Effect Of HIV On Neurological System

Today's post from zedie.wordpress.com (see link below) talks about something that is causing arguments for and against across the scientific world. Along with aging more quickly, if you have HIV, the incidence of neurological disorders (including dementia, memory loss, Alzheimers and Parkinsons and of course neuropathy) amongst HIV positive people is said to be both higher and occurs sooner, than in the general population. It's difficult to prove, which is why there are many who disagree but as far as neuropathy is concerned, when 30% to 40% of HIV carriers have neuropathic problems, those are pretty convincing statistics. The problem is that just as many diabetes patients end up with neuropathy, so restricting it to HIV patients is somewhat tenuous.

The Effect of HIV on Neurologic Disorders.
Source: Journal Watch Infectious Diseases Nov.22nd 2012

In a large cohort study, HIV-positive men developed neurologic disorders at an earlier age and more frequently than HIV-negative men.

The incidence of many neurologic complications of HIV infection has fallen dramatically since effective combination antiretroviral therapy (ART) was introduced in 1996. To determine whether HIV infection continues to have an effect on neurologic disorders during the era of combination ART, investigators studied a large cohort of men followed between July 1996 and June 2011 in the Multicenter AIDS Cohort Study.

HIV-positive (n=1862) and HIV-negative (n=2169) men who have sex with men were included in the analyses. In the HIV-positive men, the median CD4 count was 585 cells/mm3, and the average duration of ART use was 10.6 years. The incidence of neurologic disorders was higher in HIV-positive men than in HIV-negative men. The median age of first neurologic diagnosis was 48 in the HIV-positive men compared with 57 in the HIV-negative ones. Peripheral nerve and muscle disorders (the most common diagnoses), nervous system infections, dementia, and seizures were more common in HIV-infected than in HIV-negative men; when only confirmed cases were counted, stroke was not more common in the HIV-infected group. Although this study took place during the era of effective therapy, 21% of HIV-infected patients with a neurologic disorder were not receiving ART at the time of the complication.

Comment: This study suggests that HIV infection may increase the rate — and perhaps accelerate the development — of neurologic disorders. However, the relevance of these findings to patients who are doing well on current therapy is difficult to know. A substantial fraction of patients who developed neurologic complications were not receiving ART, and, of those on treatment, we are not told what proportion had virologic suppression. Moreover, the development of some diagnoses in this study, such as peripheral neuropathy, may have been exacerbated by antiretrovirals that we no longer use (e.g., stavudine, didanosine). Also, because ascertainment of neurologic conditions in this study was based on medical record review, more recently recognized and subtle entities, such as mild neurocognitive disorder, were not included. Nevertheless, this study highlights the importance of following HIV-infected patients closely for neurologic disorders and emphasizes the need to initiate effective ART before such complications develop.

http://zedie.wordpress.com/2012/11/22/the-effect-of-hiv-on-neurologic-disorders/

Faint Line On Pregnancy Test

Equate Early Result Pregnancy Test Faint Line

Hi all mummys out there i done 3 home pregnancy test and they come back i was pregnant but went to the doctors and yhey done a wee test there and it said i wasnt but .Very Faint Line on a Pregnancy Test, pregnant or not You take the test and there is a faint line. Reasons you might see a faint line on a home pregnancy test..Usually, a faint line in the test area of a pregnancy test indicates a positive result - meaning that you are pregnant. But you are probably wondering: Why is this .Am I pregnant or not? Here is a list of the most common cases of when a faint line on your home pregnancy test is actually not a positive result..I See A Faint Line On My Home Pregnancy Test, Am I Pregnant? Home pregnancy tests use a sample of a woman's urine in order to detect the 'pregnancy hormone .Have a faint positive pregnancy test? even a faint line is a positive line. You either see a second line on the pregnancy test or you don't..A faint line on a pregnancy test indicates a positive result. The reason for a faint line is that the hcg levels is probably very close to the sensitivity threshold .Probably, but you should test again in a few days to make sure. For a home pregnancy test to give you a positive result, your body has to be making a detectable level .A faint line on pregnancy tests can be frustrating! Find out what causes these faint lines find out how to eliminate them from our medical experts..Very faint line on pregnancy test: am Why is the line so faint? Pregnancy tests are and the stronger the line on your pregnancy test. So, a very faint line .

Equate Early Result Pregnancy Test Faint Line

Naked Basics Mini Review Smokey Eyes Tutorial E2 99 A5 Youtube

Very Faint Line on a Pregnancy Test, pregnant or not You take the test and there is a faint line. Reasons you might see a faint line on a home pregnancy test..Probably, but you should test again in a few days to make sure. For a home pregnancy test to give you a positive result, your body has to be making a detectable level .Usually, a faint line in the test area of a pregnancy test indicates a positive result - meaning that you are pregnant. But you are probably wondering: Why is this .A faint line on pregnancy tests can be frustrating! Find out what causes these faint lines find out how to eliminate them from our medical experts..Very faint line on pregnancy test: am Why is the line so faint? Pregnancy tests are and the stronger the line on your pregnancy test. So, a very faint line .I See A Faint Line On My Home Pregnancy Test, Am I Pregnant? Home pregnancy tests use a sample of a woman's urine in order to detect the 'pregnancy hormone .Am I pregnant or not? Here is a list of the most common cases of when a faint line on your home pregnancy test is actually not a positive result..Have a faint positive pregnancy test? even a faint line is a positive line. You either see a second line on the pregnancy test or you don't..A faint line on a pregnancy test indicates a positive result. The reason for a faint line is that the hcg levels is probably very close to the sensitivity threshold .Hi all mummys out there i done 3 home pregnancy test and they come back i was pregnant but went to the doctors and yhey done a wee test there and it said i wasnt .

The Impact of Fluctuating Symptoms on People with HIV

One of the problems about neuropathy is that in the beginning, the symptoms can fluctuate. You can have periods with relatively few problems and other times where the neuropathy is clearly a part of your life. The same applies for many people in general with HIV, where neuropathy may only be just one of the health problems they have to live with. Today's post talks about the findings of a survey by the National Aids Trust and comes from aidsmap.com (see link below). The survey found that these fluctuating symptoms can have a significant effect on people's working lives as well as their mental state at any given time. The recommendation is that more studies need to be done.

Fluctuating symptoms have major impact on quality of life and fitness to work, survey finds
Gus Cairns:Published: 07 September 2011

Common but non-specific symptoms of uncertain cause can dominate the day-to-day life of some people with HIV, a survey by the National AIDS Trust has found. In many cases symptoms such as fatigue, insomnia, depression, diarrhoea and neuropathy make it hard to work and perform other daily activities, the report of the survey finds.

The survey also found a significant degree of overlap between symptoms; generally, if people had one symptom, more than two-thirds of them were likely to have at least one other. One other finding was that the majority of respondents found that the symptoms were not only fluctuating, but were also completely unpredictable. This made planned activities, both at work and socially, difficult. About 60% of respondents were employed.

This study is a pilot survey of an independent working group brought together to review the Work Capability Assessment (WCA), the medical procedure under which claimants are assessed for Employment and Support Allowance. The WCA had been criticised, especially in an independent review conducted by occupational health expert Professor Malcolm Harrington, for being inflexible and for not being designed to accommodate illnesses characterised by fluctuating symptoms. See www.aidsmap.com/Whats-happening-to-benefits/page/1793223/ for more on the WCA and the Harrington Report.

Survey results in detail

The NAT study asked people with HIV to complete an online survey about their experience, during the previous six months, of five symptoms commonly associated with HIV: fatigue, anxiety or depression, insomnia, gastro-intestinal problems and neuropathy (nerve pain). There was space to mention other symptoms too.

It is not surprising that in a study inviting people to self-report, the majority of the 265 respondents had at least one of the symptoms on the list. The most common was fatigue, suffered by 57%, followed by depression or anxiety (55%), gastro-intestinal (GI) problems (48%), insomnia (46%) and neuropathy (33%).

More significant was the fact that more people experienced these symptoms as fluctuating rather than constant. Respondents described conditions as ‘constant’ with frequencies ranging from about 38% in insomnia to 24% in the case of GI problems, but as ‘varying over time’ with frequencies ranging from 53% in fatigue to 31% with neuropathy.

Fatigue was mentioned as a particularly common and troubling symptom. Very few respondents could usually predict when fatigue would hit them. One commented that “When I have it I am quite incapacitated and have no choice but to limit, stop or cancel plans to do things.” Another said “it is always there, lurking...if I do anything for more than an hour it begins to kick in.” One respondent managed to hold down a job but always required a nap of one to two hours immediately after coming home. Although 40% of respondents thought a combination of HIV and HIV medications caused their fatigue, 30% said they really had ‘no idea’ what caused it.

Depression and anxiety were nearly as common as fatigue, though respondents did not say they affected work so much. The main feature of these were their frequency: 90% of respondents said they had experienced either or both at some point in the last month. Given that a third of respondents said that bouts of depression or anxiety lasted more than a week at a time, many people must be living with severely disordered mood a lot of the time.

Diarrhoea, nausea and other GI problems were the symptoms most likely to be linked in people’s minds to HIV treatment. Thirty per cent of respondents thought these were the exclusive cause of their problems and 45% thought HIV and HIV treatments were both to blame. The frequency of bouts of diarrhoea varied from once to more than five times a month.

Insomnia and poor sleep, especially chronic, not only impacts on quality of life: it is a cause of significant physical and psychological illness. Although this has been associated with HIV drugs, especially efavirenz, 45% of respondents did not know why their sleep was so poor. Sleeplessness was very unpredictable – people would be fine one night and not the next. Forty-three per cent said having problems sleeping could last for more than a week. When insomnia is this prolonged, memory, mood and cognitive function can be severely affected. One respondent said sleep problems meant “I am unable to focus on my work, feeling like I have jet lag.”

Neuropathy (nerve pain) was the least-experienced of the conditions but was still suffered by a third of respondents. About equal numbers of people attributed it to HIV itself and to HIV drugs. In some cases the pain of neuropathy was constant – one person said his feet were always sore and this prevented standing or walking for more than 15 minutes. But the majority said that while some symptoms such as numbness were always there others, such as stabbing pains, were unpredictable and often severe.

Most respondents suffered from multiple symptoms: for instance, of those with depression or anxiety, 75% also had fatigue and 57% insomnia; of those with neuropathy, 61% had fatigue and 68% GI problems.

About 40% of respondents were unemployed, with a higher proportion among those reporting GI problems or fluctuating neuropathy. There was a generally positive attitude to work, with one respondent happy to have just started a job after 18 months of unemployment – “I am knackered but happy to be working,” s/he said.

In other cases however it was clear that fluctuating symptoms were significantly affecting people’s ability or willingness to work. One question asked “on how many occasions in the past four weeks have your symptoms significantly affected your ability to work”? A quarter of people with fatigue, 20% with neuropathy, and about 15% of those with depression and GI problems reported that this had happened more than five times in the past four weeks.

One respondent asked: “How do you work round this kind of thing unless you work for yourself or for an extremely understanding employer?”

Conclusions and recommendations

NAT concludes that the responses to their survey reveal that fluctuating symptoms are a cause of real morbidity and distress to people living with HIV and place significant barriers to work. They add that the variation and unpredictability of symptoms was often as much of a problem as the symptoms themselves.

Because the symptoms are fluctuating, ESAs may not capture them if the person is having a ‘good day’, but there are other methods of assessment, such as asking people to keep a symptom diary.

NAT recommends that more research needs to be undertaken into these common, fluctuating symptoms and that HIV organisations should raise awareness amongst employers, and with people with HIV themselves, about the importance of making reasonable adjustments at work to enable people with HIV to continue in employment.

In terms of the ESA itself, NAT recommends that ESAs need to take into account “the full range of barriers fluctuating symptoms present to participation in work and other daily activities,” including their unpredictability and the fact that they come in combination.

“Assessment should consider the impact of fluctuation and the cumulative impact of multiple, lower-level symptoms on people living with HIV,” they comment.

http://aidsmap.com/Fluctuating-symptoms-have-major-impact-on-quality-of-life-and-fitness-to-work-survey-finds/page/2066782/

HIGH SALT PREVENTS WEIGHT GAIN IN MICE ON A HIGH FAT DIET

In a study that seems to defy conventional dietary wisdom, University of Iowa scientists have found that adding high salt to a high-fat diet actually prevents weight gain in mice.

As exciting as this may sound to fast food lovers, the researchers caution that very high levels of dietary salt are associated with increased risk for cardiovascular disease in humans. Rather than suggest that a high salt diet is suddenly a good thing, the researchers say these findings really point to the profound effect non-caloric dietary nutrients can have on energy balance and weight gain.

"People focus on how much fat or sugar is in the food they eat, but [in our experiments] something that has nothing to do with caloric content -- sodium -- has an even bigger effect on weight gain," say Justin Grobe, PhD, assistant professor of pharmacology at the UI Carver College of Medicine and co-senior author of the study, which was published in the journalScientific Reports on June 11.

The UI team started the study with the hypothesis that fat and salt, both being tasty to humans, would act together to increase food consumption and promote weight gain. They tested the idea by feeding groups of mice different diets: normal chow or high-fat chow with varying levels of salt (0.25 to 4 percent). To their surprise, the mice on the high-fat diet with the lowest salt gained the most weight, about 15 grams over 16 weeks, while animals on the high-fat, highest salt diet had low weight gain that was similar to the chow-fed mice, about 5 grams.

"We found out that our 'french fry' hypothesis was perfectly wrong," says Grobe, who also is a member of the Fraternal Order of Eagles Diabetes Research Center at the UI and a Fellow of the American Heart Association. "The findings also suggest that public health efforts to continue lowering sodium intake may have unexpected and unintended consequences."

To investigate why the high salt prevented weight gain, the researchers examined four key factors that influence energy balance in animals. On the energy input side, they ruled out changes in feeding behavior -- all the mice ate the same amount of calories regardless of the salt content in their diet. On the energy output side, there was no difference in resting metabolism or physical activity between the mice on different diets. In contrast, varying levels of salt had a significant effect on digestive efficiency -- the amount of fat from the diet that is absorbed by the body.

"Our study shows that not all calories are created equal," says Michael Lutter, MD, PhD, co-senior study author and UI assistant professor of psychiatry. "Our findings, in conjunction with other studies, are showing that there is a wide range of dietary efficiency, or absorption of calories, in the populations, and that may contribute to resistance or sensitivity to weight gain."

"This suppression of weight gain with increased sodium was due entirely to a reduced efficiency of the digestive tract to extract calories from the food that was consumed," explains Grobe.

It's possible that this finding explains the well-known digestive ill effects of certain fast foods that are high in both fat and salt, he adds.

Through his research on hypertension, Grobe knew that salt levels affect the activity of an enzyme called renin, which is a component in the renin- angiotensin system, a hormone system commonly targeted clinically to treat various cardiovascular diseases. The new study shows that angiotensin mediates the control of digestive efficiency by dietary sodium.

The clinical usefulness of reducing digestive efficiency for treating obesity has been proven by the drug orlistat, which is sold over-the-counter as Alli. The discovery that modulating the renin-angiotensin system also reduces digestive efficiency may lead to the developments of new anti-obesity treatments.

Lutter, who also is an eating disorders specialist with UI Health Care, notes that another big implication of the findings is that we are just starting to understand complex interactions between nutrients and how they affect calorie absorption, and it is important for scientists investigating the health effects of diet to analyze diets that are more complex than those currently used in animal experiments and more accurately reflect normal eating behavior.

"Most importantly, these findings support continued and nuanced discussions of public policies regarding dietary nutrient recommendations," Grobe adds.

In addition to Grobe and Lutter, the UI research team included Benjamin Weidemann; Susan Voong; Fabiola Morales-Santiago; Michael Kahn; Jonathan Ni; Nicole Littlejohn; Kristin Claflin; Colin Burnett; and Nicole Pearson. The study was funded in part by grants from the National Heart, Lung and Blood Institute, the American Diabetes Association, and American Heart Association.

NICE Judgement On Pregabalin Lyrica

As part of the ongoing argument about the efficiency of pregabalin (Lyrica) for treating neuropathic pain symptoms, today's post from pulsetoday.co.uk  (see link below) examines the decision by NICE (the British National Institute for Health and Care) to backtrack on its plans to relegate pregabalin to a second drug of choice (behind gabapentin) in the treatment of neuropathic pain. Apart from the fact that gabapentin is cheaper than pregabalin, the ongoing controversies surrounding pregabalin (effectiveness and side effects issues) have led more and more doctors to prescribe gabapentin first. People with HIV and/or diabetes plus neuropathy should also be aware that Pfizer (the makers) have withdrawn their support (May 2012) for their own drug relating to those diseases because it has never been proved to work effectively for those groups and the law suits thanks to unpleasant side effects have brought yet more discredit on pregabalin as a treatment option. The best advice is to talk it over with your doctor or specialist but you may need to take further evidence with you if you're worried about taking pregabalin (Lyrica) because many doctors are still unaware of Pfizer's own policy. Many more articles about this drug can be found in the alphabetical list to the right of this blog.

NICE backs down on pregabalin restriction for neuropathic pain
22 November 2013 | By Caroline Price

NICE has back-tracked on controversial plans to demote pregabalin to second-line use after gabapentin in the management of neuropathic pain, it revealed in updated guidance released this week.

GPs can now offer either pregabalin, gabapentin, amitriptyline or duloxetine as initial treatment in patients with any type of neuropathic pain, with the exception of trigeminal neuralgia for which carbamazepine is the recommended initial treatment.

The decision marks an apparent climb-down by the regulator after it previously announced plans to switch pregabalin for gabapentin as a recommended first-line treatment on the grounds of cost.

NICE initially recommended amitriptyline or pregabalin first-line in treatment options in its first-ever guidance on pharmacological management of neuropathic pain published in 2010, with duloxetine recommended first-line for patients with painful diabetic neuropathy.

But within 18 months it announced a review of the decision on pregabalin, because of cost concerns – and proposed swapping gabapentin as an alternative first-line drug of choice.

However, the newly published final guidance reverses that proposal and leaves the choice down to GPs, with advice on what to try if the initial treatment is ineffective or not tolerated.

Dr Ollie Hart, a GPSI in pain in Sheffield, said the guidance was welcome and would reflect common practice, although he said most GPs would choose gabapentin before pregabalin because of the cost.

He told Pulse: ‘It reflects common practice where often clinicians rotate medications in a trial of “n=1” with the individual patient, with regular review of effects.

‘Most GPs would (and I would recommend) using gabapentin before pregabalin. Cost/value issue make this the sensible decision for most.’

Dr Hart said more detail would have been useful on how long initial treatments should be tried and it was disappointing the off-licence status of cheaper drugs has been highlighted in the guidance.

He said: ‘It would have been more helpful if they had indicated time frames for trailing meds - in reality I often allow two-to-four weeks for evidence of benefit or not.

‘It is a shame that they have chosen to highlight the off-licence aspects of some of the medications- amitriptyline for example has a long a well evidenced history of use in neuropathic pain. We are working in an NHS system where value based decisions have to be made,’ Dr Hart added.

http://www.pulsetoday.co.uk/clinical/therapy-areas/pain-relief/nice-backs-down-on-pregabalin-restriction-for-neuropathic-pain/20005139.article#.UsaDDbRhOSo

A Doctors View On Neuropathy Treatment

Today's post from neuropathytreatments.com (see link below) gives some sound advice from the point of view of a doctor with neuropathy patients. Not everything is covered here but there is some useful information for everybody living with the many forms of neuropathy. Worth a read.

The Advice Of A Medical Professional

Posted on February 24, 2014

Neuropathy is a complex condition that can have an effect on the body’s nervous system.  Peripheral nervous system occurs. The peripheral nervous system refers to the part of the nervous system outside of the brain and spinal cord; when damage occurs to the nerve cells or nerve axons, it is called peripheral neuropathy. Neuropathy is a painful condition that can have an effect on an individual’s life and their ability to maintain a normal active life.
Peripheral Neuropathy is a condition that will have an effect on an individual’s life and if not treated could have a severely negative effect. The pain and symptoms that are common place with neuropathy limit one’s mobility and ability to function in normal life situations. For instance, numbness is a symptom of neuropathy and can limit the patient’s ability to sense or feel terrain changes – risking further injury. Neuropathy symptoms have an implication on one’s social, vocational and functional life possibly causing the neuropathy patient to suffer with feelings of anxiety and depression.
Most doctors have to admit that when it comes to neuropathy treatment they have few options to offer their patients other than a prescription medication to help numb the pain. Numbing the pain does not fix the problem it only creates more problems; the medication used to numb neuropathy pain can leave the neuropathic patient juggling now both neuropathy pain and side effects from the medication.

What To Expect For Your Doctor
There are several different classes of medications for treating neuropathy. Since there is no cure for neuropathy, the only form of treatment is to discover a way to ease the painful neuropathy symptoms that create a stumbling block in one’s daily existence and most medical professionals believe that prescription medications are an excellent way to ease the pain of neuropathy. Below you will find more information on the most popular medications prescribed to those who suffer from neuropathy.

Antidepressants
Endorphins are the way the body naturally relieves pain and antidepressants are said to help treat neuropathy pain by blocking pain signals on their way to the brain and release endorphins. Antidepressants are further categorized that are available to help treat neuropathy.

Tricyclic anti-depressants calm levels of neurotransmitters in the brain. Tricyclic can reduce pain and improve mood and even help one sleep better. For help with reliving nerve pain, doctors will often prescribe the following tricyclic anti-depressants:

• Amitriptyline
• Desipramine
• Imipramine

Side Effects: dizziness, drowsiness, dries mouth and eyes as well as constipation.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase serotonin and norepinephrine one has in their system. SNRIs block serotonin and norepinephrine from being reabsorbed by brain cells.

Side Effects: dizziness, drowsiness and insomnia

Selective Serotonin Reuptake Inhibitors (SSRIs) are like SNRIs in that they help increase serotonin levels in the body, yet they differ in that they focus on serotonin levels to help decrease one’s pain perception.

Side Effects: insomnia, headaches and nausea

Anti-Seizures
Anti-seizures are medications that were originally designed to treat seizures. Anti-seizure medication is often prescribed to treat diabetic neuropathy due to its ability to slow down nerve signals so that the pain levels are not communicated to the brain. Examples of anti-seizures anti-convulsants would be:

• Pregabalin
• Gabapentin
• Gabarone
• Neurontin

Side Effects: drowsiness, weight gain, dizziness and nausea

Opioids
Also called narcotics, opioids are painkillers and serious stuff that should not be tampered with unless prescribed. Opioids are prescribed to relieve severe pain quickly but can become addictive.

Side Effects: drowsiness, nausea and constipation

Heed The Warning
Though the use of prescription medication can be effective in treating neuropathy pain and symptoms, there are several downsides to selecting medications as the primary form of neuropathy treatment. Medication can become addictive and have severe adverse side effects that could affect ones emotional, physical and mental stability. Never use narcotics out from under the care of a doctor.
Neuropathy can be emotionally, physically and mentally taxing without adding further complications such as depression, suicidal thoughts, anxiety and irritability. To prevent side effects that could cause severe damage to one’s health treating neuropathy naturally is a great alternative to prescription medication.

http://neuropathytreatments.com/2014/02/

Verging On Obese Get Ready For Neuropathy!

Today's post from mdedge.com (see link below) is so short, you might wonder why it appears here at all. It may be short but at the end of a festive season for many (if only it were festive for all!) where vast quantities of food have been eaten and waistlines have been irreversibly expanded, you may want to spare a thought for the potential consequences. Have you seen the latest statistics about obesity in the population!!! Of course, over eating and regularly eating the 'wrong' sort of food can lead to diabetes and the commonest cause of neuropathy is diabetes but the message here is much wider than that. This study shows that obese people are prone to nerve damage, irrespective of their glucose and blood sugar levels, so the message is clear - obesity is to be avoided at all costs, for all sorts of health reasons. Unfortunately, neuropathy doesn't frighten people until they have it and then it's too late! We've not even reached New Year's Eve yet, after a crazy year in human history, so before you go on that last food binge before 2017 (it's never the 'last' one), try to make and stick to a New Year's resolution before it sticks to your waistline and brings you nerve damage which you'll regret for ever!
 

Causes of Polyneuropathy in an Obese Population
JAMA Neurol; ePub 2016 Oct 31; Callaghan, et al November 15, 2016

The prevalence of polyneuropathy is high in obese individuals, even those with normal glucose levels, with diabetes, prediabetes, and obesity being the likely metabolic drivers, a recent study found. This cross-sectional study included 102 obese participants (mean age 52.9 years; 45 [44.1%] with normoglycemia, 31 [30.4%] with prediabetes, and 26 [25.5%] with type 2 diabetes), and 53 lean controls. 

Researchers found:
The prevalence of polyneuropathy was 3.8% in lean controls (n=2), 11.1% in the obese participants with normoglycemia (n=5), 29% in the obese participants with prediabetes (n=9), and 34.6% in obese participants with diabetes (n=9). 

Age (OR, 1.09), diabetes (OR, 4.90), and waist circumferences (OR, 1.24) were significantly associated with neuropathy in multivariable models. 

Prediabetes (OR, 3.82) was not significantly associated with neuropathy.

Citation: Callaghan BC, Xia R, Reynolds E, et al. Association between metabolic syndrome components and polyneuropathy in an obese population. [Published online ahead of print October 31, 2016]. JAMA Neurol. doi:10.1001/jamaneurol.2016.3745.

Commentary: Polyneuropathy can range in severity from bothersome, with intermittent tingling and numbness, to severe and disabling. We are familiar with it as a long-term complication of diabetes as well as occurring sporadically in patients without diabetes. We are beginning to recognize that many of the sporadic cases in patients without diabetes may be due to prediabetes and obesity. A previous paper in Diabetes Care demonstrated that evidence of polyneuropathy was found in 49% of a large cohort of patients with prediabetes and that progression of glucose intolerance over 3 years predicted a higher risk of peripheral neuropathy and nerve dysfunction.1 The lack of relationship to prediabetes reported in the current paper is likely due to the relatively small numbers of patients with prediabetes in the study, since the hazard ratio for polyneuropathy with prediabetes was 3.8. The current paper expands these non-diabetes related risk factors for peripheral neuropathy to include obesity as well as diabetes. —Neil Skolnik, MD
Lee CC, et al. Peripheral neuropathy and nerve dysfunction in individuals at high risk for type 2 diabetes: The PROMISE cohort. Diabetes Care. 2015;38:1-8. doi:10.2337/dc14-2585.

http://www.mdedge.com/jfponline/clinical-edge/summary/diabetes/causes-polyneuropathy-obese-population

Neuropathy Brought On By Medications

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

Medication-Induced Neuropathy
November 9, 2012 by arthuryinfan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Whats New On The Neuropathy Research Front Webinar Vid

Today's YouTube video is full of lots of useful information from a recent Neuropathy Association webinar. Unfortunately, the sound is somewhat disembodied and often sounds like those irritating, computer-generated voices but the content is valuable and worth looking at and listening to if you have a free half hour. Be warned, it can be somewhat technical but the slides do help explain the text.

"What New Neuropathy Research Can We Be Hopeful For?" - 2014 Webinar
Published on 17 Jul 2014




https://www.youtube.com/watch?v=wBbK5oKWHzA#t=169

Light Treament On The Brain To Reduce Nerve Pain

Today's interesting post from sciencedaily.com (see link below) looks at how a small area of the brain can be stimulated by directed light frequencies to control pain signals in the neurons. The difficulty lies in making sure that we still sense the pain signals that we need to sense (touching a hot surface, avoiding injury etc) and that not all pain signals are 'switched off' by the process. The ever-heroic lab mice are the current recipients of the research but hopefully it will eventually translate into something practical that humans can use. It would certainly be less invasive than many other treatments.

Optogenetic stimulation of the brain to control pain demonstrated in study 
Date: February 26, 2015 Source: University of Texas at Arlington 

Summary:

New research reveals for the first time how a small area of the brain can be optically stimulated to control pain. Researchers found that by using specific frequency of light to modulate a very small region of the brain called the anterior cingulate cortex, or ACC, they could considerably lessen pain in laboratory mice.

A new study by a University of Texas at Arlington physics team in collaboration with bioengineering and psychology researchers shows for the first time how a small area of the brain can be optically stimulated to control pain.

Samarendra Mohanty, an assistant professor of physics, leads the Biophysics and Physiology Lab in the UT Arlington College of Science. He is co-author on a paper published online Wednesday by the journal PLOS ONE.

Researchers found that by using specific frequency of light to modulate a very small region of the brain called the anterior cingulate cortex, or ACC, they could considerably lessen pain in laboratory mice. Existing electrode based ACC stimulation lacks specificity and leads to activation of both excitatory and inhibitory neurons.

"Our results clearly demonstrate, for the first time, that optogenetic stimulation of inhibitory neurons in ACC leads to decreased neuronal activity and a dramatic reduction of pain behavior," Mohanty said. "Moreover, we confirmed optical modulation of specific electrophysiological responses from different neuronal units in the thalamus part of the brain, in response to particular types of pain-stimuli."

The research focused on chemical irritants and mechanical pain, such as that experienced following a pinprick or pinch. Mohanty said the results could lead to increased understanding of pain pathways and strategies for managing chronic pain, which often leads to severe impairment of normal psychological and physical functions.

"While reducing the sensation for chronic pain by optical stimulation, we still want to sense certain types of pain because they tell us to move our hands or legs away from something that is too hot or that might otherwise hurt us if we get too close," Mohanty said.

Young-tae Kim, a UT Arlington associate professor of bioengineering and study co-author, said the research could "possibly lead to less invasive methods for treating more severe types of pain without losing important emotional, sensing and behavioral functions."

Story Source:

The above story is based on materials provided by University of Texas at Arlington. Note: Materials may be edited for content and length.

Journal Reference:
Ling Gu, Megan L. Uhelski, Sanjay Anand, Mario Romero-Ortega, Young-tae Kim, Perry N. Fuchs, Samarendra K. Mohanty. Pain Inhibition by Optogenetic Activation of Specific Anterior Cingulate Cortical Neurons. PLOS ONE, 2015; 10 (2): e0117746 DOI: 10.1371/journal.pone.0117746

http://www.sciencedaily.com/releases/2015/02/150226101656.htm

How The US Is Changing Its Mind On Marijuana

Today's interesting post from the Australian abc.net.au (see link below) takes a slightly different look at the progress of marijuana legalisation in the United States. The gradual recognition of the benefits of medical marijuana for a variety of conditions (including neuropathic pain) has led to more and more states legalising the herb thus allowing many more people to take advantage. It's one of the few areas where the USA actually seems to be taking a more liberal stand than most of the rest of the world. Worth a read.

The dope on legalising marijuana in the US
Ben Knight reported this story on Sunday, March 23, 2014
Listen to MP3 of this story ( minutes)

Alternate WMA version | MP3 download

ELIZABETH JACKSON: This month in the US, the District of Columbia became the latest jurisdiction to vote to decriminalise marijuana.

There's been a sea change in public attitudes towards the drug in America.

In the space of less than 10 years, public support for marijuana legalisation has gone from around 25 per cent to almost 60 per cent.

Much of that has to do with the medical marijuana revolution, which began in San Francisco back in 1996.

Ben Knight reports from Washington, DC.

BEN KNIGHT: Not surprisingly, there are lots of reasons for the shift in public support for marijuana law reform in the US.

One of them is simply demographics. As the baby boomers get older, there are simply more people who have had some kind of experience smoking dope, including this guy:

BARACK OBAMA: I didn't have a dad in the house, and I was angry about it, even though I didn't necessarily realise it at the time. I made bad choices. I got high, without always thinking about the harm that it could do. I didn't always take school as seriously as I should have. And the only difference is that I grew up in an environment that was a little bit more forgiving. So when I made a mistake, the consequences were not as severe.

BEN KNIGHT: It was a powerful message from president Barack Obama, because he didn't just admit that he'd used marijuana, but that he'd misused it, and that he'd been luckier than a lot of other teenagers - especially black teenagers.

In many places in this country, minorities make up the vast bulk of marijuana arrests. But this is an issue that unites the left and right wings of politics.

Libertarian Republicans look at the amount of taxpayer money that goes into marijuana prosecutions - and the cost to society - and they compare that to the tax dollars they see coming back in from states that have legal medical marijuana.

Others on the right take the view that the government simply shouldn't be regulating what people choose to do in their own lounge rooms.

Now the debate is of course far from over, and there are very real concerns, particularly about the effect of marijuana on young developing minds, and what kind of message legalising it - or even just decriminalising it - sends to teenagers.

But there's little doubt that either that marijuana supporters are winning that debate. And a lot of that has to do with medical marijuana.

(Rabbi Jeffery Kahn enters)

BEN KNIGHT: Jeffery, how are you?

JEFFERY KAHN: Great. Welcome - delighted that you're here.

BEN KNIGHT: Thank you, great to be here.

(Voiceover): This is the Takoma Wellness Centre in Washington, DC.

JEFFREY KAHN: This door leads to the dispensary.

BEN KNIGHT: Wow, look at it.

(Voiceover): There are thousands of centres like this in 20 states across the US. The owner of this one is Rabbi Jeffrey Kahn.

JEFFREY KAHN: Many of our patients are older. They have never had an experience with cannabis.

BEN KNIGHT: He started this business with his wife Stephanie in 2010.

Their only experience with marijuana was through Stephanie's parents, both of whom used medical marijuana but who had to do it illegally.

STEPHANIE KAHN: We really saw what it could do, but we also saw the fear that they had.

BEN KNIGHT: Stephanie's father was first, after he was diagnosed with multiple sclerosis.

STEPHANIE KAHN: Back in the 70s, the doctors started saying 'try marijuana.' And this was the 70s - he had a teenage daughter, and he was a very straight-laced businessman - and he was like, 'no, I'm not going to.'

But eventually he ended up trying it and it made a huge difference. It helped his spasms, it helped his neuropathies in his fingers and his feet, and it helped pain - it really helped him.

But we were all scared to death. I mean this was, again, the 70s and my parents particularly were afraid that someone was going to go knocking down their door and arrest them.

BEN KNIGHT: Then, after her father died, the family moved from Miami to Washington, where Stephanie's mother was diagnosed with cancer.

STEPHANIE KAHN: We hadn't been living here, we didn't know anybody, we couldn't get anything for her, she couldn't. And so she essentially was diagnosed in June 2009, and died in august 2009, and she wasted away. And the doctor kept saying 'you really need to try some of this and to use it just so you can take something down - eat something.'

BEN KNIGHT: This was at exactly the time that the District of Columbia voted to legalise medical marijuana. Stephanie and Jeffrey didn't think twice about opening their own dispensary.

STEPHANIE KAHN: I just fell in love with the idea. This would be something in my parents' memory. We can open some place that they could have gone to, that people like them could go to and feel safe and get help.

I get choked up every time I talk about this.

It was really important that we could do something here in their neighbourhood. It just meant a lot.

BEN KNIGHT: Tell me about your patients. I mean, do they remind you of your parents?

STEPHANIE KAHN: Yes, a number of them do, it's really amazing.

JEFFREY KAHN: I think that we're going to find some form of legalisation in just about every state. It's what's happening - there really isn't significant opposition, and I think that the old laws just don't really make any sense to anyone anymore.

BEN KNIGHT: This is Ben Knight in Washington for Correspondents Report.

http://www.abc.net.au/correspondents/content/2014/s3969374.htm