Antibiotics And Nerve Damage A Professionals View Vid

Today's post from medscape.com (see link below) is text/transcript and video talking about the link between certain antibiotics and nerve damage. There are many more articles here on the blog about the dangers of fluoroquinolone antibiotics for actual and potential nerve pain patients but this one broadens the list to include other antibiotic types as well. The article is not really aimed at patients trying to understand what sort of risks they are facing but it's always useful to hear discussion among professionals on this sort of subject. The conclusion is that if you are prescribed antibiotics by your doctor, it's always wise to have a somewhat deeper discussion, mentioning that you are concerned about the side effects on your nervous system.

Antibiotics and Neuropathy: What's the Latest?
Paul G. Auwaerter, MD Disclosures September 17, 2013

Hello. This is Paul Auwaerter from the Johns Hopkins School of Medicine, talking about peripheral neuropathy and antibiotics. This is not a topic that many in the infectious diseases community spend much time dealing with, but it recently came to our attention because of upgraded warnings to the class of fluoroquinolone drugs (such as ciprofloxacin), which may be associated with an irreversible peripheral neuropathy. The US Food and Drug Administration's Adverse Event Reporting System has received increasing numbers of reports of neuropathy.[1] Peripheral neuropathy has been included on the labeling for fluoroquinolones going back to 2004 as a warning, but there is a paucity of medical literature about this association.[2] These drugs are widely used. Rare adverse effects, such as tendon rupture and tendinopathy, have received increased press as we have had more experience with this drug class. The fluoroquinolones have been very well accepted by most of the medical community because of a generally good side-effect profile, although they have many peculiarities, such as QT prolongation.

Peripheral neuropathy is not generally associated with antibiotics.[3] The drug most often associated with peripheral neuropathy is isoniazid (INH), which is used for tuberculosis.[4] INH interferes with pyridoxine -- the vitamin B6 component of the metabolism of bacteria -- and causes B6 deficiency. This effect is enhanced in humans who might be "slow acetylators," so they accumulate very high levels of isoniazid, which could lead to toxicity. The best estimate of risk for INH toxicity is 0.2%-2% of people on long-term therapy. It usually occurs after 6 months of therapy and is usually reversible when the drug is stopped. Generally, the people who develop this complication also have comorbid conditions such as HIV, alcoholism, diabetes, or renal insufficiency.

By no means is it clear to me, at least from available data, that the story is similar for the fluoroquinolones. Whether neuropathy occurs only with long-term therapy or can occur with short-course therapy is unclear. Other antibiotics can cause neuropathy, and in my experience this typically happens with long-term administration. The drugs capable of causing neuropathy include linezolid, chloramphenicol (a drug that we don't use very much anymore), metronidazole, sulfonamides, colistin, and dapsone. Even the penicillins are capable of causing neuropathy.
The cause is not clear, although some recent work has been done by James Collins and colleagues at Boston University.[5] They are beginning to look at a systems biology approach with respect to the effects of antibiotics, not only on bacteria but also on the host. They have found that some bactericidal (rather than bacteriostatic) antibiotics can increase reactive oxygen radicals and also affect mitochondrial function. These may be some of the ways that these drugs affect different cellular structures in humans.

Antibiotics have been a godsend to our ability to thwart illness, but they do have collateral damage. We have always known this, but it is becoming increasingly recognized. Therefore, it is always good to be as cautious as possible and, when using antibiotics, to be aware of the possible side effects. At least for now, I won't change my practices because of this warning, but with long-term use of fluoroquinolones, I will perhaps be more appreciative of this possibility and stop the antibiotics at the first signs of any numbness or tingling.
References
Medscape Infectious Diseases © 2013 WebMD, LLC
Cite this article: Antibiotics and Neuropathy: What's the Latest? - Medscape - Sep 17, 2013.

http://www.medscape.com/viewarticle/810905

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/

An Irish View Of Neuropathic Pain

Today's post from irishhealth.com (see link below) is another general information article about neuropathy. You may have noticed that different countries have slightly different views on the subject and may offer different advice. This is not to say that any one is any less accurate than the other but even for experienced neuropathy patients, every description adds a little more knowledge to the puzzle and is therefore worth reading.

Neuropathic Pain
Irishhealth.com 6th November 2013

What is it?

Neuropathic pain is another term for nerve pain.

There are a number of different causes. Common ones are pain following shingles (postherpetic neuralgia), diabetic neuropathy and trigeminal neuralgia.

Other conditions affecting the nerves also cause neuropathic pain. These include cancer and pain after chemotherapy, HIV infection, phantom limb pain, multiple sclerosis, alcoholism, atypical facial pain and other common nerve disorders.

There are two types of pain:

Nociceptive pain is caused by damage to tissue e.g. cuts, burns, injuries etc... This type of pain is sharp or aching. Common painkillers like paracetamol, anti-inflammatories, codeine and morphine can ease this pain.

Neuropathic pain is caused in the nerves themselves. The sensations caused by this type of pain feel like burning, shooting, stabbing or an electric shock. There are particular types of medications which may ease this pain. Common painkillers are unlikely to work.

Nociceptive and neuropathic pain have different causes and thus require different medications. However, you can have both types of pain simultaneously. This is common in cancer, for example.

Neuropathic pain has some unusual aspects. It can get worse with a touch, prod or stimulus that normally would not cause pain. You may even feel pain when there is no touch or stimulus. This is often in the form of pins and needles or electric shock sensations.

Neuropathic pain can have a significant impact on quality of life. Your doctor will discuss your symptoms with you and try to pinpoint the nature and extent of your pain. Visual scales and charts may be used to help you and it is important to try to describe the nature of the pain, e.g. aching, shooting, burning etc...

Treatment for neuropathic pain

There are a number of treatments that may be tried by your GP or specialist. The type of treatment and dosage is individualised and different approaches may be tried before there is symptom relief. Your doctor will discuss treatment options with you and set out realistic goals - in some cases symptoms may be greatly eased but will not necessarily go away altogether.

In combination with medication, other therapies may be beneficial such as counselling, coping strategies, physiotherapy, electrical nerve stimulation and heat and cold packs. People with pain may become depressed or anxious and it is important that these are addressed as well as the physical pain.

Some antidepressants are used to treat neuropathic pain, particularly neuralgia. Unlike common pain medicines, these do not have an immediate effect but can take days or weeks before a difference is seen and the pain eases.

A more recent antidepressant, duloxetine, is also suitable for treating neuropathic pain, particularly diabetic peripheral neuropathic pain.

Pregabalin, which was originally an anti-epileptic medication, is used specifically for treating neuropathic pain. The dose is individualised and will be adjusted to suit the particular individual.

Another option is Tramadol, which is a strong pain medication. Other strong medications may be considered if you are seeing a specialist.

Strong cream may be applied to ease the pain if medicines are not effective. This appears to work by blocking the nerves from transmitting pain messages. This is applied several times a day, but can take several days before it becomes effective.

Your GP may try different doses of these medications, sometimes in combination. If the pain persists, you may be referred to a specialist pain clinic. At clinics, other physical treatments may be offered, including nerve blocks and other stimulations and devices. There are also pump implants which release drugs directly into the system.

How pain management is approached depends on individual circumstances. Seek the advice of a health professional and offer as much information as you can about your symptoms. Keeping a pain diary can be useful.

 http://www.irishhealth.com/article.html?con=656