Today's post from neuropathydr.com (see links below) is a two part article from Dr John Hayes Jr, who is a very well respected practitioner with a vast experience of neuropathy treatment. He maintains that the common link between neuropathies is a loss of oxygen at neuronal junctions and it is not enough to simply categorise neuropathy as either peripheral, autonomic or idiopathic. More study is needed into the true etiology of the condition thus leading to much needed new approaches to treatment. Well worth a read and an inspiration for further research.
Posted by john on September 23, 2010
The common link in all of these peripheral neuropathies, regardless of the cause, appears to be hypoxia.
Hypoxia is simply a word that describes loss of oxygen. This occurs at what are called the neuronal junctions. That is, the areas in the human body where one nerve cell communicates to another.
At a simplistic level, nerve cells communicate electrochemically across a gap. In neuropathy caused by hypoxia, this neuronal gap widens, which is theorized to be responsible for the symptoms that include not only the burning and the tingling but the shooting pains as well.
Neuropathy and chronic pain is characterized by pain, numbness, loss of tactile feedback, and poor tissue perfusion. These symptoms may indicate that oxygen is not getting to all the cells causing dysfunction.
Because the patient’s quality of life is decreased, these results are often devastating. Pain medications do not cure the condition; it only helps mask it and, eventually, leads to complications with adverse side effects such as mental confusion and intestinal problems.
As a result of conducting our own research and reviewing published studies from around the world, we have been led to new models concerning the causes of neuropathy and chronic pain. We have concluded that it is not reasonable to merely label neuropathy and chronic pain symptoms as diabetic, peripheral, vascular, or “idiopathic”. What is needed is a more full understanding of the etiology of the condition so new technology can be brought to bear with both ameliorative and therapeutic benefits.
What is the Common Link in Neuropathies? – Part 2
Posted by john on September 24, 2010
Neuropathy and chronic pain results when nerve signal propagation is reduced between adjacent nerve cells due to insufficient oxygen being available to support nerve cell metabolism. This is responsible for 90% of all neuropathy and chronic pain cases. The remaining 10% is caused by physical trauma. Thus it appears that the main precipitating factor for neuropathy and chronic pain is hypoxia and demineralization of the synaptic fluid which creates shrinkage of the nerve cells which widens the gap between these cells making it more difficult for normal sensations to propagate, and loss of electrical conductivity in the synaptic fluid itself.
A temporary hypoxia of nerve tissue can be traced to most causes of neuropathy and chronic pain. The primary negative effects of this hypoxia are as follows:
A defensive contraction of the nerve cell resulting in oversize synaptic junctions
A loss of electrical conductivity of the synaptic fluid between nerve cells
A defensive change in the electrical potentials of the cell membrane resulting in a higher resting state of the trigger level which effectively limits the sensitivity to incoming signals
For example, when the lumbar area experiences a muscle spasm, blood flow is restricted through that muscle resulting in reduced oxygen availability to the surrounding tissue, including nerve cells. Because muscles can use either oxygen or glucose metabolic pathways, they can recover quickly from a temporary reduction in the level of available oxygen. Nerve cells, on the other hand, are limited to the Krebs oxidative reductive metabolic system and must take immediate defensive steps to assure survival during this hypo oxygen state. One of the ways they accomplish this is to contract along their longitudinal axis like a rubber band, reducing their surface area and thus lowering their need for oxygen. (This also occurs when these cells are attacked by a harsh agent in the blood such as chemotherapeutic drugs, Agent Orange, environmental toxins, insecticides, etc.) The synaptic junctions between the axons of one nerve cell and the dendrites of the next nerve cell widen. Normal nerve transmission is now compromised because a nerve signal of normal intensity cannot jump this newly widened gap. The synaptic fluid between the nerve cells must be electrically conductive. Pure water does not conduct electricity, so this conductivity relies on minerals and specific neurotransmitters such as serotonin in the synaptic fluid to enable the propagation of the nerve signal. These minerals are delivered via the perfusion of adjacent tissues with fresh blood and kept in suspension by the periodic ionization of successfully transmitted nerve signals across the junction. When nerve signals are reduced because of these larger dimensions of the synaptic junction, necessary minerals are no longer held in place by electrical tension and are slowly leeched out. This adds to the impairment of effective nerve transmission.
Common short term remedies with prescription drugs only ameliorate the pain temporarily and do little or nothing to mitigate or cure the underlying condition. They may provide some level of temporary relief, but as the disease progresses, the effective dosage of the drug needed to continue suppressing the pain increases concurrently. The side effects of these types of drugs are difficult to deal with and add to the patient’s discomfort. When the increased drug dosage reaches a threshold level, the patient can become confused, ataxic, constipated, confined to a wheelchair or may become bedridden. Symptoms similar to Alzheimer’s may soon follow.
When nerve signals can no longer jump the enlarged synaptic gap, the electrical tension that normally holds these minerals in place is absent, causing the synaptic fluid to leach out its mineral content. Electrical conductivity is reduced, thereby inhibiting the transmission of the normal nerves’ electrical signals across this gap.
http://neuropathydr.com/what%E2%80%99s-the-common-link-in-the-neuropathies-part-1/
http://neuropathydr.com/common-link-neuropathies-part-2/
Today's post from diabeticdeals.com (see link below) is a simple but useful breakdown of what autonomic neuropathy is and how it affects us. Most people begin their nerve damage journey with 'normal' peripheral neuropathy, where the longest nerves become damaged, causing problems in feet, legs and hands but many go on to experience autonomic neuropathy, where the nerve damage starts to affect the involuntary functions we take for granted. This article is a good starting point for your own discussions with your doctor and further investigations as you try to find the best way to live with it.
18 / February 2017 Posted by Web Honkers
Autonomic Neuropathy
Overview
Autonomic neuropathy is a condition that occurs when nerves controlling involuntary body functions are damaged. When this happens, it might affect temperature control, blood pressure, bladder function, digestion and in extreme cases sexual function. This nerve damage hinders transfer of messages from the brain to the organs of the autonomic nervous system like blood vessels, the heart, as well as sweat glands. Although diabetes is the main cause of this condition, other health conditions including infections and medications might also lead to nerve damage.
Symptoms
Autonomic neuropathy may affect many organs at the same time. This can lead to a wide range of symptoms. The affected nerves usually determine symptoms and signs of this condition. However, some of the most common ones include:
- Fainting and dizziness especially when standing due to rapid drop in blood pressure - Urinary problems like incontinence, difficulty starting urination and inability to empty your bladder completely that can cause urinary tract infections. - Sexual difficulties including problems such as achieving or even maintaining an erection. Men suffer from erectile dysfunction while women suffer from vaginal dryness and problems achieving orgasm. - Difficulties in food digestion like feeling full and satisfied after just a few food bites, diarrhea, constipation, loss of appetite, abdominal bloating, nausea, heartburn and difficulty swallowing. - Sluggish pupil reaction that makes it hard to adjust your sight from light to dark. Driving at night also becomes a problem. - Exercise intolerance. This usually occurs when your heart rate fails to adjust to your changing exercise level.
Causes
As previously highlighted, various health conditions can lead to autonomic neuropathy. It might also occur as a side effect of various treatments and medications for other diseases like cancer. Some of the main causes of this condition include:
- Diabetes: This is the most popular cause of autonomic neuropathy. When this happens, it can damage nerves gradually, thus worsening the situation. - Autoimmune diseases: Especially when the immune system attacks and then damages your body parts including nerves. Some of the common examples include systemic lupus erythematosus, Sjogren’s syndrome, celiac disease and rheumatoid arthritis. Autonomic neuropathy can also be caused by a sudden attack on the immune system due to some cancers. - Abnormal protein buildup especially in organs that affect the nervous system - Nerve injury due to surgery or neck radiation - Other infectious diseases like botulism, HIV and Lyme disease can also lead to autonomic neuropathy. - Inherited disorders
Treatments Available
Treatments for this condition mainly target the damaged nerves as well as any underlying condition that might be causing injury to the nerves. Various treatments are available based on your symptoms. For the case of diabetes, control of blood sugar is the first priority. Once the underlying disease causing the nerve damage is addressed, the second step involves managing the specific symptoms. Some medications and treatments can provide relief from autonomic neuropathy symptoms. Affected body parts and organs are treated separately.
Bottom Line
Although certain hereditary diseases that expose you to autonomic neuropathy can’t be prevented, you can prevent or slow the progression of the symptoms. This can be done by taking good care of your health as well as managing your medical conditions. Ensure that you follow your doctor’s advice and recommendations on healthy living, and you will be able to control many conditions and diseases.
https://www.diabeticdeals.com/smartblog/18_Autonomic-Neuropathy.html
Today's post from relief.news (see link below) talks about how people living with HIV have lived with the disease and the pain that often goes with it - sometimes better and with more resilience than people without HIV in their lives. Up to 40% of people living with HIV suffer from neuropathy. Nobody's has got to the bottom of why this happens. It's assumed to be a side effect of long-term HIV medication, or the virus itself attacking the immune system, or a combination of both with other factors thrown in. Considering the stigma that is still attached to HIV, it makes a pleasant change to read an article that shows that HIV patients can actually live with the pain far better than the rest of the population faced with the same pain levels. An interesting article...worth a read.
The Role of Resilience and Physical Activity in HIV-Related Pain By Relief Staff December 13, 2016
How is HIV-related pain different from other types of chronic pain?
People living with HIV experience pain similar to people with other chronic conditions. For example, people with HIV can have similar nerve pain in the feet and legs as diabetics. The significance of our study is that HIV-positive patients react to their pain differently.
Many people with moderate to severe chronic pain find it difficult to move around. But we found that, in contrast, HIV-positive people who had chronic pain were still active.
There were two parts to our study: we measured activity and resilience (or a person’s ability to cope with adversity). We wanted to see if HIV-positive people with pain moved less than those without pain and if resilience affected how much they moved. We also wanted to know if resilience affected how much pain they felt.
We measured activity by getting participants to wear movement detectors over two weeks. It helped us understand how much patients with chronic pain moved and how much time they spent being active each day. The overarching finding was that activity levels did not drop as pain increased.
In previous studies, women who suffered from rheumatoid arthritis spent large parts of each day not moving. And similarly, women who experienced really bad period pain moved much less when they were menstruating.
But people living with HIV and chronic pain did not stop their usual activities, despite the pain they experienced.
To measure resilience we used a questionnaire developed by pain researchers in the U.S. Researchers from Europe have used this questionnaire to assess resilience in patients experiencing chronic spinal pain. They found that people who were more resilient coped better with chronic pain and were more active.
Our assumption was that the more resilient patients were, the more active they would be. This assumption proved to be incorrect. Resilience made no difference to activity levels. We also assumed that resilience would lead to participants experiencing less pain. But that wasn’t the case either. Patients who were more resilient did not have less pain.
What type of pain do people living with HIV experience? How common is it?
One in every two people with HIV experience pain. This includes headaches, chest pain, back pain or frequently peripheral nerve pain in their feet and hands.
The pain can be moderate to severe and can be caused by the immune system’s response to the virus or can co-occur with it. The pain does not tend to go away when patients go onto antiretroviral drugs. Some drugs have been shown to inadvertently induce pain. While the pain can be short-lived, it can also become chronic.
So what factors did play a role in activity levels and why?
There were two reasons why HIV-positive people with pain may have continued to be active: financial stresses and stigma.
We found that younger participants, unemployed participants and those that worried most about getting food were the ones who were more active. It seems they relegated their pain to a lower priority.
Our study also showed that stigma often stopped people from talking about their pain and may have motivated them to keep active.
We asked the participants with pain who they spoke to about their pain. Nearly half of the patients had not told their closest friends and some had not disclosed this to their family. They said they feared that talking about their pain might reveal their HIV status.
Why are these findings important and what’s next?
The HIV-positive patients who were more resilient were more satisifed with their health.
HIV-related pain is really difficult to treat. Improving resilience, for example, with psychological treatments, may be one way of improving patients’ satisfaction with their health even if their pain stays the same.
With other kinds of chronic pain, people who keep active do better. But sometimes, pushing through pain can actually make pain intensity and disability worse. In this study we looked at how pain affects activity in HIV. Now we need to look at how activity affects pain.
We know that for patients with other kinds of pain, social support is really important to help them cope. HIV-positive patients may go without social support if they conceal their pain. We need to understand how they cope instead.
The impact of HIV stigma on pain also needs to be investigated.Editor’s Note: Antonia Wadley, PhD, is a postdoctoral fellow in the School of Physiology, Faculty of Health Sciences, at the University of the Witwatersrand in South Africa. Wadley is originally a physiotherapist from the UK but now researches HIV-related pain. Wadley and colleagues published a recent study on the role of resilience and activity in HIV-related pain. The interview below, where Wadley describes her recent work, was originally published in The Conversation Africa, and is reprinted here with Wadley’s permission. Also see a related YouTube video on the study here.
http://relief.news/the-role-of-resilience-and-activity-in-hiv-related-pain/
