How do you know if you have Neuropathy in your feet

Today's post from articlesnatch.com (see link below) is a good general guide for people who are not sure what the feelings in their feet mean. Whatever conclusion you reach, it should always be discussed with a doctor but at least you'll have an idea what might be going on. The conclusions at the end of the article may be interpreted by some as being somewhat optimistic but again, every individual case is different, with different causes and outcomes, which is why a medical consultation is necessary.
The B-vitamin items mentioned may have different names in different countries but should be available in most health food or supplement shops.

Do I Have Neuropathy In My Feet?
By: Brandt R Gibson DPM

Often, I see patients in our office concerned about strange feelings to their feet. Many are found to have neuropathy (or peripheral neuropathy). Neuropathy is the poor functioning of nerves and can lead to significant abnormalities in the feet and legs. Do you have neuropathy? Some simple questions are:

- Are your feet numb or do your feet feel dead? - When you injure your feet, do you feel pain? - When walking on your feet, do you have difficulty feeling the feet or do you trip regularly because you can't feel your feet? - Can you feel heat or cold in my feet or hands? - Do your feet tingle? - Do you have regular "pins and needles" sensation to your feet? - Do you have burning, stabbing, shooting or electrical shock pains in your feet? - Are your feet overly sensitive to touch, including pain from bed sheets or other items that shouldn't hurt? - Do you feel like there is cotton, leather, or sock on your foot, even when there isn't? - Do your feet hurt significantly at night and keep you awake?

An abnormal answer to any of these questions usually indicates neuropathy. Neuropathy can be a complex problem with multiple possible causes including diabetes, AIDS or HIV, toxins and metallic poisons, certain chemicals, alcoholism, vitamin deficiencies or nutritional imbalances, it may also occur from systemic diseases (kidney failure, liver disease, rheumatoid arthritis, abnormal blood proteins, cancer especially with chemotherapy, leukemia and shingles). Entrapment may also lead to the symptoms of neuropathy. Diabetes is the most common, however in the United States.

There are multiple theories on the cause of neuropathy, but the most common theories included blood flow interruption to the nerves or nerve fiber damage (or a combination of these). Therefore, for many years it was thought nothing could be done to improve neuropathy. You may have been told this about your discomfort. That is no longer the case. Many new treatments are coming that may help neuropathy.

The most common natural substances to improve neuropathy are B complex vitamins: B1 (thiamine), B6, B12 and folic acid. Many of the over-the-counter vitamins that contain these products, however, are in a form that are not as easily absorbed or utilized by the body. In our research, we have found two products that provide the vitamins in a form that are beneficial and easily utilized by the body.

1. Metanx - A prescription item that contains L-methoylfolate, Pyridoxal 5'-phosphate and Methylcobalamin (all natural forms of folic acid, B6 and B12 respectively). These products work together to produce increased blood flow to the nerves and assist in nerve repair. Many people are encountering improved feeling in their feet and decrease of their symptoms. It usually will require treatment for at least 4-6 months to insure it has sufficient time to help repair nerves.

2. Neuremedy - A over-the-counter item that contains a form of B1 (benfotiamine) that is absorbed and modified by the body to the active form of B1 (thiamine). Most forms of this vitamin fail to be absorbed in the body, but the benfotiamine of Neuremedy is easily absorbed and utilized by the body. It has been shown to nourish dysfunctional nerves and allow them to conduct impulses more normally. It has been utilized since the early 1960s in Europe and Asia on thousands of patients.

So, neuropathy although a common problem doesn't need to continue to cause problems in your life. It can be treated often very effectively through the use of one of these two options. Many other options are also in the works.

Copyright (c) 2009 Mountain West Foot & Ankle Institute

http://www.articlesnatch.com/Article/Do-I-Have-Neuropathy-In-My-Feet-/774206

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How You Know Youve Got Neuropathy

Today's post from chronicbodypain.net (see link below) is a very good general post about neuropathy, its different types and the reasons why it happens. It's a good resource for those new to the disease or friends and family trying to understand what's happened to their loved ones. Some articles either over-simplify or over-complicate explanations of neuropathy but this one gets the balance just right. Worth a read.

How to know if you’re experiencing neuropathy 
May 1, 2014 by chronic pain  
 
Unlike other types of pain, pain arising from damage to the nerves or nervous system can occur for what seems like no reason. Muscular pain, for example, usually occurs because of a specific incident that the patient will be aware of. This isn’t necessarily the case with nerve damage. It can result from repetitive stress, toxic exposure or even other medications that the patient takes for other conditions. As a result, neuropathy can be a mystery, seeming to come out of nowhere.


The nervous system and brain use electricity to communicate, and anything that uses electricity is also capable of short circuiting, as in a seizure, or misfiring, as in phantom limb syndrome, where a patient still suffers pain in a limb that is no longer part of the body.

Nerve damage or neuropathy normally occurs when myelin degenerates. This is the outer sheathing and the protective covering of nerve cells. Without this protection the electrical signals are not transferred properly just like if you stripped the covering off of the electrical wires in your house. When the insulation begins to crumble, the unprotected “wire” will start short-circuiting.

As the damage gets worse, the nerves lose either their ability to transmit information, which results in numbness in the area, or they start sending false signals causing pain or a tingling sensation. Neuropathy is the condition where the nerves have sustained enough damage that numbness, pain or tingling have become noticeable to the patient. The term is almost always used to mean “peripheral neuropathy,” implying that it refers to nerve damage outside of the core.

There are three types of nerves that can be affected by neuropathy. These are the sensory nerves, autonomic nerves and motor nerves. What kind of symptoms you suffer is dependent on which types of nerves that have suffered damage.

Neuropathy can also affect either a single or one set of nerves or a number of nerves. The first is mononeuropathy, and when a number of nerves are affected, it is called polyneuropathy.

Sensorimotor Neuropathy

The majority of cases of neuropathy affect the motor and sensory nerves. Patients generally experience initial symptoms on their feet, hands, arms and legs. This is called Sensorimotor Polyneuropathy. Signs and symptoms of this type of neuropathy include:

Pins and needles in the affected parts of the body. This might be described as a tingling or prickling sensation.
A burning sensation in the skin of the feet and legs. This starts in the lower extremities, but, as it progresses, it will spread to the hands and arms as well.
Sharper, stabbing pains which grow more intense at night. These sensations feel electrical or shocking in nature. Like the burning sensations, they also generally start in the feet and legs before spreading to the upper body.
Muscle weakness
Coordination problems
Paralysis
Increased susceptibility to problems with feet, including ulcers and skin infections.

Dyesthesia

Peripheral neuropathy can also eventually develop into something called dysesthesia which is often accompanied by a more intense tingling sensation, burning sensation and by hyper-sensitivity of the skin. A patient may experience intense pain simply from contact with a towel or bedding.
Autonomic neuropathy

When the autonomic nerves have been damaged, autonomic neuropathy occurs. Patients suffering from autonomic neuropathy may experience the following:

Bowel incontinence
Bladder incontinence
Coordination problems
Diarrhea
Dysphagia – swallowing difficulties
Hypotension – low blood pressure. The patient may feel dizzy when getting up from sitting or lying down
Impotence – erectile dysfunction
Nausea
Problems emptying the bladder completely
Problems with balance
Tachycardia – accelerated heartbeat
Vomiting 

Mononeuropathy

When a single or one group of nerves are affected, then the condition is called mononeuropathy, and may cause patients to experience the following:
Eye pain or vision problems which often include difficulty focusing or double vision.
Bell’s palsy meaning that one side of the face is paralyzed or responds weakly to stimulus
Various types of pain, including chest, shin or foot pain
Carpal tunnel syndrome or pain and numbness from the wrist to the lower palm. 

Causes of neuropathy

Physical trauma, repetitive injury, infection, metabolic problems and exposure to toxins and some drugs can all lead to peripheral neuropathy.
Diabetes

Diabetes often leads to neuropathic conditions and is the leading cause of neuropathy in the US. Estimates vary, but about half of all people with diabetes also have some level of neuropathy. The excess blood glucose levels in people with diabetes can, over a number of years, injure the walls of the small vessels that supply blood to nerves. This kind of damage is especially prevalent in the legs. Because one of the consequences of nerve damage is numbness, the inability to feel pain can often cause injuries to the feet or legs to go unnoticed by people with diabetes. Diabetic neuropathy is the primary cause of foot problems and ulcers in diabetics. 

Other conditions

Diabetes is the most common cause of neuropathy, but other medical conditions can also be the underlying cause of nerve damage.

Chronic liver or kidney disease
AIDS and HIV infection
Prolonged and excessive alcohol intake
Nutritional deficiencies, especially Vitamin B
Cancer – lymphoma or multiple myeloma
Lyme disease, a tick-borne bacterial infection
Charcot-Marie-Tooth disease, a genetic condition that causes nerve damage in the lower limbs
Guillain-Barré syndrome, a rare and very serious condition that damages peripheral nerves
Diphtheria, a common bacterial infection in tropical areas of the globe, but rare in other parts of the world.
Toxic and drug causes

Neuropathy can also be caused by toxins or drugs. Toxic causes are often through exposure to lead, mercury, arsenic or thalium through a workplace, but there are a variety of other sources of toxins. Industrial compounds are sometimes abused and exposure to them is deliberate, as in glue sniffing. Finally, some herbal medicines, especially Chinese medicines, contain toxins that are known to cause neuropathy.

Nearly forty drugs are also known to cause neuropathy. Neuropathy is a common side effect of certain medications, especially those used to treat HIV/AIDS and those used in chemotherapy, to fight cancer. Always consult a pharmacist or doctor if you suspect neuropathic side-effects of a medication.

One of the major differences between neuropathy and muscle pain is that neuropathy does not necessarily stem from some form of trauma or injury. Since muscle pain can be treated with standard pain-killers and is less likely to be chronic, it is important to try to recognize when pain is neuropathic rather than muscular.

http://www.chronicbodypain.net/how-to-know-if-youre-experiencing-neuropathy/

How The Cone Snail Can Reduce Nerve Pain

Today's post from spacecoastdaily.com (see link below) revisits an older animal poison and its potential for alleviating nerve pain. We're still on the tip of the iceberg regarding the use of venoms from the natural world to help with chronic pain but as more money is ploughed into research, it's becoming clear that there is an enormous potential in the poisons of spiders, fish, snakes, scorpions and the rest, to significantly aid us in controlling pain in humans. In this article, the venom-based, pump-action fluid Prialt is used (Prialt (or Zoconitide) is a non-narcotic synthetic form of a naturally occurring venom (neurotoxin) found in the Conus Magus snail) as an effective alternative to standard pain medications. This also means a lessened future reliance on chemical pills. Yet again another by-product of the current hysteria about opioids and overdosing - pharmaceutical companies are beginning to see the financial benefit in investing in alternative sources of analgesics. It's like they say: every disadvantage has its advantage😌 By using the search button to the right of this blog, you will come across more articles about this subject.

Cone Snail Venom Effective Remedy For Pain
By Dr. Richard Gayles // June 21, 2013 

ARTICLE COURTESY OF SPACE COAST MEDICINE & ACTIVE LIVING MAGAZINE

Broadly speaking, there are two types of pain. There is nociceptive pain, which is caused by tissue injury or inflammation. This pain tends to be temporary, lessening as the tissues heal. 



THE INTRATHECAL PUMP delivers Prialt directly into the spinal space. The entire pump system is placed under the skin, and the pump is refilled every 60- 90 days by placing a needle through the skin into the pump. (Shutterstock image)

The second type of pain is far more difficult to manage and is called neuropathic pain. This pain is caused by trauma to the nervous system that directly injures nerves or interferes with the ability of nerves to process pain signals.

The intrathecal pump delivers Prialt directly into the spinal space. The entire pump system is placed under the skin, and the pump is refilled every 60- 90 days by placing a needle through the skin into the pump.

Neuropathic Pain

For patients with neuropathic pain, oral medications are often unsatisfactory. The typical patient with severe neuropathic pain has failed trials of physical therapy, TENS units, anti seizure medications (neurotin, lyrica, topamax, lamictal), anti depressant medications (Elavil, pamelor, cymbalta, effexor), and eventually may be placed on narcotics.

Prialt (or Zoconitide) is a non-narcotic synthetic form of a naturally occurring venom (neurotoxin) found in the Conus Magus snail. The snail’s venom was known since antiquity as a topical remedy for burns, abscesses and other wounds.

Neuropathic pain often does not respond well to oral narcotics, resulting in some patients being placed on escalating doses.

The most concerning aspects of high dose narcotics are side effects (which increase with the dose), tolerance (loss of effect with time requiring increasing doses), hyperalgesia (escalating doses paradoxically increasing pain), physical dependence (withdrawal if narcotics are suddenly stopped) and, rarely, addiction (uncontrolled use and craving).

Naturally Occuring Venom

Prialt (or Zoconitide) is a non-narcotic synthetic form of a naturally occurring venom (neurotoxin) found in the Conus Magus snail. The snail’s venom was known since antiquity as a topical remedy for burns, abscesses and other wounds.

Cone snails are hunting animals, which use neurotoxins to paralyze their prey. The snails use their harpoon like limb to grab, inject, and then consume the fish after it is paralyzed. Prialt is now FDA approved specifically for neuropathic pain.

In fish, prialt is a paralyzing agent, but in humans it reduces or stops pain transmission.

 

If taken by mouth prialt would be rapidly and completely destroyed by our digestive enzymes. Therefore, Prialt is only delivered by the Medtronic pain pump directly into the spinal canal fluid.

In the spinal fluid the Prialt molecules block pores on pain sensing nerve cells, which stops the flow of calcium into the cells. This reduction of calcium flow prevents the nerve cells from sending signals to the brain, reducing the perception of pain.

When used in the pain pump, Prialt can often reduce neuropathic pain allowing the patient to significantly reduce or wean off narcotics.

The pain management physician determines that a patient is a good candidate for Prialt by administering a test dose in which a small amount of Prialt is injected into the spine under x-ray guidance.

The patient is then observed closely and pain levels are recorded for the next several hours. Then the patient is asked to perform specific exercises to determine the drug’s effect on the pain. If greater than 70-80 percent of the pain is reduced, the trial of Prialt is considered successful.

After the successful test dose with Prialt, the patient may be scheduled for implantation of a Medtronic intrathecal pump.

Pump Implantation

The pump implantation is a minor outpatient surgical procedure, which provides the patient with a constant infusion of the pain relieving Prialt. After implantation, the pump is programmed to deliver slowly increasing amounts of Prialt to minimize drug side effects.



THIS SEQUENCE of events shows a cone snail catching, injecting, paralyzing, and swallowing a helpless fish.

As the Prialt dose increases and pain is reduced, narcotics are simultaneously weaned.

If you have a severe pain condition that has failed all other standard conservative therapies, consider undergoing evaluation by a pain management specialist to determine if this mode of direct intrathecal medication therapy is appropriate for you.

Facts About Cone Snail

Less than one percent of the more than 500 species of cone snails have been studied. Each snail produces multiple neurotoxins in its venom. Some scientists feel the cone snails hold more promise for new medicines than any other species in nature.

Different snail toxins in preclinical trials already hold promise for new treatments for pain, Parkinson’s Disease, and depression. The snails are found in the warm tropical coral reefs.

Unfortunately the coral reefs are being destroyed; over 26 percent of the reefs are damaged beyond repair and between 30 to 50 percent are severely degraded. If the reefs are lost, we also lose the potential cure for many diseases.

http://spacecoastdaily.com/2013/06/cone-snail-venom-effective-remedy-for-pain/

How Nerve Cell Stiffness Can Make You Cry From Pain

Today's post from .sciencedaily.com (see link below) may not be the easiest read but is nevertheless a fascinating one which once more looks into research progress in neuropathy treatment at a cellular and molecular level. Put in its simplest terms, it talks about the discovery that hypersensitive nerve pain may have a lot to do with nerve cell stiffness. If they can find a way to 'relax' this stiffness, they will be able to reduce pain to a manageable level. You will need to read the article to understand it better but it's worth the effort, if only to see where scientists are going in the search for ways of controlling nerve pain.

Study offers approach to treating pain 
Date: December 13, 2016 Source: European Molecular Biology Laboratory (EMBL)

For many patients with chronic pain, any light touch -- even just their clothes touching their skin -- can be agony. Scientists at EMBL and the Werner Reichardt Centre for Integrative Neuroscience (CIN) of the University of Tübingen have found a possible new avenue for producing painkillers that specifically treat this kind of pain. In a study published online today in eLife, they discovered how the stiffness of our nerve cells influences sensitivity to touch and pain.

"Being able to stop this mechanical pain could be very powerful, and it's something that current drugs are not very good at doing," says Paul Heppenstall, who led the work at EMBL.

Whether it's a light brush or a painful poke, when something touches you, receptors on the nerves under your skin sense it and carry that information to the brain. To be more precise, those receptors detect -- and respond to -- the bending of the nerve cell's membrane. The EMBL scientists have now discovered a molecule which, by influencing how stiff or bendy a nerve cell is, affects how sensitive a mouse is to touch and pain.

Heppenstall and colleagues genetically engineered mice so that they could not produce a molecule called Atat1. Working with Jing Hu's lab at CIN and Laura Andolfi at Istituto Officina dei Materiali-CNR, in Trieste, they found that the nerve cells in the affected mice became more stiff, and they became insensitive to light touch and to mechanical pain. This happened both when they prevented all of a mouse's cells from producing the molecule and when they did so just in the mouse's sensory neurons.

The Atat1 molecule is present in all cells. Scientists know that it modifies microtubules -- tiny tubes that act as transport network and scaffolding inside cells -- and that this happens in all cells, especially in nerve cells. So Heppenstall, Hu and colleagues were surprised to find that the other senses seem not to be affected in the mice.

"It could be that the molecule also affects the stiffness of nerves involved in other senses, but because stiffness is not important for detecting smells or tastes, for example, changes in cell stiffness might not have a detectable effect on those senses," says Shane Morley, who carried out the work at EMBL.

One difference that the scientists found between nerve cells that detect touch and other cells is in how their microtubules are arranged. In sensory cells, they form a ring just below the cell membrane. In other cells, they don't. The scientists think that this ring probably fine-tunes how stiff or bendy a nerve cell's membrane is, influencing how sensitive that cell -- and the animal in general -- is to touch.

The nervous system and sense of touch are similar in mice and humans, so the results likely hold true for people, too. And although problems in cell stiffness are unlikely to be at the root of most patients' hypersensitivity to touch, controlling how stiff nerve cells are could nevertheless be an effective way of treating that sensitivity.

"We're now looking for small molecules that interfere with this fine-tuning of cell stiffness, and which might one day be used to make painkillers specifically to treat this mechanical pain," says Heppenstall. "This is the first step in our sense of touch, so if we can stop the signal there, then we have a good chance of stopping everything which is downstream. And because only these touch-sensing nerve cells would be affected, there's hope that such a drug might not have many unwanted side-effects."

Story Source:

Materials provided by European Molecular Biology Laboratory (EMBL). Original written by Sonia Furtado Neves. Note: Content may be edited for style and length.


Journal Reference:
Shane J Morley, Yanmei Qi, Loredana Iovino, Laura Andolfi, Da Guo, Nereo Kalebic, Laura Castaldi, Christian Tischer, Carla Portulano, Giulia Bolasco, Kalyanee Shirlekar, Claudia M Fusco, Antonino Asaro, Federica Fermani, Mayya Sundukova, Ulf Matti, Luc Reymond, Adele De Ninno, Luca Businaro, Kai Johnsson, Marco Lazzarino, Jonas Ries, Yannick Schwab, Jing Hu, Paul A Heppenstall. Acetylated tubulin is essential for touch sensation in mice. eLife, 2016; 5 DOI: 10.7554/eLife.20813


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European Molecular Biology Laboratory (EMBL). "Study offers approach to treating pain." ScienceDaily. ScienceDaily, 13 December 2016. .


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https://www.sciencedaily.com/releases/2016/12/161213074114.htm

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/

How Do They Normally Treat Neuropathic Pain

Today's post from neuropathyjournal.org (see link below) covers many of the ways neuropathy is currently treated and is written by renowned neuropathy patient LtCol Eugene B Richardson. It is full of useful tips and various truths your doctor may not tell you. It is one man's opinion (backed up with useful references) but as you may already have discovered, an experienced neuropathy patient is often the best source of advice. He also states that many treatments work differently for different individuals and that is very important to realise because neuropathy rarely follows patterns of behaviour or response. Certainly worth a read.
 

How is Neuropathic Pain Treated? 
 LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

FACT: Neuropathic pain does NOT respond to ‘normal’ pain medications.

Pain signals from an external stimulus like a cut or from an internal broken bone are treated with many well-known treatment options for pain.

Pain signals from damaged nerves which send real, but faulty signals to the brain must be treated with other options which currently are limited until research provides more options at the clinical level.

WARNING: One of the most dangerous aspects of treating your pain OR symptoms in a neuropathy, is the concern that either you or the doctor will then ignore the CAUSE or TYPE of your neuropathy. Knowing the TYPE can often point to a possible treatment and NEVER accept a diagnosis of idiopathic as it adds nothing but confusion. Treating pain is to treat a symptom, but medical care must go beyond the symptoms in working with the neuropathy patient.. To understand the problem with a diagnosis of ‘idiopathic’ click here:
 
Drug Options

The majority of patients with neuropathic pain are currently treated with two classes of medication.

The anti-depressants and the anti-seizure medications either alone or in combination work for many patients to reduce such pain. Some of these options would include Nortriptyline in the first class and Lyrica in the second class. Speak to your doctor about the options, but recommend that you first consider the anti-depressants as these may have less side effects. Both the anti-depressants and anti-seizure medications reduce neuropathic pain, even if medicine is not totally sure why they work. This information is from the book by Norman Latov, MD PhD of Weill Medical College, Cornell University in his book for patients listed in our RESOURCE tab. (Ref: #4)

SPECIAL ALERT 2014: The one issue that is new is that the use of the drug Cymbalta for a protracted time period, as it has been reported that upon withdrawal from the drug there may be serious problems according to one recent news article on the subject. I personally think anyone who has taken the drug Cymbalta may want to speak to the doctor about this issue and speak to them about the use of Nortriptyline as an alternative. (Nortriptyline is an older drug with a proven track record and taken at night it helps you sleep!).

Most patients get about 85% relief and a few are lucky with 100% relief, but until there are better medications developed by research, we are fortunately to have these options.

Dr. Latov (Ref: #1) speaks of these and other medications and they do help many neuropathy patients. However, like all medications sometimes the side effects are worse than the symptoms. Each patient must decide if they are worth using if the pain is only at the nuisance level. The dosage and the combinations of these medications must be worked through by the patient with the doctor in a patient doctor partnership of trial and error. As of now, I know of no other way to find what works for you.

Other patients have been prescribed Lidocaine patches for burning pains as noted by Dr. Latov and patients report that these help reduce the burning.

I have found that the burning sensations respond best to compounded topical creams and not to the oral medications. Compounded topical creams are being prescribed more often by doctors and the benefit is the absorption into the blood is limited and it tends to stay concentrated to the area you need it the most according to Neurologist Corey Hunter (Ref: #4). Some of the ingredients physicians use in these compounds includes Lidocaine, Ketamine, Gabapentin, and Amitriptyline, mixed by a compounding pharmacy in percentages as prescribed by the physician.

For patients with an immune mediated neuropathy the use of intravenous immune globulin (IVIg) has been very effective in reducing pain in sensory neuropathies while providing more muscle strength in motor neuropathies and protecting the nerves from more damage. It works! See patient IVIg experience click here:

2015 Update on Promising Research: The Foundation for Peripheral Neuropathy in their E News March 2015, noted in a follow up of reported 2013 research a report published in the Annals of Clinical and Translational Neurology and Science Daily, noted that with “two low dose rounds of non-viral gene therapy called VM 202 patients had significant improvement of their pain that lasted for months!

“Those who received the therapy reported more than 50 percent reduction in their symptoms and virtually no side effects,” said Dr. Jack Kessler, lead author of the study. “Not only did it improve their pain, it also improved their ability to perceive a very, very light touch.

“VM202 contains human hepatocyte growth factor (HGF) gene. Growth factor is a naturally occurring protein in the body that acts on cells, in this case nerve cells – to keep them alive, healthy and functioning. Future study is needed to investigate if the therapy can actually regenerate damaged nerves, reversing the neuropathy.

“Patients with painful diabetic neuropathy have abnormally high levels of glucose in their blood. These high levels of glucose can be toxic.

“We are hoping that the treatment will increase the local production of hepatocyte growth factor to help regenerate nerves and grow new blood vessels and therefore reduce the pain,” said Dr. Senda Ajroud-Driss, associate professor in neurology at Feinberg, an attending physician at Northwestern Memorial Hospital and an author of the study.

“Right now there is no medication that can reverse neuropathy,” Kessler said. “Our goal is to develop a treatment. If we can show with more patients that is a very real phenomenon, then we can show we have not only improved the symptoms of the disease, namely the pain, but we have actually improved function.”

“A future, much larger phase three study will soon be underway. To read the full article Neuropathy: Relief for diabetics with painful condition. ” 

What about muscle cramps?

Muscle cramps are common in neuropathy patients. It is always a good idea to report such muscle cramps to your doctor and determine if it is indeed related to your neuropathy or other conditions. Levels of potassium, calcium, salt, and other substances critical to proper function of muscles may need to be tested to see if they are low.

Other patients have had levels of potassium, calcium, salt, and other substances critical to proper function of muscles tested to see if they are low. Then have the doctor prescribe a supplement at the correct dosage for you.

If you take a diuretic, muscle cramps are common and may require supplements, so speak to your doctor.

Patients have found that eating a banana at night keeps the cramps away, or eating a Tum to increase calcium, or eating salty olives or pickles if your salt levels are low work.

Some neuropathy patients have noted that the drug Venlafaxine resolves restless leg syndrome and the associated leg cramps. Dr. Levine states that this drug changes the levels of serotonin and norepinephrine (two neurochemicals) in the spinal cord and can be effective in patients with neuropathy. 

What About Exercise?

Did you know that the wrong type of exercise will force damaged nerves to work and increase the pain! See article at:

How should a neuropathy patient exercise? Consider ordering a copy of the brand new DVD from Matt Hansen the expert as his perspective on exercise for neuropathy is perfect and understands what we can and cannot do. Yet Matt makes it possible for us to exercise WITHOUT the increase in neuropathic pain, keeping muscles as strong and flexible as possible. To see article on DVD click here: When ordering enter the special code NSN 10 and Matt will give 10% of your purchase price back to support the work of the NSN!

If you want a complete discussion of medicines for the treatment of neuropathic pain, read the book by Dr. Latov.
 
Other options

Dr. Latov in his book and many neuropathy patients have reported reducing pain by the use of minerals such as Alpha Lipoic acid (600 to 800 mg) especially pain from diabetic neuropathy. Research suggests that vitamin C is important to protecting nerve cells and the lack of vitamin E can actually cause neuropathy as noted by Dr. Latov.

You see many ads for B supplements in what I call a shotgun approach to the B vitamins. For me it is like shooting a mass of vitamins at an unknown target! We know that a shortage of certain vitamins, especially the E and B vitamins, is known to cause neuropathy. Yet too much B6 can cause it! I like the suggestion of Dr. Latov that the patient have such levels tested (see his book for specific information) to determine any shortage and then treat the identified target rather than using a radium shotgun blast at an unknown target!

Good nutrition is very important for everyone, but it is especially important for neuropathy patients. Why? First good nutrition helps protect and heal the nerves. Secondly, the lack of essential vitamins can cause neuropathy according to Dr. Latov! Neuropathy caused by long term alcohol abuse may be due more too poor nutrition than the alcohol. Read his book.

In the book by Mims Cushing’s, (Ref: #2) patients report that another helpful option is to soak your feet in cold tap water for 15 minutes before going to bed. The cooler water helps by calming the nerves. DO NOT USE FREEZING ICE WATER as with sensory neuropathy this could cause damage to the skin. For those with the sensation of very COLD feet, these patients have found that doing the same with warm tap water (NOT HOT) has a soothing effect.

Acupuncture has been shown to be effective for pain reduction in some patients and this is supported by small studies showing its effectiveness.

Again, it is what works for you in treating the strange effects of neuropathic pain from damaged peripheral nerves.
 
A Word About PODS (Postural Orthostatic Tachycardia Syndrome)

Do you know how many times over the past 40 years I was sent to the Cardiologist because ‘I was having a heart attack’ only to be told my heart was fine and ask, ‘Why was I here?’ The Tachycardia (silent as I did not feel it), was never understood or recognized. It was often not even related to standing as I has been assumed. Having been diagnosed with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Small Fiber Neuropathy (SFN) and with symptoms of Autonomic Neuropathy, it was a reality for me, but eventually this symptom went away while others were reduced when I began IVIg.

The relationship of the symptoms to Small Fiber Neuropathy was noted in a February/March 2015 Article in Neurology NOW (Ref #6) among other neurological issues. The article notes that there are significant disagreements in the scientific community about what drives POTS or even what symptoms are related to PODS. Symptoms related to PODS in this article include dizziness, lightheadedness, palpitations, near fainting upon standing and unrelated to standing the symptoms noted are fatigue, nausea, autonomic systems, fibromyalgia, and others often connected to several forms of neuropathy.

While prognosis is unpredictable, research in a 2013 large study from the Mayo Clinic presented at the 24th International Symposium on the Autonomic Nervous System noted that 18.2% of patients noted complete resolution of symptoms , while 52.8% reported improved but persistent symptoms two to 10 years after diagnosis.

Several suggestions were made in the Neurology NOW article to alleviate POTS including the simple idea of (1) drinking more water especially with increases in sodium. This simple solution helps expand blood volume and increase blood flow, but it may not work for some people; (2) appropriate exercise (see exercise DVD information noted above) to prevent blood from pooling in the lower extremities and other benefits gained from even low impact exercise.

Until more research confirms what is driving this REAL disorder and the related symptoms, patients just must find ways to cope and live around the illness.
DVD and the Behavioral Sciences

In this regard, remember what I have taught in the DVD “Coping with Chronic Neuropathy”. How you THINK about something, will affect your FEELINGS, which will in turn effect or influence your BEHAVIOR. It you think something is horrible, your feelings will be one of despair and your actions will reflect a sense of defeat. Always try to turn this around to a positive thought, however difficult it may be! It works.

You may also want to find a good psychologist or trained counselor, to explore cognitive therapy as in biofeedback or relaxation techniques, visualization techniques, or a trained specialist in healing arts such as yoga or ta-chi, to find ways to utilize your body’s ability to increase natural chemicals (serotonins) which we know reduce pain. Never underestimate the body’s ability to seek balance and healing.

Soothing music or sounds are a well-known way to relax and improve the body’s response to pain and there are music tapes or even therapists to help. This is why the noise of a water fall or watching a fish tank is so relaxing and healing.

Periods of slow deep breathing together with soft music or other relaxing sounds can be very helpful. Combine this with favorite images such as rain fall, snow showers, waterfall, and fall foliage in the mountains in the fall, or visualizing soft spring rains, baby birds, or whatever and you will be surprised how much it helps. Art therapy is often used to help patients visualize and express how they feel. I have been known to sing while walking my dogs using my power scooter with neighbors looking at me with strange looks, ‘Okay, he is gone’, but who cares.

Pets can offer so much in comfort and care if you are physically able to take care of them and afford them. As we have learned many times with the chronically ill and with veterans who suffer from PTSD pets are often essential for survival. For me they have become my ‘children’ to take care of providing more love and meaning to my daily life.
 
Opiates

Opiates are often used for break through pain and for some are very helpful when there is either a short term need or no other option.

However, my opinion after working with many patients attempting to stop the use of opiates is that patients should try every option carefully before using the opiates. The opiates often require increasing dosages with unwanted side effects that become more of a problem than the symptoms you are trying to address. A day does not go by, when a patient requests help to withdrawing from opiates.

For many patients the opiate drugs will eventually become more of a problem than your symptoms of neuropathy and the body will keep demanding more and more of the drug.

However, this is a very personal decision between you and your doctor, so work with the doctor to discover what does work for you as noted. If your doctor does not work with you on this, find another doctor as every patient is different. I would always tell a patient to get a second opinion regarding opiate use for neuropathic pain.

Remember for neuropathic pain, if you get 85% relief this is probably as good as it is going to get until medical research discovers better options.
Pain Management

A patient went for decades with severe back pain from multiple problems in the spine. Nothing helped. Then they tried the epidural from a Pain Management physician, which is the only thing that helped provide some relief after decades of trying.

This epidural uses Lidocaine and Depomedrol. The patient is sedated when the procedure is done and it is done under a machine that shows the doctor what they are doing on a monitor. It gave the patient 90% relief for the first 3 weeks and then 80% relief. The patient is crippled without this epidural. Unfortunately they need to be repeated and relief is often temporary.
Pain Management can offer many ideas for patients to find some relief from chronic pain including the possible use of spinal cord stimulators, implants, and other such instruments.
 
How do you communicate pain levels?

(To see article on opening doors with doctors click here.)

One of the most difficult tasks for a neuropathy patient is communicating neuropathic pain or symptom levels to anyone, while the patient fears they are crazy from the strangeness of these symptoms and sensations.

Too many patients in frustration or in a desperate need for relief will state something like, “If 10 is the worst level, than my pain is a 20.” This may communicate your desperation, panic, frustration, or anger, but otherwise is not helpful to the doctor or you.

This is where patient awareness of the pain scale 1 to 10 is very important as you communicate with the doctor, working through the issues of what works and what does not work. This process requires a doctor and patient who LISTEN and HEAR as listening and hearing are two different tasks. You know a doctor is listening if they do not cut you off after you share for 3 seconds and if they can repeat back what you just said!

Remember, if 10 is the level of pain where you pass out and 1 is just a nuisance, then 5 is where your ability to perform daily tasks become very difficult and by 6 impossible. With practice, it will amaze you how skillful you can become in judging your pain or symptom level.

There are times when pain or other symptoms are better expressed in a range over a period of time. Examples would be the burning sensations have been a 2 to 4 or a 4 to 7. This will help you and the doctor see where you are with the medications. But remember, if you get 85% relief from neuropathic pain, this may be as good as it gets with current options. But remember, if you get 80% relief from neuropathic pain, this may be as good as it gets with current options.
 
A Note of Caution:

One final note of caution for medicine too often wants to dismiss the neuropathy patient rather than spend the time for a number of reasons to find the cause or type of neuropathy. It is not enough to treat these symptoms of a neuropathy. The physician must be willing to conduct the testing necessary in attempts to find and perhaps treat the cause or at least know the type as this often can point to a cause. Too many physicians have the attitude, there is nothing that can be done, go home, live with it. This attitude must cease, yesterday. 

References:

#1 Norman Latov, MD, PhD, FAAN Peripheral Neuropathy: When the Numbness, Weakness and Pain Won’t Stop, ANN Press, 2007

#2 Mims Cushing, You Can Cope With Peripheral Neuropathy (Ideas from neuropathy patients), with Dr. Norman Latov, DEMOS Publishing, 2009

#3 “Journal of the Peripheral Nervous System” published by the Peripheral Nerve Society.

#4 Dr. Corey W. Hunter, MD, Pain Medicine, Ainsworth Institute of Pain Management, New York, NY.

#5 Dr. Sean Levine, MD, FAAN, Professor of Clinical Neurological Surgery and Radiology, NYPH, New York, NY

#6. “Neurology NOW”, February/March 2015, Article: Taking a Stand (on PODS), By Amy Paturel, pages 44 to 47.

DISCLAIMER: The information provided is intended to be educational and informative and not medically prescriptive or diagnostic. All patients are encouraged to consult with their own medical doctor when considering any of the information contained within.

Copyright – 2014-2015 Network for Neuropathy Support, Inc., 501c3, dba as Neuropathy Support Network. This article or its contents may be reprinted or published for educational purposes as long as the printing or publishing is not for profit and acknowledgement is granted the author.

http://neuropathyjournal.org/how-is-neuropathic-pain-treated/

How Does Pernicious Anemia Relate To Neuropathy

The last 4 posts and this one, all relate to Vitamin B12 and neuropathy. If you weren't a hypochondriac before reading these, you may well be afterwards, so taking a sensible view of the many symptoms shown here is advisable. Strangely, most HIV and/or neuropathy patients aren't standard tested for B12 deficiency but it may well be worth asking your doctor to do exactly that - it may explain several things. All 5 posts come from the same site B12patch.com (see links below the articles), which is pretty much an 'all you would ever want to know' type of information site but the descriptions of what neuropathy is are accurate and honest and explained in language that we all can understand. Very interesting and worth discussing with your doctor if there's time, especially if you're considering taking B12 supplement pills (usually need Folic acid to help absorption) - injections may be better in your case.

Pernicious Anemia- Vitamin B12 Deficiency is Nerve Rattling- Peripheral Neuropathy

Saturday, March 3rd, 2012

Do your legs keep going numb? It could be vitamin B12 deficiency. Peripheral neuropathy -nerve damage from pernicious anemia-vitamin B12 deficiency- causes symptoms like pain, burning, and tingling sensations in your fingers and toes. Find out how vitamin B12 supplements can help…

They’re like Fed Ex for your nervous system

Your peripheral nerves operate outside your brain, shunting messages between your brain and your spinal cord. They communicate signals about taste, touch, hearing, smell, and sight.

The peripheral nerves also transmit messages influencing your motor skills, muscular coordination, and autonomic reflexes like breathing, heartbeat, bowel control, and blood pressure.

Damage to your peripheral nerves is called peripheral neuropathy. Depending on which nerves are impaired, symptoms of peripheral neuropathy may include disorientation, “brain fog,” loss of muscle control, “pins and needles” sensations, and digestive disorders.

Pernicious anemia-vitamin B12 deficiency is a common cause of peripheral neuropathy. (Read Do you have Franken-DNA from Pernicious Anemia?)

I think I’m having a nervous breakdown…

Symptoms of peripheral neuropathy vary from patient to patient. Nerve damage caused by pernicious anemia may differ from neuropathy resulting from alcoholism, for example.

• Burning and painful numbness in the toes, feet, legs, fingers, hands, and legs
• Decreased ability to differentiate between hot and cold
• Loss of muscular control
• Muscular feebleness
• Tripping
• Muscular twitching, including eyelids
• Indigestion, heartburn, and bloating even after small meals
• Vomiting
• Acid reflux
• Diarrhea
• Constipation
• Bladder problems
• Sexual dysfunctions
• Sensation of food getting stuck in your throat
• Dizziness
• Fatigue
• Excess sweating

What causes peripheral neuropathy?

At least 20 million US citizens suffer from one of many different types of peripheral neuropathy.
About 30% of the time, doctors are unable to find a cause or cure, and the diagnosis is “idiopathic peripheral neuropathy.” (Meaning, we don’t know why you’re having nerve pain.)
Another 30% of nerve pain is related to diabetes. Diabetic neuropathy is one of the leading known causes of painful tingling, numbness, and soreness in the feet.
The remaining 30% is caused by an assortment of conditions and ailments:

• Autoimmune disorders like pernicious anemia and rheumatoid arthritis
• Vitamin B12 deficiency
• Tumor
• Kidney disease
• Infection
• HIV
• Toxic reaction to alcohol, drugs, or chemotherapy
• Poor circulation
• Hypothyroidism
• Heredity

Treatments for peripheral neuropathy

Not all kinds of peripheral neuropathy can be cured. However, understanding the cause, be it vitamin B12 deficiency or Crohn’s disease, can help your doctor prescribe proper coping mechanisms and lifestyle habits to avoid complications.

• If vitamin B12 deficiency is the cause, then you will need to take vitamin B12 supplements, possibly for life.
• If pernicious anemia or digestive disorder is the cause of vitamin B12 deficiency, then you will have to use delivery methods that dispense vitamin B12 directly into your bloodstream, bypassing the digestive system.
• With diabetic peripheral neuropathy, you must check your feet often for blisters and cuts, in order to prevent infections.
• Daily exercise helps to improve circulation and relieve nerve pain.
• Get regular foot and hand massages to improve circulation.
• Don’t sit in the same position for a long time, and don’t put pressure on your arms and legs.
• If you suffer from Crohn’s disease or other GI disorders, then eat light meals that are low in fat, and avoid processed foods.
• Alternative treatments that are beneficial include herbal supplements, antioxidants, acupuncture, and biofeedback.

http://www.b12patch.com/blog/tag/peripheral-neuropathy/

How Pain Can Affect Your Relationship

Today's post from paincommunity.org (see link below) is another 'self-help' article for people suffering from chronic pain and in our case, neuropathic pain. This time it talks about the strains put upon relationships when one partner is living with chronic pain. Again, you may feel there are cliches written here but there is also some good advice too. Worth a read over your coffee.

Is Pain Hurting Your Love? 
Posted by Teresa Shaffer | January 21, 2014

It is hard enough living a life with pain. Add in trying to keep a healthy, happy relationship going and you could find yourself drifting in unknown waters without a paddle. I know that is how I feel sometimes.

It doesn’t matter how long you have been in the relationship nor does it matter how much each person loves the other. Pain can get in the way. It can make things difficult–uncomfortable at best.

So how do we keep our relationships healthy with our partners (much less our family and friends) as we keep up with our pain?

Do we hide the pain from those we love and hold on tight to what we hope is a healthy relationship?

Do we talk to our partner and try to explain how our hurt interferes with how and when we express our love?

How often does pain affect your intimate relationship with your partner?
Not at all Some of the time More often than not All of the time
VoteView Results Polldaddy.com

There is no right way or wrong way that I can tell. What is important is that we are willing to talk and we walk that talk. Both people in the relationship needs to be able to openly express what they are feeling and how the pain affects the relationship, even if the words may sting and hurt a little to say or hear.

If the lines of communication are open then the topic doesn’t fester into something that drives a huge wedge between the two of you. Avoid this by finding the time to talk. Make sure it is a time where you can sit with each other and not be interrupted. Find a place where you both feel comfortable, a quiet place where the two of you can open up and share your feelings gently but honestly.

Talk with each other and find ways to stop holding back thinking you are just “keeping the peace”. It may not happen the first time you talk and it may take several different conversations to allow both of you to express everything that each of you are feeling.

Be open, keep talking with each other and remember that your loved one is more than likely doing the very best that they can to understand how the pain affects you in every aspect of your life. After all, it affects them too.

Don’t forget that your pain is also affecting their life in ways that they may have never shared openly with you. They just may need you to ask them how they are dealing with the life changes that pain can causing for both of you.

Don’t give up; this is just another stepping stone in the journey of living with pain.

http://paincommunity.org/is-pain-hurting-your-love/