Neuropathy Caused By Necessary Medications Personal Story

Today's post from frankobserver.wordpress.com (see link below) is a personal account of having neuropathy as a result of cancer drug treatment but will resonate with many neuropathy patients. He makes a very good point, that many people encounter neuropathy as a result of the drugs they have been taking for other conditions and it's ironic that most neuropathy treatments also involve drugs used to treat other conditions. He points out that his doctors shrug their shoulders as if to say, well it's par for the course, which only highlights the importance of finding new treatments as quickly as possible. Science is busy doing just that and there certainly seems to be a new wave of interest in finding solutions for nerve damage but in the meantime, patients need the patience of a saint while they wait in discomfort and pain.

Living with and tackling PERIPHERAL NEUROPATHY 
Posted on May 28, 2015 by frankobserver

Peripheral neuropathy is caused when there has been damage to the nerves of the peripheral nervous system causing a loss of touch sensation or a loss of motor function in certain parts of the body; whilst this can be predominantly to the hands and feet, many different parts of the body can be affected..

Whilst diabetes and shingles (Herpes Zoster) are two common causes of peripheral neuropathy, there are several other major illnesses, diseases and treatments that can be the basis of it. 



I’ve had the neuropathy for well over six years to some degree although the severity has diminished somewhat in recent times.

It first appeared during the chemotherapy that followed my operation for cancer. The treatment was called “Folfox” and it was administered at the Drogheda Oncology Unit in County Louth during 2009. The staff and the treatment I received was excellent and for many, one can argue that peripheral neuropathy is a small price to pay but it is still frustrating!

By no means am I unusual in that I have developed peripheral neuropathy, in fact, it appears to be fairly common, especially after Folfox chemotherapy. For some it lasts six or twelve months and then goes away; for others it seems that the damage may be permanent.
When one asks someone in the medical profession “what one can do to resolve this problem”, it is normally met by a “shrug of the shoulders” It seems that, despite their incredible skills, they are technically stumped on this one. However, the medical profession make wonderful advances and there are indications that the instances of peripheral neuropathy, caused by treatment, can and will be reduced for future patients.

Accordingly, when the Folfox treatment is administered now in Ireland, there is an additional drug which can help reduce the instances of peripheral neuropathy in patients. It is considered that Xaliproden reduces neuropathy caused by FOLFOX and seriously reduces the risk of same associated with oxaliplatin which is incorporated in Folfox; this is great news for patients and for people recovering from colorectal cancer; however, the drug has to be administered at the time of ones chemotherapy – it is not practical after the treatment has been completed apparently.



My peripheral neuropathy was caused by Folfox Chemotherapy and there has been little I can do to relieve the symptoms; additionally the amount of numbness to the toes & feet can differ considerably for those affected. But for all people with peripheral neuropathy, it seems the amount of pain can vary considerably from patient to patient, and depending on the parts of the body most affected.

So for large numbers of people, the nerve damage that leads to peripheral neuropathy is caused by the drugs that have been administered to treat other diseases and not necessarily from the illness itself.

Tackling this problem is difficult but from my own experience I have found that vitamin B6 in doses of 100mg per day can assist and reduce the numbness but it remains a significant problem even now. Squeezing a tennis ball helps the hands and fingers as does exercising the toes (standing on tip toes, moving them as much as possible and massage) but it’s a gradual process.
Peripheral neuropathy caused by chemotherapy may be ‘a small price to pay’ especially if chemotherapy has helped to save your life!! But ‘non-cancer’ patients may experience problems following exposure to other toxins, some heavy metals and organophosphate pesticides. Lupus & rheumatoid arthritis can also be causes of peripheral neuropathy .There are also hereditary diseases such as Charcot-Marie-Tooth disease. Syphilis patients too can experience this and HIV can cause peripheral neuropathy as can the necessary treatment for same. 

There are many sites that discuss this issue but the best place to start is probably with your own doctor or GP. My own experiences are covered in a log that I made at the time of my treatment. Please visit COLON CANCER – MY EXPERIENCES.
Good luck and best wishes to all.

https://frankobserver.wordpress.com/2015/05/28/living-with-and-tackling-peripheral-neuropathy/

The Side Effects Of HIV Medications

Today's excellent article from thewellproject.org (see link below) will be interesting to both people new to HIV and those who have been living with it for some time. It sums up, in a well explained manner, the various potential side effects of HIV drugs. Your doctor may not have explained these in such detail, if at all and you may find reading medication box pamphlets a problem without a magnifying glass. The article relates certain HIV medications to neuropathy but it would be wise to remember that the newer medications may also have a role to play and the virus itself has now also been shown to be a relevant cause. Apart from that, your so-called HIV-related neuropathy may just as easily have emerged from nearly a hundred other possible causes. Keeping an open mind and talking it over with your doctor, is probably the best advice.

Side Effects

Updated February 2012

Side Effects and HIV Drugs

Over the years, many HIV drugs have been developed that help people live longer, healthier lives. Like all drugs approved by the Food and Drug Administration, HIV drugs are tested to make sure they are safe and effective in treating HIV. However, HIV drugs can also cause some effects that are different from what they were developed to do. These are called side effects. In most cases, the side effects of HIV drugs are mild, like a headache or an upset stomach. In some cases, however, more serious side effects like liver damage or peripheral neuropathy can occur.

Side effects are most common during the first four to six weeks you are taking a new HIV medication. After your body gets used to the new drug, the side effects usually get better or go away. Other side effects may show up later or last longer. There may also be long-term side effects we do not know about yet. Many of the HIV drugs have not been on the market long enough for us to know all the possible long-term effects.

Being Informed about Side Effects Helps

Each HIV drug comes with information on its most common side effects. It can help to read this information. However, remember that this information lists side effects you might experience, not side effects you will experience. While all HIV drugs can cause side effects, not everyone will experience every side effect of each drug, and not everyone will experience the side effect(s) the same way.

Speak to your health care provider about side effects before starting a new treatment. It will help if you know what to expect and how to handle any problems that arise. Some important points:

• Find out what side effects are possible for any new drug you are taking.
• Ask if there are ways of taking the drug that make it easier to tolerate – for example with or without food or at a certain time of day, such as bedtime.
• Find out if you can treat mild side effects with home remedies, over-the-counter medications, or prescription drugs and have these treatments on hand, especially for common side effects like diarrhea and nausea.
• Ask when you should get medical attention for a side effect.
• Let your health care provider know if you are experiencing side effects, especially if you are taking a drug that may cause a particularly serious problem.

Whether your side effects are considered mild or serious, if they are getting in the way of you taking your HIV drugs (see TWP info sheet on adherence), they are a very important concern. If you do experience side effects, do not just stop taking your medication. Talk to your health care provider, who will help you by suggesting ways to address the side effect directly, changing the dose of the drug, or switching drugs.

Women and Side Effects

Although the total number of side effects among people on HIV drugs does not differ a lot between men and women, some side effects (listed below) appear to be more common in women living with HIV (HIV+) than in men.

This may be due to the fact that women have higher levels of certain HIV drugs in their bloodstreams, even though they take the same doses as men. A woman’s smaller body size, metabolism, or hormones may cause the higher levels. For example, with the protease inhibitor (PI), Norvir (ritonavir), women seem to experience more nausea, vomiting, and weakness than men.

Despite some differences in drug levels and side effects, women seem to benefit as much from HIV therapy as men. No changes in dosing have been recommended for women.

Milder Side Effects

Below is a list of more common, milder effects associated with HIV drugs. Click the available links for more detailed information on the side effects listed.

Nausea and Vomiting

Nausea, or feeling sick to your stomach, is one of the most common side effects of taking HIV drugs. Vomiting, or throwing up, is also very common. Both of these occur when new, unknown substances – like HIV drugs – are introduced to our bodies.

The good news is that, when nausea and vomiting occur as side effects of new HIV drugs, they often get better after the first days or weeks of treatment. However, they can still be awfully unpleasant and reduce the quality of your daily life. Nausea and vomiting can get in the way of your taking your HIV drugs regularly or benefitting from the drugs you take (if you throw them up before they are digested). These side effects can also lead you not to get the proper nutrition your body needs.

It is important that you tell your health care provider if nausea is affecting your quality of life, especially your ability to eat and take medications. It is also important to tell your provider if you have vomiting lasting more than a few days, as that may lead to more serious problems.

Because nausea and vomiting are such common side effects with so many of the HIV drugs, switching drugs is often not helpful. Instead, there are some things you can do to manage nausea and vomiting:

• Eat smaller meals more often. Large amounts of food in the stomach can make nausea worse.
• Eat bland, rather than spicy foods. Bland foods are easier to digest.
• Eat room temperature foods. Very cold or very hot foods can make nausea worse.
• Ginger and peppermint have long been known to ease the stomach. Try ginger ale, ginger tea, or peppermint tea.
• Breathe slowly – in through the nose, out through the mouth. Try to avoid strong smells, like perfume, smoke, incense, or food smells.

If these tips do not work, there are prescription medications to prevent nausea and vomiting (“antiemetics”). Talk to your health care provider about which one would be best for you.

Diarrhea

Diarrhea occurs when you have bowel movements more often than you usually do and/or have very loose, watery stool. Like nausea and vomiting, diarrhea can be unpleasant and reduce the quality of your life. It can also lead to dehydration and malnutrition (not getting enough nutrients from your food).

It is important to tell your health care provider if you have diarrhea for more than a few days so that he or she can find the cause and suggest appropriate treatments.

There are many approaches to treating or managing diarrhea:

• Dietary changes:
  • Increase fluid intake to avoid dehydration.
  • Eat small meals every 2-3 hours.
  • Avoid fatty foods, very sweet or spicy foods, caffeine (found in coffee, chocolate, sodas), ‘roughage’ (lettuce, greens, seeds, corn, bran), raw or undercooked foods.
  • Try the BRATT diet: Bananas, Rice (white), Apples (without peel), Toast (white), and Tea (unsweetened and non-caffeinated).
• Herbal remedies: Chamomile, ginger, and peppermint teas have calming effects on the gut.
• Supplements, including probiotics, L-glutamine, and calcium carbonate
• Over the counter medications
• Prescription medications

For more information on managing your diarrhea, please see our Diarrhea info sheet.

Headaches

Some HIV drugs can cause headaches. These headaches usually go away on their own and are not a sign of a serious condition or disease. However, if you experience severe pain, changes to your vision, dizziness, neck stiffness, fever, nausea and/or vomiting, tell your health care provider immediately, as these symptoms can indicate something more serious. Also tell your provider if your headaches are affecting your quality of life or ability to stick to your HIV drug regimen.

If headaches are bothering you, ask your health care provider if over-the-counter pain relievers like aspirin, Tylenol (acetaminophen), Advil or Motrin (ibuprofen), or Aleve (naproxen sodium) are right for you. You may also consider alternative or complementary therapies to manage headaches.

Rash

Rash is a common side effect of many of the HIV drugs, especially the non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as Viramune (nevirapine) and Sustiva (efavirenz). Rashes are more common and more severe in women. It’s important to check your skin for changes in color or any unusual bumps, especially after starting a new medication.

In rare situations, a rash is a symptom of a severe, life-threatening skin reaction called Stevens-Johnson syndrome. Call your health care provider immediately if you experience a bad rash or a rash together with any of the following symptoms: fever, lack of energy, general feeling of illness, muscle or joint aches, itchiness of the skin, mouth sores, bloodshot or dry eyes, and blisters, especially those that look like “targets,” or “bulls-eyes.”

More Serious Side Effects

Below is a list of less common, more serious side effects associated with HIV drugs. Click the available links for more detailed information on the side effects listed.

Kidney Problems

The kidneys are the two fist-sized, bean-shaped organs that filter blood and produce urine. They get rid of waste and maintain a healthy balance of many substances, including water and electrolytes.

Often, those with kidney disease – especially early kidney disease – do not notice any symptoms. This is why it is important to see your health care provider regularly for lab tests that pick up changes to your kidney function. Symptoms of kidney disease can include: too much or too little urine; urine that is foamy, pink, red, or brown; swollen hands or feet; muscle aches or cramps; fatigue and trouble concentrating.

Sometimes people develop a serious condition called acute renal failure (ARF) in response to certain HIV drugs. ARF happens when serious damage to the kidneys occurs in a short amount of time. ARF can lead to permanent kidney damage.

Liver Problems

Some HIV drugs can cause liver problems. It is believed that women and people over the age of 50 are at higher risk of developing liver problems. Obesity, heavy alcohol use, and other liver problems (such as hepatitis B and C) can also increase this risk.

Some drugs, such as Viramune, can cause an allergic reaction in the liver that increases the liver enzymes in your blood soon after the medication is started. It is important that your health care provider do a blood test to check your liver frequently during the first few months that you are on this medication.

In addition, research has shown that women with more than 250 CD4 cells are 12 times more likely to develop life-threatening liver problems when they start Viramune. Viramune should not be used as first-time treatment in women with CD4 cell counts over 250. Women with over 250 CD4 cells should not switch to Viramune unless there are no other options. Women whose CD4 cells rise to over 250 while taking Viramune do not need to discontinue or switch their treatment.

For more information, please see our info sheet on Caring for your Liver.

Lipodystrophy

The term lipodystrophy is used to describe a number of body shape changes that result from the addition or loss of body fat. While HIV+ men and women both experience body shape changes, women are more likely to experience fat gain in the breasts, stomach, and upper bodies. Lipodystrophy can cause big changes in your appearance. If you are concerned about how you look, speak to your health care provider before making any changes to your HIV drug regimen.

Lipdystrophy also involves metabolic problems such as high blood glucose (sugar) and high lipid levels (cholesterol and triglycerides). The exact causes of lipodystrophy are not known, but may include HIV and/or certain HIV drugs.

 For more information on this topic, see our info sheet on Lipodystrophy and Body Changes.

Peripheral Neuropathy

Peripheral neuropathy (PN) happens when the nerves between the feet and/or hands and the spinal cord become damaged. Like frayed wires that can spark or misfire, these damaged nerves do not send their electrical signals properly. As a result, PN can cause feelings of numbness, tingling, burning, itching, or shooting pain. Some people with PN describe their pain as “holding a lit match to my feet,” or “walking on broken glass.”

PN pain can be constant or occasional, and usually occurs on both sides of the body. Some older HIV drugs such as Zerit and Videx can be toxic to the nerves and cause PN. Unfortunately, there are no approved medical treatments to cure PN. For now, the key to treating PN is to remove the cause and control the pain.

For more information on this topic, see our info sheet on Peripheral Neuropathy.

Lactic Acidosis

Lactic Acidosis is a buildup of lactic acid in the blood. It is a rare but serious complication of some nucleoside reverse transcriptase inhibitors (NRTIs) such as Zerit (stavudine or d4T) and Videx (didanosine or ddI). Women (especially pregnant women), overweight people, and those with a long history of NRTI use are more likely to develop lactic acidosis. Symptoms include fatigue, nausea, vomiting, stomach pain, shortness of breath, and weakness in the arms and legs. If you notice any of these symptoms, call your health care provider right away.

For more information on this topic, see our info sheet on Lactic Acidosis.

Other Possible Side Effects

Taking HIV drugs can also affect your heart and bone health. For more information, see our info sheets on Caring for your Heart, and Bone Disease.

In addition to the side effects listed above, you can find more information on other possible side effects in the Diseases and Conditions section of the TWP website.

Side Effects or Toxicities during Pregnancy

The majority of studies have shown that taking HIV drugs during pregnancy does not increase the risk of birth defects. However, there are certain HIV drugs that should not be used by pregnant women because of potential problems for the mother or the baby.

HIV+ women should not take Zerit (stavudine) and Videx (didanosine) at the same time if they are pregnant. Some pregnant women who took these drugs together developed lactic acidosis, which resulted in deaths. Sustiva (efavirenz) and Atripla (emtricitabine/tenofovir/efavirenz) should also not be used by pregnant women, because their use by women in the first trimester of pregnancy has been linked to birth defects.

If you are pregnant or thinking about getting pregnant, speak to your health care provider about all of your medications to be sure there are no specific warnings for pregnant women.

Taking Care of Yourself

HIV drugs help many people live longer, healthier lives. Side effects are an important factor in determining who stays on their HIV drugs. While the term ‘side effects’ may make them sound like they are not a big problem, if they are getting in the way of your taking your HIV drugs, they may get in the way of your good health. If you are having trouble sticking to your HIV drug regimen because of problems with side effects, speak to your health care provider before skipping, reducing, or stopping your drugs. There is usually something that can be done about it, such as changing the dose of that drug, switching to another drug, or finding ways to treat or manage the side effect directly.

http://www.thewellproject.org/en_US/Treatment_and_Trials/Things_to_Consider/Side_Effects.jsp

Neuropathy Brought On By Medications

Today's post from arthuryinfan.wordpress.com (see link below) is an important one in that it looks at the relationship between certain drugs (and combinations of drugs) and neuropathy. There are enough well-known causes of neuropathy to set your mind spinning but when you learn that certain medications themselves can bring on the condition, there's little wonder that we get confused. The lesson is, that the doctor or specialist responsible for treating the symptoms of your neuropathy, needs to be a) aware of everything you are taking (and that includes supplements and alternative therapies) and b) exactly how they may interact with each other to possibly worsen your symptoms. A classic case in point are the drugs used to control cholesterol in your body. These are called Statins but they are also renowned for causing neuropathy. You and your physician will need to make a calculated decision as to what is the lesser of two evils and that's not easy. It's vitally important that if you have neuropathy and another condition (including, cancer, diabetes, HIV etc) you discuss all your treatments and all possible interactions with your doctor. Researching beforehand may help the discussion be more constructive.

Medication-Induced Neuropathy
November 9, 2012 by arthuryinfan

Medication-Induced Neuropathy
By Peter D. Donofrio, M.D.

You’ve undoubtedly heard the old saying, “It’s what you don’t know that can hurt you.” When it comes to neuropathy, there may be something your doctors don’t know that can hurt you as well.

Renowned New York Times health columnist Jane Brody recently shared with readers of her column that she experienced a bout of peripheral neuropathy several decades ago when a misplaced shot of morphine damaged a sensory nerve in her thigh. Obviously, her doctor never intended for that to happen. Fortunately, the nerve recovered in three years, but for much of that time, Brody couldn’t even tolerate something brushing against her leg.¹ Brody’s peripheral neuropathy can be categorized as an “iatrogenic” case—that is, a condition that is actually caused by medical care.

Iatrogenic causes for peripheral neuropathy aren’t always as blatant as a misplaced shot. In fact, peripheral neuropathy can be caused by nerve toxicity from commonly prescribed drugs: medications prescribed by physicians who are not aware of the possible relationship between the medication and the neuropathy. Why aren’t they aware? After all, aren’t these the experts you trust with your health, your well-being…your life?

Your doctors are well aware of the medications they are prescribing, but the fact is they may not be aware of medications other physicians have prescribed, nor are they aware of every uncommon adverse reaction of a medication. Many medications have hundreds of reported side effects. Often primary care physicians are inundated by a waiting room full of very ill patients requiring immediate care and don’t have time to fully review in detail every note or test result they receive.

Simply put, your specialists and primary physicians need your help. If you have a neuropathy and are concerned it may arise from a medication, speak up. Some medications and interactions between drugs can cause complications and even irreversible conditions. For example, thalidomide has proven to be very effective for treating skin diseases and some kinds of cancer. In fact, thalidomide has experienced a resurgence of use in the medical community for its effectiveness against several dermatological conditions. The occurrence of neuropathy, however, has also been tied to thalidomide. It is not typically related to the daily dose of the drug nor the duration of treatment; it’s more commonly found in patients who are slow drug acetylators—in other words, those patients whose bodies take longer to metabolize certain drugs.

The good news is that when patients with neuropathy stop using thalidomide, 25 percent of them recover completely, and 30 percent improve partially. What’s not so comforting is the fact that 45 percent of reported cases do not recover at all.² This example illustrates the need for you to consult with your physician if you take any of the medications associated with causing neuropathy. It is important to remember that you are not expected to be a medical expert, however, you are expected to know the names of the medications you’re taking, how long you have been taking them, and to be able to describe them to every doctor you visit. Thus, you need to assume the role of being your own patient advocate. Today’s health care system is complicated, and as such, you need to be able to provide to your doctor and to other health care providers as much information about your treatments as possible. Communication of your medications and duration of use is critical for your primary care and specialist physicians to offer you excellence in care.

Take the first step by reviewing the list of medications below that can induce neuropathy and let your physicians know if you are taking any of them. Remember to tell your physicians that you are not questioning their judgment; just asking them to review the medications in the context of your neuropathy. More often than not, they will welcome this active role in your treatment and see this as an opportunity to better educate themselves. Not only will you be helping yourself, but you could be helping others as well. Also, keep in mind that these medication do not always cause neuropathy, and it is the unique metabolism of certain patients that may cause them to develop neuropathy when prescribed a certain drug.

The following is a list of drugs that can cause neuropathy in certain patients:

Allopurinol
Amiodarone
Ara-C
Carboplatin
Cisplatin
Colchicine
Danosine (ddl)
Dapsone
Disulfiram
Docetaxel
Etoposide (VP-16)
Ethambutol
Etoposide
Gentamin
Gold
Indomethacin
Isoniazid
Lithium
L-tryptophan
contaminant Mercury
Metronidazole
Misonidazole
Nitrofurantoin
Nitrous Oxide
Paclitaxel
Perhexilene
Phenytoin
Pyridoxine
Sulfapyridine
Statins
Stavudine (d4T)
Streptokinase
Suramin
Tacrolimus
Thalidomide
TNF-alpha antagonists
Tumor Necrosis Factor
Vincristine
Zalcitabine (ddC)
Zimeldine

The peripheral nerves are protected by a blood-nerve barrier and might be perceived to be at a lessened risk than other organs for toxicity. Certain patients, however, may be at a higher risk for developing peripheral nerve toxicity due to genetic or metabolic factors. Many therapies have toxicities that must be tolerated because the treatments are necessary, such as treatments for HIV and malignancy. Developing additional therapies to prevent and/or ameliorate the toxic neuropathy associated with certain medications is an important area of
research and clinical trials are on-going.

1 Brody, Jane. “The Many Ills of Peripheral Nerve Damage.” The New York Times, October 20, 2009.

2 Zimmer, Carl. “Answers Begin to Emerge on How Thalidomide Caused Defects.” The New York Times, March 16, 2010.

Peter D. Donofrio, M.D. is professor of Neurology and director of the Neuromuscular Division of the Department of Neurology at Vanderbilt University Medical Center. He is director of our Association’s Neuropathy Center of Excellence at Vanderbilt and also serves on The Neuropathy Association’s Medical Advisory Committee.

*We have reprinted this article from the May 2010 edition of Neuropathy News.

http://arthuryinfan.wordpress.com/2012/11/09/medication-induced-neuropathy/

The Depressing Failures Of Nerve Pain Medications

Today's post from doctorslounge.com (see link below) presents a now depressingly familiar conclusion, that most drugs used to treat nerve pain simply aren't good enough and considering the potential for side-effects, are little better than placebos. In this article, you'll read a list of drugs most people with long-term neuropathy have already tried. Not only that, but people progress along a line of standard treatments, taking in potentially dangerous medication, sometimes over many years and with hardly any areas of improvement at all. The conclusion is that we need new drugs for nerve pain and we need them quickly but they were saying that thirty years ago as well. Meanwhile the patient is the one that suffers, both physically and mentally as hopes are once again dashed by conventional science failures. If only we had the energy for a revolution!!

What Drugs Work Best for Diabetic Nerve Pain?
Last Updated: March 24, 2017. (HealthDay News)

Data review shows some meds help more than others, but better options still needed

 -- Nerve pain and numbness, also known as neuropathy, is a debilitating but common symptom of diabetes.

Now, new research suggests certain drugs may outperform others in treating diabetic neuropathy.

The new review of the data on the subject was led by Julie Waldfogel of Johns Hopkins Hospital in Baltimore. Her team noted that about half of people with diabetes have some form of nerve damage caused by high levels of blood sugar.

However, not all of them will have symptoms such as pain, numbness and tingling in the legs and feet.

In the new study, the Hopkins group reviewed 106 studies on pain relief for diabetic neuropathy. The researchers found "moderate" evidence that the antidepressants duloxetine (Cymbalta) and venlafaxine (Effexor) reduce diabetic nerve pain.

However, they only found "weak" evidence that botulinum toxin (Botox), the anti-seizure drugs pregabalin (Lyrica) and oxcarbazepine (Trileptal), and drugs called tricyclic antidepressants and atypical opioids (drugs such as Tramadol) may help reduce pain.

The researchers also noted that gabapentin (Neurontin, Gralise) works in a similar manner to pregabalin, and the review found gabapentin no more effective than a placebo.

Long-term use of standard opioids -- such as OxyContin, Vicodin or Percocet -- is not recommended for chronic pain due, including neuropathy, because of a lack of evidence of long-term benefit and the risk of abuse, misuse and overdose, Waldfogel said.

The anti-seizure drug valproate and capsaicin cream were also ineffective, according to the review published online March 24 in the journal Neurology.

The review was funded by the U.S. Agency for Healthcare Research and Quality.

"Providing pain relief for neuropathy is crucial to managing this complicated disease," Waldfogel said in a journal news release.

"Unfortunately, more research is still needed, as the current treatments have substantial risk of side effects, and few studies have been done on the long-term effects of these drugs," she added.

Two experts in diabetes care and pain management said the data review is important information for patients.

"This trial was a much needed step in the right direction in an otherwise murky field of medicine," said Dr. Caroline Messer, an endocrinologist at Lenox Hill Hospital in New York City.

She noted that "traditional teaching for endocrinologists has always included the use of gabapentin for diabetic neuropathy. Given gabapentin's host of side effects, it will be a relief to remove it from the toolbox."

And Messer added that "venlafaxine is now an interesting treatment possibility, given that one of its common side effects, weight loss, could prove useful for patients with type 2 diabetes."

Dr. Ajay Misra is chair of neurosciences at Winthrop-University Hospital in Mineola, N.Y. He noted that neuropathy can differ for people with type 1 or type 2 diabetes, with neuropathy levels correlating well with blood sugar management in people with type 1 disease, but not as well for those with type 2 diabetes.

As for pain relief, Misra said "there is clearly no medication which was found to be highly effective" in the new review, so there is clearly a need for research into better analgesic options for patients.

"We hope our findings are helpful to doctors and people with diabetes who are searching for the most effective way to control pain from neuropathy," researcher Waldfogel added. "Unfortunately, there was not enough evidence available to determine if these treatments had an impact on quality of life. Future studies are needed to assess this."

More information

The American Diabetes Association has more on nerve damage from diabetes.

SOURCES: Caroline Messer, M.D., endocrinologist, Lenox Hill Hospital, New York City; Ajay Misra, M.D., chairman, department of neurosciences, Wintrhop-University Hospital, Mineola, N.Y.; Neurology, news release, March 24, 2017

https://www.doctorslounge.com/index.php/news/hd/70923

Keep Your Medications Safe!

Today's post from pain-topics.org (see link below) looks at a very timely topic in that it talks about keeping your medicines safe during festivities when you may be less aware, more distracted and out of your normal routine. Hopefully everyone has made sure they have enough of all necessary meds at home and will remember to take them at the normal times, despite the chaos over the next few days. Keeping them locked away from children (who may see them as sweets), prying eyes and potential opportunists, is also important, especially if you have medications for more than one illness. It can be a busy time of year but looking after your pills should really be a priority.

Safeguard Your Meds This Holiday Season

Posted bySB. Leavitt, MA, PhD. December 6, 2012

During the busy holiday season, with its frequent social gatherings and celebrations, many people enter our homes — and some may venture into our medicine cabinets as well. Easily accessible medications have the potential to be misused and abused by anyone; often people we least suspect. Now is a good time to think about safeguarding those vital meds and useful advice is readily at hand.

The National Community Pharmacists Association (NCPA) and pharmaceutical manufacturer Purdue Pharma are working together to remind parents, grandparents, and all other family members about simple — yet important — steps that can be taken to protect prescription medications through their educational initiative, SafeguardMyMeds.org.

In a press release, the organization cited research that found every day more than 2,500 teenagers abuse prescription medications for the first time. Most people (70%) aged 12 and older who abused prescription pain relievers said they got them from a friend or relative. Therefore, proper storage of prescription medicines in the home can play a vital role in preventing misuse and abuse.

A national survey in 2010 of more than 1,000 adults conducted by Infogroup/ORC showed that an overwhelming majority of Americans (94%) understand it is extremely or very important to safely store and dispose of prescription medication, but many are not doing enough to protect those drugs. More than two-thirds (68%) indicated they keep prescription meds in an unlocked cabinet, closet, drawer, or other area. Most frequently, survey respondents said they store medications in the bathroom (53%) and kitchen (49%) — easily within reach in two of the most vulnerable, high-traffic areas.

At a minimum, several steps can be taken to protect prescription medications, including:

Use a locked storage container for prescription meds at greater risk of being abused, such as pain relievers, tranquilizers, stimulants, and depressants. These medicines are prime targets for theft by anyone who enters your home, so extra precautions should be taken.

Keep ongoing track of all medications — a Medication Inventory Sheet is available at SafeguardMyMeds [PDF here]

Take a complete inventory of all prescription medications in your household at least twice a year, such as when you change your clocks in the spring and fall.

Additional information is available at Safeguard My Meds on safe medication storage, including downloadable print, video, and online materials. Visitors are also encouraged to take a “Personal Responsibility Pledge” and make a commitment to always safeguard their prescription medications.

COMMENTARY: As readers of these UPDATES know, there are particular concerns regarding the safety of opioid pain relievers when it comes to misuse, abuse, overdose, and death. These strong drugs also are prime targets for thieves who seek them to sell or for personal use to get “high” — so they must be especially safeguarded.

Many of the reported problems with prescription opioids could be avoided if you follow safe practices and know how to handle opioid emergencies if they do occur. Fortunately, there is a resource you can turn to for the information and education you need.

Opioids911.org is a first-of-its-kind resource bringing all the safety essentials together in one convenient place for patients, as well as their caregivers (relatives or friends who help look after them). The Opioids911-Safety website has four sections providing an understanding of the various types of opioid pain relievers and their risks, along with specific safety-action steps for preventing opioid misuse, abuse, addiction, diversion, overmedication, and overdose. Plus, there are life-saving instructions for what to do in an opioid-emergency situation as well as links to other helpful resources.

Lastly, during this holiday period it is important to remember that sharing prescription pain relievers with a others — for example, a visiting relative or friend with an injury, toothache, or other disorder — is very unwise. For one thing, it is against the law to share these medications with someone else (even if they have their own prescription for a similar drug) and, secondly, even a single opioid pill might do them serious harm or even be life threatening.

http://updates.pain-topics.org/2012/12/safeguard-your-meds-this-holiday-season.html

Do You Take Opioid Strength Medications For Your Neuropathy

Today's post from nationalpainreport.com/ (see link below) is another very sensible article looking at the problem of what to do with patients who take their strong medications to control their pain sensibly but are now confronted by pharmacists, insurers, media and politicians who have decided in their wisdom that these people can simply do without! Yes, it's a North American problem at the moment but don't be fooled, it will spread across the world because of the international nature of the health industry.  This article asks the very pertinent question: who's thinking about these patients and what are they going to do about them? Are they going to be left to suffer pain unnecessarily because of an inflated hype? Well worth a read.

Reduce Opioids – Then What?  
Posted on May 24, 2016 in Pain Medication  By Ed Coghlan

When we read that opioid prescriptions are not only being reduced, but also Cigna, a major health plan, was committing to reduce opioid prescriptions by another 25% in the next three years, it again brought up a question that has been asked but seldom answered by government regulators (or insurers like Cigna).

“If opioids are going to be reduced, then why aren’t we talking about the alternatives to them for patients who use them responsibly?”

We turned to Beth Darnall, PhD from Stanford University. Beth is Clinical Associate Professor in the Division of Pain Medicine at Stanford University and author of Less Pain, Fewer Pills. She writes about using less medication—but also talks about alternatives.

She thinks we have to do more than simply reduce opioid prescriptions:

This is a great question. First, we need individualized pain care- one size does not fit all. Broadly speaking we need 3 things:

(1) Alternatives. It’s shortsighted to simply take something away: we have to give alternatives, ideally make them available before medications get started.

(2) Understanding that the patient experience is critical. Simply taking away opioids can engender anxiety, anger, and feelings of injustice—especially in those who believe the medications are working well. In all of the conversation about whether opioids are good or bad, there is not enough focus on how to ease the emotional distress of patients on this issue. We need to acknowledge the emotional distress and deliver treatment approaches to reduce it. Give them access to alternatives. Then, if opioids must be tapered, help patients feel more in control of the process. Tapering works best when anxiety and stress are low. I write a lot on the under appreciated importance of this topic.

(3) Recognize that most patients take opioids responsibly. The issues of whether opioids are good for chronic pain (on average) and addiction have been conflated. In my experience, the vast majority of patients taking opioids take them responsibly and exactly as prescribed. They are doing nothing wrong! Whether or not they work well, improve function, and have low side effects and low risks is a separate issue, and this is where most patients find that opioids are no panacea. The problems they experience have nothing to do with addiction or so-called “aberrant behaviors”. Patients are doing everything right, taking medications as prescribed, and they are having problems caused by the medications. In these cases – and I have seen many—tapering opioids helps reduce problems. They get better. They still have chronic pain, but they had it before on the opioids, too. Granted, when I work with patients I help connect them to those alternatives so that the focus is on managing pain differently with key lifestyle changes and use of skills. They may begin other non-opioid pain medications that may have lower risk profiles.

There’s no perfect solution here because each patient is different. Opioids do work well for some people with chronic pain, and even with the CDC guidelines in place prescribers have discretion to prescribe the medications long term. Ideally, there will be less of a focus on treating pain with opioids ONLY, as has been the case in the past.

The second question that bothered us in the wake of Cigna’s announcement was the fact that many insurers simply don’t cover alternatives.

Now, we have a new problem: insurance companies do not provide good access to the opioid alternatives so desperately needed by patients. How about providing free chronic pain self-management classes to patients? Free or low cost pain psychology classes? We need scalable solutions to meet the treatment needs of millions of Americans. In an ideal world the U.S. would have put these solutions in place before issuing edicts on prescription limits.

Here’s last week’s story on Cigna’s decision to reduce opioid prescriptions.

http://nationalpainreport.com/reduce-opioids-then-what-8830538.html