Peripheral Neuropathy
Treating peripheral neuropathy can be one of the toughest problems facing a clinician. Peripheral neuropathy simply means disease affecting the peripheral nerves.
There are a great many cause of peripheral neuropathy. This is just a partial list to give you an idea of the things that a clinician has to think about before starting treatment:
- Metabolic illnesses: Diabetes mellitus; porphyria; chronic renal failure; amyloidosis and disturbances in circulating proteins
- Vitamin deficiencies: Vitamins, B1, B3, B6 and B12
- Drugs and chemicals: Alcohol; Heavy metals like arsenic, lead and mercury; organic pesticides; several drugs used in cancer chemotherapy; isoniazid; nitrofurantoin
- Infections: Lyme disease; Herpes zoster (shingles); Diphtheria; Brucellosis; Leprosy; Tetanus; Botulism
- Malignant illnesses
- Inflammatory and autoimmune illnesses: Rheumatoid arthritis; Systemic lupus erythematosus; Polyarteritis nodosa; Sarcoidosis; Guillain-Barre syndrome; Celiac disease
- Physical injury: Trauma, stretching and compression of nerves, which can include things like carpal tunnel syndrome.
- Congenital illnesses
Many causes of peripheral neuropathy, particularly diabetes, may also damage the autonomic nervous system that controls the heart, blood pressure, swallowing, intestinal and bladder function.
Neuropathic symptoms typically start in the feet, because the nerves running down there are longer and more vulnerable than the ones going to the hands.
The most common symptoms are:
- Numbness
- Tingling
- Abnormal sensations called dysesthesias
- A characteristic form of pain, called neuropathic pain or neuralgia: people usually describe it as “pins and needles,” a steady burning sensation or “electric shocks.” These pains can be difficult to describe: typically pains, like stubbing your toe or stepping on something sharp, are transmitted through pain fibers. Neuropathy also involves other neurological pathways, so that the brain receives impressions that it cannot process.
There has been a revolution in out understanding of neuropathic pain in recent years. It is now considered to be a disease rather than a symptom. Normal pain is designed to protect you: you put your foot on a hot plate and you pull it away immediately. Neuropathic pain is different: it is non-protective and it persists and therefore behaves like a disease.
Multiple different classes of medications have been shown to be effective in some people with neuropathic pain, though most are not approved for use by the Food and Drug Administration:
- Lidocaine patches and creams
- Capsaicin creams
- Opioid analgesics
- Tricyclic antidepressants
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Anticonvulsants: Carbamazepine; gabapentin; pregabalin
Earlier this week, data presented at the European Federation of IASP (International Association for the Study of Pain) Chapters (EFIC) indicated that an innovative combination of painkillers might hold the key to unlocking the severe and relatively untreatable pain of peripheral neuropathy.
Dr Magdi Hanna, Director of Pain Clinical Research Hub at King’s College Hospital in London, has been studying the combination of the strong opioid oxycodone (OxyContin) with gabapentin (neurontin) in over 300 patients with severe diabetic neuropathy. This combination demonstrated a significant 33% improvement on top of the best pain relief achievable using the maximum tolerated dose of gabapentin as monotherapy. The study was part funded by one of the medicine manufacturers.
This study is good news, but even in this study there were a great many people who were not helped. In another blog item, I’m going to talk about some of the unorthodox approaches that have helped some people.
Parkinson’s Disease, Allergies and Inflammation
The symptoms of Parkinson’s disease have been reported throughout history, but it was first described in the modern era by the great Scottish neurologist James Parkinson in 1817. Even after all these years, we still do not know all that much about what causes it. There’s an interesting study in the August issue of the journal Neurology, which is the official publication of the American Academy of Neurology.
Investigators from the Mayo Clinic used what is known as a case-control design (196 cases and 196 matched controls). What they found was that people who suffered from hay fever or allergic rhinitis, are 2.9 times more likely to develop Parkinson’s disease over a 20-year period.
The researchers did not find any association with autoimmune illnesses such as lupus, rheumatoid arthritis, pernicious anemia or vitiligo. They also did not find any association with asthma.
In addition, people who developed Parkinson’s disease used anti-inflammatory agents less frequently than controls, although this result was not statistically significant. The results may support the hypothesis that there is an inflammatory component in the causation of Parkinson’s disease.
You may ask, “Why on earth would anyone even look at a link like this?” The answer is that there have been previous reports of an association between the use of non-steroidal anti-inflammatories and lower rates of Parkinson’s disease in men but not in women and Alzheimer’s diseases.
This study does not suggest that hay fever causes Parkinson’s disease: it provides evidence for an association between the two. Parkinson’s is probably a group of illnesses with different causes. However, if chronic inflammation around the upper airways could produce inflammation in the brain, we might have a whole new way of preventing a degenerative brain disease.
In a future posting I’ll talk about some natural methods for reducing the burden of inflammation in your body.
How Does Fiber Help You?
Unless you’ve been living on Mars (!), you will doubtless have heard of the advantages of increasing the amount of fiber in your diet. A high-fiber diet reduces your risk of colon cancer, constipation, hemorrhoids hypercholesterolemia and insulin resistance syndrome.
We have always wanted to know how fiber does so many magical things at once, and now we may an answer. In a paper published in the open-access Public Library of Science Biology today, by a group from one our local institutions – the Medical College of Georgia in Augusta – collaborating with a researcher from Josai University, Sakado, Saitama in Japan.
The epithelial cells lining the intestine have a life span measured in 1-5 days. They spend their short life times working to process enormous amounts of food residue on its way past. It is this layer of cells that acts as the barrier between the body and items floating past on the inside of the intestine.
Long before it became the topic of some popular books are over-enthusiastic magazine articles, we became very interested in the idea of the “Leaky gut:” the concept that some illnesses are a result of breakdown of the normal integrity of this protective barrier. Over 20 years ago, a friend and colleague at Northwick Park Hospital – Ingvar Bjarnason – did some pioneering work on this important issue. Several recent studies have indicated that a breakdown of this barrier may be involved in several childhood illnesses including allergies and asthma. There is also some early information suggesting that “leaky gut” may be involved in some autoimmune processes involving the intestine. Both zinc supplementation and oats may prevent gut leakiness under certain very specific circumstances.
When the epithelial cells in the gut wall encounter indigestible fibrous foods, the outer covering of the cell ruptures, releasing a coating of cell-protecting mucus. In a matter of seconds, the cell begins to repair itself, in the process releasing yet more of the beneficial mucus. Not only does it lubricate, but also it may keep some carcinogens and allergens out of your system.
The constant buffeting of the cells causes mild damage that increases the level of lubricating mucus. Injury at the cellular level promotes the health of the gastrointestinal tract as a whole.
Here we see a basic principle of nature: many of the same things that apply in the cells of the body apply equally in the life of someone trying to achieve success. Without the buffeting, the cells of the intestine could not produce the mucus on which your life depends.
Without some occasional adversity, you will find it more difficult to grow as a human being.
“Storms make oaks take deeper root.”
— George Herbert (English Religious Poet, 1593-1633)
“He who knows no hardships will know no hardihood. He who faces no calamity will need no courage. Mysterious though it is, the characteristics in human nature which we love best grow in a soil with a strong mixture of troubles.”
–Harry Emerson Fosdick (American Clergyman, Writer and Broadcaster, 1878-1969)
Lupus Question
I had a very nice letter from a gentleman who posed the following question, which I have slightly edited in order to maintain confidentiality:
"A friend of mine, a 36 year old female has been diagnosed with Lupus.Healing by her doctors is not an option. Treatment yes. That’s not good enough. Any recommendations on how to heal it, who to see, what to read?"
It is always difficult for a health care practitioner to make precise recommendations about an individual whom they have not seen. That’s why we get so frustrated by some of the people who sell “cure alls” on their websites or infomercials. And when they are challenged say “but I’m not a doctor.” In which case, why are you giving advice??
Let me first say something about lupus. Systemic lupus erythematosus (SLE) is one of the so-called non-organ specific autoimmune diseases. What that means is that it can attack virtually any organ that has a DNA “command center.” And immune complexes can attack the skin, joints, kidneys, lymph nodes and so on. The autoimmune diseases show us how unwise it is for folk to advise us to “boost” our immune systems. SLE is an example of an overly boosted immune system. We should aim to balance our immune systems.
There is a lot of evidence that SLE has been becoming more common in recent years. Though we always have to be careful when we are told that an illness is becoming more common. That apparent increase may also be accounted for by other factors:
- More physicians may be becoming familiar with the illness: I saw this happen some years ago after I published an account of the first British case of a very rare type of headache. Within months, several other cases had been found. In each case doctors wrote to me saying that they had been treating the sufferer without success for many years, but after my report, understood what the problem had been, and, following my rules, had cured their patients.
- Diagnostic tests are becoming more sensitive, so more cases are turning up.
- Specialists are very good at changing the diagnostic criteria for an illness, or the level at which treatment is required: the “when is a difference a disease?” issue. Skeptics are forever saying that the only reason for doing so is so that drug companies can sell more drugs. But that’s a real misunderstanding: it’s actually the other way round. We change criteria once we have evidence that treatment may do some good. A good example is blood pressure. The levels at which we recommend treatment have been falling in recent years, because we now know that even minor hypertension can increase the risk of heart disease. Or diabetes mellitus, where the diagnostic blood sugar levels have been reduced for this reason: even small elevations of blood glucose increase the chance of damage to some blood vessels. It’s not the glucose itself that’s the problem, but the consequences of an elevated glucose level.
The reason for this preamble is this: if SLE is becoming more common, it is difficult to explain using conventional medical models. Some years ago, there was a report that more than half of all sufferers carried an organism called mycoplasma, and that this might be the cause of the illness. Nobody was ever able to replicate that finding, so the idea of an infectious cause is firmly on the back burner.
So let’s look at the illness from the perspective of physical, psychological, social, subtle and spiritual factors, for all come into play in someone dealing with SLE. The key to treatment is to have a healing synergy between all of the interlinked aspects of our lives.
On the physical front, conventional medicines have a great deal to offer, but as you said, for treatment rather than cure. They are also used to help protect organs against damage. One potential reason for the increase in the prevalence of SLE, is that there is a close link between the amount of fat in the abdomen and the production of some classes of inflammatory mediators. So question one: does the sufferer have an excess of intra-abdominal fat? If yes, diet and much gentle exercise as the illness will allow. What kind of a diet? Balanced, and following the principles which I outlined in the final part of the Healing, Meaning and Purpose.
There have been countless reports of people with SLE and other forms of inflammatory arthritis, especially rheumatoid, having food sensitivities particularly to dairy or to alfalfa. The research base is weak, but it is always worth exploring. There has been growing interest in the use of DHEA and foods high in omega-3 fatty acids. Some people have also reported some benefit from Vitamins C and E, and selenium. The treating physician can help with doses. There are also some herbal and homeopathic remedies that may be helpful. I quite like The Arthritis Bible by Craig Weatherby and Leonid Gordin as an overview of some of these approaches.
Next is psychological. Sunlight, stress, fatigue and lack of sleep can all make the condition worse, and I would urge the person to follow some of the plans that I outline on the CDs and in the book. An awful lot of people suffer from illnesses like this as a consequence of psychological factors. So it is a really good idea to use the approaches to see if there are any emotional, cognitive or relationship problems which have triggered or are perpetuating the autoimmune process.
Next is the subtle systems that underlie the physical and psychological. These may need to be re-programmed using acupuncture, or Reiki, or Thought Field therapy, or even high potency homeopathic remedies.
Finally the spiritual. I cannot over-emphasize the importance of this in all our lives. Again, I have made some suggestions in the program. It would not be right for me to tell others what or how to practice, but keeping in touch with, and strengthening the contact with your spiritual essence provides a wellspring of healing energy and support.
There is a final point that I would like to make. Not all illnesses can be made to disappear, and sometimes our focus has to change to one of helping the individual understand, learn from and coexist with the illness.
Who to see? Any health care professional that will respect all five domains, and help the individual to help themselves.
Now, back to you: does that help?
+ Are there others out there who would like to share their experiences?
Technorati tags Lupus Thought Field Therapy Healing
