The Inherent Nonsense Of Some Neuropathy Research

Today's post from healio.com (see link below) shows yet again that good money is being spent in investigating the blindingly obvious. It's about neuropathy patients' own perceptions of their unsteadiness and lack of balance and whether this affects their state of mind or not. The conclusion is that such people take measures to adjust their walk, step or gait as a result of their own perceived unsteadiness. Well DUH! Why is it that absolutely everything has to be scientifically proved in the modern world; most probably to justify particular amounts of money being spent in certain areas? The cost of the research itself is seldom brought into question. I'm sorry but if you're going to waste our tax-payers' money in this way, there's little chance of genuine progress being made in the treatment of neuropathy symptoms. It's enough to make you choke on your coffee and reach for the walking stick!

Self-perceived unsteadiness influences balance, gait in diabetic neuropathy
February 24, 2017

In adults with diabetic peripheral neuropathy, self-perceived unsteadiness was associated with balance and gait measures, according to published findings.

“Unsteadiness and associated restrictions in activities of daily living predict depressive symptoms in patients with [diabetic peripheral neuropathy], highlighting the negative spiral between [diabetic peripheral neuropathy], unsteadiness, falls and psychological distress,” Neil D. Reeves, PhD, professor of musculoskeletal biomechanics at the School of Healthcare Science at Manchester Metropolitan University, United Kingdom, and colleagues wrote. “However, because unsteadiness has been assessed by self-report in most previous studies, it remains unknown whether a person’s perception of unsteadiness actually correlates with objective measures of balance and gait.”

Reeves and colleagues analyzed data from three groups of patients: adults with diabetic neuropathy (neuropathy disability score ≥ 6; n = 15), patients with diabetes but no neuropathy (n = 15) and matched controls without diabetes (n = 19). All participants completed the neuropathy-specific quality-of-life questionnaire to assess self-perceived unsteadiness during walking and standing. Participants underwent gait analysis using a 10-camera motion analysis system and force platforms while walking at a self-selected speed; dynamic sway was also measured.

Researchers found that the diabetic neuropathy group reported more self-perceived unsteadiness vs. those with diabetes but no neuropathy or controls (P =; .0001). Participants with diabetic neuropathy also had reduced gait velocity and step length vs. controls (P =; .0001), as well as altered body center-of-mass movement (P =; .05). Researchers observed strong correlations between self-perceived unsteadiness and gait velocity, step length and severity of diabetic peripheral neuropathy.

“The novelty of the current study is in showing that [diabetic peripheral neuropathy] patients are not only aware of themselves as being unsteady, but actually attempt to self-regulate their unsteadiness by walking more slowly and taking shorter steps,” the researchers wrote. “These gait adjustments reduce the extent to which [diabetic peripheral neuropathy] patients need to move their body forward, away from their base of support, during each step.”

The researchers noted that self-perceived unsteadiness in participants with diabetes but without diabetic peripheral neuropathy was no different from that of controls without diabetes. The researchers did not assess fear of falling, depression or fall history of participants. – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.

http://www.healio.com/endocrinology/diabetes/news/in-the-journals/%7B8989f864-2a74-4513-91d8-2ee142a17b74%7D/self-perceived-unsteadiness-influences-balance-gait-in-diabetic-neuropathy

Pain Research In The Future

 Today's post from inthefaceofpain.com (see link below) is a very useful article for anyone trying to find out what is being done about the chronic pain problem which seems to be a media hype these days. It looks into the areas of investigation for research groups and companies and tries to use a crystal ball to see how pain medication and treatment is developing for the future. As a neuropathy patient, dealing with varying degrees of pain on a daily basis, this sort of research is very important for you because it shows at least a willingness to move away from the traditional analgesic drugs and opiates. It will reassure you that they are looking very hard for new treatment options but of course seeing it in print and seeing it on your pharmacist's shelves are two different things. Worth a read for sure.
 

National Institutes of Health: What is the Future of Pain Research?
2013

This section is intended for use by health care professionals to explore additional ways that you can advocate for better pain management through your employers, professional societies or state licensing boards.



In the forefront of pain research are scientists supported by the National Institutes of Health (NIH), including the National Institute of Neurological Disorders and Stroke. Other institutes at NIH that support pain research include the National Institute of Dental and Craniofacial Research, the National Cancer Institute, the National Institute of Nursing Research, the National Institute on Drug Abuse, and the National Institute of Mental Health. Developing better pain treatments is the primary goal of all pain research being conducted by these institutes.

In the summer of 2009, key elements of the National Pain Care Policy Act were incorporated into the Patient Protection and Affordable Care Act, which President Barack Obama signed into law on March 23, 2010. These provisions include:
Mandating an Institute of Medicine (IOM) conference on pain to address key medical and policy issues affecting the delivery of quality pain care; this has been completed. Click here to access the IOM report. 

Establishing a training program to improve the skills of health care professionals to assess and treat pain.

Enhancing the pain research agenda for the NIH. This effort has been started through the Interagency Pain Research Coordinating Committee (IPRCC). The Committee accepts nominations for scientific and public members on an annual basis. You may want to consider nominating a colleague or pursuing a nomination for yourself!

Advocacy organizations are now working with appropriations committee members to ensure that this portion of the law is adequately funded. Check with pain-related organizations for the latest updates and ways that you can support.

Pain Research on the Horizon

One objective of investigators working to develop the future generation of pain medications is to take full advantage of the body’s pain “switching center” by formulating compounds that will prevent pain signals from being amplified or stop them altogether. Blocking or interrupting pain signals, especially when there is no injury or trauma to tissue, is an important goal in the development of pain medications. An increased understanding of the basic mechanisms of pain will have profound implications for the development of future medicines.

The following areas of research are bringing us closer to better pain care:

Systems and imaging: The idea of mapping cognitive functions to precise areas of the brain dates back to phrenology, the now archaic practice of studying bumps on the head. Positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and other imaging technologies offer a vivid picture of what is happening in the brain as it processes pain. Using imaging, investigators can now see that pain activates at least three or four key areas of the brain’s cortex – the layer of tissue that covers the brain. Interestingly, when patients undergo hypnosis so that the unpleasantness of a painful stimulus is not experienced, activity in some, but not all, brain areas is reduced. This emphasizes that the experience of pain involves a strong emotional component as well as the sensory experience, namely the intensity of the stimulus. 

Channels: The frontier in the search for new drug targets is represented by channels. Channels are gate-like passages found along the membranes of cells that allow electrically charged chemical particles called ions to pass into the cells. Ion channels are important for transmitting signals through the nerve’s membrane. The possibility now exists for developing new classes of drugs, including pain cocktails that would act at the site of channel activity. 

Trophic factors: A class of “rescuer” or “restorer” drugs may emerge from our growing knowledge of trophic factors, natural chemical substances found in the human body that affect the survival and function of cells. Trophic factors also promote cell death, but little is known about how something beneficial can become harmful. Investigators have observed that an over-accumulation of certain trophic factors in the nerve cells of animals results in heightened pain sensitivity, and that some receptors found on cells respond to trophic factors and interact with each other. These receptors may provide targets for new pain therapies. 

Molecular genetics: Certain genetic mutations can change pain sensitivity and behavioral responses to pain. People born genetically insensate to pain – that is, individuals who cannot feel pain – have a mutation in part of a gene that plays a role in cell survival. Using “knockout” animal models – animals genetically engineered to lack a certain gene – scientists are able to visualize how mutations in genes cause animals to become anxious, make noise, rear, freeze, or become hypervigilant. These genetic mutations cause a disruption or alteration in the processing of pain information as it leaves the spinal cord and travels to the brain. Knockout animals can be used to complement efforts aimed at developing new drugs.

Plasticity: Following injury, the nervous system undergoes a tremendous reorganization. This phenomenon is known as plasticity. For example, the spinal cord is “rewired” following trauma as nerve cell axons make new contacts, a phenomenon known as “sprouting.” This in turn disrupts the cells’ supply of trophic factors. Scientists can now identify and study the changes that occur during the processing of pain. For example, using a technique called polymerase chain reaction (PCR), scientists can study the genes that are induced by injury and persistent pain. There is evidence that the proteins that are ultimately synthesized by these genes may be targets for new therapies. The dramatic changes that occur with injury and persistent pain underscore that chronic pain should be considered a disease of the nervous system, not just prolonged acute pain or a symptom of an injury. Thus, scientists hope that therapies directed at preventing the long-term changes that occur in the nervous system will prevent the development of chronic pain conditions. 

Neurotransmitters: Just as mutations in genes may affect behavior, they may also affect a number of neurotransmitters involved in the control of pain. Using sophisticated imaging technologies, investigators can now visualize what is happening chemically in the spinal cord. From this work, new therapies may emerge, therapies that can help reduce or obliterate severe or chronic pain.

Hope for the Future

Thousands of years ago, ancient peoples attributed pain to spirits and treated it with mysticism and incantations. Over the centuries, science has provided us with a remarkable ability to understand and control pain with medications, surgery, and other alternative and complementary treatments. Today, scientists understand a great deal about the causes and mechanisms of pain, and research has produced dramatic improvements in the diagnosis and treatment of a number of painful disorders. For people who fight every day against the limitations imposed by pain, the work of the National Institute of Neurological Disorders and Stroke (NINDS)-supported scientists holds the promise of an even greater understanding of pain in the coming years. Their research offers a powerful weapon in the battle to prolong and improve the lives of people with pain: hope.

http://www.inthefaceofpain.com/take-action/health-care-professional-advocacy/

More Genetic Research into Chronic Pain

Almost every month, news emerges about another research study into gene therapy for dealing with chronic pain. Today's post from sciencedaily.com (see link below) looks at research published in Nature Medicine. It has identified a gene particularly associated with pain sensitivity and talks about an amino acid which can have a direct effect on the genetic process. Genetic science is not easy for the layman to understand and talking about molecular levels will probably leave you scratching your head but you can get the general idea. Always good to know that this sort of research is going on - hopefully we will see practical results soon.

New Way to Treat Chronic Pain, Suggested by Study
ScienceDaily (Mar. 26, 2012)

Nearly one in five people suffers from the insidious and often devastating problem of chronic pain.

That the problem persists, and is growing, is striking given the many breakthroughs in understanding the basic biology of pain over the past two decades. A major challenge for treating chronic pain is to understand why certain people develop pain while others, with apparently similar disorders or injuries, do not. An equally important challenge is to develop individualized therapies that will be effective in specific patient populations.

Research published online in Nature Medicine points to solutions to both challenges. A research team led by Prof. Jeffrey Mogil of McGill University in Montreal and Prof. Michael Salter of The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, has identified a major gene affecting chronic pain sensitivity. The findings also suggest a new approach to individualizing treatment of chronic pain.

The gene that the researchers identified encodes the pain receptor known as P2X7. Specifically, the scientists discovered that a single amino-acid change in P2X7 controls sensitivity to the two main causes of chronic pain: inflammation and nerve damage.

The amino-acid change is known to affect only one function of P2X7 receptors -- the forming of pores that permit large molecules to pass through -- while leaving intact the other function, of allowing much tinier ions to flow through. Using a peptide that targets pore formation only, the researchers found that pain behaviours were dramatically reduced.

The scientists then examined genetic differences among human patients suffering from two distinct types of persistent pain: chronic post-mastectomy pain and osteoarthritis. In both cases, they found that individuals with genetically inherited low pore formation in P2X7 receptors experienced lower pain levels.

"Our findings indicate that it may be possible to develop drugs that block pores in this crucial receptor, while leaving its other function intact -- thereby killing pain while minimizing side effects," said Prof. Mogil, E.P. Taylor Professor of Pain Research in McGill's Department of Psychology.

Prof. Salter, Anne and Max Tanenbaum Chair in Molecular Medicine at SickKids, said these discoveries "point toward a new strategy for individualizing the treatment of chronic pain." Scientists from the U.S. and Israel also contributed to the study.

The study was supported by the Krembil Foundation, the Louise and Alan Edwards Foundation, the US National Institutes of Health (NIH), the Canadian Institutes of Health Research (CIHR) and SickKids Foundation.

http://www.sciencedaily.com/releases/2012/03/120326132539.htm

FIGHT AGAINST ALZHEIMERS DISEASE NEW RESEARCH ON WALNUT

A new animal study published in the Journal of Alzheimer's Diseaseindicates that a diet including walnuts may have a beneficial effect in reducing the risk, delaying the onset, slowing the progression of, or preventing Alzheimer's disease.

Research led by Abha Chauhan, PhD, head of the Developmental Neuroscience Laboratory at the New York State Institute for Basic Research in Developmental Disabilities (IBR), found significant improvement in learning skills, memory, reducing anxiety, and motor development in mice fed a walnut-enriched diet.

The researchers suggest that the high antioxidant content of walnuts (3.7 mmol/ounce) may have been a contributing factor in protecting the mouse brain from the degeneration typically seen in Alzheimer's disease. Oxidative stress and inflammation are prominent features in this disease, which affects more than five million Americans.

"These findings are very promising and help lay the groundwork for future human studies on walnuts and Alzheimer's disease -- a disease for which there is no known cure," said lead researcher Dr. Abha Chauhan, PhD. "Our study adds to the growing body of research that demonstrates the protective effects of walnuts on cognitive functioning."

The research group examined the effects of dietary supplementation on mice with 6 percent or 9 percent walnuts, which are equivalent to 1 ounce and 1.5 ounces per day, respectively, of walnuts in humans. This research stemmed from a previous cell culture study led by Dr. Chauhan that highlighted the protective effects of walnut extract against the oxidative damage caused by amyloid beta protein. This protein is the major component of amyloid plaques that form in the brains of those with Alzheimer's disease.

Someone in the United States develops Alzheimer's disease every 67 seconds, and the number of Americans with Alzheimer's disease and other dementias are expected to rapidly escalate in coming years as the baby boom generation ages. By 2050, the number of people age 65 and older with Alzheimer's disease may nearly triple, from five million to as many as 16 million, emphasizing the importance of determining ways to prevent, slow or stop the disease. Estimated total payments in 2014 for all individuals with Alzheimer's disease and other dementias are $214 billion.

Walnuts have other nutritional benefits as they contain numerous vitamins and minerals and are the only nut that contains a significant source of alpha-linolenic acid (ALA) (2.5 grams per ounce), an omega-3 fatty acid with heart and brain-health benefits. The researchers also suggest that ALA may have played a role in improving the behavioral symptoms seen in the study.