An explanation of various treatments for neuropathy Warning! It aint gonna go viral on YouTube!

We're going to drop in on the 2006, Rare Neuroimmunologic Disorders Symposium to listen to and watch a talk given by Joanne Lynn MD. For the first two and a half minutes you may well wonder why, because the video takes some time to get to the point, or at least the points that are relevant to us. Apart from that, the good lady is not exactly the most inspiring speaker to listen to but stay with it because there is so much useful information and explanation which is specific to our problems. Apart from that, the slides that are shown, explain the difficult vocabulary that would normally go in one ear and out of the other.

You must remember that this is a medical professional talking to other medical professionals and therefore, there aren't very many fireworks to keep your attention but it's worth the effort. I've watched this three times and have learned something new and useful each time.

You can read the transcript of the video on: http://www.myelitis.org/newsletters/v7n2/newsletter7-2-02.htm
It helps!

Off Label Treatments For Neuropathy

Today's article from medicalnewstoday.com (see link below) is an important one for neuropathy sufferers who are considering using such treatments as Lyrica (Pregabalin) and Qutenza (capsaicin patch). These (amongst others) are currently not approved by the American FDA for HIV-related neuropathy but are frequently prescribed 'off-label'. Basically this means you'll have to pay for them yourself but before you do, it's worth getting medical advice as to why the drugs aren't approved and whether they will be of any value to you. More and more people are turning to the internet for treatments and drugs and I'm sure you don't need warning as to how risky this can be. Always get advice from your HIV specialist or neurologist first.

Many People Not Aware Of Their Off-Label Drug Use

Article Date: 07 Aug 2012 Written by Petra Rattue

A Mayo Clinic analysis revealed that even though numerous people have heard of off-label drug use, i.e. a physician prescribing medications prior to their approval by the Food and Drug Administration, they might not be aware that it applies to prescriptions they currently take.

Researchers have now asked and answered 10 questions about off-label drug use in an article featured in Mayo Clinic Proceedings.Leading author Christopher Wittich, M.D., an internal medicine physician at the Mayo Clinic, explains:
"Since the Food and Drug Administration does not regulate the practice of medicine, off-label drug use has become very common. Health care providers and patients should educate themselves about off-label drugs to weigh the risks and benefits before a physician prescribes one or a patient takes one."

Key points of the article include:

• Off-label drug use is common practice. According to a 2006 report, around 1 in 5 prescriptions within a group of commonly used medications were for off-label use. Another study reports that 79% of children discharged from pediatric hospitals were taking at least one off-label medication.
• Patients may be unaware that the drugs they have been prescribed are being used off-label. So far, there is no court decision to ensure that physicians must disclose using off-label drugs through informed consent. The FDA points out that it does not regulate the practice of medicine and that the federal Food, Drug, and Cosmetic Act of 1938 is not responsible to make physicians liable for off-label drug use.
• Off-label drug use can become the predominant treatment for a condition. For instance, some none-FDA approved antidepressants are used to treat neuropathic pain, whilst some drugs in this class are considered a first-line treatment option.
• Morphine, which is extensively used to treat pain in hospitalized pediatric patients is another example of widely practiced off-label drug use, whilst many inhaled bronchodilators, antimicrobials, anticonvulsants, and proton pump inhibitors also are used in children without formal FDA approval. Seeking FDA approval for a new medication can be costly and time-consuming, whilst adding additional indications for an already approved medication require another drug application, which, if approval is granted, may not be cost-effective, since the drug's revenue may not offset the expense and effort for obtaining approval.
• Generic medications may not have the necessary funding to conduct FDA-approval studies, which means that drug manufacturers may never seek FDA approval for a new drug indication.

Whilst it is not permitted for pharmaceutical manufacturers to promote off-label uses of medications, they are allowed to respond to unsolicited questions from health care providers and distribute peer-reviewed publications about off-label use. For instance, this year, GlaxoSmithKline agreed to pay a record $3 billion to settle a Justice Department case involving alleged off-label drug use marketing, and Merck Sharp & Dohme was fined $322 million over its alleged promotion of the painkiller Vioxx for being used off-label.

http://www.medicalnewstoday.com/articles/248741.php

Finding Possible Neuropathy Treatments By Examining The Spinal Cord

Today's post from sites.utoronto.ca (see link below) is a complex one for the lay reader but maybe you should give it a go anyway, even if you don't understand everything it says. The point is that it gives us as patients, an insight into how scientists are looking into our problems and trying to come up with solutions. It's like peeking through the keyhole and learning something new about what may be coming in the future, something which in itself can make us feel better about our condition because at least we know something is being done! Basically, the scientists here placed electrodes on the spinal cord at different places and measured the electronic activity of the nerve cells simultaneously. In this way they were able to identify where things were breaking down and could block nerve signals if they were causing pain. It's much more complex than this simplistic explanation of course but the potential for future treatments at source, using this sort of intervention, is enormous. Remember as long as you get a vague picture in your mind of what's going on, you're increasing your understanding of neuropathy at the same time.

Different Mechanisms of Spinal Cord Neuron Disinhibition in Neuropathic Pain Models Require Different Therapeutic Interventions
Posted on 18-09-2015 
 
Exciting new research from Dr. Steven Prescott’s lab is working to bridge the gap between basic research on neuropathic pain etiology to possible clinical interventions to treat neuropathic pain. Dr. Steven Prescott is a UTCSP member and scientist at the Hospital for Sick Children. In this paper, lead author Dr. Kwan Lee uses a unique method to measure intact spinal cord neurons from alive, anaesthetized animals, overcoming disadvantages of ex-vivo methodologies. To do this, Dr. Lee placed an array of 16 recording electrodes into the superficial spinal cord, and was able to record the electrical activity of 16 neurons simultaneously.

Using this method, Dr. Lee found that two competing mechanisms of disinhibition (blockade of inhibition that yields net neuronal excitation) of these neurons yielded almost indistinguishable phenotypes, but were differentially sensitive to different pharmacological treatments. First, he blocked the potassium chloride co-transporter KCC2 using DIOA, which leads to a dysregulation of chloride in inhibitory neurons, and thus disinhibition. This resulted in allodynia in the animal, or an increase in response to a previously innocuous brush stimulus. Using the drug ACTZ, he was able to compensate for chloride dysregulation, and restore inhibition, bringing responses to brush stimulus back down to baseline.

Then, when Dr. Lee initiated disinhibition through blockade of GABAA receptors, again yielding increased neuronal responses to brush stimulus, ACTZ was not able to reduce these aberrant neuronal responses to previously innocuous brush stimuli. This indicates that two different forms of disinhibition that lead to the same measurable phenotype of neuropathic pain react differently to pharmacological interventions. This suggests that there should be a shift in the medical field to identifying biomarkers of neuropathic pain etiology or trying several potential treatments before selecting the specific therapeutic intervention for neuropathic pain patients, in order to best treat their symptoms.

To read this article, please visit: http://www.ncbi.nlm.nih.gov/pubmed/?term=26186265

Reference: Lee, KY, Prescott, SA. Chloride dysregulation and inhibitory receptor blockade yield equivalent disinhibition of spinal neurons yet are differentially reversed by carbonic anhydrase blockade. Pain. July, 2015.

http://sites.utoronto.ca/pain/research/articles/684.html

A Summary of Neuropathy Treatments

Today’s post from kiich.sharedby.co (see link below) takes a critical look at some of the main treatments for neuropathy. As so often, the emphasis here is on diabetic neuropathy but as most readers will now know, unless you're talking about specific blood sugar issues, the information applies to all forms of neuropathy treatment. Basically and most importantly, the article calls for more and better research and better targeting regarding neuropathy treatment. It is happening but more behind the scenes and in the research facilities of the pharmaceutical companies than in the public eye and patients often get the impression that they are still being treated according to outdated guidelines - new and effective treatments are nearly always 'in the pipeline'. Progress is being made, especially in the last few years but information is always difficult for patients to find.

A Review of Painful Diabetic Neuropathy Treatments
Feb 18, 2015 | Rachel Lutz

Despite the high burden of painful diabetic neuropathy (PDN), it is under diagnosed and under treated, according to research published in Therapeutic Advances in Chronic Disease.

Researchers from the University of Manchester conducted a review of recent studies examining the efficacy of drugs used in the treatment of PDN in order to evaluate the most appropriate ones. PDN treatment is commonly categorized into 3 groups: intensive glycemic control and risk factor management, treatments based on pathogenetic mechanisms, and symptomatic pain management. Although as many as 1 in 5 diabetes patients may suffer from PDN, there are only 3 medications approved by the US Food and Drug Administration (FDA) for the treatment of PDN – duloxetine, pregabalin (both approved in 2004), and tapentadol (approved in 2012). However, many proposed treatments are undergoing studies, though the researchers commented there is an increasing need for even more studies to evaluate these options in order to maximize pain relief and improve patients’ quality of life.

Some studies have demonstrated benefits of glucose control through insulin in type 1 diabetes patients in preventing diabetic sensorimotor polyneuropathy (DSPN), the most common type of PDN. The results of the study were less clear for type 2 diabetes patients. A conducted on patients with pancreatic transplants found improvements of PDN following the transplant; however, another study suggested there was no effect on nerve conduction velocity and autonomic function. Improvements were also shown in a study of a 6 week placebo controlled benfotiamine treatment on 165 patients.

Non steroidal anti inflammatory drugs (NSAIDs) are often prescribed for short term analgesia, usually when PDN is not suspected. Even though their use has not been extensively evaluated, in some treatment experiments, NSAIDs were effective. Tricyclic agents (TCAs) like amitriptyline, desipramine, and imipramine have shown efficacy in PDN patients, even though they are noted for their high side effect frequency. Serotonin norepinephrine reuptake inhibitors (SNRI) were FDA approved for the treatment of PDN in 2004 and it, as well as other SNRIs, have been reported as efficacious across many studies, and major side effects were rare. Carbamazepine, oxcarbazepine, topiramate were initially proven to be effective for the treatment of PDN, but have later been discredited due to side effects and other reasons, though gabapentin and pregabalin are typically effective. The authors considered opioid treatment for PDN controversial, in addition to its lack of established risk benefit analyses.

Non pharmacological approaches have been developed for PDN patients who are unresponsive to conventional therapy techniques, or find those methods inadequate for relief. These forms of relief include electrical stimulation, which has found to be more effective than a placebo treatment. Another option was acupuncture, which demonstrated improvement in outcomes over a placebo acupuncture treatment.

“It is evident from the broad range of drugs that have been evaluated in PDN that there is no consensus about a single most effective drug, and monotherapy rarely provides adequate pain relief,” the authors concluded while stressing that further and more specific research is needed. “Additionally, most studies compare therapies against placebo or sham treatment and there is a need for comparative studies between different pharmacological agents.”

- See more at: http://www.hcplive.com/news/A-Review-of-Painful-Diabetic-Neuropathy-Treatments-#sthash.9S8Ge9YP.dpuf

http://kiich.sharedby.co/de4d996b4c7488eb/?web=830cc5&dst=http%3A//www.hcplive.com/articles/A-Review-of-Painful-Diabetic-Neuropathy-Treatments-

Can Massage And Other Natural Treatments Help Neuropathy Vid

Today's post from beforeitsnews.com (see link below) is a personal post including video tips from someone who's father has neuropathy problems. This person is studying massage techniques and is using them to try to help the father with his neuropathic symptoms. It's not a bad idea at all but like the author, it's probably best to have some idea of what you're doing before you begin. Massage can be extremely soothing and relaxing for people with foot and leg pain and getting a friend or family member to massage your feet and legs can really help but it's advisable to use You Tube videos (or others) to help you improve your technique before you start. Begin gently and work up; one thing a neuropathy patient will not appreciate is a full-on sports massage attack on their limbs. Ask the patient for their reactions at each stage.

Peripheral Neuropathy: Massage, Stretching And Natural Remedies Can Help (Video).
Wednesday, July 2, 2014 11:54
 
Today I want to talk about a condition called Peripheral Neuropathy which is a result of nerve damage, often causes weakness, numbness and pain, usually in your hands and feet, but it may also occur in other areas of your body, I’m interested in this condition because both my parents experience the symptoms of this condition. People generally describe the pain of peripheral neuropathy as tingling or burning, while they may compare the loss of sensation to the feeling of wearing a thin stocking or glove. Both of my parents have described the pain as tingling, pins and needles, and numbness.




The pain was getting worse on my father so I decided to do some research. At first I was really scared that it was a sign of prediabetes. I told my dad that I had this tea called Gymnema Sylvestre which I bought as a weight loss aid. I wrote a story on it…I will post the link below. Anyways, I remember reading that this herb helps with type 1 and type 2 diabetes. Even though my father hasn’t been diagnosed with diabetes I thought it would be a good idea for him to drink a couple of cups a day…if anything it will help you lose weight and what’s the harm in that, right? My dad has said that this tea helps him feel a bit better and he’s being drinking it for a while now.

Learn more about Gymnema Sylvestre: http://bit.ly/Lk4hLK

I also read that A study of over 1,200 people shows acetyl-L-carnitine relieves numbness and pain, and helps repair nerves. Your liver, kidney, and brain make all the ALC you need when you’re young and healthy. When you exercise regularly, you’re likely to have more of it. But sometimes you don’t have enough when you’re older or sick, even if you exercise a lot (instituteofnaturalhealing).


 
Also, one of the best things that has helped my father is massage. I’m in massage school right now so I have just finished learning how to do a basic Swedish massage. Lately, I have been giving my father weekly massages focusing mostly on his left leg and the top of his foot where it mostly hurts. His symptoms have been improving but they aren’t entirely gone. Since I want my father and my whole family to feel peachy keen I did some more research. I think it might by the entrapment of the tibial nerve. Below is a video showing some stretches to help with the tibial nerve:




Finding the Tibial Nerve:


If anyone has any advice on tibial nerve entrapment or Peripheral neuropathy I would sure love to hear it. Thanks for reading!
Sincerely,
Radical Rose
http://radicalrose.wordpress.com

Resources:

http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/basics/definition/con-20019948

http://institutefornaturalhealing.com/2013/10/this-amino-acid-reverses-nerve-damage/

http://www.diabeteslibrary.org/View.aspx?url=Gymnema_sylvestre

 http://beforeitsnews.com/health/2014/07/peripheral-neuropathy-massage-strecthing-and-hebal-remedies-can-help-video-2541126.html