Is Nerve Decompression Surgery The Answer For Neuropathy

Today's post from dlife.com (see link below) suggests that there is a new surgical treatment for neuropathy but doesn't expand enough to tell the reader that this is a limited option that only applies to people living with trapped nerves with still some element of function. It discusses decompression surgery which relieves the entrapment of a nerve (either by releasing the nerve, or removing the impediment but the vast majority of people with neuropathy have nerves that are so severely damaged that a surgical procedure doesn't have any point any more. This decompression surgery has been around a long time and has led to wild claims from unscrupulous operators that neuropathy can be 'cured'. It can if, as in this case, the nerve is only trapped but not destroyed (through recent injury for instance) but it can't if the nerve has been 'broken' or been stripped of its protective myelin sheath and lost all function (being effectively 'dead'). So yes, if your neuropathy problem falls under the general title of entrapment (herniated discs, carpal tunnel and cubital tunnel syndromes amongst others for instance) decompression surgery is an expensive and risky option and worth exploring with the experts but if your pain, tingling, numbness etc comes from damaged nerves, then surgery can't do the necessary repairs.

Hope for Neuropathy
Nerve decompression surgery offers treatment for symptomatic neuropathy. 
By Theresa Garnero, APRN, BC-ADM, MSN, CDE Last Modified Date: January 27, 2014

Many people react with skepticism when hearing that surgery can relieve the pain of neuropathy. Why haven't we heard about this before? Even though it is a relatively novel surgical procedure, it has been performed for over 15 years and is based upon principles learned from more commonly performed operations which surgeons have been performing for decades. Moreover, the results can be life-changing and important for dLife community members to consider.

Have you ever had a pinched nerve or had your arm fall asleep after laying on it? If that's all you've had, consider yourself lucky. How long would it take for your arm to wake up if you had fallen asleep on the nerves for a few years? What if the pressure on your arm nerves continued—would the arm ever wake up? For many people with diabetes, this is the manner in which their nerves become injured and is the reason the symptoms of neuropathy appear. Neuropathy caused by uncontrolled diabetes can be very painful and in severe cases, debilitating. Treatment options typically focus on medications that reduce the painful symptoms while the root cause of the problem, pressure on the nerve, continues (see related article about neuropathy by clicking here).

That was until Dr. Ziv Peled enlightened us with the latest surgical treatment options. Dr. Peled is Director of The Dellon Institute for Peripheral Nerve Surgery and Plastic Surgery in San Francisco, California. He gave a recent educational program on surgical nerve decompression for the Center for Diabetes Services staff at California Pacific Medical Center in San Francisco, California. Dr. Peled explained that the body has many known nerve compression sites where nerves pass through tight tunnels (fascial bands). If the nerves swell within the fixed space of these tunnels (as is the case of people with diabetes), the nerves effectively become compressed or entrapped and the symptoms of neuropathy rear their ugly heads. Common sites include, but are not limited to:

Arms

The median nerve (wrist), which may get caught in the carpal tunnel (i.e. carpal tunnel syndrome).
The ulnar nerve (elbow), which may get caught in the cubital tunnel.
The radial sensory nerve (arm), which may get caught in the dorso-radial forearm.
The radial nerve (just past the elbow), which may get caught in the radial tunnel.

Legs
The common peroneal (knee), which may get caught near the fibular head.
The superficial peroneal nerve, which may get caught approximately 12 cm above the outside ankle bone.
The deep peroneal nerve, which may get caught in the dorsum (top) of the foot.
The distal tibial nerve, which branches to give the medial/lateral plantar nerves (providing sensation to the bottom of the foot), and the calcaneal nerves (providing sensation to the heel region), which may get caught in the tarsal tunnel (behind the inside ankle bone).

Anatomical jargon aside, you can see we have a lot of places along a nerve's path in which these nerves can become entrapped. A nerve that is wrapped up and bound may result in pain and/or decreased sensation, which lead to a higher risk for ulcers, wounds and potentially the need for amputations. The further out the nerve is from the spinal cord, the higher the rate of nerve problems (e.g. the feet are more often involved than the thighs).

Dr. Peled shared his research and multiple cases of surgically released nerves with a resulting dramatic improvement in pain and sensation. If tight compressive band is cut, the nerve can go on doing its job.

Who qualifies?
Not everyone is a surgical candidate. The first step is to be examined so that your doctor can check if the nerve is still able to function (the Tinel sign). In addition, a sophisticated type of neurosensory testing is used to corroborate the severity of nerve dysfunction. This testing with the Pressure Specified Sensory Device (PSSD), detects exactly how much pressure is required to elicit a sensation of being touched. The PSSD has been demonstrated to be more sensitive than a needle conduction study (i.e. EMG) and best of all, is completely painless (needle conduction studies are painful—trust me).

How long is the surgery?
Surgery is usually about a 2-hour outpatient procedure. One extremity (arm or leg) is done at a time; as soon as six weeks later, the other lower extremity can be done. Patients can use their extremity immediately after surgery (walk, use their arm). Many insurance plans cover the procedure.

What kinds of surgeons perform this procedure?
Specialized plastic surgeons who have completed at least a six-month fellowship in peripheral nerve surgery are the most qualified to perform surgical nerve decompression for diabetic neuropathy, a procedure pioneered by Dr. Lee Dellon. For example, after completing his plastic surgery training at Harvard University, Dr. Peled spent an entire year studying these procedures at the Dellon Institute in Tucson, Arizona. Dr. Dellon is an accomplished plastic surgeon as well as a professor of Plastic Surgery and Neurosurgery at the Johns Hopkins University School of Medicine in Baltimore, Maryland. The Dellon Institutes for Peripheral Nerve Surgery owe their name to him.

Where can I have this done?
To date, this surgery is only available in San Francisco, Tucson, St. Louis, Boston, New York, Tennessee, and Baltimore. For more information, check out www.dellon.com and click on the "contact us" link on the left side of the home page. The clinical results are promising so perhaps this vital procedure will be more widely available in the near future.

http://www.dlife.com/diabetes/complications/neuropathy/garnero_0108

Will HGF Injections Be The Answer For Neuropathy

Today's post from type2nation.com (see link below) talks about injecting HGF (hepatocyte growth factor - a protein associated with tissue regeneration) to treat neuropathy. Notice, I say neuropathy and not neuropathy symptoms because this is designed to help regenerate nerve growth where damaged and not just the symptoms of nerve pain or tingling. However and this is a big however, in the study, the majority of subjects did not respond to the treatment, which leaves the whole idea open to doubt. The article author suggests that this still shows HGF injections to be potentially useful for neuropathy patients but it seems that many more studies and lots more research may be needed first before this can be assumed.
 

Injections May Combat Diabetic Neuropathy
Published on January 25th, 2016 | by Travis Manni

One common side effect of living with diabetes can be painful diabetic neuropathy, which is nerve damage in the arms, hands, legs, or feet; the condition is caused by chronically high blood sugar levels. There are limited treatment options to deal with diabetic peripheral neuropathy, or the pain it causes.

However, a new multi-center study showed hepatocyte growth factor (HGF) injections helped treat the condition for a good amount of study participants. The study was published in the May 2015 issue of the journal Annals of Clinical and Translational Neuropathy. However, the treatment did not work for the majority of individuals studied, meaning HGF may be a good treatment option, but not necessarily a silver bullet in treating diabetic peripheral neuropathy.

According to the National Center for Biotechnology Information, HGF is a protein in the body that is associated with organ development, tissue regeneration, and wound healing in adults. It also supports the growth and nourishment of neuron cells. In the double-blind Phase II study, 96 individuals were given either a placebo or HGF intramuscular injections in the leg twice over two weeks; the experimental group received either 8 mg (low-dose) or 16 mg (high-dose) of HGF. Participants were asked to record information in a pain and sleep diary.

The low-dose experimental group showed the greatest reduction in pain after three months, according to a MedScape article. In particular, those who were not not already taking other prescription drugs that treat this type of pain reported a statistically significant decrease on the pain measurement scale. Additionally, 48% of those surveyed in the low-dose group reported their pain was either “improved” or “very much improved” after three months; 31% of people in the high-dose group also reported “improved’ or “very much improved” pain levels. Improvement in touch sensitivity was also observed in those treated with HGF.

Researchers hope this form of treatment, which would require only eight injections a year, will eliminate the need for patients experiencing painful diabetic neuropathy to take daily medication. The HGF injections also could be seen as an alternative option for those who do not experience pain relief with currently available prescription drugs. Further study will be needed before the treatment might become available on the market, and researchers expect to conduct a new trial in 2016.

http://www.type2nation.com/treatment/new-injection-treatment-may-combat-diabetic-neuropathy/

Is Cymbalta Duloxetine The Answer For Neuropathic Pain

Today's post from battlediabetes.com (see link below) is a two pronged one for neuropathy sufferers. It talks mainly about taking cymbalta (duloxetine) to control neuropathy symptoms and comes up with some negative conclusions (which won't be a surprise for many on the drug). It also highlights diabetes and shows a video of a young boy's daily life with that disease. Whatever the cause of your neuropathy, if it is not diabetes, then for general knowledge alone the video is worth watching, if only to understand how difficult life with diabetes can be.

How Can Cymbalta Fight Diabetic Neuropathy Nerve Pain?

Cymbalta is an SSRI antidepressant which was being prescribed off label to diabetes patients who were suffering from diabetes nerve pain known as diabetic peripheral neuropathy. The FDA approved Cymbalta for treatment of diabetes neuropathy but does Cymbalta’s pros outweigh it’s cons?

Cymbalta is a dual re-uptake inhibitor of serotonin and norepinephrine. It is this characteristic that causes Cymbalta to drastically reduce pain. I have been checking out some message boards in which people who began taking Cymbalta saw a great improvement in their pain associated with diabetic peripheral neuropathy. If you’ve never had nerve pain, you just can’t imagine how painful it is. Pretty much nothing gives you relief. That is why Cymbalta is becoming so popular to treat the pain.

Not only does Cymbalta relieve some of the nerve pain associated with the diabetic peripheral neuropathy but since it is an antidepressant it is also providing a better quality of life to those suffering from both pain and depression. The risk of depression is raised in diabetes patients.



Think your diabetes is difficult to manage? Meet Calvin. A 10 year old boy with a deep enthusiasm for life. But every day is a constant battle against an enemy that will not relent; an enemy that requires careful vigilance and treatment; an enemy that science can not‚ as yet‚defeat.

After reading up on the subject of Cymbalta for diabetes peripheral neuropathy I started coming across a lot of message boards containing messages from diabetes patients who were in the process of weening off of Cymbalta because it was no longer working for their pain. Why were they needing to ween off of Cymbalta? Because the Cymbalta withdrawal is pretty severe. So severe, that even though people are slowly weening off (I’m talking taking a couple of months to ween off) they are still experiencing severe withdrawal symptoms.

I have found a site that lists a possible 85 Cymbalta withdrawal symptoms. Some of these are minor and just irritating such as canker sours but otherwithdrawal symptoms can be quite sever and disruptive to daily life such as a buzzing in one’s brain. I have seen those called brain zaps or brain shivers. Try walking around with what feels like electric shocks in your brain and see how normal you appear.

So to me, it seems like in some cases the Cymbalta works for diabetes peripheral neuropathy for a couple of months but then it takes up to 3 more months after realizing it doesn’t work anymore to actually be completely off of the Cymbalta. Is it worth it? That is really up to the person that is going to be taking it. I understand that diabetes nerve pain can be almost intolerable so I can see why someone would want to try anything that might possibly work.

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http://www.battlediabetes.com/cymbalta-diabetes-nerve-pain