Today's short post from alert.psychnews.org (see link below) reports that a new study has shown both Duloxetine (Cymbalta and others) and Venlafaxine ( Effexor, Trevilor, Lanvexin, others) to be reasonably effective treatments for nerve pain. Well reasonable in the sense that they performed better than other pills...when compared to placebos. These two serotonin-norepinephrine reuptake inhibitors (anti-depressants) are already widely prescribed for neuropathic pain but as we know, what works for one patient, doesn't necessarily work for others, which leads to patient frustration and difficulties for researchers and studies to come to definitive conclusions. The article also states that pregabalin is FDA approved for neuropathic pain - it's not! The FDA goes as far as to demand that warnings about the side effects be placed on boxes. It's a minefield for patients wondering whether what their doctor has prescribed is a)going to work and b) going to be safe. It is safe to say that almost all drugs prescribed to limit neuropathic pain can have side effects and therefore it's vitally important that you have a serious discussion with your doctor before embarking on a course of drugs. Together you need to weigh up the benefits and risks and even then there's no guarantee that your symptoms will diminish. However, maybe that shouldn't stop you trying - anything is better than that relentless pain...right! But your doctor should monitor your progress on any given drug, with great care and if necessary change the treatment. 
Duloxetine, Venlafaxine May Be Most Effective at Reducing Diabetic Nerve Pain
Posted by Psychiatric News Monday, March 27, 2017
The serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine appear to have the best evidence for being effective at reducing nerve pain in people with diabetes, according to a meta-analysis published in Neurology. Duloxetine is FDA-approved for treating pain in diabetic neuropathy, though venlafaxine is not.
The researchers pooled together data from 106 clinical studies published between 2011 and 2015 examining the effectiveness of pharmacologic approaches to improving pain in patients with diabetic peripheral neuropathy. The analysis compared outcomes in patients taking 21 different medications, though the authors were unable to draw conclusions for any head-to-head drug comparisons due to insufficient evidence.
The researchers found moderate evidence to suggest that duloxetine and venlafaxine were more effective at reducing neuropathy-related pain than placebo. Tricyclic antidepressants, botulinum toxin, the opioids tramadol and tapentadol, and the anticonvulsants pregabalin and oxcarbazepine were also found to be more effective than placebo, but the evidence base for these medications was weak.
In contrast, the anticonvulsant gabapentin, mood stabilizer valproate, and capsaicin cream were all found to be no more effective than placebo; these findings run contrary to guidelines for treating diabetic peripheral neuropathy published by the American Academy of Neurology in 2011, which listed all three agents as probably effective.
“Our findings generally support the effectiveness of the three drugs approved by the Food and Drug Administration (FDA) for the treatment of pain in diabetic peripheral neuropathy: duloxetine, pregabalin, and tapentadol,” wrote Julie Waldfogel, Pharm.D., of the Johns Hopkins Hospital and her colleagues. “Additional studies evaluating longer term outcomes are needed to better inform clinical decision-making, patient choice, and clinical practice guidelines.”
http://alert.psychnews.org/2017/03/duloxetine-venlafaxine-may-be-most.html
Today's post from helium.com (see link below) is the second part of a description of the human nervous system. Today's description is by a different author and you may notice one or two repetitions of information provided yesterday but that just helps to fix it in your brain. It's all very useful information and most certainly aids understanding of what your nervous system does and where it's going wrong if you have neuropathy. Both parts worth a read. 
An overview on the human nervous system
by Jose Juan Gutierrez : Created on: October 23, 2011
The nervous system is a communication network of nerve fibers, surrounded by a fatty substance known as myelin, and connective tissue that is constantly sending messages in and out of the human body. The complex activities performed by the nervous system include the motor, integrative, and sensory functions. The nervous system is classified into two subdivisions: the central nervous system (CNS), consisting of the brain and spinal cord; and the peripheral nervous system (PNS), consisting of nerves and ganglia (nerve cells outside the CNS).
The spinal cord and the brain form part of the CNS. The CNS is encased in bone for protection; the brain in the cranial vault and the spinal cord in the vertebral canal. The spinal cord is a long tube of nerve tissue that is located in the hollow channels of the vertebrae. The brain and spinal cord are surrounded by cerebro-spinal fluid (CSF) which protects the brain and spinal cord from injury. Membranes known as meninges prevent CSF from leaking to the outside.
The peripheral nervous system includes the nerve fibers that spread out from the spinal cord and the brain. These nerve fibers form the communication network between the CNS and the various organs of the body. The peripheral nervous system is subdivided into the somatic and the autonomic nervous systems. The somatic nervous system comprises the nerve fibers that connect to the skin and muscles and involves conscious activities. The autonomic nervous system includes the nerve fibers that communicate the CNS to organs, including the intestines, stomach, glands, and the heart, and involves unconscious actions.
Neurons are the nerve cells that carry out the functions of the nervous system; a neuron consists of a cell body (soma), a single axon, and one or more dendrites; neurons are classified as afferent, efferent, and inter-neurons; afferent (sensory) neurons carry signals from the peripheral sense receptorsto the CNS. Efferent (motor) neurons carry out signals from the CNS to organs, such as glands, or muscles. Inter-neurons (integration) neurons serve as connections between afferent and efferent neurons within the CNS. Millions of sensory receptors detect changes occurring inside and outside of the body (sensory function); from the outside, they can detect changes, such as light, temperature, and sound; from the inside, they can detect carbon dioxide concentration, pH levels, and blood pressure. This information is known as sensory input; sensory input is changed into electrical signals (nerve impulses) which travel to the brain; once in the brain, these signals generate memory, thought, or decisions in a process known as (integration). Depending on the sensory input and integration, the nervous system reacts by signaling glands to secrete hormones, or muscles to contract; this is in response to an instruction from the nervous system, therefore, the muscles and glands are called effectors. This is known as the motor function of the nervous system. Spinal reflex arc is a unit of the nervous system where responses to stimuli do not require conscious thought and as a consequence reactions occur more quickly than if the stimuli had travelled to the brain centers. There are two distinct types of reflex arc: one is autonomic reflex arc (having an effect on inner organs); and somatic reflex arc (having an effect on the muscles). Al the systems in the human body are important to maintain the body in optimum functioning. The single movement of one leg involves the muscular, circulatory, and skeletal system; however it´s the nervous system which coordinates the activities of all these systems and without it, the human body wouldn´t be able to perform all its daily functions.http://www.helium.com/items/2244685-an-overview-on-the-human-nervous-system
