Monday, 22 December 2014

Effect Of Nerve Decompression On Balance In Neuropathy Patients

Today's post from (see link below) looks at nerve decompression surgery in the lower extremities of neuropathy patients and asks the question as to whether it's a valid treatment or not. Nerve decompression surgery is a minimally invasive surgical procedure to relieve pressure caused by a neuroma which is basically a pinched or entrapped nerve. The question for readers is whether their own neuropathy symptoms are actually caused by trapped nerves or not. In most cases of neuropathy, we're not looking at trapped nerves but damaged nerves caused by a variety of other possible causes. However, considerable numbers of people do have trapped nerves in their backs, legs or arms, or elsewhere and nerve decompression surgery is a treatment possibility. The study mentioned here looked a stability in those patients after surgery and concluded that there was little evidence to show an improvement but some surgeons claim a significant improvement in both balance and pain levels. The jury still seems to be out but it may be worth talking over with your specialist, if your neuropathy stems from nerve entrapment.
Does Nerve Decompression Improve Static Balance In Patients With Painful Diabetic Neuropathy?
 By Brian McCurdy, Managing Editor Friday, 11/21/14 |

Issue Number:

Volume 27 - Issue 12 - December 2014

A recent study questions whether nerve decompression will improve static balance in patients with diabetic neuropathy.

The study, recently published in Clinical Rehabilitation, focused on 39 patients with painful diabetic polyneuropathy. Patients had unilateral surgical nerve decompression at four sites in the lower extremity and the study used the contralateral limb as control. Researchers measured weightbearing and five variables of sway of the center of pressure with a pressure mat both with the patients’ eyes open and their eyes closed. The study authors obtained measurements preoperatively and at six and 12 months postoperatively, using the T-test for evaluation of postoperative results.

The authors concluded that there is no evidence that surgical decompression of nerves of the lower extremity in patients with painful diabetic polyneuropathy influences stability.

Stephen Barrett, DPM, FACFAS, has noted significant improvements in balance in many nerve decompression patients, but has not specifically correlated both findings over the last decade that he has performed the surgery. He notes the study focused on unilateral decompressions with the contralateral limb as a control. However, Dr. Barrett cites a 2006 study in the Annals of Plastic Surgery concluding that there was statistically significant improvement in static balance after bilateral decompression both with eyes open and eyes closed in unilaterally decompressed patients.

Dr. Barrett has found that if a patient demonstrates a positive Tinel’s sign or a positive provocation test, the success rate is up to 90 percent for a reduction in pain and 75 to 80 percent for restoration of sensation.

“In properly selected patients, peripheral nerve surgery is highly successful and more than 85 percent of my patients return to have nerve decompression done on their other extremity,” says Dr. Barrett, a Fellow and the President of the Association of Extremity Nerve Surgeons.

Although he has not studied stability after nerve decompression, Peter Bregman, DPM, says his patients have said they can walk better after the surgery due to less pain. If the pain is gone, he says the patients should have more stability in their gait if they are not fighting pain.

Dr. Bregman notes nerve decompression is only effective in patients with a diagnosed nerve compression and adds that the procedure would be contraindicated in patients with renal failure, leg edema or any active ulcers. Dr. Barrett adds that peripheral nerve decompression surgery in patients with diabetes is contraindicated in a patient who does not have adequate vascular supply or has some other comorbidity that would preclude safe surgery.

One year after nerve decompression surgery, Dr. Barrett has found patients have done very well and many relate an increased benefit from pain reduction and the restoration of sensation after 24 months. He says only a few have had to have another decompression surgery due to scar tissue formation.

Dr. Bregman concurs. “They do very well if (decompression is) successful, which is around 85 percent (pain relief). After one year, they have only gotten better, if anything, as far as sensation is concerned, thus reducing risk for ulcer or amputation,” says Dr. Bregman, a Past President of the Association of Extremity Nerve Surgeons.

Sunday, 21 December 2014

Welsh Guidelines For Neuropathic Drugs And Opiates

Today's post from (see link below) is a very useful one for anybody living with neuropathy severe enough to require the use of opiates to control the symptoms. The page consists of a series of links which you can choose to follow; all leading to important information about the title subject. Very often, we're prescribed drugs by our doctors but have little idea of what they are and how they work. It's always useful to have a resource which medical practitioners also use because then you can be sure that the information is accurate. Don't be afraid to check up on what you're putting into your body and if you have questions, take them to your doctor or specialist.

PAIN (neuropathic, opiates etc) Guidelines and Resources
 Aneurin Bevan University Health Board Medicines & Therapeutics Committee

May 2011
 Diagnosis & management of NEUROPATHIC PAIN - ABUHB guidance
 Patient Information Leaflets (from the Faculty of Pain Management) covering use of
Dec.2008 (updated Sep.2010 & Jan.2014)
 Advice for non-specialist prescribers for patients maintained on longer term opiate therapy
 on Tramadol, Managing Chronic Persistant Pain (CPP) and; Strong Opiates in CPP
 TRAMADOL - All Wales Educational Resource Materials:
Initial prescribing analysis
Audit Materials
Educational Slide Set
WeMeReC Maps
WeMeReC Things to Know
Patient Information Leaflet
Shared Decision-Making Toolkit
 OPIATE CONVERSION DOSES - ABUHB guidance on approximate dose equivalences of opiates
 All Wales Patient Information Leaflet - Medicines for MILD to MODERATE PAIN
 PAIN LADDERS - Stepwise recommendations for Primary & Secondary Care

Saturday, 20 December 2014

2014/2015 The Global Year Against (Neuropathic) Pain

Today's post from (see link below)  Who knew? Had you heard of this? No, me neither. However laudable such an initiative is, if it's only announced by one group of pain specialists and not given much publicity across the world's media, there's very little likelihood that it will have much impact either. Unfortunately, every year is the international year of something and for most people, you just can't see the wood for the trees, so most initiatives fall on deaf ears. It's a shame because there's no doubt that chronic pain is a feature of our age. More and more people suffer from it in one form or another and the statistics for pain-relief drugs being regularly used across the world are mind-boggling and there should be as much attention given as possible. I just wonder how many of the general public and chronic pain sufferers are going to be aware that 2015 is officially their year!!

Global Year Against Neuropathic Pain
by Giorgio Cruccu
01 Dec 2014

The International Association for the Study of Pain (IASP) has launched the Global Year Against Neuropathic Pain on 20 October 2014. The Neuropathic Pain Year is intended to last till the end of 2015 (it seems to be a really special year that lasts 15 months!).

The aims are:

1. Disseminate information about neuropathic pain worldwide
2. Educate pain researchers and health-care professionals who see the issues associated with neuropathic pain firsthand in their interactions with patients
3. Increase awareness of neuropathic pain among government officials, members of the media, and the general public worldwide
4. Encourage government leaders, research institutions, and others to support policies that result in improved pain treatment for people with neuropathic pain

Because the initiative is meant to mobilize IASP members and chapters and forge partnerships with other organizations in the field, such as the EAN, I herewith promote this issue on Neuropenews.

What is neuropathic pain?

According to the latest definition, it is pain that arises as a direct consequence of a lesion or disease affecting the somatosensory system [1]. Neuropathic pain typically manifests with continuous pain (burning, squeezing, pressure) or paroxysmal pain (electric shock-like sensations, stabbing pain), and provoked (brush-evoked, pressure-evoked, cold-evoked), or paraesthetic and dysaesthesic (tingling, pins and needles) sensations.

Which are the most common conditions?

From distal to proximal: distal symmetrical peripheral neuropathies (such as diabetic neuropathy) and focal neuropathies related to trauma (such as traumatic brachial plexus injuries), and following surgical interventions (such as breast surgery). CNS diseases that commonly cause neuropathic pain include multiple sclerosis, spinal cord injury and stroke. To tell the truth, central post-stroke pain (or “thalamic pain”) is less frequent than commonly believed: only 8% of patients who had a brain infarction develop a real neuropathic pain. They may indeed suffer from pain, but most often their pain is secondary to the postural changes induced by motor weakness or spasticity) [2].

According to the latest surveys, the prevalence of Neuropathic pain is about 8% of the general European population. The economic and social burden for the health care systems is terrible. For many patients the physical and psychological suffering can be even worse. So far, the most reliable estimates conclude that less than 50% of patients with neuropathic pain achieve ;50% pain relief using any drug or their combination [3].

I believe that neurologists should become more and more aware of neuropathic pain because the field is very difficult and neurologists have the right anatomical-physiological knowledge to master the many pathophysiological mechanisms that are involved [4].
Next time your neurological patient also complains of pain, please think of it.

Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008; 70:1630-5.
Klit H, Hansen AP, Marcussen NS, Finnerup NB, Jensen TS. Early evoked pain or dysesthesia is a predictor of central poststroke pain. Pain 2014. pii: S0304-3959(14)00475-8. doi: 10.1016/j.pain.2014.09.037.
Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T; European Federation of Neurological Societies. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010; 17:1113-e88.
Truini A, Garcia-Larrea L, Cruccu G. Reappraising neuropathic pain in humans—how symptoms help disclose mechanisms. Nat Rev Neurol. 2013; 9:572-82.

Professor Giorgio Cruccu works at the Department of Neurology and Psychiatry, at the University of Rome “La Sapienza”, Italy

Friday, 19 December 2014

Limited Modern Drugs Determine Neuropathy In S.African Kids

Today's post from (see link below) highlights a problem that just doesn't seem to go away and is based on the lack of financial resources. The fact is that many HIV+ children in Africa are still being given older HIV drugs to control the virus; the result being consistently high numbers of kids suffering terribly from neuropathy brought about from the drugs themselves. The older drugs are cheaper; the pharmaceutical companies refuse to lower the prices of modern drugs sufficiently and the incidence of neuropathy therefore remains stable but never reduces. It's scandalous in today's world that children have to suffer from nerve damage symptoms purely because of arguments over the costs of drugs suppressing the HIV virus they carry. Drug companies must bear a large percentage of the blame!

Peripheral neuropathy in South African children highlights limited ARV choices
Carole Leach-Lemens Published: 23 July 2012

Jump to
Look out for peripheral nerve damage; "talk to the child", advises researcher
Further information

Look out for peripheral nerve damage; "talk to the child", advises researcher

Peripheral neuropathy was identified in one-in-four children on HIV treatment in rural Mopani District, one of the poorest and least well-resourced areas in South Africa, Dr Remco Peters reported today at the 19th International AIDS Conference (AIDS 2012) in Washington, DC.

The findings underline the importance of improving paediatric antiretroviral formulations suitable for use in sub-Saharan Africa.

In this cross-sectional study of 182 children, aged from 5 to 15, 86% were receiving an antiretroviral (ART) regimen that included d4T (stavudine, Zerit).

Among HIV-infected adults, peripheral neuropathy is common and well recognised. It affects between 30 and 60% of people with HIV and may be related to HIV infection and/or the drugs used to treat HIV. Few studies have been able to distinguish between peripheral neuropathy as a result of HIV itself and neuropathy as a side-effect of ART. Other contributing factors include vitamin and mineral deficiencies and autoimmune effects.

Peripheral nerves are responsible for sensation-pain, pressure, heat sensation (sensory nerves) movement (motor nerves) and automatic bodily functions such as breathing, heartbeat, sweating and emptying of the stomach (autonomic nerves). Damage to these nerves is called neuropathy.

In most people with HIV, nerve damage usually starts in the hands or feet (hence the term 'peripheral' neuropathy), affecting both sides of the body and involving multiple nerves. It can range from mild numbness or pain to debilitating pain. Other symptoms include increased sensitivity to touch, diminished reflexes and weakness. It can severely affect quality of life.

Stavudine (d4T) and didanosine (ddI, Videx, Videx EC) are two of the anti-HIV drugs known as dideoxynucleoside reverse transcriptase inhibitors or ‘d-drugs’, which can cause peripheral neuropathy.

The World Health Organization (WHO), concerned about the side effects of d4T (principally abnormal body fat loss, or lipoatrophy, and peripheral neuropathy in adults) has urged national treatment programmes – wherever affordable – to drop d4T and move to tenofovir- (Viread) or AZT-based treatment regimens in adults.

The findings of the study presented today are likely to reinforce calls for access to paediatric formulations of abacavir (Ziagen) in settings where d4T is the only current alternative. Abacavir is already available for paediatric use in southern Africa, and is recommended by the World Health Organization as a component of first-line paediatric treatment, but remains substantially more expensive than stavudine.

A powder version of tenofovir suitable for use in children aged two to five years is licensed for use in the United States, but safety studies have not been carried out in children in sub-Saharan Africa to evaluate any potential risk of kidney toxicity or decreased bone mineral density. The South African HIV Clinicians Society has suggested that tenofovir should be used with caution in young children until further safety data are available.

In June of this year, WHO issued guidance on the best use of tenofovir in adolescents and children over two years of age The recommended dose is 8 mg/kg body weight (up to a maximum of 300 mg), administered once daily using either an oral powder formulation or low-strength tablets. Caution is needed nonetheless since tenofovir in combination with ddI increases the risk of ddI-related toxicities, including peripheral neuropathy.

Peripheral neuropathy is diagnosed based on symptoms and is more difficult to diagnose in children. Few tools exist for clinical screening for peripheral neuropathy in children. Children may find it difficult to describe their symptoms.

Few data exist on the extent, symptoms or causes of peripheral neuropathy among HIV-positive children in sub-Saharan Africa, where d4T is in common use. Among the estimated 2.3 million HIV-positive children, between 2008 and 2009, approximately 90% were on an ART regimen containing d4T.

The researchers chose to use neuropathy symptom score (NSS) and neuropathy disability score (NDS) to screen for peripheral neuropathy in this cohort of children.

NSS, a subjective assessment tool, includes a series of questions about location and severity of pain and pain relief (for example, does sitting help?) in the feet and legs. Each response is given a score of 0, 1 or 2. Total scores of 3, 5 and 7 indicate mild, moderate and severe neuropathy, respectively.

The NDS, an objective assessment tool, looks at ankle reflex (0, 1 or 2), vibration perception (0 or 1), pin-prick perception (0 or 1) and temperature perception (0 or 1) and scored. A reflex hammer, cotton swabs, a toothpick and cold water are all that is needed to carry out the test.

An NSS score equal to or above 3 or an NDS score equal to or above 2 was used as a definitive diagnosis of peripheral neuropathy. Dr Remco noted these were conservative cut-off points.

In total, 96% (174/182) of this cohort of children, all collecting ART from nurse-managed treatment programmes, completed screening for peripheral neuropathy. This included a questionnaire, physical exam, NSS and NDS scores.

The median age was 9.2 years with median time on ART of two years (2 months to 6.4 years).

Forty-nine children (27%) reported symptoms related to neuropathy, while 25 children (14%) met the NDS criteria. Overall, 43 children (25%) were identified as having peripheral neuropathy. Examples of children's descriptions of symptoms included:
“My feet are burning, I must take off my shoes in class otherwise I can’t concentrate.”
“I can’t sleep at night because of the tingling in my feet; I’m tired during the day.”

Dr Remco noted that, while the cause of peripheral neuropathy was not addressed in depth, being on ART for a longer period of time (p=0.06) was a major contributor.

Dr Remco concluded that, in this region, peripheral neuropathy among children is common and often goes undiagnosed. Simple and easy to use, the NSS and NDS are valuable tools for assessing peripheral neuropathy in a resource-poor and skills-limited setting.

The most important lesson learned is “quite simply, to talk to the child”, he added. In these settings, “We [healthcare workers] do not talk to the children, we will talk to the mother or caregiver about the child but never directly to the child.” 


van Ramshorst R et al. Clinical screening shows high prevalence of peripheral neuropathy in children taking antiretroviral therapy in rural South Africa. 19th International Conference on AIDS, abstract MOAB0205, Washington, DC, July 2012.

Thursday, 18 December 2014

Sensory Polyneuropathy: All You Need To Know

Today's post from (see link below) is a general but extensive post about the sorts of neuropathy that affect most people with the condition. Every now and then, it's important for this blog to publish general information for people either new to the disease, or coming to terms with what their doctor may have told them. This article tells you much of what you need to know and is useful for both patients and those living with patients, helping them to understand exactly what's going on with the strange symptoms they're experiencing. Worth a read.

Sensorimotor polyneuropathy
Medline Plus Update Date: 2/10/2014

Sensorimotor polyneuropathy is a condition that causes a decreased ability to move or feel (sensation) because of nerve damage.


Neuropathy means a disease of, or damage to nerves. When it occurs outside of the brain or spinal cord, it is called a peripheral neuropathy. Mononeuropathy means one nerve is involved. Polyneuropathy means that many nerves in different parts of the body are involved.

Neuropathy can affect nerves that provide feeling (sensory neuropathy) or cause movement (motor neuropathy). It can also affect both, in which case it is called a sensorimotor neuropathy.

Sensorimotor polyneuropathy is a body-wide (systemic) process that damages nerve cells, nerve fibers (axons), and nerve coverings (myelin sheath). Damage to the covering of the nerve cell causes nerve signals to slow down. Damage to the nerve fiber or entire nerve cell can make the nerve stop working. Some neuropathies develop over years, while others can start and get severe within days.

Nerve damage can be caused by:

Autoimmune (when the body attacks itself) disorders
Conditions that put pressure on nerves
Decreased blood flow to the nerve
Diseases that destroy the glue (connective tissue) that holds cells and tissues together
Swelling (inflammation) of the nerves

Some diseases lead to polyneuropathy that is mainly sensory or mainly motor. Possible causes of sensorimotor polyneuropathy include:

Alcoholic neuropathy
Cancer (called a paraneoplastic neuropathy)
Chronic inflammatory neuropathy
Diabetic neuropathy
Drug-related neuropathy
Guillain-Barre syndrome
Hereditary neuropathy
Vitamin deficiency (vitamins B12, B1, and E) 


Decreased feeling in any area of the body
Difficulty swallowing or breathing
Difficulty using the arms or hands
Difficulty using the legs or feet
Difficulty walking
Pain, burning, tingling, or abnormal feeling in any area of the body (called neuralgia)
Weakness of the face, arms, or legs, or any area of the body

Symptoms may develop quickly (as in Guillain-Barre syndrome) or slowly over weeks to years. Symptoms usually occur on both sides of the body. Most often, they start at the ends of the toes first.
Exams and Tests

An exam may show:
Decreased feeling (may affect touch, pain, vibration, or position sensation)
Diminished reflexes (ankle most commonly)
Muscle atrophy
Muscle twitches (fasciculations)
Muscle weakness

Tests may include:

Blood tests
Electrical test of the muscles (EMG)
Electrical test of nerve conduction
X-rays or other imaging tests

Goals of treatment include:

Finding the cause
Controlling the symptoms
Promoting a patient's self-care and independence

Depending on the cause, treatment may include:

Changing medicines, if they are causing the problem
Controlling blood sugar level
Not drinking alcohol
Taking daily nutritional supplements

Exercises and retraining to maximize function of the damaged nerves
Job (vocational) therapy
Occupational therapy
Orthopedic treatments
Physical therapy
Wheelchairs, braces, or splints


Safety is important for people with neuropathy. Lack of muscle control and decreased sensation can increase the risk of falls or other injuries.

If you have movement difficulties, these measures can help keep you safe:
Leave lights on.
Remove obstacles (such as loose rugs that may slip on the floor).
Test water temperature before bathing.
Use railings.
Wear protective shoes (such as those with closed toes and low heels).
Wear shoes that have non-slippery soles.

Other tips include:
Check your feet (or other affected area) daily for bruises, open skin areas, or other injuries, which you may not notice and can become infected.
Check the inside of shoes often for grit or rough spots that may injure your feet.
Visit a foot doctor (podiatrist) to assess and reduce the risk of injury to your feet.
Avoid leaning on your elbows, crossing your knees, or being in other positions that put prolonged pressure on certain body areas.

Medicines used to treat this condition:

Over-the-counter and prescription pain relievers to reduce stabbing pain (neuralgia)
Anticonvulsants or antidepressants
Lotions, creams, or medicated patches

Avoid pain medicine whenever possible, or use it only when necessary. Keeping your body in the proper position or keeping bed linens off a tender body part may help control pain.

Support Groups

For additional information and support, see:
Outlook (Prognosis)

In some cases, you can fully recover from peripheral neuropathy if your health care provider can find the cause and successfully treat it, and if the damage does not affect the entire nerve cell.

The amount of disability varies. Some people have no disability. Others have partial or complete loss of movement, function, or feeling. Nerve pain may be uncomfortable and may last for a long time.

Occasionally, sensorimotor polyneuropathy causes severe, life-threatening symptoms.
Possible Complications

Injury to feet (caused by bad shoes or hot water when stepping into the bathtub)
Trouble walking
When to Contact a Medical Professional

Call your health care provider if you have loss of movement or feeling in a part of your body. Early diagnosis and treatment increase the chance of controlling the symptoms.
Alternative Names

Polyneuropathy - sensorimotor


Katitji B, Koontz D. Disorders of the peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 76.

Shy ME. Peripheral neuropathies. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 428.
Update Date: 2/10/2014

Updated by:
Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

Wednesday, 17 December 2014

Sea Anemones Similar To Humans At Producing Nerve Cells

Today's post from (see link below) refers to yet another member of the animal kingdom that may be relevant for people living with nerve damage - the humble sea anemone. If you've followed research into neuropathy treatment over the years, you'll be used to seeing stories about bees, scorpions, snakes, spiders and the like, providing possible ingredients for nerve pain relief treatments but this one is slightly different in that it has been found that sea anemones have a remarkable capability to generate nerve cells and these stem cells are very similar to human stem cells. The implications then become clearer, especially as stem cell and genetic research is one of our best options for the future. Interesting story.

How are sea anemones so good at producing nerve cells?

Date:December 1, 2014 Source: Uni Research


A research group has revealed how a seemingly simple animal is able to produce nerve cells throughout its entire body. The study shows that the stem cells that a sea anemone uses to generate its nervous system are more similar to those of humans than expected.

The sea anemone that the researchers used in their experiments: Nematostella vectensis.
Credit: Chiara Sinigaglia
[Click to enlarge image]

A research group at the Uni Research Sars Centre in Bergen, Norway, has revealed how a seemingly simple animal is able to produce nerve cells throughout its entire body. A study published in the journal Development shows that the stem cells that a sea anemone uses to generate its nervous system are more similar to those of humans than expected.

In this tissue, neural stem cells give rise to nerve cells through a complicated process of cell division and stepwise specialization.

The nerve cells or their progenitor cells then move through the embryo to their final destination where they provide us with the ability to sense our environment, move our bodies and play chess.

Few of the stem cells that generate nerve cells when we are embryos, are still alive once we are adults, and it is therefore difficult for us to replace damaged nerve cells, for instance after an injury or a stroke.

Other animals are much better at replacing nerve cells, and among the champions of this are sea anemones -- animals that do not have a brain and are only very distantly related to us.

A new study by Gemma Richards and Fabian Rentzsch has now shown that one of these animals, the starlet sea anemone Nematostella vectensis, uses stem cells that are surprisingly similar to ours to generate their nerve cells.

"Embryos of the sea anemone can generate nerve cells throughout their entire body and they can completely regenerate their nervous system as adults," says postdoc Gemma Richards, the first author of the study.

Previously it was thought that this ability was based on a special type of stem cells in these animals, stem cells that can generate all kinds of cells, not only nerve cells.

"We have now been able to genetically label a specific group of cells in the sea anemone, and with this technique we can see that they build their nervous system from stem cells that exclusively generate nerve cells, resembling the way humans do this," Richards explains.

The gene that has been used to label these neural stem cells is important for nerve cell formation in humans as well.

The Rentzsch group has now started to compare this process in more detail between sea anemones and other animals.

"There is no straight connection to nervous system regeneration in humans, but the question as to why these animals can do it so much better than we can, is of course in the back of our heads," says Rentzsch.

Story Source:

The above story is based on materials provided by Uni Research. The original article was written by Andreas R. Graven. Note: Materials may be edited for content and length.

Journal Reference:

G. S. Richards, F. Rentzsch. Transgenic analysis of a SoxB gene reveals neural progenitor cells in the cnidarian Nematostella vectensis. Development, 2014; 141 (24): 4681 DOI: 10.1242/dev.112029

Tuesday, 16 December 2014

International Day Of Persons With Disabilities

Today's post from (see link below) talks about something that may have slipped your attention a couple of weeks ago. It slipped your attention because it wasn't announced on world news desks, thus revealing how much importance the media placed on the story!! You may wonder what it has to do with neuropathy, as the vast majority of people living with neuropathy and the vast majority of the public, probably don't see neuropathy patients as 'disabled'. However, when the symptoms of neuropathy result in chronic pain, or discomfort, or affect the way you react to sensory impulses including walking normally, you are to some extent 'disabled' and are entitled to be included in that category. The UN does include people suffering from chronic pain and as such a day like this is important for neuropathy patients, sick of being ignored or not taken seriously. It's just a pity that the media didn't see it as necessary to inform the public!

Observing The International Day of Persons With Disabilities
By Joe Carlon| December 3rd, 2014

Over one billion people in the world live with a disability. Some of these disabilities are visible, but others are hidden. The United Nations has designated December 3, 2014 as International Day of Persons With Disabilities. This year’s theme is “Break Barriers, Open Doors: For An Inclusive Society And Development For All.”

Disability disproportionately affects the poorest populations of the world, preventing them from accessing education and employment. Disabled persons in developing countries face extraordinary barriers to full participation in society. They lack access to healthcare, legal services, and other basic provisions that could benefit them. Without equal access, their voice cannot be heard. Indeed, there is very little mention of addressing issues of access and equality in the development plans of most nations.

In 2011, the United Nations General Assembly held a High Level Meeting on Development and Disability (HLMDD) that involved heads of state. The theme for this meeting was “The way forward: a disability inclusive development agenda towards 2015 and beyond.” Its goal was to outline strategies to begin to make sure that inclusion was on the agenda for the development of nations.

The HLMDD also looked forward to the time after the achievement of the Millennium Development Goals (MDGs). These goals are:

Eradicate extreme hunger and poverty
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria and other diseases
Ensure environmental sustainability
Develop a global partnership for development

All of these goals are directly related to equality for persons with disabilities, but they did not occur in a vacuum. In 1982, nearly 20 years before the MDGs, the UN outlined three areas to focus on for persons with disabilities. Called the World Programme of Action, the three areas that they hoped to address and improve were prevention, rehabilitation, and equalization of opportunities.

The MDGs specifically address maternal health and the eradication of hunger and poverty. These two areas can be a factor in disabilities that occur as a result of improper fetal nutrition.

Universal primary education is a tool that can help to better identify and remediate learning disabilities and other “invisible” disabilities. Empowering women to seek these opportunities out will also help with rehabilitation efforts.
Equalization of opportunities

Equal opportunity is a main theme in the MDGs, and the World Programme of Action believes that equality and empowerment need to be a crucial part of any plan for development in nations across the world.

The World Programme of Action initiative formally ended in 1992, but the effects of its strategies have shaped the UN’s work in developing countries and informed their policies when designing the MDGs. This year’s International Day of Persons with Disabilities theme “Break Barriers, Open Doors” reiterates the UN’s commitment to opening access for all, regardless of ability. This commitment is crucial, as is understanding of the different types of disability.

Visible disabilities are universally recognized and can include:

Vision loss
Cerebral palsy
Loss of limb
Down’s syndrome
Other disabilities that requires visible ambulatory assistance (wheelchair, crutches, etc)

Invisible disabilities are more complex and often are not recognized or acknowledged in a discussion about disability. These are conditions that are not immediately apparent, but are just as important to recognize on the International Day of Persons with Disabilities.

The list of invisible disabilities can include:

Mental disorders
Autism or Asperger’s
Hearing loss
Post-traumatic stress disorder
Chronic pain

A previously healthy person can develop an invisible disability that is just as serious as a visible one. This can result in a lowered quality of life and fewer opportunities. A person with dyslexia may have difficultly succeeding in school. Someone with chronic pain may have bad days that make steady work impossible. Post-traumatic stress disorder colors every aspect of a person’s interaction with the world. These are only a few examples of how invisible disabilities can hinder a person and hold back a nation.

Support for people with disabilities can be complicated, as their needs can change over time. When someone is first diagnosed with a disability or sustains a disabling injury, their needs will be much different than someone who has been living with a disability for a long time. There are a few general rules for supporting people with disabilities.

Treat disabled persons as you would treat anyone else

Mind your manners and don’t stare, talk condescendingly, or assume that you must help with everything. Many persons with disabilities are extraordinarily capable of everyday tasks and do not need your help, however well-intentioned.
Do not stigmatize disabled persons or their disability

Disability is not something to be ashamed of. It helps to think of the term “differently abled” rather than “disabled.” The first connotes differing strengths, while the second seems more negative and judgmental.

Do not make assumptions regarding ability

This is an especially useful thing to keep in mind with regard to invisible disabilities such as learning disabilities, autism, or Asperger’s. There is a high incidence of giftedness that occurs simultaneously in people with Asperger’s and ADHD. A learning disability does not always equal a lack of ability.
Focus on what disabled people can do, not what they can’t

This comes from a place of acceptance and abundance rather than scarcity. An example of this is Stephen Hawking, a renowned physicist who cannot walk, talk, or move. Focusing on only his challenges would deny the world of his exceptional mind.
Stand up for disabled people, and teach your children to do the same

There are bullies who will take any opportunity to demean and devalue people who are different. If you see that happening, say something if it is safe to do so. Teach your children compassion, acceptance, and understanding so that they will do the same.

Be a friend

Be the same friend for a disabled person as you would for a person without disabilities. Invite them out, laugh, cry, and joke around. Know that everyone has good days and bad days and not all are related to the disability. For people who struggle with depression and anxiety especially, stay in their lives, even when they push you away. Love them as they are.

There are many support services for persons with disabilities, their families and friends. is a great place to start for information on disability programs and services in the United States. Disabled People’s International is another organization that provides support and advocacy worldwide.

On December 3, 2014, join the world in celebrating the International Day of Persons With Disabilities. Find out about events happening all around the world, and join in to spread awareness!

Monday, 15 December 2014

Avelox: (Antibiotic) A High Risk Of Causing Neuropathy

Today's post from (see link below) is another one showing the progress of patient actions against the big drug companies and their lack of sufficient warnings regarding fluoroquinolone antibiotics. In this case, the subject is Avelox and the makers are Beyer and Merck. It cannot be stressed enough that if your doctor prescribes any of the antibiotics in the list below, you need to query why and whether there are alternatives available (there almost always are). For people already living with neuropathy, these drugs should be avoided at all costs and for those with conditions which commonly cause nerve damage, the same applies. Despite strong FDA pressure to increase warnings on packets, both manufacturers and doctors continue to issue them across the world, either unaware, or unimpressed by the dangers they bring. In cases like these, we need to become our own advocates and take responsibility for our own care. Look carefully at both the brand name and the proper name of any antibiotics you're given and if they belong to the fluoroquinolone group - go back to your doctor straight away.

Bayer and Merck Hit with Peripheral Neuropathy Lawsuit 
By Karina Basso December 3, 2014

A quinolone peripheral neuropathy lawsuit has been filed against pharmaceutical companies Bayer and Merck alleging their quinolone antibiotic drug Avelox caused a Tennessee woman to develop irreparable nerve damage.

Peripheral neuropathy is a condition in which a patient’s nerves become damaged, resulting in impairment of sensation and movement, as well as other health issues.

Plaintiff Sherri K. filed this Avelox peripheral neuropathy lawsuit in August alleging she developed permanent nerve damage after taking the prescription antibiotic.

According to the Avelox lawsuit, “The warning label for Avelox during the period from September 2004 through August 2013 misled Plaintiff and her treating physician by incorrectly advising patients and physicians that peripheral neuropathy associated with Avelox was ‘rare’ and failing to mention the possibility that it could result in irreversible nerve damage.”

Because of the high incidence rates of peripheral neuropathy when taking fluoroquinolone drugs like Avelox, in August 2013 the U.S. Food and Drug Administration (FDA) required Bayer, Merck, and other pharmaceutical companies that produce quinolone drugs to include more serious warnings about the possibility of nerve damage when taking these types of antibiotics.

Since then, Avelox’s label has made the warning more prominent and stopped referring to the condition as rare. However, these actions by Bayer and Merck occurred after the plaintiff had taken the quinolone drug.

Sherri K. alleges that the warning of the “rare” peripheral neuropathy was buried underneath a long list of other Avelox side effects and did not impress upon consumers that peripheral neuropathy is serious, significant, and can be debilitating.

This Avelox peripheral neuropathy lawsuit brings several allegations against Bayer and Merck, including claims of strict liability, failure to warn, negligence, breach of warranty, fraud, negligent misrepresentation and fraudulent concealment. The plaintiff is seeking relief from the drug manufacturers in the form of non-economic and economic damages, payment of medical expenses, refund of drug purchases, and compensatory, consequential, and punitive damages.

The Avelox Peripheral Neuropathy Lawsuit is Case No. 3:14-cv-03680, in the U.S. District Court for the Northern District of California.
Fluoroquinolone Drugs

New research and FDA adverse event drug reports suggest that patients taking quinolone antibiotic drugs, also known as fluoroquinolones, face an increased risk of developing peripheral neuropathy (nerve damage) when compared to patients on other types of antibiotics.

Drugs included in the quinolone drug family known to allegedly cause the development of peripheral neuropathy include:

levofloxacin (Levaquin)
ciprofloxacin (Cipro)
moxifloxacin (Avelox)
norfloxacin (Noroxin)
ofloxacin (Floxin)
gemifloxacin (Factive)
Quinolone Peripheral Neuropathy

In general, quinolone peripheral neuropathy begins rapidly, and patients begin presenting symptoms just a few days after taking the quinolone drug.

Some signs of quinolone peripheral neuropathy side effects include:

Tingling or numbness in the extremities starting in the hands and feet and spreading to the arms and legs
Burning pain
Sharp, jabbing pain or electric-like pain
Extreme touch sensitivity
Skin, hair or nail changes
Lack of coordination
Muscle weakness
Heat intolerance
Bowel, bladder of digestive problems
Dizziness or light-headedness

Many individuals and families of individuals who have allegedly suffered from severe nerve damage after taking Avelox or another fluoroquinolone antibiotics have filed quinolone peripheral neuropathy lawsuits or joined quinolone peripheral neuropathy class action lawsuits.

Sunday, 14 December 2014

Faulty Circuitry In The Spine Responsible For Nerve Pain

Today's post from (see link below) looks at new findings which show that a neural mechanism in the spinal cord is capable of sending faulty and erroneous pain signals to the brain. Sounds familiar doesn't it? Symptoms that everyone with neuropathy will recognise but finding why and where this happens in the nervous system is always a question of looking for needles in haystacks. Many people don't appreciate just how complex the nervous system actually is and how many intricate neural processes are involved with every action we take and everything we sense in our daily lives. Mapping these processes and discovering the reasons for malfunction and where in the system this occurs, is a life's work for many scientists. Consequently, every discovery like the one described in this article, helps map the system and make sense of the incredible circuitry that makes up the human nervous system.

Spinal circuitry responsible for chronic pain charted 
December 5, 2014 Salk Institute for Biological Studies


Pain typically has a clear cause–but not always. When a person touches something hot or bumps into a sharp object, it’s no surprise that it hurts. But for people with certain chronic pain disorders, including fibromyalgia and phantom limb pain, a gentle caress can result in agony. Findings of new research could lead to new therapeutics for disorders such as fibromyalgia and phantom limb pain.

Pain typically has a clear cause–but not always. When a person touches something hot or bumps into a sharp object, it’s no surprise that it hurts. But for people with certain chronic pain disorders, including fibromyalgia and phantom limb pain, a gentle caress can result in agony.

In a major breakthrough, a team led by researchers at the Salk Institute and Harvard Medical School have identified an important neural mechanism in the spinal cord that appears to be capable of sending erroneous pain signals to the brain.

By charting the spinal circuits that process and transmit pain signals in mice, the study, published online November 20, 2014 in Cell, lays the groundwork for identifying ways to treat pain disorders that have no clear physical cause.

“Until now, the spinal cord circuitry involved in processing pain has remained a black box,” says Martyn Goulding, Salk professor in the Molecular Neurobiology Laboratory and a co-senior author of the paper. “Identifying the neurons that make up these circuits is the first step in understanding how chronic pain stems from dysfunctional neural processing.”

In many instances, people who suffer from chronic pain are sensitive to stimuli that don’t normally cause pain, such as a light touch to the hand or a subtle change in skin temperature. These conditions, referred to generally as forms of allodynia, include fibromyalgia and nerve damage that is caused by diseases such as diabetes, cancer and autoimmune disorders.

In other instances, the mysterious pain arises after amputation of a limb, which often leads to discomfort that seems to be centered on the missing appendage. These sensations often subside in the months following the amputation, but may linger indefinitely, causing long-term chronic pain for the sufferer.

“These disorders are extremely frustrating for patients, because there is still no effective treatment for such chronic pain disorders,” says Qiufu Ma, a professor of neurobiology at Harvard Medical School and co-senior author on the paper.

Scientists have long theorized that pain signals are sent from sensory neurons in the limbs and other extremities to transmission neurons in the spinal cord, which then relay the information to the brain. At each of these three steps–extremities, spinal cord and brain–the pain information can be altered or even blocked before being relayed onward through the nervous system to the brain. The circuitry in the spinal cord is particularly important, as it is able to gate painful stimuli, thereby acting as a checkpoint between the body and the brain to make sure that only the most important pain signals are transmitted.

Previous studies had determined that two types of sensory neurons appeared to be involved in these circuits: pain receptors and touch receptors.

In their new study, the Salk and Harvard researchers set out to precisely identify the spinal neurons involved in these circuits. They deciphered the role each of two neuronal cell types play in the processing of pain signals in the dorsal horn, the location where the sensory neurons connect with the spinal cord.

The scientists discovered that a class of mechanoreceptors in the skin that detect painful mechanical stimuli are part of a feedback circuit in which excitatory neurons that produce the hormone somatostatin are inhibited by neurons that synthesize dynorphin (a natural analgesic molecule that produces effects similar to opiates). The inhibitory neurons they identified appear to control whether touch activates the excitatory neurons to send a pain signal to the brain.

This finding begins to explain how a light touch can cause discomfort in someone with allodynia: if something is awry in the pain circuitry, then the sensations of touch that normally travels through the mechanoreceptors could instead activate other neurons that trigger a pain signal. Similarly, mechanoreceptor fibers that project to the spinal cord from a missing limb might spur erroneous pain signals.

“Normally, only pain receptors are involved in sending pain signals to the brain, but when the spinal dynorphin inhibitory neurons are lost, touch sensation are now perceived as painful,” says Goulding, holder of Salk’s Frederick W. and Joanna J. Mitchell Chair. “This really opens the door to understanding what’s happening in these pain disorders where the cause of the pain is seemingly innocuous or not known. It could be that something has gone awry in how this spinal circuitry is operating, so sensations become jumbled together and emerge as pain.”

Story Source:

The above story is based on materials provided by Salk Institute for Biological Studies. Note: Materials may be edited for content and length.

Journal Reference:

Bo Duan, Longzhen Cheng, Steeve Bourane, Olivier Britz, Christopher Padilla, Lidia Garcia-Campmany, Michael Krashes, Wendy Knowlton, Tomoko Velasquez, Xiangyu Ren, Sarah E. Ross, Bradford B. Lowell, Yun Wang, Martyn Goulding, Qiufu Ma. Identification of Spinal Circuits Transmitting and Gating Mechanical Pain. Cell, 2014; 159 (6): 1417 DOI: 10.1016/j.cell.2014.11.003

Saturday, 13 December 2014

How Can A Metabolic Syndrome Affect Neuropathy?

Today's post from (see link below) looks at something called  'metabolic syndrome' and for once applies primarily to people in danger of getting diabetes. Basically, it's a disorder in your energy and energy storage system and comprises a combination of danger factors mainly caused by lifestyle choices. Metabolic syndrome increases the risk of developing cardiovascular disease, particularly heart failure, and diabetes and by definition, nerve damage as a result. It means that your body's metabolism is out of balance and not functioning effectively, leading (amongst other things) to an inability to regulate insulin in your bloodstream. It may well be a leading cause of your neuropathy symptoms but other health factors may also come into play. The answer lies in changing habits; preferably before diabetes, heart or nerve problems occur. Worth a read for everybody, whether you currently have diabetes or not.

What You Need To Know About “The Silent Killer” Metabolic Syndrome
Posted by john on January 1, 2012

What You Need To Know About “The Silent Killer” Metabolic Syndrome

Increased blood pressure…

Higher than normal insulin or blood sugar levels…

Excess body fat, particularly around your waist…

Abnormal cholesterol levels – and that means both “good” and “bad” cholesterol…

If you have not just one but all of these conditions, you may have Metabolic Syndrome. And that increases your risk for heart disease, stroke and diabetes.

If you know you have one of these symptoms, you may have others and not know it. Do any of these sound familiar?

1. Obesity – Are you carrying excess weight, particularly around your waist? Do you have an “apple shape”?

2. Elevated Blood Pressure – If your systolic (the top number) blood pressure is higher than 120 or your diastolic (the bottom number) is higher than 80, you have blood pressure issues that you need to talk to your doctor about.

3. Abnormal Cholesterol Levels - If you have high triglycerides (blood fat) and low “good” or HDL cholesterol, you need to ask your doctor about treatment.

4. Insulin Resistance – If your body doesn’t properly regulate the amount of sugar in your blood, you could be on your way to becoming diabetic.

If you have any of these symptoms, talk to your doctor about testing to make sure you don’t have others. With the exception of obesity, any of these could be silent symptoms that remain undetected without proper medical testing.

What Causes Metabolic Syndrome?

Sometimes Called Pre-Diabetes Metabolic Syndrome is rampant in our society…

As the name implies, Metabolic Syndrome is linked to your body’s metabolism and could be caused by your body’s inability to properly regulate the amount of insulin in your bloodstream. Insulin is a hormone made by your pancreas and it helps control the amount of sugar in your blood.

If your body is operating normally, your digestive system breaks down the food you eat into sugar (what doctors normally refer to as glucose). Your blood then carries the glucose to your tissues where the cells use it as fuel. Insulin helps the glucose enter the cells. If you’re insulin resistant, your cells don’t respond normally to insulin and glucose can’t enter the cells as it should.

The body reacts by producing more and more insulin thinking that will help the glucose get into the cells, sort of like pumping the gas pedal in your car to get more fuel to the carburetor. Just as that can flood the engine in your car, the result is higher than normal levels of insulin in your blood. And that can, and often does, lead to diabetes.

Even if you don’t develop diabetes, elevated glucose levels can raise your triglyceride levels or interfere with how your kidneys work. All of which puts you at higher risk for heart disease, stroke and a host of other conditions.

Think You May Have Metabolic Syndrome?

If any of these symptoms or conditions applies to you, talk to your doctor about testing to make sure you don’t have the others before they cause serious health problems.

If you’re not sure what to ask your doctor, here are some basic questions:

• Are the symptoms I’m experiencing now related to metabolic syndrome or some other condition?

• What kinds of tests do I need to best manage my conditions?

• What else can I do to improve my health?

• What other options do I have to manage the conditions that cause metabolic syndrome?

• How do best manage all of these conditions together?

• What restrictions do I need to follow?

• Where can I get more information on metabolic syndrome or any of the conditions I currently have?

One More Thing to Think About

We’re seeing more and more metabolic syndrome in younger patient populations. And one of the first symptoms they experience is peripheral neuropathy. Because nerve tissues are especially vulnerable to damage from diseases that affect the body’s ability to transform nutrients into energy or produce some of the components of cell repair (think diabetes), nerve damage and the resulting peripheral neuropathy is very common.

Classic symptoms of peripheral neuropathy are:

• Tingling and/or burning in hands and feet

• Neuralgic-like pains

• Loss of the sense of touch or an inability to feel vibration

• Temperature changes in the flesh – do your extremities feel excessively warm or cold?

• Serious sleep disturbances with resultant depression or side effects from pain medication

If you have a confirmed diagnosis of metabolic syndrome and are now experiencing any of these symptoms, you don’t have to just live with it. Contact us today for information on how peripheral neuropathy can be treated, your suffering lessened and exactly how to find a NeuropathyDR Treatment Center in your area.

Friday, 12 December 2014

A Beneficial Neuropathy Diet

Today's post from (see link below) is advice for the long term. It's no good trying a diet and giving it up after a week, especially when it's designed to support your nervous system. You need to make it a long-term feature of your life and give it at least six months before deciding whether it's made any improvements to your situation or not. This also means ditching certain foods that may be making your neuropathy symptoms worse but you don't need to do everything in a day. People tend to stick to dietary changes if they absorb them gradually into their daily routines - sometimes too much change in one go can work against you and cause you to give up too soon.

What Are the Key Elements of a Beneficial Neuropathy Diet?
Posted by Editor on November 24, 2014

Nutrition Plays a Big Role in Healing Neuropathy—and Poor Nutrition Can Make Your Symptoms Worse.

Neuropathy symptoms resulting from conditions like cancer, HIV/AIDS, lupus, diabetes, or shingles can make life pretty miserable. Unfortunately, a medical treatment program focused on managing neuropathy only through injections or other medication may ultimately provide you with little relief.
That’s because so many symptoms of neuropathy are caused or made worse by nutritional deficiencies. Only by addressing those key elements missing in your diet can you see substantial and long-term improvement in neuropathy pain.

A beneficial neuropathy diet is especially important for you if you’re also dealing with gastritis, Crohn’s disease, or similar types of digestive issues. In that case, your body is simply not able to absorb the needed nutrients from the foods you eat, leading to chronic vitamin deficiency that over time can encourage neuropathy symptoms. As you can see, your body’s ability to process nutrients properly can have systemic effects that go beyond your digestive system to alter your quality of life.

Fortunately, what this means is that you can take charge of your neuropathy symptoms by making dietary changes. Following a neuropathy diet, along with other supportive treatments recommended by your NeuropathyDR® clinician, is likely to manifest noticeable differences in your symptoms.
Key Elements of a Neuropathy Diet

A nutritional plan for neuropathy should include the following:

Lots of veges, beans and peas otherwise known as legumes and with any grains always going gluten free; these can be a great source of B vitamins to support nerve health. 

Eggs and fish, which contain additional B vitamins including B1 and B12.

Fruits and vegetables with a yellow or orange color, including yellow bell peppers, squash, oranges, and carrots, which contain vitamin C and vitamin A for an immune system boost.

Kale, spinach, and other leafy green vegetables that offer magnesium and calcium for your immune system and nerve health.

Foods rich in vitamin E (avocado, almonds, unsalted peanuts, tomatoes, unsalted sunflower seeds, fish).

If there are any nutrient gaps in your neuropathy diet due to an inability to eat some of the foods listed above, your NeuropathyDR® clinician will work with you to provide an appropriate supplement.

Remember, one key way that you can take charge of your health starting today is to implement beneficial dietary changes. Your neuropathy diet can make all the difference in the world.

For more information about neuropathy diet components and other ways to take control of your neuropathy symptoms, take a look at these resources for Self-Guided Care.

Thursday, 11 December 2014

Coping With Chronic Neuropathy Pain

Today's post from (see link below) is another self-help post which although it applies to life in general when you're in pain, is especially applicable at this time of year, when you're workload suddenly seems to double. It's full of useful tips to help you find a balance when the pain is bad and the pressure to act in a certain way means you can't just take to your bed. You may cringe at internet 'nannies' telling you how to behave but sometimes you're just not aware of how the pressure is building up and it's only when your body screams 'enough already!' that you realise you need to take a step back. This article may help you prepare a little better.

When The Mind Says Yes But The Body Says No
Posted on October 28, 2014 237 by Jen Reynolds Posted in FibroTV Blog

Many times when you are chronically ill there are things you want to do but because of symptoms they can be difficult. This is more so for people that have suddenly became ill and had full and busy lives before they became sick. The sudden reduction in physical activity can leave someone with a chronic illness to have feelings of guilt and feeling as if they are a burden to others. Also, many people with chronic illnesses have a people pleasing trait and have a hard time saying “No” which can sometimes leave the person with the illness physically and emotionally drained. So what do you do when the mind says yes but the body says no? Here are some tips!

Don’t Judge Yourself

When you have to cancel plans, rearrange appointments, or just flat out say no to an obligation because of illness the last thing you want to do is be self critical or judge yourself. Don’t let people make you feel guilty! You know your body and if you can’t do something it is because you can’t do it at the time. Be kind to yourself and gentle with your choices that are best for your health. There are enough people that will try to make you feel bad and/or guilty for not being there. You do not have to make that any worse by making yourself feel bad.

Evaluate What You CAN Do

If a person focuses on what they can do instead of what they can not do, the world opens up to many astonishing opportunities. This positive outlook reveals it self in the form of more energy, increased creativeness and a stronger sense of competence. Focusing on what you can do instead of focusing on what you can not do will make all the difference in the world! On the other hand, when you focus on your weak points and disappointments, the world becomes terrible place of “whoa” and anguish. You may start to believe that you cannot accomplish anything so you stop trying, which may cause mental distress. These anxious thoughts fill one’s day with trepidation and drudgery, and may weigh a person down with a sense of bleakness.

To modify your self-talk or attitude you must change that inner conversation or dialogue you are having. To stop it you must catch it in action. So, pay attention to yourself. You must connect to and listen for that inner voice whenever possible. What do you tell yourself all day long?

For those with children there are obviously certain things you must do for them as you are personally responsible for your kids and you can’t just say no about things like taking them to school, the doctors, Etc etc etc. I think it is important to be open and honest with your children and let them know when you are having a rough day. They know anyways! They pick up on your energy so being up front and telling them that “Today I might not be able do everything I like with you but I will try my best to do all I can for you.” can really help them to be more prepared and understand that you have limits that day. Your kids being told up front helps them be prepared if you do have to say no to something later in the day. If your children are older make sure they help out around the house when you are not feeling well. Most kids like to help out and don’t feel as helpless in the situation of a parent being ill if you give them a few things to do (even when they give you an attitude about it). Let’s face it!! You are not a super parent anymore and that is okay! Don’t try to be. That is a lot of pressure and can be unachievable even for a healthy person!

Make Large Meals With Leftovers For Those Days You Can’t Cook

We all have to eat and we normally eat unhealthy when we are not feeling well. We turn to fast food or heavily processed food because it is cheap, easy and fast! This is where larger meals when you are having a good day and feeling up to cooking come in handy. Just put the left overs in the freezer for a night you are not feeling up to cooking and reheat. Also crock pots are awesome! Toss in the one pot meal and it slow cooks all day and you have a very healthy and homemade meal that taste like you slaved in the kitchen for hours!

Take cat naps or/and mediate during the day

We all know stress and not enough sleep makes our symptoms worse so including short naps during the early afternoon (Be careful not to take naps too late or you will be up all night!) and taking time out to meditate will reduce your stress and pain.

Don’t know how to meditate? Try free guided meditation videos on Youtube! Not all meditations are the same and you have to find ones the resonate with you and relaxes you so browse a few! There are even meditations for every belief system and religion!

Weather permitting get outside AT LEAST once a day

Even if it is just sitting in the backyard or front porch, getting outside is good for your overall health!

Here are five good reasons to get outdoors:

Your vitamin D levels rise. Sunlight hitting the skin begins a process that leads to the creation and activation of vitamin D. Studies suggest that this vitamin helps fight certain conditions, from osteoporosis and cancer to depression and heart attacks. Limited sun exposure (don’t overdo it), supplemented with vitamin D pills if necessary, is a good regimen.

You’ll get more exercise. If you make getting outside a goal, that should mean less time in front of the television and computer and more time walking and doing other things that put the body in motion.

You’ll be happier. Light tends to elevate people’s mood, and there’s usually more light available outside than in. Physical activity has been shown to help people relax and cheer up, so if being outside replaces inactive pursuits with active ones, it might also mean more smiles.

Your concentration will improve. Children with ADHD seem to focus better after being outdoors. It might be a stretch to say that applies to adults, but if you have trouble concentrating, outdoor activity may help.

You may heal faster. In one study, people recovering from spinal surgery experienced less pain and stress and took fewer pain medications when they were exposed to natural light. An older study showed that the view out the window (trees vs. a brick wall) helped recovery in the hospital.

Find something creative to do if you are bedridden for the day

Nothing is worse for your mind/body/spirit than laying around thinking about all the pain you are in. What you think about expands. It is the natural law of attraction. Finding an activity that will make you feel like you have been productive even if you are not able to get out of bed can make a huge difference emotionally. Remember our mind and body are connected so when you are not doing well emotionally it will cause more physical symptoms! Many people have found new and exciting talents through chronic illness and downtime due to injury. What excites you? Is there something you always wanted to do creatively or to help others but you never had the time to do it before? Maybe learn how to knit or scrapbook? How about writing letters to those soldiers that are serving in another country or have been injured? Sit down and write down what you would like to try and maybe you will find a new passion and a new purpose!

Wednesday, 10 December 2014

How Those In Chronic Pain Can Survive The Holidays

Today's post from (see link below) is a self-help article designed to help people in chronic pain to cope with the stresses of the holiday season. Whatever you may think of self-help articles, there are some good ideas here for when it all seems to be getting on top of you. Let's face it, the holidays are an artificial time in which you're obliged to do things you would normally avoid and those living with painful conditions can quickly get tired and dispirited, which other people may misinterpret. It's a question of thinking through exactly what you can and can't do and planning for all eventualities, so that you can minimise stress as much as possible.

Surviving the Holidays when You’re Chronically Ill
Four suggestions for making the best of the holidays 
Published on November 23, 2014 by Toni Bernhard, J.D. in Turning Straw Into Gold

For the chronically ill—which includes those who suffer from chronic pain—the holidays can feel like a no-win situation. If we participate at all, there's likely to be payback later. On the other hand, if we don’t participate, we'll feel isolated and risk other people not understanding why we haven't joined in the festivities.

I encounter this no-win dilemma at Thanksgiving, which is the only winter holiday that my husband and I celebrate with other people. We host a Thanksgiving dinner. (I use "we” loosely here; my husband does most of the work.) My son and his family come; my husband’s brother and sister-in-law come; a few friends come. Here’s my no-win dilemma: On the one hand, I want to be part of the festivities from beginning to end, but if I do that, I’ll land in bed for days. On the other hand, if I stay in the bedroom most of the time, I hit the emotional skids. My solution? I compromise, even though that compromise results in several days of payback.
Here are four suggestions for surviving the holiday season—from Thanksgiving to New Year’s.

  • Come up with a plan of action before everyone arrives or before you go to other people’s houses.

  • Doing this will allow you to keep the chronically ill person’s best friend by your side: pacing.

I figured out that our Thanksgiving gathering is divided into four periods:

  • a burst of socializing when people first arrive;
  • more socializing, accompanied by snacking, in the hours leading up to dinner;
  • dinner itself; and
  • after-dinner socializing.

I’ve got my plan of action, although, I admit, it’s a challenge every year for me to garner the discipline to follow it: I limit myself to visiting for two of these four periods. I’m present when people first arrive, then I retire to my bedroom and lie down until dinner is served. I eat dinner with everyone. Then I retire to my bedroom again after dinner.

Is this a satisfying arrangement for me? Not really. But it’s my compromise…the most amount of socializing I can handle that results in the least amount of payback in the days to come.

Your ability to participate may differ from mine. I suggest you figure out ahead of time what's best for you, given your limitations. It will be much easier to muster the discipline to leave the gathering if you have a plan in place. (Hopefully, if you’re at another person’s house, they’ll have a room you can lie down in.)

It can also be helpful to tell someone who’ll be there—someone you feel comfortable with—about your plan of action so he or she can prompt you: “Why don’t you rest before dinner?” But a warning: the burden may still fall on you to carry out your plan because your “helper” may get caught up in socializing or helping with meal preparations and forget to give you that prompt. I’ve had that happen. Bottom line: I know that pacing is my responsibility.

Lower your standards regarding holiday gifts and cooking.

Doing this has been very helpful to me. I now do all my shopping online. I miss the ambience of being at a mall with its decorations, holiday music, and wide-eyed kids lined up to see Santa. On the other hand, I don’t miss the crowds. On balance, I’m happy to shop online.

Recently, I’ve lowered my standards even more and have started buying gift cards. At first, I felt bad about it—that is, until a friend gave me a gift card to Amazon. I loved it! Yes, it was not as personal as getting a wrapped gift, but then again, I was saved the experience of opening a box and gazing upon something I knew I’d never use. I bought a new quilt for my bed with the gift card, something I’d never have spent my own money on. After choosing the exact one I wanted, I sent the Amazon link to my friend. She loved seeing that I'd gotten for myself something I really wanted.

As for cooking, I’ve learned that I can cut corners and no one notices. The last two years, my contribution to Thanksgiving Dinner has been to make a pumpkin pie. I've always taken pride in my pie crusts, but I no longer have the energy to make one from scratch, so I had my husband buy a pre-made one. The first time he did this, I felt terrible about it. But when everyone ate the pie, no one noticed. I got compliments all around. Yes, I noticed…but I was the only one…and so I decided it was time to let go of my “have-to-make-pie-crust-from-scratch” directive.

And here's your bonus for lowering your standards regarding gifts and cooking: It’s highly likely that no one was holding you to as high a standard as you were holding yourself to in the first place! I’ve discovered that this is true in general in my life when it comes to those who care the most about me. And so, when I lower my standards, they're still usually higher than what my loved ones are expecting of me anyway.

Look for the joy in the holiday you’re capable of celebrating.


I can’t spend Christmas with my children and their families because I can’t travel to where they are. So where’s the joy? I’ll admit that sometimes I have to look hard for it and, yes, the holidays can be a mixed bag for me…not all joy. But if I look, I can find it. My first joy is a perverse one, but what the heck! When I see news stories about the nightmare holiday travel people have to endure—getting stuck on snowy roads, sleeping in airports because of cancelled flights—I say to myself: “I’m glad I’ll be at home.”

My second source of joy is the peaceful quietness of my husband's and my Christmas Day. This makes Christmas feel old-fashioned and in harmony with the spiritual nature of the day. Yes, it can be tinged with a feeling of emptiness now and then, having raised two children in this house. But the quiet is nice.

Sometimes we try to find an espresso place that’s open so we can chat and people-watch. I’ve noticed an unspoken camaraderie among those who, like the two of us, aren’t with family on Christmas Day. That sense of kinship brings me joy.

Keep mindfulness, self-compassion, and equanimity as your faithful companions.

Why mindfulness? Because mindfulness is caring attention to what’s going on in the present moment. That includes what’s going on in your body and your mind. The more you stay attuned to how you’re feeling physically and the more you know how your mind responds to what’s happening, the better able you’ll be to take care of yourself.

For example, if you’re at a gathering, mindfulness can help you become aware that your body is too tired to continue socializing. It’s important then to become aware of what your mind does when your body sends this message. Does your mind try to talk you out of listening to your body? Does it try to guilt trip you into socializing longer than you can handle? The more you know about how your mind reacts, the better you’ll be able to choose to take self-protective action.

Why self-compassion? Why not self-compassion? It’s not easy to have to limit yourself so severely during the holidays and not to be able to do what you want to do the most. My first choice would be to go to my daughter’s house in Los Angeles for Christmas morning and then drive to San Diego and spend Christmas afternoon and dinner at my son’s in-laws’ house. But I’m not able to do it. This doesn’t call for self-blame; it calls for self-compassion—an essential survival tool for the chronically ill.

Why equanimity? Equanimity is that calm and balanced state of mind that is always aware that life has its share of ups and downs, and successes and disappointments. Life is a constant mix getting what we want and not getting what we want. When I’m able to accept with grace that I simply cannot celebrate the holidays the way I would if wishes always came true, I can begin to let go of any resentment I feel about the life I have—and that feels good. That letting go also makes me feel a special connection to others who are in the same situation. That connection—that kinship—goes a long way to helping me feel at peace during the holidays.

Peace on earth and goodwill toward all of you.

© 2014 Toni Bernhard

You might also like “How to Ease the Pain of Isolation During the Holidays.”

Thank you for reading my work. My most recent book is titled How to Wake Up: A Buddhist-Inspired Guide to Navigating Joy and Sorrow.

I'm also the author of the award-winning How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and their Caregivers.