorders

An overview of peripheral nerve disorders and associated clinical trials, genetics, journal artic...

Neuropathic Pain
American Chronic Pain Association

Basic overview of neuropathic pain and a number of useful worksheets and logs that help to monito...


An overview of singles and associated clinical trials, genetics, journal articles and patient han...

Nerve Man
American Chronic Pain Association

Track your pain symptoms on this interactive 'Nerve Man' map. You can also print it out for your ...

Diabetic Peripheral Neuropathy Pain Map
American Chronic Pain Association

An interactive tool for people with diabetic peripheral neuropathy. This tool helps you map out p...

Peripheral Neuropathy Caused by Chemotherapy
American Cancer Society

This PDF is a summary of chemotherapy-induced peripheral neuropathy including symptoms, causes an...

Opioid Induced Constipation Conversation Guide
American Chronic Pain Association

This PDF is a helpful worksheet to help track and monitor opioid induced constipation. This will ...

Nerve conduction

This video explains how both the central nervous and peripheral nervous systems work within your ...

Guillain-Barré Syndrome Fact Sheet
National Institute of Neurological Disorders and Stroke

An overview of the Guillain-Barré syndrome which includes diagnosis, treatment and the long term ...

Neurological Diagnostic Tests and Procedures
National Institute of Neurological Disorders and Stroke

An overview of diagnostic tests and procedures to identify different neurological conditions.

Pain: Learning to Live Without It
David Corey

This self-help book is based on Corey’s work at Ontario’s first multidisciplinary facility dedica...

Coping with Chronic Pain: A Guide to Patient Se...
Richard W. Hanson, PhD

Stressing self-management, Drs. Hanson and Gerber present a comprehensive description of an integ...

Chronic Pain for Dummies
Stuart Kassan, Charles J. Vierck, Elizabeth Vierck

This reassuring, practical guide helps you understand what causes pain and how to manage it with ...

McMaster University

PAIN+ shares the most relevant and newsworthy research news around the topic of pain.

The Official Patient's Sourcebook on Syringomyelia
Icon Health Publications

This sourcebook has been created for patients who have decided to make education and research an ...

Mayo Clinic

Overview of the condition, causes, treatments and coping techniques.

Tell-Tale Brain
V. S. Ramachandran

Storytelling meets neuroscience to discuss phantom limbs, synaesthesia and autism.

Positive Options for Reflex Sympathetic Dystrop...
Elena Juris

This book provides self-help techniques, focusing on complementary therapies and holistic strateg...

RSD in Me: A Patient and Caretaker Guide to Ref...
Barby Ingle

This book is written by a pain patient based on her experiences in dealing with pain and the heal...

The Sjogren's Book
Daniel J. Wallace

The Sjogren's Book provides readers with the best medical and practical information on this disor...

The First Year: Lupus: An Essential Guide for t...
Nancy C. Hanger

Starting with the day of diagnosis, Hanger provides vital information about the nature of lupus, ...

Pain BC
Pain BC

Pain BC is a collaborative non-profit organization made up of people in pain, health care provide...

Hereditary Neuropathy Foundation
Hereditary Neuropathy Foundation

The Hereditary Neuropathy Foundation's mission is to increase awareness and accurate diagnosis of...

Arlene on the Scene
Marybeth Sidoti Caldarone

A children's book that helps kids to better understand those living with CMT.

Pain Waves Radio
Pain BC

Pain Waves Radio is a call-in internet radio show where listeners can listen to, and interact wit...

Chronic Pain Association of Canada
Chronic Pain Association of Canada

The Chronic Pain Association of Canada is a not-for-profit consumer Association.

Promoting Awareness of RSD and CRPS In Canada

An organization focused on education around Reflex Sympathetic Dystrophy.

What is CMT?
Hereditary Neuropathy Foundation

A personal story about life after being diagnosed with Charcot-Marie-Tooth disease (CMT).

CMT Patient Inspire Community
Hereditary Neuropathy Foundation

An online community for those dealing with Charcot-Marie-Tooth disease.

Global Year Against Neuropathic Pain
International Association for the Study of Pain (IASP)

IASP sponsors and promotes the Global Year Against Pain, a yearlong initiative designed to raise ...

Numb Toes and Aching Soles: Coping with Periphe...
John A. Senneff

Numb Toes and Aching Soles written to present the patient's view of neuropathic pain. Incorporate...

Peripheral Neuropathy: Nine Simple Steps To Red...
Dean Lewis

Dean Lewis shares his experience with severe peripheral neuropathy, multi-organ system failure an...

Trigeminal Neuralgia Association of Canada
Trigeminal Neuralgia Association of Canada

The Trigeminal Neuralgia Association of Canada (TNAC) is the only registered charity in Canada th...