How Important Is Vitamin B In The Treatment Of Nerve Damage

Today's post  from cidpneuropathysupport.com (see link below) looks at the role of Vitamin B in both the prevention of and treatment of neuropathy. This article looks at it from the inflammatory neuropathy angle but it can be argued that all neuropathy is inflammatory by nature. The nerves become inflamed and/or damaged through inflammation and a vitamin B deficiency is often seen as contributing to that. That said, you need to be tested by your doctor to establish a deficiency before embarking on vast amounts of supplements. For neuropathy patients with a normal Vitamin B level, there'll be enough extra in your daily multivitamin. There are also different forms of vitamin B and excessive amounts can bring about side-effects - best discuss it with your doctor.

CIDP Type Neuropathy and Vitamin B
Author: Shiraz Abbas May 27, 2017

Studies are now suggesting that vitamin B may have an important role in healing or easing the pain of peripheral neuropathy and CIDP type of neuropathy in particular.

Peripheral neuropathy is a disorder of the peripheral nerves. It is often characterized by weakness of limbs, numbness and pain. CIDP type neuropathy is a form of neuropathy in which there is a progressive and gradual destruction of the nerves through inflammation.

The vitamin B family of vitamins (also known as B complex vitamins) are critical for the proper functioning of the human body. They play a role in our immune system, energy, and red blood cell formation. Vitamin B12 is particularly important for neurological health and is a vitamin of choice to help treat neuropathy.

Vitamin B is commonly used to treat neuropathy. According to one study, people given high doses of vitamin B for four weeks had their pain reduced and saw improvement in their vibration perception threshold (VPT), that is, a testing that is used to measure large nerve fiber function in the body. People with lesser doses in a 8 week span saw lesser improvement.

Deficiency in B vitamins may lead to neurological problems. B12 in particular is important for the development of the central and peripheral nervous system. It has a critical role in maintaining the myelin sheath which ensures the transmission of nerve signals in the central and peripheral nervous system.

In neuropathy, especially CIDP type neuropathy, the signals between the spinal cord and other parts of the body are disrupted. With CIDP in particular, the myelin sheath is gradually but progressively damaged through inflammation and hence leading to an impairment of the transmission of nerve signals. This process of demyelination leads to axonal destruction. The disease is thus characterized by the following symptoms: weakness of the limbs, numbness, tingling sensation and pain. Loss of sensation and activity also happens depending on where the damage is occurring.

As B vitamins, particularly vitamin B12 play a role in maintaining a healthy peripheral nervous system, the vitamin may also play a role in the reconstruction of the nerves and more particularly the myelin sheath and hence helping the reduction of pain and improving sensation.

Some people with neuropathy may not be able to absorb vitamin B12 due to the loss of the “intrinsic factor” that is produced in the stomach and hence the loss of ability to absorb B12 through the digestive tract. In these cases like these, B12 may be injected into the body. Please check with your doctor if you have digestion problems with it comes to B12.

For those who can absorb it through the digestive tract, the following foods are high in B12 in addition to B12 supplements:

Beef Liver (71 mcg for a three-ounce serving, provides 2951% of the daily recommended intake).
Mackerel (16 mcg for a three-ounce serving, provides 661% of the daily recommended intake).
Sardines (8 mcg for a three-ounce serving, provides 333% of the daily recommended intake).
Read Meat (5 mcg for a three-ounce serving, provides 208% of the daily recommended intake).
Salmon (4 mcg for a three-ounce serving, provides 167% of the daily recommended intake).


Shiraz Abbas is the founder and manager of the CIDP Neuropathy Support Group. He is also one of the main community educators of IVIG therapy. He resides in Fresno, California. Shiraz can be contacted through our free CIDP advice service at 1-855-782-0574.

http://cidpneuropathysupport.com/cidp-neuropathy-and-vitamin-b/

Topical Creams Any Good For Nerve Pain

Today's post from piedmontpmr.com (see link below) asks the question as to whether topical creams (creams applied to the skin at the area of most pain) are any good for neuropathy. It's an attractive prospect. We're so used to popping pills meant for other diseases and trying to live with the side effects, that the idea of a topical cream is tempting. However, as the article points out, it's often a question of 'suck it and see!' One of the proven analgesic creams for neuropathy is capsaicin (either as a cream or a patch) but you really have to watch out for burning side effects and depending on the strength of the cream, you may need expert help with its application. However, it's not the only one and some people even gain benefit by using sports creams meant for joint or muscle relief. Discuss it with your doctor first and then maybe try some out. You never know, you may find something that's just as effective as the strong pain killers you're normally prescribed.

Are Topical Creams Effective For Neuropathy?
Robert D. Schwartz MD 2016

You feel a tingling or slight burning sensation in your hands or feet and you know it’s a symptom of your neuropathy. These areas, especially your feet, tend to be targeted first because the nerves leading down to those extremities are the longest and the easiest to damage. But at the moment, you know its not a sign for major concern, you just want relief from the discomfort or pain as soon as possible.

Supplements are one way to treat these symptoms, but you don’t really know when they’ll start working and if there will be side effects. By taking any oral medication, you are prone to drowsiness, dizziness or simply lethargy. So what could you do to relieve the pain without all the other baggage? Well, there’s topical creams. They can be applied right onto the pained area usually without fuss and are usually better accepted by patients because they are painless.

It’s easy to be overwhelmed by all the products sitting on drug store counters for pain relief. They all claim to have the same end goal, but you’re not sure which one is right for you. Some are for muscle pain, joint back or back pain, but there are also plenty of non-prescription creams that you could use for neuropathy pain. What you should be looking out for are the two predominant components in topical over-the-counter creams/ointments: capsaicin and herbs. Several creams use a combination of these ingredients amongst others for effective pain relief.

Capsaicin

Capsaicin is a substance found in hot peppers, but interestingly, it also works as pain reliever for those with peripheral neuropathy symptoms. The slight burning sensation that is felt when capsaicin creams is applied counteracts the pain signals within your body, thus ceasing pain altogether temporarily. But capsaicin products aren’t for everyone. Some people can’t handle the initial pain sensation when it if first applied, despite proving to be an effective source for painful neuropathy.

Capsaicin products should not be applied on or near damaged, broken or irritated skin. It also needs to be applied several times a day and might take weeks for it to truly take effect.
Herbs

Another common non-prescription alternative is topical herbal products. Herbal products contain anti-inflammatory and analgesic (pain relief) properties. They essentially trick the brain into thinking your skin has changed temperature with a cooling sensation, relieving inflammation. They also widen blood vessels in the area so that blood flow is increased, allowing nutrients to be delivered more efficiently for quicker healing.

One of the most common herbal ingredients that uses these pain relief tactics is menthol. Menthol comes from peppermint plants — specifically extracted from wild mint or corn mint, and is used in a majority of pain relief ointments.

Herbs with these properties have been in use since ancient times. From North America to South East Asia, those around the world have turned to herbal medicine for effective pain relief. Other herbs that contain such properties include, balm of gilead, Calendula flowers and oil of clove. It’s hard to deny herbal effectiveness when it has stood against the test of time.

So now that you know a few ingredients in over-the-counter topical creams, what are some products that you can look out for?

Biofreeze
Capsin
Double Cap
Icy Hot Arthritis Therapy
Minagin
Rid-a-Pain
Sportsmed
Tiger balm
Trixaicin

You won’t really know which one works best for you until you try it. You can go online and do your research, but everyone’s condition is different, and everyone’s body will react differently to different medication.

If you find that over-the-counter products aren’t quite working for you, then maybe it’s time to turn to a prescription cream or ointment. Most likely, your doctor will prescribe a topical agent with either clonidine or lidocaine. Clonidine is used to treat high blood pressure, but those with nerve pain will also find relief in that department. And lidocaine has mainly been used for mouth numbing in a dentist’s chair, but has shown to be effective against neuropathy pain as well.

So if you’re thinking about getting quick relief from topical creams, then it is definitely recommended. Creams can give your fast temporary relief if your pain is mild to moderate. If you’re dealing with a burden that’s a bit bigger, we advise you to talk to your doctor right away for the best route for relief. You might be given a prescription cream, taken daily for a period of time, or recommended toward other avenues altogether. Whatever your symptoms may be, ensure that your are taking care of your body and your health.

http://piedmontpmr.com/topical-creams-effective-neuropathy/

Quell Neurodevice For Nerve Pain Will It Be Any Good

Today's post from diabetesselfmanagement.com (see link below) anounces another electro-stimulant device designed to reduce neuropathic pain. Not quite on the market (later this year), it reflects the growing interest in electro-neurostimulation but it has to be said that so far, results from these sorts of devices have been patchy to say the least. Maybe this one will provide more people with a positive result. It's lightweight and wearable and can be tracked with a smart phone, so these things at least stand in its favour. Time will tell.

CES Dispatches: Pain-Relieving Device for Diabetic Neuropathy
January 6, 2015 by Diane Fennell


(Quell[TM] Wearable Pain Relief Device [Photo: Business Wire])

Quell, a device that can relieve chronic pain in people with conditions such as diabetes, sciatica, and fibromyalgia, was unveiled this week at the 2015 International Consumer Electronics Show (CES), taking place in Las Vegas from January 6–9.

Roughly 60% to 70% of people with diabetes have some form of the often painful condition neuropathy (nerve damage), according to the National Diabetes Information Clearinghouse, and surveys of people with diabetes reflect rates of chronic pain ranging from 20% to 60%.

Created by NeuroMetrix, Quell is lightweight, wearable device that uses noninvasive neurostimulation technology to reduce chronic pain. The device, which has been approved by the U.S. Food and Drug Administration (FDA) for use without a prescription, can be worn both during the day and at night, and users will have the option of using their smartphone to track and personalize their pain treatment.

“Recent studies have shown that chronic nerve pain dramatically reduces the quality of life in people with diabetes,” notes Shai N. Gozani, MD, PhD, President and Chief Executive Officer of NeuroMetrix. “We believe that Quell may help many of these people reclaim their life from chronic pain.”

Quell is expected to be available for purchase by consumers later this year.

For more information, see the press release from NeuroMetrix.

http://www.diabetesselfmanagement.com/blog/ces-dispatches-pain-relieving-device-diabetic-neuropathy/

Shellfish Toxins For Nerve Pain

Today's interesting post is a press release from labspaces.net (see link below) and talks about something for the future of neuropathy treatment. It describes using liposomes, which are lipid spheres smaller than a red blood cell, to deliver powerful anaesthetics (sourced from shellfish) to the source of neuropathic pain. It still looks to be very much work in progress but is yet another sign that serious efforts are being made to research new nerve damage treatments and that can only be a good thing.

Putting a block on neuropathic pain before it starts

Tuesday, October 9, 2012 Thanks to Boston Children's Hospital for this article.

Using tiny spheres filled with an anesthetic derived from a shellfish toxin, researchers at Boston Children's Hospital and the Massachusetts Institute of Technology have developed a way to delay the rise of neuropathic pain, a chronic form of pain that arises from flawed signals transmitted by damaged nerves.

 The method could potentially allow doctors to stop the cascade of events by which tissue or nerve injuries evolve into neuropathic pain, which affects 3.75 million children and adults in the United States alone.

The researchers, led by Daniel Kohane, MD, PhD, of Boston Children's Department of Anesthesia and Robert Langer, ScD, of MIT, reported the results of animal studies online the week of October 8 in the Proceedings of the National Academy of Sciences.

Neuropathic pain can be long lasting and debilitating. Caused by shingles, nerve trauma, cancer and other conditions, it arises because damaged nerves send unusual signals to the spinal cord and the brain. The constant signaling effectively reprograms the central nervous system to react to any stimulus to the affected area, or even no stimulus at all, by triggering unpleasant sensations ranging from tingling and numbness to shooting, burning pain.

"Currently neuropathic pain is treated with systemic medications, but there has been significant interest in using powerful local anesthetics to block aberrant nerve discharges from the site of injury to prevent the onset of neuropathic pain," said Kohane. "Others have tried with varying degrees of success to do this in animal models using a variety of methods, but if applied clinically, those methods would require surgical intervention or could be toxic to tissues. We want to avoid both of those concerns."

The team's method combines saxitoxin, a powerful local anesthetic, and dexamethasone, which prolongs saxitoxin's effects. The two are packaged in liposomes—lipid spheres about 5.5 micrometers wide, or a bit smaller than a red blood cell—for nontoxic delivery to the site of nerve or tissue damage.

To assess whether the anesthetic-loaded liposomes (called SDLs for saxitoxin dexamethasone liposomes) might work as a potential treatment for neuropathic pain, Kohane and Langer—along with Sahadev Shankarappa, MBBS, MPH, PhD (a fellow in the Kohane lab) and others—attempted to use them to block the development of signs of neuropathy in an animal model of sciatic nerve injury. They found that a single injection of SDLs had a very mild effect, delaying the onset of neuropathic pain by about two days compared to no treatment. Three injections of SDLs at the site of injury over the course of 12 days, however, delayed the onset of pain by about a month.

The signal blockade mounted by the SDLs also appeared to prevent reprogramming of the central nervous system. The team noted that astrocytes in the spine, which help maintain the pain signaling in neuropathic patients, showed no signs of pain-related activation five and 60 days after injury in animals treated with SDLs.

"Ultimately we'd like to develop a way to reversibly block nerve signaling for a month with a single injection without causing additional nerve damage," Kohane explained. "For the moment, we're trying to refine our methods so that we can get individual injections to last longer and figure out how to generalize the method to other models of neuropathic pain.

"We also need to see whether it is safe to block nerve activity in this way for this long," he continued. "We don't want to inadvertently trade one problem for another. But we think that this approach could be fruitful for preventing and treating what is really a horrible condition."

http://www.labspaces.net/124304/_Putting_a_block_on_neuropathic_pain_before_it_starts_

HOMOEOPATHIC REMEDIES FOR NERVE AFFECTIONS

A nerve is an enclosed, cable-like bundle of axons (nerve fibers, the long and slender projections of neurons) in the peripheral nervous system. A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons to peripheral organs.

In the central nervous system, the analogous structures are known as tracts. Neurons are sometimes called nerve cells, though this term is potentially misleading since many neurons do not form nerves, and nerves also include non-neuronal Schwann cells that coat the axons in myelin.

Each nerve is a cordlike structure that contains many axons. Within a nerve, each axon is surrounded by a layer of connective tissue called the endoneurium. The axons are bundled together into groups called fascicles, and each fascicle is wrapped in a layer of connective tissue called the perineurium. Finally, the entire nerve is wrapped in a layer of connective tissue called the epineurium

HOMOEOPATHIC REMEDIES .

ACONITUM NAPELLUS 30- Suuden inflammation of the nerves due to anxiety or fear worse with noise and light

APIS MEL 30- Optic neuritis in the first stage

ARGENTUM NITRICUM 30- Inflammation of the nerves. Loss of control and want of balance anywhere- mental and physical

BELLIS PRENNIS 30- Results of injuries to nerves with intense soreness and intolerance to cold bathing

CARBONEUM SULPH 30- For atrophy of optic nerve and  optic disc

CHENOPODIUM AN. 30- Affections of auditory nerve . Hearing better for high pitched sounds. Comparative deafness to  the sound of voice. Burning in ears. Numbness of the auditory nerve

CIMCIFUGA RACEMOSA 30- Inflammation of nerves due to reflex disorders

CINNABARIS 3X –Pain in the ciliary nerve causing redness of the eyes, canthi and lids. Pain around the eyes to templates and orbit of the eyes

CYPRIPEDIUM 30- Nerves shortened by long illness or excessive tea or coffee drnking

GLONOINUM 30- Inflammation of nerves due to heat of sun. Better by motion and uncovering the head. Pulsations all over the body

HYPERICUM PERF. 3X- Crushing injuries to the nerve sheaths of the spine and other nerves causing tearing , burning and stinging pains. Slight paralysis caused by enlargement of nerves in the sacrum. Numbness of parts affected and constant drowsiness

KALI PHOS 6X – An excellent nerve tonic

LYCOPERSICUM ESCU. 30- Tingling along the right ulnar nerve

MAGNESIUM PHOS 12X- It is a remedy of nerve tension as exhibited in pulse. In severe nerve tension , the wrists also become tense. If it is in both wrists , it shows that the whole nervous system is involved. Three tablets given with hot water 2 hourly will remove the tension. Pain is on the right side, better by heat and pressure

NAPHTHALINUM 30- Paralysis of the optic nerve causing blindness and opacity of the cornea

PHOSPHORUS 200-Atrophy of the optic nerve with cataract and due to paralysis

RHUS TOX 30, HYPERICUM 30, KALMIA LAT. 30- Pain along the ulnar nerve , according to symptoms of the remedy

SAPONARIA OFF. 30- Affections of the 5^th nerve. Pain or loss of sensation in the face, forehead, temple and eyes. Deviation of jaw

Were You Relieved When You Were Diagnosed With Nerve Damage

Today's post from themighty.com (see link below) reflects, by means of a personal story, what millions of neuropathy sufferers across the world feel before they receive their definitive diagnosis. It seems astonishing in this day and age that we have to jump through hoops of disbelief, suspicion, inaccurate evaluations and faulty diagnoses before a medical professional finally comes up with the answer but it still happens continually in 2016. Naturally, the more neuropathy hits the news, the more patients will have light bulb moments and emerge from the darkness but is the medical profession ready for it? Not by a long chalk! Not only are we prescribed the same medications that were issued 30 years ago but the time scale between symptoms and diagnosis is unforgivably long. Add on to that the general lack of expert knowledge among doctors and you have patient frustration on a massive scale. That said, it is changing and the medical profession and pharmaceutical companies are finally waking up to the problem and working on solutions but hey...it's about time! The author of this article's patent relief at being given a diagnosis is therefore perfectly understandable. Do you recognise yourself in her story? I have a feeling you will.
 

Why I'm Happy I Received Diagnoses of Neuropathy and Myopathy  
11/19/16 By Jen Hardy Contributor I write about Hereditary Neuropathies
 
Let me start by saying I do not want to be sick. I am not lazy, or trying to get attention. What I do want is a diagnosis, so medical professionals can treat my symptoms, and if possible, heal me. There are so many people who do not understand people with chronic illness and why we want a diagnosis so badly. I want to share my story so I can help other people understand how difficult it is to live with unidentified health issues.

As a young girl, I spent a lot of time during my non-school hours in bed and on the couch. My parents chalked it up to me being a lazy person, but when I would get bursts of energy, I’d be out doing all I could, and I didn’t feel lazy! In middle school P.E., I would always stop running because of sharp pain and a burning sensation in my chest. Again, I was labeled as lazy and told to work through the pain. (Twenty-five years later, we would discover I had asthma.) My parents had me in soccer and softball for several years, but I would get worn out quickly, begging to be benched after a few quarters or innings. As you see, there was a pattern. High school went on the same way, only with the emergence of back pain on top of everything else.

I started falling down in my early 20s. People just thought that was funny. “Look how clumsy she is,” they said. Everyone thought I was both lazy and clumsy. I had x-rays and all the standard blood tests, but nothing was showing up. After I had a couple of children, my energy plummeted, but after seeing a variety of doctors, and with a chart thicker than a Harry Potter book, I still had no diagnosis. The medical and family consensus was that I was fine, lazy, and maybe a little depressed. I was a little depressed; my body was betraying me and I didn’t know why. Not only that, but no one who was close to me believed what I was saying.

In my 30s, the pain became more intense. It was difficult for me to get around, and I was becoming more unsteady. My pain was mostly in my back, but slowly creeping in a little bit everywhere else too. “Where did it come from? Why was it there?” Those were my questions. What answer did I get? “You must want drugs.”

Through all of this, I would argue with anyone who told me to take so much as an aspirin. I was so anti-any-medicine that wasn’t absolutely life-saving that taking strong pain killers was out of the question. I wanted a permanent solution, not a temporary fix. Again and again and again I was asked, “Why do you want something to be wrong? Why do you keep looking for something to be wrong with you? Why can’t you just do what you’re supposed to do like everyone else?”

I was told by those close to me, “Obviously if the doctor says nothing is wrong, then nothing is wrong.” And, “I’m certainly not going to help you get things done when you are perfectly capable of doing them yourself. Stop being lazy and snap out of it!” But more symptoms kept emerging, and I just kept asking questions, and going to doctors, and not giving up. It’s not easy to keep that up when you feel miserable.

A good personal support system helps not only physically, but emotionally as well. When I was 40, I married a soldier. He not only fought for our country, but he fought for me. He went to doctors with me and explained things when I couldn’t, he helped me to remember to take my medicine when I was too tired to remember by myself, and he always had faith that we would find help and I would get better. With his help, I found a pulmonologist who discovered that I have asthma and sleep apnea. Treating those helped some of my symptoms, but there were still several things going on with my body that no one could figure out.

In my early 40s, my husband got sick with what we thought was a cancerous kidney tumor. I didn’t want to tell him that I’d fallen down the stairs twice in one week, but my sister-in-law did. He immediately sent me to the doctor, where I got an MRI of my back, and they finally found something. Ironically, they didn’t actually find it, they said it was still there! A diffuse atrophy that was found in my back seven years earlier that no one ever mentioned to me. The muscles outside of my lower spine had completely atrophied and been replaced by fat. How could this have happened? Why? We didn’t know, but it explained the pain, weakness, and falling I’d been experiencing for years.

I saw several neurologists. My second one actually told me I had too many symptoms and had to pare down my symptom list for him to be able to help me. “Which symptoms are the right ones?” I cried, but he didn’t know, so it was time to find another neurologist. It is so important for patients to keep searching until they find a doctor who listens to them. If I had listened to the first doctors, I might not be here today. I was misdiagnosed and put through risky treatments that didn’t help, and even a major surgery I didn’t need.

I finally went to a new doctor, my eighth neurologist, who sent me to another neurologist 300 miles away at a medical center that specializes in rare neuromuscular diseases. Finally, the wrong diagnosis was officially ruled out. We also found out answers to the health questions I’d had for years. I don’t have one neuromuscular disease, I have two: neuropathy and myopathy. That’s why I had too many symptoms. That’s why none of it made sense. That’s why no one believed that I was telling the truth. It seemed like too much. Like I was making it up.

We now have names for four out of five of my main diseases: asthma, arthritis, sensory neuropathy, and sleep apnea. The fifth is idiopathic myopathy for now. That means I have a muscle wasting disease and no one knows the cause. I’ve had medical testing, the likes of which I wouldn’t wish on my worst enemy, to get to the root of it, but we’re still waiting for the final results. If they’re negative, it means my disease is so rare, it hasn’t even been discovered yet. But my ninth neurologist has done the testing necessary to know I have a serious disease. My body is like a snowman in February; the thaw is coming, we don’t know when, and little bits of me melt away as we wait.

I don’t want to be sick. I don’t want to have an illness. But I do. And because I have fought to find someone to believe in and help me, I have found answers and now I have help managing my pain and fatigue. I still don’t know what’s causing my muscles to atrophy, but in July 2016 I found out that I have neuropathy and myopathy. That’s where most of my system-wide pain is coming from, that’s why I fall, and the muscles that are left work so hard I get fatigued doing the most mundane things.

I’m very happy to finally have a name for what’s been happening to my body for years. I’m not happy because I’m chronically ill. No one wants to be chronically ill, but we do want to be helped. And that’s what a diagnosis does. It helps us get the treatment we need, and live happier, more productive lives.

https://themighty.com/2016/11/ive-been-diagnosed-with-neuropathy-and-myopathy-so-why-am-i-so-happy/

Puffer Fish Poison For Nerve Pain

Today's post from smithsonianmag.com (see link below) talks about yet another poison (tetrodotoxin) from the animal world which may turn out to be useful in the struggle to control nerve pain. This time it's the Simpson's favourite - the Puffer fish, which kills a handful of trainee chefs every year. It's not such a stretch as you might think. Most animal poisons work by attacking the nervous system of their victims, so it's logical to assume that with modification, these poisons can be used to develop drugs which will act positively on the nervous system itself. Along with spiders, snakes, scorpions and others, this is the latest toxin which may be the answer to relentless nerve pain and that of course, affects all people living with neuropathy. Watch this space.

Pufferfish’s Deadly Toxin Could Help Chemo Patients
By Mary Beth Griggs smithsonian.com June 27, 2013

Researchers in New Jersey are working on an experimental drug that they hope will provide pain relief to cancer patients going through chemotherapy. The drug uses tetrodotoxin, the neurotoxin found in pufferfish.

Cancer is awful. And treatments for cancer, including chemotherapy, can be incredibly painful. Even the treatments for the pain, usually opioids like morphine, can be debilitating, with side effects like dizziness, vomiting, constipation and addiction.

Because of this, medical researchers are very interested in developing alternatives to opioid medications. Researchers at the John Theurer Cancer Center at Hackensack University Medical Center, in New Jersey, are working on an experimental drug that they hope will provide pain relief to cancer patients going through chemotherapy. The drug uses tetrodotoxin, the neurotoxin found in pufferfish.

In a statement, lead investigator Dr. Samuel Goldlust said, “Tetrodotoxin has been found to be 3,000 times more potent than morphine without the negative side effects of opioids.”

Tetrodotoxin is better known for providing a dangerous allure to foodies who enjoy living on the edge. Even though pufferfish contain enough of the toxin to kill 30 people, they are considered a delicacy—delicious if prepared correctly, deadly if not.

From io9:

chefs have to be trained for two years, during which they will eat many of the fish that they themselves prepare. And make no mistake, people do die from fugu poisoning. About five people a year make puffer fish their last meal, and many more get violently sick from it. It’s not a pleasant way to go.

The poison, tetrodotoxin, is actually produced by the bacteria that the fish allows to colonize its various parts. Tetrodotoxin is a neurotoxin, meaning it takes out the nervous system as it moves through the body. This may sound like a relatively painless death, with the brain going offline quickly. That’s not the case. The toxin starts with the extremities. The first place people notice it is in the lips. Then the fingers. There’s a tingling numbness, and a loss of control. This is a sign that it’s time to get to the hospital. The toxin moves inwards from there, taking out the muscles, often causing weakness, while paradoxically bringing on vomiting and diarrhea. Then tetrodotoxin hits the diaphragm. This is the large, muscular membrane in the chest that lets the lungs breathe in and out. The respiratory system is paralyzed while the person is still fully conscious. Eventually the toxin does get to the brain, but only after the person involved has felt their body being paralyzed completely, entombing them inside. Even then, some people aren’t lucky enough to completely lose consciousness. There are people who report being conscious, either occasionally or continually, throughout their coma.

The same qualities that make tetrodotoxin so deadly—taking out parts of the nervous system—are being harnessed by these researchers to block pain signals from parts of the damaged nervous system from getting to the brain. Forty percent of patients undergoing chemotherapy report having this kind of pain, and it is one of the more common reasons that patients will cite as a reason they choose to stop chemotherapy.

Dining on pufferfish, though, isn’t even remotely a good idea for chemo patients: The treatment developed by Goldlust and WEX Pharmaceuticals uses 300 times less toxin than is found in a single puffer fish and has a very long way to go before it is available to patients. It’s currently in a phase II trial (one of about 100-300 people, according to the FDA, which looks at how effective—and, extra key in this case, how safe—the drug is) and is being tested specifically on its ability to treat patients with “chemotherapy-induced neuropathic pain”—pain caused when chemotherapy treatment damages parts of the nervous system.

There’s two more phases after this, one before and one after the drug goes to market. Only about a third of experimental drugs make it through phases I and II of testing, and phase III is the most expensive and lengthiest part of the FDA approval process. But when dealing with painkillers, particularly painkillers that are based on deadly neurotoxins, it certainly makes sense to take the time to make sure the treatment is safe.

 http://www.smithsonianmag.com/smart-news/pufferfishs-deadly-toxin-could-help-chemo-patients-3446252/#hvJxYvYMcFAsV2B2.99

Occupational Therapists Tips For Reducing Nerve Pain

Today's post from diabetesselfmanagement.com (see link below) looks at non-chemical means of controlling neuropathic pain and comes up with some valuable suggestions. It is written by an occupational therapist who clearly has experience of advising people in this area. However, nobody should expect these to be wonder cures. If some or all manage to reduce your discomfort just a little bit, they've worked and maybe saved you using too many pain drugs in the meantime but they will not be effective for everybody and you do need to try these over a period of time to see any effect. As the author says, 'none of these techniques will make your pain any worse – at least not in a lasting way – so what do you have to lose?'
 

Controlling Neuropathic Pain
Published October 18, 2011 by Erica K. Jacques Updated April 15, 2014

Tips From an Occupational Therapist

I am an occupational therapist. In my line of work, I see many clients with neuropathic pain stemming from diabetes. I have never experienced neuropathy myself, but I know from working with my clients that it is often an unrelenting, terrible kind of pain. The burning, the pins and needles, the stabbing sensations, the numbness – peripheral neuropathy is hard to live with and can also be hard to treat.

The causes of peripheral neuropathy (neuropathy affecting the legs, feet, arms, or hands) are not well understood, although it is clear that the condition can have a number of triggers, including physical trauma, infections, and toxins. In people with diabetes, neuropathy is usually the result of elevated blood glucose levels, which in many cases leads to permanent nerve damage. However, many people with diabetes find that improving their blood glucose control – especially if their blood glucose far exceeds recommended levels – can lead to a reduction or even elimination of neuropathy symptoms.

In part because of the unknowns surrounding the physical mechanisms of neuropathy pain, conventional drug treatments can be hit or miss when it comes to getting relief. You may have to be zonked out on pain medicine to get any substantial effect, and even then you may still feel pain. It can be hard to find the balance between pain relief and quality of life. However, we therapists have a few techniques up our sleeves for “tricking” the nervous system into perceiving less pain.

As a disclaimer, everyone responds differently to each of these techniques. You may have to try several approaches before you find one that works for you. The word “works” also carries some ambiguity, since none of these approaches is a cure-all for neuropathic pain. However, one or more of them may help you get your pain to a more manageable level, so you can go about your daily routine and spend more time living again.

The good news: None of these techniques will make your pain any worse – at least not in a lasting way – so what do you have to lose?

Heat

Most people find warmth soothing. When is the last time you didn’t feel relaxed in a warm bath or while lying in the sun? Warmth provides the body with a pleasant, comfortable sensation that might just be enough to provide some relief from neuropathic pain. The body only has so many sensory nerve receptors, so why not give some of them something nice to do for a change?

Heat can be applied in a number of ways. You can purchase a plug-in heating pad in almost any pharmacy; many pads have temperature controls to make them adjustable to your needs. Place the heating pad on the body part that needs soothing, taking care to place a layer or two of fabric (such as folded dish towel) between yourself and the heat source. Leave the heat on the affected area for a maximum of 10 minutes; remove it earlier if it becomes uncomfortable. (For more on applying treatments safely, see “Tips for Using Heat and Ice.”)

If you want to experience a spa-like treatment at home, you can purchase a paraffin wax warmer, which is also available at many pharmacies. This device is slightly messier and hotter than a heating pad, but using it can feel nice for your hands. If you use one, be sure to follow the package instructions and to check the temperature of the wax before putting your hand in it. Use a candy thermometer to ensure the wax temperature is no higher than 100°F, and continue to monitor it as you use the bath. Temperatures over 120°F can cause serious burns.

Another option – and the least expensive – is simply to use warm water. Again, make sure the temperature of the water is no higher than 100°F. Run your hands under the faucet, submerge your hands or feet in a basin of warm water for several minutes, or soak towels in warm water and wrap them around the affected area. Add some scented oil or shower gel to the water for an even more pleasant sensory experience.

Ice

In general, ice is not as soothing as heat. However, it does have the advantage of being an analgesic: It can provide a mild numbing effect, which can relieve pain. Ice is also anti-inflammatory, meaning it helps reduce swelling. This can be useful if your hands or feet are prone to edema (fluid buildup), which can increase sensations of pain. Ice may also be the key for someone whose pain does not respond to heat.

Using ice is as simple as going to your freezer: Fill a large freezer bag about halfway with ice cubes and seal it. Place a doubled-up towel over the area you are treating, then mold the bag of ice to the area and keep it in place for no more than 10 minutes. Some people prefer using bags of frozen vegetables such as peas, which are easy to shape to various body parts and can simply be thrown back into the freezer when done to reuse later. Just be sure to label your “cold pack” so that no one cooks it for dinner. You can also buy different sizes of reusable cold packs – filled with gel or pellets – at a drugstore and keep them in your freezer; having options can be helpful if you use ice frequently or for more than one area of your body.

Contrast baths

Contrast baths are a little messy, but they may offer some relief from both pain and swelling in the hands or feet. Start with two basins: one filled with ice water, the other with warm water. Starting with the ice water, submerge your hand or foot for 30 seconds – if you can tolerate it – and then immediately switch to the warm water for 2 minutes. Repeat the process about five times. If you can’t tolerate the entire 30 seconds of cold, you can cut the time for each bath in half.

Contrast baths are nice for people who get good results from ice but cannot tolerate using it for long periods of time. Like ice, contrast baths can keep edema under control. If you decide to try this method, be sure to keep several towels handy – no matter how careful you are, water tends to get everywhere.
 
Distraction

Have you ever had a headache or some other kind of pain, then forgotten about it? Later you might realize the headache or pain has gone away or is less bothersome somehow. Sometimes you only notice the pain again when you remember that you felt it before. Did your pain actually go away and then come back? Probably not; more likely, you were just distracted.

Distraction works under the principle that pain is all in your head. It’s not that you are imagining your pain; it’s that your brain – where feelings of pain are processed – only has so much attention to give. The more it focuses on pain, the less likely it is to notice much else. The flipside, however, is that if you can direct some of that attention elsewhere, your brain will have to turn down the “noise” caused by the pain.

Anything can be grounds for distraction: music, a good book, television, calling up a friend to chat. Whatever you enjoy and can focus on, do it. Distraction can be especially helpful when your pain is holding you back from a task that needs to be done. This applies most often to physical tasks such as exercise or mundane housework – although if a mental task does not demand all of your focus, it may benefit from distraction, too.
 
Minimizing effort

Sometimes the pain caused by peripheral neuropathy gets worse with overuse of the affected area. Just as your body would ache after a heavy workout, your hands may ache when you demand too much of them. But how to avoid this? Can you name a household activity that doesn’t use your hands? Most likely, you have a daily routine that includes holding, lifting, and carrying objects. If you can find a way to make those tasks easier, it might lessen the burden on your hands and spare you some pain. There are two ways to approach reducing the physical burden of tasks: joint protection and work simplification.

Joint protection means performing daily tasks in ways that lessen the load on your joints, particularly those in your hands and wrists. Joint protection is all about physics: using larger-handled objects, for example, or replacing knobs with levers, which require less force to operate. There are joint-protecting tools for just about any task or hobby, from eating to gardening. (See “Sources of Aids for Daily Living.”)

Work simplification also involves making tasks easier. Rather than focus on reducing the stress on joints, however, work simplification aims to eliminate some of the steps or effort required in routine tasks. Some examples of this strategy include switching to wrinkle-free clothing, using automatic cleaning devices (such as those for showers and toilet bowls, or a robotic vacuum cleaner), and choosing pre-chopped vegetables for cooking.

Both of these strategies may require some monetary investment – after all, new gardening equipment and a new wardrobe generally don’t come cheap. But if a purchase helps you get back to a hobby that you love, or even if it makes your daily routine a bit less strenuous, it’s probably worth it.
 
Journaling

Pain has a tendency to make people feel grumpy and edgy – meaning that the frustration caused by neuropathic pain can be about far more than the pain itself. Holding this frustration inside is almost always a bad idea, and it can be enormously therapeutic just to vent. One excellent way to do this – even though it may sound a bit hokey – is to write about your feelings.

A major advantage of using a journal over, say, a good friend to vent is that the journal never gets tired of listening to you gripe. It never judges you. You can use the strongest language you want, and no one ever has to hear it. A journal is a safe place to write anything you need to get out of your system – just be sure to keep your journal locked or hidden away if you want to keep your thoughts private. After you have vented in your writing, you can then call a friend and talk about something more pleasant.

Another advantage of journaling is that you can track your pain. By noting what you are doing when your pain gets worse (or better), including what time of day it is and details such as what you’ve been eating, you may discover patterns that you might not otherwise notice.
 
Relaxation

Relaxation is a powerful pain-fighting tool. Think about it: When you’re in pain, do you feel relaxed or tense? Are your muscles at rest, or clamped up? Is your nervous system calm, or do you feel anxious and edgy? By consciously working to control these reactions to pain, you can sometimes reduce your perception of the pain itself. To use an analogy, the fire alarm may be disturbing you as much as the fire – and you’ll feel better if you manage to turn it off.

Naturally, different people find different activities relaxing. If you have a tried-and-true method of relaxation, that activity may be a good remedy when your pain starts to act up. If you don’t have an activity in mind, though, here are a few ideas.

Go to a gentle yoga class. Yes, you will be moving, and moving hurts. But in yoga, you focus on the breath (distraction!) and slowly relax the muscles and the mind. You finish by lying down and simply breathing. Be sure to choose a class for beginners (avoid any class with the word “power” in the title) and to inform the teacher of your condition beforehand. He may help you modify a few poses to increase your comfort.

Don’t have time for a whole yoga class? Turn on some peaceful music. Use headphones if you can, to help block out the rest of the world. You can also look for a CD or a free podcast that provides guided imagery, in which you slowly let go of all of your tension while imagining you are somewhere peaceful and safe. Using guided imagery – or any other form of guided relaxation – at home may be an attractive alternative to a public class.
 
Exercise

You may be skeptical of exercise as a remedy for neuropathic pain – and such skepticism would be justified, since some exercise can make pain worse. But exercise can also help; you just have to do it the right way. This means, above all, exercising gently – no grunting, heavy lifting, or sweating bullets.

People with peripheral neuropathy may experience more than just nerve pain; they can also have motor nerve damage, which affects how the muscles function. Exercise won’t repair damaged motor nerves, but it can help your muscles compensate for any damage. Specialized strengthening exercises can help you reclaim muscle function and thereby lessen the burden of day-to-day tasks.

If you are new to exercise or if you haven’t exercised in a while, it is a good idea to consult an experienced occupational or physical therapist before embarking on any program. Unlike a personal trainer, therapists have specialized education in treating a wide range of health conditions. A therapist knows how muscles and nerves function, and what can interfere with their performance. By seeing a therapist, you can get an exercise program that is tailored to your particular needs. 

Getting help

Neuropathic pain can range from annoying to practically debilitating, and sometimes the available remedies may seem troublesome or inadequate. But many people find at least partial relief from one or more of the treatments and strategies described in this article. If one attempt to soothe your pain doesn’t work, it is important to keep trying. Whether through heat or cold therapy, relaxation, exercise, or adaptations to your daily routine, you may find a reduction in pain – and greater peace of mind – somewhere you didn’t expect to find it.

http://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/controlling-neuropathic-pain/

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Oxytocin Not Oxycontin! Vital For Control Of Nerve Pain

Today's fascinating post from sciencedaily.com (see link below) talks about another element of our nervous system essential for reducing pain responses naturally and that is Oxytocin. Oxytocin is a peptide that is synthesised in the hypothalamus (The hypothalamus is in the brain and is responsible for certain metabolic processes and other activities of the autonomic nervous system.) What it does when it's released into the blood and spinal cord, is reduce the severity of pain signals to a bearable degree, otherwise they would be too extreme and traumatic and possibly cause a shut-down of all systems (during childbirth for instance). Oxytocin release is controlled by 30 neurons that are situated in the hypothalamus and are essential messengers in the neurological system. Having discovered this nerve control centre (so to speak) scientists will be able to target it to release more oxytocin and diminish the negative effects of certain treatments. It is true, the more this sort of information is released, the more confused we could become (through sheer information overload) but on the other hand, you get the feeling that we are only at the beginning of astounding new discoveries as to how our nervous system works and as long as we can get the gist of what's being discovered as we go along, we can trust the scientists to take their discoveries to logical and beneficial conclusions and eventually relieve nerve pain much easier. Oxytocin is also known as the 'love hormone' but you'll need to Google why!

30 small neurons join forces against pain 
Date: March 3, 2016 Source: CNRS

Oxytocin plays a crucial role in modulating the response to pain, but until now the process leading to its release was unknown. An international team[1], coordinated by Alexandre Charlet, at the CNRS Institut des Neurosciences Cellulaires et Intégratives in Strasbourg (France) and Valery Grinevich from the DKFZ[2] in Germany, has just identified a new pain control center situated in the hypothalamus. It comprises some thirty neurons that are wholly responsible for coordinating the release of oxytocin into the blood and spinal cord, thus reducing painful sensations. These findings, which open new perspectives in the treatment of pathological pain, are detailed in an article published on 3 March 2016 in Neuron.

That hammer blow on the fingers of the weekend DIY enthusiast must have hurt. But it would have been worse if oxytocin, a peptide synthesized by a region in the brain called the hypothalamus, had not intervened very rapidly in the cerebral processes modulating the pain response. From contractions of the uterus during delivery to the release of breast milk after birth, and not forgetting its involvement in regulating social interactions, anxiety or pain, oxytocin is an essential, but currently somewhat mysterious, messenger. Indeed, the mechanisms which lead to its dissemination had never previously been deciphered.

An international team of scientists coordinated by Alexandre Charlet at the CNRS Institut des Neurosciences Cellulaires et Intégratives (France) and Valery Grinevich at DKFZ (Germany) focused on the process underlying oxytocin release when pain is perceived. It discovered that the control center in the brain that coordinates the release of oxytocin only comprises some thirty neurons in the hypothalamus.

During acute pain or inflammatory sensitization (burns, pinching, cuts, etc.), information is transmitted via the peripheral nerves[3] to neurons in the spinal cord. These interpret the intensity of the message and encode it accordingly. The information is then sent to other neurons, which include the small population of 30 small cells in the hypothalamic paraventricular nucleus that has been identified by Alexandre Charlet's team. These in return activate a family of large, magnocellular neurons in another region of the hypothalamus, which release oxytocin into the bloodstream. The target is the peripheral neurons that continue to send the message responsible for pain to the brain. Oxytocin has "anesthetized" them and thus reduced the pain.

However, the thirty controlling neurons do not stop there. In parallel, projections from these cells, or axons, which are up to a meter long in humans, reach the deepest of the ten layers of the spinal cord (where the intensity of the sensory message is encoded) and release oxytocin. Thus via two simultaneous pathways, they diminish retransmission of the pain signal to the brain.

Work by the team has thus explained how different populations of oxytocin neurons are coordinated in order to control interpretation of the "pain" message by the nervous system. Discovery of this analgesic control center is promising in the context of treating pathological pain. Targeting this handful of neurons could indeed diminish the adverse effects of potential therapies. At present, the team is continuing to study them, this time in order to discover their involvement in oxytocin release that enables lactation and certain sexual behaviors.

[1] The team included scientists from the CNRS, Inserm, Université de Strasbourg, DKFZ and other institutions in Germany, Switzerland, China, Italy and the US.

[2] Deutsches Krebsforschungszentrum (German Cancer Research Center).

[3] The peripheral nerves link different organs to the central nervous system, made up of the brain and spinal cord.

Story Source:

The above post is reprinted from materials provided by CNRS. Note: Materials may be edited for content and length.

Journal Reference:
Marina Eliava, Meggane Melchior, H. Sophie Knobloch-Bollmann, Jérôme Wahis, Miriam da Silva Gouveia, Yan Tang, Alexandru Cristian Ciobanu, Rodrigo Triana del Rio, Lena C. Roth, Ferdinand Althammer, Virginie Chavant, Yannick Goumon, Tim Gruber, Nathalie Petit-Demoulière, Marta Busnelli, Bice Chini, Linette L. Tan, Mariela Mitre, Robert C. Froemke, Moses V. Chao, Günter Giese, Rolf Sprengel, Rohini Kuner, Pierrick Poisbeau, Peter H. Seeburg, Ron Stoop, Alexandre Charlet, Valery Grinevich. A New Population of Parvocellular Oxytocin Neurons Controlling Magnocellular Neuron Activity and Inflammatory Pain Processing. Neuron, 2016; DOI: 10.1016/j.neuron.2016.01.041

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CNRS. "30 small neurons join forces against pain." ScienceDaily. ScienceDaily, 3 March 2016. .

https://www.sciencedaily.com/releases/2016/03/160303133628.htm

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Cannabis CBD Patch For Nerve Pain Relief Something For You

 Today's post from ireadculture.com (see link below) offers an alternative to smoked, or inhaled cannabis for nerve pain relief. A new product in transdermal patch form has arrived, which distributes CBD extract through the body and avoids many of the things that put people off using cannabis as a pain killer (you don't get high with CBD folks). This could be a major breakthrough for neuropathy patients. You may already have seen CBD oil products on your health shop shelves, or advertised on internet (depending on where you live in the world and what the attitude there is) but if you want to take the step towards trying cannabis to control your symptoms, what better way is there than a patch on the skin! Definitely worth a read.

New CBD Patches Combat Nerve Pain and Fibromyalgia
by Jacob Cannon | November 4, 2016

Although cannabis is still considered to have no medical use by the Drug Enforcement Administration, pharmaceutical companies continue to create medications that prove its efficacy against countless ailments. Cannabis Science, Inc. has developed two new pain relief patches that are specifically for patients with Diabetic Neuropathy nerve pain and Fibromyalgia.

Fibromyalgia is a medical condition in which the individual experiences chronic widespread pain and a higher, more painful response to pressure. Neuropathy damages or spreads disease to nerves and can have various painful effects depending on which nerves are affected. Now patients facing either of these ailments might find relief with the transdermal CBD patches created by Cannabis Science.

The transdermal pads are made with high potency cannabinoid (CBD) extract. The extract is released in a controlled fashion, which enters into the bloodstream through a medicated adhesive patch that is put on the skin. The CBD extract enters through the skin and into the central nervous system, which is how patients receive pain relief.

The Cannabis Science CEO, Raymond C. Dabney, confirmed that these developments are just the beginning for his company, according to www.biospace.com. “The development of these two new pharmaceutical medicinal applications are just the tip of the iceberg for what we see as the future of Cannabis Science,” Dabney said. “While we strive to increase our land capacity for growth and facilities to produce our own product to supply our scientists with proprietary materials to make these formulations, we are so busy researching more potential needs for cannabis-related medical applications and developing the methods for delivery of these medications.”

CBD is notorious for being one of the active ingredients in cannabis that leads to various healing properties from helping to reduce seizures to acting as an anti-inflammatory and pain reliever. One of its most attractive properties to many is that it does not have any psychoactive properties. As more states vote soon on allowing medical cannabis programs in their state, Cannabis Science only sees greater opportunity to help more patients.

“As more states nationwide legislate for the legalization of cannabis and cannabis derived medications, we here at Cannabis Science are focused on developing pharmaceutical formulations and applications to supply the huge growing demand expected over the coming few years,” Dabney said.

http://ireadculture.com/new-cbd-patches-combat-nerve-pain-fibromyalgia/

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Stop Searching For A Nerve Pain Cure And Begin Learning To Live With It

Today's interesting post from healthskills.wordpress.com (see link below) is an impassioned and intelligently written plea for doctors to start aiming their treatment (at least partially) at learning to live with pain instead of constantly trying to 'cure' it with chemicals. Now nobody knows better than the average neuropathy patient, that chemical treatments almost never take neurological pain away completely. We're well aware that the pills we take are doing nothing to improve our nerve damage and at best provide a sort of security blanket that masks the pain. That security blanket then becomes something we rely on to get us through the day but its side effects can severely affect our well-being and sense of self. Pain is an experience not a disease. Pain is just pain and doesn't mean that the problem is getting worse, so why can't we learn better to accept it for what it is and manage it in such a way that it becomes part of our daily lives. Stop trawling through drug lists in the search for pain reduction and begin learning to manage it. That begins by accepting that the pain is there; every day and maybe for the rest of our lives. It's not a threat; it's just an experience and by using the proper management techniques we can probably put up with more pain than we think we can - now that would be an achievement in itself! Try not to dismiss the idea because pain is so entrenched in your life and try to be open to change. All that said, I too live with daily pain and I too take the drugs to dampen it but I wish I didn't, so if there are effective methods to learn to live with it and reduce its importance, bring them on! For that, we need doctors who are willing to say:' less pills, better management and here's how.'
 

Deciding when to say when: pain cure? or pain managed?
Bronwyn Thompson, PhD, MSc (Psych) 1st Class Hons, DipOT, Registered Occupational Therapist 

I think the subject of this post is the singularly most important yet neglected topic in chronic pain research today. When is it time to say “All this looking at pain cure, or reducing your pain isn’t working, it’s time to accept that pain is going to part of your life.” It’s difficult for so many reasons whether you’re the person experiencing the pain, or the clinician trying to help. It’s also incredibly important for everyone including our community.

Cures for pain that persists are not easily found. One possibility is that the underlying disease or dysfunction has not yet been treated – pain in this case is the experience we have when there’s an unresolved threat to body tissues. Find the source of the problem, treat it, and voila! No pain.

Another possibility is that a new or groovy treatment has been developed – something extraordinary, or something that’s being applied to a different problem or something that’s emerging from the experimental phase to clinical practice. This means clinicians need to have heard about it, maybe will have had to think hard about their clinical reasoning, have developed skills to apply it, and be ready to talk about it with the person they’re treating.

In the case of much chronic pain, pharmacological approaches simply do not work. Machado and colleagues (2009), in a large meta-analysis of placebo-controlled randomised trials, found 76 eligible trials reporting on 34 treatments. Fifty percent of the treatments had statistically significant effects, but for most the effects were small or moderate … the analgesic effects of many treatments for non-specific low back pain are small”, while Machado, Maher and colleagues found that paracetamol was “ineffective” for reducing pain intensity or improving quality of life for people with low back pain, and although there was a statistically significant result for paracetamol on osteoarthritis pain (hip or knee), this was not clinically important (Machado, Maher, Ferreira, Pinheiro, Lin, et al_2015). Clifford Woolf said “most existing analgesics for persistent pain are relatively ineffective… the number of patients who are needed to be treated to achieve 50% reduction in neuropathic pain in one patient is more than four – a high cost for the three unsuccessfully treated patients and their physicians” (Woolf, 2010).

Woolf’s sentence ends with an important statement: A high cost for the three unsuccessfully treated patients and their physicians. I have emphasised the final three words, because this might be the most difficult to process. It’s hard for clinicians to say “I can’t reduce your pain”, and “there isn’t a cure”. It’s incredibly hard. And it’s perhaps because it’s so hard that I’ve found very little published research looking at the way clinicians go about telling people their pain is likely to be ongoing. It’s like a taboo – let’s not talk about it, let’s pretend it doesn’t happen, after all it doesn’t happen often. Really?

Amongst allied health (I can’t bear to use the word “non-medical”), and in particular, physiotherapists, there continues to be a push to address pain intensity and (ultimately) to cure pain. Innovative treatments such as mirror therapy, graded motor imagery, therapeutic pain neuroscience (we used to call it psycho-education in the 1980’s when I first started working in this area), reducing the threat value of the experience have all come into their own over the past 15 years or so. Even long-standing pain problems apparently respond to these approaches – people cured! Who wouldn’t be keen to try them?

Most of these latter treatments are based on the idea that our neurology is plastic; that is, it can change as we change input and thoughts/beliefs about what’s going on. Unfortunately, the systematic reviews of trials, and at least one “real world” trial of graded motor imagery haven’t shown effects as great as promised from the early research (eg Johnson, Hall, Barnett, Draper, Derbyshire et al, 2012). There are sure to be people who can point to amazing outcomes in the people they treat. I’m certain that it’s not just the “treatment” but an awful lot to do with the person delivering the treatment – and the treatment context – that might make a difference to outcomes.

But where this all leads me to is who makes the decision to stop chasing pain reduction and pain cure? When does it happen? What’s the process? And what if we treatment providers are actually prolonging disability out of the goodness of our hearts to find a cure?

Let me unpack this a little.

In my research, several important factors led to people deciding to begin flexibly persisting (and getting on with life as it is, not as it was, or might be).
The first was knowing the diagnosis and that it would not be completely cured but could be managed.
The second, that hurting didn’t mean harm (pain is just pain, not a sign of ongoing damage).
The third, that there was something important the person wanted or needed to do to be themselves.

There were other things as well, like having a clinician who would stand by the person even if the person didn’t “do as the Doctor ordered”, and developing their own personalised model or explanation for their pain as it fluctuated from day-to-day. BUT the single most important factor was knowing that the problem needed to be managed because there was no cure. Knowing this meant that energy used chasing a cure was redirected towards learning to live well and be the person they were, rather than a patient or being dominated by pain.

Unfortunately, I think that many clinicians confuse the idea of managing pain with that of resignation to a lesser life. Even the wonderful Lorimer Moseley and crew wrote recently that “CBT literature seemed to focus on this idea of ‘pain is now unavoidable so it is now time to learn how to cope with it.’ He goes on to argue that because a CBT approach focuses on thoughts and beliefs (much like Explain Pain does), it’s not incompatible with the idea that the plastic brain can learn to reduce the threat value even further to ultimately “helping them live well with less pain, or perhaps without any pain at all.”

Here’s my concern: Right now there are many people living with chronic pain who have lost their sense of hope. They’ve pursued pain cure after pain cure, and in doing so, they’ve lost normal routines and habits, lost their usual occupations (activities), stopped being around people, stopped working, and have suffered in the true sense of the word – they’ve lost their sense of self. While I applaud the efforts of researchers like Moseley and colleagues, and I think we must continue to seek treatments to reverse the neurobiological underpinnings of pain, at the same time I think we need to look at the psychological and social aspects of our attitudes and expectations towards experiencing pain. And we must think of the negative effects of our emotional response to seeing another person who is experiencing pain.

Is it so terrible to experience pain every day? Speaking as one who does – despite my knowledge of neuroplasticity – my pain doesn’t represent a threat. It’s just an experience. It’s there. I notice it, I can feel it. And the participants in my research similarly acknowledged pain as present – but it didn’t have the emotional primacy that pain can represent before it is explained. In fact, some of the participants said they’d learned important things because they’d had pain. A lot like having a mood disorder (that must be managed), or diabetes (that must be managed), or heart disease (that must be managed), or respiratory disease (that must be managed), perhaps it’s OK to have pain – that must be managed. Because until our research has advanced a LOT further than it has, there are an awful lot of people living with chronic pain, and who will continue to live with chronic pain. And even more sadly, there are an awful lot of people who don’t even get the opportunity to know that it’s possible to live well despite experiencing chronic pain because we (as part of society) still don’t accept that pain can be present without it being a threat.

Sometimes I wonder at our (clinicians and researchers) blind spot. We just don’t seem to be ready to accept persisting pain as something that can be lived with. Is it time to look at our own discomfort with allowing pain to be part of life?

Sources

Bowering, K. J., O’Connell, N. E., Tabor, A., Catley, M. J., Leake, H. B., Moseley, G. L., & Stanton, T. R. (2013). The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. Journal of Pain, 14(1), 3-13.

Cossins, L., Okell, R. W., Cameron, H., Simpson, B., Poole, H. M., & Goebel, A. (2013). Treatment of complex regional pain syndrome in adults: a systematic review of randomized controlled trials published from June 2000 to February 2012. European Journal of Pain, 17(2), 158-173.

Johnson, S., Hall, J., Barnett, S., Draper, M., Derbyshire, G., Haynes, L., . . . Goebel, A. (2012). Using graded motor imagery for complex regional pain syndrome in clinical practice: failure to improve pain. European Journal of Pain, 16(4), 550-561.

Machado, LAC, Kamper, SJ, Herbert, RD, Maher, CG, & McAuley, JH. (2009). Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology, 48(5), 520-527.

Machado, Gustavo C, Maher, Chris G, Ferreira, Paulo H, Pinheiro, Marina B, Lin, Chung-Wei Christine, Day, Richard O, . . . Ferreira, Manuela L. (2015). Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials (Vol. 350).

Woolf, Clifford J. (2010). Overcoming obstacles to developing new analgesics. Nature Medical, 16(11), 1241-1247. doi: doi:10.1038/nm.2230

https://healthskills.wordpress.com/2015/07/27/deciding-when-to-say-when-pain-cure-or-pain-managed/

Lupus And Neuropathy Autoimmune Nerve Diseases

Today's post and podcast from beatingneuropathy.com (see link below) talks primarily about lupus, as well as other autoimmune diseases. Lupus is a very strange disease because through its symptoms, it can imitate other diseases and cause all sorts of diagnostic confusion. It can also imitate neuropathy but at the same time, neuropathy can be the first sign of lupus. Unfortunately, just as with neuropathy, there's no current cure and the best that can be done is treatment of the symptoms. Reading this article will probably leave you needing more information and in that sense, Google may be your best friend.

Neuropathy, Lupus and Autoimmune Diseases
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This week on Beating Neuropathy Radio, we’re talking about “Neuropathy, Lupus and Autoimmune Diseases”

Today 1:4 people suffer from some form of chronic pain and up to half of those people suffer from neuropathic pain, meaning they suffer from neuropathy or some type of nerve “damage”.

Lupus (SLE) “The great imitator” is a systemic autoimmune disease that can affect any part of the body, mimicking many other illnesses making it hard to diagnose. Autoimmune diseases such as lupus detects our own body cells as enemies causing our body to attack itself. The cells that our bodies produce to fight off bacteria and viruses consider themselves to be damaging causing everything from heart to kidney disease.

Lupus is sometimes difficult to discover because it can mimic so many other diseases such as MS and even cancer. Just like neuropathy can be the 1st sign of diabetes as well as metabolic syndrome, neuropathy can also be the first sign of lupus. A common sign of lupus is the “malar rash” which is also known as the butterfly rash seen on many faces of young females with lupus. Other signs or symptoms may include kidney disease or disorders, fatigue, muscle and joint pain.

Lupus is diagnosed through simple, and pretty straight forward lab work. Family history, age of onset as well as your signs and symptoms are all looked at by your doctor for an accurate diagnosis. there is a known hereditary gene that causes lupus which is why Its very important to do your research on family history to see if any other family members have been diagnosed with any other autoimmune diseases. Knowing your family history can help your doctor make a proper diagnosis. There is no known cure for lupus. However, there are many drugs used to treat various symptoms. Drugs used to treat Lupus can damper down our bodies own immune system, as with any drug you and your physician need to out weight the risks vs benefits.

Over the past 25 years autoimmune diseases has increased significantly possibly due to the chemicals in the environment and poor lifestyle choices such as lack of exercise and poor high carb diets. The “Toxic body burden” by Dr. Jeffery Bland refers to the amount of chemical exposure our bodies receive daily. Dairy plays a major role in irritation and inflammation. for example the cows we get our milk from may be grassing on pesticide grass or could be exposed to heavy metals, leaving us unsure of the amount of chemicals being passed though the cow to the milk. And since autoimmune diseases make a person much for sensitive to these chemicals, we highly recommend a dairy and gluten free diet.

Depending on how sensitive your body is to toxins and chemicals you may want to consider eliminating these toxins at home. One way is properly disposing of cleaning products, lawn care and even cosmetics and perfumes. Air freshners and dryers sheets also contain hyper sensitive chemicals that you may want to keep out of your home. Learn much more in the patient library at neuropathyDR.com.

 http://www.beatingneuropathy.com/neuropathy-lupus-autoimmune-diseases