Start watching to learn about nerve pain treatment! Why does neuropathic pain occur? What are alternative treatments? What prescription medications and topical treatments are used? Data on gabapentin and sativex (synthetic marijuana). Peripheral nerve and spinal cord stimulators.
Peripheral neuropathy is basically when you have damage to your peripheral nerves from either a trauma or disease. This can cause your hands and/or feet become numb and tingly. I’ll focus on the feet/legs for this video.
APS machines – pain treatment
Two MS Specialist Nurses from at MS Therapy Centre in Bedford, UK, have been trialling a drug-free microcurrent machine to treat pain in MS with very positive, and surprisingly wide ranging effects.
The treatment, Action Potential Simulation Therapy, or APS Therapy, uses a copy of the body’s own electrical signals – the ‘action potentials’ that travel along nerve fibres, to enhance communication between the cells, using an APS Therapy machine.
Neurons and nerve pain
“The results we’re seeing, are, firstly, pain relief, in over 3/4s of the people with MS who have been treated over the past 3 years at the clinic. This is really significant, especially as the type of neuropathic, or nerve pain, that many people with MS experience, is very difficult to treat, and there are so many problems with side effects from the medication.
“I started off being most excited by the pain relief, and helping people to reduce and in some cases withdraw from medications they’re taking for pain, and of course I still am.
But recently, I’ve been most excited by the other improvements that some people
get – we had a lot of people reporting improvements in energy, with reduced fatigue, better sleep quality, feeling less stiffness and spasm, and often, really improved wellbeing, when they used the machines for pain, and so in the past year we’ve begun to try using the machines specifically for these problems, and had some lovely results,” says Miranda Olding.
The nurses, Queen’s Nurse Emma Matthews from Northampton, and Miranda Olding from Bedford, cannot share the full results of their report on the first two years of treatment with APS Therapy until it’s been presented at the CMSC conference in Maryland, which they are travelling to in June. They also aim to present their 3rd year results at other clinical conferences during the year.
The mode of action of APS Therapy is to enhance cellular communication by sending replicated action potentials, which are up to 4 times stronger than the naturally occurring signals, through the body, between electrodes attached to the skin.
This assists the removal of waste and inflammatory products, which can reduce localised pain and swelling. The production of ATP ( adenosine triphosphate) is boosted by the therapy, which results for some people in increased energy levels, and also stimulates natural healing mechanisms. Other neuro-hormones that encourage healing and endogenous pain relief are also boosted, and some neuropathic pain seem to respond very well to the application of this correct, rather than disordered, nerve signal.
Results for people with MS can be very wide-ranging. This report came from Maggie, who has had MS for over 20 years, on her 4th week into the treatment. (She has retained all these benefits)
“‘Notes on progress of the fourth week”
• ˜Sleep improvements maintained although still wake frequently.
• ˜Pain during day virtually gone.
• ˜Pain at night much reduced – now only troubling between 6-8am.
• ˜Energy levels greatly improved. Much more stamina…
• ˜I can now easily get up from a chair even one without arms!
• ˜I can lower myself gently down instead of flinging myself down.
• ˜I can move around with ease and no longer have to plan everything I need to do. I can walk around indoors without a stick.
• ˜I can stand long enough to do some housework and get myself some lunch.
• ˜The ‘electric shock’ feelings I was experiencing in the head have been getting less in frequency.
• ˜The physio that I do in the group and in the pool have got better.
• ˜I can stay on a gym ball for the whole session and the physio has noticed as improvement in my posture and walking.
• ˜Mood- has elevated to new heights. I am delighted with the transformation – I feel I am getting me back.”
Not everyone who tries APS Therapy experiences these type of benefits, but the
Maggie does APS Therapy
team are having enough similar reports to merit offering APS Therapy as a trial treatment for people with MS who are struggling with fatigue as well as solely for pain, and to be excited by the potential applications of APS Therapy in people with MS.
Miranda Olding now splits her time between working as an MS Specialist Nurse, and working on introducing APS Therapy in the UK, both teaching and training and collecting data, and running a business where people can train, or rent or buy APS Therapy machines with one to one support over Skype, Facetime or Webex. You can find out more at www.painfreepotential.co.uk
Neurons and nerve pain
Small study could lead to identification of treatable diseases for some with chronic pain syndrome
About half of a small group of patients with fibromyalgia – a common syndrome that causes chronic pain and other symptoms – was found to have damage to nerve fibers in their skin and other evidence of a disease called small-fiber polyneuropathy (SFPN). Unlike fibromyalgia, which has had no known causes and few effective treatments, SFPN has a clear pathology and is known to be caused by specific medical conditions, some of which can be treated and sometimes cured. The study from Massachusetts General Hospital (MGH) researchers will appear in the journal Pain and has been released online.
“This provides some of the first objective evidence of a mechanism behind some cases of fibromyalgia, and identifying an underlying cause is the first step towards finding better treatments,” says Anne Louise Oaklander, MD, PhD, director of the Nerve Injury Unit in the MGH Department of Neurology and corresponding author of the Pain paper.
The term fibromyalgia describes a set of symptoms – including chronic widespread pain, increased sensitivity to pressure, and fatigue – that is believed to affect 1 to 5 percent of individuals in Western countries, more frequently women. While a diagnosis of fibromyalgia has been recognized by the National Institutes of Health and the American College of Rheumatology, its biologic basis has remained unknown. Fibromyalgia shares many symptoms with SFPN, a recognized cause of chronic widespread pain for which there are accepted, objective tests.
Designed to investigate possible connections between the two conditions, the current study enrolled 27 adult patients with fibromyalgia diagnoses and 30 healthy volunteers. Participants went through a battery of tests used to diagnose SFPN, including assessments of neuropathy based on a physical examination and responses to a questionnaire, skin biopsies to evaluate the number of nerve fibers in their lower legs, and tests of autonomic functions such as heart rate, blood pressure and sweating.
The questionnaires, exam assessments, and skin biopsies all found significant levels of neuropathy in the fibromyalgia patients but not in the control group. Of the 27 fibromyalgia patients, 13 had a marked reduction in nerve fiber density, abnormal autonomic function tests or both, indicating the presence of SFPN. Participants who met criteria for SFPN also underwent blood tests for known causes of the disorder, and while none of them had results suggestive of diabetes, a common cause of SFPN, two were found to have hepatitis C virus infection, which can be successfully treated, and more than half had evidence of some type of immune system dysfunction.
“Until now, there has been no good idea about what causes fibromyalgia, but now we have evidence for some but not all patients. Fibromyalgia is too complex for a ‘one size fits all’ explanation,” says Oaklander, an associate professor of Neurology at Harvard Medical School. “The next step of independent confirmation of our findings from other laboratories is already happening, and we also need to follow those patients who didn’t meet SFPN criteria to see if we can find other causes. Helping any of these people receive definitive diagnoses and better treatment would be a great accomplishment.”
Pain for pressure
Treatment for peripheral neuropathy may include treating any underlying cause or any symptoms you’re experiencing.
Treatment may be more successful for certain underlying causes. For example, ensuring diabetes is well controlled may help improve neuropathy or at least stop it getting worse.
There are many different possible causes of peripheral neuropathy, some of which can be treated in different ways. For example:
diabetes can sometimes be controlled by lifestyle changes, such as stopping smoking, cutting down on alcohol, maintaining a healthy weight and exercising regularly
vitamin B12 deficiency can be treated with B12 injections or tablets
peripheral neuropathy caused by a medication you’re taking may improve if the medication is stopped
Some less common types of peripheral neuropathy may be treated with medication, such as:
corticosteroids – powerful anti-inflammatory medication
immunosuppressants – medications that reduce the activity of the immune system
injections of immunoglobulin – mixture of blood proteins called antibodies made by the immune system
However, the underlying cause may not always be treatable.
You may also require medication to treat any nerve pain (neuropathic pain) you’re experiencing.
Unlike most other types of pain, neuropathic pain doesn’t usually get better with common painkillers, such as paracetamoland ibuprofen and other medications are often used.
These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect, because the ideal dose for each person is unpredictable. Higher doses may be better at managing the pain, but are also more likely to cause side effects.
The most common side effects are tiredness, dizziness or feeling “drunk”. If you get these, it may be necessary to reduce your dose. Don’t drive or operate machinery if you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol.
The side effects should improve after a week or two as your body gets used to the medication. However, if your side effects continue, tell your GP as it may be possible to change to a different medication that suits you better.
Even if the first medication tried doesn’t help, others may.
Many of these medications may also be used for treating other conditions, such as depression, epilepsy, anxiety or headaches. If you’re given an antidepressant, this may treat pain even if you’re not depressed. This doesn’t mean your doctor suspects you’re depressed.
The main medications recommended for neuropathic pain include:
amitriptyline – also used for treatment of headaches and depression
duloxetine – also used for treatment of bladder problems and depression
pregabalin and gabapentin – also used to treat epilepsy, headaches or anxiety
There are also some additional medications that can be used to relieve pain in a specific area of the body or to relieve particularly severe pain for short periods. These are described below.
If your pain is confined to a particular area of your body and you can’t, or would prefer not to, take the medications above, you may benefit from using capsaicin cream.
Capsaicin is the substance that makes chilli peppers hot and is thought to work in neuropathic pain by stopping the nerves sending pain messages to the brain.
A pea-sized amount of capsaicin cream is rubbed on the painful area of skin three or four times a day.
Side effects of capsaicin cream can include skin irritation and a burning sensation in the treated area when you first start treatment.
Don’t use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.
Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that doesn’t respond to other treatments your GP can prescribe.
Like all opioids, tramadol can be addictive if it’s taken for a long time. It will usually only be prescribed for a short time. Tramadol can be useful to take at times when your pain is worse.
Common side effects of tramadol include:
feeling sick or vomiting
dizziness
constipation
In addition to treating pain, you may also require treatment to help you manage other symptoms you’re experiencing as a result of peripheral neuropathy.
For example, if you have muscle weakness, you may need physiotherapy to learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around.
Other problems associated with peripheral neuropathy may be treatable with medication, such as:
constipation
the slow movement of food through your stomach (gastroparesis)
In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis or urinary catheterisationif you have problems emptying your bladder.
As peripheral neuropathy can be a very painful and troublesome condition that may only partly be relieved by medication, some people may be tempted to try other treatments, such as:
herbal medicine
benfotiamine (a form of vitamin B1) supplements
alpha-lipoic acid (an antioxidant) supplements
However, while some people may find these helpful, the evidence for them isn’t always clear. It’s advisable to speak to your doctor before trying these treatments in case they could interfere with your ongoing treatment.