Poor Self Esteem Leads To More Pain Duh!

Today's short post from sciencedaily.com (see link below) falls in the category of 'duh' findings as far as most patients with severe neuropathic pain are concerned. Basically, research has shown that patients living with severe pain, internalise their resulting depression, which in turn leads to worsening of the symptoms and tendencies to catastrophise about their pain. Is there anything surprising about this? Most people with chronic pain are fully aware that their state of mind has an effect on their levels of pain and most people are quite happy to accept that a percentage of their discomfort is psychosomatic and therefore maybe feels worse at times than it actually is. Inventing new terms to describe feelings as old as the hills doesn't exactly push forward the boundaries of science and as many readers of this blog frequently point out - it can be both aggravating and frustrating for the patients themselves!

Internalized Stigma Linked With Poor Self Esteem, Pain Self-Efficacy May 30, 2014 The above story is based on materials provided by American Pain Society.

Results of an Australian study published in The Journal of Pain showed that after controlling for depression internalized stigma is negatively associated with lower levels of self-esteem and personal control of pain.

The Journal of Pain is the peer-reviewed publication of the American Pain Society, www.americanpainsociety.org.

Internalized stigma refers to the internalization or absorption of negative attitudes. It also is linked with a greater tendency to catastrophize about pain and with a reduced sense of personal control over pain. Evidence indicates that internalized stigma has negative effects on health and psychological functioning in general. Researchers from the Australian National University and the Kolling Institute of Medical Research sought to learn whether an individual's experience, perception or anticipation of negative social reactions to their pain may become internalized.

In the study, surveys were administered to 92 adults with chronic pain to explore the presence of internal stigma and its association with a range of psychological consequences in people with chronic pain.

Results showed that nearly 40 percent of the chronic pain sample reported experiencing internalized stigma. The findings showed that internalized stigma can cause low self-esteem, impaired pain self-efficacy, a greater tendency to catastrophize about pain, and a reduced sense of personal control over pain. The authors noted their findings have important implications regarding the role of internalized stigma as an outcomes measure and as a verifiable treatment target for individuals with chronic pain.
 
 http://www.sciencedaily.nl/releases/2014/05/140530092255.htm

VM202 More Gene Therapy Evidence For Neuropathy

We've mentioned the subject of today's post from endocrinologyadvisor.com (see link below) several times already but this article explains this exciting new development in terms that almost everybody can understand. Certainly worth talking over with your doctor or specialist and maybe even getting your name onto some trial lists in your area (you may have to fight for that one). However, the idea of 8 injections per year taking away most of our pain, is a very attractive one - let's hope this is a development with real substance. Well worth a read.

Can Gene Therapy Reverse Diabetic Neuropathy?
John Schieszer, MA July 24, 2015 

  A nonviral gene therapy may relieve symptoms of painful diabetic neuropathy.

Gene therapy in the form of a plasmid containing two human hepatocyte growth factor isoforms administered via intramuscular injection may alleviate symptoms and improve quality of life in patients with painful diabetic neuropathy.

In addition, the plasmid —VM202 — may be particularly beneficial in those patients not taking gabapentin or pregabalin, according to researchers at Northwestern University.

In a recently completed double-blind, placebo-controlled study, 84 patients were randomly assigned to receive injections of 8 mg or 16 mg of VM202 per leg (calf muscles and lower leg) or placebo, with doses administered on days 0 and 14.

At 3 months, patients in the low-dose group experienced a significant reduction in pain compared with the placebo group, the researchers found.1

“I am very excited about it. This is an enormous problem, and it has a huge impact on people's lives. [These patients] spend so much time in agony,” said study investigator Jack Kessler, MD, who is a professor in the department of neurology at Northwestern University Feinberg School of Medicine in Chicago.

“The data are very, very strong. One issue that remains to be resolved is if we are modifying the disease, and at this time, the jury is still out. In our last study, we had some improvement in patients to feel light stimuli, but we need additional data to say we are altering the course of the disease. If our phase 3 study gives us the same results, then this treatment will be the best option for treating diabetic neuropathy.”

Study Results

The primary outcome for this current study was change in the mean pain score measured by a 7-day pain diary. The analysis also included quality of life and pain measures, and measurement of intraepidermal nerve fiber density, according to Kessler.

The study showed that patients receiving 8 mg of VM202 per leg improved the most in all efficacy measures, including a significant reduction at 3 months in the mean pain score. The reductions in pain continued but were not statistically significant at 6 and 9 months.

“We would probably inject patients four times a year. If it turns out that we are actually making the neuropathy better, then it is reason to think patients would graduate from this, but if it turns out we are just treating the symptoms and not the disease, then we would see injecting the patients four times a year,” Kessler said in an interview with Endocrinology Advisor.

The mean age of the patients in this study was 60 years (approximately 75% men), and the mean duration of diabetes was 15 to 16 years.

The researchers found that 48% of the patients experienced at least a 50% reduction in pain in the treated group compared with 17% in the placebo group. The study also demonstrated significant improvements in the brief pain inventory and the questionnaire portion of the Michigan Neuropathy Screening Instrument.

The researchers noted that the largest reductions in pain were found among patients not on pregabalin or gabapentin.

There were no significant adverse events attributable to VM202 and this treatment was deemed safe and well tolerated. 

More to Learn

It is hoped that VM202, which contains a human hepatocyte growth factor gene, will increase the local production of hepatocyte growth factor to help regenerate nerves and grow new blood vessels and subsequently reduce the pain.

“We believe we are getting a two-for-one treatment. We are supplying nourishment to the nerves, but we are also helping to improve blood vessel function,” said Kessler. “The most remarkable thing is that we pushed the dose up and we had literally not one serious side effect in the entire trial, only [injection] site soreness.”

A large trial is now planned, and the researchers hope to enroll 475 patients at 20 sites across the United States starting in December.

Amanda Peltier, MD, who is an assistant professor of neurology at Vanderbilt University in Nashville, Tennessee, said these study findings are interesting, and this approach could represent a new way of treating diabetic neuropathy with fewer treatment-related adverse effects.

“There is a huge unmet need for diabetic neuropathy as the current medicines have side effects and do nothing to improve or retard the progression of the underlying neuropathy, only treat the pain. In addition, our understanding of diabetic neuropathy has improved for type 1 diabetes, but there has been little headway in improving neuropathy for patients with type 2 diabetes,” Peltier told Endocrinology Advisor.
Looking Ahead

According to M. Sue Kirkman, MD, who is a clinical professor of medicine and the medical director of the Diabetes Care Center Clinical Trials Unit at the University of North Carolina School of Medicine in Chapel Hill, this is a quality of life issue.

Although there are several medications that may help symptoms, they are not effective in all patients and may come with significant side effects, Kirkman said.

“This trial showed promising results, but was relatively small and short-term. Larger and longer-term trials will be important to see if the benefits pan out, and also to get a better feel for potential adverse events. Up to now, treatments for diabetic neuropathy have been purely palliative, with no interventions that seem capable of actually improving nerve function,” Kirkman told Endocrinology Advisor.

“There are some hints from this study that this agent could actually improve nerve function. If that pans out in larger trials, it would be very exciting, since lack of feeling in the feet from advanced diabetic neuropathy is a risk factor for foot ulcers and amputations.”
Reference
Kessler JA et al. Ann Clin Transl Neurol. 2015;2(5):465-478.

http://www.endocrinologyadvisor.com/diabetes/painful-diabetic-neuropathy-gene-therapy/article/428342/

More Bloodroot

Did I say 11? I meant 25. What I didn't see was how many little babies were nestled underneath!
OK so I am a bit obsessed with this plant. I watch her every year, in endless awe of her beauty and sensual embrace. I have had folks write me in question of offering a bloodroot salve for sale, but I have never harvested Bloodroot. The application of bloodroot for the curing of cancerous skin spots is somewhat documented, with both success and distress. Some report great pain and burning of holes in the skin, and some report complete healing. I would do some serious research before I tried it. There is an excellent account of Bloodroot (Sanguinaria Canadensis) in the compilation book "Planting the Future" the entry written I think by Brooke Medicine Eagle.

I have however, as I got to do with my Jr. Herbalists last Friday, unearthed the incredible root to study. She grows laterally, technically a rhizome, and is easy to uncover from the one or two inches of soil. I have found it to be anywhere from a few inches long to several, varying in thickness from skinny to maybe 1 1/2 inches. And yes, when you break it, it bleeds the most riveting crimson color you can imagine.

This end tip of the root, if you were to harvest a little for some reason, is the bit you could take. The rest of the plant can still grow and reproduce. But as an at-risk plant, I would check with your local regulations on whether this is legal or not, and use common sense as to whether there is enough for you to take a few snippets.

The root has also been used, and perhaps still is, in oral care. It is said to strengthen and repair gum tissue, and prevent gum disease. I know herbalists who add a little of this tincture to their mouth rinse. This potion definitely warrants a 'do not swallow' label. It is said to be dizzying and in regular quantities toxic. The fresh juice of the plant can also give sensitive skinned ones blisters. I have not had it happen, but my little neighbor girl learned her respect-for-nature lesson with this plant quite expressly. The Latin genus name: Sanguinaria, means blood, appropriately, and although obvious when looking at the behavior of the root, could also indicate a native use relating to the blood.

Bloodroot likes loamy, partly shady soil. I usually find her in the woods or the periphery thereof.
I am convinced that she only grows where the fairies are.
Despite her threatening claims, she is certainly medicine. But all you have to do is just watch her.