Causes of HIV Related Pain

It may seem that the blog is being flooded with pain articles at the moment but as anybody with both HIV and neuropathy will know, putting your finger on the cause of your pain (or pains) is anything but straightforward. Today's excellent article from thewellproject.org (see link below) addresses the HIV-patient directly and explains that it's not that simple putting the correct neuropathic, or arthritic, or stomach-related or muscular, or whatever label on your pain. With a bit of luck, after reading this, you will be able to locate the source and reason for your pain before you take it to the doctor and have to explain the whole story again. It's also possible that you have more than one source of pain and it's important to know what causes what. Forewarned is forearmed and if you have a good idea of where the problem is and what's causing it, you'll help your doctor considerably to decide the appropriate tests and treatment. However, having read this, or an article like this, never go ahead and self-medicate! Drugs can very easily negatively interact with each other and it is very important that you talk everything over with your doctor before beginning any form of treatment. This may seem like a lecture but you know it makes sense!

HIV Related Pain
Updated November 2010

Pain is common in people living with HIV (HIV+ people). One study of HIV+ people found that more than 50 percent had pain. Pain can occur at all stages of HIV disease and can affect many parts of the body. Usually pain occurs more often and becomes more severe as HIV disease progresses. But each individual is different. Some people may experience a lot of pain, while others have little or none.

What Causes Pain?
HIV related pain can have many causes:

- A symptom of HIV itself
- A symptom of other illnesses or infections
- A side effect of HIV drugs

Regardless of the reason, pain should be evaluated and treated to help HIV+ people have a good quality of life.

Common Types of Pain
The first step in managing HIV related pain is identifying the type, and if possible, the cause of pain. Some common types of pain include the following:

Peripheral Neuropathy – Pain due to nerve damage, mostly in the feet and hands. It may be described as numbness, tingling, or burning. Nerve damage can be caused by HIV drugs or other medical conditions such as diabetes. The older HIV drugs that caused the most peripheral neuropathy are not commonly used today

Abdominal Pain – There are many possible causes of abdominal pain:
A side effect of some HIV drugs (for example cramps)
Infections caused by bacteria or parasites
Problems of the intestinal tract such as irritable bowels
Inflammation of the pancreas (pancreatitis) caused by some HIV drugs or by drinking alcohol.
Bladder or urinary tract infections (especially in women)
Menstrual cramps or conditions of the uterus, cervix, or ovaries

Headache – Head pain can be mild to severe, and may be described as pressure, throbbing, or a dull ache. The most common causes of mild headaches include muscle tension, flu-like illness, and HIV drug side effects. Moderate or severe headaches can be caused by sinus pressure, tooth infections, brain infections, brain tumors, bleeding in the brain, migraines, or strokes. Sometimes the cause cannot be determined.

Joint, Muscle and Bone Pain – This pain can also be mild to severe. It may be related to conditions such as arthritis, bone disease, injury, or just aging. It can also be a side effect of some HIV drugs and medications for other conditions like hepatitis or high cholesterol.

Herpes Pain – Herpes is a family of viruses common in HIV+ people. Herpes viruses stay in the body for life, going into hiding and flaring up later. The varicella-zoster herpes virus first causes chickenpox and later can cause shingles, a painful rash along nerve pathways. Herpes simplex virus types 1 and 2 cause painful blisters around the mouth (“cold sores”) or genital area. Even after a herpes sore heals, a person may still have persistent pain.

Other Types
- Painful skin rashes due to infections or HIV drug side effects
- Chest pain caused by lung infections such as TB, bacterial pneumonia or PCP pneumonia (Pneumocystis pneumonia)
- Mouth pain caused by ulcers (“canker sores”) or fungal infections like thrush
- Fibromyalgia or related chronic pain conditions
- Pain due to cancer anywhere in the body

Assessing Pain
Once the type of pain is identified, the next step is to evaluate its characteristics. The goals of pain assessment are to:

Define the severity of pain (how much it hurts): Your health care provider may ask you to assign a number to your pain, from one (very mild pain) to ten (the worst possible pain). Pictures can also describe pain. A smiling face represents little or no pain, while a crying face represents severe pain.
Describe details of your pain: Your health care provider may ask you to describe how your pain feels, for example sharp, dull, throbbing, or burning. Is it new (acute) or have you had it for a while (chronic)? Where is it located? Is it constant or does it come and go?

You may be having pain but do not want to complain. Talking about pain to your health care provider is not the same thing as complaining! Telling your health care provider exactly how you feel is the best thing you can do to find out what is wrong and get the right treatment.

Pain Management
Once the type and characteristics of pain are identified, you and your health care provider will decide how to manage or treat it. The following factors will play a role in selecting the right type of treatment for you:

- Cause, type, and severity of pain
- Whether it is short-term or long-term
- History of substance abuse
- If your pain is being caused by a medication you are taking or another illness, your health care provider will want to take care of that first. If you are still experiencing pain, there are many options for pain relief.

Non-medicinal Therapies
Pain relief without medications such as:

- Massage
- Relaxation techniques
- Physical therapy
- Acupuncture
- Heat and cold therapy
- Hypnosis
- Mental imagery or visualization

While these may be enough to relieve pain, they are often used along with pain medications.

Non-opioid Medications
Pain relief medicines that do not contain narcotics (opiates). They are available over-the-counter or by prescription. These medicines relieve mild to moderate pain related to inflammation or swelling. Some people with a history of drug addiction prefer non-opioid pain medicines such as:

- Tylenol (acetaminophen)
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (for example Advil)
- COX-2 inhibitor, a type of NSAID that is less likely to cause stomach problems, for example Celebrex (celecoxib)
- Steroids, natural or manufactured hormones that reduce inflammation. Examples include prednisone and hydrocortisone

Non-opioid pain medicines can cause side effects including liver damage (Tylenol), easy bleeding (aspirin), stomach pain or damage (aspirin and other NSAIDs), and heart problems (COX-2 inhibitors).

Opioids/Narcotics
Narcotics and related drugs known as opioids are the strongest pain relievers, available only by prescription. They are used to treat moderate to severe pain.

Opioids are classified by how fast and how long they work.

Immediate release opioids – act rapidly but pain relief lasts for a shorter period of time
Sustained-released opioids – take longer to start working but pain relief lasts longer

Opioids are also classified by their strength.

Mild to moderate pain relievers (they are often mixed with non-opioid medicines to improve their action):
- Hydrocodone
- Vicodin (hydrocodone plus acetaminophen)
- Codeine
- Tylenol with codeine (acetaminophen plus codeine)
- Ultram (tramadol)
- Severe pain relievers:
- Morphine
- Fentanyl
-OxyContin (oxycodone)
- Methadone or Buprenorphine (not commonly prescribed in first-line pain reliever treatment)
Opioids can cause side effects including drowsiness, nausea, and constipation. Overdoses can slow down breathing and cause death. Opiates can lead to dependence or addiction and may be a problem for people with a history of substance use.

Topical or Local Therapies
These are medications that are injected or applied to the skin around a painful area. Examples include the local anesthetic Xylocaine (lidocaine) and capsaicin, which comes from chili peppers.

Other Therapies
There are medicines prescribed for other purposes that also have pain-relieving properties.

Anti-depressants – relieve neuropathic pain such as peripheral neuropathy. An example is Cymbalta (dulozetine).
Anti-convulsants – usually used to treat seizures, some of these drugs work for peripheral neuropathy. An example is Neurontin (gabapentin).

Determine if the Pain Treatment Works
Once you start medication or other pain treatment, your health care provider should assess your pain regularly to see if treatment is working. Sometimes pain medications can stop working over time.

What to Do if You Have Pain?
When you experience pain, it is important to know how to get fast, safe relief.

Do not ignore your pain – Pain is the body’s way of telling us something is wrong. Ignoring pain often makes matters worse and can cause more damage in the long run.
Assess your pain – When pain occurs ask yourself the following questions:
- How long have I had the pain?
- Did it happen suddenly or over time?
- Is the pain sharp or dull?
- What makes the pain worse?
- Does anything ease the pain?
- Is the pain limited to one place or does it spread out to other areas?
- Are there other symptoms (for example numbness, cough or fever)?
Notify your health care provider – Report pain to your provider without delay. Describing your pain will help find the cause and how best to treat it.
Take your pain medicine as directed – If you need pain medications, make sure you take them exactly as prescribed. Pain medications work best if they are taken at the first sign of pain. Breaking the cycle of pain means taking medications before your pain is at its worst.
Be responsible – Pain medications are very effective when taken as prescribed. Taking them incorrectly can be dangerous. Opioids are addictive, meaning you can develop physical and emotional dependence on a drug. High doses can cause breathing problems. In the worst cases, incorrect use of opioids can be fatal.
Tell your health care provider if treatment does not work – If your pain medicine is not relieving your pain, talk to your providers. You may be taking a medication that will not work for you, or you may have built a tolerance to the drugs over time. You may need to change doses or switch to a new medication.
Pain is common among HIV+ people. But it can be managed using a variety of methods. Talk to your health care provider if you are having pain. He or she can work with you to find the cause, manage the pain, and improve your quality of life.

http://www.thewellproject.org/en_US/Living_Well/Health/HIV_Pain_Mgmt.jsp

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/

Rhinitis Of Pregnancy

Allergic Rhinitis

Rhinitis or coryza is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip..Pregnancy Rhinitis. Feeling a little stuffed up lately? Or perhaps you are constantly blowing a runny nose? If so, you are not alone. Many women experience symptoms .Severe stuffy nose during pregnancy. pregnancy rhinitis. rhinitis of pregnancy. what it is, and what to DO about it!.During pregnancy, the body is going through many changes as it supports the growing fetus. At this time, it is much more important to be aware of the substances .Allergic rhinitis, also known as hay fever, is a type of inflammation in the nose which occurs when the immune system overreacts to allergens in the air. Signs and .Do you feel like you have a rotten cold? It could be pregnancy rhinitis. These tips can help alleviate symptoms..Nonallergic rhinitis doesn't usually cause itchy nose, eyes or throat symptoms associated with allergies such as hay fever. When to see a doctor.Find out why pregnancy can cause a stuffy nose or runny nose and what you can do about this nasal congestion, also known as rhinitis of pregnancy..Learn more from WebMD about nonallergic rhinitis, including causes, symptoms, diagnosis, and reme.s..If you're dealing with a stuffy nose and constant sneezing while pregnant, you're probably dealing with pregnancy rhinitis. Find out what you can do to alleviate your .

Allergic Rhinitis

Atrophic Rhinitis

Pregnancy Rhinitis. Feeling a little stuffed up lately? Or perhaps you are constantly blowing a runny nose? If so, you are not alone. Many women experience symptoms .Do you feel like you have a rotten cold? It could be pregnancy rhinitis. These tips can help alleviate symptoms..During pregnancy, the body is going through many changes as it supports the growing fetus. At this time, it is much more important to be aware of the substances .If you're dealing with a stuffy nose and constant sneezing while pregnant, you're probably dealing with pregnancy rhinitis. Find out what you can do to alleviate your .Severe stuffy nose during pregnancy. pregnancy rhinitis. rhinitis of pregnancy. what it is, and what to DO about it!.Rhinitis or coryza is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip..Allergic rhinitis, also known as hay fever, is a type of inflammation in the nose which occurs when the immune system overreacts to allergens in the air. Signs and .Learn more from WebMD about nonallergic rhinitis, including causes, symptoms, diagnosis, and reme.s.. Find out why pregnancy can cause a stuffy nose or runny nose and what you can do about this nasal congestion, also known as rhinitis of pregnancy..Nonallergic rhinitis doesn't usually cause itchy nose, eyes or throat symptoms associated with allergies such as hay fever. When to see a doctor.

HOMOEOPATHIC REMEDIES FOR LOSS OF APPETITE

A decreased appetite is when your desire to eat is reduced. The medical term for a loss of appetite is anorexia.Any illness can reduce appetite. If the illness is treatable, the appetite should return when the condition is cured.

Causes - A decreased appetite is almost always seen among elderly adults, and no physical cause may be found. But emotions such as sadness, depression, or grief can lead to a loss of appetite.

Cancer can also cause decreased appetite. You may lose weight without trying. Cancers that may cause you to lose your appetite include-:Colon cancer, Ovarian cancer, Stomach cancer, Pancreatic cancer

Other causes of decreased appetite include:--Chronic liver disease, Chronic kidney failure, Chronic obstructive pulmonary disease (COPD), Dementia, Heart failure, Hepatitis, HIV, Hypothyroidism, Pregnancy (first trimester), Use of certain medications, including antibiotics, chemotherapy drugs, codeine, and morphine, Use of street drugs, including amphetamines (speed), cocaine, and heroin

HOMOEOPATHIC MEDICINES

ALFALFA Q and GENTIANA LUTEA Q --  A mixture of both in equal quantities and a ten drops dose is a good appetizer

ANTIMONIUM CRUDUM 30- Loss of appetite. Desire for pickles and acidic things. Eructation taste of ingesta. Tongue thickly coated white

AURUM ARS 30—It causes rapid increase of appetite specially in anemia and chlorosis

GENTIANA LUTEA Q- Simple loss of appetite .Acts  as a tonic and  increases appetite. Loss of appetite after illness. Give 5 drops after each meal

LECITHINUM 3X—Loss of appetite with craving for wine and coffee

NUX VOMICA 200—Bitter taste. Tongue coated yellow at the back with loss of appetite.

THUJA OCCIDENTALIS 200- Complete loss of appetite. Dislike for fresh meat, potatoes, and onions. Rancid eructation’s after fat food

  

COULD READING GLASSES SOON BE A THING OF THE PAST

A thin ring inserted into the eye could soon offer a reading glasses-free remedy for presbyopia, the blurriness in near vision experienced by many people over the age of 40, according to a study released at AAO 2014, the 118th annual meeting of the American Academy of Ophthalmology. A corneal inlay device currently undergoing clinical review in the United States improved near vision well enough for 80 percent of the participating patients to read a newspaper without disturbing far distance vision needed for daily activities like driving.

Presbyopia affects more than 1 billion people worldwide.[1] As people age, the cornea becomes less flexible and bends in such a way that it becomes difficult to see up close. While the most common remedy is wearing reading glasses, a host of new corneal inlay products are in development to treat the condition, with three types currently under review by the U.S. Food and Drug Administration (FDA). The theoretical advantage of using corneal inlays over wearing reading glasses is that corneal inlays prevent the need for constantly putting on and taking off glasses, depending on whether the person needs to see near or far.

One of the devices is the KAMRA inlay, a thin, flexible doughnut-shaped ring that measures 3.8 millimeters in diameter, with a 1.6 millimeter hole in the middle. When dropped into a small pocket in the cornea covering the front of the eye, the device acts like a camera aperture, adjusting the depth of field so that the viewer can see near and far. The procedure to insert the implant is relatively quick, lasting about 10 minutes, and requires only topical anesthesia.

To test the inlay's efficacy, clinicians conducted a prospective non-randomized study of 507 patients between 45 and 60 years of age across the United States, Europe and Asia with presbyopia who were not nearsighted. The researchers implanted the ring in the patients and followed up with them over the course of three years. In 83 percent of eyes with the implant, the KAMRA corneal inlay allowed presbyopic patients to see with 20/40 vision or better over the three years. This is considered the standard for being able to read a newspaper or drive a vehicle without corrective lenses. On average, patients gained 2.9 lines on a reading chart. The researchers report that the results remained steady over a three-year period.

Complications from corneal inlays in general have included haziness that is treatable with steroids; however, improvements in inlay design have made the effect less common. If necessary, inlays can be removed, making it a reversible treatment, unlike other procedures such as LASIK for presbyopia.

"This is a solution that truly delivers near vision that transitions smoothly to far distance vision," said John Vukich, M.D., author of the poster and a clinical adjunct professor in ophthalmology and vision sciences at the University of Wisconsin, Madison. "Corneal inlays represent a great opportunity to improve vision with a safety net of removability."

The device is sold in regions including Asia, Europe and South America, but is not yet approved by the FDA for use in the United States. There are two other types of corneal inlays, Raindrop Near Vision Inlay and Presbia Flexivue Microlens, also in development for the U.S. market.

DENDRITIC CELLS AFFECT ONSET PROGRESS OF PSORIASIS

Different types of dendritic cells in human skin have assorted functions in the early and more advanced stages of psoriasis report researchers in the journal EMBO Molecular Medicine. The scientists suggest that new strategies to regulate the composition of dendritic cells in psoriatic skin lesions might represent an approach for the future treatment of the disease

"We urgently need new ways to treat psoriasis, treatments that will deliver improved benefits to patients and reduce the incidence of known side effects for existing drugs," says EMBO Member Maria Sibilia, a Professor at the Medical University of Vienna in Austria, and one of the lead authors of the study. "Our experiments have revealed that increases in the number of plasmacytoid dendritic cells are important early triggers of the disease while other types of dendritic cells, the Langerhans cells, help to protect the balance of the immune response that is established during inflammation of the skin."

Psoriasis is an autoimmune disease that affects around 125 million people worldwide. Symptoms, which include the formation of red inflamed lesions that appear on the skin, vary from mild to severe. The disease is often associated with other serious health conditions such as diabetes, heart disease and depression.

The researchers observed an increase in the accumulation of plasmacytoid dendritic cells in the psoriatic lesions of patients as well as in mice that are model organisms for the study of the disease. Plasmacytoid dendritic cells are a specific type of immune cell that can infiltrate damaged tissue during the early phase of psoriasis. In contrast, the levels of another type of dendritic cells known as Langerhans cells, were significantly decreased in the lesions compared to healthy skin in humans and mice. If the levels of plasmacytoid dendritic cells in mice were decreased during the early stages of the disease then the symptoms of psoriasis were quelled. A similar decrease in Langerhans cells at an early stage of the disease had no effect. If the levels of Langerhans cells were reduced at advanced stages of the disease, the symptoms of psoriasis were exacerbated.

"The changes in the severity of symptoms we have observed related to changes in the composition of dendritic cells most likely impact the balance of inflammatory mediators at the site of disease. It may well be that by inducing favourable compositions of dendritic cells at the early stages of psoriasis we may be able to help reduce the effects of psoriasis by achieving a better balance of these mediators at the site of the disease. Further work is needed before we can say with any certainty if such an approach will lead to a viable clinical treatment for psoriasis."

NEWLY DISCOVERED BRAIN CELLS EXPLAIN A PROSOCIAL EFFECT OF OXYTOCIN

Oxytocin, the body's natural love potion, helps couples fall in love, makes mothers bond with their babies, and encourages teams to work together. Now new research at Rockefeller University reveals a mechanism by which this prosocial hormone has its effect on interactions between the sexes, at least in certain situations. The key, it turns out, is a newly discovered class of brain cells.

"By identifying a new population of neurons activated by oxytocin, we have uncovered one way this chemical signal influences interactions between male and female mice," says Nathaniel Heintz, James and Marilyn Simons Professor and head of the Laboratory of Molecular Biology.

The findings, published today in Cell (October 9), had their beginnings in a search for a new type of interneuron, a specialized neuron that relays messages to other neurons across relatively short distances. As part of her doctoral thesis, Miho Nakajima began creating profiles of the genes expressed in interneurons using a technique known as translating ribosome affinity purification (TRAP) previously developed by the Heintz lab and Paul Greengard's Laboratory of Molecular and Cellular Neuroscience at Rockefeller. Within some profiles from the outer layer of the brain known as the cortex, she saw an intriguing protein: a receptor that responds to oxytocin.

"This raised the question: What is this small, scattered population of interneurons doing in response to this important signal, oxytocin?" Nakajima says. "Because oxytocin is most involved in social behaviors of females, we decided to focus our experiments on females."

To determine how these neurons, dubbed oxytocin receptor interneurons or OxtrINs, affected behavior when activated by oxytocin, she silenced only this class of interneurons and, in separate experiments, blocked the receptor's ability to detect oxytocin in some females. She then gave them a commonly used social behavior test: Given the choice between exploring a room with a male mouse or a room with an inanimate object -- in this case a plastic Lego block -- what would they do? Generally, a female mouse will go for the non-stackable choice. Legos just aren't that interesting to rodents. But Nakajima's results were confusing: Sometimes the mice with the silenced OxtrINs showed an abnormally high interest in the Lego, and sometimes they responded normally.

This led her to suspect the influence of the female reproductive cycle. In another round of experiments, she recorded whether the female mice were in estrus, the sexually receptive phase, or diestrus, a period of sexual inactivity. Estrus, it turned out, was key. Female mice in this phase showed an unusual lack of interest in the males when their receptors were inactivated. They mostly just sniffed at the Lego. There was no effect on mice is diestrus, and there was no effect if the male love interest was replaced with a female. When Nakajima tried the same alteration in males, there was also no effect.

"In general, OxtrINs appear to sit silently when not exposed to oxytocin," says Andreas Görlich, a postdoc in the lab who recorded the electrical activity of these neurons with and without the hormone. "The interesting part is that when exposed to oxytocin these neurons fire more frequently in female mice than they do in male mice, possibly reflecting the differences that showed up in the behavioral tests."

"We don't yet understand how, but we think oxytocin prompts mice in estrus to become interested in investigating their potential mates," Nakajima says. "This suggests that the social computation going on in a female mouse's brain differs depending on the stage of her reproductive cycle."

Oxytocin has similar effects for humans as for mice, however, it is not yet clear if the hormone influences the human version of this mouse interaction, or if it works through a similar population of interneurons. The results do, however, help explain how humans, mice and other mammals respond to changing social situations, Heintz says.

"Oxytocin responses have been studied in many parts of the brain, and it is clear that it, or other hormones like it, can impact behavior in different ways, in different contexts and in response to different physiological cues," he says. "In a general sense, this new research helps explain why social behavior depends on context as well as physiology."

Early Signs Of Pregnancy Cramping

Early Penile Cancer Symptoms

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Early Penile Cancer Symptoms

Traffic Signs

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Coming of age Spring

The Earth turns in her growing skin, uncomfortably like a first sip of wine or a first kiss. The sun glows down, seducing the green from slumber, like a dance from Baubo. The snow, on it's way down to the roots, turns an ugly shade of slop, sticking angrily to our pants and boots, as if to stamp her adolescent complaint on our day. The ground melts and freezes, melts and freezes, obeying the shapeshifting weather. Mother in her round power soothes her belly with bird songs and wintergreen leaves crushed under paws. She breathes up the birch sap with each contraction, giving flow to life and anesthesia to winter's sting. She sings up a grand Menarche in each Maple trunk, and releases the snowdrop munchkins from hiding. She hums the bears awake and cracks the chains of early dusk. Grandmother drum keeps the veil thin while Spring becomes.

Welcome.

Take Care Of Your Toes And Feet With Neuropathy

Today's short post from journal.diabetes.org (see link below) contains advice you really need to follow if you have neuropathy in your feet. Many articles on this subject refer to diabetic neuropathy but as we all know by now, diabetes is just one of the many forms of neuropathy that can cause you to either lose feeling, or suffer extreme feeling in your feet. Listening to a friend's recent story of having painful and infected toenail wounds from clipping too close, led me to publishing this article. It's a very common problem but one that's easy to forget. Read carefully - with the Winter coming on in the northern hemisphere, care of our feet is especially important.

How To Avoid Foot Problems If You Have Neuropathy
Ingrid Kruse, DPM CLINICAL DIABETES VOL. 18 NO. 3 Summer 2000

Inspect Your Feet Daily.
Look at your feet every day. Check for blisters, cuts, scratches, or cracks in the skin (commonly in the heel). Remember to check between your toes. A mirror can help you see the bottom of your feet, or you can ask a family member or friend to help you.

If you experience flu-like symptoms or increased blood glucose levels, be sure to check your feet. They may provide the only warning signals you will receive when a foot infection is present.

Make the daily foot inspection a regular part of your morning or evening routine, just like brushing your teeth. This simple task has kept many people with diabetes from losing their feet by helping them identify problems early on.

Wear Proper Shoes and Socks
All shoes should be comfortable at the time of purchase. Choose a shoe with a soft leather upper, or try athletic shoes for everyday wear. Do not try to "break in" uncomfortable shoes. Buy your shoes at the end of the day when your feet tend to be more swollen than in the morning.

The first time you wear your shoes, wear them only for 1 hour and only around the house. Take them off and inspect your feet for blisters or red areas. Slowly increase the wearing time, giving yourself about a week before you wear a new pair all day.

Do not wear sandals with thongs between the toes because they can rub deep gashes.

Never wear shoes without socks. Socks should be changed daily. Avoid wearing socks with holes or those that have been mended. In sporting good stores, you can find socks that have extra padding under the heel and ball of the foot for better shock-absorption.

Do not forget to check your shoes before you put them on by sliding your hand into them. Feel for nail-points and foreign objects such as keys, small toys, bird seed, or pebbles.

Practice Proper Foot Hygiene.
Wash your feet daily with mild soap, and dry them carefully, especially between the toes. Apply a moisturizing cream everywhere except between the toes. Too much moisture between toes will encourage the growth of microorganisms that can cause infection.

Trim your nails straight across with a slightly rounded edge. If you have trouble seeing, have neuropathy, or have difficulty trimming your nails yourself (because of thick fungus on your nails, for example), see a podiatrist. Avoid all types of "bathroom surgery," such as trying to fix an ingrown nail yourself or trimming your own corns and calluses. The results can be disastrous.

Do not walk barefoot—even in the house—because of danger from stepping on pins, needles, tacks, glass, or other items on the floor.

Be Mindful of Other Dangers to Your Feet.
Neuropathy can affect the set of nerves that detect heat. When these nerves are damaged, you cannot always tell when something is too hot, making burn injuries more likely. Always check bath water with your hands, or use a thermometer if you also have neuropathy in your hands.

Other heat-related problems that could cause serious burns include walking on hot pavement in the summer, using heating pads or hot water bottles to warm your feet, or putting your feet too close to radiators or space heaters in the winter.

If your feet feel cold at night, wear a pair of socks to bed. This is most likely due to neuropathy and not to poor circulation. Neuropathy can cause hot or cold sensations in your feet.

Permission is granted to reproduce this material for nonprofit educational purposes. Written permission is required for all other purposes.

http://journal.diabetes.org/clinicaldiabetes/V18N32000/pg119.htm

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

Cite This Page:
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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

EFFECTS OF HIGH RISK PARKINSONS MUTATIONS ARE REVERSIBLE

Researchers from the University of Sheffield have found vital new evidence on how to target and reverse the effects caused by one of the most common genetic causes of Parkinson's.

Mutations in a gene called LRRK2 carry a well-established risk for Parkinson's disease, however the basis for this link is unclear.

The team, led by Parkinson's UK funded researchers Dr Kurt De Vos from the Department of Neuroscience and Dr Alex Whitworth from the Department of Biomedical Sciences, found that certain drugs could fully restore movement problems observed in fruit flies carrying the LRRK2 Roc-COR Parkinson's mutation.

These drugs, deacetylase inhibitors, target the transport system and reverse the defects caused by the faulty LRRK2 within nerve cells. The study is published today (15 October 2014) month in Nature Communications.

Dr De Vos, a Lecturer in Translational Neuroscience at the world-leading Sheffield Institute for Translational Neuroscience (SITraN), said: "Our study provides compelling evidence that there is a direct link between defective transport within nerve cells and movement problems caused by the LRRK2 Parkinson's mutation in flies."

Co-investigator Dr Alex Whitworth explained: "We could also show that these neuronal transport defects caused by the LRRK2 mutation are reversible.

"By targeting the transport system with drugs, we could not only prevent movement problems, but also fully restore movement abilities in fruit flies who already showed impaired movement marked by a significant decrease in both climbing and flight ability."

The LRRK2 gene produces a protein that affects many processes in the cell. It is known to bind to the microtubules, the cells' transport tracks. A defect in this transport system has been suggested to contribute to Parkinson's disease. The researchers have investigated this link and have now found the evidence that certain LRRK2 mutations affect transport in nerve cells which leads to movement problems observed in the fruit fly (Drosophila).

The team then used several approaches to show that preventing the association of the mutant LRRK2 protein with the microtubule transport system rescues the transport defects in nerve cells, as well as the movement deficits in fruit flies.

Dr De Vos added: "We successfully used drugs called deacetylase inhibitors to increase the acetylated form of α-tubulin within microtubules which does not associate with the mutant LRRK2 protein. We found that increasing microtubule acetylation had a direct impact on cellular axonal transport.

"These are very promising results which point to a potential Parkinson's therapy. However, further studies are needed to confirm that this rescue effect also applies in humans."

Dr Beckie Port, Research Communications Officer at Parkinson's UK, which helped to fund the study, said: "This research gives hope that, for people with a particular mutation in their genes, it may one day be possible to intervene and stop the progression of Parkinson's.

"The study has only been carried out in fruit flies, so much more research is needed before we know if these findings could lead to new treatment approaches for people with Parkinson's.

Parkinson's is a degenerative neurological condition, for which there currently is no cure. The main symptoms of the condition are tremor, slowness of movement and rigidity.

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Vast Numbers Of Americans Live With Daily Chronic Pain

Today's post from drugs.com (see link below) looks at the huge numbers of Americans living with chronic pain on a daily basis. From this, you can also assume that similar proportions apply to many other first world regions and this highlights how ironic it is that nations with the best health services and facilities still have such a high proportion of chronic pain sufferers. A possible cause of this could be put down to lifestyle choices but most neuropathy patients will agree that their pain is a secondary result of another disease or condition. The article talks about the majority of these 25 million having back and joint pain but given that we know that 20 million Americans are living with neuropathy, they will all be experiencing some form of pain, or uncomfortable symptoms. Makes you wonder what the cross-over statistics really mean. Nevertheless, 25 million American chronic pain sufferers means 25 million people receiving medication of one sort or another and over a long period of time. The problem is obvious!

25 Million U.S. Adults Struggle With Daily Pain 
TUESDAY Aug. 18, 2015, 2015

 Pain is widespread in much of America, with more than 25 million adults -- 11 percent -- suffering on a daily basis, a new national survey reveals.

And approximately 14 million adults -- roughly 6.4 percent -- experience severe pain, which can be associated with poorer health and disability, researchers found.

Other national studies of chronic pain have yielded similar results, said study author Richard Nahin, an epidemiologist with the National Center for Complementary and Integrative Health at the U.S. National Institutes of Health (NIH).

"What makes this study unique is that I also looked at how often adults have mild pain," he said.

Nahin found that about 54 million adults -- nearly one-quarter -- reported "mild," but not incapacitating, pain.

Whether pain is increasing nationally is difficult to say, Nahin said. But the good news is that roughly half of those living with severe pain indicated in the survey that they were nevertheless in good or excellent physical health overall.

And even better news: The poll found that 44 percent of American adults say their lives are pain-free.

The estimates are based on the responses of nearly 9,000 adults who took part in the 2012 National Health Interview Survey. The poll is conducted annually by the U.S. Centers for Disease Control and Prevention.

The NIH says more Americans are affected by pain overall than are touched by diabetes, heart disease and cancer combined. Also, chronic pain is the leading cause for long-term disability.

Nahin said joint pain and back pain are the most common sources of discomfort.

"About one-third of all adults have joint pain in a given year, and a bit more than a quarter of all adults have back pain," he said.

For the study, published in the August issue of the Journal of Pain, Nahin asked survey participants about the frequency and intensity of pain experienced in the preceding three months. He coded reported pain into five categories of severity, based on persistence and the degree to which it was "bothersome."

About one in 10 adults experiences "a lot" of pain, researchers found, and nearly 56 percent reported some pain in the preceding three months.

Overall, the researchers found that whites, women, and the elderly were more likely than others to report relatively severe pain.

The survey also found that adults experiencing the most severe levels of pain are likely to be more disabled, in worse overall health, and in need of more health care, compared with people dealing with relatively mild pain.

For those looking to mitigate chronic pain, Nahin said various health approaches can be tried with -- or in place of -- prescription painkillers. Many people turn to yoga, massage and meditation to relieve pain, for example.

"Evidence-based clinical practice guidelines from the American College of Physicians and the American Pain Society found good evidence that cognitive behavioral therapy, exercise, spinal manipulation and interdisciplinary rehabilitation are all moderately effective for chronic or subacute [lasting more than four weeks] low back pain," Nahin noted.

In addition, American College of Rheumatology guidelines advocate tai chi, acupuncture and/or walking aids for knee arthritis, he said.

People in search of a pain plan will often need to mix it up, said Dr. Edward Michna, director of the Pain Trials Center at Brigham and Women's Hospital in Boston, and a board member of the American Pain Society.

"Certainly not all pain requires opioids," Michna said, referring to narcotic medications such as hydrocodone (Vicodin) and oxycodone (OxyContin, Percocet).

"They have a role to play, of course," he added. "But what is needed is an individualization of care and a multidisciplinary approach that might include physical therapy, mind-body therapy, alternative medicines of various kinds, and other types of nonnarcotic medications."

The best treatment "will usually be a combination of these things. There is no one right answer," said Michna, who was not involved in the study.

More information
There's more on pain management at the American Chronic Pain Association.

Posted: August 2015

http://www.drugs.com/news/25-million-u-s-adults-struggle-daily-pain-57937.html

HEALTH BENEFITS OF AROMATHERAPY

Aromatherapy is a commonly known relaxation treatment that uses essential oils extracted from flowers, seeds, barks, herbs and roots. It helps in improving our health, mood and mind.

Here are some health benefits of aromatherapy:

Eases Insomnia

Aromatherapy helps in treating insomnia which causes acute health problems and huge disruption in our life. The relaxing effect of essential oils, and even massages, can help you relieve stress and get to sleep.

Reduces stress

Aromatherapy is populary known for reducing stress. Essential oils known as relaxants helps to soothe your mind and eliminate anxiety. The best essential oils for stress relief are lemon oil, lavender, bergamot, peppermint, vetiver and ylang ylang.

Depression

The citrus and vibrant aromas tend to reduce the effects of depression. A massage with essential oils will help you get out from depression.

Relief pain

One of the best benefits of aromatherapy is that it relieves pain. The clary sage, a great natural scent, is used for the reduction of pain. It is most commonly known for its success for relieving menstrual pains.

Improves blood pressure

Aromatherapy helps to lower blood pressure in patients with hypertension. It relaxes enough to get your blood pressure levels closer to a healthy range.

UNSUNG CELLS DOUBLE BENEFITS OF ANEW OSTEOPOROSIS DRUG

 Experiments in mice with a bone disorder similar to that in women after menopause show that a scientifically overlooked group of cells are likely crucial to the process of bone loss caused by the disorder, according to Johns Hopkins researchers. Their discovery, they say, not only raises the research profile of the cells, called preosteoclasts, but also explains the success and activity of an experimental osteoporosis drug with promising results in phase III clinical trials

A summary of their work will be published on Oct. 5 in the journal Nature Medicine.

"We didn't know that the drug affects preosteoclasts, nor did we understand how important preosteoclasts are in maintaining healthy bones," says Xu Cao, Ph.D., the Lee H. Riley Jr., M.D., Professor of Orthopaedic Surgery. "Now drug companies hoping to reverse osteoporosis can look for even more drugs that make use of and target these interesting cells."

The bones of mice, people and all land animals are not only necessary for strength and structure, but also as warehouses for calcium, which cells throughout the body use continuously for everyday tasks like cell-to-cell communication, muscle strength, and even embryo fertilization and hormone balance.

Calcium is taken from digested food and stored in the semihollow space inside bones. To access the stored calcium, the inner bone goes through a process called resorption, in which cells called osteoclasts attach to the bone and dissolve the calcium and other stored minerals. Nearby, specialized blood vessels pick up the calcium and send it throughout the body. They also bring in nutrients needed for new bone formation.

Under normal conditions, bone resorption is carefully balanced with bone rebuilding to maintain bone strength. But in women who have entered menopause, decreases in estrogen can cause bone resorption to overcome bone rebuilding, leading to osteoporosis and frequent bone breaks. In the U.S., an estimated 25 million women have osteoporosis.

"Most osteoporosis drugs on the market slow down bone resorption but do nothing to encourage bone rebuilding," says Cao. Previous data, including that from early clinical trials in humans, indicated that the drug odanacatib decreases bone resorption by hobbling CTSK, one of the enzymes used to resorb bone. What came as a pleasant surprise was that the same drug also increased bone rebuilding, but the question was how it did so, Cao says.

To learn more, Cao and his team studied mice genetically engineered to have neither bone-dissolving osteoclasts nor their precursors, preosteoclasts. Though the inner bones of the mice were abnormal, as expected, the team also found that the outside layers of the bones were thin. Moreover, the specialized blood vessels needed to transport bone-building supplies were in scarce supply, suggesting overall that osteoclasts and their precursors regulate bone building and bone resorption.

The team grew the two cell types separately in the laboratory and collected the liquid around them to test for proteins released by the cells. They found that preosteoclasts -- but not mature osteoclasts -- secrete a protein called PDGF-BB, which is a powerful attracter both of cells that make bone-building cells and those that make the specialized blood vessels. As expected, when the preosteoclasts of mice were prevented from making PDGF-BB, the mice had weak bones.

"Before a new building is constructed, the roads have to be in place so that the materials and equipment can be brought in," says Cao. "In a similar way, preosteoclasts call blood vessels into an area before bone-building cells begin to make new bone."

When mice were given L-235, the animal form of odanacatib, the numbers of their preosteoclasts and osteoclasts increased, and they secreted more PDGF-BB. The increased PDGF-BB brought in more cells for making blood vessels and bone, which led to more of the specialized blood vessels and thicker bones.

To see if the drug could help reverse the increased bone resorption and decreased blood vessel formation of postmenopausal osteoporosis, the researchers simulated menopause in female mice by removing their ovaries. At first, the mice had thinner bones and fewer blood vessels, but treatment with the drug increased the concentration of PDGF-BB in the blood, the number of specialized blood vessels both inside and outside of the bones, and the overall thickness and density of the bone.

According to Cao, in addition to slowing bone resorption by blocking CTSK, an osteoclast "weapon," the drug also appears to slow down the maturation of preosteoclasts, lengthening the amount of time they secrete PDGF-BB before becoming osteoclasts. With increased PDGF-BB, more specialized blood vessels are made and more bone-building cells arrive, restoring the balance between bone resorption and bone rebuilding.

Odanacatib is produced by Merck & Co. Inc. and has already gone through phase III clinical trials with good results, according to Cao. "It is unusual to see a single drug that decreases bone resorption and increases bone rebuilding at the same time," says Cao. "Beyond that, we now know just how important preosteoclasts and PDGF-BB are to bone building, which is information we can use in designing future studies."

The Language Of Neuropathy

Today's post from blogs.bmj.com (see link below) looks at the language surrounding neuropathy but it doesn't give definitions or explanations; it's more one doctor talking to other medical professionals. For that reason, it may not be immediately accessible for the patient looking for answers. However, it is interesting in how it gives a rare insight into how many doctors think about the condition and it is thoroughly referenced.

The language of peripheral neuropathy
11 Apr, 2012 | by Arun Krishnan, Web Editor

In daily neurological practice, peripheral neuropathy remains one of the most common reasons for neurological referral. The worldwide diabetes epidemic will no doubt ensure that more and more patients are seen with the classic syndrome of length-dependent sensory and motor impairment that inevitably sets in train a range of investigations: nerve conduction studies, blood tests including the usual suspects such as B12, folate, creatinine and possibly an oral glucose tolerance test. In some centres, coeliac serology may be added to that panel, although I suspect that your hit rate will be low 1. Every so often, we are surprised by what we find when we order these tests. I recently had a patient who actually was B12 deficient and who did improve with appropriate treatment. Some of you may have had patients with copper-deficient myeloneuropathy, which again is amenable to therapy 2.

The occurrence of demyelinating changes on NCS is particularly rewarding as it not only alleviates the inevitable boredom of seeing scores of patients with axonal neuropathy, but also provides an interesting intellectual challenge. Some of these patients may have inherited neuropathy and depending on where you live, this may result in little or no further investigation or potentially a mass of ‘neuropathy panels’ looking for one of the zillion genes that we think may underlie charcot-marie-tooth disease. Without a good family history, the greatest beneficiaries of such intense investigation may be the scores of commercial outfits that provide these investigations. Certainly, in my experience the patient does not always benefit beyond testing for the most common genetic abnormalities (PMP 22, MPZ, mitofusin) and further research may be hampered until another family member comes along with a similar complaint.

In terms of acquired demyelination, we all think about chronic inflammatory demyelinating polyneuropathy, a condition that I use as a retort against my friends’ frequent verbal assaults that generally centre on the all pervading therapeutic nihilism that apparently still characterises 21st century neurology. (Neurology can be summed up in two words, they tell me, “Diagnose, adios”: I ask them what the temperature is like on Mars these days). But yes, CIDP is a breath of fresh air: intravenous immunoglobulin, steroids, cyclosporine, methotrexate, mycophenolate, rituximab 3. Wow…. I am not sure if they all work but they certainly sound great in unison.

Over the years there have been many excellent contributions to JNNP in the area of neuropathy research 1-5 and the trend continues in the May issue of the journal. Two prominent neuropathy groups from Chiba and Rochester suggest that we keep in mind a rare but potentially underrecognised form of demyelinating neuropathy and just when you were coming to grips with DADS, MADSAM, MMNCB 3 and other forms of neuropathy soup, here is another – POEMS syndrome 4,5 (polyneuropathy, organomegaly, endocrinpoathy, M-protein and skin changes). As noted in both these papers and the accompanying Editorial 6, the papers provide clinicians with some clues as to how to separate POEMS patients from ‘run-of-the-mill’ CIDP. In particular, they highlight the fact that POEMS patients appear to have more uniform demyelination along the peripheral nerve trunk, while the changes in CIDP patients are relatively polarized either to proximal or distal regions of the peripheral nervous system. In addition, the changes of axonal loss appear to be more prominent in POEMS, with greater muscle atrophy particularly in the lower limbs. The papers also provide potential ways of differentiating these two disorders on the basis of nerve conduction abnormalities. As noted in the Editorial 6, there may be a very direct clinical benefit from being able to differentiate these condition as the prognosis of POEMS is largely dependent on early identification and treatment, and as highlighted in these papers, a ‘neuropathy presentation’ of this systemic disorder is a common enough occurrence.

Research papers

1. Rosenberg et al. Should coeliac disease be considered in the work up of patients with chronic peripheral neuropathy? J Neurol Neurosurg Psychiatry 2005;76:1415-1419 doi:10.1136/jnnp.2004.048413 http://jnnp.bmj.com/content/76/10/1415.full?sid=27d23c4f-2cc3-459e-bcd8-ff52e2c66545

2.Goodman BP et al. Clinical and electrodiagnostic findings in copper deficiency myeloneuropathy. J Neurol Neurosurg Psychiatry 2009;80:524-527 doi:10.1136/jnnp.2008.144683 http://jnnp.bmj.com/content/80/5/524.full?sid=a2769e05-41c5-4a16-a551-986d4067440e

3.Lunn MPT, Willison HJ. Diagnosis and treatment in inflammatory neuropathies. Journal of Neurology, Neurosurgery & Psychiatry. 2009 Mar;80(3):249-58.http://jnnp.bmj.com/content/80/3/249.full?sid=7f5e07bb-96ec-4d0a-9b06-e7cb750886e5

4. Nasu et al. Different neurological and physiological profiles in POEMS syndrome and chronic inflammatory demyelinating polyneuropathy. J Neurol Neurosurg Psychiatry 2012;83:476-479 Published Online First: 15 February 2012 doi:10.1136/jnnp-2011-301706.http://jnnp.bmj.com/content/83/5/476.full

5. Mauermann et al. Uniform demyelination and more severe axonal loss distinguish POEMS syndrome from CIDP. J Neurol Neurosurg Psychiatry 2012;83:480-486 Published Online First: 6 March 2012 doi:10.1136/jnnp-2011-301472. http://jnnp.bmj.com/content/83/5/480.full

6. Arimura K. Early recognition of POEMS syndrome: what is the role of clinical neurophysiology? J Neurol Neurosurg Psychiatry 2012;83:474 doi:10.1136/jnnp-2012-302477http://jnnp.bmj.com/content/83/5/474.full.

http://blogs.bmj.com/jnnp/2012/04/11/the-language-of-peripheral-neuropathy/