Friday, 29 April 2016

Opioids Versus Non-Opioids For Neuropathic Pain: Debunk The Myth

Today's excellent post from painnewsnetwork.org is a sensible look at the whole issue of prescribing opioids vs non-opioid medications for chronic pain (and especially chronic nerve pain) patients. It debunks the myth that chronic pain patients, willingly or unwillingly are on a rapid path to becoming junkies and/or criminals and its most important quote may well be: “Does the CDC really believe that a pain patient on long term opiates hasn't already tried everything else possible?” The crux of the matter is this: do we abandon chronic pain patients to a life of misery because we have a moral, or political issue with the very drugs that will relieve them of that pain? They have already been through the medication mill of trying this and that before all parties reach the conclusion that there's simply nothing else that will tackle their pain. Do you seriously think that neuropathy pain patients unanimously shout: 'Oh goodie...we can begin taking opioids...yippee'!! The powers that be need to tackle the criminal problem behind commercial abuse before taking criminal actions to inflict further pain on long-suffering patients!


Patients Say Non-Opioid Therapies Often Don’t Work  
By Pat Anson, EditorOctober 15, 2015

Pain treatments recommended by the Centers for Disease Control and Prevention (CDC) as alternatives to opioids often do not work and are usually not covered by insurance, according to a large survey of pain patients. Many also believe the CDC’s opioid prescribing guidelines discriminate against pain patients.

Over 2,000 acute and chronic pain patients in the U.S. participated in the online survey by Pain News Network and the Power of Pain Foundation. Most said they currently take an opioid pain medication.

When asked if they think pain patients are being discriminated against by the CDC guidelines and other government regulations, 95% said they “agree” or “strongly agree.” Only 2% said they disagree or strongly disagree.

The draft guidelines released last month by the CDC recommend “non-pharmacological therapy” and “non-opioid” pain relievers as preferred treatments for chronic non-cancer pain. Smaller doses and quantities of opioids are recommended for patients in acute or chronic pain. A complete list of the guidelines can be found here.

“Many non-pharmacologic therapies, including exercise therapy, weight loss, and psychological therapies such as CBT (cognitive behavioral therapy) can ameliorate chronic pain," the CDC states in internal briefing documents obtain by PNN.

“Several nonopioid pharmacologic therapies (including acetaminophen, NSAIDs, and selected antidepressants and anticonvulsants) are effective for chronic pain. In particular, acetaminophen and NSAIDs can be useful for arthritis and low back pain, and antidepressants such as tricyclics and SNRIs as well as selected anticonvulsants are effective in neuropathic pain conditions and in fibromyalgia.”

Most patients who were surveyed said they had already tried many of these non-opioid treatments and had mixed results, at best.

“Does the CDC really believe that a pain patient on long term opiates hasn't already tried everything else possible?” asked one patient.

“The CDC says don't do something but comes up with NO viable, realistic alternatives. Tylenol, etc., are unrealistic. Exercise is unrealistic when you are in too much pain to move! “ said another patient.

“Anti-anxiety meds are just as addictive. Over the counter pain medicines are not strong enough to cover the pain in a patient with chronic pain. And there are hundreds of pain patients who can't take NSAIDs because of an allergic reaction. Same thing with steroids,” wrote another.

When asked if exercise, weight loss or cognitive behavioral therapy had helped relieve their pain, only about a third of the patients surveyed said they “helped a lot” or “helped a little.” Nearly two-thirds said they “did not help at all.”

Over half said non-opioid medications such as Lyrica, Cymbalta, Neurontin, anti-depressants and anti-anxiety medications “did not help at all.”

Over the counter pain relievers such as acetaminophen and NSAIDs were even less helpful. Three out of four patients said they “did not help at all.”

“We must be mindful of the treatment options that the CDC guidelines stress over opioids,” said Barby Ingle, president of the Power of Pain Foundation. “For instance in my case, taking NSAIDS for an extended period (a little over 1 year) caused internal bleeding and ulcers which lead to being hospitalized, a surgical procedure, and months of home nursing and physical therapy that could have been avoided.

“It is important to include a multi-disciplinary approach to care. We have to use non-pharmacological treatments and non-opioid medications in conjunction with more traditional treatments. Using chiropractic care, nutrition, good dental health, better posture, meditation, aqua therapy, etc., can go a long way in the management of chronic pain conditions.”

But the survey found that many of those treatments are simply out of reach for pain patients because they’re not covered by insurance.

When asked if their health insurance covered non-pharmacological treatments such as acupuncture, massage and chiropractic therapy, only 7% said their insurance covered most or all of those therapies.

About a third said their insurance “covers only some and for a limited number of treatments” and over half said their insurance does not cover those treatments. About 4% do not have health insurance.

“I tried acupuncture and massage, paying out of my pocket, but neither helped. In fact, they hurt. I tried Lyrica, Savella, and Cymbalta. No luck. I do warm water aerobics three days a week WHEN I CAN TAKE MY OPIATES FIRST,” wrote one patient.

Although the CDC didn’t even raise the subject of medical marijuana in its guidelines, many patients volunteered that they were using marijuana for pain relief and that it worked for them.

“Alternative medicine is needed. I am a huge advocate of medicinal marijuana, in addition to opioids to treat my disease,” wrote a patient who suffers from CRPS (Chronic Regional Pain Syndrome).

“If cannabis was legal and accessible, it would greatly lessen the need for prescription pain medication,” said another patient.

“I should be able to get the proper medical marijuana legally. I have tried it from a friend and it helps tremendously. However, I will not purchase it because it is illegal. I pray every day I can get it someday,” said a patient who suffers from lupus, arthritis and other chronic conditions.

The survey found patients were evenly divided on whether they should be required to submit to urine drugs tests for both prescribed medications and illegal drugs.

"In order to receive my monthly pain medication, I must submit to a urine screen and a pill count each and every month. I must (whether they work or not) agree to have steroid injections every few months. While I don't have any problem to submitting to urine screenings or pill counts, I do not like having injections that provide no help. I am trapped playing this game,” said a patient.

“99.9% of pain patients are responsible adults but are treated like toddlers who need constant supervision. Pain patients are sicker, fatter, and poorer because they are pumped full of chemicals and steroids. Forced to be experimental guinea pigs or forced to suffer if they say NO,” said another patient.

"As both a chronic pain patient and a provider I get to view this issue from multiple perspectives. Of course opioids aren't the first line treatment for chronic pain, and when they are used they shouldn't be the only treatment. They are one part of a larger toolkit for managing chronic pain," wrote a registered nurse practitioner.

"There are many fortunate people who are able to manage their pain without medication, or even recover from pain completely using some of the wonderful new interventions we now have available. But there are large numbers of patients out there who have tried all the other medications and dietary changes and injections and PT (physical therapy) modalities and mindfulness. And they are still left with pain that only responds to opiates."

For a complete look at all of the survey result, visit the "CDC Survey Results" tab at the top of this page or click here.

http://www.painnewsnetwork.org/stories/2015/10/14/patients-say-non-opioid-therapies-often-dont-work
 

Thursday, 28 April 2016

Why Neuropathic Pain Hurts (Vid)

Today's YouTube video is a Ted Talk video about why pain hurts and this applies to neuropathic pain too. In fact, you'll learn more about how your nervous system responds to and delivers pain signals than from a host of text-only articles. There's a good chance you'll have a giggle too (something never to be turned down) because this guy is funny and knows how to engage an audience. If he can engage an audience of neuropathic patients (that's you, the readers), he's a freaking genius! he may use the word 'groovy' a bit too much but you'll forgive him. Give it a try, you're going to learn something about your brain and the nervous system for sure. Definitely worth 15 minutes of your time.

TEDxAdelaide - Lorimer Moseley - Why Things Hurt


TEDx Talks Uploaded on 21 Nov 2011 Why do we hurt?

Do we actually experience pain, or is it merely illusion?

In this video, Lorimer Moseley explores these questions, and position the pain that we feel as our bodies' way of protecting us from damaging tissues further. He also looks at what this might mean for those who suffer from chronic pain.




https://www.youtube.com/watch?v=gwd-wLdIHjs#t=8s

Wednesday, 27 April 2016

Neuropathy: When A Picture Says It Better

Have you ever wished you just had the right image to send to someone who'd just sent you yet another e-mail asking how you are and noting how well you looked the last time they saw you? You need the image that says more than a thousand words right? Now neuropathy is not normally a laughing matter but there are a few 'lighter' images out there you might want to send, without any explanatory text, or long explanations. Given the choice between strangling your well-meaning friends, or firing a humour-bullet...one of these may fit the bill. If you know of more...let us know..they just might make someone's day a tiny bit better.



I've Got Neuropathy...Deal With It!
Dave R April 2016




















 
www.neuropathyandhiv.blogspot.com

Tuesday, 26 April 2016

Why Does Neuropathy Make Us So Damned Tired?

Today's post from neuropathyjournal.org (see link below) tries to explain why many people living with neuropathy (especially autonomic neuropathy) become progressively more tired as the years go on. There's no easy answer and there can also be many other reasons why fatigue and weakness start to affect our lives so strongly but for many people, along with degradation of nerve fibres, comes muscle and mental fatigue and it can be very difficult to live with. LtCol Richardson does a good job of explaining the process but also offers some helpful tips to help us cope with and improve our tiredness levels. Worth a read.

Fatigue in Peripheral Neuropathy 
By LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS9

Unfortunately fatigue is a central part of many neuropathies and especially the immune mediated neuropathies. It is central to many other chronic illnesses that affect the body’s immune system. The causes are often complex and many.

Dr. Scott Berman, in his book Coping with Chronic Neuropathy notes in chapter VIII “Dealing with Fatigue and Insomnia” that this symptom is one of the most difficult and challenging for the neuropathy patient. Dr. Berman is a Psychiatrist, a member of the Board of Directors of the NSN and a Medical Advisor. Scott lives with untreatable CIDP.

He notes:

…that in one study looking at fatigue in autoimmune neuropathy 80% of 113 patients had severe fatigue. The fatigue was independent of motor or sensory symptoms and was rated as one of the top three most disabling symptoms. (“Fatigue in Immune-Mediated Polyneuropathies,” Neurology 53: 8 November 1999, I.S.J. Merkies, et al).

For decades in living with untreated Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Autonomic Neuropathy (AN) and Progressive Polyneuropathy due to exposure to Agent Orange in Vietnam, I can attest to the facts noted above. While other major symptoms respond to treatment with Immune Globulin (IVIg), the symptom of severe fatigue continues as one of the symptoms that responds only temporarily to the infusions followed by several days of total fatigue following infusion and then with some lessening until the next infusion.

Dr. Norman Latov in his book “Coping with Peripheral Neuropathy”, states what I have heard other neurologists share, that the fatigue we feel, first appearing as weakness, increases as the weakness (or damage) of motor nerves expands. At this point with only a few muscles doing the whole job of lifting a leg or arm or carrying on autonomic functions, the body becomes weak and eventually extreme fatigue occurs. Think of a young child who tires easily because the muscles and nerves are not fully developed and only a few underdeveloped nerves or muscles are doing the job of moving!

On the other hand, to state the obvious, pain in some neuropathies does not help us sleep. Neuropathy patients must seek medical help in finding medications or other options which works for them. The medical practitioners have increased their knowledge in recognizing the reality of neuropathic pain. These strange symptoms from damaged peripheral nerves are present in sensory neuropathies. It is become less common for these patients to be told that it is all in their ‘head’ and are finally getting the help they need.

Impact on family and friends:

Families and friends, as we all have learned, may not understand this reality since we “look so good” and may even believe/suggest that you are just lazy or unmotivated or worse. The best thing you can do for them is to have them watch the DVD Coping with Chronic Neuropathy which will be an education about the impact of any neuropathy on our lives.

Educating yourself about neuropathy:

At any rate, fatigue is something we struggle with every day and often regulates/determines our daily activities.

While fatigue in neuropathy and other chronic illnesses is not fully understood by the experts, from a practical standpoint, here is what I have learned to do or not do in coping with fatigue. If you have found other things that help, send us a message and we will add it to the list.

1. DO NOT think negatively about fatigue, thus feeling guilty about your fatigue. Go take a nap! (See DVD “Coping with Chronic Neuropathy”).

2. Learn when your “fatigue” periods occur, as these often establish a pattern at certain times of the day. Then go lay down and stop moaning about it, as it is what it is until it isn’t.

3. I have learned that you do not even have to actually “sleep”, but just allowing your body to rest/stop for an hour takes care of the exhaustion as the body recovers. But whatever works for you, do it without guilt or apology.

4. For nighttime, have a standard bedtime routine in preparing for sleep that tells your body that it is time to sleep.

5. Do not eat a large meal just before bedtime or take a stimulant that keeps you awake or might interfere with sound sleep (i.e. caffeine, for some alcohol).

6. Do consider drinking a glass of milk as for many this encourages the body to sleep.

7. Do consider one of those special recordings of quiet music or rain falling or similar if it helps.

8. Do consider using a ticking clock if that helps. As a child in the 40s I got my best sleep on the floor in front of the big radio in the living room listening to Dragnet or was it the Lone Ranger, maybe the Big Story. Today most TV programs have the same effect, sleep! Pun intended.

9. Muscle spasms and/or restless leg can make sleeping difficult and rob you of needed sleep. Speak to your doctor and have tests done for calcium, salt, potassium levels and other deficiencies which can make it difficult for muscles to work properly. This is especially true if you are on a diuretic which can empty your body of needed minerals. Getting up and having a glass of orange juice worked for my mother and works for me. If the lack of something is not the problem, have the doctor find out what may be causing these muscle problems. There are also medications to help prevent these muscle spasms and cramps for they are very common in neuropathy.

10. I have found that if I wake up with my mind creating solutions to an issue or writing poetry (happens) and not able to sleep, I go to another room or go do some work on my computer (write out the solution or poetry) until I begin to feel sleepy again. It works for me.

11. For some insomnia is a real curse. There are medications that one can use as Dr. Scott Berman mentions in his book, so speak to your doctor. Frankly, I would work on natural solutions first and be creative to see what works for you. But if ALL else fails these medications may help and be a heaven sent blessing.

12. My Nurse told me that many patients with this effect of a chronic illness, take Folic Acid and it is known to help. So you many want to speak to your doctor in this regard.

13. Dr. Erika Schwartz, M.D. (national leading expert on wellness) suggests that patients with extreme fatigue have the physician check your basal metabolic rate and your thyroid function. Low thyroid is a common cause of fatigue. So speak to your doctor in this regard.

14. So what do you do or not do that helps? Send it to us and we will enter it here!

DISCLAIMER: The information in this article and on the website or the links or in the guidance provided is intended to be educational and informative and not medically prescriptive or diagnostic. All patients are encouraged to consult with their own medical doctor when considering any this information.

Copyright – 2014-2015 Network for Neuropathy Support, Inc., 501c3, dba as Neuropathy Support Network. This article or its contents may be reprinted or published for educational purposes as long as the printing or publishing is not for profit and acknowledgement is granted the author.

https://neuropathyjournal.org/fatigue-in-peripheral-neuropathy/

Monday, 25 April 2016

Lyrica Once Again Shown To Be Ineffective

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

eellis@vancouversun.com

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

Sunday, 24 April 2016

Fibromyalgia Vs Neuropathy: The Argument Goes On

Today's post from consultqd.clevelandclinic.org (see link below) highlights something that has seemed pretty obvious to both neuropathy and fibromyalgia patients for a long time - both conditions are neurological in origin and both are treated by much the same medications, with the same lack of success. Basically, fibromyalgia is a rheumatic condition characterized by muscular or musculoskeletal pain with stiffness and localized sensitivity and tenderness at specific points on the body. Patients have highly sensitised nerves that display strange sensations including severe pain. No difference with neuropathy there then. The point is that for many years, doctors have refused to put the two conditions together because it was assumed that the problems were solidly muscular or rheumatic in nature; or, even worse, psychosomatic! However, just as with neuropathy, the pain and other sensations can only be experienced through nerves and neural pathways, so how can it not be neuropathic too? This article tries to both legitimise fibromyalgia and prove that neural dysfunction is a key element. Why is this important to the average neuropathy patient? Well because the symptoms can be so similar in terms of what the patient actually feels, that he or she just doesn't understand the diagnosis he or she is given. There are so many forms of neuropathy, why shouldn't fibromyalgia be one of them!


Why Fibromyalgia Is Neuropathic:
Central sensitization is one explanation

Mar. 8, 2016 / Pain Management 

The etiology of fibromyalgia is still largely unknown, but it isn’t as controversial as it used to be.

A decade ago, the chronic rheumatic disease was most often attributed to muscle and ligament problems. Some declared it a psychogenic disorder. (Some still do.) More recently, however, studies have linked fibromyalgia with malfunctioning neurotransmitters, neurochemical imbalances and other neuropathic conditions.

“Today, it’s more widely accepted that fibromyalgia is primarily a neurogenic disease,” says Philippe Berenger, MD, a pain management specialist at Cleveland Clinic. “It still doesn’t explain the disease, but it’s a step forward.”

Dr. Berenger bolstered this belief in a presentation at Cleveland Clinic’s 18th Annual Pain Management Symposium in San Diego in March.
Definitions we can agree on

In 1994, the International Association for the Study of Pain (IASP) defined neuropathic pain as “initiated or caused by a primary lesion or dysfunction of the nervous system.” In 2008, the IASP’s Neuropathic Pain Special Interest Group tweaked the definition to include “disease of the somatosensory nervous system.”

“Fibromyalgia fits these definitions,” says Dr. Berenger. “Although the condition has no anatomically definable lesions, it is marked by altered neurological function in the spinal cord and brain. It can, therefore, be considered a dysfunction of the central inhibitory process of pain control.”
Fibromyalgia’s link to central sensitization

It’s clear that fibromyalgia has mechanisms and pathways associated with central sensitization, he notes. The condition follows similar pathways as other neuropathic pain syndromes, such as complex regional pain syndrome, interstitial cystitis and irritable bowel syndrome.

“All nerves in fibromyalgia patients are more sensitive than they should be — including the brain and spinal cord,” says Dr. Berenger. “Many patients have difficulty with concentration or have hypersensitivity to light, odors or sounds. Some have additional neuropathic pain syndromes or struggle with autonomic dysfunction, such as vasovagal symptoms.”

Central sensitization has been demonstrated in animals and humans by using various triggers (e.g., mustard oil, heat, hypertonic saline injection) to activate nociceptors in skin, viscera or muscle. Sensitization presents as:
Tactile allodynia
Hyperalgesia
Enhanced pressure and thermal sensitivity
Spreading to neighboring nonstimulated sites and remote regions

Increased excitability of spinal cord neurons can cause a series of events:
Increased duration (spontaneous firing) and a growing area of response
Abnormal neuro-anatomical reorganization (new connections between A-beta, A-delta and C fibers, which spread and involve multiple dermatomes)
Diffuse symptoms — which can outlast the stimuli (long-term potentiation)
Newer evidence supports neurogenic claim

In 2014, researchers discovered through skin biopsy that patients with fibromyalgia had lower epidermal nerve fiber density than patients without fibromyalgia. Small fiber neuropathy, therefore, is likely another contributing factor in fibromyalgia pain — and yet more evidence that the condition has neurogenic roots, notes Dr. Berenger.
What this means for treatment

“Most of the drugs used today to treat fibromyalgia — like antidepressants and antiepileptics — are already focused on neurological targets,” says Dr. Berenger.

However, considering fibromyalgia as a central sensitization disorder opens up a larger array of treatment options, he says. Agents active on the central nervous system include:
Sodium channel blockers
Calcium channel blockers
Serotonin-norepinephrine reuptake inhibitors (SNRI)
NMDA receptor antagonists
Nerve growth factor (NGF) inhibitors

Low-dose naltrexone is another treatment option on the horizon. One 2013 study found that the drug significantly reduced pain and improved mood and general satisfaction in people with fibromyalgia. Other studies have reported similar positive responses to the drug.
“It’s all in the mind”

Saying that fibromyalgia is “all in the mind” isn’t entirely wrong, concludes Dr. Berenger.

“Pain pathways and centers are in the brain. And we can employ techniques like mindfulness and biofeedback to control pain,” he says. “However, it’s more helpful — and accurate — to consider it a neurogenic disorder.”

https://consultqd.clevelandclinic.org/2016/03/why-fibromyalgia-is-neuropathic/

Saturday, 23 April 2016

Intra-Muscular Vitamin D Injections Reduce Neuropathy Symptoms

Today's post from vitamindcouncil.org (see link below) makes some remarkable claims about the benefits of a single, high-dosage injection of vitamin D for neuropathy patients. The results were seen after some weeks and had no effect on the disability of a patient but definitely on the severity of their symptoms. Personally, I find it an encouraging research but it definitely needs some significant follow-up to confirm its conclusions. The injections were intra-muscular and therefore administered by a doctor or medical professional, which may be a good thing, to dissuade people from rushing to the supplement store to swallow 600,000 IU of vitamin D in pill form in one go! Vitamin D supplementation has been a buzz therapy among the neuropathy communities for some time now but most doctors will agree that vitamin D supplementation is only really necessary if there is proven vitamin D deficiency. The word has it that it is certainly beneficial for nerve health but you need to do more of your own research and consult with a trusted medical professional before embarking on a self-help course of vitamin D. Most articles place an emphasis on diabetes-related neuropathy patients but as we all know by now, that's only because the vast majority of neuropathy sufferers come from the diabetic community. Most information regarding neuropathy applies to the condition irrespective of its cause. More articles can be found by using the search button to the right of this blog.

Research finds vitamin D to be a safe and effective treatment for painful diabetic neuropathy
Posted on April 11, 2016 by Amber Tovey

A new study published in the journal BMJ Open Diabetes Research and Care discovered that treatment with a single intramuscular dose of 600,000 IU of vitamin D in patients with painful diabetic neuropathy caused significant reductions in symptoms.

Diabetic neuropathy is a type of nerve disorder that can occur if a person has diabetes. High blood sugar can injure nerves throughout the body, but diabetic neuropathy most commonly affects nerves in the legs and feet. It often causes pain and numbness in the extremities, but may also cause problems in the gastrointestinal tract, urinary tract, blood vessels and heart.

Approximately 21% of the population is affected by painful diabetic neuropathy. Treatments for diabetic neuropathy are limited. The therapeutic effectiveness for all medications is at best near 50% pain relief. In addition, most of the medications are accompanied by unwanted side effects. This has left the medical community searching for new treatments.

A previous study suggested vitamin D supplementation may help treat diabetic neuropathy. The researchers found that weekly vitamin D supplementation of 50,000 IU for 8 weeks reduced symptoms but not disability. In an effort to confirm the treatment effect of vitamin D on diabetic neuropathy, researchers recently conducted a prospective open-labeled trial in Pakistan.

A total of 143 patients with type 1 or type 2 diabetes were included in the study. All patients received a single intramuscular dose of 600,000 IU of vitamin D3.


Pain was assessed using three different questionnaires: The Douleur Neuropathique 4 (DN4), total McGill pain and Short Form McGill Pain Questionnaire (SFMPQ). The researchers wanted to compare pain severity before and after the administration of the vitamin D injection. Here is what they found:
Average vitamin D levels increased from 31.7 ng/ml at baseline to 46.2 ng/ml at week 20.
Total McGill pain score, DN4 and SFMPQ significantly decreased after vitamin D administration (p is less than 0.001).

The researchers concluded,

“The administration of 600 000 IU of vitamin D results in a modest but significant increase in 25(OH)D levels measured at 20 weeks. This improvement in 25(OH)D levels was associated with an improvement in several independent measures of PDN, which became significant approximately 10 weeks after administration of vitamin D.”

The researchers noted that the average vitamin D levels of the patients at baseline was much higher than previous studies, indicating that a proportion had likely received vitamin D supplementation from their primary physician previously. This shows vitamin D supplementation has become a more widely accepted practice for diabetic patients.

Future studies should follow a randomized controlled trial design and use a daily dosage regimen.

Citation

Tovey, A.; Cannell, JJ. Research finds vitamin D to be a safe and effective treatment for painful diabetic neuropathy. The Vitamin D Council Blog ; Newsletter, 2016.

https://www.vitamindcouncil.org/blog/research-finds-vitamin-d-to-be-a-safe-and-effective-treatment-for-painful-diabetic-neuropathy/

Friday, 22 April 2016

New Findings Reveal More Damage To Nerves Than Thought

Today's post from medicalxpress.com (see link below) may look as though it's primarily aimed at people already with diabetes or at the so-called pre-diabetes stage (high blood sugar) but if you read further, it applies to most people living with 'classic' neuropathy and its symptoms, irrespective of the cause. Previously it was thought that because the symptoms in the feet and lower legs are so predominant, that is where the initial damage to motor nerves is happening...at least at first. However, new research has shown that in fact there is visible damage/degredation along the entire length of sensory nerves, rather than just at the ends of the longest nerves first. The nerve deterioration is therefore happening along both large and small fibre nerve lengths. The professor here likens the small fibre neuropathy (characterised by burning and tingling in most cases) to a 'canary in a coal mine'...a warning of worse things to come. These findings may seem a somewhat far-from-our-bed-show but the fact is that current neuropathy testing methods won't show this up...perhaps leading to the huge number of 'idiopathic' ('we haven't a clue why this has happened') neuropathy diagnoses.

Small nerve fibers defy neuropathy conventions
April 11, 2016

Results of a small study of people with tingling pain in their hands and feet have added to evidence that so-called prediabetes is more damaging to motor nerves than once believed, in a report on the study published online in JAMA Neurology on April 11.

Johns Hopkins neurologists say the study of patients with small fiber neuropathy showed unexpected deterioration over the entire length of sensory nerve fibers, rather than just at the longest ends first, which the investigators say defies the conventional wisdom of how nerves were thought to deteriorate.

Over the three-year course of the study of the 62 participants, 13 of them with prediabetes, the investigators found that generalized damage occurs in those with prediabetes, and that the precursor condition may be less benign than most clinicians appreciate.

"I liken small fiber neuropathy to the canary in the coal mine," says senior author Michael Polydefkis, M.D., professor of neurology at the Johns Hopkins University School of Medicine and director of the Cutaneous Nerve Lab. "It signals the beginning of nerve deterioration that with time involves other types of nerve fibers and becomes more apparent and dramatically affects people's quality of life. The results of this new study add urgency to the need for more screening of those with the condition and faster intervention."

Small diameter nerve fibers reach out to the surface of the skin, and their damage is often marked by development of burning pain in the feet. But routine nerve tests, like nerve conduction, and routine examinations often fail to identify nerve damage because those measurements mostly assess injury to large diameter nerve fibers. The most common cause of small fiber neuropathy is diabetes, Polydefkis notes, but it can also be caused by lupus, HIV, Lyme disease, celiac disease or alcoholism.

In an effort to measure damage more accurately in small nerve fibers in people with small fiber neuropathy symptoms, Polydefkis and his team took small samples of skin—the size of a large freckle—from 52 patients diagnosed with small fiber neuropathy and from 10 healthy controls. Of the 52 patients enrolled in the study with small fiber neuropathy, 13 were considered to have prediabetes, 14 had type 2 diabetes, and 25 had normal blood sugar and an unknown cause of neuropathy. The participants ranged in age from their mid-40s to late 60s, and just less than half were female. Skin samples were taken from the ankle, the lower thigh near the knee and the upper thigh. Three years later, samples from the same area in the same group were taken for comparison.

Microscopic analysis of the skin samples was done to determine the density of small nerve fibers over time. According to the lead author of the study, Mohammad Khoshnoodi, M.D., assistant professor of neurology at Johns Hopkins, a lower density of fibers indicates more nerve damage.

Initially, he says, all patients with small fiber neuropathy had fewer nerve fibers at the test site on the ankle compared to the upper thigh, demonstrating more nerve damage the further down the leg measured. After three years, all three groups of those with small fiber neuropathy lost nerve fibers at the site tested in the ankle. But what surprised the researchers was that nerve fibers were lost at similar rates from the lower and upper thigh sites as well, a phenomenon that would not have been expected if the longest nerve fibers were the most vulnerable.

"We are all taught in medical school that the longest nerves degrade first, and we show that this isn't always the case," says Khoshnoodi.

Patients with prediabetes or diabetes had at least 50 percent fewer small nerve fibers in their ankles initially than those participants with an unknown cause for their small fiber neuropathy, indicating these patients started the study with more damage to their small nerve fibers.

The patients with prediabetes continued to have worsening damage to their small nerve fibers over the course of the study; they lost about 10 percent of their nerve fiber density each year at all sites tested along the leg. Patients with diabetes also lost similar rates of nerve fibers along the three sites of the leg.

"I expected that people with diabetes would do worse, but I didn't really expect people with prediabetes to experience a similar rate of degradation of their small nerve fibers," says Polydefkis.

Khoshnoodi cautions that the study was small, and that other factors in addition to high blood sugar, such as smoking, high blood pressure and high cholesterol, may also have contributed to the decline. Future studies that address these risk factors will need to be performed to determine if prediabetes is as debilitating to nerves as full-blown diabetes.

According to the National Institute of Neurological Disorders and Stroke, an estimated 20 million people in the U.S. have some form of peripheral neuropathy. About 50 percent of people with diabetes have neuropathy.

Explore further: Researchers uncover source of mystery pain

Journal reference: Archives of Neurology

Provided by: Johns Hopkins University School of Medicine

http://medicalxpress.com/news/2016-04-small-nerve-fibers-defy-neuropathy.html

Thursday, 21 April 2016

Slow-Release Safety Opioids Will Solve Abuse Problem At A Stroke

Today's post from wlky.com (see link below) makes you wonder why these abuse-deterrent opioids aren't already available everywhere and why they aren't mandatory!! This isn't news...these slow-release drugs have been available for years; so what's the hold-up? Speaking on behalf of all those neuropathy patients who have tried everything else to curb their symptoms and have been forced to take opioids as the only way to ensure some sort of normal life; there wouldn't be a so-called opioid epidemic if the opioids themselves were 'slow-release' and thus impossible to snort or crush or whatever else the junkies do. That said, genuine patients don't need anything more than what they currently take because they're responsible adults who take control of their medication, with advice and control from their doctors. However, their drugs are being denied to them because of; a) an irresponsible and often criminal few; b) drugs companies who don't want to spend money on creating new forms of the same drug and c) a media who lusts after sensation and blows the problem out of all proportion. If the answer is 'abuse-deterrent' pills than get the hell on with it...we don't mind...but stop restricting what for us is essential because you may tackle a much wider criminality in the world of drug abuse. Sledge hammer!...nut much!!
 
Abuse-deterrent opioids aim to curb epidemic 
UPDATED 6:53 PM EDT Apr 13, 2016
 
Show Transcript 

LOUISVILLE, Ky. —As Kentucky continues to battle a drug epidemic, doctors are finding innovative ways to treat addiction, by prescribing uniquely designed abuse-deterrent opioids (ADOs).

"We stock a few of them here. We work a lot with our pain management clinic, to keep on hand what we need," said Norton pharmacist Kassandra Fernsler.

ADOs are specifically designed to be taken only as directed. The pills have physical and chemical barriers that make them tough to crush or tamper with, making it difficult for someone to snort, inject or smoke the drug. If manipulated, the drug's effectiveness significantly diminishes.

Advocates, including emergency room physician Robert Couch, said the reformulated versions of hydrocodone, oxycodone or morphine can help a patient who has a legitimate need for pain relief, but may have a history of abuse.

Recovering addict at The Healing Place in Louisville, Jack, became addicted to painkillers after back surgery in 2012. He said while ADOs sound like a step in the right direction, he's not sure they would have helped him during his darkest moments.

"Where there's a will, there's a way, there's always different tricks to get around stuff like that, it all goes back to dealing with the mental state the person is going through," he said.

"I don't think it's a bad thing to have these tamper proof medications or deterrents to abusing them, I just think that can't be the only solution," said The Healing Place program services director Heather Gibson.

Currently most insurance companies do not cover abuse-deterrent opioids, but House Bill 330 in Kentucky's Legislature aims to change that.

Kentucky has the third highest rate of overdose deaths in the country. And in Jefferson county, more people die from overdoses than any other part of the state.

http://www.wlky.com/news/abusedeterrent-opioids-aim-to-curb-epidemic/39009976

Wednesday, 20 April 2016

Salicylates (Found In Aspirin) May Reduce Neuropathic Pain

Today's post from herald-review.com (see link below) takes a look at the possibility that Salicylates (most commonly found in aspirin) may be able to help control the symptoms of neuropathy by reducing so-called proinflammatory cytokynes (you're going to need to Google that one - not enough space here). Recent research suggests that Salicylates will target these cytokines, thus reducing  the symptoms that make our lives miserable. It's a short article and interesting but you may need to increase your background knowledge through your own research to understand the science behind it. One thing is sure (and the article emphasises this) you should consult with your doctor or neurologist before taking too much aspirin.

Dear Pharmacist: Salicylates may be key to easing neuropathy
SUZY COHEN For the Herald Review Apr 13, 2016

We take for granted the comfort we feel in our hands and feet, but some people have lost that comfort, and they suffer all day long with strange nerve-related concerns. There is new research about aspirin that could help them; but first, let’s talk about that nerve pain, called “neuropathy.”

Neuropathy feels like you are touching or stepping on pins and needles. It can affect you all over, not just your hands and feet. Depending on various factors (race, age, weight, alcohol consumption, insulin and A1c), your experience of neuropathy may also include pain, vibration or buzzing sensations, lightheadedness, burning sensations (even in your tongue), trigeminal neuralgia or cystitis.

Recognizing what your neuropathy stems from is critical to you getting well. For some, it is due to a vitamin deficiency. For example, vitamin B12 or probiotics that help you to manufacture your own B12 in the gut. For others, it could be that wine you drink with dinner because wine is a potent drug mugger of B1 (thiamine) which protects your nerve coating. By a mile, the most common cause of neuropathy is diabetes.

Approximately half of all people with diabetes experience diabetic neuropathies, mainly in the hands and feet. Some doctors will tell you that maintaining healthy blood glucose will reverse neuropathy but that’s not true, we know from The Diabetes Control and Complications Trial that even intensive glucose control is insufficient to control the risk of diabetic neuropathy.

It’s tough love, but I need to say it: Uncontrolled neuropathy can cause a 25 percent higher cumulative risk of leg amputation. So, gaining control is important for your independence. I’ve written about natural supplements for neuropathy in the past (articles are archived at suzycohen.com), and you can have a free ebook “Spices that Heal” which offers more natural advice (get it by signing up for my email newsletter).

New research was published last March in Current Diabetes Reports. Scientists confirmed that targeting inflammatory cytokines can help relieve diabetic neuropathy. Oftentimes, that bad gateway called NF Kappa B (NFKB) opens its floodgates, and spits out proinflammatory cytokines such as COX-2 (Celebrex lowers this), nitric oxide synthase, lipoxygenase, TNF alpha and a lot of pain-causing interleukins (IL-1β, IL-2, IL-6, IL-8).

The researchers reported that something as simple as salicylate therapy could help reduce some of these cytokines as well as circulating glucose, triglycerides, C reactive protein and free fatty acids. When you think of salicylates, please understand this is a broad group of compounds found naturally in the plant kingdom. Salicylate is the main ingredient in aspirin and other analgesics, both prescribed and over-the-counter. Salicylates include spearmint, peppermint (even in mint toothpaste) and in muscle rubs. White willow bark is an herb that is morphed and turned into aspirin. They’re not right for everyone; so please ask your doctor about salicylates for neuropathy. Also ask if you can have a blood test to evaluate some of the proinflammatory markers I noted above.

Suzy Cohen can be reached at www.SuzyCohen.com

http://herald-review.com/news/opinion/editorial/columnists/dear-pharmacist-salicylates-may-be-key-to-easing-neuropathy/article_0549df7f-5c1b-5987-9900-f629df764099.html

Tuesday, 19 April 2016

Restless Leg Syndrome: What's That?

Today's post from theconversation.com (see link below) looks at an affliction which many people experience during their lives, without realising that it falls into the category of neuropathic disorders. It's important to realise that you can have neuropathy and restless leg syndrome; or restless leg syndrome can be a part of your neuropathy but equally, you can have RLS without any other symptoms of nerve damage. Many people are confused by exactly what it is and why it happens and this article goes some way to explaining it in terms we can all understand and maybe putting your mind at ease (if not your legs!!)
 

Explainer: what is restless leg syndrome?
Author Andrew Lavender March 29, 2016

Lecturer, Faculty of Health Sciences, Curtin University
Disclosure statement Andrew Lavender does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

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Restless leg syndrome is a common affliction characterised by uncomfortable feelings in the legs accompanied by an irresistible urge to move the legs to relieve the sensations. People with restless leg syndrome often keep their legs moving by pacing or constantly moving their legs while sitting. The sensations commonly occur at night and have been described by patients as itching, throbbing, pulling, pins and needles or a creepy crawly feeling.

Onset of the sensations usually occur, or get worse, while the person is relaxed, sitting or lying down. Restless leg syndrome is known to affect both males and females of any age but is more common in women and older individuals. Misdiagnosis is not unusual since the symptoms tend to come and go and may be quite mild.


Causes

In many cases of restless leg syndrome the cause is not known. However, it is thought to have a genetic link as many who experience restless leg syndrome have relatives who also experience the sensations.

Restless leg syndrome has been associated with some medical conditions including Parkinson’s disease, diabetes and peripheral neuropathy (any damage or disease of the nerves that impairs sensation, movement or gland function depending on which nerves are affected).

It can also be seen in those with iron deficiency or poor kidney function. Some women experience restless leg syndrome during pregnancy. Pregnant women who experience restless leg syndrome usually find the symptoms occur in the third trimester, with symptoms ceasing within four weeks of delivery.

Research has shown restless leg syndrome is likely related to dysfunction of neural circuits of the basal ganglia (a group of structures at the base of the brain with links to the area that controls movement), which uses the neurotransmitter dopamine. Dopamine is needed to control muscle activity for smooth, purposeful movement, so disruption of the dopamine pathways leads to involuntary movements. Parkinson’s disease is also a disorder of dopamine pathways of the basal ganglia and Parkinson’s patients often experience restless leg syndrome.

Individuals with chronic kidney failure, diabetes or peripheral neuropathy usually find relief from restless leg syndrome with treatment of the underlying condition.

Symptoms of restless leg syndrome may also be aggravated by certain medications. These include anti-nausea drugs, antipsychotic drugs, antidepressants and some cold and allergy medications that contain sedating antihistamines. The intake of alcohol or lack of good-quality sleep often triggers the condition.


Diagnosis

There is no test for restless leg syndrome. The four criteria below are used to diagnose the condition:


symptoms worsen at night and are minimal in the morning
there is a strong urge to move the affected limb or limbs
symptoms are triggered when trying to rest or relax
symptoms are relieved by moving the affected limb, and return when movement stops.

The descriptions given by the patient provide important information about when and how often the symptoms occur, so triggers can be identified and avoided where possible. Family history also helps to provide clues about the cause of the symptoms and potential interventions for treatment.

Diagnosing restless leg syndrome in children is particularly challenging since children find it hard to describe their symptoms and where and how often they experience them. This sometimes results in misdiagnosis as growing pains or attention deficit disorder.


Treatment and prognosis

Doctors focus on relieving symptoms by identifying triggers and relieving factors, and the presence or absence of symptoms during the day. Often the symptoms will resolve with treatment of an underlying disorder such as diabetes or peripheral neuropathy.

Making changes to your lifestyle may affect mild or moderate symptoms. This might include stopping or reducing your intake of caffeine, alcohol or tobacco.

If the symptoms are related to a dietary deficiency in iron, folate or magnesium, the symptoms can be treated with adjustments of diet or supplementing the diet with the appropriate supplement. This may be identified through a blood analysis by a GP.

When symptoms are more severe or associated with an underlying disorder, it is very important to consult a GP, who may refer you to a specialist.

While there is no cure for restless leg syndrome, there are options for therapy and control of symptoms to increase periods of restful sleep. Symptoms generally increase with age and the rate of this increase varies greatly depending largely on the associated disorder.

Some people experience periods of remission, which may last a few days or months. However, symptoms will usually reappear.

It is important to note that a diagnosis of restless leg syndrome is not an indication of any other, more serious, disorder such as Parkinson’s disease.

https://theconversation.com/explainer-what-is-restless-leg-syndrome-56140

Monday, 18 April 2016

Useful Facts About Neuropathy

Today's excellent post from mollysfund.org (see link below) is the latest in a series of general information posts to be found here on this blog about neuropathy which regular readers will recognise as being important for those who need to brush up on the facts, or are meeting neuropathy for the first time. This comprehensive and informative article covers most of the bases and will answer most of your basic questions. However, you need to remember that not everything will apply to your situation and not every suggestion will be useful to you either. That's what makes neuropathy such a difficult disease - it's unique to every individual and one size does most definitely not fit all. However, even for experienced neuropathy patients, the information provided here will increase your knowledge and help your discussions with the doctors or specialists that you meet along the way.

Peripheral Neuropathy
Molly's Fund.org

 
What is peripheral neuropathy?


Peripheral neuropathy is a general term for a series of disorders that result from damage to the body’s peripheral nervous system. The body’s nervous system is made up of two parts; the central nervous system (CNS) and the peripheral nerve system (PNS). The CNS includes the brain and the spinal cord. The PNS connects the nerves that run from the brain and spinal cord to the rest of the body. This includes the legs, arms, hands, feet, joints, eyes, ears, mouth, nose and skin. These neurons transport signals about physical sensations back to your brain. An estimated 20 million people in the United States have some form of peripheral neuropathy, a disorder that results from damage that occurs to your peripheral nerves. These damaged or destroyed nerves can no longer send out messages, or they send incorrect or distorted information, between the brain and spinal cord and the skin, muscles or other parts of the body. Generally speaking, this often causes unusual sensations, burning, numbness, weakness, loss of balance, and even pain. The symptoms usually occur in your hands and feet, but other areas of your body can also be affected. There are three types of peripheral nerves and all of them can be affected by peripheral neuropathy. Peripheral neuropathy is also categorized by the size of the nerve fibers involved, large or small. The three types peripheral nerves are:


Sensory Nerves: These connect to your skin
Motor Nerves: These connect to your muscles
Autonomic Nerves: These connect to your internal organs.

It can be scary to get diagnosed with any disease, especially one with a ominous sounding name like peripheral neuropathy. We hope that by providing information in this blog, about the symptoms, diagnosis, treatment, prevention and some potential causes of peripheral neuropathy, you will feel more empowered, and armed with the information that will help you live your best life with this condition.


What causes peripheral neuropathy?

There are many causes of neuropathy. Approximately 30% of neuropathies are “idiopathic,” meaning that the cause is unknown and in another 30% of cases, diabetes is the cause. According to some studies, nearly 60 percent of diabetics have some sort of nerve damage. This damage is often due to high blood sugar levels, and the risk for neuropathy increases for diabetics who are over the age of 40, have high blood pressure, or are overweight. Having a family history of peripheral neuropathy increases the chances of developing the disorder. However, a variety of factors and underlying conditions may also cause this condition. Some other causes of peripheral neuropathy may include:


Autoimmune disorders: Diseases in which the immune system attacks the body’s own tissues can lead to nerve damage. This can include disorders such as systemic lupus erythematosus, Sjögren’s, rheumatoid arthritis, etc.


Infections: This can include certain bacterial or viral infections such as Lyme disease, shingles, Epstein Barr virus, hepatitis C, leprosy, HIV, and diphtheria.
Heredity: Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy. 


Tumors: Peripheral neuropathy can occur as a result of tumors or growths putting pressure on nerves.
Nutritional imbalances and vitamin deficiencies: B vitamins, including B-1, B-6 and B-12, vitamin E and niacin are crucial to nerve health, imbalances and deficiencies can lead to peripheral neuropathy. 


Traumatic injury: Traumatic injury from sports or vehicular accidents can sever or damage peripheral nerves. Pressure on nerves may also result from having a cast, using crutches or repeating a motion many times, such as typing (this is often referred to as carpal tunnel syndrome, a type of peripheral neuropathy).


Exposure to poisons or toxins: This includes those that contain heavy metals or chemicals, lead, mercury, and arsenic. In addition, neuropathies have also been known to have been caused by certain insecticides and solvents. 


Certain medications: The medications used to treat cancer (chemotherapy) can cause neuropathy. In addition, anticonvulsant agents (medications used to reduce seizures) and even some medications prescribed to treat heart and blood pressure can cause peripheral neuropathy. In most cases, when these medications are discontinued or dosages are adjusted, the neuropathy resolves.


Disorders of the bone marrow: Peripheral neuropathy may also be caused by lymphoma, disorders that include abnormal protein in the blood, some forms of bone cancer, and amyloidosis (a disorder where amyloid, an abnormal protein that is usually produced in your bone marrow builds up in any tissue or organ).
Other diseases: These could include connective tissue disorders, liver disease, kidney disease, liver disease, and an underactive thyroid (hypothyroidism), vasculitis.


Alcoholism: Heavy alcohol consumption is a common cause of peripheral neuropathy. Chronic alcohol abuse often leads to certain nutritional deficiencies (particularly thiamine, B 12, and folate) that are linked to neuropathy. Damage may not be reversible but if the person stops drinking alcohol, the symptoms may lessen.

What are the symptoms of peripheral neuropathy?

Symptoms of peripheral neuropathy may be experienced over a period of days, weeks, or years. They can be acute or chronic. In acute neuropathies, the symptoms will appear suddenly, rapidly progress, and resolve slowly as damaged nerves heal. In chronic forms of neuropathy, the symptoms often begin subtly and progress slowly. Some people may have periods of little symptomatic activity (remissions) followed by periods of increased symptoms (flares). Others may reach a stage where symptoms stay the same for many months or even years. Many chronic neuropathies worsen over time. Although peripheral neuropathy may be potentially debilitating, very few forms are fatal. The specific symptoms of peripheral neuropathy will vary depending on whether motor, sensory, or autonomic nerves are damaged. These are some of the most common symptoms:


Tingling in hands and/or feet
Pain described as sharp, stabbing or burning
Loss of balance
Numbness in hands and/or feet
Heavy feeling in the arms and/or legs, sometimes described as feeling like your legs or arms “lock” in place
The feeling of wearing tight gloves or socks when you are not
Buzzing, vibrating or shocking sensation in muscles

Often the symptoms are symmetrical involving both hands and/or both feet. Because these symptoms occur in areas covered by gloves or stockings, peripheral neuropathy is often described as having a ‘glove and stocking’ symptom distribution. In many cases these symptoms improve with treatment especially if the underlying cause or condition is treatable.
Here are the symptoms that might be experienced when the different types of nerves are involved:

Motor nerve damage symptoms: The motor nerves control voluntary movement of muscles such as those used for walking, grasping things or talking. If these motor nerves are damaged, the following symptoms might occur:


Muscle weakness
Cramping
Decreased motor skills
Atrophy (shrinking) of the muscles
Twitching
Cramping
Slower reflexes

Sensory nerve damage symptoms: The sensory nerves have a broad range of sensory functions. Any damage to these nerves might cause a person to experience these symptoms: 


Decreased sensations of touch. This can lead to not experiencing the pain from a cut or injury, or the feeling of wearing gloves or stocking when they are not.
A loss of ‘sense of position’ which can make coordinating complex movements like walking or buttoning a shirt very difficult. Balance might also be affected.
Difficulty in transmitting temperature sensations which could lead to burns. This loss of pain sensation can be a very serious problem for those suffering from diabetes and may contribute to a high rate of lower limb amputations among this group.
Increased sensation of pain is often a debilitating symptom of neuropathy. Instead of numbness, it can produce the opposite effect of an increased sensation of pain or feeling severe pain from stimuli that would normally be painless. It can severely affect quality of life, ability to sleep, emotional well-being, and the ability to work.

Autonomic nerve damage symptoms:


  If the autonomic nerves are involved, nearly every organ can be affected. The autonomic nerves control the functions of the body that happen automatically. Autonomic neuropathy can have symptoms that affect the loss of control of some of these functions. Symptoms may include: 

Problems with heart rate
Difficulty with the body’s ability to regulate blood pressure which may cause dizziness or light-headedness
Problems with digestion (this may include diarrhea, or constipation)
Loss of bladder control
Inability to sweat normally which could lead to heat intolerance or overheating
Difficulty eating or swallowing

Seek medical care right away if you notice unusual pain, weakness or tingling in your hands or feet. Early diagnosis and treatment offer the best chance for preventing further damage to your peripheral nerves and controlling your symptoms.

 
How is it diagnosed?

Peripheral neuropathy is not a single disease, but rather describes damage to the nerves that produces varying symptoms. Because there are many potential causes for peripheral neuropathy, your doctor will need to examine where the nerve damage is in your body and attempt to determine what may be causing it. A neurologist is typically the type of doctor who will diagnose and treat neuropathy. A diagnosis of peripheral neuropathy usually requires:


Complete medical history: Your physician will first review your medical history, this will include discussions of any current or past medical conditions, your lifestyle, any exposure to toxins, your drinking habits, and any family history of nervous symptom diseases. 


Physical exam

 
Neurological exam: Your physician will check your reflexes, muscle tone and strength, ability to feel sensations, coordination and posture.


Blood tests: Blood tests can detect vitamin deficiencies, liver or kidney dysfunction, diabetes, other metabolic disorders, and/or any signs of abnormal immune system activity


Diagnostic and imaging tests: This may include CT or MRI scans to show muscle quality and size, look for tumors, herniated discs or any other abnormality that might be causing your symptoms. Electromyography involves inserting a fine needle into a muscle to record electrical activity when muscles are at rest and when they contract. This can determine if your symptoms are being caused by muscle or nerve damage. 


Nerve biopsy: This is where a small portion of a nerve is examined to determine the cause of your specific nerve damage.


Skin biopsy: A skin biopsy would be taken to observe the number of nerve endings in the skin. A reduction of nerve endings can signal neuropathy.


Other tests to analyze nerve function: Sweat tests to record how your body sweats, autonomic reflex screen test that will record how the autonomic nerve fibers are functioning, and other sensory tests to indicate how you feel touch, temperature changes, and vibrations.

If your lab and other diagnostic tests do not indicate any underlying condition, your doctor may recommend ‘watchful’ waiting to see if your neuropathy symptoms improve. If either exposure to toxins or alcohol consumption are the suspected causes of your condition, your doctor will recommend avoiding those substances to see if your symptoms improve before prescribing any medications or developing a treatment protocol. 


How is it treated?

Peripheral neuropathy can be very uncomfortable and debilitating. Fortunately, treatment can be very helpful in the management of neuropathy symptoms. But before any treatment can begin, the most important step is to determine the underlying cause of the neuropathy to plan the correct course of treatment. Some of the treatments for peripheral neuropathy may include:


Medications 

 
Over-the-counter or non-prescription pain relievers: Over-the-counter pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including acetaminophen, ibuprofen, aspirin, etc. can be very helpful in relieving mild or moderate symptoms. For more-severe symptoms, your doctor may recommend prescription painkillers. Because these drugs can affect your liver or stomach function, it is very important to avoid using them for an extended period of time, especially if you regularly drink alcohol.


Prescription medications: Medications containing opioids can lead to dependence and addiction and are therefore generally prescribed only when other treatments fail. These drugs can include tramadol, oxycodone, conzip and others, COX-2 inhibitors, etc.


Steroid Injections: Corticosteroid injections can help with pain and inflammation
Anti-seizure medications: Medications developed to treat epilepsy may also relieve nerve pain. These medications can may cause side effects that include drowsiness and dizziness.


Capsaicin: Capsaicin is a substance naturally in hot peppers and can cause modest improvements in peripheral neuropathy symptoms. Doctors may suggest you use this cream with other treatments. However, some people can’t tolerate it and side effects such as skin burning and irritation may occur (these often lessen over time). Topical lidocaine, an anesthetic agent might also be prescribed for localized chronic neuropathic pain such as pain from the shingles virus. Their helpfulness in the treatment of diffuse chronic diabetic neuropathy is limited.


Antidepressants: Certain antidepressants have been shown to interfere with the chemical processes in the brain and spinal cord that cause the body to feel pain. These medications may include tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline (Pamelor).


Immunosuppressant medications: Medications to reduce the immune system’s reaction, such as prednisone, cyclosporine (Neoral, Sandimmune, others), mycophenolate mofetil (CellCept) and azathioprine (Azasan, Imuran), may also help people with peripheral neuropathy associated with autoimmune conditions such as [lupus] and [RA].


Other medications: Pregabalin (Lyrica) is a medication that is used for the treatment of postherpetic neuralgia (postherpetic neuralgia is a complication of shingles) and diabetic peripheral neuropathy. Duloxetine (Cymbalta) has been approved for use in the treatment of diabetic peripheral neuropathy.


Therapies

Various therapies and procedures may help ease symptoms of peripheral neuropathy.


Intravenous immunoglobulin and plasma exchange: This treatment is also very common in the treatment of chronic inflammatory demyelinating polyneuropathy (a disorder characterized by progressive weakness and impaired sensory function in the legs and arms) and other inflammatory neuropathy. In immune globulin therapy, you receive high levels of proteins that work as antibodies. This helps to suppress immune system activity. Plasma exchange (called plasmapherisis) involves removing your blood and then removing antibodies and other proteins from the blood. The blood is then returned to your body. 


Transcutaneous electrical nerve stimulation (TENS): TENS is a non-invasive intervention used for pain relief for a range of conditions, and a number of studies have described its use for neuropathic pain. In TENS, varying currents of gentle electrical current is delivered through adhesive electrodes placed on the skin. It is recommended that TENS should be applied for 30 minutes daily for about one month.


Physical therapy: Physical therapy can help improve your movements and counteract muscle weakness. Assistive medical devices such as canes, walkers, hand/foot braces might also be needed and helpful for those with mobility issues related to neuropathy.


Surgery: If pressure on the nerves is being caused by tumors for example, surgical intervention might be required and recommended to reduce the pressure. In carpal tunnel, where there is typically injury to a single nerve, surgery may be an effective solution. Some surgical procedures reduce pain by destroying the nerve when other treatments have failed to provide relief. Typically, diabetic neuropathy is not treated with surgical intervention.


Nerve block: A nerve block is an injection of anesthetics directly into the nerves.

Many treatments can bring relief to neuropathic symptoms and can help you to return to your regular activities. Often, a combination of lifestyle adjustments, treatments and therapies may work best.

 
Alternative treatments and self-care options

Complementary and alternative treatments have been shown to provide relief of peripheral neuropathy symptoms. The following therapies have shown some promise despite the fact that researchers have not studied these techniques as thoroughly as they have most traditional pharmaceutical medications. Some of these complementary and alternative treatments may include:


Fish oil supplements:These supplements, which contain omega-3 fatty acids, may reduce inflammation, improve blood flow and improve neuropathy symptoms in people with diabetes. Check with your doctor before taking fish oil supplements if you’re taking anti-clotting medications.


Herbs: Certain herbs, such as evening primrose oil, may help reduce neuropathy pain in people with diabetes. Some herbs may interact with medications or make some medications less effective, so please discuss any herbs or supplements that you are considering adding to your diet with your doctor.


Acupuncture: Acupuncture, which involves inserting thin needles into various points on your body, may reduce peripheral neuropathy symptoms. Multiple sessions might be required before any significant symptom improvement is noticed. Always be sure find a certified acupuncture specialist using sterile needles.


Chiropractic care: This can include massage, muscle stimulation, ultrasound therapy and manipulation.


Massage

 
Alpha-lipoic acid: This antioxidant has been used as a treatment to help reduce symptoms of peripheral neuropathy in Europe for years. Blood sugar levels may be affected by this antioxidant, so please discuss using alpha-lipoic acid with your physician. Other side effects could include skin rash and stomach upset. 


Amino acids: In people who have undergone chemotherapy and in people with diabetes, amino acids, such as acetyl-L-carnitine, may help improve peripheral neuropathy. Side effects may include nausea and/or vomiting.


Some suggestions to help you self-manage peripheral neuropathy


Quit smoking: Cigarette smoking can affect circulation by constricting the vessels that supply nutrients to the peripheral nerves, increasing the risk of foot problems and other neuropathy complications.


Exercise: Ask your doctor about starting an exercise routine. Regular gentle exercise, such as walking, or swimming may reduce neuropathy pain, control cramping, improve your muscle strength, prevent the muscles from atrophy, and help control blood sugar levels. Yoga and tai chi might also help.


Eat a balanced diet: Healthy eating is especially important to ensure that you get essential vitamins and minerals. Emphasize low-fat meats and dairy products and include lots of fruits, vegetables and whole grains in your diet. Protect against vitamin B-12 deficiency by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. If you’re vegetarian or vegan, fortified cereals are a good source of vitamin B-12, but also talk to your doctor about B-12 supplements. Speak with your doctor about using various dietary strategies to improve gastrointestinal symptoms from neuropathy.


Avoid excessive alcohol: Alcohol may worsen peripheral neuropathy.


Meditation

 
Monitor your blood glucose levels: Monitoring your blood glucose levels, if you have diabetes, will help keep your blood glucose under control and may even help improve your symptoms of neuropathy.


Take good care of your feet, especially if you have diabetes: Wash and inspect your feet daily for any injuries, blisters, cuts or calluses. Help to keep the skin moist with lotion. Timely treatment of injuries can help prevent permanent damage. Wearing soft, loose cotton socks and shoes with padded inserts may also help. To keep bedcovers off of hot or sensitive feet and provide a better night’s sleep, you may wish to use a semicircular hoop. These can be found in medical supply stores. 


Making Your Home Safe

If you have peripheral neuropathy, you are potentially at greater risk for accidents in the home due to muscle weakness, loss of balance, decreased sensitivity to sensations of pain, etc. Here are few things to keep in mind to make yourself safer in your home and decrease your chances of injury:


Protect your feet by always wearing shoes.
Things laying around on the floor can be a tripping hazard, so try to keep your floor clear.
Use your elbow, not your hand or foot to check the temperature of your bath or dishwater.
Installing handrails in your bathtub or shower, as well as anti-slip bath mats can reduce the odds of falling or slipping and injuring yourself.
For those whose work involves sitting for long periods of time, make the effort to get up and move around a few times each hour to improve circulation. It is important to not stay in one position for too long.

 
In Conclusion

Peripheral neuropathy, while it cannot be cured, can most likely be well-managed if it is caused by a treatable underlying condition. The best way to prevent peripheral neuropathy is to manage those conditions that may put you at risk, such as diabetes, alcoholism or rheumatoid arthritis. Even if you have a family history of this disorder, you may be able to prevent its onset by taking the following precautions to lower your risk:


Being aware of any toxins that you might be exposed to at work or at school
Protecting your feet during sports, especially those that involve kicking
Never inhaling toxins like glue to get high
Managing your alcohol intake
Avoiding tobacco and smoking
Maintaining a healthy weight and lifestyle
Avoiding factors that may cause nerve damage such as repetitive motions, staying in one position for long periods of time, staying in cramped positions

The goal of treatment and therapy for peripheral neuropathy is targeted at treating the underlying disease and improving the symptoms with the right combinations of medications and therapies. Finding a knowledgeable and experienced neurologist who listens and supports you, and makes you feel more comfortable can greatly improve your quality of life. It is very important to find a neurologist as soon as you notice any of the above-listed symptoms. This will provide the opportunity for you to receive the necessary treatment that can stop the disease before it has a chance to cause permanent damage help to ensure your best possible health.


 Neuropathy, fibromyalgia, lupus, rheumatoid arthritis and many other conditions are considered invisible illnesses meaning they cannot be seen, but they exist. Being misunderstood and judged are two of the most common frustrations with those suffering from invisible illnesses. In addition to educating yourself about peripheral neuropathy, you might find it helpful to provide your family, friends and co-workers with information as well. Sharing this blog might be a good start! We want you to know that you are not alone as you learn to navigate living with a chronic and invisible illness. Our Facebook community is a great place to share and get great support from others who know exactly what you are experiencing and our online support groups are also a great way to get connected. We are here for you. 

Sources: http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm, http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/basics/definition/con-20019948, http://www.healthline.com/health/peripheral-neuropathy#Overview1, http://www.medicinenet.com/peripheral_neuropathy/article.htm, https://www.foundationforpn.org/, http://www.neuropathy.org/site/PageServer?pagename=About_Facts

http://www.mollysfund.org/2015/02/peripheral-neuropathy/