Today's post from chiroeco.com (see link below) looks at the value of nutrition and nutrition supplements in helping to control the worst aspects of neuropathy. Either used together with pain medications (as mentioned below) or separately, there are certain nutrients, vitamins and minerals that will help restore nerve function. However, just as with drugs, there are no cures here, just options to help your system stay as healthy as possible. Worth a read but bear in mind that the cost of these things can be high.
Natural hope for neuropathy
Research supports nutritional remedies for a common diabetic ailment. by Terry Lemerond
Pins and needles. A burning that begins in the feet and legs and progresses to the arms. An unpleasant crawling sensation that travels under the skin. Stabbing, intense leg pain that keeps one awake at night. The symptoms of peripheral neuropathy can develop suddenly or progress slowly, sometimes over years. Neuropathy is the most common complication of diabetes, affecting 50 percent of patients with Type 1 or 2.1
Prescription drugs, including anti-depressants, anti-seizure medications, pain relievers, and anti-nausea drugs are used in the treatment of neuropathy. But none of them result in repairing delicate blood vessels and nerve endings or helping the body learn to properly metabolize sugar again. Fortunately, nutrition research has found that along with lifestyle choices, specific nutrients can relieve — and even reverse — the symptoms and causes of neuropathy.
Bioactive B vitamins
B vitamins are crucial for blood sugar metabolism and proper nerve function. Inadequate or deficient levels of B vitamins are often noted in patients with diabetes. Replenishing this vitamin not only improves blood sugar control but also reduces inflammatory homocysteine levels and relieves the pain of neuropathy.
Clinical effects in neuropathy treatment may be improved with the use of the active forms of specific B vitamins, which do not require conversion into a usable form by the liver. Pyridoxal-5'-phosphate (vitamin B6), methylcobalamin (vitamin B12), and folate (vitamin B9) are examples of B vitamins in their active forms.
A study of epidermal nerve fiber density in patients with Type 2 diabetes treated with an oral combination of vitamin B9, B12, and B6 reported that nearly 75 percent of patients showed an increase in nerve fiber density, and slightly more than 80 percent of patients experienced reduced frequency and intensity of burning, tingling, and abnormal sensitivity to touch.2
Benfotiamine is a fat-soluble form of vitamin B1 that is retained in the body at five times the concentrations of standard water-soluble thiamine. A scientific study at the University of Florida College of Medicine showed that benfotiamine prevented glucose toxicity and brought elevated blood sugar levels down to normal.3
This form of vitamin B1 has also been clinically proven to reduce pain and complications of diabetic neuropathy, the “pins and needles” and “tingling” sensation that people with diabetes may feel in their feet and legs.
In a Serbian clinical study, patients with diabetes were treated with a combination of benfotiamine and vitamin B6 for 45 days. At the end of the study, just over 85 percent of the patients reported a significant reduction in overall pain. Hyperpathia (pain due to the loss of muscle fibers) was also reduced from 90 percent of patients to around 30 percent. The researchers felt that these results “confirmed that benfotiamine was a good starting choice for the treatment of diabetic polyneuropathy.”4
Chelated minerals
Chromium is essential for blood sugar metabolism. It activates insulin receptors, helping prevent the buildup of glucose in the bloodstream. In one clinical study, individuals taking chromium reduced their fasting blood glucose level from an average of 197 to 103 in just three months, and their triglyceride and LDL cholesterol numbers were brought down to healthier levels as well.5
Zinc stabilizes pancreatic storage of insulin and inhibits oxidative stress that promotes insulin resistance and diabetes. Research published in Diabetes, Obesity, and Metabolism reported that reduced zinc levels in the pancreas are associated with diabetes, and proper amounts of this mineral tend to keep insulin levels on an even keel.6,7
Although many forms of minerals are available as supplements, amino acid chelated forms are more easily and efficiently used by the body. The bonding of a mineral to the amino acid glycine creates a mineral form that passes through the intestinal wall and is incorporated into the blood stream more efficiently.
Blood sugar lowering nutrients
Alpha lipoic acid can boost levels of glutathione to protect delicate nerves from oxidative damage. In a review by researchers at Oregon State University, the evidence shows that alpha lipoic acid
(ALA) fights diabetic neuropathy by helping to normalize the muscles’ blood sugar intake, which reduces the pain and tingling of peripheral nerves. Other laboratory research published in Diabetes found that ALA reversed markers of diabetic neuropathy and improved peripheral nerve function.8,9
Boswellia (Boswellia serrata) is one of nature’s most powerful anti-inflamma- tory medicines. It is a specific inhibitor of 5-LOX, an enzyme that activates inflammation-inducing leukotrienes. One of the biggest challenges for people with diabetes and nerve damage is the pain and inflammation that accompany the condition.10,11
The most active and beneficial of the boswellic acids is known as AKBA (acetyl-11-keto-?-boswellic acid). However, not all boswellia extracts are equally beneficial. For example: In unstandardized boswellia products, AKBA levels can be quite low — sometimes as small as 1 percent. To make sure you get the best product, look for boswellia standardized to at least 10 percent AKBA. Additionally, unstandardized boswellia contains a pro-inflammatory compound called beta boswellic acid (BBA), which must be reduced to less than 5 percent for optimal effectiveness.
Heal naturally
There is a growing awareness of the benefits of nutrients for slowing or reversing disease.
For example: Following the clinical trial published in Diabetes Research and Clinical Practice, researchers concluded that micronutrients, including B1, B2, B6, B12, folate, and zinc could “ameliorate diabetic neuropathy symptoms.”12 These interventions are starting to garner wider acceptance as linchpins for effective treatment protocols.
The damage done by elevated blood sugar levels (as seen with Type 2 diabetes) happens over time. The disease is not always noticed at first. But through a sensible exercise regimen, disciplined eating habits, and well-guided use of nutrient ingredients, the pain, numbness, and tingling of neuropathy can be overcome.
Terry Lemerond is a natural health expert with more than 40 years’ experience. He has owned health food stores, founded dietary supplement companies, and formulated more than 400 products. A published author, he appears on radio, television and is a frequent guest speaker. He can be contacted through europharmausa.com.
References
1Quan D, Lin HC, Khardori R, et al. Diabetic Neuropathy: Practice Essentials. Medscape. emedicine.medscape.com/article/1170337-overview. Updated May 29, 2013. Accessed June 17, 2014.
2Jacobs AM, Cheng D. Management of diabetic small-fiber neuropathy with combination L-methylfolate, methylcobalamin, and pyridoxal 5'-phosphate. Rev Neurol Dis. 2011;8(1-2):39-47.
3Oh SH, et al. Detection of transketolase in bone marrow-derived insulin-producing cells: benfotiamine enhances insulin synthesis and glucose metabolism. Stem Cells Dev. 2009;18(1):37-46.
4Nikoli? A, Kacar A, Lavrni? D, Basta I, Apostolski S. The effect of benfothiamine in the therapy of diabetic polyneuropathy. Srp Arh Celok Lek. 2009;137(11-12):594–600.
5Sharma S, Agrawal RP, Choudhary M, Jain S, Goyal S, Agarwal V. Beneficial effect of chromium supplementation on glucose, HbA(1)C and lipid variables in individuals with newly onset type-2 diabetes. J Trace Elem Med Biol. E-pub ahead of print; May 11, 2011.
6Wijesekara N, Chimienti F, Wheeler MB. Zinc, a regulator of islet function and glucose homeostasis. Diabetes Obes Metab. 2009;11 Suppl 4:202-14.
7Senapati A. Zinc deficiency and the prolonged accumulation of zinc in wounds. Br J Surg. 1985;72(7):583-4.
8Shay KP, Moreau RF, Smith EJ, Smith AR, Hagen TM. Alpha-lipoic acid as a dietary supplement: molecular mechanisms and therapeutic potential. Biochim Biophys Acta. 2009;1790(10):1149-60.
9Kishi Y, Schmelzer JD, Yao JK, et al. Alpha-lipoic acid: effect on glucose uptake, sorbitol pathway, and energy metabolism in experimental diabetic neuropathy. Diabetes. 1999;48(10):2045-51.
10Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006;72(12):1100-16.
11Poeckel D, Tausch L, Altmann A, Induction of central signalling pathways and select functional effects in human platelets by beta-boswellic acid. Br J Pharmacol. 2005;146(4):514-24
12Farvid MS, et al. Improving neuropathy scores in type 2 diabetic patients using micronutrients supplementation. Diabetes Res Clin Pract. 2011;93(1):86-94.
http://www.chiroeco.com/news/chiro-article.php?id=15478
Today's post from painnewsnetwork.org (see link below) is advice from one doctor to other medical practitioners regarding the prescription of opioids to chronic pain patients. It's directly applicable to many hundreds of thousands of neuropathy patients who have ended up on opioid management because there's literally been no other option. It's full of common sense and reinforces what this blog has believed from the beginning of this (primarily) USA row and that is that existing chronic patients should never be denied the medication they need to reduce their pain but should be carefully monitored and guided, so that the chances of addiction and over-prescription are minimised. Pain control must be the priority. At the moment, many doctors are refusing to issue new opioid prescriptions because of the fear that they will end up in a law court, or at best, be castigated by their local health authorities. In the meantime, the patient suffers from cold-turkey withdrawal and searches the internet or the black market to find the drugs they need, leading to more criminality and a dangerous and much bigger problem. As I said, this is currently a North American issue but as we all know, what happens in America, happens in the rest of the world shortly after. Panic law-giving and lack of understanding of medical nuances has led to a hysterical media campaign and a profession afraid of its own shadow - this can't be healthy, for patient or professional and needs to be addressed urgently. Definitely worth a read.
By now chronic pain patients and practitioners are well aware of the new Center for Disease Control and Prevention (CDC) “Guidelines for Opioids for Chronic Pain” released on March 15, 2016. Although these guidelines have been, and will continue to be, strongly criticized for the process by which they were created, they are now published.
One of the often stated goals of CDC, despite widespread skepticism from many pain specialists, is that they did not want to limit access to pain care. Let’s take them at their word.
A major “bone of contention” regarding the guidelines is the recommendation that a daily dose of opioid should seldom go over 90 mg equivalents of morphine a day. In the CDC’s words:
“Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when increasing dosage to 50 morphine milligram equivalents (MME) or more per day, and should avoid increasing dosage to 90 MME or more per day or carefully justify a decision to titrate dosage to 90 MME or more per day.”
Thankfully, few chronic pain patients require more than 90 MME for pain management. Be alert, however, to the fact that 90 MME in the guidelines is not a maximum ceiling dose but a “trigger” or “call” for a medical-necessity evaluation, including a possible consultation or referral to a pain specialist.
My personal objection about all the new opioid prescribing guidelines, including CDC’s, is that they seem to want all patients on high-dose opioids to be managed by pain specialists rather than primary care physicians (PCPs).
Unfortunately we don’t have enough pain specialists to medically manage these legitimate, suffering patients who can’t function or leave the couch without an opioid dosage above 90 MME.
While the intent of the CDC to have the most serious pain patients managed strictly by pain specialists may be laudable, this won’t solve our nation’s epidemic of untreated and undertreated chronic pain. Incidentally, the new guidelines rightfully mention all the risks of high-dose opioids, such as addiction, diversion, and overdose; but they wrongfully fail to mention all the serious, life-shortening, and physiologic impairments that are the risks of under treated, severe, chronic pain.
Sadly, without opioids, some of these unfortunate individuals will suffer immense physical dysfunction, endocrine failure (see Hormone Testing and Replacement), cardiovascular collapse, immune dysfunction, dementia, and premature death.
This memo is a plea to not discharge severe pain patients who are currently taking over 90 MME or avoid and deny patients who may need this level of opioid in the future. Be aware that the CDC guidelines do not prohibit dosages over 90 MME—what they rightly recommend is that physicians do an assessment and document medical necessity for dosages above that level.
Here are my personal practice policies and recommendations for dealing with past, current, and future patients who require over 90 MME:
The pain practitioner has to clearly state, in the patient’s chart, that the patient has severe chronic pain due to a specific underlying cause. For a patient to receive high-dosages of opioids, the physician must obtain and document the history, relevant physical exam, laboratory data, informed consent, and past records of treatments that have been tried.
Opioids should not be prescribed in isolation. Rather than just continuing to increase the dose, the physician needs to revisit what other modalities are being used or have been tried. These include: non-opioid medications such as an anticonvulsant if the pain has neuropathic elements, (being certain to titrate up to an effective dose); a topical medication such as Lidoderm patch, Voltaren gel, etc.; a physical therapist-guided home exercise program and other physical activities, including massage; consultation with an interventionist if appropriate; assessment and treatment of co-occurring anxiety or depression.
The new guidelines, in my opinion, could worsen a growing problem of access to medication. Already, in some locales, patients can’t obtain prescriptions and insurance companies don’t want to pay for opioids (or much else!!). If patients need a high, costly opioid dosage, they must personally determine the limits of their insurance coverage and identify pharmacies that will supply opioid medications.
We physicians can help but none of us has the time or influence to help every pain patient with his or her personal supply of medication and insurance issues. Simply stated, a patient must be an active rather than traditional, passive patient: pain patients must now join advocacy groups and begin to lobby for their right to obtain opioids and avoid an agonizing existence and premature death.
Millions of chronic pain patients now take opioids responsibly and constructively. While opioids aren’t for everybody, many pain patients who are taking high-dose opioids have enhanced their overall health, achieved a decent quality of life, and have likely extended their life span. These patients don’t abuse, divert, or overdose on their opioids, and they don’t develop hyperalgesia or the need to continually escalate their dosage. Isn’t it time we pay as much attention to these worthy folks as those who non-comply, abuse, and overdose?
Dr. Forest Tennant is pain management specialist in West Covina, California who has treated chronic pain patients for over 40 years. He has authored over 300 scientific articles and books, and is Editor Emeritus of Practical Pain Management.
This column is republished with permission by Practical Pain Management, which featured the opinions of several other practitioners on the CDC guidelines this month. You can see them all by clicking here.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.
http://www.painnewsnetwork.org/stories/2016/4/21/dont-flinch-from-prescribing-pain-medications
Today's post from kiich.sharedby.co (see link below) is very useful and well-written information about neuropathy from a physical therapist, responding to discussions with one of his patients. His advice is spot on and the information he provides can be understood by everybody (in contrast to many neuropathy information sites). From someone new to neuropathy, to experienced patients who have suffered for years, a few minutes reading this will not be time wasted.
Are you suffering from peripheral neuropathy?
By Bob Cairo Special to the Coastal Point Date Published: March 20, 2015
A few weeks ago, a patient told me he wanted me to write an article about diabetic neuropathy. As I was thinking about it, it occurred to me that there are so many kinds of peripheral neuropathy that I wanted to make sure I help all of you who are struggling with it or might be soon.
It’s complicated, it’s painful and it can change your life in dramatic ways. Are you experiencing sharp or stabbing pain in your knees and ankles? Do your calves ache or are your feet numb? Do your legs feel like they are on fire?
Pain in our lower extremities is a very common issue, especially as we age. But, if you haven’t taken a fall, twisted a knee or done something that would easily identify exactly what’s causing your problem, you may be suffering from peripheral neuropathy. Understanding what it is and what you need to do if you or a loved one is diagnosed with peripheral neuropathy could have a lifelong impact on mobility and quality of life.
We all understand that our nervous system controls the proper function of every system in our bodies. The peripheral nervous system involves the nerves that lead from our brain and spinal cord to the rest of our body. When one of these nerves becomes diseased or damaged from a trauma or even repetitive stress, it’s called peripheral neuropathy.
Some 2 to 3 million Americans are struggling with a type of peripheral neuropathy. This is a problem that doesn’t discriminate in gender or age, but it’s particularly common in people older than 55. If you are a diabetic and you aren’t doing all that you should to control it, you are a high-risk candidate.
Because there are so many potential problems, I’m going to focus on the lower extremities, because that is one of the most common areas of impact.
It’s tricky to diagnose peripheral neuropathy, because there are so many potential causes, and doctors will tell you that not all the causes are known. We know that more than 50 percent of diabetics experience at least one type of neuropathy, and feet and legs are one of the biggest areas of impact.
We also know that some viruses and bacteria will attack the nerves. We know that alcoholism, vitamin deficiencies, traumas, some autoimmune diseases, infections and even tumors, whether benign or malignant, can be among the many potential causes.
People who are afflicted with a peripheral neuropathy in their lower extremities often talk about burning and sharp or stabbing pain. In many cases, there’s a tingling sensation. Sometimes, numbness and tingling comes on gradually in the feet and will spread to the legs.
Many people talk about the terrible discomfort associated with a simple touch, and some people lose feeling all together. Others lose coordination and start having a problem with falling, as a result. Muscle weakness is another potential symptom.
If you start to experience pain, weakness, tingling or any of the symptoms we were just talking about in your legs, knees, calves, ankles or feet, see a doctor immediately. Waiting to get help can be a terrible, costly decision, because the sooner you are diagnosed and treatment begins, the better your chances of getting those symptoms under control and stopping any additional damage occurring.
It’s a good idea to prepare for your doctor’s appointment by remembering to bring a list of all your medications with you and include any vitamins and supplements you might be taking.
It often helps to write down your symptoms and make sure you include any problems you might be experiencing. A problem that might seem unrelated to a symptom you are experiencing could actually be directly related. I’m sure you’ve heard this before, but it’s always better to write down your questions and leave some blank space to write down information your doctor is giving you as it happens. It can be so hard to remember everything that is said later on.
I also suggest you bring someone with you. There’s something to that old saying that two heads are better than one. You might miss something that is said, and having a second listener can be very helpful to keep all that information straight.
You can expect that your doctor will conduct a thorough examination and will likely perform some tests to determine the cause of your problem. If it’s peripheral neuropathy, your doctor may refer you to a neurologist. Your doctor will be looking to determine the cause of your neuropathy, the type of nerve problems and what damage has already taken place.
Clearly, the type of treatment you receive depends on the problem that’s causing the neuropathy. In some cases, medications may help.
For problems such as muscle weakness, you will likely be sent to a physical therapist to help you expand your range of motion and build muscle strength. Your doctor may also ask your physical therapist to work with you on building an exercise program to help with pain management and, in the case of diabetes, to help control your blood sugar.
If you are diabetic, make sure you are checking your feet regularly for any signs of trouble and regularly monitor your blood glucose levels. Don’t be surprised if your doctor makes other recommendations about your diet and suggests some actions you take at home to manage your peripheral neuropathy.
One final thought: If you or a loved one has been diagnosed with peripheral neuropathy, make it your job to learn everything you can about your particular condition. It’s important to be an active participant in your care plan. You want to be armed with the information you need to make informed decisions about your treatment as you work with your care team of professionals to get the best possible outcome.
Bob Cairo is a licensed physical therapist at Tidewater Physical Therapy. He can be reached by calling (302) 537-7260.
http://kiich.sharedby.co/de4d996b4c7488eb/?web=9dbef0&dst=http%3A//www.coastalpoint.com/content/are_you_suffering_peripheral_neuropathy_03_20_2015
Today's post from topclassactions.com (see link below) is the latest article warning of the dangers of nerve damage from fluoroquinolone antibiotics. This time the warning comes from the FDA themselves. Last year they instructed the pharmaceutical companies to put warning labels on the boxes of these drugs and now they are advising doctors who prescribe these antibiotics, to be especially alert to symptoms of nerve damage in their patients (at which point of course, it could be too late). There's no doubt that this has been the hot topic in neuropathy circles for some time now but with good reason. If your doctor prescribes antibiotics for you, ask him or her if they belong to the fluoroquinolone group and if they do, don't leave the surgery until you have had a serious discussion as to whether they're going to harm you or not. There are alternatives but successful marketing campaigns have made these drugs the most popular antibiotics around. However, if you're prone to neuropathic problems or have them already you really need to question their value for you.
By Amanda Antell January 13, 2015
Due to the mass concern of fluoroquinolone side effects, the FDA recently announced that it wants healthcare professionals to watch for the risk of peripheral neuropathy in patients prescribed these antibiotics.
As of Aug. 15, 2013, fluoroquinolones had become a major concern for the FDA for a number of reasons, but this particular warning surrounded the devastating side effect peripheral neuropathy, which can cause nerve damage, burning pain, paralysis and more.
The agency advises prescribing physicians to closely monitor patients who are prescribed any members of the fluoroquinolone family, which include the antibiotics levofloxacin (Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), and gemifloxacin (Factive).
In its announcement, the FDA reiterated its requirement for manufacturing companies to have their medications’ labels include peripheral neuropathy on their list of side effects, and emphasized the danger with a recent toll of injuries. If not diagnosed in time, this condition can cause severe to permanent damage.
According the FDA’s Center for Drug Evaluation and Research Trade press team, the agency made the decision to update the warning for fluoroquinolone peripheral neuropathy due to the number of injury reports the agency had received. While the agency decided against withdrawing fluoroquinolones from the market, the FDA did revise its systemic benefit and risk evaluations regarding these antibiotics.
A recent review of the FDA’s Adverse Event Reporting System (AERS) Database had identified 83 cases of fluoroquinolone peripheral neuropathy between Jan. 01, 2003 and Aug. 01, 2012; this was the report discussed in the Aug. 15, 2013 FDA warning. Each of these patients had become disabled due to some degree of antibiotic nerve damage, which furthered the FDA’s concern of this possible correlation.
Antibiotic Nerve Damage a Concern for Years
The concern of peripheral neuropathy being associated with fluoroquinolones started in 2004, when the FDA required all fluoroquinolones to carry this risk on their list of side effects.
While the complication of antibiotic nerve damage is a frightening thought, it’s the fact that the injury reports indicate that the condition could start within a few days of starting the medication, and continue for years after stopping it, that has many so concerned. Even in 2015, the FDA and other medical institutes have not managed to identify what exactly causes peripheral neuropathy from antibiotics, but it appears not to be related to age or duration of medication use.
Additionally, during their August 2013 warning, FDA MedWatch stated that physicians should give patients a medication guide for every fluoroquinolone prescription, and patients should be instructed to contact their physicians if they show signs of peripheral neuropathy. While suddenly ceasing medication is not advisable without a physician’s consultation, the FDA generally recommends that the medication should be switched with a non-fluoroquinolone antibiotic, unless the risks of the new antibiotic outweigh the benefits.
Medical experts state that a majority of peripheral neuropathy reports indicate that it is not linked with diabetes, thyroid conditions, vitamin deficiencies, or environmental factors. It is important to note that the risk of peripheral neuropathy is still a relatively recent concern, but remains prevalent because there are no known prevention methods.
Overview of Quinolone Peripheral Neuropathy
Fluoroquinolones are among the most popularly prescribed antibiotics in the United States, and are used to treat a variety of bacterial infections. In 2011, over 23 million patients were prescribed a member from this antibiotic family to treat their conditions. As mentioned before, peripheral neuropathy has been listed as a side effect for fluoroquinolones since 2004, with patients reporting long-lasting or permanent disability, allegedly in direct consequence of using this medication.
Peripheral neuropathy is a condition where the nerves that send signals from the brain and spinal cord become damaged, which disrupts communication with the rest of the body. Symptoms of peripheral neuropathy will vary depending on which nerves are affected. Generally speaking, the symptoms are in the arms and legs and include numbness, tingling, burning, or shooting pain.
It is important to note that peripheral neuropathy symptoms start quickly, and spread just as fast, so it is vital that patients see their physicians immediately. http://topclassactions.com/lawsuit-settlements/lawsuit-news/47255-fluoroquinolone-peripheral-neuropathy/
