Has Spinal Cord Stimulation Improved To The Point Where It Provides A Viable Alternative For Chronic Nerve Pain

Today's post from medlatest.com (see link below) reports on an interesting discussion about Spinal Cord Stimulation as being a means of reducing chronic nerve pain. Spinal Cord Stimulation has been around for years of course but has suffered from poor results and neuropathy patients and doctors alike have become reluctant to offer, or try it. In these days of looking for opioid alternatives, it's logical that SCS methods will be re-examined and that's exactly why these specialists got together to discuss the issue. It's somewhat ironic that research into treatments for neuropathy has been stagnant for decades but the minute that opioids become a 'hot' issue, then research into pain relief goes into overdrive. That said, nerve pain patients mustn't grumble: at least efforts are now being made to find alternative solutions. However, this discussion concluded that patient reluctance regarding SCS is based on past experiences with older technology which rarely worked as was hoped. The physicians maintain that the technology has now moved on to the point where success in controlling pain via electrical stimulation is now much more likely. The problem lies in how you measure pain and results and this is a whole new ball game because pain is so subjective and by asking a patient to point to a smiley face to indicate their pain levels, you might as well lick your finger and stick it in the air. The conclusion must be that if SCS technology is so much better, then evaluation methods need to drastically change to catch up. Interesting read.

The Case for Spinal Cord Stimulation in Chronic Pain
Source: Boston Scientific March 10, 2017 

Expert physicians gathered in a round table event to discuss Spinal Cord Stimulation as a treatment for chronic pain.

Background 

With opioid abuse posing a national health crisis, the American College of Physicians recently issued a new guideline to promote treatment alternatives like acupuncture and yoga ahead of opioids on the treatment continuum for low back pain. But, many pain specialists believe alternative therapies like these don’t provide adequate symptom relief, leaving patients to look toward opioids as their only option.

A group of the nation’s leading experts in spinal cord stimulation (SCS) convened for a roundtable discussion at the 2017 North American Neuromodulation Society Annual Meeting to discuss why SCS should be used earlier in the treatment continuum and how it can play a role in addressing the ongoing opioid epidemic.

What becomes immediately apparent on reading the executive summary from the discussion, is that all 6 participants shared the view that SCS should play a much greater role in the management of chronic pain. There was unanimity of opinion that opioid use is problematic, carrying risks of misuse and abuse, while also only being “50% effective in 30% of patients treated.”

Management of patients off their opiates is of course another problem for the clinician, withdrawal being a weaning process and requiring an educational approach. The consensus seemed to be that SCS should be positioned ahead of opiates in the pain treatment continuum.

So why isn’t that already the case? Well it seems that the early days of the therapy weren’t quite as successful as today, which may have spawned resistance in both the clinical and patient community. The panel took this subject on too, suggesting that older technologies presented difficulties targeting specific nerves, while today’s is considered “not the same therapy” and “capable of yielding 100% pain relief.”

The final topic was the SCS patient pathway, the group concluding that the subjective nature of current pain scoring methods meant that their use should not be the only factor. The group expressed a desire to work with medical societies and regulatory bodies to develop a more nuanced standard for measuring patient outcomes.

Selected Physician comments 

Dr. Mark Wallace, chair of the division of Pain Medicine in the Department of Anesthesiology of University of California at San Diego stated; “In my 25 years’ experience, all of my patients reduced their opiates once I put a spinal cord stimulator in them. Most of them completely go off of the opiates. So what we need to do is we need to position the neuromodulations before opiates, and we need to change the pain treatment continuum and get it earlier in the treatment continuum so we can keep patients from starting the opioids in the first place.”

On the subject of the modern SCS therapies, Dr Julie Pilitsis, professor of neurosurgery and of neuroscience at Albany Medical College and Chair of the Department of Neuroscience and Experimental Therapeutic, stated; “I would just like to encourage people…that may have had a negative experience with spinal cord stimulation 20 or 30 years ago to come back to the therapy. It is not the same therapy. We have so many more capabilities. We can help so many more people.”

On the need for a new approach to scoring patients for pain levels, Dr Simon Thomson, consultant in pain medicine and neuromodulation at Basildon and Thurrock University NHS Trust, UK, stated; “I think most people would say in something like chronic pain, it’s plainly ridiculous just to have linear pain scores to define, if you like, the suffering that this patient and those around them are going through … the measure that seems to best define what we’re looking at achieving in our patients is a health-related quality of life measure.”

http://www.medlatest.com/clinical-educational/congresses-meetings/case-spinal-cord-stimulation-chronic-pain/

Pregnancy Weeks To Months

28 Weeks Pregnant

TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Pill nowadays is the most popular pregnancy termination option. Medical Pill - is a method of in early pregnancy 6-7 weeks .

28 Weeks Pregnant

26 Weeks Pregnant

TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Pill nowadays is the most popular pregnancy termination option. Medical Pill - is a method of in early pregnancy 6-7 weeks .

How To Avoid Being The Neuropathy Grinch At Christmas

Today's short post from nationalpainreport.com (see link below) is about as current a topic as you can get and talks about dealing with chronic pain and other neuropathic symptoms when everyone around you is hollering and whooping with (enforced) joy. You often just want them to go away and leave you alone, curled up in a ball in a Harry Potter cupboard under the stairs. Not a good idea if you want sympathy from your nearest and dearest for the rest of the year! However, your problems are all too frequently underestimated and ignored and that can double their effect. This article gives a pretty skimpy and clichéd set of advisory tips but in the end, you have to face the problem and develop your own strategies to survive the holiday period. That doesn't mean giving in to all demands and wearing your plastic smile until the twelfth day of Christmas but it does mean setting boundaries for yourself and getting your alone time if and when you need it. A bit of explanatory preparation will help others to understand you're not going to be 'on' all the time. look after yourself first but helping others enjoy themselves is a positive distraction from your daily pain.

The Christmas Holidays and Chronic Pain
Posted on December 24, 2015 

The holidays are a joyous time for many – but for others, including many who suffer from chronic illness, it can be a difficult time. What the head of the Southern Pain Society calls the “Holiday Blues” or the “Charlie Brown Christmas” may occur at any holiday or vacation time, but most commonly happens during the December holidays.

We asked one of our contributors, Dr. Geralyn Datz about the difficulty that some people have in the holiday season. She says the sadness and even depression can come on for a variety of reasons, like high physical stress as well as psychological and financial and family tension. Dr. Datz is a licensed clinical psychologist who specializes in behavioral medicine.

For some pain patients, it can be caused by both the memories of what life was like when you were pain free and/or because, well, the pain just hurts.

What helps manage it?

The answers are not surprising but often for pain patients, they just aren’t easy to do:

Rest and Get Enough Sleep
Regular Exercise
Eat a balanced/healthy diet

Dr. Datz talks about coping…and has some tips on what to do.
Surround yourself with supportive people—reconnect with old friends
Talk with family about the limitations your pain imposes, “Be honest with yourself and with your family about what you can and cannot do,” she said.
If you are religious, “focusing on the spiritual significant of the holidays can also help.”

Dr. Datz leads the Southern Pain Society which was incorporated in 1989 and is a region of the American Pain Society covering the 18 southern states and Puerto Rico.

“Our mission is to serve people with pain by advancing research and treatment and to increase the knowledge and skill of the regional professional community,” she said.

The Christmas holidays aren’t easy for the chronic pain patient.

In our commentary section to this article tells us how you are doing during the holidays and what you do to cope. We’ll take some of the comments and share them in a story on Christmas Day.

Your friends at the National Pain Report wish you a Merry Christmas and happy holiday season, and know that we are thinking about you.

http://nationalpainreport.com/the-christmas-holidays-and-chronic-pain-8828839.html

Dont Underestimate The Patient When It Comes To Opioid Medication

Today's post from webmd.com (see link below) unfortunately adds somewhat to the hysteria currently surrounding opioid prescription for chronic pain. Yes the statistics are alarming and yes the potential for addiction is high if doctors don't have a serious follow-up program of control but the vast majority of patients with chronic pain, don't take opioids because they want to, they take them because all other alternatives have been exhausted and are not working. In that respect, opioids are an extremely useful and effective painkiller. They do require careful monitoring and that needs to be an active partnership between doctor and patient but the current assumption is that patients can't be trusted to do things properly and that is insulting to say the least. Nobody with chronic pain such as neuropathy wants to be addicted to a drug but everybody wants their symptoms to be reduced so that a normal life is possible. Under the right conditions, opioids can be very effective in doing that. Hopefully, common sense and not hysteria will rule the day.

Most Doctors 'Overprescribe' Narcotic Painkillers
By Alan Mozes HealthDay Reporter  WebMD News from HealthDay FRIDAY, March 25, 2016 (HealthDay News) 
 
While 99 percent exceed the recommended 3-day dosage limit, a quarter write prescriptions for a full month

-- When American doctors give their patients narcotic painkillers, 99 percent of them hand out prescriptions that exceed the federally recommended three-day dosage limit, new research suggests.

And some doctors exceeded that limit by a lot: Nearly one-quarter gave out month-long dosages, despite the fact that research has shown that a month's use of prescription narcotic painkillers can cause brain changes, the National Safety Council survey found.

"Opioids do not kill pain. They kill people," Dr. Donald Teater, a medical advisor at the safety council, said in a news release. "Doctors are well-intentioned and want to help their patients, but these findings are further proof that we need more education and training if we want to treat pain most effectively."

The problem has reached the point where these highly addictive painkillers, which include commonly prescribed drugs such as Oxycontin, Percocet and Vicodin, now account for more drug overdose deaths than heroin and cocaine combined, according to the report.

Unfortunately, the survey further revealed that while almost 85 percent of doctors screen for signs of prior narcotic painkiller abuse, just one-third ask about a family history of addiction. Only 5 percent offer direct help to patients when signs of abuse are uncovered, and less than 40 percent refer such patients for treatment elsewhere, the survey found.

The survey results, conducted in early March and released Thursday, come at a time when drug overdoses have reached record highs in the United States. Just this month, two federal agencies proposed measures to try to curb the narcotic painkiller abuse epidemic.

On Tuesday, the U.S. Food and Drug Administration ordered that warning labels be used for prescription narcotic painkillers. And last week, the U.S. Centers for Disease Control and Prevention issued tough new guidelines for doctors on prescribing these medications.

In December, the CDC announced that fatal drug overdoses had reached record highs in the United States -- driven largely by the abuse of prescription painkillers and another opioid, heroin. Many abusers use both.


According to that December report, more than 47,000 Americans lost their lives to drug overdose in 2014, a 14 percent jump from the previous year.

The safety council survey, of 200 doctors, found other troubling trends: Roughly three-quarters of doctors indicated that they believed that pain relief is best achieved by offering patients one of two opioids: morphine or oxycodone (Oxycontin). But experts from the safety council noted that over-the-counter pain relievers (including ibuprofen and acetaminophen) are more effective at providing short-term pain relief.

Misinformation particularly seems to be at play when it comes to tackling back pain and dental pain. While more than 70 percent and 55 percent of doctors say they prescribe narcotic painkillers for back pain and dental pain, respectively, these drugs are not considered the ideal treatment for either condition, according to the safety council.

Interestingly, the safety council found in an earlier survey that roughly half of all patients are actually more inclined to see their doctor again if non-narcotic painkillers are offered.
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Copyright © 2013-2016 HealthDay. All rights reserved.

http://www.webmd.com/mental-health/addiction/news/20160325/nearly-all-us-doctors-overprescribe-addictive-narcotic-painkillers-survey

An Easy Guide To Neuropathy

As regular readers of the blog will know; every now and then a general post about neuropathy and its causes and treatments will appear. These are all different and represent world wide views on neuropathy as a disease. They are simply written and easy to understand and are meant for new patients, or people coming into contact with neuropathy for the first time. Today's post comes from mdhil.com (see link below) and is written by an Indian doctor. The information is universally accepted as being true of neuropathy in general and can be seen as a starting point for further research into the disease. Other general articles about neuropathy can be found by scrolling down the alphabetical list to the right of the blog.

 Neuropathy – Causes, classification and treatment
December 6, 2012 By Dr Nisreen Nakhoda

Neuropathy is the medical term given to nerve damage in all the nerves of the body. It could be reversible or irreversible and generally the pain hampers the person from living a normal life.

Causes of neuropathy

The causes of neuropathy are varied and range from mild to serious.
The most common cause of nerve affliction or neuropathy is diabetes mellitus. If the blood sugar level of a diabetic patient is uncontrolled, chances of him/her developing peripheral neuropathy are high.

Injury to the nerves or prolonged pressure on a group of nerves can cause neuropathy, so also damage can result due to less blood supply to the nerves.

Systemic conditions like amyloidosis (abnormal protein deposits seen in various tissues of the body), rheumatoid arthritis, systemic lupus erythematoses and kidney failure can result in nerve damage.
Toxins and poisons like lead, mercury, arsenic and pesticides are some of the poisons which can lead to peripheral neuropathy.

Genetic or inherited conditions like Friedreich’s ataxia can cause nerve problems.

Drugs like vincristine used in chemotherapy and antibiotics like metronidazole have also been implicated.

Tumours, whether benign or malignant can invade the nerves or put pressure on them leading to neuropathy.

Lastly, many cases of neuropathy are idiopathic, that means no cause can be identified.

Classification of neuropathy

Neuropathy can be classified as acute, sub-acute or chronic depending on the duration of the problem.

Another way is to classify them depending on the location of the nerves involved.

Cranial neuropathy – involves any of the twelve cranial nerves coming out from the brain.

Peripheral neuropathy – this term is used for nerve problems outside the brain and spinal cord. It refers to nerves in the shoulders, entire upper and lower limbs and also hips.

Autonomic neuropathy – the autonomic nerves are those around the heart, lungs, liver and other involuntary organs. When these nerves are damaged, it is known as autonomic neuropathy.

Focal neuropathy – this refers to nerves from only one area of the body.
Symptoms and signs of neuropathy

These are characteristic and not related to the cause of neuropathy.
Damage to sensory nerves (nerves carrying receptors of taste, touch, smell, vision and hearing) cause loss of pain sensation and is common in the feet of those suffering from diabetics.

Damage to motor nerves (nerves connected to muscles and ligaments) leads to gait abnormalities, loss of reflexes, weakness in limbs and cramps.

Damage to autonomic nerves (supplying internal organs) leads to constipation, bloating of the abdomen, dizziness, intolerance to heat, blurred vision, impotence and urinary symptoms.

Diagnosis of neuropathy

If you experience any of the above symptoms or are a diabetic, visit your doctor who will take a complete history. This includes family history, history of recent surgeries and exposure to poisons. A complete general and neurological examination should be done to check sensory and motor nerves.
Investigations to diagnose neuropathy

Depending on the cause, several investigations are prescribed. Routine tests like CBC, ESR, liver and kidney function tests, urine and stool analysis and tests to detect HIV, rheumatoid factor and tumour markers are done in certain cases.

Nerve conduction velocity test is done to determine nerve function. This is a simple test and can be done in the clinic. It measures the rate at which a signal travels through the nerve.

EMG or electromyogram is also important as it gives an indicator of nerve function. A thin needle is inserted into a muscle and an electrode within the needle measures muscle activity.

In some cases, a nerve biopsy may be required to reach a diagnosis.
Treatment of neuropathy

The treatment of the cause is important. Nutritional deficiencies must be corrected, alcoholics should be advised to abstain from alcohol and exposure to poisons should be avoided.

If there is pressure on the nerve due to a tumour, surgery to remove the latter should be done soon.

Drugs:

Drugs for pain relief should be prescribed. Simple analgesics like ibuprofen and paracetamol are ineffective in controlling nerve pain. Many types of drugs are used to relieve pain. They include:
Anti-convulsants like lamotrigine, carbamazepine and gabapentin.
Anti-depressants like imipramine, amitriptyline, paroxetine and duloxetine
Opioid analgesics like tramadol

Others: Topical creams containing capsicain (a natural substance forund in bell peppers) or lignocaine help. Antioxidants like alpha-lipoic acid are effective in diabetes.

TENS is a short form for trans-cutaneous electrical nerve stimulation and is used when drugs become ineffective. It is useful for diabetics.

Prevention of neuropathy

Diabetics should go for regular check-up and check their feet for injuries and sores every day. Avoid wearing tight socks and ill-fitting shoes.
Persons working in industries should avoid exposure to poisonous substances.
Inherited conditions causing neuropathy cannot be prevented.
Long term glucose control for diabetics is a must.Written by Dr Nisreen Nakhoda, General Physician

http://www.mdhil.com/neuropathy-causes-classification-and-treatment/

Nerve Damage Patients Need To Be Aware Of Fake Neuropathy News

Today's short post (see link below) looks at the current internet trend of tricking readers into thinking you're a serious information-providing site about neuropathy and then hitting you with the hard sell at the end. It's clever and insidious and is part of the advertising pyramid that seeks to take our last cents and convince us that they're doing us a favour by doing it.

Fake News Hits The Neuropathy Web
27th February 2017 Dave R.

I'm constantly looking for articles with information that may be of benefit to people living with nerve damage (neuropathy) but rejecting those that involve advertising a product or service. There are various 'newspaper' sites and blogs available (like mine) that attempt to do this on a daily basis but because they tend to rely on search bots, they trawl and publish articles that are actually subtly-constructed advertisements. The titles and 70% of the content seem completely convincing and are often helpful in the information they provide but their intentions are a little more devilish than that. Having hooked the readers into believing they're reading a genuine information article about their medical problem, they then launch the hard-sell and promote their own product and/or service. Already convinced, the reader takes the next logical step and reaches for their credit card.

Naturally, the worst are those that suggest they have a 'cure' for neuropathy - believe me, they don't...there is no cure currently for neuropathy! The best we can hope for is temporary relief from the symptoms, so if you see the word 'cure' in their text; treat the article with enormous skepticism because it's Trumpist 'fake news'!

Many commercial sites are extremely subtle in their approach. They have a product and/or treatment that may indeed help alleviate your symptoms. There's nothing wrong with what they say and they are not providing untruths. What they are doing is selling a product or service, to people who are desperate for any form of relief and those people are the most vulnerable to sales patter. If what they offer seems reasonable to you, do your own research to see if you can do it yourself but much cheaper. For instance, many products that claim to improve neuropathy symptoms long term, contain combinations of recognised vitamins, minerals, anti-oxidants, herbs which you can easily buy for yourself at a much cheaper rate. Of course there's convenience in buying something in one 'packet' so to speak (multivitamin tablets are a very successful case in point) but before you shell out your hard-earned cash, make sure you know exactly what you're buying and what it contains or entails. Let the buyer beware! A little research can lighten the load on your wallet (as well as increasing your knowledge base substantially).

The basic message here is: take every promise with a pinch of salt; be hyper critical of what's on offer and armed with as many facts as you can find, make a decision based on what's best for you and not what the advertiser tells you is best. Applies to everything in life doesn't it but we're a vulnerable market. We live daily with sometimes unbearable symptoms and we're 'open' for the next 'best thing' and will seize on exaggerated promises as if they're an oasis in the desert.

Of course there are genuine clinics and practices out there and genuine supplements and alternative therapies and treatments and you may benefit greatly from what they offer but please be a critical consumer - if they want money from you, they're going to exaggerate their claims - it's the name of the game. However, neuropathy patients are used to disappointments and can never say that 'if one thing works for him or her, it's bound to work for me' - it doesn't - neuropathy's too individual and unique to each patient for that, so we have to take responsibility for our own treatment. It's a minefield unfortunately but we need to sort out the wheat from the chaff and reject those who are only interested in emptying our wallets. Desperate patients will clutch at straws (nobody knows that better than the long-term nerve pain sufferer) but we deserve better than to be seduced by sly and clever advertising jargon. It's up to you. If you don't buy into it, it will go away and you'll be doing a service for the rest of the community.

Good luck
Dave R.

How Important Is Vitamin E To Nerve Health

Today's post from neuropathydr.com (see link below) is another useful and easy to understand article from the ever-reliable, Dr John Hayes jr. He explains the benefits of vitamin E to nervous system health and quite rightly warns against over-use, which can be harmful. It is important to state here that supplementing with vitamin E alone will not help your neuropathy on its own. It's a question of finding the right balance and package of supplements for you and that can be determined by vitamin and mineral level tests carried out by your doctor. These will highlight deficiencies you may have and help you decide where you need to take extras. It's also wise to look at the amounts of various vitamins and minerals that are contained in your daily multi-vitamin pills (a good idea anyway) and bear in mind that whatever you take extra, may push you over the best daily amounts for you. It's very easy to over use supplements, which may lead to health problems and will certainly lead to wallet problems! Dr Hayes also wisely points out that improvements don't happen overnight - you need to take these supplements for some months before you may notice any benefits. Many people give up after a few weeks when they fail to see any improvements.

Vitamin E and Nerve Health
Posted by john on January 9, 2014
 
With neuropathy, if you lack vitamin E, it will be impossible for your nerves to heal and function properly.

Vitamin E is an essential nutrient for all of us, especially those who suffer from many forms of peripheral neuropathy.

As a member of the fat-soluble vitamin family that includes vitamins A, D, E and K, it is also lacking in many modern diets.

This is also one key nutrient that occurs in eight different forms; two are the most biologically active. The most common are gamma and alpha. In your diet this will be found primarily in nuts, seeds, and vegetable oils.

Vitamin E is an antioxidant, which basically means it helps prevent cells from damage due to “free radicals”, or cell destruction generated by some biochemical reactions.

Although Vitamin E is best known for its role as an antioxidant, it does have some profound roles in protecting the nervous system. Vitamin E is essential to helping healthy nerve function, as it helps us repair and protect myelin, the sheath that insulates our large nerves.

Healthy myelin is largely responsible for normal nerve conduction.

In fact, studies suggest that Vitamin E, when given to diabetics can improve nerve conduction significantly1.

But there are some precautions: First, there are no overnight miracles. Supplementation for months may be necessary to see a significant effect. Too much Vitamin E can cause the blood to thin; this has an additive effect for anyone who takes Coumadin and other anticoagulant medications, including aspirin. Be especially careful here!

In addition to seeds and nuts (almonds and sunflower in particular), there are some other good dietary sources of Vitamin E, such as palm oil, the principal ingredient in “Earth Balance”, a butter substitute and line of products we recommend. To a lesser extent, leafy green vegetables and avocadoes will provide some active vitamin E.

Generally, safe supplementation is in the range of 2 to 400 international units of mixed tocopherols for most patients.

There maybe other occasions where your physician may want to prescribe larger amounts of the d-alpha tocopherol form. This is sometimes done in other neurologic conditions including multiple sclerosis.

As we say all the time, there is no one single magic nutrient. But if you lack vitamin E, it will be impossible for your nerves to heal and function properly.

This is another reason why multiple nutrient components are necessary for effective health maintenance and treatment of disease; this is not a short-term proposition.

As always, with neuropathy it is important to work very carefully with your physicians and therapists and make sure that your progress is monitored.

1. 10.2337/diacare.21.11.1915 Diabetes Care November 1998 vol. 21 no. 11 1915-1918

Dietary antioxidant interventions in type 2 diabetes patients: a meta-analysis The British Journal of Diabetes & Vascular Disease March 1, 2011 11:62-68

http://neuropathydr.com/vitamin-e-and-nerve-health/

Tips For Neuropathic Footware Time To Throw Out The Old And Break In The New!

Today's post from everydayhealth.com (see link below) looks at finding the best solutions for your burning, tingling or numb feet. That requires finding shoes that will provide the best support and the most comfort - no easy task. If you, like me, are still wearing the same sneakers you bought 5 years ago, even though they're falling apart but are so damned comfortable, your conscience will be pricking you that it's really time for a new pair. That's a big step for the neuropathic foot - literally because new shoes can provide all kinds of torture to the healthiest of feet until they're broken in. This article gives some excellent tips - both practical and with the nerve damaged feet in mind. 
 

Shoe Shopping With Diabetes 
By Mary Elizabeth Dallas, HealthDay News
Medically Reviewed by Farrokh Sohrabi, MD
 
If you have diabetes, choosing the right shoes can help protect your feet from injury. Learn which styles could put you at risk for complications.

If you are living with diabetes, shopping for shoes is more than a matter of style. By following some simple guidelines to ensure a good, comfortable fit, you can prevent potentially serious foot problems.

Even minor foot problems, like calluses or blisters, can lead to serious diabetes-related complications. Diabetes can cause poor blood flow to your feet, making it more difficult for wounds to heal, sometimes resulting in infections and possibly amputation. Complicating matters, poorly controlled diabetes can also lead to nerve damage called peripheral neuropathy. This may cause you to lose sensation in your feet, so you may not feel potentially harmful cuts or blisters. To help protect your feet and overall health, it's important to know what to look for in diabetes shoes.

"It's all about prevention," said Katherine Dux, DPM, a podiatrist at Loyola University Medical Center in Maywood, Ill., who treats patients with diabetes. "Any friction in the shoe could lead to irritation and possible blister formation. This could lead to trouble down the road."

Before you shop for diabetes footwear, it's important to have your feet evaluated by a podiatrist to determine your risk for infections or complications, said Dr. Dux. Based on this assessment, the doctor can recommend exactly which types of shoes will be best for your feet.

What to Look For in Diabetes Footwear

Even if your diabetes is under control and your feet are healthy, there are a number of factors you should consider when selecting shoes. By looking for certain characteristics and avoiding others, you can protect against irritation, infections, ulcers, and potentially worse foot problems.

First, look for a shoe that has a large enclosed front, as well as a closed back and top. Shoes that expose your toes or heels increase your risk for injury and infection. You may love slip-on shoes, sandals, clogs, and mules, but they could trip you up when it comes to diabetes foot care.

Other good shoe features for a person with diabetes include:

Adjustable Closure. Look for shoes that have laces or Velcro. The built-in flexibility allows you to tighten or loosen your shoes depending on whether or not your foot is swelling.

Wide Toe. Steer clear of shoes with narrow or pointed toes. "It's best to stay with a shoe that has a wider toe box area as well as something with increased depth to the toe box," advises Christina Sigur, DPM, a podiatrist at Wake Forest Baptist Medical Center in Winston-Salem, N.C. Shoes with a round or wide toe box provide your feet with more room and are less likely to cause irritation.

Low Heel. Flats or shoes with heels less than two inches high are a better option than shoes with higher heels. Lower-heeled shoes reduce the amount of pressure applied to the ball of the foot.

Soft Material. Choose styles made from soft materials, such as leather, mesh or a pliable synthetic fabric. Since feet tend to swell throughout the day, these softer fabrics will give and allow for swelling. Breathable fabrics will also prevent the build up of moisture within the shoe, Dux added.

Cushioned Inner Sole. It’s important to choose footwear with a good amount of cushioning inside the shoe. This added support helps reduce foot pressure and the risk for developing foot ulcers, or sores, and other complications, Dr. Sigur noted.

Hard Outer Sole. Although the inside of your shoe should provide support with cushioning, the outer sole of any shoe you select should be hard. This will help protect your feet from rough or sharp objects and provide shock absorption.

When to Use Therapeutic Diabetes Shoes

For some people with diabetes, a podiatrist may recommend therapeutic shoes. "People with foot deformities, such a hammer toes and bunions, are at greater risk for irritation from ill-fitting shoes," Dux said.

Therapeutic shoes are advisable for anyone with diabetes who also has a history of any one of the following:
An amputation of any part of their foot or toe
Foot ulceration
Calluses that lead to an ulceration
Neuropathy or nerve damage
A foot deformity such hammer toes, bunions, flat feet, or high arches
Poor circulation in their lower extremities

At the Shoe Store

If it’s time for some new kicks, consider shopping later in the day. Since feet tend to swell throughout the day, Dux recommends visiting the shoe store in the afternoon or evening in order to get a more accurate sizing of your foot.

And don’t forget to bring your socks. Experts recommend that people with diabetes wear socks to decrease the friction in shoes and soak up extra moisture to prevent infections. To ensure a proper fit, it's important to always try on shoes with the socks you intend to wear with them.

Finally, ask a trained sales professional to measure both of your feet. One foot is typically larger than the other. You’ll want to determine which one is longer and base your shoe size off of that foot to get the best fit.

Other Ways to Protect Your Feet

Consider Fit, Not Fashion. The type of shoes you wear should have less to do with fashion and have everything to do with proper fit. "Shoes should feel comfortable from the moment you put them on,'" Dux said. "There is no true break-in period for shoes." Dux adds that shoes should never feel tight, rub, or cause irritation.

Inspect Your Feet Daily. It's important to routinely remove your shoes and inspect your feet for problems or signs of irritation, such as redness or marks along the top, sides, or sole. This is particularly true when wearing new shoes. "Any areas of redness or marks that do not resolve in 10 to 15 minutes could be an indication that the shoes need to be addressed or adjusted," Dux noted.

Visit a Podiatrist Regularly. People with diabetes who do not have any foot problems should still be evaluated by a podiatrist annually. Anyone diagnosed with peripheral neuropathy — or those with a history of calluses or foot ulcers — should be reassessed more frequently, according to experts.

Know When to Buy New Shoes. Whether or not to replace a pair of shoes depends on how often you wear them. For everyday shoes, however, Sigur says a good rule of thumb is to change them at least once a year since the interior cushioning of the shoe wears down over time.

http://www.everydayhealth.com/type-2-diabetes/living-with/shoe-shopping-with-diabetes/

Cannabis To Manage Neuropathic Pain

Today's post from cornerstonecollective.com (see link below) talks about the usefulness of cannabis in reducing nerve pain. It's been a while since the last cannabis post on this blog but it remains one of the proven aids to reducing neuropathic pain and deserves regular attention. This excellent article is another one that goes into some detail as to how cannabis works in inhibiting neuropathic pain. It's interesting to note that many articles about cannabis as an analgesic, are better-researched, better-written and much more detailed than their counterparts about main-line drug strategies. The reason for this may be that cannabis is such a controversial and potentially divisive issue - articles need to be properly grounded in fact and most of them are. There are more articles to be found in the alphabetical list to the right of this blog. This one is definitely worth a read.

Managing Neuropathic Pain with Cannabis
7th October 2014 No Author named

Chronic neuropathic pain affects between 1% and 2% of all adults, which means that you’ve likely encountered someone suffering from neuropathic pain or experienced it directly. As would be expected from the sheer prevalence, there are many causes for such pain, ranging from illness, such as diabetes, to specific events of trauma, such as car accidents or work injuries. Traditionally, neuropathic pain has been considered “refractory” to treatment options, meaning that it is difficult to manage consistently and effectively. However, new research has pointed to cannabis as a viable option for treatment of neuropathic pain.

As has been the basis of many of the therapeutic effects of cannabis, the anti-inflammatory properties of cannabis are likely responsible for the observation of cannabis use reducing neuropathic pain. Although the specific mechanisms of neuropathy are poorly understood, it is speculated that glial cells, which are the immune system enforcers of the brain and spinal cord, are not functioning properly or are overcompensating for injury by over-producing inflammatory mediators such as interleukin-1beta. It is also known that the endocannabinoid system is capable of regulating and signalling production of this very molecule, as well as other inflammatory molecules, which draws an obvious link between cannabis consumption and neuropathy.

However, while the specific mechanism of action is not mapped, researchers are continuing with the testing of cannabinoids in models of neuropathy. One particularly comprehensive study from the University of Calgary focused on neuropathy stemming from diabetes, which is a common side effect of the illness (50% of diabetes patients suffer neuropathic pain). In this study, researchers used rodents with artificially induced diabetes and subsequent neuropathy. Once diabetes was confirmed, researchers then tested application of both cannabinoid receptor agonists (drugs which activate cannabinoid receptors) as well as cannabinoid receptor antagonists (which block receptor activation) and then ran various tests on the rodents to evaluate pain. Two common indicators of neuropathic pain are pain due to stimulus that would not normally produce pain as well as over-sensitivity to temperature, both experienced by diabetes patients. To quantify these experiences for the rodents, researchers used both a metal rod prodding test (that measured the force necessary for the rod to cause discomfort and force the rodent to move) as well as a thermal test which heated the rodents paws and recorded exposure time necessary to cause the rodent to move its paws. Rodents suffering from pain will consistently react more quickly than those un-pained by the prod or heat being applied.

The results to this study showed great promise; both major types of cannabinoid receptor agonists were shown to ameliorate hypersensitivity to mechanical or thermal stimulus. As seen in the accompanying graphs, higher doses of cannabinoid receptor agonists also corresponded to increased effectiveness in muting pain when administered both nasally and intravenously.



Regardless of how these agonists enter the body of the rodent, they are effective at reducing pain commonly associated with neuropathy and specifically neuropathy resulting from diabetes. As it turned out, receptor antagonists seemed to have no effect at all in any trial, further implicating that activation of these specific cannabinoid receptors is responsible for the changes in pain threshold observed. However, not content to stop at this stage, researchers also performed surgical dissections to analyze the accumulation of microglia in the spinal cord and in the thalamic part of the brain. Upon doing this, the study found that cannabidiol (CBD) was capable of reducing the accumulation of microglia in these areas, even after administration had ceased.

As it turns out, a study from the University of Milano-Bicocca performed a similar experiment two years prior, with many of the same design considerations. Although this study was much less broad and objective, the results mirror those observed from the Calgary group, with additional focus given to the effect of CBD on Nerve Growth Factor (NGF), since many of the neurons that transmit pain are supported by NGF. Not surprisingly, patients with diabetes are known to have consistently lower levels. In this study, researchers found that NGF content in rodents was restored to normal following repeated treatment with CBD, which indicates that cannabis use may go beyond attenuation of symptoms but further into actual prevention and restoration of nerve damage via contributing to new nerve growth.

The largest looming question of any rodent based research, of course, is whether the results found in the lab will be duplicated in the field of human treatment, which differs substantially, biologically, externally, and socially. In other words: beyond mouse trials, how effective are cannabinoids at reducing pain in actual human cases of neuropathic pain? One Canadian research group at McGill University set out to answer this question. For the design of the study, the group screened 116 patients suffering from neuropathy, ultimately selecting 23 that had not used cannabis within the previous year and therefore would more accurately reflect how a non-active-consumer might benefit from the start of cannabis therapy. The ultimate goal of the study was to test how various levels of THC administered affect assessments of pain, sleep, and mood states, both during use and in the period following use.

After supervision during an initial session, patients were given a schedule to follow for consuming their cannabis specimens, with the instructions to re-dose three times a day for a five day period, followed by a nine day “wash out” period, designed to allow to the THC to leave their systems while observing continued effects of the THC administration. As it turned out, “no evidence of significant carryover” existed for any outcome, meaning that in this study, pain relief was limited to time during exposure to cannabis. However, the study did confirm with statistical significance that the average daily pain intensity was lower consistently by a full step on a 10-step pain ladder and that mood and sleep were also improved.

While this might be expected, two interesting points emerged from the study. One stumbling block to any type of research involving THC and pain or mood assessment has been that it is difficult to control for the effects of placebo, or in other words, to account for effects not produced from the actual substance, but produced from the patients’ perceptions of how the substance will affect their pain or moods. In most studies, patients are given sugar pills so that they will not know whether what they are consuming is the drug or not, eliminating their reporting bias. However, with THC, most patients know immediately if they have been dosed, due to the psychoactive effects that manifest. To get around this, the group created a range of cannabis samples with THC levels from 0% to 9%, and ran tests to see if the patients could properly identify in what order they had been dosed or if they had been dosed at all. Due to both the relatively low doses of THC, which were on the threshold of perception, as well as the similarity in taste even with the 0% THC cannabis, patients were not able to identify dosing, which illustrates the effectiveness of this approach and the ability to have true placebo cannabis testing in humans.

Another interesting point is that the study focused on THC, excluding and ignoring the effects of cannabidiol (CBD), which must have been present as well in the cannabis samples used. It is very possible that the increased THC cannabis samples also had increased CBD levels or other cannabinoid levels, meaning that to attribute the effects here to THC is hasty and the study can only objectively be observed as the effectiveness of cannabis as a whole (including all cannabinoids, terpenoids, and other chemicals), as opposed to the effectiveness of THC in treating neuropathic pain.

However, the bottom line is that evidence is supporting both rodent models and human models of treatment of neuropathic pain with cannabis. It is reasonable to believe that these effects will continue to be honed in on and re-produced with more direct chemical analogues, and that in the meantime, patients suffering from neuropathic pain may find comfort in cannabis use.

Works Cited

Mark A. Ware, Tongtong Wang, Stan Shapiro, Ann Robinson, et al. (2010) Smoked cannabis for chronic neuropathic pain: a randomized controlled trial, Canadian Medical Association Journal (2010) 182 (14).

Cory Toth, Nicole Jedrzejewski, Connie Ellis, and William Frey. (2010) Cannabinoid-mediated modulation of neuropathic pain and microglial accumulation in a model of murine type 1 diabetic peripheral neuropathic pain, Molecular Pain 2010 6:16

Francesca Comelli, Isabella Bettoni, Maripia Colleoni, et al. (2008) Beneficial effects of a Cannabis sativa extract treatment on diabetes-induced neuropathy and oxidative stress, Phytotherapy Research Journal (2009) 23:12

http://cornerstonecollective.com/managing-neuropathic-pain-with-cannabis/

Inadequate Approaches To Neuropathy

 Today's post comes from pain-topics.org (see link below) talks about the recent Neuropathy Association conclusions, that will be familiar to most neuropathy patients, that the disease is often wrongly diagnosed and inappropriately treated. The poll used was small but the results would surely be mirrored if it were much larger. The article pleads for a much more effective approach regarding both diagnosis and treatment - something nobody can argue with.

Neuropathy Inadequately Diagnosed; Treated

Wednesday, May 16, 2012

A recent national poll found that persons with neuropathy face delayed diagnoses, inadequate pain care, and distressing life changes due to their painful disorders. Peripheral neuropathy affects nearly 7% of Americans and from 2% to 8% of populations worldwide. The many types of neuropathy pose diverse challenges for patients, their families, and healthcare providers, yet relatively few resources are devoted to research and treatment of these disorders.

More than 1,900 patients responded to an online survey recently conducted by The Neuropathy Association [full results here]. A majority of survey participants indicated they experienced an extended period of time from symptom onset to diagnosis of their neurological disease — taking more than one year in 75% of cases, and more than 5 years for 20% of patients.

After delays in diagnosis, nearly half of patients (49%) were finally told that their neuropathy was “idiopathic” (due to unknown causes). The second most common type, at 15%, was prediabetic/diabetic neuropathy. Other types listed in the survey included: autoimmune-related (10.7%), hereditary (6.1%), and cancer or chemotherapy-related (4.7%). To lesser extents, respondents indicated entrapment or trauma-associated neuropathy, and those related to toxins, nutritional deficiencies, gastrointestinal disorders, metabolic diseases, or infections (including Lyme disease and HIV/AIDS).

In all, there are more than 100 known types of neuropathy, according to the Neuropathy Association.

Nearly 3 in 10 respondents (29.9%) said they receive no treatments for pain relief, and the remainder indicated that they currently use multiple therapies, including:

•medications, such as pregabalin, gabapentin, duloxetine, amitriptyline, or opioids — 66%,

•complementary therapies, including vitamins, acupuncture, or TENS units — 22.7%,

•topical pain relievers, such as lidocaine or capsaicin — 16.5%,

•rehabilitation therapy, including physical or occupational therapy — 10.5%,

•intravenous immunoglobulin or plasmapheresis — 4.6%,

•interventional therapies, including anesthetic blocks, intrathecal pumps, or spinal neurostimulators — 4.1%.

Respondents indicated that they face many challenges on a daily basis in coping with their neuropathy and associated pain. The top 5 included: adjusting to disabling effects (51.4%), finding strength and energy for daily activities (49.7%), staying positive and hopeful (48%), describing the ordeal to family and friends (45.8%), and getting necessary rest and sleep (44.6%).

Commentary: This was a relatively small and nonrandom survey, with possible selection bias, since participants volunteered to respond online. However, it provides some important insights that will hopefully be confirmed and expanded in larger assessments.

According to background information from The Neuropathy Association, peripheral neuropathy affects more than 20 million (or 1 in 15) Americans, making it one of the most common chronic diseases and a leading cause of adult disability. Early warning signs may include pain, numbness, tingling, and/or weakness. With early diagnosis, neuropathy can often be controlled, but, if ignored, symptoms can intensify to persistent weakness, loss of sensation, chronic pain and/or disability.

“With the potential for millions of Americans to suffer from neuropathy’s progressive chronic pain and disability, the U.S. is currently unprepared to face a major public health crisis if healthcare providers, the media, and public policy officials continue to ignore the inadequacy of medical resources and research funding for neuropathy,” observes Tina Tockarshewsky, president and CEO of The Neuropathy Association.

“Our community is gravely underserved with treatments to bring relief, and the available treatments are not always a perfect fit, leaving patients to try a variety of approaches to find help,” she emphasizes. “We have only 7 FDA-indicated treatments: 1 for CIDP [chronic inflammatory demyelinating polyneuropathy, an autoimmune form of neuropathy], the remainder are for diabetic neuropathic pain and post-herpetic neuralgia; this addresses only about a third of our patients— which begs the question: what are the other two thirds supposed to do for their suffering?”

Posted bySB. Leavitt, MA, PhDat

http://updates.pain-topics.org/2012/05/neuropathy-inadequately-diagnosed.html

How To Deal With Entrapment Compression Neuropathies

Today's post from drducicplasticsurgery.com (see link below) looks at neuropathy from the point of view of a surgeon and in this case, a plastic surgeon. As you all know, there's no cure per se for neuropathy but certain forms may be relieved by surgery of one form or another. These are compression neuropathies (sometimes called entrapment neuropathies) which are caused by a nerve becoming trapped. This can be because a disease causes the nerve pathways to narrow, or it can be as a result of injury. Either way, releasing the trapped nerve may result in a huge improvement in symptoms, although there are no guarantees, depending on the damage to the nerve itself. Worth a read.

Compression Neuropathies in Extremities
03 Aug 2016 Compression Neuropathies in Extremities

The many types of neuropathies are a series of complex conditions that can take many forms and be caused by many different things depending on the type of neuropathy that is diagnosed. Understanding what your specific neuropathy is and what the symptoms are is the first step in taking control of your condition.

What are Neuropathies?

This term describes a problem with the nerves (typically the peripheral nerves) and it could involve one of three nerve types. These three different nerves include:

Sensory Nerves – an issue with these nerves causes tingling, pain, numbness, and weakness in the hands and feet
Motor Nerves – issues with these nerves causes weakness in the hands and feet
Autonomic Nerves – a problem with these nerves causes changes in the heart rate and blood pressure as well as swelling

There are two major types of neuropathies and knowing this information can help determine the severity of the issue you are currently suffering from. These two types include mononeuropathy and it affects a single nerve. The other is called polyneuropathy and affects several different nerves.

When studying the specific forms of neuropathies, a common form is called compression neuropathy. This is caused by damage to sensory nerve roots or even peripheral nerves and could potentially have many different causes.

What are Common Causes and Symptoms?

Compression neuropathy is caused by mechanical pressure or occasionally localized trauma from an injury to a specific area. This form of neuropathy is normally characterized by paresthesia, weakness or even paralysis. This will depend on what specific form of neuropathy you may have.

Diabetes and pre-diabetes are the most common causes of compression neuropathy although they are not the only causes. This being the most common cause is because with diabetes the nerves are swollen and when these nerves run through certain tight channels within the body, they become compressed. This causes the resulting pain and numbness.

Treatment Options

The most popular form of treatment is surgery although there may be other options for your form of compression neuropathy. The decompression surgery relieves the compression on the nerves and can reduce or completely eliminate pain, improve sensation, improve balance and also prevent ulcerations or amputations. This form of surgery has great results and it is estimated that about 80% of diabetic and pre-diabetic patients have some success from receiving this surgery.

Checking for other conditions is very important because some forms of compression neuropathy have causes that can be treated without the need for surgery. For example, if the issue is a thyroid based problem, other treatment options may be a possibility.

Common Forms of Compression Neuropathies

There are many forms of compression neuropathies that are common and well known. 
 
Carpal Tunnel Syndrome 

caused by compression of a nerve in the wrist
Involves numbness in the first three fingers. 

Cubital Tunnel Syndrome

caused by compression of ulnar nerve at elbow
Numbness in 4th and 5th fingers, hand weakness

Radial Nerve Neuropathy

compression of radial nerve in forearm or upper arm
Often follows humeral fractures and surgery
Forearm pain, weak wrist dorsiflexion or finger extension 

Tarsal Tunnel Syndrome

caused by compression of the tibial nerve in the ankle
also called posterior tibial neuralgia

Meralgia Paresthetica (LFCN Neuropathy) 

caused by compression of a nerve in the thigh area
may follow surgery in groin/hip area, professions caring belts around waist, like police officers, fire fighters, contractors 

Foot Drop 

most often caused by an injury to the peroneal nerve
there are options for treatment beyond surgery although surgery is an option that can be considered

Compression neuropathies include many different forms and have just as many causes. Understanding the proper form of treatment begins with first understanding what the cause was. While diabetes and pre-diabetes are often causes, there may have been trauma from a sports injury or another disease that is the root issue. Having all of this information may help you and your healthcare provider decide whether or not surgery is the best choice for your individual condition.

https://drducicplasticsurgery.com/compression-neuropathies-in-extremities/