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

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Do You Take Opioid Strength Medications For Your Neuropathy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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