A Simple Explanation Of Neuropathy For All Sufferers

Today's post from fosters.com (see link below) is something everybody learning to live with neuropathy should read - from beginners to those who've endured years of suffering. Strictly speaking it tells us nothing that can't be found in hundreds of other articles but it is so clearly written and so easily understood, it may well trigger several light-bulb moments in your brain and explain things you thought you knew and understood about the disease but really never got to the bottom of. Worth a read over your morning coffee.

Pain of neuropathy is sometimes treatable
By Karen Dandurant
news@seacoastonline.com
Posted May. 31, 2015

EXETER — Neuropathy, defined as a disease causing nerve pain, has many possible causes, but in more than half the cases it is associated with diabetes.
Dr. Geoffrey Starr, of Core Neurology at Exeter Hospital, said there are two types of neuropathy, polyneuropathy, meaning many nerves are affected, and peripheral neuropathy, dealing with pain in nerve endings.

“The most common is peripheral neuropathy, usually in the fingers and toes,” Starr said. “The patient can have numbness, tingling, a lack of sensation, cramps, muscle loss and imbalance and, in some cases, it affects the blood pressure.”

Starr said diabetes is the No. 1 cause and it affects people with both type 1 and type 2 diabetes. Other causes can be a thyroid problem, endocrine imbalances, a vitamin B12 deficiency or an excess of vitamin B6.

“Overuse of alcohol and smoking can cause neuropathy because of the toxins,” Starr said. “Chemotherapy can be another factor.”

For about 20 percent of the cases, there is no clear cause. Starr said it can be familial, genetic or age related.

Dr. Karen Lauze, a neurologist at Portsmouth Regional Hospital, said nerves have multiple functions in the body and which one is affected has a bearing on how treatable the disease is.

“The central nervous system controls the brain and the spine. Other systems control sensory perception, muscles and can be responsible for making the organs, like the heart, function. There are so many ways for nerves to be injured, so neuropathy is a very wide field.”

Lauze said a pinched nerve in the neck or carpal tunnel can cause the disease. Autoimmune diseases like lupus or rheumatoid arthritis can be responsible. Exposure to toxins such as heavy metals, imbalances in the B vitamins, Vitamin E or niacin, or a poor diet can be factors.

“If we can find the cause, we can usually treat it,” Starr said. “We may be able to correct it, control it or lessen the symptoms. We can deal with the pain. Tingling sensations do not respond well to medication but taking the pain away will help the person cope so the disease is not as functionally limiting.”
Diagnosing neuropathy involves sensory examination, assessing the nerve endings. Star said nerve conduction testing can be more definitive in sorting out the source of the problem.

“The initial signs are usually tingling in the fingers or toes,” Starr said. “People should seek help then, because addressing this early can have better results.”
Lauze said neuropathy usually starts with longer nerve fibers, because there is a larger area. That's why the feet are the most common initial site.
“Beside the pain and tingling, it can cause imbalances,” Lauze said. “That puts people at risk of falling and receiving other injuries.”

Autonomic nerves can be affected, resulting in the heart racing, or fainting. Lauze said doctors have little control over that condition.
Michael Davidson, DO, of Endocrinology and Diabetes Consultants, affiliated with Wentworth-Douglass Health Partners in Dover, said his practice deals mostly with diabetics, representing the largest population of people suffering from neuropathy.

“Twenty-six percent of people, at the time they are diagnosed with Type 2 diabetes, will have clinical manifestations of neuropathy,” Davidson said. “That's partly because type 2 diabetics are not diagnosed right away. Of the 29 million people with Type 2 diabetes in the U.S., it is estimated that 8 million do not know they have it. Neuropathy is often their first indication.”
Davidson said it is thought that neuropathy tingling is directly related to the length of time and the severity of blood sugar issues.

“Other factors can play a role, like high blood pressure, smoking and cholesterol, but blood sugar is the main factor,” Davidson said. “Diabetic amputations are directly related to neuropathy. If a patient cannot sense pain in their extremities, cannot feel temperature differences, or may not have a visual of the damage occurring, they may not respond appropriately. If they are not responding to the injury, or if another condition like heart failure is causing edema, that sensory deprivation and lack of self-care can be devastating.”
Davidson talked about a patient who had neuropathy and tended to wear Mary Jane style shoes. Her neuropathy got so bad, the strap of the shoe had cut right down to the bone. It sounds extreme, but he said he has had patients who have stepped on tacks and not discovered them for six months, after the damage has been done.

“Their symptoms are related to the distal nerves, farthest away from the body core,” Davidson said. “Generally it's the feet before the hands or legs. It travels in a predictable fashion.”

Treating diabetic neuropathy begins with treating blood sugar levels. Davidson said getting the blood sugar under control can lessen symptoms and will arrest the factors leading to the disease.

“For a diabetic, care of the feet is crucial,” Davidson said. “When patients come to see me, their shoes are off. Examination of the feet is always important. There is no way to stop nerve fibers from dying, but medication can change the perception of pain and calm the symptoms.”

Two drugs are approved by the Food and Drug Administration to treat diabetic neuropathy. They are Cymbalta (duloxetine) and Lyrica (pregabalin). Davidson said sometimes the use of specific antidepressants can help.

“The antidepressants change the way the brain processes the signals,” Davidson said. “By treating the central nervous system, it changes how patients perceive the symptoms. Pain relievers like Tramadol can also help.”

Over-the-counter medications can be tried first, with less invasive impacts. Davidson said alphalipoic acid or vitamin D have been shown to be effective in some patients.

Opiods for pain are the last line of defense because of addiction concerns.
“We have some success with capsaicin, a cream for the feet,” Lauze said. “The cream sucks out a specific protein in the pain fibers (protein C). Basically, it depletes the the fiber's ability to feel pain. Antiseizure medication might help. The sooner we find the cause, the better for the patient.”

http://www.fosters.com/article/20150531/ENTERTAINMENTLIFE/150539991

Stop The Stigma Against Chronic Pain Sufferers

Today's post from paincommunity.org (see link below) is another very forceful article from Teresa Shaffer on behalf of chronic pain sufferers. Many people living with neuropathy fall into that category and should read this article if they feel doubted, demeaned or belittled by others, especially medical professionals and the media. She encourages people to be more proactive in fighting back against such stigma and she's quite right. Well worth a read.

Now is the Time to Scream, Holler and Shout!
Posted by Teresa Shaffer | August 19, 2014

I recently wrote a blog titled, Enough is Enough! Stop the Stigma Against People Living with Pain. This is the second entry sharing the frustration that I, along with other people living with pain, face every day. I am angry, fed up and I am not afraid to talk about it. Now is the time for me to scream, holler and shout!

I am sick to death of the media playing havoc with our lives with articles that are meant to cause fear and written with poorly researched information. I am sick to death of reading article after article written because someone who is out for political gain or to advance their own agenda. I am sick to death of their walking on the backs of people living with pain in order to achieve fame, power or other forms of influence.

From all of this biased and what I consider sloppy media coverage you would never know that there have been some really great advances in the science of pain and pain management. Pain continues to be misunderstood, untreated, undertreated or improperly treated and poor media coverage deserves to “take it on the chin” as they have contributed to this situation. Their sham journalism continues to deflate any hope that is out there and makes the situation seem dire for those living in pain.

People living with pain: You do have some wonderful allies out there like, The Pain Connection, the State Pain Policy Advocacy Network (SPPAN), National Pain Report, US Pain Foundation and The Pain Community (TPC) just to name a few. We need to step up and help those who are trying to help us. We can no longer hide away and wait for someone else to fix this problem.

We are being blamed for drug abuse in this country and this must stop. People living with pain are being used as stepping stones to move forward personal causes and political agendas.Are we to believe that this pretense is just about drug abuse?

Come on, really? Were we born yesterday?

Yes, absolutely there is a drug abuse problem in this country. Yes, people are dying from drug abuse. Yes, it is heartbreaking for the loved ones left behind to carry on. I can say without a doubt that I, along with most people living with pain, feel sadness for those families who have been affected. People living with pain do not want to hear of anyone dying from abuse just like we do not want to hear of people with pain who give up and commit suicide. Like chronic pain, addiction is a disease which deserves to be treated as such. Changing the formula of all the pain medications to try to make them tamper-resistant is one step forward but that is not going to stop drug abuse. Someone who is fighting the demons of abuse will always find a way to get what their body is craving. Treatment of the problem is key; the elephant in the room is that those who choose to abuse medications must receive treatment to help break the cycle of abuse.

We must use education and treatment to help curb the start of abuse. We must use education to stop young people from participating in “pill parties or pharm parties”, where all types of over the counter and prescription medications are placed in a bowl and people take them to get high. For some, the pills they take cause overdose and death. It is the behavior that is at fault, yet no one wishes to face this and take on the responsibility of dealing with the cause directly. It is far easier to demonize the medication, rather than the activity. Parents need to be better informed about these dangers.

Look, we should be working together to start moving forward and making a difference rather than against each other. We must start treating those who abuse so they can take back their lives and allow people living with pain to once again find healthcare providers willing to treat them. Do I need to remind you that chronic pain is a real and complex disease too?

So, stop putting the issue of drug abuse on the backs of people living with pain and start making a difference by treating addiction as a disease. Those who abuse do so to escape from the stress of life and to do that they seek an altered state of mind. People living with pain are not looking for that “high” or means of escape. We are desperately trying to find at least a brief moment of pain relief. We only want the chance to be able to participate in life with family and friends and to be able to continue to work and support our families.

To each of you who live with pain, I must be frank. We can no longer afford to sit back and complain behind closed doors about how stigma and discrimination is affecting us. We must stand up and be heard. Who has become my health provider nowadays? I ask this because it sure seems like my well-being and health care has been taken out of the hands of my health care provider or should I say stolen. Politicians, law enforcement, journalists and others with narrow points of view and self interest are the thieves. Their motives have nothing to do with what is in my best interest; I can assure you of that! My optimal health care depends on my health care provider and me! We need to tell these encroachers to butt out of our pain care!!

Do you honestly think that these “journalists” care about us, the ones living with pain? They would rather talk to self-proclaimed experts who spout unsubstantiated claims and pass it off as the truth. They don’t care that they are making it harder and harder for legitimate people living with pain to receive the care that is needed to live our lives with less pain. We are merely the “unintentional consequence”—the nameless, faceless statistic that is frequently misinterpreted or maligned. The almighty dollar is what serves as master. They aren’t living with pain so it is not hurting them. They have they own agenda, sell newspapers, magazines and get those hits from the internet, in other words, keep their jobs. So, articles are badly written, “facts” are not verified, stories are slanted to one-side to ensure those that read it become more fearful. These articles rarely tell both sides of the story which would be the right thing to do, take time to develop and result in what is considered good journalism—a fading talent.

Please don’t take the following statements wrong; I would never ever wish a life of chronic pain on any one. However, I have often wondered:
How fast these news articles would change and both sides of the story would be told IF the editors and/or writers were suddenly thrust into a life of pain.
To those politicians and others who are advocating for medications to be taken off the market: How fast do you think the tables would turn if it was you or a loved one dealing with pain?

I bet we would hear the person with pain’s side of the story then and the politicians and the media would move heaven and earth to ensure they or a loved one had access to all treatments available, including opioid pain medications. Gosh, insurance companies might even start paying for appropriate pain care! That would be a novel thought.

Here is reality. Those of us living with pain are not asking for special treatment; we only wish that we can have our pain treated with appropriate treatments including pain medications when/if appropriate. We are only asking, no we are begging for the right to be able to see a healthcare provider who is not afraid of the DEA breaking down his/her door. We are asking, no begging that we are able to go into a pharmacy and to fill our lawful prescriptions without the stares, without being “outed” in public that we are taking pain medication or the interrogation from pharmacists who are trying to decide if we are legitimate human beings or not.

Until you have lived with never-ending pain that literally takes your breath away and makes it impossible to sit, stand or lay down for any length of time, please stop thinking you know what is best for us. You, who live without pain, have no idea what a life of pain is like and I hope those of you who call yourselves experts in these media articles never do feel the pain I live with 24/7.

Please hear me. Stop the mistruths, the propaganda and promotion of your personal agenda. Start trying to make a difference in lessening drug abuse and improving pain care, in an effective way, that is guided by public health solutions and critical research rather than sanctions and policing. Work together with all interested parties and educate about medication safety. Stop the fiction and biased articles and start telling both sides of this story. Currently, we are just running in circles and chasing our tails. Drug abuse has continued on like a moving target while legitimate people living with pain are running head on to more and more barriers in care. People are being hurt on both sides of this issue. People are dying on both sides, too.

In the words of Forrest Gump, “Stupid is as stupid does”. I am tired of stupid, aren’t you? Now is the time to scream, holler and shout!

http://paincommunity.org/now-time-scream-holler-shout/

Tai Chi The Gentle Exercise For Neuropathy Sufferers Vid

Today's post from foundationforpn.org and denverpost.com (see links below) revisits a therapy for people living with neuropathy that is gaining in popularity, mainly because it's so easy to perform. In contrast with yoga and other forms of exercise (which we all know we have to try to do), Tai Chi is far less painful and stressful and yet the results have been shown to be extremely helpful for nerve damage patients. The article (plus videos) pretty much covers all you need to know and even if you dismiss the idea, is worth a read. Gentle therapies are exactly what older people with neuropathy are asking for and Tai Chi fits the bill perfectly. Definitely worth a read.

Tai Chi for Peripheral Neuropathy
Researchers have determined that an ancient Chinese health practice called Tai Chi (Taiji) may provide benefits to people who suffer from PN.

How Tai Chi Can Help

A 2010 study published in the American Journal of Chinese Medicine from the Department of Kinesiology, Louisiana State University, showed that Tai Chi (also known as Taiji) practice actually increases the nerves’ ability and speed of sending signals back to the brain and spinal cord. After only a few weeks of Tai Chi practice, patients with PN can improve physical function and it is a safe and effective intervention.

Tai Chi can significantly improve balance, reducing both the likelihood – and the fear -of falling. Since the mid-1990‘s the Surgeon General has recommended that people over the age of 65 practice Tai Chi to improve balance and stability. One reason Tai Chi is so effective is that it teaches you to re-integrate the muscle control of legs, hips and low back. As we get older, or succumb to the side effects of diseases like diabetes, we start to lose muscle strength and function in certain areas of our bodies. Often this is a function of lifestyle – you know the old saying, “Use it or lose it.”

People with Peripheral Neuropathy tend to be less active because of the pain and uncertainty that comes with movement. And the less active they are, the more that whole body synergy is lost. It’s a vicious cycle. But Tai Chi can re-awaken the connections between muscles in the body, and between the muscles and the mind. Studies on Taiji and PN show that the more someone with Peripheral Neuropathy learns to use their whole body for both exercise and simple daily tasks – even walking! – the less pain they experience, and the more comfort they have in their bodies overall.

Recommendations

As with any new exercise program, I recommend starting small and easy – but the good news is that Tai Chi is as easy as walking and maybe less demanding! I am looking forward to providing some simple steps to making Tai Chi a part of your daily life and reducing the pain levels for those suffering from this disease.

Ezy Tai Chi: A simpler practice for seniors

As a form of exercise, tai chi increasingly appeals to the growing proportion of older adults that looks for alternative and convenient ways to exercise for health. Originally developed for martial arts purposes in China more than 300 hundred years ago, this practice has been used as a traditional exercise to improve fitness, health and longevity for individuals of all ages. Tai chi’s low-to-moderate intensity and beneficial effects on strength, flexibility, breathing and balance make it especially attractive to mature adults. Click here to read the full article.

 Click on the following links below to view Tai Chi instructional videos:




Want to Live Longer? Try Tai Chi

Dr. Xianglan Zhang, Vanderbilt School of Medicine, in a recent study found that Chinese men who practiced TaiChi were less like to die over a five-year period than men who didn’t exercise at all.

https://www.foundationforpn.org/living-well/integrative-therapies/tai-chi/

Want to live longer? Try tai chi 
By Reuters PUBLISHED: July 23, 2013 at 12:13 am | UPDATED: April 29, 2016 at 5:15 pm

 
People practice tai chi, a Chinese martial art, during morning exercises at Longtan Park in Beijing September 13, 2010. REUTERS/Grace Liang

Chinese men who practiced tai chi were less likely to die over a five-year period than men who didn’t exercise at all, in a new study.

The findings support past studies that found health benefits related to the traditional Chinese exercise.

“It combines slow motion exercise and mind concentration to focus on movement. That itself can reduce your stress and, of course, it will increase your flexibility and endurance,” said Dr. Xianglan Zhang, one of the study’s authors from the Vanderbilt University School of Medicine in Nashville, Tenn.

Zhang said her study could not prove, however, that tai chi was responsible for some men’s longer lifespan.

Earlier research has shown tai chi can be beneficial for people with chronic conditions, for example by improving balance among those with Parkinson’s disease.

To see whether tai chi and other forms of exercise might influence lifespan, Zhang and her colleagues looked to a large study of middle aged and elderly men in Shanghai.

More than 61,000 men participated in the study. Researchers tracked their health and lifestyle for more than five years.

Close to 22,000 participants reported that they exercised at least once a week, and the rest were considered non-exercisers.

Over the course of the study, 2,421 men died, including 3.3 percent of the non-exercisers and 5.1 percent of the men who exercised.

Exercisers tended to be older and more of them had heart disease and diabetes.

After Zhang’s group took into account men’s age, health conditions and whether they smoked, exercise was tied to a 20 percent lower likelihood of dying.

Similarly, 6.2 percent of the close to 10,000 men who practiced tai chi died during the study, but after accounting for other risk factors, the researchers found they were 20 percent less likely to die than men who didn’t exercise.

Men who walked regularly were 23 percent less likely to die during the study, and men who jogged were 27 percent less likely to die, Zhang’s team reports in the American Journal of Epidemiology.

Dr. Chenchen Wang, director of the Center for Complementary and Integrative Medicine at Tufts Medical Center in Boston, said that because Zhang’s study was observational, and did not randomly assign people to practice tai chi or not, it’s impossible to say whether the exercise itself is responsible for the findings.

There’s always the possibility, for instance, that people who choose tai chi tend to have healthier lifestyles.

But Wang, who wasn’t involved in the new study, told Reuters Health the results are interesting, and “they provide a very important foundation for future research.”

Zhang said the findings support tai chi as a healthy activity.

“I think for the elderly people, especially to maintain flexibility and balance, this is a good option for people to consider,” Zhang told Reuters Health.

http://www.denverpost.com/2013/07/23/want-to-live-longer-try-tai-chi/

A Smart Cane For Neuropathy Sufferers

Today's post from themayerinstitute.ca (see link below) reveals a new development in walking sticks/canes which could be of help to neuropathy sufferers, who need a cane for balance while walking. There's a 'smart' everything else, so why not also a smart cane! With a few clever extras, it may well be a great option for many people walking with neuropathic symptoms.

Improving Balance: Who says that can’t be cool.
by GENE OSTROVSKY on Feb 25, 2013 March 1, 2013

Fujitsu Prototype Smart Cane Makes You Want to Get Old (w/video)

The classic walking cane has remained pretty much unchanged for millenia. Really just a walking stick with an ergonomic handle, it’s hard to come up with novel improvements to the cane. Fujitsu engineers, nevertheless, decided to integrate a bunch of technology into a cane to see what they could come up with.

The intriguing result is a device that uses GPS to guide the user who now doesn’t have to use a smartphone with the other hand. It also integrates a small heart rate meter right into the handle and, because there’s wireless connectivity, it can call loved ones automatically if the rate is too high. Also, the handle monitors the ambient temperature and humidity and counts walking steps. Here’s a quick demo video from Engadget:

http://www.themayerinstitute.ca/improving-balance-who-says-it-cant-be-cool/

Opioids It Can Be A Matter Of Semantics For Chronic Pain Sufferers

Today's short post from health.economictimes.indiatimes.com (see link below) has implications for neuropathy patients who have been forced to take opioids in order to control their pain. The current hoo-ha about opioids presents a real danger to patients who genuinely need them because literally nothing else works! This article takes the view that opioid prescription is questionable if there are no ensuing physical function benefits. However, you have to ask whether opioids were ever thought to improve physical function - they're not steroids after all. The point of opioids is that they dampen pain signals and if used properly, they're very effective indeed, so improved physical function is of secondary importance to neuropathy patients - the fact that their pain is reduced to a point where they can live more or less normal lives, is the priority. Physical function improvement can come from other sources. 

Opioids don't guarantee improvement in physical function IANS 24 January 2016

 Patients who were not prescribed any opioids had statistically lower disability and higher physical functioning scores.

People suffering from neuropathic pain complex, chronic pain that usually is accompanied by tissue injury report no improvement in physical functioning after taking opioids that tackle pain, researchers said.

"Even though opioid medications can be a powerful pain killer, it does not necessarily mean improved function will follow," said lead author Geoff Bostick, associate professor at the University of Alberta in Canada.

Patients who were not prescribed any opioids had statistically lower disability and higher physical functioning scores, the findings showed.

Opioids can help people with severe pain be more comfortable, but if they are not facilitating improved physical function, the impact of these medications on quality of life should be questioned, the researchers said in the study published in the journal Pain Medicine.

Stressing the importance of physical function, the researchers suggested that patients who are experiencing chronic pain and are medically cleared for physical activity should find a way to promote movement, even if it is painful.

The study looked at 789 patients across Canada who provided baseline measures of self-reported function, and again at six and 12 months after treatment.

These patients suffered with neuropathic pain from nerve injuries such as diabetic neuropathy and pinched nerves.

http://health.economictimes.indiatimes.com/news/industry/opioids-dont-guarantee-improvement-in-physical-function/50703209