Welsh Guidelines For Neuropathic Drugs And Opiates

Today's post from wales.nhs.uk (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
 

1	FENTANYL  FENTANYL PATCHES - ABUHB guidance  FENTANYL (SUBLINGUAL TABLETS & NASAL SPRAY) for BREAKTHROUGH PAIN - ABHB guidance	May 2011 Dec.2011
2	NEUROPATHIC PAIN   Diagnosis & management of NEUROPATHIC PAIN - ABUHB guidance     NEUROPATHIC PAIN (inc.Diabetic Peripheral Neuropathic Pain) PATHWAY  VERSATIS - agreed local process covering off-label GP repeat prescribing  Patient Information Leaflets (from the Faculty of Pain Management) covering use of  AMITRIPTYLINE, DULOXETINE, GABAPENTIN and PREGABALIN in neuropathic pain	Dec.2008 (updated Sep.2010 & Jan.2014) Jan.2014   Jun.2012
3	STRONG OPIOIDS IN NON MALIGNANT PAIN - ABUHB guidance  OPIOID ANALGESIC REVIEW  Advice for non-specialist prescribers for patients maintained on longer term opiate therapy	Nov.2012 Feb.2014
4	10 KEY MESSAGES:  on Tramadol, Managing Chronic Persistant Pain (CPP) and; Strong Opiates in CPP	Feb.2014
5	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
6	OPIATE CONVERSION DOSES - ABUHB guidance on approximate dose equivalences of opiates	Nov.2010
7	OXYCODONE ABUHB guidance	Mar.2012
8	All Wales Patient Information Leaflet - Medicines for MILD to MODERATE PAIN	Jul.2012
9	PAIN LADDERS - Stepwise recommendations for Primary & Secondary Care	Nov.2012

http://www.wales.nhs.uk/sites3/page.cfm?orgid=814&pid=72052

Australian Assessments Of Neuropathic Drugs

  Today's interesting post comes from nps.org.au (see link below) and is a list of medications used to treat neuropathy in Australia . The TGA mentioned here is the Australian Therapeutic Goods Administration and the letters PBS stand for Pharmaceutical Benefits Scheme. Also the term 'streamlined authority' means medicines are prescribed for specific conditions and do not need prior approval from the Department of Human Services or the Department of Veterans' Affairs. Instead the process is streamlined by providing a four digit streamlined authority code. What's interesting is the way certain drugs for neuropathy are regarded in different parts of the world.
It may be worth checking what you take against how the Australians assess their worth - it may not always be the same as in your region. That begs the question why and may stimulate further research on your part. There is a seperate assessment of Lyrica (pregabalin) at the beginning of the list (see live link) and this may also be of interest because as we know, Pfizer (manufacturers) withdrew approval of its own drug Lyrica for Diabetes and HIV-related neuropathies in May this year (2012) and yet it is still widely prescribed for both forms of neuropathy. If you yourself know of other differences in national approvals or rejections for drugs used to treat neuropathy, please use the contact button to let us know. Knowledge is strength and we must be sure we are being treated safely and responsibly for neuropathic symptoms.
 

Prescribing drugs for adults with neuropathic pain: TGA approval status and PBS listing restrictions.
Date published : 6 December 2012

Additional content — Pregabalin (Lyrica) for neuropathic pain


Prescribing drugs for adults with neuropathic pain: TGA approval status and PBS listing restrictions (December 2012)

Drug (Brand)	TGA-approved indication	PBS listing restriction
Antidepressants
Amitriptyline (Endep)	Not TGA approved for neuropathic pain	Unrestricted
Duloxetine (Cymbalta), Nortriptyline (Allegron) Venlafaxine (Efexor)	Not TGA approved for neuropathic pain	Major depressive disorders (Restricted benefit)
Anticonvulsants
Pregabalin (Lyrica)	Neuropathic pain in adults; 18 years +	Refractory neuropathic pain (Streamlined authority)
Carbamazepine (Tegretol, Teril)	Idiopathic trigeminal neuralgia, trigeminal neuralgia due to multiple sclerosis, idiopathic glossopharyngeal neuralgia	Unrestricted
Gabapentin (Gabahexal, Gabaran, Gantin, Neurontin, Nupentin, Pendine)	Neuropathic pain in adults; 18 years +	Epilepsy (Streamlined authority) Refractory neuropathic pain not controlled by other drugs (RPBS authority listing only)
Lamotrigine (Elmendos, Lamictal, Lamidus, Lamitrin, Lamogine, Seaze)	Not TGA approved for neuropathic pain	Epilepsy (Streamlined authority)
Oxcarbazepine (Trileptal)	Not TGA approved for neuropathic pain	Epilepsy (Streamlined authority)
Phenytoin (Dilantin)	Not TGA approved for neuropathic pain	Unrestricted
Opioid analgesics (including tramadol)
Morphine (Anamorph, Kapanol, MS Contin, MS Mono, Ordine)	Moderate to severe acute or chronic pain	Immediate-release preparations (e.g. oral liquid, tablet): severe disabling pain not responding to non-narcotic analgesics (Restricted benefit).   Controlled-release preparations (e.g. tablet, capsule, granules): chronic severe disabling pain not responding to non-narcotic analgesics (Restricted benefit).
Oxycodone (Endone, OxyContin, OxyNorm)	Short-term treatment of acute pain, when aspirin and/or paracetamol alone are inappropriate or have failed (Restricted benefit)
Tramadol (Durotram, Tramahexal, Tramal, Tramedo, Zydol)	Moderate to severe pain	Short-term treatment of acute pain, when aspirin and/or paracetamol alone are inappropriate or have failed (Restricted benefit)
Topical preparations
Capsaicin 0.075% (Zostrix HP)	Diabetic neuropathy and postherpetic neuralgia	Not applicable (unscheduled)
Lignocaine (Xylocaine)	Not TGA approved for neuropathic pain	Not applicable (Schedule 2)

............................................................................................................
http://www.nps.org.au/publications/health-professional/nps-radar/2012/december-2012/web-extras/web-extra/web-extra-prescribing-drugs-for-adults-with-neuropathic-pain-tga-approval-status-and-PBS-listing-restrictions

Acid Reflux Drugs And Neuropathy

Today's post from blogs.naturalnews.com (see link below) takes a look at one of the possible causes of nerve damage and neuropathy and that is excessive use of acid reflux drugs (such as nexium, prevacid, omeprazole and prilosec plus many others). Neuropathy forums have long featured this problem but so many people now take acid reflux drugs as a matter of course, they have come to be seen as harmless and a daily necessity needed to balance our diets. You should also be aware of the fact that these drugs can prevent proper absorption of other drugs prescribed for other problems, which need to be broken down in the stomach in order for them to start working. You should certainly have a constructive discussion with your doctor as to whether these drugs are absolutely necessary because altering your diet to help your digestive system may be a far better option.

Acid Reflux Drugs May Cause Dementia and Neuropathy   
By Dr. Brent Hunter Posted Thursday, December 12, 2013 
 
Has your memory been slipping lately? Have you experienced unexplained pain, weakness, numbness or tingling in your arms of legs? Have you also been taking an acid reflux drug like Nexium, Prevacid or Prilosec for a couple years? If so, then you may be the latest victim of the pharmaceutical industry’s medical model of healthcare.

After that first paragraph, you may have expected to see an attorney’s phone number to call and join a class action lawsuit! Well, I am sure that it won’t be long before that actually happens. New research, published Monday in The Journal of the American Medical Association (JAMA), showed that certain acid reflux drugs are “significantly associated” with vitamin B12 deficiency. In turn, vitamin B12 deficiency causes serious health consequences including anemia, osteoporosis, depression, memory loss, dementia, neuropathy and cardiovascular disease.

If you have acid reflux, you need to understand what is causing it. Find the cause and correct the cause. Simply popping pills to block the natural production of stomach acid has proven to only cause even more serious health conditions. Read on to learn how to restore your health without these dangerous drugs!

Acid Reflux Drugs Linked to Vitamin B12 Deficiency

Acid reflux drugs, like Nexium, have long been known to cause some very serious side effects. Among them are problems such as anemia, heart problems, hypertension, osteoporosis and further digestive problems including irritable bowel syndrome (IBS). In fact, drugs used to treat acid reflux do not treat the condition itself but only the symptoms. They are not designed to correct the cause of the problem. As a result, the problem continues to worsen over the years. Drug treatment is continued and the drug side effects continue to worsen as well.

This new research(1) sheds further light on this problem. It showed that people taking certain acid reflux drugs are far more likely to suffer from vitamin B12 deficiency. The study implicated proton pump inhibitors (PPIs) – Nexium, Prevacid and Prilosec – and histamine 2 receptor antagonists (H2RAs) – Pepcid, Tagamet and Zantac. Proton pump inhibitors proved to be the worst.

Unfortunately, the study’s senior author, Dr. Douglas Corley, stated(2) that patient’s should not stop taking the drugs but should get their B12 levels checked. If your levels are deficient, then presumably, you should treat that as another symptom as well. All the while, the underlying causes are left unaddressed. Vitamin B12 deficiency cannot be corrected unless the cause of the deficiency is addressed. In this case, the cause may be your acid reflux pill.

Left uncorrected, this leads to fatigue, anemia, irritable bowel syndrome, increased risk of bone fracture, hypertension, dementia, depression and neuropathy. It is dangerous, costly, and simply ridiculous to continue treating symptoms of any condition rather than addressing the cause. Wouldn’t it be much better to find what is causing the acid reflux and correct the cause? 

Why Do You Have Stomach Acid?

Stomach acid has been unjustly vilified as the cause of acid reflux and GERD. In a similar fashion, cholesterol was incorrectly pegged as the cause of deadly heart disease. Just as pharmaceutically lowering cholesterol increases the heart attack death rate, blocking stomach acid with drugs only makes the problem of reflux and GERD even worse!

You have acid in your stomach for a reason. The cells that line your stomach produce it. In fact, your stomach is specifically designed with a layer of cells that protect it from the otherwise damaging effects of the acid. This stomach acid is required by your body for:

proper digestion of food, especially carbohydrates
Absorption of nutrients (such as vitamin B12)
Killing harmful bacteria and limiting bacterial overgrowth

Without this acid in your stomach, you cannot properly digest carbohydrates or effectively absorb certain nutrients. Blocking this acid production also allows for overgrowth of bacteria and opens the door for H. pylori infections. Simply having the stomach acid is not the problem. In fact, most people suffering from acid reflux actually have too little stomach acid rather than too much.

What Causes Acid Reflux and GERD?

The problem is when the acid leaks (refluxes) into the esophagus. Your esophagus does not have the protective lining that your stomach has. When stomach acid gets into the esophagus, the burning pain of acid reflux results.

Your body has a very strong valve – called the Lower Esophageal Sphincter (LES) - between the stomach and esophagus that is designed to prevent the reflux of acid. The cause of the acid reflux is a dysfunctioning LES muscle which allows the acid to reflux into the esophagus.

It is not a problem of having too much acid. Again, most cases of acid reflux actually occur with low levels of stomach acid. The acid is just in the wrong place. Lowering acid levels or blocking its production does not fix the problem with the LES. As a result, the acid reflux continues and you are prescribed acid blocking drugs for the rest of your life.

So, the real question is what is causing the dysfunction with the LES muscle and how can your correct this cause of acid reflux? 

Correcting the Cause of Acid Reflux

Your Nerve System and Chiropractic Care. The LES is an autonomic muscle. That means that it is automatically controlled by your autonomic nervous system. Stress on the nerves that control this muscle can cause it to malfunction. Additionally, production and secretion of stomach acid is controlled by your nerve system. Ensuring proper nerve system function is the first step to healing acid reflux and GERD naturally. Chiropractic physicians are trained to find and correct nerve interference such as this. As a result, many people experience significant relief simply from including regular chiropractic care in their wellness lifestyle.

Eliminating Drug Effects. It is also important to consider other prescription drugs that you are taking that may be causing the problem. Common culprits include steroid drugs, NSAIDS (such as Advil and Aleve), and aspirin. These drugs are commonly prescribed for various pain syndromes. However, there are many natural, safe, and more effective methods for correcting these conditions as well.

Excessive Carbohydrates. Consuming excessive carbohydrates – especially simple carbs like sugars, breads, pastas, pastries, etc. – create an inflammatory environment in your body. This can prevent normal production of stomach acid and allow bacterial overgrowth. This leads to gas production and increased intra-abdominal pressure. As a result the LES muscle becomes inhibited and acid reflux occurs. Simply switching to a low carbohydrate, anti-inflammatory diet naturally corrects this cause of acid reflux.

Balancing Bacteria. Low stomach acid allows for bacterial overgrowth and disrupts the balance of healthy gut bacteria. Consuming foods rich in probiotics (healthy bacteria), such as raw fermented foods, restores this balance. Taking a probiotic supplement may be necessary as well. Restoring the normal, healthy bacteria in your gut helps to correct many digestive disorders, including acid reflux. 

Natural Remedies for Acid Reflux

Using these methods addresses the actual cause of acid reflux and GERD and allows your body to heal itself naturally. While you are healing, you may need to use some natural remedies as well to help with the symptoms. As mentioned earlier, the problem is most often a result of not enough stomach acid production in order to digest food, absorb nutrients and kill harmful bacteria.

Bitter herbs can be used to increase production of stomach acid. These include herbs such as barberry bark, caraway, dandelion, fennel, ginger, goldenseal root, peppermint, and wormwood. They are typically taken in very small doses and made in a tincture of water. Consult an well-trained herbalist for best results.

While you are reconditioning your body to produce the proper amount of stomach acid, you may benefit from natural digestive enzyme supplements as well. Without proper levels of stomach acid, the pH is too high to stimulate the release of these enzymes naturally. These supplements can help provide your body with the support it needs to break down carbohydrates and proteins more effectively. 

As with all health conditions, dangerous drugs are not the only option. It may seem easy to simply pop a pill and ignore the problem. However, your body and your long-term health will ultimately suffer the consequences. You can live a radiant and vibrantly healthy life! Simple lifestyle changes make a huge difference in your vitality and they will help you heal acid reflux naturally!

http://blogs.naturalnews.com/acid-reflux-drugs-may-cause-dementia-and-neuropathy/

Neuropathy From Older HIV Drugs in South Africa

Today's post comes from hivhaven.com (see link below) and continues the debate about the use of older HIV drugs in the Third World. The fact that older HIV medications are now used in large parts of Africa and Asia because they are cheaper than more modern and user-friendly treatments, is an indictment of political will and economics in this day and age. The result is an unsurprisingly huge increase in side-effect, related diseases such as neuropathy, bringing further misery to millions of people. People call it progress because people are being prevented from dying and their reduced quality of life is largely seen as an unavoidable price to pay. The drug companies must take responsibility for the ridiculously high prices of their newest drugs in the Third World and governments must make decisions which not only save their people's lives but make their lives better as a result. I wonder if any of these decision-makers had neuropathy themselves, they would realise that it's not a price worth paying to maintain profit margins?

South Africa: Stavudine Trial Causes Split

Created on 11 June 2012
 

AIDS activists and researchers are at loggerheads over the planned South African trial of a lower dose version of the controversial antiretroviral stavudine, which has in the past been responsible for debilitating side-effects in HIV patients.

The main adverse effect is peripheral neuropathy, which can be corrected by reducing dosage.

The symptoms of peripheral neuropathy include burning, stiffness, prickling, tingling, and numbness or a loss of feeling in the toes and soles of the feet. Sometimes the nerves in the fingers, hands, and wrists are also affected.

Stavudine is also one of the most likely ARVs to cause lipodystrophy, and for this reason it is no longer considered an appropriate treatment for most patients in developed countries and is no longer recommended by the World Health Organisation.

However, due to its low price, it is still widely used in the developing world.

Lipodystrophy is the redistribution of fat in the body, which manifests as excess, or lack of, fat in various regions of the body. People can have sunken cheeks and/or "humps" on the back or back of the neck (also referred to as buffalo hump).

In the one camp, the Treatment Action Campaign, Medecins Sans Frontieres (Doctors without borders) and the Treatment Action Group have serious concerns about the proposed trial.

They are concerned that stavudine is more toxic than tenofovir (the drug which replaced stavudine in the government treatment programme), making it an inferior treatment.

Patients' poor tolerance means that they are more likely to not adhere to treatment and will have to be switched to more expensive second-line treatment when they fail first line treatment.

MSF's experience in Lesotho has also shown that the costs related to treating the side effects of stavudine neutralised any cost-saving by placing patients on the cheaper option.

The group also claims that stavudine compromises second-line treatment in that it affects the tolerability of the next level of drugs, the longer the patient has been on the failing first line regimen.

In addition, stavudine must be taking twice-daily (as opposed to tenofovir's once-daily), tenofovir is recommended for HIV Hepatitis B co-infection and massive community opposition to the return of stavudine.

Those supporting the stavudine trial claim that tenofovir is unaffordable to most African countries and thus unsustainable.

However, the TAC/MSF group said this argument might become irrelevant by the end of the trial, which could take nine years to complete.

The price of tenofovir has more than halved in the last several years and is expected to decrease further as demand increases.

The stavudine research team led by the Wits Reproductive Health and HIV Institute's Professor Francois Venter said the evidence that stavudine produced bad side-effects was at the 40mg dose, but that it has been as effective as tenofovir at suppressing HIV at half this dose. However, this has not been rigorously established, which is why he believes the study is needed.

"Tenofovir is expensive and in most African countries its use is unsustainable. However, we have been hopelessly overdosing patients on stavudine, just like we did with AZT 15 years ago," said Venter.

Venter said stavudine was still widely used across Africa and that it made sense to establish how the drug could be used more safely.

He said all drugs had problems at the wrong dose and that stavudine would be tested to exactly the standards to which tenofovir was tested.

"The study design is not controversial, it follows standard scientific practice and could be run in a rich country," said Venter, adding that the study had been through rigorous international scientific and ethics scrutiny, and will be rigorously monitored throughout.

Venter has in the past been a staunch ally of the activist movement, including TAC and MSF, placing the parties in the unfamiliar position of opposing camps.

"It's awkward and not a position we are used to being in. We have worked together very well in the past and I am sure we will be able to take this debate forward in a collegial manner," said Venter.

A decision by the Gates Foundation to fund the study has also seen activists sending an impassioned plea to Bill and Melinda Gates, urging them to rethink their support for the trial.

http://www.hivhaven.com/2012-04-13-23-02-40/africa-hiv-news/1536-south-africa-stavudine-trial-causes-split

Current Drugs For Neuropathic Pain

Today's post from thedoctorwillseeyounow.com (see link below) gives a breakdown of current treatments for neuropathic pain and discomfort. Unfortunately even though the old adage, 'treat the cause not the symptoms' applies to most diseases, neuropathy is the exception to the rule because it doesn't disappear if the cause is addressed. Therefore, medication is necessary to control the symptoms. This article could have been written ten years ago and still be valid today because breakthroughs in effective medication for nerve damage are just not happening so patients need to find the drug that will help them best. This often requires a long process of trial and error. This article will help you understand which choices your doctor may make and why.

Pain Free: Modern Drugs and Neuropathic Pain
Howard L. Fields, M.D., Ph.D. First posted June 1, 2001

Dr. Fields is Professor of Neurology and Physiology, and Director, Wheeler Center for the Neurobiology of Addiction, University of California, San Francisco.

In the past three years, Dr. Fields has served as a consultant for Neurogen and Endo Pharmaceuticals, and has served on the Speakers' Bureau for Pfizer, Abbott and Merck.

During the last millenium, mankind made revolutionary advances in relieving pain. Treatment progressed from non-treatments, such as "biting the bullet," to alcohol and crude opium-based drugs, to the development of safe modern opioids, or narcotic-based painkillers, and a wide range of general and local anesthetics. At least in the developed world, most everyone has found pain relief, at one time or another, from one of these drugs.

Yet despite all our advances, there is one type of pain which, until recently, could not effectively be controlled by modern medicine — neuropathic pain.

Usually chronic and often devastating, neuropathic pain is the result of damage to the body's nervous system. The two most common causes are diabetes ("diabetic neuropathy") and herpes zoster ("postherpetic neuralgia" or "shingles"), an infection of the nerves by the same virus that causes chickenpox. Both cause excruciating pain.

What Does Neuropathic Pain Feel Like? Although neuropathic pain is highly variable and is felt very differently by different people, doctors can easily distinguish it from other causes of pain. There is usually some abnormality of skin sensation in the painful area and sufferers usually describe neuropathic pain as strange, unfamiliar, often as a burning sensation. It can have a sharpness or a brief shooting quality, as well as a sensation that is described as tingling, crawling, electrical.

Frequently, there is a long delay between the actual nerve injury and the appearance of pain; in fact, it is not unusual for the pain to begin at about the time a person is beginning to recover physically.

Treating Neuropathic Pain 
 The main problem with treating neuropathic pain is that the standard array of non-narcotic analgesics [acetaminophen, aspirin, non-steroidal anti-inflammatory agents (NSAIDs and cyclooxygenase 2 inhibitors)] have little effect on neuropathic pain. Recently, however, several different classes of drugs have been developed that do help people suffering from neuropathic pain. 
These are: 
Antidepressants
TCAs Tricyclic antidepressant drugs, or TCAs, are the most extensively studied treatments for neuropathic pain.(22) The most commonly prescribed TCA is amitriptyline. While effective, this drug does have significant side effects,(17) including a type of low blood pressure called orthostatic hypotension. Other side effects include urinary retention, memory loss, heart problems and drowsiness. Because of these significant and potentially serious side effects, doctors normally start patients on a very low dose and increase the dosage slowly.

Desipramine, another TCA, appears to be almost as effective as amitriptyline in most studies,(13)(15) but with fewer side effects and significantly less drowsiness.
SSRIs For most types of neuropathic pain, selective serotonin reuptake inhibitors (SSRIs) are significantly less effective than TCAs, although the SSRI, paroxetine, has been reported to help pain caused by diabetic neuropathy.(21) On the other hand, SSRIs have virtually none of the side effects of desipramine or amitriptyline, and are non-sedating, that is, they don't cause drowsiness. An added benefit of SSRIs is that they are very effective at treating the depression and anxiety that sometimes afflict those with chronic pain. 

Newer Drugs Though still under study, one of the newer generation antidepressants, venlafaxine (sold under the brand name Effexor®), is a promising drug for neuropathic pain control. Like the SSRIs, venlafaxine is safer than TCAs but acts in a similar way to TCAs and, thus, seems to be more effective than other SSRIs for pain relief.(12)(16)

Anticonvulsants 
Anti-seizure drugs, phenytoin (Dilantin®) and carbamazepine (Tegretol®), are effective in treating pain caused by a cranial nerve disorder called trigeminal neuralgia (also known as tic doloreux). Unfortunately, most of these drugs do not seem to help with other types of neuropathic pain. An exception is gabapentin (Neurontin®), which does appear to be effective against a broad spectrum of neuropathic pains, including postherpetic neuralgia18 and diabetic neuropathy.1 Many pain specialists are now using gabapentin as a first line drug for neuropathic pain because it is safe and has few unpleasant side effects other than sedation.
Anesthetics and Antiarrhythmics The local anesthetic lidocaine, given I.V., brings significant relief to those suffering from postherpetic neuralgia19 and some other neuropathic pain syndromes.(10)(4)(23)

Certain drugs designed to treat irregularities of heart rhythm ("anitarrhythmics") work in a similar way to lidocaine and are being used to treat some types of neuropathic pain. These drugs include tocainide (Tonocard®) and mexiletine (Mexitil®). Mexiletine is less toxic and has been shown to be effective for pain caused by diabetic neuropathy6 and other neuropathic pains.(3) Currently, it is used as a third line drug after TCAs and gabapentin. The main side effect of these drugs is gastrointestinal problems, although these can be managed with antacids or other "upset stomach" medications.
Opioids, or Narcotics 
We live in a culture in which opioid, or narcotic, drugs are associated with moral, political and legal controversy. Until recently, there was wide disagreement, even among pain experts, over whether opioid painkillers should be given to those with chronic neuropathic pain.

Recent studies, however, have made it clear that opioids can safely relieve many types of neuropathic pain. These drugs include morphine, fentanyl,(7) oxycodone(24) and tramadol.(11) As effective as they are, the potential risk for addiction or abuse is something that both doctors and patients need to keep in mind. Anyone starting on opioids should be very careful to follow their doctor's instructions and use the drugs exactly as directed.

Topical Medications 
Topical medications, a category of drugs designed to be applied externally, rather than injected or swallowed, are most commonly used in cases of postherpetic neuralgia.

One example is capsaicin extracts. Found naturally in peppers and other members of the deadly nightshade family, capsaicin14 is commercially available in two forms, Zostrix® and Zostrix-HP®(2) While some studies have found it somewhat effective, many patients stop using it before it begins to work because capsaicin can produce a burning sensation.(25)

A more useful topical medication for neuropathic pain, especially for shingles, is the local anesthetic lidocaine (see above).(8)(20) Available in patch form under the brand name Lidoderm®, it is very safe and convenient. And the lidocaine patch has the added benefit of providing a barrier which helps protect an area of hypersensitive skin.

Treatment Plan  
The ideal in medicine is to treat the cause of a disease rather than its symptoms. Unfortunately, for patients with painful nerve injuries, this is often not possible.5 The majority of patients require some type of medical pain management.

Depending on the individual case, the first step is to try the topical local anesthetic patch, Lidoderm®. If local treatments do not work, doctors generally move on to one of the tricyclic antidepressants (TCAs). If these are not effective, or if there is a problem with side effects, the next step is to try gabapentin, sometimes in combination with a TCA. If patients still have significant pain, doctors may then prescribe antiarrhythmics.(9)

Finally, if all other options have been tried and failed, the last resort is to give patients the milder opioid, tramadol. If that does not work, then the more powerful opioids are used, often in combination with a TCA or other drug.

While neuropathic pain is often difficult to treat, new medicines and better approaches are now available. Research in this field is active and promises to provide further improvements in the near future.

http://www.thedoctorwillseeyounow.com/content/behavior/art1958.html?getPage=2

Erection Drugs Help Neuropathy!

Today's post from diabetesselfmanagement.com (see link below) is a rare neuropathy hot topic on the internet at the moment and one you may welcome as being something capable of killing two birds with one stone - if you're a man that is (for women, the benefits may only apply to their neuropathic problems). Basically, the theory is that sildenafil will improve blood flow to the nerves and by testing it on mature mice, it has been found that their neuropathic symptoms improved considerably. More information tomorrow.
 

ED Medicine Reduces Diabetic Nerve Damage in Animal Study
March 20, 2015 by Diane Fennell

The erectile dysfunction drug sildenafil (brand name Viagra) may be effective at relieving painful neuropathy, or nerve damage, in men with long-term diabetes, according to preliminary animal research recently published in the journal PLOS ONE. Approximately 60% to 70% of people with diabetes have some form of neuropathy, according to the National Institutes of Health.

In previous animal studies, sildenafil has been shown to improve blood supply to the sciatic nerve, which extends from the lower end of the spinal cord into the legs, and it has also been noted that people with diabetes taking the medicine have fewer symptoms of peripheral neuropathy (a type of nerve damage in the arms, legs, hands, and feet).

Many other drugs have been shown to be effective at relieving neuropathy in animal studies but have not demonstrated benefits in human trials. According to scientists at Henry Ford Hospital, this may be because these trials use young animals with an early stage of peripheral neuropathy, while most people used in studies of the condition are older and have an advanced form of peripheral neuropathy.

To better simulate the condition of participants in human trials, the researchers used 30 male mice with Type 2 diabetes that were 36 weeks old, which is roughly equivalent to middle age in people. Fifteen of the mice were given an oral dose of sildenafil every day for eight weeks, while the other fifteen mice served as a control group and were given the same amount of saline daily.

After performing a variety of nerve and function tests on both groups of mice, the researchers found that mice given sildenafil experienced noticeably improved neuropathy symptoms starting at six weeks after treatment compared with the mice that were given saline.

“Generally, young diabetic animals with an early stage of peripheral neuropathy are used to investigate various drug treatments. But patients with diabetes who are enrolled in clinical trials often are older and have advanced peripheral neuropathy,” notes lead study author Lei Wang, MD. “These data indicate that sildenafil improves neurological function even in middle-aged mice with long-term diabetic peripheral neuropathy.”

Although this line of research is still in the early stages, it has the potential to eventually lead to the development of a sildenafil-based treatment for long-term diabetic peripheral neuropathy, Dr. Wang added.

For more information, read the Henry Ford Health System press release “Erectile Dysfunction Drug Relieves Nerve Damage in Diabetic Mice” or see the study in PLOS ONE. And for more information about coping with painful neuropathy, see the article “Controlling Neuropathic Pain: Tips From an Occupational Therapist,” by Erica K. Jacques.

http://www.diabetesselfmanagement.com/blog/ed-medicine-reduces-diabetic-nerve-damage-in-animal-study/