Can Poor Sleep Patterns Cause Chronic Pain In Older People

Today's article from sciencedaily.com (see link below) looks at the link between restless and disturbed sleep patterns and chronic pain, especially amongst older people. I think almost everybody living with chronic pain can identify with that. A bad night's sleep almost always results in more pain in the morning. Whether it's the pain that causes the poor sleep, or the other way around, is the question.
 

Could Restless Sleep Cause Widespread Pain in Older People? 
Date:
February 13, 2014
Source:
Wiley
 
Summary:
Researchers in the U.K. report that non-restorative sleep is the strongest, independent predictor of widespread pain onset among adults over the age of 50. According to the study anxiety, memory impairment, and poor physical health among older adults may also increase the risk of developing widespread pain. Muscle, bone and nerve (musculoskeletal) pain is more prevalent as people age, with up to 80% of people 65 years of age and older experiencing daily pain. Widespread pain that affects multiple areas of the body —- the hallmark feature of fibromyalgia —- affects 15% of women and 10% of men over age 50 according to previous studies.

Researchers in the U.K. report that non-restorative sleep is the strongest, independent predictor of widespread pain onset among adults over the age of 50. According to the study published in Arthritis & Rheumatology (formerly Arthritis & Rheumatism), a journal of the American College of Rheumatology (ACR), anxiety, memory impairment, and poor physical health among older adults may also increase the risk of developing widespread pain.

Muscle, bone and nerve (musculoskeletal) pain is more prevalent as people age, with up to 80% of people 65 years of age and older experiencing daily pain. Widespread pain that affects multiple areas of the body -- the hallmark feature of fibromyalgia -- affects 15% of women and 10% of men over age 50 according to previous studies.

Led by Dr. John McBeth from the Arthritis Research UK Primary Care Centre, Keele University in Staffordshire, this newly published population-based prospective study identified factors that increase the risk of the development of widespread pain in older adults. The team collected data on pain, psychological and physical health, lifestyle and demographic information from 4326 adults over the age of 50 who were free of widespread pain at the start of the study (1562 subjects reported no pain and 2764 had some pain). These participants were followed up three years later for the development of widespread pain.

Results show that at follow-up, 800 (19%) reported new widespread pain. The development of new widespread pain was greater in those with some pain at the start of the study; 679 (25%) of those with some pain and 121 (8%) of those with no pain at the start developed new widespread pain at three year follow-up.

Analyses determined that pain status, anxiety, physical health-related quality of life, cognitive complaint and non-restorative sleep were associated with increased risk of widespread pain development, after adjusting for osteoarthritis (OA). Increasing age was associated with a decreased likelihood of the development of widespread pain.

"While OA is linked to new onset of widespread pain, our findings also found that poor sleep, cognition, and physical and psychological health may increase pain risk," concludes Dr. McBeth. "Combined interventions that treat both site-specific and widespread pain are needed for older adults."

Story Source:

The above story is based on materials provided by Wiley. Note: Materials may be edited for content and length.

Journal Reference:
John McBeth, Rosie J Lacey, Ross Wilkie. Predictors of new onset widespread pain in older adults Results from the prospective population-based NorStOP study. Arthritis & Rheumatology, 2013; DOI: 10.1002/art.38284

http://www.sciencedaily.com/releases/2014/02/140213083711.htm

Can Flouroquinolone Antibiotics Cause Neuropathy

As has been mentioned before on the blog, a type of antibiotic called Flouroquinolone has been shown to cause Neuropathy (amongst other things). However, not only for neuropathy patients but for HIV patients in general, this sort of information is vital. People with HIV are prone to various secondary infections, especially if their immune system is compromised and the correct antibiotic needs to be used. Apart from that, certain antibiotics clash with certain HIV medications and doctors need to be extra aware when prescribing antibiotics for infection.
Today's post comes from Antibiotics.org (see link below, which is an "Antibiotics drug reaction support site" and states clearly the risks of taking Flouroquinolones. The lesson here is both to discuss the possible side effects of antibiotics with your doctor and read the labels when you get them. Flouroquinolones certainly look like they need to be avoided.

Flouroquinolones

Food and Drug Administration imposed the government's most urgent safety warning on Cipro, Levaquin, Avelox and many other flouroquinolone antibiotics. The FDA orders a prominent "black box" warning and the development of new literature for patients emphasizing the risks. The most prominent risk is tendon rupture causing long term disability, possibly permanent.

This is an important first step to ensuring these antibiotics are only used when the patient faces a potential fatal outcome, and only after the use of all other antibiotics have been ruled out. This is not due to the probability of risk, but rather severity.

To those who have been affected, prognosis is normally not good. There is no cure. Often repeat exposure through food and water cause a continual never ending cycle of symptoms. Many victims face the fact that their lives have been completely destroyed. Many face loss of job and income, some face breakup of the family. Some have even committed suicide because of the pain inflicted by these drugs.

Unfortunately, physicians currently give these prescriptions out like candy. To emphasize the ignorance of physicians, Cipro is often prescribed post-op for tendon repair surgery. The physician will often prescribe a drug known to cause tendon rupture as a preventive to infection after tendon repair surgery. There is an obvious neglect on the part of the physicians who simply do not known the potential dangers of the drugs they prescribe. So where is the breakdown of information? Unfortunately many physicians mistakenly rely on pharmaceutical drug reps to point out any potential side effects rather than investigating it themselves. Further implicating the physicians, they accept gifts from drug companies and in return will prescribe unnecessary and dangerous substances. Drug Reps, paid on commission, find themselves making more sales by not disclosing the dangers, or make light of potential side effects. Making the problem worse, the drug manufactures trivialize and distort the potential risks.

A pending U.S. Senate bill would require drug companies to report gifts to doctors of more than $25. New York State's legislature plans to hold hearings this year on the relationship between doctors and drug companies. One congressional critic has even compared the drug industry with the tobacco industry, and Senator John McCain has called drugmakers the "bad guys."

Antibiotics known as flouroquinolones have been associated with some or all of the following adverse drug reactions:

* Tendonitis, Tendon Rupture, Tendon, Ligament, Joint and Muscle Damage
* Vision Damage, Hearing Loss, Taste Perversion
* Peripheral Neuropathy (Tingling, burning sensation)
* Insomnia, Nightmares, Anxiety Attacks, Depersonalization, Cognitive Disorders
* Brain, Heart, Liver, Kidney, Pancreas, Blood and Endocrine Disorders
* Severe Psychotic Reactions, Suicidal Thoughts or Actions
Gastrointestinal Damage

Compounding the problem, there are numerous drugs which should not be taken in combination with this class of antibiotics. There are increased risks of injury when they are taken in combination with corticosteroids (e.g.: Prednisone, Flovent, Nasarel, Azmacort, Advair Disku, Methylprednisolone Dospak, Elocon Cream, Desoximetasone Cream, and Sterapred) and when taken in combinations with non-steroidal anti-inflammatory drugs (NSAIDs) (e.g.: Motrin, Pamprin, Aleve, Advil, and Ibuprofen, among others). Physicians are frequently not aware of these contraindications and prescribe dangerous combinations of drugs which cause severe injuries to their patients. Physicians may also not be able to identify that their patient is suffering an adverse reaction and instruct them to continue to take more of the antibiotic resulting in very serious and perhaps preventable injuries.

http://www.antibiotics.org/

Colon Cancer Drug may cause Neuropathy

It's of course pretty well known that chemotherapy can leave patients with neuropathy as a side effect but how does this have anything to do with HIV- patients, besides the normal percentage who unfortunately contract a form of cancer?
One of the fastest growing cancers, especially for HIV positive men, is colon or rectal cancer and this associated with the alarming rise in HPV infections means that significant numbers of HIV patients are needing cancer treatment.
One of the best known drugs aimed specifically at colon cancer is Oxaliplatin and its success rates make it more and more popular but there's a sting in the tail and that is permanent and debilitating neuropathy. Once more HIV patients are being faced with unexpected extra problems, something we're long used to but the reality is that neuropathy is the price that sometimes has to be paid for extending your life. This article from sciencedaily.com (see link below) explains the pros and cons of using Oxaliplatin. Once again, a serious discussion with the oncologist, neurologist and hiv-specialist is necessary - don't be palmed off without the facts - in that way you avoid nasty surprises!

Popular Colorectal Cancer Drug May Cause Permanent Nerve Damage, Study Suggests
ScienceDaily (Sep. 28, 2011)

Oxaliplatin, a platinum-based anticancer drug that's made enormous headway in recent years against colorectal cancer, appears to cause nerve damage that may be permanent and worsens even months after treatment ends. The chemotherapy side effect, described by Johns Hopkins researchers in the September issue of Neurology, was discovered in what is believed to be the first effort to track oxaliplatin-based nerve damage through relatively cheap and easy punch skin biopsies.

The Johns Hopkins investigators emphasize that the drug therapy clearly improves length of survival in advanced cancer by months to years, and that the goal of their new study is to find ways of preventing or slowing the damage through nerve-protective therapies identfied through simple skin testing.

Many patients who take oxaliplatin report bothersome neurological side effects, including pain in the hands and feet and a numbness or tingling in the throat that affects swallowing, according to study leader Michael Polydefkis, M.D., M.H.S., associate professor of neurology at the Johns Hopkins University School of Medicine and director of the EMG Laboratory and Cutaneous Nerve Laboratory at Johns Hopkins Bayview Medical Center. Though these symptoms develop over time in the majority of patients, some report neuropathies as early as when the drug is first infused.

To get a better sense of how oxaliplatin affects nerve cells, Polydefkis and his colleagues recruited eight cancer patients about to begin oxaliplatin treatment at The Johns Hopkins Hospital. All had been diagnosed with advanced colon cancer.

Before their first oxaliplatin infusion, each patient underwent a comprehensive neurological examination, including nerve conduction testing, a clinical exam to look for signs of nerve damage, and a punch biopsy that removed tiny (3-mm diameter) portions of skin near their knees and ankles. Once oxaliplatin treatment began, consisting of infusions over two days once every two weeks for 12 cycles, the researchers performed the same tests after 30, 90 and 180 days. Another 180 days after they finished with treatment, the patients received one final exam.

Test results showed that each of the patients' nerve function and neuropathy symptoms worsened over time and that results from the punch skin biopsies neatly mirrored the side effect arc. Using a microscope, the researchers saw that nerve cells' long extensions, called axons, degenerated over the course of oxaliplatin therapy. This progression persisted after treatment stopped. Even 180 days after their last doses, seven out of the eight patients' axons continued to wither.

"This drug has rapidly become the standard of care for people with advanced colon cancer, but we really knew little about how oxaliplatin affects nerves over time," he says. "With people living longer lives on oxaliplatin, it's important to know more about these neurological side effects so patients and their physicians can make educated choices on how this drug is used, and perhaps suggest ways to limit the damage."

The new study strongly suggests that punch skin biopsies could be an easy and inexpensive way to follow nerve cell degeneration, a crucial prerequisite for testing the effectiveness of drugs currently in development to trace, prevent or slow nerve damage.

"Skin biopsies can be done pretty easily, uniformly and cheaply anywhere, including hospitals, doctors' offices and clinics, and those places can have the tissue sent to Hopkins for analysis," Polydefkis says. "High-quality neurological testing isn't nearly as easy or economical to do, so it's possible that the biopsies could play a pivotal role in bringing neuroprotective drugs to fruition."

Other Johns Hopkins researchers who participated in this study include Ahmet Z. Burakgazi, M.D., Wells Messersmith, M.D., Dhananjay Vaidya, M.D., Ph.D., Peter Hauer, B.S., and Ahmet Hoke, M.D., Ph.D.

http://www.sciencedaily.com/releases/2011/09/110928105911.htm

Sebivo Tyzeka Hepsera Can Cause Neuropathy

Today's post from drugs.com (see link below) talks about the risks posed by telbivudine, also known as Tyzeka, or Hepsera. It is a drug used to treat chronic Hepatitis B. Many people will be aware that Hepatitis B can be serious for people with HIV but taking telbivudine may also bring neuropathy to the equation and that could make life pretty miserable all round. If you are being treated for Hepatitis B it may be worth checking the drugs you have been prescribed and talking them over with your doctor. 
In December, 2011, the FDA also included neuropathy in its warnings about telbivudine (see here)

Risk of Peripheral Neuropathy with Sebivo (telbivudine)
LONDON, Feb. 14, 2008

The European Medicines Agency’s (EMEA) Committee for Medicinal Products for Human Use (CHMP) has recommended that new warnings be included in the product information for Sebivo (telbivudine), from Novartis Europharm Ltd. This warning is intended to inform doctors about the risk of peripheral neuropathy in patients with chronic hepatitis B who are being treated with Sebivo.

Doctors are advised to monitor patients carefully for signs of peripheral neuropathy and to reconsider treatment options if they suspect that a patient is developing peripheral neuropathy.

Sebivo is indicated for the treatment of chronic hepatitis B in adult patients with compensated liver disease and evidence of viral replication, persistently elevated serum alanine aminotransferase (ALT) levels and histological evidence of active inflammation and/or fibrosis as monotherapy only.

Cases of peripheral neuropathy have been uncommonly reported in patients treated with telbivudine as monotherapy. In a clinical trial investigating the combination therapy of telbivudine 600 mg daily with pegylated interferon alfa-2a 180 ?g once weekly, an increased risk of peripheral neuropathy was observed.

The CHMP, after evaluating the available data, has recommended the inclusion of the following warning in the product information for Sebivo:

Peripheral neuropathy has been uncommonly reported in telbivudine-treated patients. If peripheral neuropathy is suspected, treatment with telbivudine should be reconsidered (see section 4.8).

An increased risk of peripheral neuropathy has been observed when telbivudine and pegylated interferon alfa-2a are co-administered (see section 4.5). Such increased risk cannot be excluded for other interferons alfa (pegylated or standard). Moreover, the benefit of this combination of telbivudine with interferon alfa (pegylated or standard) is not currently established.

For further information, please contact:

Noël Wathion
Head of Unit
Post-Authorisation Evaluation of Medicines for Human Use


7 Westferry Circus, Canary Wharf, London, E14 4HB,
UK Tel. (44-20) 74 18 84 00 Fax (44-20) 74 18 84 09
E-mail: mail@emea.europa.eu http://www.emea.europa.eu

http://www.drugs.com/news/risk-peripheral-neuropathy-sebivo-telbivudine-7777.html

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