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Diabetic Neuropathy: Diagnosis and Treatment

Diabetic neuropathy develops over time...and of course, the first thing to be considered when symptoms emerge is a history of diabetes.  Depending on the type of neuropathy involved, the symptoms will vary, as I discussed in the post just prior to this one.  Upon examination, the health care provider will take a look at a number of things including the patient's reflexes, loss of sensation,  and changes in skin coloration.

Tests that can help determine the presence of diabetic neuropathy may be ordered at this time. Here again, the type of neuropathy in question dictates the nature of the testing. It is not unreasonable to expect EMG, NCV, Gastric Emptying Studies, or a tilt table study

Once a diagnosis is established, you may be prescribed medications to manage the symptoms. The drugs commonly used for the pain management aspect of neuropathy are not usually those which cause problems with addiction. Some antidepressant and anticonvulsant medications, for example,  are actual…

Symptoms of Diabetic Neuropathy

Diabetic neuropathy has various forms...there are four classes, or subtypes.

The first subtype is Autonomic neuropathy.  This can affect the heart, blood vessels, GI tract, urinary tract, sex organs, sweat glands, eyes, and lungs. Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. Also affected are the nerves of the heart, and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also trigger  hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.

The second subtype  is known as Focal neuropathy.  Affected body parts include eyes, facial muscles, ears, pelvis/low back, chest, abdomen, thighs, legs and feet. Patients with this subtype experience sudden muscle weakness or pain. Literally any body part can be affected.

The third subtype  is known as Proximal neuropathy.  This problem causes pain in the hips, buttocks,…

Obesity-->Diabetes-->Diabetic Neuropathy

In recent years, it seems like we are hearing about the risks of obesity in the news, on television, from our healthcare providers. You might think, "I am only a few pounds overweight, so what's the big deal?" or "I only get to live once, and I want to be happy. So,
I'm going to eat what I want, when I want."  Okay...

I am a child of the 50's.  Back when I was young,  processed foods were not as commonplace as they are now; they were sort of an "emerging market."  My mother cooked mostly from scratch, and I think we were a lot healthier, in at least some respects. Antibiotics and steroids were not  used in cattle or poultry feed; GMO foods were not yet in existence, and the use of preservatives and dyes was nothing like it is at present. Nowadays, people are a lot busier, and the depend on the mass market of processed foods to keep meals on the table. Carbohydrate addiction is a growing problem today. I don't think we are really better off…

Part 3: What are the BENEFITS of Non Drug Pain Managment Ideas?

Many of the chronic pain conditions people face are chronic because, while they can be treated, there is no cure.  At the time of diagnosis, no one really knows how long they are going to be fighting the battle against the condition at hand. Thinking that you might be in this situation for the long haul changes perspective and approach to finding a solution.

Over the years that I have been in pharmacy practice, the treatment approach to many health conditions has shifted dramatically.  Rheumatoid arthritis is a good example.  In the earliest days of professional life, the NSAID drugs were the latest and greatest, and steroids were commonly used. Some people were receiving gold injections at doctor's offices. Nowadays, the standard of treatment is vastly different; many patients benefit from monoclonal antibody therapies via hospital infusion and self care strategies.

Where am I going with this?  When you have a chronic pain condition, there is much uncertainty. Medical treatments…

Study: Electromagnetic Therapy Offers Relief To Fibromyalgia Sufferers

A treatment that is already used to treat depression is showing promise in the treatment of fibromyalgia. Dr. Max Gomez of  CBS New York recently reported on the use of Transcranial Magnetic Stimulation, or TMS  in some patients--with good results.  A new study in the Journal Neurology finds that magnetic stimulation can actually improve the non-pain symptoms of fibromyalgia, like depression, mood and overall quality of life. Other studies have found that TMS also alleviates the pain symptoms. The difference is where and how the magnetic pulses are used.

  Since the brain is an electrical device, the electromagnetic pulses that are pushed into the brain during treatment seem to modulate brain activity.  Treatment of fibromyalgia in this manner is an off-label use at present. Results are preliminary but offers some hope to the 12 million Americans who suffer from this chronic ailment.  Traditional medicine seems to be of little use to most fibro patients, so the search for novel…

Part 2: What are the BENEFITS of Non Drug Pain Managment Ideas?

To a large extent, non drug pain management interventions are really about adopting a healthier lifestyle.

Some examples-

Smoking Cessation
Using smoking as a way to cope with chronic pain can actually make the pain worse! 

Weight Loss 
A healthy body weight reduces stress on the joints and spine. The goal is to achieve a healthy Body Mass Index (BMI).

Exercising within the limits of one's condition promotes weight loss, cardiovascular health, preserves joint function, and raises endorphin levels,promoting an overall sense well being.  It's all good.

Alcohol Moderation
While alcohol may help a person to forget their troubles for a time, it actually has no analgesic properties.  Chronic use of alcohol can damage the liver, which is can effect the metabolism of medications and body toxins.

Practicing Behaviors that Promote a Good Night's Sleep 
A good night's sleep go a long way in improving everyone's day to day function.  Sleep is restorative and is vital to …

Aches and Gains: Dr. Paul Christo on "Chronic Pain In America"

Dr. Paul Christo, leading pain expert from The John Hopkins Hospital and host of the radio show Aches and Gains, appears on The Balancing Act to talk about the epidemic of chronic pain in America, and where pain sufferers can go for relief.

Part 1: What are the BENEFITS of Non Drug Pain Managment Ideas?

I have decided to devote a few posts to my thoughts about why non-drug pain management ideas are important.  Up until the present, I have focused on over 60 different ideas ( see recap #1 and recap #2 for a quick overview) . Not every intervention is appropriate for every situation-for example, inversion tables are primarily used for people with back problems, but would probably not be of much use for someone with fibromyalgia.

In any event, for this first post I would like to point out that medications have a role in the treatment of chronic pain, but there ARE limitations.  Some thoughts:

 Dosage ranges need to be observed to reduce the risk of side effects/toxicity/drug interactions.  The more medications a person takes, and the higher the dosages they take, the more likely they are to encounter problems at some point. Of particular danger is the use of opioid medications because of the risks associated with the nature of the drug: addiction, dependency, and tolerance.  Opioid over…

Fibromyalgia: Strategies for Enhancing Pain Management

I saw an article some time ago about this topic and put it aside for a while.  I have already discussed some of these concepts in some of my earlier posts.  I am going to give you the nutshell version here: you can read it in entirety by going to the link I am providing at the end!

Medications--at least to date-- are of limited use in Fibromyalgia (and Chronic Fatigue Syndrome as well).  So it is very important to know some coping skills.  It might take some experimentation and/or practice to see what works for you.

So, without further ado--

1)Pace yourself.

It's important to know what your limits are and to live within the confines of those limits.
No permission is needed from anyone except you!

2) Relax!

Muscle tension and anxiety can really enhance the pain you are feeling. Take time out for a massage, a whirlpool bath, or a little meditation.  It will pay off in the long run.

3) Know your triggers.

In knowing what activities, foods, sleep situations, make you feel better or w…

Non Drug Pain Management Ideas: Hydrotherapy

Nowadays many of us have access to a whirlpool bath or hot tub..maybe at the gym or YMCA, swim club, or even at home.  Using water in this way, for therapeutic purposes has existed for many years.  While it may not be a long term solution to the problem of chronic pain,  the combination of warm water and massaging effect of body jets can feel very soothing to achy joints.  There is a mental effect as well; enjoying the sensation can give a brief respite to mental tensions and anxieties, even if only for a few moments!  Muscles  relax ; circulation is increased and the body's immune system can be strengthened by way of hydrotherapy.  The heat of the water can induce sweating, which can help to detoxify our bodies of unwanted impurities. 

What's not to like?  :)


The Spoon Theory written by Christine Miserandino

Have you ever heard the term"spoonie?" I have seen it in a lot of blog posts and it led me to the creation of this post.  First and foremost, I looked in the Urban Dictionary, because it just seemed like that kind of word.  Here is what I found:

Spoonie A person living with chronic illness, that identifies with Christine Miserandino's Spoon Theory. Spoonies are people that live with chronic illness; theoretically measuring personal daily abilities much as one would measure the proper amount of spoons needed for an event or occasion... sometimes having an abundance, other times coming up short. by SansNom75 October 12, 2009 

This led me on a search for "The Spoon Theory." I have attached a link below the picture if you want to read it.  I am not really one to label people. In this case, the term spoonie came from one of its own, and many chronic pain sufferers seem to use it willingly in their conversations amongst themselves.  I guess the theory makes sense …

Non Drug Pain Management Ideas: Emotional Support

Dealing with chronic pain over weeks, months and perhaps years can take its toll on an individual.  There are good days and bad, just like anything else, but as time goes on, the chronic pain problem slowly becomes a part of who that person is as a whole.  It is important to understand this if you have a relative, co-worker, or friend who suffers from chronic pain.

For the most part, most patients with chronic pain really do want to feel better.  They have been from one doctor to another, have tried numerous prescription remedies and lifestyle changes, surgery,physical therapy, etc. with varying results.  Some people find a good "cocktail of remedies" and function pretty well; others may be on the lookout for a suitable path.

No matter where these folks fall on the spectrum, the one thing that is always of benefit is emotional support.  Living in pain is hard on the mental self as well as they physical self; knowing how to be supportive is just as important as any medical tr…

Fibromyalgia Resource: National Fibromyalgia Association

In the months that I have been writing this blog, it has come to my attention that many are on the lookout for help with fibromyalgia.  This mystifying condition affects about 10 million people in the US alone. Efforts to find a cause and/or treatments for this chronic pain condition are still in their infancy.

For that reason, I am sharing a link in this post to the National Fibromyalgia Association. Here you can find a number of resources: support groups, chat room,community resources, latest news and information, and the like. I have also posted a graphic of their magazine, Fibromyalgia Aware (You can view this online or subscribe as well!)

I hope you will take a few minutes to have a look around!

Sources: National Fibromyalgia Association; Flickr

Non Drug Pain Management Ideas: If The Shoe Fits, Wear It!

A pair of shoes in today's world can serve a variety of purposes--dress shoes, running shoes, work boots...but they are not all constructed with pain management in mind.  Wearing the wrong shoes for the wrong purpose can lead to all kinds of problems--foot pain, back pain,and so on.  So with that in mind, I decided to do a little bit of research on how to get shoes that fit well, and spare yourself unnecessary foot and back pain!

1) The size of a person's foot changes with age, so measuring your feet every time you shop for shoes is a great idea.  Over the course of a day, feet become a bit larger. Therefore, shoe shopping later in the day will give you best fit.

2) Most people's feet are not exactly the same size.  Try on both shoes of a pair before buying them.

3) Select a shoe that is shaped in a similar way to your foot's shape.

4) The size on the shoe box is not that relevant.  What really matters is how the shoe feels on your foot.

5) Don't buy shoes that are…

A Patient Guide to Topical Analgesics

Even though I am a pharmacist, I do not write or share much information about medication in this blog, because I do not feel it is appropriate to promote the use of medication as if it's some kind of nirvana.  But occasionally I find things I think worth sharing, and this is one that I got from one of the pain management websites that I frequent.  So, for your reading pleasure-  I present "A Patient Guide to Topical Analgesics."


Non Drug Pain Management Ideas: Android Apps for Chronic Pain Management

Yesterday I wrote a good sized blog post about iTunes "apps" that can help people with chronic pain, available for iPhone and iPad.  Today I am looking at the Android smartphones, and what chronic pain users who use this technology can find for this platform.  The first step in doing this is to visit "Google Play", where one can find all kinds of apps for the Google based phones/tablets/etc. 

This is a screenshot of what I found there.  I will review a few of these apps in the paragraphs that follow the image.

1)  WebMD Pain Coach:
WebMD Pain Coach™ offers a holistic approach to balancing lifestyle with chronic pain conditions to help inspire a better day. WebMD’s new app is a mobile companion to help you through daily health and wellness choices so you can better manage your chronic pain. Enjoy a personalized experience as physician-reviewed tips related to your specific condition are delivered daily to you. WebMD Pain Coach™ puts you in control of your l…

Non Drug Pain Management Ideas: iPhone and iPad Apps for Chronic Pain Management

If you own an iPhone or and iPad, and you also suffer from chronic pain...this post is for you!

The smart phone revolutionized the way people use their cell phones.  It is more like having a pocket computer that's also a telephone than the other way around. In addition, the iPad so wonderfully marries the technology of a computer to the portability of a tablet.  Splendid, indeed!

Now to the part about chronic pain.  As owners, of these devices you must by now be aware of all the "apps" that you have available to you.  Some of them cost a little money..and by paying the fee, you have something to gain in the way of advertisement-free information. Some of us prefer that.  Others do not mind paying a little extra to get rid of those annoying ads.  In any event, today I am going to share with five or six of the most popular Apple
"apps" for smart phones and tablets.  I am going to share the free ones because I know that most people like being able to get free stuf…

New drug treatment on horizon for chronic pain from shingles

Good news for you...from College of London

A new drug treatment has been found to be effective against chronic pain caused by nerve damage, also known as neuropathic pain, in patients who have had shingles.
The researchers hope that the drug might also be effective against other causes of chronic neuropathic pain, such as diabetes, HIV, nerve injury and cancer chemotherapy, as it targets a mechanism that is not targeted by any existing therapies and has fewer side effects.
Drugs available now have limited success at treating neuropathic pain and often have unpleasant or disabling side effects.

read more here...


Non Drug Pain Managment Ideas: Glucosamine for Osteoarthritis

Glucosamine is a nutritional supplement that has gained attention in recent years as a treatment for osteoarthritis.  This substance occurs naturally in the human body and is an ingredient used by the body for the production of cartilage.  There are numerous products in the marketplace that contain glucosamine; it may be available as tablet, liquid or powder.  Some products that contain glucosamine also contain chondroitin, which is another naturally occurring chemical that plays a role in formation of cartilage.

As to whether or not taking glucosamine or glucosamine with chondroitin is actually of benefit-the answer is unclear.  This type of nutritional supplement does seem to help some people, but for others, the opposite is true.  In my opinion, it does not hurt to try one of these products if you have osteoarthritis, but if there is no perceived benefit after a few weeks' time, it probably is not worth continuing.

A note of caution: do not use this product if you are allergic …

The Hidden Risks of Rheumatoid Arthritis

In this video, Dr. Sanjay Gupta explains that people with RA have increased risk of heart disease.  This is thought to be due to the inflammatory disease process that accompanies rheumatoid arthritis.

The earlier a person is diagnosed with Rheumatoid Arthritis, the earlier treatment can begin. Most of the treatments of modern day are focused at attacking the disease at its core, attempting to induce remission from  the destructive, inflammatory effects of this disease.  It is hoped that controlling the disease in this way will help patients have more pain free, productive time in their lives and that the damage to joints and potential heart disease can be diminished.

If you think you might have rheumatoid arthritis, do not hesitate to seek medical help. You can also help yourself in a couple of ways:
1) Exercise as per your doctor's recommendations and
2) consider the anti inflammatory diet! (Follow this link to my first post on this topic, but there are others in this blog if you…