Neuropathy In The Winter

Very topical at the moment in the Northern hemisphere (and in 6 months, applicable to the Southern hemisphere too) today's post from blog.dana-farber.org (see link below) gives some helpful and timely hints about taking care in the winter if you have neuropathy. It's all to do with lack of feeling in your feet and hands and not being able to judge your footing in slippery circumstances. It's vital that you are always aware of the possibility of falling. Many neuropathy patients suffer broken bones from falls in the winter purely because the wrong signals reach your brain. This article is simply put and worth a read, if only to remind you of what you are probably already well aware of.

Tips for Managing Neuropathy During Winter 
January 15, 2014 Dana-Farber 

Staying warm and healthy during the winter can be challenging for anyone in most parts of the country, but it can be especially difficult for cancer patients, particularly those who may be experiencing treatment-related neuropathy.

Peripheral neuropathy is a temporary or long-lasting nerve problem that may occur as a result of certain chemotherapy drugs. It can cause pain, numbness, tingling, or loss of feeling, usually in the hands or feet, making snowy weather and freezing temperatures all the more challenging.

Clare Sullivan, BNS, MPH

“Peripheral neuropathy occurs from certain treatments affecting the nerves in the body, especially the nerves that sense pain, heat, cold, touch, balance, and fine motor movement,” says Clare Sullivan, BSN, MPH, Clinical Program Manager, Patient Education at Dana-Farber Cancer Institute, who urges patients with neuropathy to take extra precautions in cold weather.

If you experience numbness in the hands and feet as a result of cancer treatment, consider these tips from Sullivan:

Keep hands and feet warm and dry

Invest in good, warm gloves and extra socks during the winter. Layers will help keep your hands and feet dry, which may help ease numbness in colder weather.

Wear boots with traction

This will create an extra layer between your feet and the snow or ice, giving you additional protection against the elements, while helping keep you steady on slippery ground and prevent falls.

Dress warm

Wear a warm coat with thick padding to protect your body, especially your lower arms. Staying warm will help maintain circulation to and from the hands, and may lessen pain and help maintain your range of motion.

Walk with hands out of pockets

Keep your hands free and stretched out to prevent falls and protect yourself when they do occur. Rather than confining your hands to your pockets, which can create cramping and increase the likelihood of falls, wear warm gloves and keep your hands free instead.

View this Dana-Farber Slideshare presentation to learn more about neuropathy diagnosis, treatment, and management from Cindy Tofthagen, PhD, ARNP, an assistant professor of nursing at the University of South Florida, and post-doctoral fellow at Dana-Farber and the University of Massachusetts.

http://blog.dana-farber.org/insight/2014/01/tips-for-managing-neuropathy-during-winter/

Life Story With Neuropathy

Today's post is a personal account of life with neuropathy from neuropathyawareness.blogspot.com/2011/11/living-life-with-peripheral-neuropathy (see link below). I am sure that many people will identify with many of the experiences described here and may wish to join the 'Support for Neuropathy' group highlighted on the original page.

Living Life with Peripheral Neuropathy
Monday November 7th 2011

Living life with peripheral neuropathy has been a challenge for sure! I never would of thought that my life would revolve around being in chronic pain 24/7. One day I was in great health and the next it was all taken away from me in Jan 2001. Before all this I had never heard of peripheral neuropathy so when I was told that this was my diagnosis and it was permanent with no cure I just about lost it! I remember thinking how can no cure be available and no specific medicine for neuropathy be available. When my neuropathy symptoms first started it came on strong and on a pain scale the pain was a 10 and still is, but controlled with medications/narcotics. So now my life also revolves around being on heavy narcotics and this is someone who never took anything besides a asprin before all this! Even with being on heavy narcotics I still have pain and some days are very bad! I take medicine that is given to cancer patients and still can't get pain control on some days. That is just crazy to me and something has to be changed! We need help spreading the word about PN so a cure can be found. No one should have to live there life in chronic pain! No one can understand what its like to live like this unless they have it personally. It takes over your mind and controls everything you do from spending time with family or friends. It follows you everywhere and is always a constant reminder that you have PN. As bad as my life can be with having PN I have found its the little things that can make me happy. Little things like the smell of a flower or watching a new flower grow, enjoying my morning coffee, my fragrant candles, a new recipe etc and best of all being a great mom! I have had time over the years to accept this is the new me and its how it is. Of course I have days that I get depressed, but I try and think tomorrow will be a better day! I'm so glad to have the support from the group called Support for Neuropathy that I joined on facebook. For about 9 out of the 11 years of having PN I had no support and it was very lonely. I have meet many caring and awesome friends in my support group and I'm very thankful to have them all!!

Written by Michelle Cornell Monroe, Support for Neuropathy member

http://neuropathyawareness.blogspot.com/2011/11/living-life-with-peripheral-neuropathy.html

MUSIC THERAPY REDUCES DEPRESSION IN YOUTH

Researchers at Queen's University Belfast have discovered that music therapy reduces depression in children and adolescents with behavioral and emotional problems.

In the largest ever study of its kind, the researchers in partnership with the Northern Ireland Music Therapy Trust, found that children who received music therapy had significantly improved self-esteem and significantly reduced depression compared with those who received treatment without music therapy.

The study, which was funded by the Big Lottery fund, also found that those who received music therapy had improved communicative and interactive skills, compared to those who received usual care options alone.

251 children and young people were involved in the study which took place between March 2011 and May 2014. They were divided into two groups -- 128 underwent the usual care options, while 123 were assigned to music therapy in addition to usual care. All were being treated for emotional, developmental or behavioral problems. Early findings suggest that the benefits are sustained in the long term.

Professor Sam Porter of the School of Nursing and Midwifery at Queen's University, who led the study, said: "This study is hugely significant in terms of determining effective treatments for children and young people with behavioral problems and mental health needs."

Dr Valerie Holmes, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences and co-researcher, added: "This is the largest study ever to be carried out looking at music therapy's ability to help this very vulnerable group, and is further evidence of how Queen's University is advancing knowledge and changing lives."

Ciara Reilly, Chief Executive of the Northern Ireland Music Therapy Trust, said: "Music therapy has often been used with children and young people with particular mental health needs, but this is the first time its effectiveness has been shown by a definitive randomized controlled trial in a clinical setting. The findings are dramatic and underscore the need for music therapy to be made available as a mainstream treatment option. For a long time we have relied on anecdotal evidence and small-scale research findings about how well music therapy works. Now we have robust clinical evidence to show its beneficial effects."

Neuropathy Asking For Help

Today's post from neuropathy.org (see link below) discusses the importance of asking for help if you need it with neuropathy problems. It's something that almost everybody is reluctant to do; preferring to battle on through on your own but there's no shame in asking someone to help and most people are only too willing to do that. This article gives some good advice as to how to approach people.

Asking for Help
By Leslie MacGregor Levine

This column, written by neuropathy support group leaders Leslie MacGregor Levine and Linda McIntosh, aims to provide insight into the questions and concerns people battling neuropathy have. It also addresses—through experiences of people living with neuropathy in the community—the importance of asking questions, seeking answers, and finding the strength to fight back against neuropathy.

Many of us don’t like asking others for help; and, even when we need it most, we have trouble asking for help. Truth is, asking for help makes us feel: vulnerable; like we are losing our independence; like we are imposing on others. However, when dealing with a chronic disease such as neuropathy, asking for help does not mean giving in to the disease; it means finding the strength to fight back, to make daily tasks a little easier, to make time to rest...

We recently spoke with Herb Fine (leader of the Neuropathy Association’s support group in Silver Spring, Maryland and a neuropathy patient) about some of his insights on asking for help. Herb shared this experience of a stranger stepping in to help him even though he did not ask for it: “I found myself driving home one afternoon after running errands and being on my feet most of the morning; I knew I had overdone it, but I believed I could make it home safely. En route home, I was stopped by a policeman who had noticed that my car was weaving in and out of its lane. I explained to the policeman that I was very tired, having over-extended myself despite my medical condition; the policeman was sympathetic and did not give me a ticket. Instead, he followed me to make sure I got home safely.”

We have all been in situations where we needed help; but rather than relying on others to notice we need help or offer assistance—as the policeman did for Herb—we must ask for help. The following are a few strategies for asking for help:

- Make lists of the tasks you need help with (e.g., groceries, babysitting, and changing a light bulb) and of family members and friends who have offered to help. Using these lists, match up the task you need help with the person you believe would be most likely to help;

- State what it is that would be helpful and be specific. People generally want to help…but they need to know exactly what is expected of them and they need advance notice (e.g., Could you please pick up the kids after work? or I am having a bad day…could you take care of dinner?); and

- Acknowledge and thank those who have helped you by sharing with them just how many their efforts are making your day easier. And if you'll need to ask for help again, they will be happy and willing to help out.

Neuropathy limits our stamina and ability to perform tasks that we once considered routine or even effortless. Accepting that to live life to the fullest extent possible and to minimize stress (which can worsen our symptoms), asking our family members and friends for help is key. There will always be people who cannot deal with our illness or offer support; in time, they may come around. Asking for help allows our family members and friends to be supportive and not feel powerless in the face of our health challenges.

http://www.neuropathy.org/site/PageServer?pagename=Resources_Peer_to_Peer

Neuropathy Just One Of The Statins Side Effects

Today's post from articles.mercola.com (see link below) looks at the risks of taking statins for people with nerve problems amongst other things. Statins are a very fast growing market in a world where heart attacks and strokes plus high cholesterol, are increasing medical issues thanks mainly to modern life-styles. They will work very effectively to reduce cholesterol and thus prevent a whole array of problems but they do have their side effects and many people just aren't aware of the risks they run when taking statins. This especially applies to neuropathy patients and people at risk of nerve damage. Statins can unfortunately bring on nerve damage, or make it considerably worse and as we all know, that's the last thing we want. It's important that if your doctor suggests taking statins that you bring up the subject of potential nerve damage yourself. It needs to be discussed.

The Ugly Side of Statins: Systemic Appraisal of the Contemporary Unknown Unknowns
By Dr. Mercola October 09, 2013

Statin cholesterol-lowering drugs are among the most widely prescribed drugs on the market, bringing in $20 billion a year.1 They are a top profit-maker for the pharmaceutical industry, in part due to relentless and highly successful direct-to-consumer advertising campaigns.

One in four Americans over the age of 45 now takes statins, typically for the primary prevention of heart attacks and strokes. Traditionally, primary prevention usually involves healthy lifestyle choices that support heart health, things like eating right and exercising, yet here we have millions of Americans taking pills instead.

Has anyone unbiased stopped to find out if these drugs are really the best method for heart attack prevention? After all, as researchers noted in the Open Journal of Endocrine and Metabolic Diseases (OJEMD):2

“…naive indiscriminate acceptance of novel mainstream therapies is not always advisable and prudence is required in unearthing harmful, covert side effects.”

This is precisely the task that researchers from Ireland took on by completing an objective review of Pubmed, EM-BASE and Cochrane review databases.3 Their results speak volumes…


“It is beginning to dawn on some clinicians that contemporary treatments are not only failing to impact on our most prevalent diseases, but they may be causing more damage than good. A perfect example of such an issue is the statin saga.” 

The Evidence Is In: Lifestyle Trumps Statins for Primary Heart Attack Prevention

For a drug therapy that appears to offer little by way of primary prevention, the risks were alarming. For every 10,000 people taking a statin, there were:
307 extra patients with cataracts
23 additional patients with acute kidney failure
74 extra patients with liver dysfunction

The landmark review revealed “a categorical lack of clinical evidence to support the use of statin therapy in primary prevention.” They also found that statins actually increase cardiovascular risk in women, the young and people with diabetes. The review also showed that statin therapy increased:
Muscle fatigabilty by 30% with more than 11% incidence of rhabdomyolysis (a life-threatening muscle condition) at high doses
Coronary artery and aortic calcification
Erectile dysfunction, which is 10 times more common in young men taking the lowest dose of statin.
Diabetes
Cancer

The researchers noted:

“There is increased risk of diabetes mellitus, cataract formation, and erectile dysfunction in young statin users, all of which are alarming. Furthermore there is a significant increase in the risk of cancer and neurodegenerative disorders in the elderly plus an enhanced risk of a myriad of infectious diseases. All side effects are dose dependent and persist during treatment.

Primary prevention clinical results provoke the possibility of not only the lack of primary cardiovascular protection by statin therapy, but highlight the very real possibility of augmented cardiovascular risk in women, patients with diabetes mellitus and the young. Statins are associated with triple the risk of coronary artery and aortic calcification.

These findings on statins' major adverse effects had been under-reported and the way in which they [were] withheld from the public, and even concealed, is a scientific farce.

… Cardiovascular primary prevention and regeneration programmes, through life style changes and abstaining from tobacco use have enhanced clinical efficacy and quality of life over any pharmaceutical or other conventional intervention.” 

If You Take Statins, Your Vision Could Be at Risk

The featured review found an increased risk of cataracts with statin use, and this was supported by a new JAMA study,4 which further revealed that the risk of cataracts is increased among statin users, compared with non-users. As a main cause of low vision among the elderly, cataract is a clouding of your eye lens.

It has previously been hypothesized that statin antioxidant effects may slow the aging process of the lens, but the current study revealed that they, instead, raise cataract risk, again calling into question the usefulness of statins for primary prevention of heart attacks. The researchers concluded:

“The risk-benefit ratio of statin use, specifically for primary prevention, should be carefully weighed, and further studies are warranted.” 

Certain Statins May Impair Your Memory and May Even Lead to Amnesia

Still more research revealed that rats taking the statin Pravachol (pravastatin) had impaired learning, with lower abilities to perform simple learning and memory tasks.5 This isn’t exactly news, as in 2012, the US Food and Drug Administration (FDA) announced it would be requiring additional warning labels for statins, one of which warned that statins may increase the risk of memory loss and confusion. The warnings, particularly the one for memory loss, came as the result of anecdotal reports compiled over the previous year…

Interestingly, the animal study found no association between another statin drug, Lipitor, and impaired memory in the rats. But Dr. Duane Graveline, a medical doctor and former astronaut, has written an entire book on this very topic, titled Lipitor: Thief of Memory.

In my interview with him, Dr. Graveline shared his powerful story about how Lipitor caused him severe global transient amnesia, which is what brought him out of retirement to investigate statins. There have been thousands of cases of transient global amnesia and other types of cognitive damage associated with statin use, reported to the FDA’s MedWatch site. It is believed that statin drugs damage your brain by creating a cholesterol deficiency.

Insufficient cholesterol results in your brain not having the raw materials it needs to make biochemicals critical for memory and cognitive function, including coenzyme Q10 and dolichols, the latter of which carry the genetic instructions from your DNA to help create specific proteins in your body that are crucial for cognitive function, emotions and mood.
High Cholesterol Levels May Be Protective

Any discussion of statins would be incomplete without a discussion of cholesterol – the ‘villain’ that these drugs mercilessly lower. Many buy into the conventional belief that lower cholesterol equals a lower risk of heart disease, but this is not always the case. And, in fact, high cholesterol levels are indeed protective in some cases, whereas low cholesterol levels are very clearly linked to chronic disease. Writing in OJEMD, researchers explained:

“Cholesterol is crucial for energy, immunity, fat metabolism, leptin, thyroid hormone activity, liver related synthesis, stress intolerance, adrenal function, sex hormone syntheses and brain function. When prescribing HMGCoA reductase inhibitors [statins] one needs to be cognizant of the fact that the body had increased its’ cholesterol as a compensatory mechanism and investigate accordingly.

We seem to have fallen into the marketing trap and ignored the niggling side effects with regard to the HMGCoA reductase inhibitors. The only statin benefit that has actually been demonstrated is in middle-aged men with coronary heart disease. However, statins were not shown to best form of primary prevention.

… In actual fact, high cholesterol levels have been found to be protective in elderly and heart failure patients and hypo-cholestereamic [low cholesterol] patients had higher incidence of intra-cerebral bleeds, depression and cancer. … We are observing the revealing of the utmost medical tragedy of all time. It is unprecedented that the healthcare industry has inadvertently induced life-threatening nutrient deficiency in millions of otherwise healthy people. What is even more disparaging is that not only has there been a failure to report on these negative side-effects of statins, there has actually been active discouragement to publish any negative studies on statins.”

This is, in large part, why so many people are completely unaware that statin drugs have been directly linked to over 300 side effects,6 which include:

Cognitive loss Neuropathy Anemia
Acidosis Frequent fevers Cataracts
Sexual dysfunction An increase in cancer risk Pancreatic dysfunction
Immune system suppression Muscle problems, polyneuropathy (nerve damage in the hands and feet), and rhabdomyolysis, a serious degenerative muscle tissue condition Hepatic dysfunction. (Due to the potential increase in liver enzymes, patients must be monitored for normal liver function)

Ask Yourself – and Your informed Physician -- if You Really Need to Be Taking Statins

I've long stated that the odds are very high -- greater than 100 to 1 -- that if you're taking a statin, you may not even need it, as cholesterol is NOT the cause of heart disease. To further reinforce the importance of cholesterol, I want to remind you of the work of Dr. Stephanie Seneff, who works with the Weston A. Price Foundation.

One of her theories is that cholesterol combines with sulfur to form cholesterol sulfate, and that this cholesterol sulfate helps thin your blood by serving as a reservoir for the electron donations you receive when walking barefoot on the Earth (also called grounding). She believes that, via this blood-thinning mechanism, cholesterol sulfate may provide natural protection against heart disease.

In fact, she goes so far as to hypothesize that heart disease is likely the result of cholesterol deficiency — which of course is the complete opposite of the conventional view. So if your physician is urging you to check your total cholesterol, know that this test will tell you virtually nothing about your risk of heart disease, unless it is 330 or higher. HDL percentage is a far more potent indicator for heart disease risk. Here are the two ratios you should pay attention to:
HDL/Total Cholesterol Ratio: Should ideally be above 24 percent. If below 10 percent, you have a significantly elevated risk for heart disease.
Triglyceride/HDL Ratio: Should be below 2.

Additional risk factors for heart disease include: 

Your fasting insulin level: Any meal or snack high in carbohydrates like fructose and refined grains generates a rapid rise in blood glucose and then insulin to compensate for the rise in blood sugar. The insulin released from eating too many carbs promotes fat production and makes it more difficult for your body to shed excess weight, and excess fat, particularly around your belly, is one of the major contributors to heart disease
Your fasting blood sugar level: Studies have shown that people with a fasting blood sugar level of 100-125 mg/dl had a nearly 300 percent increase higher risk of having coronary heart disease than people with a level below 79 mg/dl
Your iron level: Iron can be a very potent oxidative stress, so if you have excess iron levels you can damage your blood vessels and increase your risk of heart disease. Ideally, you should monitor your ferritin levels and make sure they are not much above 80 ng/ml. The simplest way to lower them if they are elevated is to donate your blood. If that is not possible you can have a therapeutic phlebotomy and that will effectively eliminate the excess iron from your body 

Try This Instead for Primary Heart Attack Prevention

Make no mistake about it, statin drugs are some of the most side effect-ridden medications on the market, and they frequently do more harm than good. Of utmost importance, statins deplete your body of CoQ10, which accounts for many of its devastating results. Therefore, if you take a statin, you MUST take supplemental CoQ10, or better, the reduced form called ubiquinol. If you are interested in optimizing your cholesterol levels (which doesn't necessarily mean lowering them) and lowering your risk of heart disease and heart attacks, there are natural strategies available for doing so.
Reduce, with the plan of eliminating, grains and sugars in your diet, replacing them with mostly whole, fresh vegetable carbs and healthy fats. Also try to consume a good portion of your food raw.
Make sure you are getting enough high-quality, animal-based omega-3 fats, such as krill oil.
Other heart-healthy foods include olive oil, coconut and coconut oil, organic raw dairy products and eggs, avocados, raw nuts and seeds, and organic grass-fed meats.
Optimize your vitamin D levels.
Exercise daily, especially with high-intensity interval training (HIIT) exercises.
Avoid smoking or drinking alcohol excessively.
Be sure to get plenty of good, restorative sleep. 


Sources and References

Open Journal of Endocrine and Metabolic Diseases 2013, Vol. 3, No. 3
JAMA Ophthalmology September 19, 2013
Medical News Today September 26, 2013
PLoS ONE 8(9): e75467.

1 Open Journal of Endocrine and Metabolic Diseases 2013, Vol. 3, No. 3
2 See ref 1
3 See ref 1
4 JAMA Ophthalmology September 19, 2013
5 PLoS ONE 8(9): e75467.
6 GreenMedInfo Statin Drugs 
 
http://articles.mercola.com/sites/articles/archive/2013/10/09/statin-cholesterol-lowering-drugs.aspx

Is Methadone An Option For Neuropathic Pain

Today's post from eperc.mcw.edu/ (see link below) was last revised in 2009 but nevertheless sums up current thinking regarding the use of methadone to control neuropathic symptoms. If you Google the subject you will come up with many other articles, including studies, about using methadone as a specific opioid to control nerve pain but this one is relatively easy to understand and sums up the dilemmas that doctors and specialists face in the current climate, where opioid prescription is coming under both social and legal scrutiny, especially in North America. Methadone's efficiency as an analgesic is somewhat clouded by its reputation, as a substitute for morphine, heroine and other opiate-acting drugs but that may be unfair. It seems however, that more and more people are finding that relatively low-dose methadone use can bring relief from their neuropathic pain and it may be worth discussing the possibility with your specialist or doctor, especially if all else seems to have failed. Methadone may well be a good alternative to Tramadol and Oxycodone but it is essential that the decision to take it is taken in complete agreement with your doctor. Just as with all other opioids and strong painkillers, ensuring that your progress will be monitored is also essential to avoid overdose and addiction potential. This article is not the full story but provides useful background information to help with your decision making.
Never attempt to self-medicate with Methadone or other opioids.

Methadone for Neuropathic Pain
Author(s): David E Weissman MD FAST FACTS AND CONCEPTS #171 PDF

Background Prescriptions for methadone have greatly increased in the past six years (1). The reason for this increase is likely related to two factors: reduced cost relative to other potent opioids and basic science data suggesting that methadone may be particularly useful in treating neuropathic pain. Two previous Fast Facts #75, 86) reviewed methadone’s pharmacological properties. This Fast Fact examines the research base regarding methadone and neuropathic pain and reviews the rise in methadone-related deaths.

Historical Context
 
Prior to 1985, when long-acting morphine preparations were introduced, methadone was commonly prescribed for cancer-related pain as it had a longer duration of action than morphine. However, it was well appreciated that methadone had a higher risk of respiratory depression due to drug accumulation with chronic dosing – an effect not associated with other opioids, for which there is no drug accumulation in the setting of normal renal function.

Prior to 1990 there was a widespread belief that opioids were relatively ineffective in treating neuropathic pain. Since then, there been a much greater understanding that opioids are an effective part of neuropathic pain treatment.

Basic science data Methadone inhibits reuptake of norepinephrine and serotonin in a similar manner to newer anti-depressants, some of which are effective against neuropathic pain (e.g. venlafaxine). Also, methadone binds to the NMDA receptor, a known modulator of neuropathic pain. Finally, methadone has demonstrated efficacy in animal models of neuropathic pain (1).

Patient data Small non-controlled case series and at least one small randomized study (methadone vs. placebo) have demonstrated that methadone can reduce neuropathic pain in both cancer and non-cancer patients (2-5). There is no data, for or against the proposition, that methadone is superior to other opioids for neuropathic pain. A 2004 Cochrane Collaborative review found, “there is no trial evidence to support the proposal that methadone has a particular role in neuropathic pain of malignant origin” (6). Furthermore, the review cautioned clinicians about the danger of methadone-induced respiratory depression due to its long terminal half-life.

Methadone deaths There is a growing awareness that the increased prescription of methadone is being paralleled by a similar increase in methadone-related deaths. Florida, Utah, North Carolina, Oregon, Indiana, Maryland, Alabama and West Virginia have all reported a spike in deaths related to methadone since 2000 (7,8). The US Department of Health and Human Services convened an expert panel in 2003 to investigate the rise in methadone deaths and concluded that the rise was largely due to the increasing use of methadone as an analgesic (9). The Center for Disease Control published a report detailing data from Utah in 2005, suggesting that part of the problem was due to increased prescribing (10). The current data seem to suggest that the general increased supply of methadone, via legitimate prescribing, is leading to deaths due to accidental overdose through improper prescribing or illicit diversion/recreational use. In addition to concern about respiratory depression, there has been a relatively recent observation that methadone, unlike morphine or hydromorphone, can prolong the QTc interval and lead to serious cardiac conduction abnormalities. Note: the overall number of opioid-related deaths has increased, not just from methadone. Note: there are no data on untimely deaths related to methadone prescribing in hospice/palliative care patients.

Summary The renewed interest in an old drug based on new science holds exciting promise of benefit for the many patients with neuropathic pain. However, clinical research has yet to confirm or deny a unique clinical role for methadone compared to other opioids. The risk of respiratory depression should give clinicians pause before prescribing methadone based solely on the theory that it is a superior opioid in neuropathic pain. Furthermore, given that diversion of legitimate opioid prescriptions to the illicit market can occur, even in the practice of hospice and palliative care, physicians and hospice agencies need to recognize they also have a larger social responsibility to the public welfare, and prescribe methadone with care and caution.

References
Foley KM. Opioids and chronic neuropathic pain. NEJM. 2003; 348:1279-1281.
Morley JS, et al. Low-dose methadone has an analgesic effect in neuropathic pain: a double-blind randomized controlled crossover trial. Pall Med. 2003; 17:576-587.
Altier N, et al. Management of chronic neuropathic pain with methadone: a review of 13 cases. Clin J Pain. 2005; 21:364-369.
Gagnon B, et al. Methadone in the treatment of neuropathic pain. Pain Res Manage. 2003; 8:149-154.
Moulin DE, et al. Methadone in the management of intractable neuropathic non cancer pain. Can J Neuro Sci. 2005; 32:340-343.
Nichloson AB. Methadone for cancer pain: Review. Cochrane Database of systematic reviews. 2004;2:CD003971.
Google Search: ‘Methadone deaths.’ December 2007.
Finn S, Tuckwiller S. Feds act on methadone deaths. West Virginia Gazette. July 23 2006.
Increase in poisoning deaths caused by non-illicit drugs--Utah, 1991-2003. MMWR Weekly. 2005; 54:33-36.
US Department of Health and Human Services – Division on Pharmacologic Therapies. Report on Methadone Mortality (http://dpt.samhsa.gov/reports/methodone_mortality-05.htm - no longer publicly available). Updated Report available at: http://www.dpt.samhsa.gov/pdf/MethadoneBackgroundPaper_72007_2_.pdf.
Fast Facts and Concepts are edited by Drew A Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For more information write to: drosiell@mcw.edu. More information, as well as the complete set of Fast Facts, are available at EPERC: www.eperc.mcw.edu.

Version History: This Fast Fact was originally edited by David E Weissman MD and published in December 2006. Current version re-copy-edited in April 2009; web-links updated.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Weissman DE. Methadone for Neuropathic Pain. Fast Facts and Concepts. December 2006; 171. Available at: http://www.eperc.mcw.edu/FastFactsIndex/ff_171.htm.

Disclaimer: Fast Facts and Concepts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_171.htm

HOMOEOPATHIC REMEDIES FOR ICHTHYOSIS VULGARIS

Ichthyosis vulgaris  is an inherited skin disorder in which dead skin cells accumulate in thick, dry scales on your skin's surface.

The scales of ichthyosis vulgaris, sometimes called fish scale disease or fish skin disease, can be present at birth, but usually first appear during early childhood. Sometimes, mild cases of ichthyosis vulgaris go undiagnosed because they're mistaken for extremely dry skin.

Most cases of ichthyosis vulgaris are mild, but some are severe. Sometimes other skin diseases, such as the allergic skin condition eczema, are associated with ichthyosis vulgaris.

There are various types of ichthyosis , but Ichthyosis vulgaris is the most common and mild form. It is characterised by mild scaling and dryness of skin.

Causes--Ichthyosis vulgaris is commonly caused by a genetic mutation that's inherited from one or both parents. Children who inherit a defective gene from just one parent have a milder form of the disease. Those who inherit two defective genes have a more severe form of ichthyosis vulgaris. Children with the inherited form of the disorder usually have normal skin at birth, but develop scaling and roughness during the first few years of life.

If genetic abnormalities aren't responsible for ichthyosis, it's referred to as acquired ichthyosis. It's usually associated with other diseases, such as cancer, thyroid disease or HIV/AIDS.

Symptoms-Ichthyosis vulgaris slows your skin's natural shedding process. This causes chronic, excessive buildup of the protein in the upper layer of the skin (keratin). Symptoms include:

·         Dry, scaly skin

·         Tile-like, small scales

·         Scales colored white, dirty gray or brown — with darker-colored scales typically on darker skin

·         Flaky scalp

·         Deep, painful cracks in your skin

The scales usually appear on your elbows and lower legs and may be especially thick and dark over your shins. Most cases of ichthyosis vulgaris are mild, but some can be severe. The severity of symptoms may vary widely among family members who have the condition.

Symptoms usually worsen or are more pronounced in cold, dry environments and tend to improve or even resolve in warm, humid environments.

Complications--Some people with ichthyosis may experience:

Overheating. In rare cases, the skin thickness and scales of ichthyosis can interfere with sweating. This can inhibit cooling. In some people, excess sweating (hyperhidrosis) can occur.

Secondary infection. Skin splitting and cracking may lead to infections.

HOMOEOPATHIC REMEDIES

Homoeopathic remedies are found to be very effective for this condition . Some of the effective remedies are given below-

 ARSENIC IODIDATUM 30-Arsenic iodatum is one of the top remedies for Ichthyosis.There is  marked exfoliation of large scales from the skin that leave behind a raw surface. The  skin is  scaly with much itching .

HYDROCOTYLE ASIATICA 6-- Hydrocotyle asiatica is another effective medicine for Ichthyosis.There is  great thickening of epidermal layer and exfoliation of scales of the skin. Circular spots on the skin  with scaly edges.Another prescribing symptom is  intolerable itching , especially  of soles

                                                                                                                                     

PETROLEUM 30-Petroleum is prescribed  where the skin is rough, dry and thick, with the presence of cracks. The skin is very sensitive .

SEPIA 200-Sepia is very effective for ichthyosis . Sepia is prescribed for ichthyosis with offensive odour of skin. Severe itching which is not relieved by scratching. Worse in bends of elbows and knees

KALI SULPH 30— Kali Sulph is the best Homoeopathic medicine  for icthyosis with dry, flaky skin with prominent, yellow scales.

PLATANUS OCCIDENTALIS  30—Platanus occidentalis is prescribed for X linked ichthyosis with corneal opacity and cataract .

NATRUM CARB. 30-Natrum carb. is prescribed for Lamellar ichthyosis with photophobia

CLEMATIS ERECTA 30-Clematis erecta is prescribed when red, brown , scaly, scabby skin occurs.  There is intense itching ,  worse washing in cold water

ZINCUM METALLICUM 30-Zincum metallicum is effective for ichthyosis with corneal dystrophy.