How Good Is Methadone For Neuropathic Pain

Today's post from mypcnow.org (see link below) takes a look at methadone as an alternative to other opioids for controlling neuropathic pain. Methadone has had an extremely bad rap over the years, mainly because of its association with withdrawal from drug addiction programmes. However, it is an extremely cheap and effective drug for nerve pain and because only low doses are needed, the risks of side effects and addiction are much less than for instance morphine or oxycodone. That said, it is a powerful drug and once you begin, you need to be very careful when and if you want to taper off. Never go cold turkey with methadone - it will react almost instantly. Many doctors are reluctant to issue methadone prescriptions but that's often based on lack of experience rather than factual dangers. If a patient discovers over time that nothing else works, then methadone can be very effective in controlling nerve pain. Remember, all drugs for neuropathy have side effects, so don't be put off by what you may have heard - it all boils down to careful monitoring by your doctor. Discuss it with him or her if you find that almost nothing works for you in reducing the pain of neuropathy.

METHADONE FOR NEUROPATHIC PAIN
David E Weissman MD FAST FACTS AND CONCEPTS #171

Background Prescriptions for methadone have greatly increased in the past decade (1). The reason for this increase is likely related to two factors: reduced cost relative to other potent opioids and basic science data suggesting that methadone may be particularly useful in treating neuropathic pain. Two previous Fast Facts (#75, 86) reviewed methadone’s pharmacological properties. This Fast Fact examines the research base regarding methadone and neuropathic pain and reviews the rise in methadone-related deaths.

Historical Context

Prior to 1985, when long-acting morphine preparations were introduced, methadone was commonly prescribed for cancer-related pain as it had a longer duration of action than morphine. However, it was well appreciated that methadone had a higher risk of respiratory depression due to drug accumulation with chronic dosing – an effect not associated with other opioids, for which there is no drug accumulation in the setting of normal renal function.

Prior to 1990 there was a widespread belief that opioids were relatively ineffective in treating neuropathic pain. Since then, there been a much greater understanding that opioids are an effective part of neuropathic pain treatment.

Basic science data Methadone inhibits reuptake of norepinephrine and serotonin in a similar manner to newer anti-depressants, some of which are effective against neuropathic pain (e.g. duloxetine, venlafaxine). Also, methadone binds to the NMDA receptor, a known modulator of neuropathic pain. Finally, methadone has demonstrated efficacy in animal models of neuropathic pain (2).

Patient data Small non-controlled case series and two small randomized study (methadone vs. placebo) have demonstrated that methadone can reduce neuropathic pain in both cancer and non-cancer patients (3-6). There is no data, for or against the proposition, that methadone is superior to other opioids for neuropathic pain. A 2007 Cochrane Collaborative review found, “there is no trial evidence to support the proposal that methadone has a particular role in neuropathic pain of malignant origin” (7). Furthermore, the review cautioned clinicians about the danger of methadone-induced respiratory depression due to its long terminal half-life.

Methadone deaths There is a growing awareness that the increased prescription of methadone is being paralleled by a similar increase in methadone-related deaths. Methadone has been implicated in 30% to 40% of opioid related deaths in the US, even though methadone remains a small minority of opioids prescribed (8). The US Department of Health and Human Services convened an expert panel in 2003 to investigate the rise in methadone deaths and concluded that the rise was largely due to the increasing use of methadone as an analgesic (9). The Center for Disease Control published a report detailing data from Utah in 2005, suggesting that part of the problem was due to increased prescribing (10). The current data seem to suggest that the general increased supply of methadone, via legitimate prescribing, is leading to deaths due to accidental overdose through improper prescribing or illicit diversion/recreational use. In addition to concern about respiratory depression, there has been an observation that methadone, unlike morphine or hydromorphone, can prolong the QTc interval and lead to serious cardiac conduction abnormalities especially when coadministered with antiretrovirals in HIV patients (11). Note: the overall number of opioid-related deaths has increased, not just from methadone. Note: there are no data on untimely deaths related to methadone prescribing in hospice/palliative care patients.

Summary The renewed interest in an old drug holds exciting promise of benefit for the many patients with neuropathic pain. However, clinical research has yet to confirm or deny a unique clinical role for methadone compared to other opioids. The risk of respiratory depression should give clinicians pause before prescribing methadone based solely on the theory that it is a superior opioid in neuropathic pain. Coadministration of methadone with antiretrovirals may pose a particular risk for cardiac arrhythmias and therefore should be avoided if at all possible., Given that diversion of legitimate opioid prescriptions to the illicit market can occur, even in the practice of hospice and palliative care, physicians and hospice agencies need to recognize they also have a larger social responsibility to the public welfare, and prescribe methadone with care and caution.

References

Warner M, Chen LH, et al. Drug poisoning deaths in the United States, 1980–2008. NCHS Data Brief. 2011; 1-8.

Foley KM. Opioids and chronic neuropathic pain. NEJM 2003; 348:1279-1281.

Morley JS, et al. Low-dose methadone has an analgesic effect in neuropathic pain: a double-blind randomized controlled crossover trial. Pall Med. 2003; 17:576-587.

Altier N, et al. Management of chronic neuropathic pain with methadone: a review of 13 cases. Clin J Pain. 2005; 21:364-369.

Gagnon B, et al. Methadone in the treatment of neuropathic pain. Pain Res Manage. 2003; 8:149-154.

Moulin DE, et al. Methadone in the management of intractable neuropathic non cancer pain. Can J Neuro Sci. 2005; 32:340-343.

Nicholson, AB. Methadone for cancer pain. Cochrane Database Syst Rev 2007; 4.4.

Centers for Disease Control and Prevention (CDC). Vital signs: risk for overdose from methadone used for pain relief – United States, 1999-2010, Morb Mortal Wkly Rep 2012; 61:493-497.

Increase in poisoning deaths caused by non-illicit drugs--Utah, 1991-2003. MMWR Weekly. 2005; 54:33-36.

US Department of Health and Human Services – Division on Pharmacologic Therapies. Report on Methadone Mortality (http://dpt.samhsa.gov/reports/methodone_mortality-05.htm - no longer publicly available). Updated Report available at: http://www.dpt.samhsa.gov/pdf/MethadoneBackgroundPaper_72007_2_.pdf.

Kao D, Bartelson BB, et al. Trends in reporting methadone-associated cardiac arrhythmia, 1997-2011. Ann of Int Med 2013;158: 735-740.

Version History: This Fast Fact was originally edited by David E Weissman MD and published in December 2006. Version copy-edited in April 2009: web-links updated. Revised again in July 2015 by Sean Marks MD: references and epidemiological data updated.

Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s content. The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact information, and how to reference Fast Facts.

Copyright: All Fast Facts and Concepts are published under a Creative Commons Attribution-NonCommercial 4.0 International Copyright (http://creativecommons.org/licenses/by-nc/4.0/). Fast Facts can only be copied and distributed for non-commercial, educational purposes. If you adapt or distribute a Fast Fact, let us know!

Disclaimer: Fast Facts and Concepts provide educational information for health care professionals. This information is not medical advice. Fast Facts are not continually updated, and new safety information may emerge after a Fast Fact is published. Health care providers should always exercise their own independent clinical judgment and consult other relevant and up-to-date experts and resources. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

http://www.mypcnow.org/blank-ari0c

Is Antidepressant Milnacipran Any Good For Neuropathy

Today's post from cochrane.org (see link below) looks at Milnacipran, an antidepressant and asks whether it's effective in reducing neuropathic pain. Due to antidepressants and especially SNRI (serotonin–norepinephrine reuptake inhibitor) antidepressants, being standard treatment for neuropathic pain, that doesn't mean to say that every antidepressant in the range is effective. Cochrane has looked at the drug and concludes that there is no evidence to suggest Milnacipran is of any help in taming nerve pain. Forewarned is forearmed as they say, so if your doctor suggests taking Milnacripan, it may be worth presenting this evidence to him or her.

Milnacipran for neuropathic pain in adults
Authors: Derry S, Phillips T, Moore R, Wiffen PJ Published: 6 July 2015
 
Neuropathic pain is pain coming from damaged nerves. It is different from pain messages that are carried along healthy nerves from damaged tissue (for example, a fall, or cut, or arthritic knee). Neuropathic pain is treated by different medicines to those used for pain from damaged tissue. Medicines such as paracetamol or ibuprofen are not usually effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.

Milnacipran is an antidepressant, and antidepressants are widely recommended for treating neuropathic pain; milnacipran may also be useful in these painful conditions.

This is an update of a review of milnacipran for neuropathic pain and fibromyalgia, first published in 2012. That review has been split so that this one looked only at neuropathic pain, and a separate review looks at fibromyalgia.

In February 2015 we performed searches to look for clinical trials where milnacipran was used to treat neuropathic pain in adults.

We found only a single, small study of 40 participants who had chronic low back pain with a neuropathic component. Milnacipran was no different from placebo in terms of pain or adverse events (very low quality evidence).

There was no evidence to support use of milnacipran to treat neuropathic pain conditions.

Authors' conclusions:

There was no evidence to support the use of milnacipran to treat neuropathic pain conditions. 

Background:

Milnacipran is a serotonin–norepinephrine reuptake inhibitor (SNRI) that is sometimes used to treat chronic neuropathic pain and fibromyalgia. This is an update of an earlier review of milnacipran for neuropathic pain and fibromyalgia in adults originally published in The Cochrane Library Issue 3, 2012. We split that review so that this one looked only at neuropathic pain, and a separate review looks at fibromyalgia. 

Objectives:

To assess the analgesic efficacy and associated adverse events of milnacipran for chronic neuropathic pain in adults. 

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE to 23 February 2015, together with reference lists of retrieved papers and reviews. 

Selection criteria:

We included randomised, double-blind studies of eight weeks' duration or longer, comparing milnacipran with placebo or another active treatment in chronic neuropathic pain. 

Data collection and analysis:

Two review authors independently searched for studies, extracted efficacy and adverse event data, and examined issues of study quality. We did not carry out any analysis. 

Main results:



We included a single study of 40 participants with chronic low back pain with a neuropathic component. It found no difference in pain scores between milnacipran 100 mg to 200 mg daily or placebo after six weeks (very low quality evidence). Adverse event rates were similar between treatments, with too few data to draw conclusions (very low quality evidence).

http://www.cochrane.org/CD011789/SYMPT_milnacipran-neuropathic-pain-adults

Is Zonisamide A Good Idea For Neuropathic Pain

Today's post from onlinelibrary.wiley.com (see link below) looks at Zonisamide as a possibly effective drug for reducing neuropathic pain. Zonisamide is one of the anti-epileptic/ anti-convulsant drugs that are designed to treat epilepsy. Like some other anti-convulsants, it's now being prescribed to treat neuropathic pain and discomfort. However, this study shows that there is very little evidence to support its effectiveness in suppressing nerve pain and that other anti-epileptics are far more effective - for instance, Gabapentin and pregabalin (Lyrica). However, there are also questions surrounding the effectiveness of pregabalin especially for neuropathy caused by diabetes and HIV (see other articles on this blog), not least from the manufacturers themselves! Gabapentin has a far better reputation but as this article shows, Zonisamide hasn't proved to be effective at all. Worth discussing with your doctor or neurologist, if anti-convulsants are being prescribed for you.
 

Zonisamide for neuropathic pain in adults
R Andrew Moore1,*, Philip J Wiffen1, Sheena Derry1, Michael PT Lunn2 
Editorial Group: Cochrane Pain, Palliative and Supportive Care Group
Published Online: 22 JAN 2015

Abstract

Background

Antiepileptic drugs have been used in pain management since the 1960s; some have shown efficacy in treating different neuropathic pain conditions. The efficacy of zonisamide for the relief of neuropathic pain has not previously been reviewed.

Objectives

To assess the analgesic efficacy and associated adverse events of zonisamide for chronic neuropathic pain in adults.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (via CRSO), MEDLINE, EMBASE, and two clinical trials databases (ClinicalTrials.gov. and the World Health Organisation Clinical Trials Registry Platform) to 1 August 2014, together with reference lists of retrieved papers and reviews.

Selection criteria

We included randomised, double-blind studies of at least two weeks' duration comparing zonisamide with placebo or another active treatment in chronic neuropathic pain. Participants were adults aged 18 and over. We included only full journal publication articles and clinical trial summaries.

Data collection and analysis

Two review authors independently extracted efficacy and adverse event data, and examined issues of study quality. We considered the evidence using three tiers. First tier evidence derived from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for dropouts; at least 200 participants in the comparison, 8 to 12 weeks duration, parallel design); second tier evidence derived from data that failed to meet one or more of these criteria and were considered at some risk of bias but with adequate numbers in the comparison; and third tier evidence derived from data involving small numbers of participants that were considered very likely to be biased or used outcomes of limited clinical utility, or both.

We planned to calculate risk ratio (RR) and numbers needed to treat (NNT) and harm (NNH) for one additional event using standard methods expected by The Cochrane Collaboration.

Main results

We included a single study treating 25 participants (13 zonisamide, 12 placebo) with painful diabetic neuropathy over 12 weeks. No first or second tier evidence was available for any outcome. The small size of the study and potential major bias due to a high proportion of early study withdrawals with zonisamide precluded any conclusions being drawn. There were two serious adverse events (one death) in zonisamide-treated participants, which were apparently not related to treatment.

Authors' conclusions

The review found a lack of evidence suggesting that zonisamide provides pain relief in any neuropathic pain condition. Effective medicines with much greater supportive evidence are available.

Plain language summary

Zonisamide for neuropathic pain in adults

Neuropathic pain can arise from damage to nerves and injury to the central nervous system. It is different from pain messages carried along healthy nerves from damaged tissue (a fall, or cut, or arthritic knee). Neuropathic pain is treated by different medicines than those used for pain from damaged tissue. Medicines like paracetamol or ibuprofen are not usually effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.

Zonisamide is one of a type of medicine normally used to treat epilepsy. Some of these medicines are also useful for treating neuropathic pain. We looked for clinical trials that used zonisamide to treat neuropathic pain. We found a single study with 25 participants treated either with zonisamide or placebo. Study reporting may have led to major over-estimation of any treatment effects because most (8/13) participants treated with zonisamide withdrew before the end of 12 weeks of treatment for a variety of reasons, mostly adverse events (side effects).

There was too little information, which was of inadequate quality, to give any guidance as to whether zonisamide works as a pain medicine in any neuropathic pain condition. Other medicines have been shown to be effective in some types of neuropathic pain.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011241.pub2/abstract

Are Tens Units Any Good For Neuropathy

Today's post from diabetic2.tophealthychoices.com (see link below) reflects the varying opinions about the benefits of electrical nerve stimulation machines such as Tens, for people with nerve damage. As a result, this article can only be seen as one person's opinion and the best advice would be to consult as many people as possible (including your doctor) and do your own research before  starting using such appliances. That said, if numbers are to be believed, thousands of people across the world do get some benefit from using Tens and others but that can be said from almost all given neuropathy treatments. Do all the research you can but remember, as with all neuropathy treatments, what works for some doesn't work for others - it remains a minefield.

Using Electrical Nerve Stimulation Machine for Diabetic Neuropathy Should Be Considered  

No visible author 18 Jun, 2015

 The most common forms of electro-analgesia is the Tens machine. There has been several clinical reports and ongoing research with regards to the use of Tens machines for certain medical conditions such as arthritic pain, myofacial, lower back pain, bladder incontinence, visceral pain, post operative pain and neurogenic pain. Due to these studies being inconclusive, the question as to whether the Tens are more effective than a placebo in combating pain is still unresolved. The mechanisms currently proposed with regards to the Neuro modulation that Tens produces include pain control, restoration of input afferent, and presynaptic inhibition in the dorsal horn of the spinal cord and direct inhibition of an abnormal excited nerve.

Studies revealed that the electrical stimulation reduces pain via nociceptive inhibition in the horn of the spines dorsum horn at a presynaptic level and in turn limits its central transmission and that the electrical nerve stimulation machine on the skin myelinated nerve fibres and the electrical stimuli activates a low threshold. With low frequency Tens a marked increase in met-enkephalin and beta endorphins were noted and also demonstrated antinociceptive reversal effects by naloxone. Through micro opioid receptors the effects were postulated. However, naloxone was not reversed with high frequency Tens analgesia, implicating a dynorphin binding receptor that is naloxone resistant. Increased levels of dynorphin A were revealed in cerebral spinal fluid samples. Pain in interpreted when painful peripheral stimulation occurs as the C fibres carry the information which causes the T cells to open the gate which in turn the cortex and thalamus receive the pain transmission centrally. This theory explains the gate control theory, as the gate is usually closed. A range of both positive and negative outcomes have been noted in a wide range of medical conditions when using the Tens machine. Due to several trials and studies conducted there has been an overall consensus in favour of the use of Tens. Around 70 to 80% of patients experience initial pain relief provided by Tens, and around 20 to 30% success rate decreased after a few months of using Tens. In order to establish the full benefits, the Tens should be applied for at least an hour.

The stimulus preferences differ, and studies revealed that 57% of patients that used the Tens machine daily most definitely benefited as well as displayed different stimuli to particular pulse patterns and frequencies and were found to be adjusting their stimulators in subsequent treatment sessions. Tens has also proved positive for mild levels of pain post operative and post traumatic and proved ineffective for acute pain and tension headaches. However, Tens proved positive for painful diabetic neuropathy and treatment using Tens should be considered for this disorder.

http://diabetic2.tophealthychoices.com/using-electrical-nerve-stimulation-machine-for-diabetic-neuropathy-should-be-considered-31/

BABIES REMEMBER NOTHING BUT A GOOD TIME

Parents who spend their time playing with and talking to their five-month-old baby may wonder whether their child remembers any of it a day later

Thanks to a new BYU study, we now know that they at least remember the good times.

The study, published in Infant Behavior and Development, shows that babies are more likely to remember something if there is a positive emotion, or affect, that accompanies it.

"People study memory in infants, they study discrimination in emotional affect, but we are the first ones to study how these emotions influence memory," said BYU psychology professor Ross Flom, lead author of the study.

Although the five-month-olds can't talk, there are a number of different ways that researchers can analyze how the babies respond to testing treatments. In this particular study, they monitored the infants' eye movements and how long they look at a test image.

The babies were set in front of a flat paneled monitor in a closed off partition and then exposed to a person on screen speaking to them with either a happy, neutral or angry voice. Immediately following the emotional exposure, they were shown a geometric shape.

To test their memory, the researchers did follow-up tests 5 minutes later and again one day later. In the follow-up test, babies were shown two side-by-side geometric shapes: a brand new one, and the original one from the study.

The researchers then were able to record how many times the baby looked from one image to the next and how long they spent looking at each image. Babies' memories didn't improve if the shape had been paired with a negative voice, but they performed significantly better at remembering shapes attached to positive voices.

"We think what happens is that the positive affect heightens the babies' attentional system and arousal," Flom said. "By heightening those systems, we heighten their ability to process and perhaps remember this geometric pattern."

This paper was co-authored with Professor Brock Kirwan as well undergraduate and masters students Rebecca B. Janis and Darren J. Garcia. It follows a string of Flom's significant research on infants' ability to understand each others' moods, the moods of dogs, monkeys, and classical music.

How Good Is The Scrambler Treatment For Neuropathy

Today's post from mayoclinic.org (see link below) is a strong claim for the benefits of the so-called 'scrambler' treatment for neuropathy. The scrambler treatment is basically one of the several electro-stimulation devices on the market today. It is somewhat surprising that the Mayo clinic places so much faith in this apparatus but they do admit that it may not work for all patients and as such, it joins the ranks of other electrical stimulant devices like TENS. You have to make up your own mind in the end and discuss it carefully with your doctor or specialist and not just the clinic that offers it as part of their services. It may also be wise to be prepared for failure or disappointment but there's no doubt that some people are helped by these treatments. The reader's comment at the end of this article may well be worth reading - it does offer an alternative opinion.

Breaking Away From Pain With the Help of 'The Scrambler'
Posted by Hoyt Finnamore (@hoytfinnamore)

Karen Safranek didn't take a worry-free step for 10 years. Severe peripheral neuropathy — a side effect of breast cancer treatment she received in 2002 — left her with constant burning, tingling, numbness and pain in both her feet.

Over time, Karen tried dozens of treatments to rid herself of the discomfort. Nothing worked. So in 2012 when she found out about a clinical research trial available at Mayo Clinic for people who had peripheral neuropathy after chemotherapy, she was interested, but not optimistic.

"I tried so many things. Anything a doctor recommended or heard about, or anything I heard about, I'd give it a try if I could," Karen says. "But years past, and the pain didn't get any better. By 2011, life was not good. I was analyzing my house to figure out where we could put a wheelchair ramp. At that time, I thought it wouldn't be much longer before I couldn't walk anymore."

This new treatment was different. With MC-5A Calmare Therapy, often called "the scrambler" for short, Karen noticed improvement following the first session. After completing a series of treatments, she was pain-free for the first time in more than a decade. Through her participation in the clinical trial and occasional follow-up treatments at Mayo Clinic, Karen has been able to leave peripheral neuropathy behind and reclaim her life.

Battling pervasive pain

Karen began to notice symptoms of peripheral neuropathy shortly after she started receiving chemotherapy. By the end of her treatments, her breast cancer was gone, but she had constant shooting pain and numbness in her feet and legs that left her weak and unable to maintain her balance.

Peripheral neuropathy is a common side effect of some chemotherapy drugs. For many people, the condition fades away after treatment is over. But for some, like Karen, it can last long after other chemo side effects are gone and can have a significant impact on day-to-day life. The effect on Karen's life was overwhelming.

"It hurt if I was sitting, walking or standing," she says. "Blankets hurt my legs. I wasn't getting a good night's sleep. Going back to work wasn't an option. In time, it got so bad that whenever I went somewhere, I would analyze where I had to park my car and how far it was to get to the building. If there wasn't a spot close enough for me to walk the distance to and from my car, I would just go home."

Retraining the brain
Traditionally, chronic peripheral neuropathy has been challenging to successfully treat. Like many others who have this debilitating disorder, Karen tried everything she and her doctors could think of to relieve her pain. But still she suffered. Then in December 2013, Karen learned of the clinical trial at Mayo Clinic that would change everything for her.

Peripheral neuropathy happens as a result of nerve damage. The damaged nerves send aberrant signals to the brain, causing pain and the other symptoms of peripheral neuropathy. During her treatment sessions as a participant in the research study, the damaged nerves in Karen's feet were connected by electrodes to the scrambler. The device sent painless electrical signals to the damaged nerves, and the nerves relayed those signals to the brain. The new signals broke the pain cycle by retraining Karen's brain to understand that it was not really experiencing pain.

Reclaiming her life

Although the scrambler does not ease symptoms of peripheral neuropathy in all cases, Karen's response was dramatic.

"I was tremendously better after just one treatment," she says. "My feet and legs felt light and pain-free. Previously, I had felt as though they were very heavy to lift and walking was comparable to wearing cement shoes. After the treatment, I could walk really fast. I could take the stairs. I could even run."

After a total of 10 treatment sessions in January 2013, Karen no longer had any symptoms. The effects of the treatment were not permanent, however. She returned to Mayo Clinic for additional scrambler treatment nine months after her first sessions and again eight months after that.

Even though she knows she'll likely need follow-up care over the long-term to keep peripheral neuropathy at bay, Karen is enthusiastic about the difference the treatment has made for her.

"Before this, I wasn't able to do some of the smallest things. I couldn't go grocery shopping alone. If I reached up to take an item off the shelf, I'd lose my balance and tip over. I couldn't walk on uneven ground because I couldn't feel my feet. I'd just fall down," she says. "Being able to participate in this clinical trial at Mayo Clinic with the scrambler, it brought my life back to me. It's a miracle. It really is."
..................................................................................................
COMMENT:
Oscar Lonzo (@oscarlonzo) · 9 hour(s) ago · I hope everyone appreciates how nonsensical the sentence, "The device sent painless electrical signals to the damaged nerves, and the nerves relayed those signals to the brain," is? I suggest anyone interested in this device contact a local neuroscientist and inquire as to the validity of that statement. I'm confident that they will agree with my own assessment that ALL that Ms. Safranek experienced was some benign TENS therapy and ALL she achieved was a placebo effect.

The device itself was "invented" by character named Giuseppe Marineo. In its original incarnation, it was designed to treat AIDS. Fortunately, Italian authorities arrested Mister Marineo for practicing medicine without a license before he injured too many people. Subsequently, it became a device to cure cirrhosis by "adjusting" hepatocellular "entropy." While that didn't get him in trouble with authorities, it also didn't attract much attention, and perhaps that led to its next "incarnation" as a device to treat pain. You can check out his "deltard" website and read all about the latest marvels it achieves in removing scars and reversing the effects of aging.

In promoting his "research," Mister Marineo has in various publications claimed to have a "MD,PhD," "MD,DSc," "PhD" degrees and has only this month claimed "DSc,ScD" degrees! Unfortunately, Mister Marineo has NONE of those. In fact, I seriously doubt he has ever attended college! Indeed, I'd be willing to bet hard currency that Dr. Loprinzi hasn't the faintest idea where Marineo got his degrees and wouldn't be willing to try and find out either!

The company that has been promoting this QUACK medical device for over EIGHT YEARS now is called "Calmare Technologies" -- a near bankrupt penny stock ("CTTC") trading in the "pink sheets." It's currently being sued by GEOMC -- the company that manufactured the device for them -- because CTTC hasn't paid them. According to GEOMC, ALL of the devices CTTC has distributed are outdated and in need of servicing. Does Dr. Loprinzi's patients know that? Indeed, does Dr. Loprinzi know how to determine whether the device is indeed putting out the appropriate "signals." If he does, then he must have his own personal oscilloscope because the device itself has NO mechanism for ascertaining whether it's producing the correct signals.

Congratulations to Mayo for the part its playing in promoting fraud and medical quackery in the US. I'm sure all the naive victims of chronic pain who read thie article and who, in consequence, find themselves looted of the 3-5 THOUSAND dollars charged for this "therapy" NOT covered by insurance will applaud you.

http://sharing.mayoclinic.org/discussion/breaking-away-from-the-pain-with-the-help-of-the-scrambler/

A Good Explanation Of Autonomic Neuropathy

Many people write to the blog worried that their peripheral neuropathy is turning into Autonomic neuropathy because essential involuntary functions in their bodies seem to be letting them down, alongside their normal neuropathic symptoms. Today's post from lodiseases.com (see link below) provides a comprehensive description of possible features of autonomic neuropathy and will give you enough information to begin a constructive discussion with your doctor or specialist. It is tempting to believe that more of these symptoms apply to you than you think; or that they are all neuropathy-based when in fact they can be the result of aging or other conditions. It's important to have the experts assess your neuropathy. If you have idiopathic neuropathy (no apparent cause) then your account of the progression of symptoms becomes very important - try to keep a record of what's happening and when - it will help your doctor enormously. Remember, individual symptoms of autonomic neuropathy may well be individually treatable, so try not to let it get you down too much.

 

List Of DiseaseS

Diseases Resource and Database

Autonomic neuropathy
lodiseases | December 30, 2012 |

Definition:
Autonomic neuropathy is a nerve disorder that affects involuntary body functions, including heart rate, blood pressure, perspiration and digestion.

It isn’t a specific disease. Autonomic neuropathy refers to damage to the autonomic nerves. This damage disrupts signals between the brain and portions of the autonomic nervous system, such as the heart, blood vessels and sweat glands. This can cause decreased or abnormal performance of one or more involuntary body functions.

Autonomic neuropathy can be a complication of a number of diseases and conditions. And some medications can cause autonomic neuropathy as a side effect. Signs, symptoms and treatment of autonomic neuropathy vary depending on the cause, and on which nerves are affected.

Symptoms:
Signs and symptoms of autonomic neuropathy vary, depending on which parts of your autonomic nervous system are affected. They may include:
Dizziness and fainting upon standing caused by a drop in blood pressure.
Urinary problems, including difficulty starting urination, urinary incontinence and an inability to completely empty your bladder, which can lead to urinary tract infections.
Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men, and vaginal dryness and difficulties with arousal and orgasm in women.
Difficulty digesting food, due to abnormal digestive function and slow emptying of the stomach (gastroparesis). This can cause a feeling of fullness after eating little, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn.
Sweating abnormalities, such as excessive or decreased sweating, which affects the ability to regulate body temperature.
Sluggish pupil reaction, making it difficult to adjust from light to dark and causing problems with driving at night.
Exercise intolerance, which may occur if your heart rate remains unchanged instead of appropriately increasing and decreasing in response to your activity level.

When to see a doctor
Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy. If you have diabetes, a compromised immune system or another chronic medical condition, see your doctor regularly to be checked for nerve damage.

The American Diabetes Association (ADA) recommends that people with type 2 diabetes be screened every year for autonomic neuropathy starting as soon as they receive their diabetes diagnosis. For people with type 1 diabetes, the ADA advises annual screening beginning five years after being diagnosed with diabetes.

Causes:
Autonomic neuropathy can be caused by a large number of diseases and conditions or can be a side effect of treatment for diseases unrelated to the nervous system. Some common causes of autonomic neuropathy include:
Abnormal protein buildup in organs (amyloidosis), which affects the organs and the nervous system.
Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves. Examples include Sjogren’s syndrome and systemic lupus erythematosus. Autonomic neuropathy may also be caused by an abnormal attack by the immune system that occurs as a result of some cancers (paraneoplastic syndrome).
Diabetes, which is the most common cause of autonomic neuropathy, can gradually cause nerve damage throughout the body.
Injury to nerves caused by surgery or radiation to the neck.
Treatment with certain medications, including some drugs used in cancer chemotherapy, some antidepressants and some heart medications.
Other chronic illnesses, such as Parkinson’s disease.
Certain infectious diseases. Some viruses and bacteria, such as botulism, leprosy and diphtheria, can cause autonomic neuropathy.
Inherited disorders. Certain hereditary disorders can cause autonomic neuropathy.

Treatments and drugs:Treatment of autonomic neuropathy includes:
Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you’ll need to control your blood sugar to keep it as close to normal as possible. Treating the underlying disease can help stop autonomic neuropathy from progressing.
Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.

Digestive (gastrointestinal) symptoms
Your doctor may recommend:
Modifying your diet. This could include increasing the amount of fiber you eat and fluids you drink. Supplements containing fiber, such as Metamucil or Citrucel, also may help. Be sure to increase the fiber in your diet slowly to avoid gas and bloating.
Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication may cause drowsiness, and its effectiveness wears off over time.
Medications to ease constipation. Over-the-counter laxatives may help ease constipation. Ask your doctor how often you should use these medications. In addition, increasing the amount of fiber in your diet may help relieve constipation.
Antidepressants. Tricyclic antidepressants, such as imipramine (Tofranil) or nortriptyline (Pamelor), can help treat diarrhea and abdominal pain. Dry mouth and urine retention are possible side effects of these medications.

Urinary symptoms
Your doctor may suggest:
Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder’s capacity and retrain your bladder to empty completely at the appropriate times.
Medication to help empty the bladder. Bethanechol is a medication that helps ensure complete emptying of the bladder. Possible side effects include headache, abdominal cramping, bloating, nausea and flushing.
Urinary assistance (catheterization). During this procedure, a tube is threaded through your urethra to empty your bladder.
Medications that decrease overactive bladder. These include tolterodine (Detrol) or oxybutynin (Ditropan XL). Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.

Sexual dysfunction
For men with erectile dysfunction, your doctor may recommend:
Medications that enable erections. Drugs such as sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) can help you achieve and maintain an erection. Possible side effects include mild headache, flushing, upset stomach and altered color vision. Men with a history of heart disease, stroke or high blood pressure need to use these medications with caution and medical supervision. Seek immediate medical assistance if you have an erection that lasts longer than four hours.
An external vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.

For women with sexual symptoms, your doctor may recommend:

Vaginal lubricants. If vaginal dryness is a problem, vaginal lubricants may make sexual intercourse more comfortable and enjoyable.

Heart rhythm and blood pressure symptoms
Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor may prescribe:
Medications that help raise your blood pressure. If you get dizzy or feel faint when you stand up, your doctor may suggest a drug called fludrocortisone acetate. This medication helps your body retain salt, which helps regulate your blood pressure. Other drugs that can help raise your blood pressure include midodrine (ProAmatine) and pyridostigmine (Mestinon). High blood pressure when lying down is a possible side effect of midodrine.
Medication that helps regulate your heart rate. A class of medications called beta blockers helps to regulate your heart rate if your heart rate doesn’t respond normally to changes in activity level.
A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high fluid diet may help maintain your blood pressure.

Sweating
If you experience excessive sweating, your doctor may prescribe:

A medication that decreases perspiration. The drug glycopyrrolate (Robinul, Robinul Forte) can decrease sweating. Side effects may include dry mouth, urinary retention, blurred vision, changes in heart rate, loss of taste and drowsiness.

There is no medication to increase sweating if you have lost the ability to sweat.

 

http://lodiseases.com/448/autonomic-neuropathy.html

Some Good Advice About Neuropathy

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