Monday, 25 September 2017

The Future For Neuropathic Pain Treatment

Today's post from clinicalpainadvisor.com (see link below) is a very interesting analysis of the current state of neuropathy diagnosis and treatment - I'll say it now...it's worth a careful read. Its conclusions, that a holistic and poly-pharmaceutical treatment has to be the way forward, is absolutely in line with modern thinking about nerve damage and something this blog has called for for years. At the moment, doctors tend to prescribe a single drug, followed by another single drug when the first one fails, to tackle the complexity of nerve pain. It's not worked for decades therefore a combination therapy has to be the way forward but that requires the medical establishment to seriously reconsider its thinking and training when it comes to neuropathy. The problem of course, is that combination therapies require more of the doctor's time, both to assess the patient and then assess that patient's progress through the therapies. That's not the patient's problem - it's the system's problem but what's the end goal here...a pain free patient surely? So they need to pull their finger out and put the patient first!


Neuropathic Pain Complexity Requires Thoughtful Approach and Combination of Interventions 
Tara Haelle, MS March 27, 2017 
 
As the population ages, and as both the incidence of diabetes and the survival rates after chemotherapy treatment increase, the number of patients with neuropathic pain is expected to rise.

The wide range of etiologies underlying neuropathic pain render this modality a particularly challenging condition to manage. In addition, most available treatment options have limited efficacy. As the population ages, and as both the incidence of diabetes and the survival rates after chemotherapy treatment increase, the number of patients with neuropathic pain is expected to rise, according to a recent Nature Reviews article.1

"Pain is complex, and even if you identify a medication that has an effect on a specific aspect of the pain pathway, the ascending or descending pathway, it is an extremely complex condition," said Vernon Williams, MD, a neurologist and director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine at Kerlan-Jobe Orthopaedic Clinic in Los Angeles, California, in an interview with Clinical Pain Advisor.

"It is not just sensory; there's an emotional and cultural aspect," he explained. This is true for nociceptive pain as well, he said, but it is particularly true for neuropathic pain because it tends to cause much worse quality of life than nociceptive pain does, and it is an unfamiliar kind of pain that people can have difficulty understanding.

Preventing Neuropathic Pain

The challenge of treating neuropathic pain makes prevention a particularly high priority. Genetic etiologies cannot be prevented; however, preventing shingles, which often causes postherpetic neuralgia, with herpes zoster vaccination is critical to the prevention of neuropathic pain.

In addition, providers can work with patients to manage conditions or treatments known to increase the risk for neuropathic pain, such as diabetes, chemotherapy, and perioperative interventions, to reduce the likelihood of postsurgical pain.

Screening and Diagnosing Neuropathic Pain


In cases in which prevention fails or is not an option, 3 diagnostic classifications exist for neuropathic pain: possible, probable, and definite.2 A "possible" diagnosis applies when the patient's history suggests a neurological lesion or disease or an account of one's pain consistent with biological plausibility, but such categorization requires further testing. A "probable" diagnosis, determined on the basis of clinical examination of sensory signs with bedside and/or quantitative sensory testing, indicates a need to start treatment. Only those patients who have undergone an objective diagnostic test (eg, skin biopsy, neurophysiological assessment) that indicates either a lesion or dysfunction of the somatosensory nervous system would receive a "definite" diagnosis.

Validated screening tools for neuropathic pain, which can suggest a probable diagnosis requiring treatment initiative, include the following: Leeds Assessment of Neuropathic Symptoms and Signs, Douleur Neuropathique 4 questions, Neuropathic Pain Questionnaire, painDETECT, ID Pain, and Neuropathic Pain Symptom Inventory. Each of these tools relies on varying requirements in assessing specific symptoms or descriptors of pain, clinical exam items, affect or location of pain, provoking factors of pain, and/or temporal aspects.

"From a practical standpoint, the things most commonly done have to do with the patient history and physical examination," Dr Williams said. "If the character and distribution of the pain by patient history is consistent with neuropathic pain, that is often sufficient." Pain descriptions that include burning, electric, or radiating pain are common, as are presence of allodynia or hyperpathia. Bedside assessment of sensory symptoms might involve observing the response to pressure, vibration, pinpricks, cold, heat, or light touch (to assess allodynia).

Several objective tests for nerve damage are of varying utility:

 
Quantitative sensory tests, using standardized mechanical and thermal stimuli, provide reliable information about loss and gain of function of different afferent nerve fibers classes and can be useful in identifying different phenotypes.3
Laser-evoked potentials most reliably assess integrity of Aδ and C fibers, whereas nerve conduction studies, trigeminal reflexes, or somatosensory-evoked potentials assess Aβ function.4
Skin biopsy is highly sensitive for identifying small-fiber neuropathies, but evidence linking neuropathic pain to skin biopsy findings is limited.5
Corneal confocal microscopy is noninvasive, but costly, and not widely available; in addition, evidence linking neuropathic pain with corneal abnormalities is scarce, and nonneuropathic eye conditions may affect the results.6

Treatment Options and Pain Management

The 3 broad categories of pain management include medications, interventional therapies, and physical or psychosocial therapies. Generally speaking, a single medication will usually be inadequate to treat such a complex and intense condition, and typical analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, or weak opioids are nearly always ineffective.

"There is going to be some kind of rational polypharmacy instead of a single bullet," Dr Williams said. "The combination of medications and interventional treatments can be very effective with neuropathic pain."

The only drug classes with solid evidence of effectiveness are tricyclic antidepressants, such as amitriptyline and serotonin-noradrenaline reuptake inhibitors like duloxetine, which are considered first-line treatments. The antiepileptics pregabalin and gabapentin are also first-line, but best for peripheral neuropathic pain, although more recent research has produced negative results. Combining either of these antiepileptics with a tricyclic antidepressant can be more tolerable and effective than monotherapy, particularly for diabetic neuropathic pain.

Second-line treatments include lidocaine 5% patches (modest effect), capsaicin 8% patches (lacks long-term safety data), and tramadol (primarily for peripheral neuropathic pain), which work in some patients, but often modestly, and with low success rates.

BotulinumtoxinA as a third-line treatment has proven particularly beneficial for peripheral neuropathic pain and neuropathic pain resulting from diabetes, herpes, and trigeminal neuralgia. Opioids such as oxycodone and morphine are also considered third-line treatment for neuropathic pain, but are less effective and more prone to misuse, overdose, morbidity, death, and diversion.

Patients who do not show adequate response to medications may try interventional treatments such as nerve blocks, modulation of specific neural structures, or surgical procedures for targeted drug delivery, but risks for infection or other adverse effects are possible.

Neurostimulation to interfere with pain signals at different processing stages consist of cryoablation or the application of electrical, radiofrequency, or magnetic energy to pain pathways. Nerve blocks and steroid injections offer short-term relief (typically lasting a few months), and do not reduce the likelihood of later surgical intervention.

Spinal cord stimulation is ideal for patients not responding to other treatments, as it was shown to be relatively safe, reversible, cost-effective, and long-lasting (with results lasting a minimum of 24 months in several studies), particularly if burst- and high-frequency stimulation is used vs monophonic square-wave pulse. Although less evidence supports neurostimulation of afferent fibers outside the spinal cord as a viable option, this intervention has also shown relief for several neuropathic pain conditions, including occipital and postherpetic neuralgia.7

Epidural motor cortex stimulation, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation comprise the 3 types of epidural or transcranial cortical neurostimulation.8 An estimated 60% to 65% of patients experience at least a 40% reduction in pain intensity from epidural motor cortex stimulation, which requires surgery to place the electrodes. Meanwhile, repetitive transcranial magnetic stimulation and transcranial direct current stimulation are noninvasive and use magnetic coils or electrodes placed on the scalp to ease central, peripheral, and facial neuropathic pain for a minimum of 2 weeks. However, repetitive transcranial magnetic stimulation is contraindicated for those with aneurysm clips, deep brain electrodes, cardiac pacemakers, cochlear implants, or a history of epilepsy.

A more controversial approach is that of deep brain stimulation: whereas this intervention was found to be effective for some patients, it is associated with serious risks, including seizure during the procedure, lead fractures, and wound infections.8

Intrathecal therapy to deliver morphine or ziconotide to specific nerves using an implanted, refillable pump is considered a last resort option.9 Dizziness, nausea, confusion, memory impairment, uncontrolled eye movements, and an increase in serum creatine kinase are the most common adverse events, but more serious morbidities and death are also associated with this treatment.

Of all psychological interventions, cognitive behavioral therapy is the only one supported by evidence; however, effect size is modest and varies across patients.10

"People with chronic pain are not passive; they actively attempt to change the causes of pain and change their own behaviour in response to pain," wrote review author, Luana Colloca, MD, PhD, an associate professor of anesthesiology at the University of Maryland School of Nursing, and colleagues. "However, for many patients, such change without therapeutic help is unachievable, and repeated misdirected attempts to solve the problem of pain drive them further into a cycle of pain, depression and disability." Further, it is not currently possible to reliably determine patients who will benefit most from psychological treatments or those most at risk for pain that is exceptionally difficult to manage.

Cognitive behavioral therapy would need to be part of an interdisciplinary approach, Dr Williams said, just as would biofeedback, acupuncture, mindfulness meditation, or other nonpharmacological approaches if any of those offer a patient some additional relief.

Looking Ahead: Phenotyping and Personalized Medicine


Although emerging, the practice of identifying specific phenotypes to better determine course of treatment is promising for a future of personalized medicine. For example, evidence suggests that patients displaying mechanical allodynia, but with intact nociceptive function, will be more likely to respond to systemic and topical sodium channel blockers, botulinum toxin A, and clonidine gel. "It would not be surprising if phenotyping has a great part to play in demonstrating the efficacy of psychological interventions as it does for medications," the authors wrote.

Phenotype identification could also rely on genetic identifiers or certain combinations of symptoms or subjective descriptions of pain. For example, the voltage-gated sodium channel, Nav1.7, is established as an important pharmacological target, and identification of genetic mutations affecting this protein may inform treatment decisions.11

Dr Williams told Clinical Pain Advisor that the field is headed in the direction of using genetics, phenotype identification, and personalized medicine, but it is still in the early stages.

"It's an approach that makes sense and that we're all endeavoring to get to, and sometimes we can do that, but we're still defining what those characteristics are," Dr Williams said. The neuropathic pain categories that present the biggest challenges for genetics-based stratification are acquired ones, such as neuropathic pain resulting from diabetes, stroke, cancer, trauma, shingles, or anything else that's polygenic or specific to an acquired disease. But eventually overcoming these challenges to offer personalized approaches to pain management will pay off in multiple ways.

"It's good medicine, it tends to be less costly, and people tend to have higher satisfaction, as opposed to starting treatment in a stepwise fashion," Dr Williams added. "Trial-and-error has dominated our approach for quite some time, but we're starting to be able to move out of that and have a more specific approach that's stratified and hopefully gives us a higher hit rate in terms of success sooner than that trial-and-error and stepwise approach."

Related Articles

 
Assessing Biomarker Validity for Neuropathic Pain
Neurofeedback for Chemotherapy-induced Peripheral Neuropathy
Classification of Peripheral Neuropathic Pain Based on Sensory Profiles
Central Neuropathic Pain Syndromes


Disclosures


Anthony H. Dickenson has received speaking or consulting fees from Seqirus, Grünenthal, Allergan, and Mundipharma.

Didier Bouhassira has consulted for Grünenthal, Pfizer, and Indivior.

David L. Bennett has consulted for Abide, Eli Lilly, Mundipharma, Pfizer, and Teva.

David Yarnitsky has received a lecture honorarium from Pfizer and holds equity in BrainsGate, and Theranica.

Roy Freeman has served on the advisory boards for Abide, Astellas, Biogen, Glenmark, Hydra, Novartis, and Pfizer.

Andrea Truini has received research funding, lecture honoraria, and speaking or consulting fees from Mundipharma, Pfizer, Grünenthal, and Angelini Pharma.

Nadine Attal has received advisory board or speakers honoraria from Astellas, Teva, Mundipharma, Johnson and Johnson, Novartis, and Sanofi Pasteur MSD.

Nanna B. Finnerup has received advisory board honoraria from Teva Pharmaceuticals, Novartis, and Grünenthal, and research funding from EUROPAIN Investigational Medicines Initiative.

Eija Kalso has served on the advisory boards of Orion Pharma and Grünenthal and received lecture honoraria from Orion Pharma and AstraZeneca.

Robert H. Dworkin has received compensation for research activities from Abide, Aptinyx, Astellas, Boston Scientific, Centrexion, Dong-A, Eli Lilly, Glenmark, Hope, Hydra, Immune, Novartis, NsGene, Olatec, Phosphagenics, Quark, Reckitt Benckiser, Relmada, Semnur, Syntrix, Teva, Trevena, and Vertex.

Srinivasa N. Raja has received research funding from Medtronic Inc and advisory board honoraria from Allergan, Daiichi Sankyo, Grünenthal USA Inc, and Lexicon Pharmaceuticals.

Christopher Eccleston and Taylor Ludman reported no relevant financial relationships.

Follow @ClinicalPainAdv


References
Colloca L, Ludman T, Bouhassira D, et al. Neuropathic pain. Nat Rev Dis Primers. 2017;3:17002. doi: 10.1038/nrdp.2017.2
Finnerup NB, Haroutounian S, Kamerman P, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016;157:1599-1606.
Backonja MM, Attal N, Baron R, et al. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus. Pain. 2013;154:1807-1819.
Valeriani M, Pazzaglia C, Cruccu G, Truini A. Clinical usefulness of laser evoked potentials. Neurophysiol Clin. 2012;42(5):345-353.
Truini A, Biasiotta A, Di Stefano G, et al. Does the epidermal nerve fibre density measured by skin biopsy in patients with peripheral neuropathies correlate with neuropathic pain? Pain. 2014;155:828-832.
Papanas N, Ziegler D. Corneal confocal microscopy: recent progress in the evaluation of diabetic neuropathy. J Diabetes Investig. 2015;6(4):381-389.
Mekhail NA, Mathews M, Nageeb F, Guirguis M, Mekhail MN, Cheng J. Retrospective review of 707 cases of spinal cord stimulation: indications and complications. Pain Pract. 2011;11(2):148-153.
Moore NZ, Lempka SF, Machado A. Central neuromodulation for refractory pain. Neurosurg Clin N Am. 2014;25(1):77-83.
Pope JE, Deer TR, Bruel BM, Falowski S. Clinical uses of intrathecal therapy and its placement in the pain care algorithm. Pain Pract. 2016;1092-1106.
Otis JD, Sanderson K, Hardway C, Pincus M, Tun C, Soumekh S. A randomized controlled pilot study of a cognitive-behavioral therapy approach for painful diabetic peripheral neuropathy. J Pain. 2013;14(5):475-482.
Cregg R, Cox JJ, Bennett DL, Wood JN, Werdehausen R. Mexiletine as a treatment for primary erythromelalgia: normalization of biophysical properties of mutant L858F NaV 1.7 sodium channels. Br J Pharmacol. 2014;171(19):4455-4463. 


http://www.clinicalpainadvisor.com/neuropathic-pain/neuropathic-pain-prevention-diagnosis-and-treatment/article/646294/2/

Sunday, 24 September 2017

A Few Natural Remedy Suggestions For Nerve Pain

Today's post from rd.com (see link below) is simplistic at best but may provide one or two ideas that you might add to your treatment regime, without the need for more drugs. It's by no means extensive and there are many more natural remedies that can be tried - you may already be working your way through the lists to try to find something that works. That's the problem with this sort of article - it's harmless and may help but everything 'neuropathy' is unique to the individual patient and what works for one may not work for another. Because the largely unsuccessful drug treatments haven't changed in decades, people are always searching for alternatives to try. This article may fill in some gaps and in that respect is helpful but it should only be the beginning of your research into natural, or alternative remedies. Sharing your experiences with others in the same boat is always helpful - after all, the medical community isn't coming up with anything better! More articles on natural remedies can be found by using the search button here on the blog and remember, take all advertising promises with a pinch of salt (also a natural remedy but this time against fraudsters).


4 Natural Remedies to Try If You’re Experiencing Peripheral Neuropathy
By Suzanne Robotti with Ronni Gordon, MedShadow Foundation

 If you're among the more than 20 million Americans who suffer from this kind of nerve damage, you'll want to try the natural remedies that really work instead of jumping to medications that may not.
 

If you've complained to your doctor about prickling in your fingers and numbness or cold in your feet, you might have been diagnosed with peripheral neuropathy, a condition involving damage to the peripheral nervous system, the nerves running from the brain and spinal cord to the rest of the body. Peripheral neuropathy symptoms can seem scary, painful, and difficult to deal with. They include numbness and a prickling or tingling sensation in your feet or hands, which can spread to the legs and arms. Other signs are sharp, throbbing, freezing or burning pain, extreme sensitivity to touch, weakness, and a lack of coordination that can lead to falls. 


So if your doctor recommends medication to treat peripheral neuropathy, which may be caused by diabetes (called diabetic neuropathy), some medications (especially those used to treat cancer), other diseases (including kidney, liver, and autoimmune disease), and even vitamin deficiencies, you might want to try some natural remedies first. That's because the current medications are no home run, according to The MedShadow Foundation, a nonprofit organization that raises awareness about medical conditions, side effects, and alternative therapies. 

The drugs to treat peripheral neuropathy include antidepressants and anti-seizure medications, though it is not clear how they work for nerve pain. Commonly prescribed medications include Neurontin (gabapentin), Lyrica (pregabalin), and Cymbalta (duloxetine). But not all patients benefit from these drugs and even if they do, many experience a host of significant side effects including fatigue, nausea, drowsiness, confusion, and weight gain or loss, especially if the dose is high enough to actually work (which often it's not). "Many patients find the side effects of increased dosages intolerable," Marlene Dodinval, executive director of The Foundation for Peripheral Neuropathy, a nonprofit in Buffalo Grove, IL, told the MedShadow Foundation 

The good news: There are alternative, natural treatments and therapies that many patients have used to get pain relief. And as an added benefit, you'll cut back on the number of prescription medications you may be taking at any given time. (These are the signs you may be taking too many prescription drugs.) 

Talk to your doctor about trying some of these natural remedies for peripheral neuropathy: 1. Capsaicin: Capsaicin, the active compound found in hot peppers, is thought to reduce chronic neuropathic pain by making nerves less sensitive to pain messages. Valerie Lloyd, a 65-year-old Alexandria, Va., resident, says she has found some relief for her peripheral neuropathy in a foot cream with capsaicin.

 2. Water Aerobics: This gentle workout improves cardiovascular circulation without putting pressure the joints, which may be painful. Water aerobics helped Lloyd feel better about her strength and state of mind. 

3. Acupuncture: Since acupuncture delivers pain relief, it's no surprise that it can ease symptoms of peripheral neuropathy. Carolyn Hicks, a psychologist and landscape painter in Northampton, MA, found relief in acupuncture. She says the thin needle treatment gave her more energy and balance, and reduced symptoms such as numbness and tingling pain.

 4. Wraps: Elayne Goldstein, a 68-year-old retired teacher from Philadelphia, wears magnetic wraps around her stomach at night, because, she says,something compressing the pained area helps. 

When trying the natural remedies above, it's a good idea to keep a written account of how your pain changes, so you can track its effectiveness. Also, you may find that some of these natural treatments will work better for you than others. Be patient and don't get discouraged. It may take a few days or a week of trying a new therapy before you start to feel relief.

https://www.rd.com/health/conditions/natural-remedies-peripheral-neuropathy/

Saturday, 23 September 2017

Parasthesia: What's That In Nerve Damage Terms?

Today's post from verywell.com (see link below) discusses parasthesia, which is a term many people living with neuropathy may have heard of but have little idea what it means. Actually, those very symptoms that characterise neuropathy (numbness, tingling, burning, itching etc) are manifestations of parasthesia and you may be able to impress your doctor by tossing that one back to him or her! Unfortunately parasthesia is one of the aspects of neuropathy that baffles doctors the most. They're not sure what causes it, whether it's nerve damage, or inflammation, it goes right to the core of why neuropathy remains such a mysterious condition. Reading this article may give you a little more insight into why your symptoms are so specific but will provide few answers.


Odd Nerve Sensations in Fibromyalgia and Chronic Fatigue Syndrome
By Adrienne Dellwo | Reviewed by a board-certified physician  Updated August 07, 2017  


Learn About Paresthesias

Definition:

Paresthesia is the medical term used to describe odd, but not usually painful sensations including tingling, crawling, itching, numbness, and prickling.

These sensations can be mild, somewhat annoying, uncomfortable, or, in people with fibromyalgia, even quite painful. Some people describe them as an annoying tickle or a hair brushing against their skin. Others may experience a sensation similar to the "pins and needles" of a foot that's "fallen asleep" due to restricted blood flow, or bugs crawling under the skin.

Paresthesias often come and go rather than being a constant sensation. They can strike without warning, usually without an obvious trigger. While these sensations are most common in the extremities--your feet, hands, and face--they can be present anywhere in the body.

Paresthesias in Fibromyalgia and Chronic Fatigue Syndrome


Fibromyalgia and chronic fatigue syndrome are both associated with paresthesias, including the painful kind. They can be of any severity and get more or less painful over time.

In chronic fatigue syndrome, we have no real research on paresthesias but a wealth of anecdotal reports. As in fibromyalgia, they can range from mild to severe and can show up just about anywhere.

In fibromyalgia, this symptom is firmly established by research as well as by anecdotal reports from people with the condition.
 

A 2009 study suggested that people with fibromyalgia who also smoke cigarettes tend to have more severe pain from paresthesias.

(This is just one of several fibromyalgia symptoms that smoking may exacerbate.) Quitting smoking may help alleviate the pain, as well as other smoking-related symptoms.

A 2012 study suggests that carpal tunnel syndrome (CTS) is more common in people with fibromyalgia than in the general population.

CTS is a painful and potentially debilitating condition that involves nerve compression and/or swelling in the wrist. It's especially common in people who spend a lot of time on the computer or playing video games, and in checkers at the grocery store.

The researchers who found this link warned that CTS can be hard to spot in people with fibromyalgia because the pain can be mistaken for paresthesias. If you have pain in your hands, especially nerve pain or nerve "zings," and especially if they get really bad when you're asleep or trying to sleep, you may want to ask your doctor to check for CTS. Left untreated, it could get significantly worse over time.

Causes of Paresthesias


Paresthesias are most often caused by damage to peripheral nerves (those in the arms and legs) or pressure on those nerves, which may be caused by inflammation or injury. They can also be caused by chemotherapy drugs. However, most of the time the cause is unknown.

In fibromyalgia and chronic fatigue syndrome, one hypothesis is that they're the result of generally heightened sensitivity of the nerves as well as an amplified pain response in the brain. However, with further research, more possibilities are arising.

Chronic fatigue syndrome is believed to be associated with inflammation, which is a potential cause of paresthesia. Fibromyalgia was long believed not to involve inflammation, but research has found evidence suggesting low levels of inflammation in the connective tissue called the fascia. That raises the possibility that inflammation may at least contribute to paresthesias in this condition.

Another more recent line of inquiry involves damage to small nerve fibers, which are in your skin, organs, and the nerves of your arms and legs (peripheral nerves). Their job is to provide sensation for your skin, such as when you touch something, and to control the function of your autonomic nervous system.

That includes all of the automatic things, such as regulating heart rate, breathing, and body temperature. Damage to these nerves is called peripheral neuropathy.

Treating Paresthesias

When paresthesias aren't painful or disruptive, they're not something that needs to be treated. When they are painful, there are several treatment methods.

Some options for peripheral neuropathy are already used to treat fibromyalgia, including Lyrica (pregabalin) and Neurontin (gabapentin). See more options in the Painful Paresthesias section of 7 Types of Fibromyalgia Pain.

The doctors most likely to understand paresthesias and how to treat them are neurologists and rheumatologists.

Sources:

Gupta D, Harney J. Small fiber neuropathy demonstrated in pain syndromes. Poster session presented at Annual Meeting of the American Academy of Neurology; 2010 Apr 10-17; Toronto, Ontario.

Liptan, GL. Fascia: A missing link in our understanding of the pathology of fibromyalgia. Journal of bodywork and movement therapies. 2010 Jan;14(1):3-12.

Nacir B, Genc H, Duyur Cakit B, et al. Evaluation of upper extremity nerve conduction velocities and the relationship between fibromyalgia and carpal tunnel syndrome. Archives of medical research. 2012 Jul;43(5):369-74.

Pamuk ON, Donmez S, Cakir N. The frequency of smoking in fibromyalgia patients and its association with symptoms. Rheumatology international. 2009 Sep;29(11):1311-4.

Uceyler N, et al. Brain. 2013 Jun;136(Pt 6):1857-67.

Small fibre pathology in patients with fibromyalgia syndrome.

https://www.verywell.com/odd-nerve-sensations-chronic-fatigue-syndrome-3972955

Friday, 22 September 2017

Intravenous Lidocaine May Be The Answer To Neuropathic Pain

Today's post from clinicalpainadvisor.com (see link below) talks about a recent, relatively small-scale study into the effects of intravenous Lidocaine on chronic pain patients (80% of which were neuropathy patients). Although side effects of the treatment were noted, they weren't serious and as the treatment was stopped when the pain was gone, long-lasting side effects are unlikely. You may already be aware of Lidocaine patches that have been available for some years but intravenous treatment may be much more effective. Given all that, more trials are needed in order to a) evaluate the true effectiveness of the drug and b) adjust dosage so that the treatment can be more standardised and therefore more predictable. Nevertheless, it sounds promising and for some severe nerve pain patients, Lidocaine injections may just be the treatment they're looking for. As with so many of these things, patience is a virtue but there's no harm in asking your neurologist if there's a trial in your area.


Intravenous Lidocaine Safe, Effective for Chronic Pain
Jessica Martin August 30, 2017  

A total of 41% of patients in the study experienced pain relief for ≥7 days after treatment.

Lidocaine infusions were shown to provide long-lasting and adequate analgesia in 41% of patients with chronic pain, and to be associated with mild side effects in a study recently published in Pain Medicine.1

Researchers retrospectively reviewed the charts of 233 adult patients (average age, 51; 54% women) with chronic pain (average pain duration, 7.7 years; 80% with neuropathic pain) who had received an initial lidocaine challenge of 1000 mg/h for ≤30 minutes (infusion rate, 16.67 mg/min), followed by up to 2 more lidocaine infusions (average lidocaine administered during first infusion, 381.4 mg). Lidocaine infusions were discontinued upon complete pain relief, experiencing of intolerable side effects, after 30 minutes of infusion, or if requested by patients.

The initial lidocaine infusion led to side effects in 47% of patients (most commonly, perioral tingling, 9.87%; dizziness, 7.73%; and tinnitus, 5.58%). Fewer side effects were reported for the second and third lidocaine infusions.

A total of 41% of patients in the study experienced pain relief after the initial infusion, with an average pain relief of 1 to 2 weeks across the study cohort. Among patients who experienced benefits from the challenge infusion (100% of patients with diabetic neuropathic pain; 57.1% with posttraumatic or postsurgical pain; 55.6% with trigeminal neuralgia; 50.0% with migraine or headache), 94% were administered another infusion, 60% of whom continued to benefit from the treatment. Clinical diagnosis, demographics, and pain duration had no significant effect on the likelihood of achieving pain relief from the lidocaine treatment.

Related Articles
Neuropathic Pain: Assessing Safety, Efficacy of Higher Pregabalin Doses
Perioperative Lidocaine Offers No Benefits in Patients Undergoing Spinal Fusion
Acute Pain Management in the Emergency Department With SoluMatrix Indomethacin

Patients who experienced side effects were less likely to benefit from lidocaine treatment. In addition, patients who did not receive benefit from the initial lidocaine challenge (40.3%) were less likely to receive additional infusions.

The authors concluded that "lidocaine may be beneficial for a range of chronic pain diagnoses. Future studies are necessary to explore the relationships between lidocaine infusion dosage, treatment frequency, benefit duration, and treatment cost-effectiveness."

Follow @ClinicalPainAdv


Reference
Iacob E, Hagn EE, Sindt J, et al. Tertiary care clinical experience with intravenous lidocaine infusions for the treatment of chronic pain [published online July 28, 2017]. Pain Med. doi: 10.1093/pm/pnx167


http://www.clinicalpainadvisor.com/chronic-pain/lidocaine-infusions-provide-long-term-analgesia-for-several-chronic-pain-conditions/article/685071/

Thursday, 21 September 2017

Infectious Auto-Immune Diseases Often Cause Nerve Damage

Today's post from neuropathydr.com (see link below) highlights the fact that many forms of neuropathy are caused by infectious diseases. This is a much underestimated fact when it comes to nerve damage discussions but auto-immune diseases caused by bacterial or viral invasion can frequently lead to neuropathy, therefore the quicker you can get the disease under treatment, the less likely severe nerve damage will occur. Read the article to get a clearer picture.
 
















An Infectious Disease Could Just Be The Start of Your Problems

by john | Jun 12, 2011

If you have lupus, Lyme Disease, Varicella Zoster (aka Shingles), HIV/AIDS, or even Legionnaire’s Disease, you’re probably dealing with some combination of:-

• Extreme fatigue

• Headaches

• Painful, swollen joints

• Anemia

• Fever and chills

• Swelling in your feet, legs or hands

• Pleurisy

• Rashes

• Hair loss

These are all symptoms we’re familiar with when we hear about these infectious diseases[1].

But what you may not realize is that any of these diseases can cause peripheral neuropathy.

If it does, the pain, swelling or even loss of sensation won’t go away on its own. And more than just causing pain, it can be deadly if the wrong nerves are affected.

How Can An Infectious Disease Cause Peripheral Neuropathy?


Excellent question.

Many of these infectious diseases are caused by viruses or bacteria. Viruses and bacteria can attack nerve tissue and severely damage sensory nerves. If those nerves are damaged, you’re going to feel the pain, quickly.

The virus that causes HIV, in particular, can cause extensive damage to the peripheral nerves. Often, the progression of the disease can actually be tracked according to the specific type of neuropathy the patient develops. Painful polyneuropathy affecting the feet and hands can be one of first clinical signs of HIV infection.

Any of these viral or bacterial disorders can cause indirect nerve damage and bring on conditions that we refer to as autoimmune disorders. Autoimmune disorders cause the body’s immune system to go on the offensive and attack its own tissues. These assaults by the body on the body damage the nerve’s protective covering. Think of it as “internal friendly fire” – misdirected but potentially serious.

Aside From Discomfort, What Other Problems Could I Have?


You could have serious problems.


If your peripheral neuropathy affects the autonomic nervous system, you could develop

• Blood pressure problems

• Heart rate issues

• Bladder or bowel control issues

• Difficulty swallowing because your esophagus doesn’t function properly

• Bloating

• Heart burn

• Inability to feel sensation in your hands and feet

Beyond being uncomfortable, any of these conditions can cause serious health issues; some can even be fatal.

How Can You Protect Yourself?

If you suspect you have any of these diseases, get medical treatment immediately. The earlier you start treatment, the less likely you’ll be to develop peripheral neuropathy and nerve damage.

One of the smartest things you can do for yourself to head off potential problems is to consult a specialist who treats neuropathy and will recognize problems quickly and act to resolve them. A great place to start is with your local NeuropathyDR® clinician. Your NeuropathyDR® specialist follows a very specific protocol specifically designed to minimize nerve damage from peripheral neuropathy.

In addition to the NeuropathyDR® protocol and specific drug therapies designed for your particular condition, there are a few things you can do to help yourself[2]:

• Get plenty of rest

• Pace yourself and limit your activities

• Exercise regularly – walking and swimming are good exercises for neuropathy patients

• Take care of your skin and limit your exposure to the sun

• If you smoke, stop

• Eat a healthy, well balanced diet

• If you’re a woman, pay particular attention to birth control issues. Any of these infectious diseases can cause serious problems during pregnancy.

Your NeuropathyDR® clinician or other healthcare provider can work with you to design a diet and exercise plan that will help you fight back against these infectious diseases and the long term problems they can cause.

Contact us today for information on the best course of treatment to make sure that once your infectious disease is cured or under control, you won’t carry the burden of nerve damage from peripheral neuropathy.

[1] www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm


[2] http://lupus.webmd.com/guide/lupus-systemic-lupus-erythematosus-home-treatment

http://neuropathydr.com/an-infectious-disease-could-just-be-the-start-of-your-problems/

Wednesday, 20 September 2017

Why Neuropathy Sufferers Are Sacrificial Lambs To Big Pharma Profits

Today's post from psychiatryadvisor.com (see link below) is an important one for neuropathy sufferers, who go to the doctor and are prescribed antidepressants as a first line entry drug to control the pain and other symptoms. We are so desperate to find something to control our symptoms that we accept the doctor's advice and follow a course of drug treatments that frequently involve anti-depressants, anti-seizure drugs and others which carry a high risk of serious side effects. Why do doctors prescribe these things and why do we accept it as if it's the most normal thing in the world? Because there's no alternative and there hasn't been for decades. Yet it's wrong on so many counts but still we're stuck between a rock and a hard place. Amitriptyline heads the list in this article but reading on, you'll come across several other drugs commonly prescribed for nerve pain. The dangers to patients, especially if they are on drugs for other conditions and the cause of their neuropathy, are clear and alarming, yet nothing changes. Yes there are other drugs and treatments, supplements and therapies but these are only brought into play after the patient has already travelled though the standard list and found them all to be unsatisfactory. The fact that many end up on opioids, says more about the nature of the pain than the value of the drug but it's clear that opioids aren't the only land mines on the neuropathy patients' path. If you're on these drugs for nerve pain then you need to have a serious discussion with your doctor. The time for change is long past; now it's time for action!
 


Antidepressant Death Found Most Often With Amitriptyline Tara Haelle, MS   February 24, 2017 

 Death and serious outcomes resulting from overdose or poisoning from drugs used to treat depression more than doubled during the last decade and a half, found a recent study, with amitriptyline topping the list. Fatal cases overall increased by 32%, and amitriptyline accounted for approximately 2 of 5 deaths from antidepressants, the results showed.

"Unfortunately, the same medications that are given to patients to treat depression can become the vehicle for a serious suicide attempt," reported J. Craig Nelson, MD, from the University of California at San Francisco, and Daniel A. Spyker, PhD, MD, from the Oregon Health and Science University in Portland. "Because many suicide attempts are impulsive, readily available medications may be chosen."


Suicides involving poisoning increased 38.5% from 2000 through 2014, with medications comprising the vast majority of these (89%-92%), the study notes.


The researchers analyzed all records from the National Poison Data System for single exposures of psychotropic medications in people aged 12 years and older from 2000 to 2014. Their query included 48 drugs used to treat depressive and related mood disorders, including antidepressants, atypical antipsychotics, anticonvulsants, lithium, and others.
Nearly a million exposures (962,222) occurred from these medications, with the incidence more than doubling during the 15-year period. The patients were an average age of 35.8 years, and 62.8% were women. Just more than half the exposures (51.4%) were suspected suicide attempts, which also accounted for 66.9% of cases with serious outcomes and 74.1% of the fatal cases. Only 10% overall involved intentional misuse or abuse, and 1 in 5 involved therapeutic mistakes.


Instead of calculating rates, the researchers calculated indices for morbidity and mortality: each index represented the proportion of deaths and/or serious cases out of 1000 exposures.


"The most common clinical events in patients with serious outcomes (frequencies;10%) were drowsiness/lethargy (42.3%), tachycardia (40.7%), hypertension (18.6%), agitation/irritability (17.5%), hypotension (13.4%), confusion (13.2%), tremor (12.4%), and conduction disturbance (10.2%)," the authors reported.


The highest indices of morbidity and mortality occurred with tricyclic and monoamine oxidase inhibitor drugs, but high morbidity indices also occurred from lithium, quetiapine, olanzapine, bupropion, and carbamazepine. The drugs associated with higher mortality indices included, in decreasing lethality, lithium, venlafaxine, valproic acid, bupropion, quetiapine, olanzapine, ziprasidone, carbamazepine, and desvenlafaxine.


"Relative to other compounds, tricyclic antidepressants were associated with higher rates of acidosis, cardiac conduction problems, respiratory depression, and seizures," the authors reported. Amitriptyline was responsible for two thirds of all tricyclic antidepressant exposures and 39.5% of deaths from all antidepressants.


"Arguably one of the most important public health implications of our data is that the prescribing of amitriptyline should be reconsidered when safer alternatives are available," the authors wrote.


Monoamine oxidase inhibitors, although representing a small percentage of exposures, involved high rates of hypertension and confusion and increased creatinine and fever. Among second-generation antidepressants, bupropion had the highest rate of seizures and hallucinations, as well as a high mortality index.


Quetiapine and olanzapine had comparatively higher rates of coma and respiratory depression, and the authors note that effects from respiratory depression "can be additive and may become clinically relevant in vulnerable persons, such as patients with sleep apnea."
Higher rates of bradycardia, confusion, and renal problems, such as elevated creatinine, oliguria, polyuria, and renal failure, occurred with lithium than with other drugs.


"Lithium poses a dilemma for clinicians," the authors noted. "It is one of the most dangerous drugs in overdose, and it is one of the only drugs that has been shown to reduce suicidality in depressed patients."


The authors concluded that serious outcomes, including deaths, from drugs used to treat depression have been increasing more rapidly than such outcomes from other drugs, likely in part because depressed patients are already at higher risk for suicide.


"As a consequence, clinicians need to be aware of the potential risks when they prescribe antidepressants and other drugs used in the treatment of depression," the authors wrote.

Related Articles
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Hormonal Contraception Associated With Depression
Reference Nelson JC, Spyker DA. Morbidity and mortality associated with medications used in the treatment of depression: an analysis of cases reported to U.S. Poison Control Centers, 2000-2014 [published online January 31, 2017]. Am J Psychiatry. doi: 10.1176/appi.ajp.2016.16050523


http://www.psychiatryadvisor.com/depressive-disorder/amitriptyline-has-the-highest-rate-of-morbidity-and-mortality-in-depression/article/640096/?DCMP=EMC-PA_Update&;cpn=&;hmSubId=VD7QWAtW_5U1&;NID=&dl=0&;spMailingID=16666681&;spUserID=Mjk3NTM4NDc4NDE5S0&;spJobI

Tuesday, 19 September 2017

Hormones, Schmoremones - Unless There's Profit To Be Made They Won't Be Developed For Nerve Pain

Today's slightly complex post from clinicalpainadvisor.com (see link below) looks at the findings of Dr. Forest Tennant, that he presented at a recent Pain Week conference. His conclusions that neuropathic pain is the body's response to massive inflammation of the nervous system will come as little surprise to neuropathy patients whose symptoms scream 'inflammation'. However, you may not be as aware of his ideas, that hormone therapy may be the answer. He claims that hormonal treatment may suppress that inflammation and that there is enough research to bear that out. However, pharmaceutical companies are not exactly falling over themselves to develop practical treatments because hormones can't be patented and therefore, profits can't be made. So where does that leave us long-suffering nerve pain patients? If Dr Tennant is right and neuro-hormones are a proven answer to neuropathic pain, then we still can't roll up at the doctor's practice and ask for them because plainly they don't yet exist as marketable therapies. More research and clinical trials are necessary but who's going to finance them if there's no profit to be made! Same old story eh!!


Neuroinflammation: Treating the Underlying Cause of Chronic, Severe Pain
Tori Rodriguez, MA, LPC September 08, 2017 
 
“Neuroinflammation due to microglial activation is the underlying cause of severe persistent or constant pain,” pointed Dr Tennant.

The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of Clinical Pain Advisor's conference coverage.


LAS VEGAS – At Pain Week 2017, held September 5-9, Forest Tennant, MD, DrPH, an internist, addictionologist, and researcher at the Veract Intractable Pain Clinics in West Covina, California, sought to highlight the role of neuroinflammation in severe chronic pain.1

Dr Tennant aimed to help attendees identify patients with neuroinflammation, the diseases most commonly implicated in severe neuroinflammation, complications and outcomes associated with the condition, and optimal treatment options. “Neuroinflammation due to microglial activation is the underlying cause of severe persistent or constant pain, and unless it is suppressed, no real treatment of the cause of pain can be realized,” Dr Tennant told Clinical Pain Advisor.2,3

“Time has taught us that there is a relatively short list of pathologic conditions that cause the most severe, chronic pain — every pain practitioner should have awareness of these,” he added. These conditions include Ehlers-Danlos syndrome, sickle cell disease, Lyme disease, and severe peripheral neuropathies. Dr Tennant also gave examples of pathologic consequences and symptoms of neuroinflammation, including constant pain, insomnia, depression, central sensitization with allodynia and hyperalgesia, and febrile heat episodes.

Physical examination findings may include elevated pulse rate, respiratory rate, blood pressure, and reflex activity; cold extremities; mydriasis; and diaphoresis. Diagnostic tests may reveal elevated serum levels of inflammatory markers such as high-sensitivity C-reactive protein, interleukins, and tumor necrosis factor, as well as abnormal levels of hormones such as dehydroepiandrosterone, testosterone, and progesterone.

Here are the 4 components of treatment for centralized pain and neuroinflammation:


Pain relief using standard nonpharmacologic and pharmacologic approaches 


Neuroinflammation control with varying combinations of low-dose corticosteroids, anti-inflammatories, microglial suppressors, and nutritional supplements 


Spinal fluid flow exercises including walking arm swings, upper body gyration, and deep breathing 


Neuroregeneration with B12, replenishment of hormones showing low serum levels, and the administration of neurohormones that have been found to produce neuroregeneration in animal studies — for example, oxytocin, human growth hormone, and human chorionic gonadotropin4

According to Dr Tennant, there is a large body of animal and in vitro research on neuroregeneration and hormonal suppression of neuroinflammation, and results have been positive among the few clinical researchers who have applied the basic science findings to real patients. He recommends clinical trials with neurohormones in motivated patients whose pain is reasonably under control. “It is too early to recommend a specific clinical indication, but the neurohormones appear quite safe and I believe astute practitioners should begin using neurohormones,” he added.

Related Articles
Diabetic Peripheral Neuropathic Pain: Evaluating Treatment Options
Updated Diagnostic Criteria for Neuropathic Pain in SCI, Stroke, MS
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Risks Associated With Neuropathic Pain Treatment

He stated that neither FDA approval of these agents nor a consensus on evidence-based practice in this area is likely, as pharmaceutical companies will not spend money on large trials since hormones cannot be patented, and they have not been in use long enough to accumulate much evidence-based data. He distributed references to give practitioners confidence that prescribing neurohormones is not a “pie-in-the-sky” concept.

“Overall, hormone treatment of both types should begin to be a new paradigm in pain treatment,” Dr Tennant said. “To date, we've been simply throwing symptomatic pharmaceuticals at pain patients because that is all we have had — now we can begin to treat the underlying cause of pain as opposed to just symptomatic care.”

 
Disclosures Dr Tennant is Editor in Chief of the journal Practical Pain Management, and is a speaker for Regenesis Biomedical.


Read more of Clinical Pain Advisor's coverage of PAINWeek 2017 by visiting the conference page.

References

Tennant F. Neuroinflammation: treating the underlying cause of chronic, severe pain. Presented at Pain Week 2017; September 5-9, 2017; Las Vegas, NV.
Graeber MB, Christei MJ. Multiple mechanisms of microglia: a gatekeeper's contribution to pain states. Exp Neurol. 2012; 234(2):255-61. doi:10.1016/j.expneurol.2012.01.007
Gwak YS, Hulsebosch CE. Remote astrocytic and microglial activation modulates neuronal hyperexcitability and below-level neuropathic pain after spinal injury in rat. Neuroscience. 2009;161(3):895-903. doi:10.1016/j.neuroscience.2009.03.055
Lei ZM, Rao CV. Neural actions of luteinizing hormone and human chorionic gonadotropin. Semin Reprod Med. 2001;19(1):103-9. doi:10.1055/s-2001-13917 


http://www.clinicalpainadvisor.com/painweek-2017/chronic-and-severe-pain-often-accompanied-with-neuroinflammation/article/685529/

Monday, 18 September 2017

Electro-Stimulation Can Help With Sleep Apnea As Well As Neuropathy

Today's post from upi.com (see link below) may at first seem to be unrelated to neuropathy (it talks about a stimulator device to control sleep apnea); however, it's amazing how many people living with neuropathy and especially, autonomic neuropathy, also have problems with sleep apnea. It's also thought that apnea can directly cause neuropathy. Considering that electro-stimulatory devices are being used in neuropathy treatment to block pain signals and stimulate nerve action and are now being adapted to help with apnea, the link with neuropathy can easily be made. The most common current treatment for sleep apnea requires the patient to sleep with a mask over the face to enable enough oxygen intake through the night but these things are so uncomfortable that many people can't sleep anyway. This stimulator breakthrough may help millions of people across the world but it is expensive (prohibitively for many). You need to read the article to see if it can be of any help for you but it does indicate the rise of electro-stimulation in controlling misplaced nerve signals that lead to a variety of conditions.


Nerve 'zap' treatment could be alternative to CPAP for sleep apnea
By Amy Norton | Sept. 14, 2017

THURSDAY, Sept. 14, 2017 -- People with more serious cases of sleep apnea may get lasting relief from an implanted nerve stimulator, a new study finds.

One specialist says the device might benefit those who can't tolerate the current standard treatment for sleep apnea: continuous positive airway pressure (CPAP). CPAP involves wearing a mask over the nose and/or mouth every night, and many people balk at that.

The new device, called Inspire, works by sending electrical impulses to a nerve that controls the muscles of the tongue. When the stimulator is turned on before a person goes to sleep, it causes the tongue to protrude forward, which helps keep the airways open.

Inspire was approved in the United States in 2014, after a trial showed it was safe and effective over one year.

The new study followed 65 of those patients to the five-year mark, and found they were mostly still doing well.

On average, researchers found, the patients' ratings of their sleepiness and quality of life had "normalized." And they were still having far fewer apnea episodes -- pauses in breathing during sleep.

"This shows the improvements are durable," said researcher Dr. B. Tucker Woodson, an otolaryngologist and sleep specialist at the Medical College of Wisconsin.

Obstructive sleep apnea is a disorder in which the muscles of the throat fail to keep the airways open during sleep. That results in repeated interruptions in breathing -- along with symptoms like loud snoring and daytime grogginess due to poor sleep.

The disorder is common, affecting more than 18 million U.S. adults, according to the National Sleep Foundation.

Sleep apnea can be effectively treated with CPAP, but many patients won't try it.

"About one-third of patients look at it and walk away," said Dr. Kathleen Yaremchuk, a sleep specialist who was not involved in the study.

Still others try CPAP but do not manage to use it consistently, said Yaremchuk, who is chair of otolaryngology at the Henry Ford Health System in Detroit.

The mask doesn't always fit well, she explained, and there's the inconvenience of having to travel with it and clean it.

So, Yaremchuk said, nerve stimulation offers a potential alternative for at least some patients.

The Inspire device has a few components, according to Minneapolis-based manufacturer Inspire Medical, which funded the current study. The pulse generator, which is implanted in the chest, has two wires. One senses the person's breathing patterns; the other, which runs through the neck, stimulates the hypoglossal nerve when needed. The hypoglossal nerve controls tongue movements.

The device is turned on and off daily via remote control.

According to Yaremchuk, the new findings help answer a couple of questions.

For one, she said, it seems that people will keep using the stimulator over the years.

Plus, Yaremchuk said, it appears the device remains effective without having to up the voltage over time, which, in theory, could make it less comfortable to use.

At the end of the five-year follow-up, Woodson's team found, patients were typically having about seven apnea episodes an hour each night -- down from 29 before the device was implanted. And 89 percent were no longer snoring, or only "softly" snoring, versus 42 percent before.

The therapy is not perfect, Woodson said. A couple of patients in the original trial needed to have the device repositioned because of discomfort. Others had temporary numbness of the tongue, while 21 percent complained of tongue soreness.

The approach is only for certain patients, Yaremchuk said, not a "first-line" option.

Officially, the device is approved for people with moderate to severe sleep apnea who either do not find relief with CPAP or cannot tolerate it. It's also intended for patients with a body mass index of less than 32 -- which excludes many obese people.

That's because the device stimulation is not strong enough for larger bodies, Yaremchuk explained.

Patients need a full evaluation to know whether the implant is a good option. And only specialized sleep centers offer it now, Woodson said.

Then there's the cost; the device alone is around $20,000. Because it's a fairly new therapy, insurers are only approving it on a case-by-case basis, according to Inspire Medical.

The estimated battery life of the generator is 11 years, Woodson said, so it will need to be replaced near that time.

The findings were to be reported at this week's annual meeting of the American Academy of Otolaryngology - Head & Neck Surgery, in Chicago. Data and conclusions presented at medical meetings are usually considered preliminary until published in a peer-reviewed medical journal.

More information The National Sleep Foundation has more on sleep apnea treatment.

Copyright © 2017 HealthDay. All rights reserved.

https://www.upi.com/Health_News/2017/09/14/Nerve-zap-treatment-could-be-alternative-to-CPAP-for-sleep-apnea/8691505436171/

Sunday, 17 September 2017

'Pain Break' For Nerve Pain? More Like Give Us A Break!

Today's post from benzinga.com (see link below) announces an (on the way towards) FDA approval of a new non-opioid drug designed to alleviate neuropathic symptoms. It's called Pain Break and apparently it's a modification of an existing and already marketed drug that can be dosed in specific amounts and is non-addictive. Hooray, you might think...at last something to keep the opioid police off our backs. However, there's plenty of reason to take this announcement with a pinch of salt. It doesn't exist yet; certainly doesn't have FDA marketing approval yet and nowhere in the article is there any explanation of what it contains. Just saying that it's an existing drug modification could mean anything. If it's such an exciting advance in medicine, then tell us what's in it! GT Biopharma inc. are known for their cancer drugs, so maybe it's one of those that has been adapted but they don't say. By the way, there is already a gel called Pain Break on the market aimed at neuralgia sufferers but I can't imagine this is one and the same product - the internet advertising screams 'let the buyer beware'. Look out for patenting lawsuits with this one!  Experienced neuropathy patients are frankly weary of these hot air announcements, years ahead of production and self-promoted, promising results they can't prove. It's a marketing ploy to get people excited ahead of time and therefore spring a jump on competitors. Fake news...probably not but real news...certainly not. Don't hold your breath.


GT Biopharma Announces Development Plan For Non-Opioid Neuropathic Pain Treatment "PainBrake" 
LOS ANGELES, CA / ACCESSWIRE / September 11, 2017 /

 GT Biopharma Inc. announced today that it has made the required payment to license and develop PainBrake, a non-opioid pain medication, to Accu-Break Pharmaceuticals Inc.

The payment allows GT Biopharma (OTCQB: OXISD) to begin the clinical development process and the filing of a New Drug Application, the final step for a commercial license from the Food and Drug Administration. The company expects to submit an NDA for PainBrake within 18 months.

PainBrake will use a patented technology - and unique shape - that allows tablets to be easily broken into smaller, precise doses, for maximum dose flexibility and accuracy. The top layer contains the pain-killer and is pre-divided by deep scoring during the manufacturing process to provide exact doses. The bottom layer is drug-free and provides a stable breaking region when splitting the tablet.

PainBrake is a new formulation of a marketed drug for the treatment of neuropathic pain, a chronic condition associated with a variety of causes, including diabetic neuropathy, postherpetic neuralgia, trauma, certain forms of chemotherapy, and multiple sclerosis. In 2009 almost 16 million Americans suffered from chronic neuropathic pain, and the prevalence is expected to increase in the future due to the aging population.

Current drugs provide a useful degree of pain relief in only about half the patients. It is estimated that very few patients achieve complete pain relief, only one in four patients experiences over 50% pain relief, and 30% of patients have no or very little relief (Nightingale 2012).

In most patients, pain relief is obtained at the price of burdensome side effects, such as sedation, drowsiness, problems with balance, risk of addiction (Nightingale, 2012). Current treatments for neuropathic pain include narcotic analgesics, anticonvulsants, antidepressants, and cannabinoids. However, these therapies have safety and tolerability issues including, for some, tolerance, abuse and addiction liability. PainBrake is a new delivery system of a pain killer that is expected to decrease side effects and allow for maximum pain relief to be achieved. It is not an opioid, and does not give rise to tolerance and does not have abuse potential.

Because PainBrake is a modified version of an existing drug, only a few short trials are expected. These trials are expected to begin in the third quarter of 2018.

GT Biopharma Chief Executive Officer Dr. Kathleen Clarence-Smith said, "I am looking forward to initiating the development of PainBreak as we anticipate that many patients with difficult to treat neuropathic pain could benefit from this product."

Dr. Elliot F.Hahn, the Executive Chairman of Accu-Break Pharmaceuticals, Inc. added, "We are delighted by the opportunity for our patented technology to provide a product that will treat such a critically important disease as neuropathic pain. We are pleased to assist GT Biopharma in the development of this very important product."

GT Biopharma obtained the rights to license PainBrake as part of its recent acquisition of Georgetown Translational Pharmaceuticals Inc.

GT Biopharma Executive Chairman Anthony J. Cataldo said, "We are thrilled to take this key step toward commercialization of PainBrake, a non-opioid pain reliever that we believe will fulfill a significant need in the treatment of neuropathic pain. PainBrake and the other assets in GTP's Central Nervous System pipeline were major reasons why we agreed to acquire GTP. They are exceptional additions to our company, which already has a rich pipeline of targeted immunotherapy BiKE and TriKE technologies."

GT Biopharma is collaborating with a New Jersey manufacturing facility that is equipped to produce these high technology tablets.

About GT Biopharma Inc.: GT Biopharma, Inc (formerly known as Oxis International Inc.) is an immuno-oncology focused company developing innovative drugs focused on the treatment of cancer and other unmet medical needs. Oxis' lead drug candidate, OXS-1550 (DT2219ARL) is a novel bispecific scFv recombinant fusion protein-drug conjugate composed of the variable regions of the heavy and light chains of anti-CD19 and anti-CD22 antibodies and a diphtheria toxin as its cytotoxic drug payload. OXS-1550 targets and binds to cancer cells expressing the CD19 receptor or CD22 receptor or both receptors. When OXS-1550 binds to cancer cells, they internalize the drug and are killed due to the cytotoxic payload. OXS-1550 has demonstrated encouraging results in early human clinical trials in patients with relapsed/refractory B-cell lymphoma or leukemia. OXS-3550 TriKE technology was developed by researchers at the University of Minnesota Masonic Cancer Center. As demonstrated in non-clinical models, this targeted immunotherapy directs NK cells to kill cancer cells while diminishing drug-related toxicity, and is anticipated to be to NK cells what CAR-T is to T-cells. Additionally, GT Biopharma is focused on acquiring or discovering and patenting late-stage, de-risked, and close-to-market improved treatments for CNS disease (Neurology and Pain) and shepherding the products through the FDA approval process to the NDA. GTP products currently include treatment for neuropathic pain, refractory epilepsies, the symptoms of myasthenia gravis, and motion sickness.

Forward-Looking Statements: Except for historical information contained herein, the statements in this release are forward-looking and made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking statements are inherently unreliable and actual results may differ materially. Examples of forward-looking statements in this news release include statements regarding the payment of dividends, marketing and distribution plans, development activities and anticipated operating results. Factors which could cause actual results to differ materially from these forward-looking statements include such factors as the Company's ability to accomplish its business initiatives, significant fluctuations in marketing expenses and ability to achieve and expand significant levels of revenues, or recognize net income, from the sale of its products and services, as well as the introduction of competing products, or management's ability to attract and maintain qualified personnel necessary for the development and commercialization of its planned products, and other information that may be detailed from time to time in the Company's filings with the United States Securities and Exchange Commission. The Company undertakes no obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events or otherwise.

Media contact:


Stuart Pfeifer

Tel: (310) 788-2850

Email: spfeifer@sitrick.com

SOURCE:
GT Biopharma Inc.

https://www.benzinga.com/content/10039487/gt-biopharma-announces-development-plan-for-non-opioid-neuropathic-pain-treatment-p

Saturday, 16 September 2017

Nobody With Neuropathy Wants To Hear That They Have To Exercise

Today's post from everydayhealth.com (see link below) is another exercise post that will cause regular neuropathy readers to cringe. Living with neuropathy means living with constant discomfort and pain and the idea of exercising to help that pain smacks more of torture than therapy. However, unpalatable as it may be, exercise is essential to stop our muscles from wasting away and our joints from becoming arthritic and even more painful; plus it stimulates blood flow and forces our nerves into action and makes you look and feel better! Does it sound better if you call it 'physical therapy'? Maybe...read the article to form your own conclusions.
 

Physical Therapy for Pain Management
By Diana Rodriguez Medically Reviewed by Pat F. Bass, III, MD, MPH

You may think the last thing you want to do when you're in pain is get moving, but physical therapy can be an essential part of pain management.


 Chronic pain may leave you wanting to curl up in bed with a heating pad and a bottle of medication to help ease your aches. Although doing exercise may sound like sheer torture, it may actually be one of the best pain management options for your chronic pain.

"Physical therapy can be highly effective for all types of chronic musculoskeletal and neuropathic types of pain," says Tom Watson, PT, DPT, clinical director of Peak Performance Physical Therapy in Bend, Ore.

Physical Therapy for Pain Management

Physical therapy is used to alleviate sources of chronic pain, including:
Osteoarthritis
Fibromyalgia
Chronic headaches
Rheumatoid arthritis
Neuropathic pain (pain caused by injury to tissues or nerves)

One of the goals of physical therapy, says Watson, is "to help chronic pain patients become stronger, because they're usually weak from not moving."

As a chronic pain treatment, physical therapy can teach people how to move safely and functionally in ways that they haven't been able to for quite a while, Watson adds.

Physical Therapy: Chronic Pain Treatment Options

Physical therapy involves a number of different types of pain management methods, says Watson, including: 



Massage
Manipulation of joints and bones
Manual therapy using hands or tools on soft tissue
Cold laser therapy to alleviate inflammation and pain and release endorphins
Microcurrent stimulation, which emits alpha waves into the brain and increases serotonin and dopamine to alleviate pain naturally
Movement therapy and exercise

Within each of these categories, there's much that a physical therapist has to offer as far as variety of treatments. Exercise may involve walking on a treadmill or swimming in a pool, depending on the person's pain and physical abilities.

A physical therapist works with each patient to understand his or her particular pain — what causes it and what can be done to manage it. This is the kind of attention that a regular doctor doesn't often have the time to give, but a physical therapist can ask questions and talk about pain issues as you are going through your exercise routine.

How Physical Therapy Helps Chronic Pain

Exercising for just 30 minutes a day on at least three or four days a week will help you with chronic pain management by increasing:


Strength in the muscles
Endurance
Stability in the joints
Flexibility in the muscles and joints

Keeping a consistent exercise routine will also help control chronic pain. Regular therapeutic exercise will help you maintain the ability to move and function physically, rather than becoming disabled by your chronic pain.

Physical therapy tackles the physical side of the inflammation, stiffness, and soreness with exercise, manipulation, and massage, but it also works to help the body heal itself by encouraging the production of the body's natural pain-relieving chemicals. This two-pronged approach is what helps make physical therapy so effective as a chronic pain treatment.

Pain Management: Finding the Right Combination

The less you move, the more pain you'll experience. Conversely, the more safe, therapeutic activity and exercise you get — and the more you learn how to exercise to accommodate your pain, the less pain you'll feel and the more you'll be able to function on a daily basis.

While physical therapy can be extremely effective against chronic pain, says Watson, it's important to understand that physical therapy is part of a combination approach to resolving chronic pain.

Watson recommends nutritional supplements, heat and cold therapy, and even transcutaneous electrical nerve stimulation (TENS) therapy as good additional pain management options along with physical therapy. He notes that it's important to work not just with a physical therapist, but also with a medical doctor who can prescribe any necessary medications. A clinical psychologist and a pharmacist are also important members of a pain management team, says Watson. Put all these components together to find the most effective chronic pain treatment for you.

Last Updated:3/9/2010

https://www.everydayhealth.com/pain-management/physical-activity-and-therapy.aspx