Can Mirogabalin Help With Neuropathy Pain

Today's post from medscape.com (see link below) is an interesting one concerning a new drug - Mirogabalin - to treat neuropathy. It has been tested against pregabalin (Lyrica) which may raise eyebrows considering Lyrica's bad reputation and has shown promise. I can't find out for sure if it's an anticonvulsant but assume that it is, if it's being tested against pregabalin (the name is also similar). Anyway, if you find that your current treatment is not working, it may be worth mentioning it to your doctor. Although the drug is not yet on the market, it's worth getting him or her to note it down. certainly worth doing some more research of your own.
 

Diabetic Neuropathy Pain: Mirogabalin Promising in Pilot StudyMiriam E. TuckerOctober 10, 2014 Medscape Medical News

Mirogabalin (Daiichi Sankyo) has shown promise as a potential treatment for diabetic peripheral neuropathic pain in a dose-ranging, proof-of-concept study that pitted it against both placebo and pregabalin (Lyrica, Pfizer).

Results from a phase 2, randomized, double-blind study were presented September 12 at Neurodiab, the annual meeting of the Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes by Domenico Merante, MD, of Daiichi Sankyo, Buckinghamshire, United Kingdom, and were also published online September 17 in Diabetes Care by Aaron Vinik, MD, of Eastern Virginia Medical School, Norfolk, and colleagues.

In the study of 452 subjects with type 1 or type 2 diabetes who also had painful distal symmetric sensorimotor polyneuropathy for 6 months or longer, mirogabalin doses of 5, 10, 15, 20, and 30 mg produced greater reductions in average daily pain scores at 5 weeks than did either placebo or 300-mg pregabalin, both of which performed similarly.

Both gabapentin and pregabalin are first-line treatments for diabetic peripheral neuropathic pain, but only pregabalin is approved specifically for this indication by the US Food and Drug Administration, Dr. Vinik and colleagues explain. Mirogabalin is being developed worldwide by Daiichi Sankyo for the treatment of neuropathic pain.

Conference session comoderator James W. Russell, MBChB, professor of neurology, anatomy, and neurobiology at the University of Maryland, Baltimore, told Medscape Medical News, "This is a phase 2 study, so it's really the first serious look at this compound. Obviously, one needs more data to be able to say that mirogabalin is superior to pregabalin or is itself efficacious."

He also cited some concerns, including the lack of effect for the established treatment pregabalin compared with placebo, the short duration of the trial, and combining data from patients with type 1 and type 2 diabetes. Nonetheless, he noted that the study was well-conducted and that the investigators are "top-notch."

"I think mirogabalin is definitely a promising medication. It is a potential therapy to be added to our armamentarium for a very serious and disabling complication, painful diabetic sensory polyneuropathy," he told Medscape Medical News.

Mirogabalin More Selective for Pain than Pregabalin?

In the paper, Dr. Vinik and colleagues explain that mirogabalin binds to the same neuropathic pain-associated alpha-2-delta calcium-channel ligand subunits as pregabalin but is preferentially selective for alpha-2-delta-1, which is believed to be associated with analgesic effects, whereas pregabalin nonselectively targets both alpha-2-delta-1 and alpha-2-delta-2, which appears to contribute to central nervous system (CNS) side effects.

Thus, mirogabalin may provide a wider therapeutic index with fewer CNS complications, they suggest.

Of the 452 patients randomized to 1 of the 7 treatment groups in the trial, 383 completed the study, but 433 were included in the analysis using a last-observation-carried-forward design. Discontinuation rates were 13% for placebo, 18% for mirogabalin 30 mg, and 27% for pregabalin.

The subjects were 75% white and 54% male. Most (92%) had type 2 diabetes, with a mean HbA1c of 7.4% at baseline and an average 5.8 years of diabetic peripheral neuropathic pain. About a third had used either pregabalin or gabapentin in the past.

The primary end point was mean change from baseline in the 11-point average daily pain score (with 0 being no pain and 10 being worst possible pain).

At baseline, that score was 7.0 in the placebo arm, 6.7 across mirogabalin groups, and 6.6 for the pregabalin subjects.

Mean Reductions in the Pain Score at Week 5

Treatment Reduction in Pain Score
Placebo 1.9
Mirogabalin, mg
5 2.0
10 2.3
15 2.7
20 2.6
30 2.8
Pregabalin, 1.8 mg 1.8


The drops for the highest 3 mirogabalin doses were statistically significant compared with placebo (P < 0.05), beginning at week 1 and continuing through week 5.

The mean differences for pregabalin vs placebo were significant at weeks 1 and 2 but not weeks 3 through 5. The difference between mirogabalin 15 mg and 30 mg and pregabalin 300 mg were statistically significant, the investigators report.

The proportion of subjects achieving pain-score improvements of 30% or greater were 56% through 67% in the top 3 mirogabalin dose groups, compared with 38% with pregabalin and 42% with placebo.

Improvement of 50% or more points was achieved in 39% to 44% of the 15-, 20- and 30-mg mirogabalin groups, vs 28% with pregabalin and 24% for placebo.

But Lack of Effect of Pregabalin Is Concerning, and Side Effects Seem Similar

Dr. Russell urged caution in interpreting these findings. "The study actually showed a minimal effect on neuropathic pain scores with pregabalin compared with mirogabalin. This to me is a little concerning, since there are at least 3 class I studies showing efficacy of pregabalin and over longer periods of time. When you're doing a comparison of a new drug vs the established approved medication, it raises a little bit of concern when the established proved medication doesn't perform as expected."

He added, "I think most physicians who use pregabalin extensively would agree it clearly has a benefit in the treatment of painful diabetic sensory polyneuropathy."

With regard to safety, adverse events were mostly mild, and included central nervous system events in 2.8% with placebo, 14% in all mirogabalin groups combined, and 12% with pregabalin. Dizziness and somnolence were the most common, and most had resolved by study end.

Edema occurred in 1% of those taking placebo, 5% of the mirogabalin subjects, and in 10% of those on pregabalin. Mildly blurred vision was reported in 2% of both placebo and mirogabalin groups and 4% with pregabalin. No deaths occurred during the study, and only 1 serious medication-related adverse event — a gallstone in a man with comorbidities taking 15 mg mirogabalin — was reported.

Study discontinuations due to adverse events were 2% of the placebo group, 7% of mirogabalin subjects, and 4% with pregabalin.

Dr. Russell told Medscape Medical News that he didn't see much difference between the side-effect profiles of mirogabalin and pregabalin, but that future studies would need to compare whatever the most effective dose of mirogabalin turns out to be with the standard 300-mg dose of pregabalin.

"You compare the optimal dose of each drug, so it's apples to apples."

More Data Needed, and Longer Duration

Dr. Russell added — and the authors acknowledge as well — that 5 weeks is probably not long enough for a study to evaluate the full effects of a neuropathy medication.

"Until we start to see data to at least 12 weeks or even longer showing mirogabalin is efficacious over that period of time, we have to remain open as to its overall efficacy," he commented.

He also said that although mirogabalin's half-life is longer than pregabalin's and therefore could perhaps be dosed less often — once or twice daily vs 2 or 3 times a day — most of the pain effect would likely be related to peak drug levels.

"With a longer study, you'd get more info about when peaks and troughs occur and whether peak levels correspond to changes in average daily pain scores."

Also related to the longer half-life is a potential concern about renal excretion in patients with impaired renal function. The study excluded such patients, but the issue is important because painful diabetic neuropathy and impaired renal function often coexist in patients with long-term diabetes, Dr. Russell noted.

He also said that because neuropathy in type 1 and type 2 diabetes differs, studies shouldn't lump the 2 patient groups together.

"Type 1 diabetes is far more dependent on glycemic control than type 2, whereas other factors are more important in type 2, like lipid metabolism and inflammatory markers. They really are different. I'd like studies to move away from the idea that all diabetic neuropathy is the same."

Dr. Vinik received research funding from Daiichi Sankyo for this study, and Dr. Merante is an employee of the company. Disclosures for the coauthors are listed in the article. Dr. Russell's institution received a grant from Impeto Medical to study a device to measure neuropathy, but he personally received no direct funding.

Diabetes Care. Published online September 17, 2014. Abstract

http://www.medscape.com/viewarticle/833017#vp_2

Can Probiotics Help Neuropathy Symptoms

Today's very interesting article from markbrudnak.com (see link below) talks about the role supplemented probiotics may have in helping with neuropathy symptoms. You see them in every supermarket, very often in daily liquid doses but if you are considering them, health food shops may have better (if more expensive) options. The benefits of probiotics are being promoted more and more across the neuropathy forums and studies, although at first glance, it may be difficult to make a link in your mind between the brain, nervous system and what's going on in our intestines. The point is that probiotics help stimulate regrowth in cell walls and preserving cellular life expectancy. Nerve cells can be helped by probiotics in that they are believed to maintain mitochondrial integrity. The mitochondria are the energy sources of our nerve cells and mitochondrial dysfunction is a common feature of neuropathy. If nothing else, it is believed that probiotics can slow down the progression of neuropathy. Many HIV specialists also support probiotic supplementation, if only to help reduce intestinal and stomach side effects of certain drugs. This article is well worth reading and discussing with your doctor. 

Peripheral Neuropathy: The Role of Probiotics and Other Nutrients in Neurodegenerative Diseases.
Townsend Letter for Doctors and Patients: Aug/Sept 2003

When I saw the theme for this edition, I was some what taken aback. The reason is that this is rather a topic close to my heart as a good friend what just diagnosed with peripheral neuropathy. In fact, I'm having dinner with him later tonight to discuss various natural options he has available.

In my recent book, The Probiotic Solution (Dragon Door Publications)1, I discuss the role that probiotics can play in helping to restore eukaryotic (Human) cellular function. I will come back to that in a minute but let's first discuss what is 'peripheral neuropathy. First, Neuropathy is defined classically as "an abnormal and usually degenerative state of the nervous system or nerves; also: a systemic condition that stems from a neuropathy." The later definition is annoying but is commonly found in dictionaries. I think it is annoying because the use the same word to define what the word is. That has never had sense to me, personally.

With neuropathy define; we need to explore what peripheral is. The number one definition is equally annoying as it is, "1: of, relating to, involving, or forming a periphery or surface part." If we go and find what 'periphery' means we find the definition of, "the external boundary or surface of a body." Now that makes sense!

So what do we have here? Peripheral neuropathy is, to boil it down, a degeneration of neurons in distal (far from the center) places of the body. In my friend's case, it is his legs. This is common with this diagnosis.

If that is peripheral, what is the center? That becomes a bit more complicated. Typically, it is considered to be the brain and spinal cord, for neurons. This is where the bulk is thought to be. However, there is certainly more to this.

We are now coming to understand that the 'gut' (gastrointestinal tract) is loaded with enough neurons as to be dubbed, 'The Second Brain." So what? Why is that important?

We now know that every single neurotransmitter in the 'brain' is also produced in the human gut. The cool thing about nature, and evolution, is it wastes nothing. I was at a DAN! Think-tank a couple of years ago and heard of Dr. Michael Gershin's book, The Second Brain(Harper Collins, New York, 1998). This fascinated me, because I have a strong background in gut-based immune competence of the body. He basically lays out the case that the gut and the Brain are intimately connected, though we are not sure how.

There are many things that are cytotoxic to cells. For instance, we know that Prostaglandins (of which there are numerous ones) are such compounds. These are formed by the degradation of arachidonic acid by cyclo-oxygenases –1 and –2 (cox1 and cox2, respectively). There has been much ado about how bad inhibiting cox1 on enzyme is on mucosal membranes and its possible contribution to ulcers and cancer. This paper is not really about but rather to let you know that those active enzymes, both of them, are in part responsible for the degradation of cells.

What all can be done and what role can probiotics play in this? All nerve cells have a cell membrane. That membrane is composed of phospholipids, which are fat molecules with phosphates attached to them. All cells have phospholipids, especially the bilayer of human cells. If a cell does not have them, or enough of the, then the integrity of the cellular membrane will be weakened. Eventually, if this goes on for protracted periods, the cell will die. The translation, if we are talking about neurons, is that the neuropathy will result.

The use of probiotics has several important implications in treating and even preventing peripheral neuropathy. For instance, taking phosphatidyl serine (PS) can restore the weakened cell membrane that's thought to lead to disease. PS can be produced in the body and also introduced by ingesting things such as eggs and other supplements. Doing so will ensure that every living thing in the body-the bacteria as well as the human cells- will contain membranes composed mainly of phospholipids, interspersed with sundry protein and glycoproteins.

Taking PS has both prophylactic (that is, preventive) and therapeutic purposes. Any cell that's starting along the road toward death (and remember, all cells eventually die) will be much more stable and much happier if you give it a supply of PS. With this boost, the cell will be better ale to fend off the ill effects of accumulated toxins. Remember the prostaglandins? Hopefully, a picture is starting to form for you. Taking something like Alzheimer's Disease as an example, it has been shown that at least 300 mgs / day of PS will have significant results.

Where do the probiotics come in? If one starts ingesting a bunch of bacteria (in the multiple billions / gram), many of them will die. This is actually good because the cell wall components of these bacteria, most of which are phospholipids, will become available for absorption by the body.

Can the degenerative process be stopped or at least slowed? Yes! at least to some degree. Again, supplementing with PS is a good idea. Also, we can use high-dose probiotics (my favorite for a number of situations). As a brief aside, there may be other natural ingredients that can slow the body's production of cytotoxic compounds. For instance, overproduction of Nitric oxide (NO) has been implicated in various pathological processes, including septic shock, tissue damage after inflammation, and rheumatoid arthritis.2 Inhibitors of NO synthase, natural ones, would be very interesting to look at as possible targets for reduction of inhibition of the inflammatory cascade, which in my humble opinion, is at the root of most of our degenerative diseases.

Along those same lines, knocking out cox1 and cox2 is not a bad idea either. I think it is important to stress that while a full-blown assault on these enzymes is not a great idea, low level, chronic inhibition may prove fruitful. In fact, recently it was shown that a modified PG can actually inhibit the formation of prostaglandins in the first place. That is exciting!3

Mitochondrial dysfunction is also thought to be at play here. The mitochondria are the powerhouses of the cell, supplying it with energy. When the mitochondria don't function properly, there's an increase in the accumulation of free radicals and also influence in the calcium (a very important second messenger that affects DNA expression) levels. All of this is significant in terms of neurodegradation. Some common supplements that can assist with this are things that quench the reactive oxygen species (ROS) and other free radicals. My favorites are enzyme CoQ10 and green tea. The inflammatory response is so good at its job that it is actually capable of over doing it and tearing apart/destroying healthy cells. This can largely be prevented by the constant consumption of large amounts of antioxidants. Personally, I must drink a gallon or two of green tea a day. I am that convinced of how important it is to a long and healthy life.

A free radical is a molecule that has an uneven number of electrons; as such, it has an open (or half) bond that is highly reactive. The production of free radicals is a normal part of the body's living process; in fact, they are produced all the time. But usually, mechanisms are in place to control free radicals and eliminate them once produced. When free radicals are allowed to accumulate, they go after healthy cells and cellular components. They are like little lightning, zapping other cells and producing even more free radicals.

Having too much calcium in the body is not always a good thing, despite what the large pharmaceutical companies (one in particular) are claiming on TV ads. Why? Calcium is intimately involved in a process called signal transduction. Basically, this involves taking a signal from out side a cell to inside and affecting the DNA. When this happens to nerve cells, it affects the voltage gradient required for the passage of electrical impulses. Calcium is a charged molecule, and changing the amount of calcium inside or outside a cell can change the level of current the cell is able generate.

Probiotics can help stabilize the level of calcium. If a large amount of calcium is ingested, for instance, then the probiotics will be able to consume much of it. And what the probiotics don't consume, they will push out of the body along with the normal waste material. Also, calcium is usually bound, so if there is too little, the probiotics will help liberate the calcium front a bound state.

Isoflavones (naturally occurring, weakly estrogenic compounds that are derived from soy, usually) have been shown to be important for neurodegenerative diseases, in a sort of roundabout way. There is a protein called tau that's regulated by estrogen and estrogen-like compounds, such as isoflavones found in plants and, in particular, in soy. There are two types of isoflavones' those with and without a sugar (glycone and aglycone, respectively). Isoflavones are big and bulky when the sugar is attached; in order for them to be absorbed, the sugar has to be removed. This is done by and enzyme called glycosidase (literally "sugar cleaver"), which cuts the sugar from the isoflavone molecule and allows for absorption. This must happen before the body can use the isoflavone.

Products such as Fermasoy have been fermented with probiotics to create a protein powder that's high in aglycone isoflavone. Consuming these products not only provides high-quality protein but also a relatively high level of the absorbable isoflavone.

Not all probiotics can create the sugarless isoflavones at the same level though. Certain ones have been tested and selected for their various abilities. The MAKTech process of strain validation and certification is designed to optimize just this sort of parameter.

Given the 'baby boom' generation is fast approaching the age which neurodegeneration is going to start appear more and more often, it's vital that we lean more about this process. Doing so is of particular importance when we consider that many of the people who run our governments are at or near this age. Personally, that is somewhat frightening.

Until a cure for conditions such as peripheral neuropathy is found, taking probiotics may serve well as a valuable tool in at least slowing the progression of the disease. And in terms of improving the quality of life for people with neurodegenerative diseases, as well as those around the, this would have an enormous and far-reaching impact.

References

1. Brudnak, Mark A. The Probiotic Solution Dragon Door Publications, MN.

2. Di Giacomo C, Sorrenti V, Salerno L, Cardile V, Guerrera F, Siracusa MA, Avitabile M, Vanella A. Related Articles, Links Abstract Novel inhibitors of neuronal nitric oxide synthase. Exp Biol Med (Maywood). 2003 May;228(5):486-90.

3. Zhuang H, Pin S, Li X, Dore S. Related Articles, Links Abstract Regulation of heme oxygenase expression by cyclopentenone prostaglandins. Exp Biol Med (Maywood). 2003 May;228(5):499-505.

http://markbrudnak.com/Articles/proneurodegen.htm

Can Acupuncture Help with Neuropathy

Acupuncture is one of those treatments that divides opinion. Most people reason that if it has worked for thousands of years in Chinese medicine, it must be good. That may well be so and we've all seen the TV clips of operations undertaken with acupuncture needles but without anaesthetics but like any other treatment, alternative or otherwise, evidence-based proof is needed that it works when applied to nerve disease. Neuropathy is such a difficult affliction that even experienced Chinese doctor/acupuncturists admit that acupuncture is very much a hit and miss method as regards effectiveness in controlling neuropathic symptoms. Nevertheless, many people have found relief from acupuncture sessions. Today's enlightening post from Natural News.com (see link below) explains how Chinese medicine sees neuropathy and its potential treatment with acupuncture.
Although not normally done on this blog; the footnotes and references are added at the end to show that the article is based on research and not just alternative theory.

Acupuncture Treats Peripheral Neuropathy
Wednesday, May 06, 2009 by: Melissa Sokulski

Neuropathy, or Peripheral Neuropathy, is defined as having numbness, tingling or pain in nerves apart from the spine or brain, often in the hands and feet (1). It is a fairly common symptom, occurring in people with spinal injuries, diabetes, and genetic conditions such as Charcot-Marie-Tooth Syndrome (2,3). Acupuncture can be an effective way to treat these symptoms, bringing energy, life and feeling back into the extremities.

Neuropathy is a serious symptom, which often affects people`s quality of life. When people don`t feel parts of their bodies, they are more prone to injury and infection, as well as finding difficulty in daily tasks such as walking, fine motor work, or gripping. People who have this symptom as part of a genetic disorder also deal with the fears and hopes that go along with having a rare medical disorder(4).

Acupuncture is a powerful tool not only to balance qi - or energy - in the body, but to bring peace, hope and alignment into the mind, emotions and spirit as well.

When there is numbness in the periphery, there is not enough qi reaching these areas, according to traditional Chinese medicine. This can be for a variety of reasons, but mainly either:

1) there is too little energy in that organ system/meridian (energy pathway)

2) something is blocking the energy from reaching the area.

Sometimes there will be a combination of the two, and often multiple organ systems/meridians are involved. There are also different causes for the condition. Each of these things is considered and addressed by the acupuncturist, and a treatment plan which best suits the patient is mapped out.

In general, treatment would involve selecting points that promote circulation of energy in the meridians. If heat or cold is the cause, treatment would include either dissipating heat or warming coldness.(5)

Sometimes, weakness and flaccidity in the extremities is classified as wei syndrome. According to Traditional Chinese Medicine, this results from malnourishment of the tendons due to depletion of body fluids, caused by "excess heat" remaining in the body after illness.(6) Wei syndrome often requires longer periods of treatment.

Acupuncture often brings immediate relief - especially when there is pain - though it will likely take a series of treatments for the feeling and strength to come back completely and for the body to stay in balance, providing lasting effects. How often or how long treatment should proceed will be individual, depending on the cause and the overall constitution and health of the patient. As mentioned above, Wei syndrome can require a long course of treatment.

Acupuncture works by treating the person as a whole, balancing body, mind and spirit and allowing the body to do what it needs to do to heal itself. Acupuncture helps remove blocks, helps the body focus on increasing energy in areas of deficiency, and helps the patient be more present and focused, but ultimately it is our own bodies and energy that are able to heal.

Footnotes:
1) http://en.wikipedia.org/wiki/Neuropathy
2) http://www.medicinenet.com/peripheral_neuropathy/article.htm#1whatis
3) Charcot-Marie-Tooth Disorders (from CMT Facts III, Special Report, p.24):
- CMT is the most common inherited neuropathy, affecting about 125,000 Americans
- CMT is also known as peroneal muscular atrophy and hereditary motor sensory neuropathy
- does not affect life expectancy
- can vary greatly in severity, even within a family
- is the focus of significant genetic research
4) Flapan, Mark, p.10 of CMTA Special Report.
5) Xinnong, p.444
6) Xinnong, p.443

References:

CMTA Special Report: CMT Facts III. Published by Charcot-Marie-Tooth Association. 2700 Chestnut Parkway. Chester, PA. 19013.

Flapan, Mark. Living With A Rare Disorder: Hope and Fear. CMTA Special Report: CMT Facts III. Published by the Charcot-Marie-Tooth Association.

Maciocia, Giovanni. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Second Edition. Churchill Livingstone. 2005.

Xinnong, Cheng. Chinese Acupuncture and Moxibustion. Foreign Languages Press. Beijing. 1990.

http://www.naturalnews.com/026211_acupuncture_neuropathy_energy.html

Can Topical Agents Help With Neuropathy

Today's post from diabeticconnect.com (see link below) talks about topical pain relief, which for many neuropathy patients, is a desirable alternative to pills, although it has to be said that the ingredients of topical creams are often the same as some pill alternatives. It all depends on your history of neuropathy really and where it affects you most on your body. What's worked and what's failed and whether your doctor will offer the option of topical creams or not. For some, the medications that are absorbed through the skin give more relief, if only because they avoid stomach problems; while for others they just feel better and give you the idea that your pain is being tackled at source so to speak. The point is that if we're guinea pigs anyway (as far as neuropathy medications go) and we're working through lists to find that one thing that works best for us, why not try topical creams. That said, medications such as capsaicin have to be applied very carefully and if you're forced to use stronger agents like fentanyl patches, you need to do it under supervision - just because it's a cream doesn't make it any less powerful. Apart from that, the possibility of side effects still exists with topical agents. Talk it over with your doctor and do your own research and then make a decision based on what works best for you.

Topical Pain Agents for Pain Relief  By Lana Barhum
  
Learn your topical treatment options to manage painful diabetic neuropathy.
 
Lana Barhum is a legal assistant, patient advocate, freelance writer, blogger, and single parent. She has lived with rheumatoid arthritis and fibromyalgia since 2008 and uses her experiences to share expert advice on living successfully with chronic illness.

When you’re experiencing pain in your joints and muscles, topical pain relievers are a good alternative for pain management. These medications are delivered through a variety of dosage forms, including patches, gels, lotions, creams, sprays, and ointments. Topical agents have been used for decades to help prevent and treat a wide variety of health conditions, including pain from arthritis, diabetes, and other chronic conditions.

Topical pain medications are absorbed through the skin and are best for relieving joint and muscle pain close to the skin's surface, including the hands, elbows, knees, and feet. If you are reluctant to take pills, you may opt for an over-the-counter cream or patch. You could also have your doctor prescribe a stronger topical medication.

So, what are your options? And will they work to manage your pain?

Non-steroidal anti-inflammatory agents

Diclofenac is a topical non-steroidal anti-inflammatory medication available for topical pain management. Diclofenac is available in both patch and solution/gel formulas. The patch (Flector Patch) was first approved by the FDA in 1998 and can be used for the treatment of sprains and strains, but the solution/gel (Voltaren Gel) was designed for arthritis pain. Diclofenac works by reducing substances that cause inflammation and pain in the body. It is only available as a prescription and carries the same risk as other non-steroidal anti-inflammatory drugs (NSAIDs). 

Topical anesthetics

Topical anesthetics are local anesthetics that are used to numb the surface of a body part. They are available in creams, ointments, lotions, and sprays. Transdermal patches that contain lidocaine can offer chronic pain relief but are only available with a prescription. The lidocaine transdermal patch (Lidoderm) works by stopping the nerves from sending pain signals to the brain. You should only use one patch a day. Using too many patches or wearing a patch for too long may result in overdose, in which too much lidocaine is absorbed into the blood. In case of an overdose, discontinue use and call 911. 

Counterirritants

Counterirritants contain substances that create a hot or cold sensation in one location to temporarily lessen pain and inflammation. Counterirritants are generally non-prescription and available for topical use to manage muscle pain. Counterirritants contain capsaicin, methyl salicylate, menthol, and/or camphor. Capasagel, Benjay, Icy Hot, Biofreeze, and Tiger Balm are all brand-name topical pain agents containing one or more of these ingredients, but there are other brands including generics. These products are intended for short-term use of mild pain. Use of heat with these products should be avoided.

Narcotic analgesics

The FDA has only approved two narcotic analgesics for chronic pain. Fentanyl patches have been around since the 1990s and buprenorphine patches were approved in 2010. Both of these medications carry a high risk for abuse and misuse. The Fentanyl patch is usually prescribed to patients who are dependent on opioids (medications that reduce the intensity of pain signals to the brain) and require continuous opioid treatment. Buprenorphine patches are usually given to those who require long-term chronic pain management.
Treatment considerations

Topical medications are available in a variety of dosage formulas and more are being researched to improve pain management. Not everyone will experience good pain relief from using topical pain agents.

Here is what you can do to get the greatest effect from using these medications:

• Follow usage instructions carefully.

• Wash your hands before applying them.

• Do not apply patches, creams, gels, sprays, or lotions to damaged skin.

• Never use topical pain agents with heating pads or tight bandages.

• Do not use non-prescription topical pain agents for more than seven days.

• Monitor yourself for signs of toxicity (tinnitus, nausea, vomiting). Products containing methyl salicylate can absorb into the bloodstream.

• If you are allergic to aspirin or take blood-thinning medicines, check with your doctor before taking topical pain agents containing methyl salicylate.

http://www.diabeticconnect.com/diabetes-information-articles/general/1883-topical-pain-agents-for-pain-relief

Will Massage Therapy Help Your Neuropathy

Today's post from foundationforpn.org (see link below) looks at massage as a viable therapy for nerve pain. You'd be surprised how many people contact this blog regarding the benefits or not of massage. Then again, if you've tried almost everything else, including strong medication and nothing helps, then you're going to start exploring other options aren't you! It may be wise to avoid amateur masseurs (especially if you're paying good money) because of the potential for making things worse but that doesn't preclude your partner or close friend from helping you out because then you can set your own limits. This very useful article sets out the various massage therapies and explains how they work. This sort of information is helpful in making choices of what's best for you. Given that most people enjoy a massage anyway, irrespective of the medical benefits, why not give it a go but keep close control over the effects on your body. Even if a comfortable massage does very little to alleviate your nerve pain, it should make you feel better anyway if only because that's the nature of the beast. For many people the biggest hurdle is getting over the physical contact and the fact that someone else is exploring your body on an intimate level. However, if you don't try you'll never know and even if only your muscles and mind are relaxed, doesn't that make it worthwhile in itself? Maybe time to overcome your prejudgements and let your body make its own mind up!

Massage for Neuropathy
No date or author given but the source is reliable

Massage or massage therapy is a sytem of structured palpations or movements of the soft tissues of the body. The massage system may include, but is not limited to, such techniques as, stroking, kneading, gliding, percussion, friction, vibration, compression, passive or active stretching within the normal anatomical range of movement; effleurage (either firm or light soothing, stroking movement, without dragging the skin, using either padded parts of fingertips or palms); petrissage (lifting or picking up muscles and rolling the folds of skin); or tapotement (striking with the side of the hand, usually with partly flexed fingers, rhythmic movements with fingers or short rapid movements of sides of the hand).

These techniques may be applied with or without the aid of lubricants, salt or herbal preparations, hydromassage, thermal massage or a massage device that mimics or enhances the actions possible by human hands. The purpose of the practice of massage is to enhance the general health and well-being of the recipient. Massage does not include the diagnosis of a specific pathology, the prescription of drugs or controlled substances, spinal manipulation or those acts of physical therapy that are outside the scope of massage therapy.

Today, people use many different types of massage therapy for a variety of health-related purposes, such as pain management, prevent injuries, restore a healthy immune system, reduce stress, increase relaxation, address anxiety and depression, and facilitate overall wellness.

The benefits of neuropathy massage therapy

In the United States, massage therapy is often considered part of complementary and alternative medicine (CAM), although it does have some conventional uses. It is increasingly being offered along with standard treatment for a wide range of medical conditions and situations.

While more research is needed to confirm the benefits of massage, some studies have found neuropathy massage treatement may also be helpful for:
Alleviate low-back pain and improve range of motion.
Lessen depression and anxiety
Enhance immunity by stimulating lymph flow—the body’s natural defense system
Sports injuries
Improve the condition of the body’s largest organ—the skin
Increase joint flexibility
Pump oxygen and nutrients into tissues and vital organs, improving circulation
Paresthesia and nerve pain
Reduce spasms and cramping
Release endorphins—amino acids that work as the body’s natural painkiller
Arthritis
Relieve migraine pain

Studies of the benefits of massage demonstrate that it is an effective treatment for:
Decreased anxiety
Enhanced sleep quality
Greater energy
Improved concentration
Increased circulation
Reduced fatigue
Types of massage

There are many different types of massage, those that are for comfort and or those for specific conditions or diseases. Here are a few types:

Aromatherapy
 
Many essential oils that are derived from plants, herbs, flowers, and roots have beneficial therapeutic qualities. Aromatherapy involves the “burning” of essential oils to elicit a desired effect; for example, lavendar is known to induce calmness and relaxation. When combined with bodywork, aromatherapy can enrich the massage experience immensely. A few drops of essential oil can be added to massage cream or oil and applied to the skin. Professionally trained aromatherapists also blend oils to treat specific conditions. Only experienced professionals and/or those knowledable in the properties of aromatherapy should attempt to blend oils or utilize them in practice, as some oil combinations can be toxic, while others can burn the skin.

Connective Tissue Massage
 
Connective tissue massage is similar to myofascial release in that it involves working with the body’s fascia, or soft tissue, to relieve pain, tightness, and discomfort. The idea behind connective tissue massage is that restriction in one area of the body negatively affects other areas of the body. Practitioners of this technique “hook” their fingers into the connective tissue and utilize pulling strokes to lengthen the area. Benefits include pain reduction, tension relief, improved mobility and stress reduction.

Deep-Tissue Massage
 
Deep-tissue massage utilizes slow strokes, direct pressure or friction applied across the grain of the muscles with the fingers, thumbs or elbows. Deep-tissue massage works deeply into the muscles and connective tissue to release chronic aches and pains; its purpose is to reach the fascia beneath the surface muscles.

Practitioners must have a thorough understanding of the human body and have been trained to administer deep-tissue massage, as injury can occur if the technique is not performed properly. This technique is useful in treating chronic pain, inflammation and injury.

Geriatric Massage
 
Geriatric massage involves treating the elderly, often in resident-care facilities, and addressing their needs related to aging, depression and illness. Geriatric massage is usually shorter in duration, and involves the application of gentle techniques to facilitate pain relief, relaxation, and an overall feeling of wellness.

Lymph Drainage Therapy (LDT)
 
Developed by French physician Bruno Chikly, this technique involves the application of light, rhythmic strokes to help alleviate various conditions related to the body’s lymph system. Among other things, the lymph system is responsible for flushing out toxins and draining fluid, which supports a healthy immune system. When lymph circulation stagnates, however, fluid can build up and cause physical problems, such as inflammation, edemas and neuropathies.

LDT enables practitioners to restore proper lymph flow by using a “mapping” system to assess congested areas in the body, then apply gentle, pressure using the fingers and hands on these areas to reactivate proper circulation.

Massotherapy
 
Massotherapy involves working primarily with the muscles. Practitioners of massotherapy have a background in science, but often incorporate other modalities into their treatments when working with the muscle groups. Benefits of massotherapy include improved circulation and blood flow, as well as pain management.

Medical Massage
 
Practitioners of medical massage have a strong background in pathology, disease, illness and injury, and the contraindications of specific massage techniques related to various medical conditions. Medical massage therapists frequently work under the direction of or at the request of physicians.

Neuromuscular Therapy (NMT)
 
NMT is massage applied to specific muscles, often used to increase blood flow, release knots of muscle tension, or release pain/pressure on nerves. This therapy is also known as trigger-point therapy in that concentrated finger pressure is applied to “trigger points” to alleviate muscular pain.

Reflexology
 
This technique is based on a system of points on the hands, feet and ears that correspond, or “reflex,” to other areas of the body. Similar in theory to acupressure, reflexologists believe that applying appropriate pressure to these points stimulates the flow of energy, thus helping to relieve pain or blockages throughout the entire body. A very pleasurable form of bodywork, reflexology is also used to ease stress and promote relaxation.

Sports Massage
 
Sports massage therapies are both preventative and therapeutic, and used for athletes during warm ups, training and competition to treat and/or aid in the prevention of injuries; help improve flexibility, range of motion, and performance; and aid in mental clarity. Virtually every professional sports team employs professional sports massage therapists, and are often privately employed by professional athletes.

Swedish Massage
 
Generally regarded as the most common form of massage, Swedish massage involves a combination of five basic strokes and concentrates on the muscles and connective tissues of the body for improved circulation, relaxation, pain relief, and overall health maintenance and well-being. Swedish massage is also one of the less demanding techniques for massage therapists to practice as it usually does not involve deep-tissue work.

Talk to your healthcare providers about massage for peripheral neuropathy.

Despite its benefits, massage isn’t meant as a replacement for regular medical care. Let your doctor know you’re trying massage therapy and be sure to follow any standard treatment plans you have. Also ask about the number of treatments that might be needed, the cost, and insurance coverage. If a massage therapist suggests using other CAM practices (for example, herbs or other supplements, or a special diet), discuss it first with your regular health care provider. 

Risks of massage

Most people can benefit from massage for neuropathy. Massage therapy appears to have few serious risks — if it is performed by a properly trained therapist and if appropriate cautions are followed. Some forms of massage can leave you feeling a bit sore the next day. But ordinarily it shouldn’t be painful or uncomfortable. If any part of your massage doesn’t feel right or is painful, let your therapist know right away. Most serious problems come from too much pressure during massage or sensitivity or allergy to massage oils.

Cautions about massage therapy include the following:
Vigorous massage should be avoided by people with bleeding disorders or low blood platelet counts, and by people taking blood-thinning medications
Massage should not be done in any area of the body with blood clots, fractures, open or healing wounds, skin infections, or weakened bones (such as from osteoporosis or cancer), or where there has been a recent surgery.
Although massage therapy appears to be generally safe for cancer patients, they should consult their oncologist before having a massage that involves deep or intense pressure. Any direct pressure over a tumor usually is discouraged. Cancer patients should discuss any concerns about massage therapy with their oncologist.
Pregnant women should consult their health care provider before using massage therapy.
Licenses and certifications

Some common licenses or certifications for massage therapists include:
LMT Licensed Massage Therapist
LMP Licensed Massage Practitioner
CMT Certified Massage Therapist
NCTMB Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage and bodywork
NCTM Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage

Research

American Massage Therapy Association Consumer Survey Facts
75% of individuals surveyed claim their primary reason for receiving a massage in the past 12 months was medical (43%) and stress (32%) related.
87% of individuals view massage as being beneficial to overall health and wellness
61% of respondents said their physician has recommended they get a massage.

Source:

National Institutes of Health, National Center for Complementary and Alternative Medicine

American Massage Therapy Association: definition of massage therapy and basic massage therapy terms. www.amtamassage.org

Complementary and alternative methods: types of bodywork. Available at www.cancer.org

MassageTherapy.com. www.massagetherapy.com

https://www.foundationforpn.org/living-well/integrative-therapies/massage/

Can Cannabis help

In the States, there are constant arguments regarding the value of cannabis in treating pain and most states have legal problems anyway. Here in the Netherlands, we have no such problems, so this should be of interest. The problem is that if you're a non-smoker, you might have extra difficulty using cannabis.
According to the Californian doctor, Dr. Sean Brean...

This week I was contacted by the director of operations for The Foundation for Peripheral Neuropathy in Chicago because of the feedback they are getting from patients about how much it helps them. Unfortunately Illinois does not have a medical marijuana law on the books so the patients there are frustrated and want relief. The women I spoke with reached out to me because I have blogged about the success I have had using medical marijuana to treat neuropathic pain. READ ON….
...Neuropathic pain can happen from a number of different reasons. One of the most common is cause by high circulating blood sugars seen in patients with Diabetes. These sugars bind to the nerves and alter various proteins resulting a damage. Also, diabetes affects the small blood vessels that supply the nerves. When the blood flow is limited there is less oxygen to the nerves and they die off. The #2 and #3 reasons patients develop neuropathy is HIV infection and medication induced (many chemotherapy agents cause neuropathy).

There have been numerous studies that show medical marijuana’s efficacy. If you google “Center for Medical Cannabis Research, UCSD” it will link to 14 completed studies showing the efficacy of medical marijuana. Many of those studies demonstrated the positive benefit of using marijuana for neuropathic pain.

When patients follow up with me after using medical marijuana they report:

1. Decreased dependance on other pain meds.

2. Improved sleep. Many times they sleep through the night “for the first time in years”.

3. Improved Mood. They now have hope and have a better outlook on their lives. Finally something that gave them some relief!

4. Improved appetite.

It has been very rewarding taking care of patients with neuropathic pain. Traditional medicine has not given enough credit to cannabis as a treatment for this disease. As more and more patients use this my hope is that more doctors will hear their success stories.
Medical Marijuana and Peripheral Neuropathy

8 Gly Carb To Help Reduce Neuropathic Pain

Today's post from fiercebiotechresearch.com (see link below) talks about microglia, which are cells in the spinal cord that are responsible for releasing nitrous oxide when there's nerve damage. This nitrous oxide is partly responsible for the extent of your neuropathic pain at a later stage. Scientists have found a compound which (simply put) can inhibit nitrous oxide release and thus theoretically, reduce pain and other symptoms. The compound is called 6-chloro-8-(glycinyl)-amino-β-carbolin, or 8-Gly carb which hardly rolls off the tongue for patients but the name isn't important, its potential is.As usual, the end product is still somewhere in the future but every little snippet of news increases our general understanding of our condition and puts pressure on the relevant authorities to work as fast as they can to improve our lives with neuropathy.

UC Davis team finds a prime drug candidate for neuropathic pain  

February 10, 2015 | By John Carroll

Neuropathic pain has been linked closely to microglia, immune cells in the spinal cord which are known to release cytokines and other chemicals including nitrous oxide in the wake of peripheral nerve damage. A team of UC Davisresearchers says that inhibiting nitrous oxide at the time that nerve damage is done could prevent neuropathic pain from occurring later. And they've found a compound that they say is very effective at doing just that.

The compound is 6-chloro-8-(glycinyl)-amino-β-carbolin, or 8-Gly carb, which belongs to a class of compounds known to blunt nitrous oxide. The team says that this compound is significantly better at that task than any other known compound. And it appears to do its work without blocking cytokine expression.

Neuropathic pain often doesn't begin until well after physical trauma. And once it does begin it can linger for years as the brain is believed to be misinterpreting nerve signals from the site of the damage.

"A compound like 8-Gly carb that selectively targets nitrous oxide production and does not block cytokine expression makes a promising candidate for drug development aimed at preventing a neuropathic pain syndrome without interfering with recovery," said Fredric Gorin, professor and chair of the UC Davis Department of Neurology and co-principal investigator for the study.

Now new preclinical work is being planned that could set the stage for clinical studies.

- here's the release

http://www.fiercebiotechresearch.com/story/uc-davis-team-finds-prime-drug-candidate-neuropathic-pain/2015-02-10

Can Lasers Possibly Help Reduce Neuropathy Problems

Today's post from neuropathydr.com (see link below) looks at laser therapy for neuropathic problems. The problem is that this article doesn't explain how laser therapy works, or the science behind it; it just states that many cases of neuropathy can be helped by using directed lasers. If you're interested in the possibilities, it would be advisable to talk it over carefully with your doctor or specialist and find out exactly what's involved. it's true that lasers are being used as surgical tools but how this can help with nerve damage is unclear.

Laser Neuropathy Treatment: How Does It Help?
Posted by Editor on November 17, 2014
 
Lasers are no longer the giant, destructive beams that were featured in sci-fi movies of the past. Today, laser neuropathy treatment uses low-level focused lasers with healing powers.

Lasers used to be the stuff of science fiction, but today they seem to be everywhere—from the checkout station at your local library to the self-scan at the grocery store. Of course, lasers have also been in use as a surgical tool for many years now.

These days, the use of Low Level Laser Therapy, or LLLT, and Light Emitting Diodes (LED) is commonplace, with much continuing research that shows their effectiveness as healing modalities for neuropathic pain and discomfort.

The fact is, many cases of peripheral neuropathy can be significantly improved with the use of laser neuropathy treatment. Laser treatment can reduce symptoms in chronic pain and even for conditions like disc degeneration and spinal stenosis. What’s more, the use of lasers can also help to stimulate nerves in order to speed up the body’s natural healing process.

You don’t need to understand the actual science behind how lasers work, which can be pretty challenging for the layperson to grasp. But the user experience of laser neuropathy treatment is simple. A laser is a painless and highly focused light beam, which is carefully directed at a specific part of your body for short amounts of time. The time duration and laser power is based on research about the effects of laser treatment on certain body tissues.

Laser neuropathy treatment isn’t an immediate fix for your chronic pain or discomfort. It does take several treatments for an effect to be noticed. However, many patients see a significant positive change within about 12 treatments.

http://neuropathydr.com/laser-neuropathy-treatment-overview/

ACETAMINOPHEN MAY NOT HELP BACK PAIN

Even though its use is often advised by doctors, the painkiller acetaminophen — best known as Tylenol — does not help treat lower back pain, according to a new Australian study.

The researchers found the drug was no more effective than a dummy pill for more than 1,600 people suffering from acute lower back pain

Besides showing no effect in easing discomfort, the study also found the drug was no help in improving sleep woes tied to back pain, nor did it improve patients’ overall quality of life.

The research team said the findings call into question the belief that acetaminophen should be the first choice when treating this common form of back pain.

The drug “might not be of primary importance in the management of acute lower back pain,” study lead author Dr. Christopher Williams from the George Institute for Global Health at the University of Sydney in Australia, said in a news release from the journal The Lancet.

The study was published online in the July 23 issue of the journal.

However, one expert said it’s probably too early to abandon acetaminophen for lower back pain.

“While this is a fascinating study, it is only one study and shouldn’t change clinical behavior,” said Dr. Houman Danesh, director of Integrative Pain Management and assistant professor of anesthesiology at The Mount Sinai Hospital in New York City.

For its part, McNeil Consumer Healthcare, which makes Tylenol, said doctors need to consider “the entire body of scientific evidence when making recommendations or changing guidelines.” The company said that “the safety and efficacy profile of acetaminophen is supported by more than 150 studies over the past 50 years.”

The new study involved more than 1,650 people averaging 45 years of age. All had suffered lower back pain and were treated at 235 different primary care facilities throughout Sydney. Each person was randomly assigned to take either three doses of acetaminophen daily (a total of 3,990 milligrams) for up to four weeks, or a placebo pill.

The researchers pointed out the maximum daily dose of the drug is 4,000 milligrams (mg).

All of the patients received follow-up “reassurance and advice” from a doctor for three months.

According to the study, there were no differences in the amount of time it took any of the patients involved in the study to feel better. The median time to recovery for those taking acetaminophen was 17 days, compared to 16 days for patients in the placebo group.

The drug also appeared to have no effect on the patients’ level of pain, compared to people who took the dummy pill, the researchers noted. Acetaminophen also did not improve patients’ level of disability, sleep quality or quality of life. About the same number of patients in each group experienced negative health issues, the study found.

The researchers suggested that the medical reassurance the patients received during the study — something many won’t get in a “real world” setting — could have had a more significant effect on their lower back pain than the medication.

“It would be interesting to see whether advice and reassurance [as provided in our trial] might be more effective than pharmacological strategies for acute episodes of low-back pain,” Williams said.

Another expert agreed that encouragement and counseling can be key.

Everyone involved in the study received ongoing ” ‘good-quality advice and reassurance,’ which appears to be a big factor in recovery,” said Dr. Michael Mizhiritsky, a physiatrist and specialist in pain relief at Lenox Hill Hospital in New York City.

“In my opinion, positive reinforcement about treatments — including medications and physical therapy — in the management of low back pain is vital to a quicker and successful recovery,” he added.

Both Danesh and Mizhiritsky also took issue with some of the study’s methods.

“The drawback I see is there was no group that did not receive any treatment — meaning there could be a placebo effect” at work, Mizhiritsky said.

And Danesh said people could still get relief from acetaminophen/Tylenol — just not the kind of relief outlined in the study.

“The criteria was to be pain-free for seven continuous days when using Tylenol,” he pointed out. “It does not address if Tylenol will give you a few hours of relief or a few days.”

In the meantime, the prognosis for most people with lower back pain is actually quite good, Danesh stressed.

“Most back pain patients improve in 6-8 weeks,” he said. “It is important to note that the best treatment of back pain involves not only pain medication, but also physical therapy to address muscle imbalances. Acupuncture for back pain has also been researched by the U.S. National Institute of Health, and after reviewing the literature they state that there is evidence to support the use of acupuncture for back pain.”

The study was partially funded by drug maker GlaxoSmithKline Australia. HealthDay reached out for comment to McNeil Consumer Healthcare, the makers of Tylenol, but did not receive a reply.