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Medication-Induced Neuropathy

Medication-Induced Neuropathy
By Peter D. Donofrio, M.D.

http://www.neuropathy.org/site/News2?page=NewsArticle&id=7873&news_iv_ctrl=1221

You’ve undoubtedly heard the old saying, “It’s what you don’t know that can hurt you.” When it comes to neuropathy, there may be something your doctors don’t know that can hurt you as well.

Renowned New York Times health columnist Jane Brody recently shared with readers of her column that she experienced a bout of peripheral neuropathy several decades ago when a misplaced shot of morphine damaged a sensory nerve in her thigh. Obviously, her doctor never intended for that to happen. Fortunately, the nerve recovered in three years, but for much of that time, Brody couldn’t even tolerate something brushing against her leg.¹ Brody’s peripheral neuropathy can be categorized as an “iatrogenic” case—that is, a condition that is actually caused by medical care.

Iatrogenic causes for peripheral neuropathy aren’t always as blatant as a misplaced shot. In fact, peripheral neuropathy can be caused by nerve toxicity from commonly prescribed drugs: medications prescribed by physicians who are not aware of the possible relationship between the medication and the neuropathy. Why aren’t they aware? After all, aren’t these the experts you trust with your health, your well-being…your life?

Your doctors are well aware of the medications they are prescribing, but the fact is they may not be aware of medications other physicians have prescribed, nor are they aware of every uncommon adverse reaction of a medication. Many medications have hundreds of reported side effects. Often primary care physicians are inundated by a waiting room full of very ill patients requiring immediate care and don’t have time to fully review in detail every note or test result they receive.

Simply put, your specialists and primary physicians need your help. If you have a neuropathy and are concerned it may arise from a medication, speak up. Some medications and interactions between drugs can cause complications and even irreversible conditions. For example, thalidomide has proven to be very effective for treating skin diseases and some kinds of cancer. In fact, thalidomide has experienced a resurgence of use in the medical community for its effectiveness against several dermatological conditions. The occurrence of neuropathy, however, has also been tied to thalidomide. It is not typically related to the daily dose of the drug nor the duration of treatment; it’s more commonly found in patients who are slow drug acetylators—in other words, those patients whose bodies take longer to metabolize certain drugs.

The good news is that when patients with neuropathy stop using thalidomide, 25 percent of them recover completely, and 30 percent improve partially. What’s not so comforting is the fact that 45 percent of reported cases do not recover at all.² This example illustrates the need for you to consult with your physician if you take any of the medications associated with causing neuropathy. It is important to remember that you are not expected to be a medical expert, however, you are expected to know the names of the medications you’re taking, how long you have been taking them, and to be able to describe them to every doctor you visit. Thus, you need to assume the role of being your own patient advocate. Today’s health care system is complicated, and as such, you need to be able to provide to your doctor and to other health care providers as much information about your treatments as possible. Communication of your medications and duration of use is critical for your primary care and specialist physicians to offer you excellence in care.

Take the first step by reviewing the list of medications below that can induce neuropathy and let your physicians know if you are taking any of them. Remember to tell your physicians that you are not questioning their judgment; just asking them to review the medications in the context of your neuropathy. More often than not, they will welcome this active role in your treatment and see this as an opportunity to better educate themselves. Not only will you be helping yourself, but you could be helping others as well. Also, keep in mind that these medication do not always cause neuropathy, and it is the unique metabolism of certain patients that may cause them to develop neuropathy when prescribed a certain drug.

The following is a list of drugs that can cause neuropathy in certain patients:

Allopurinol Amiodarone Ara-C Carboplatin Cisplatin Colchicine Danosine (ddl) Dapsone Disulfiram Docetaxel Etoposide (VP-16) Ethambutol Etoposide Gentamin Gold Indomethacin Isoniazid Lithium L-tryptophan contaminant

Mercury Metronidazole Misonidazole Nitrofurantoin Nitrous Oxide Paclitaxel Perhexilene Phenytoin Pyridoxine Sulfapyridine Statins Stavudine (d4T) Streptokinase Suramin Tacrolimus Thalidomide TNF-alpha antagonists Tumor Necrosis Factor Vincristine Zalcitabine (ddC) Zimeldine

The peripheral nerves are protected by a blood-nerve barrier and might be perceived to be at a lessened risk than other organs for toxicity. Certain patients, however, may be at a higher risk for developing peripheral nerve toxicity due to genetic or metabolic factors. Many therapies have toxicities that must be tolerated because the treatments are necessary, such as treatments for HIV and malignancy. Developing additional therapies to prevent and/or ameliorate the toxic neuropathy associated with certain medications is an important area of
research and clinical trials are on-going.

1 Brody, Jane. “The Many Ills of Peripheral Nerve Damage.” The New York Times, October  20, 2009.

2 Zimmer, Carl. “Answers Begin to Emerge on How Thalidomide Caused Defects.” The New York  Times, March 16, 2010.

Peter D. Donofrio, M.D. is professor of Neurology and director of the Neuromuscular Division of the Department of Neurology at Vanderbilt University Medical Center. He is director of our Association’s Neuropathy Center of Excellence at Vanderbilt and also serves on The Neuropathy Association’s Medical Advisory Committee.

*We have reprinted this article from the May 2010 edition of Neuropathy News.

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Is Traditional Chinese medicine Effective For Peripheral Neurology Pain?

Original article is at http://articlesprofessionals.com/health-fitness/is-traditional-chinese-medicine-effective-for-peripheral-neurology-pain September 11, 2011 | Author: Barbara Thomas

Leads to of Peripheral Neurophysiology

Peripheral neurophysiology is a typical issue that specifically affects diabetics, individuals present process radiation treatment, and those with HIV. The most common regions impacted by neuropathy are the ft with the second becoming the fingers. Peripheral neuropathy signs might be diverse and can involve decreased sensation, elevated feeling, weak point of ankle or hand muscles, and signs and symptoms related to changes in the skin and nails.

Unfortunately, as the prevalence of diabetic issues increases, person suffering from diabetes neuropathy becomes more common. Statistics transcribe that 25% of person suffering from diabetes patients will experience neuropathic feet discomfort. And, because the incidence of diabetic issues is increasing, so is the incidence of neuropathy signs or symptoms.

Solution Choices

Of course, the most efficient implies of assisting to management diabetic issues connected path discomfort is working to manage all forms of diabetes itself. After signs and symptoms possess started, drugs like Lyrica and Neurontin are frequently recommended to assist management the neurological discomfort. For a lot of, the use of these medications are either ineffective or have facet effects which threshhold their use. In view of these the use of replenishable medicines similar to acupuncture is a far more prevalent.

Acupuncture Study

Once thinking about any solution hope it is fair to evaluate what the explore has to say regarding how effective the remedy is. For individuals suffering from peripheral neuropathy, there is great information regarding chinese medicine.

A 2007 examine entitled “Clinical commentary on bring about of acupuncture in healing diabetic peripheral neuropathy” concerned a overall of 60 participants. The study observed which individuals receiving chinese medicine had a statically higher remodeling in neurological signs and symptoms as well as enhanced nerve act for each sensory and engine nerve conduction when in contrast to the control organization team.

An additional examine carried out in Africa in 2006 located that for the 126 individual patients which received traditional chinese medicine for person suffering from diabetes peripheral neuropathy, 86% deemed the therapy as being efficient for lowering symptoms in their fingers and ft.

In a 2006 Canadian examine entitled “Traditional chinese medicine treatment for chemotherapy-induced peripheral neuropathy–a claim series” chinese medicine was utilized in five instances to decrease neuropathic pain in cancer patients. The chinese medicine treatment was considered effective in these instances where medication had failed.

And finally, in a Chinese language examine involving 90 participants, individuals receiving whole body or arm and ankle traditional chinese medicine has appreciably improved blood vessels glucose and lipids, decreased bloodstream viscosity, and enhanced features of peripheral nerve cells, therefore provoking therapeutic results for diabetic peripheral neuritis when in contrast to the control organization team. The examine additionally observed no significant difference in between the full body group and the ankle and arm remedy group.

Doing so sampling of the research in the use of acupuncture for the solution of peripheral neuropathy is really encouraging. Due to the nominal facet effects using chinese medicine in contrast to pharmaceutical remedy options, traditional chinese medicine should be regarded as as a reasonable treatment option for symptoms of neuropathy.

Is Chinese medicine Effective For Peripheral Neuropathy Pain? – Check Out peripheral neuropathy and neuralgia

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Acupuncture Cured Neuropathy Caused By Lipitor, By Arthur Yin Fan 03/28/2010, Video On YouTube.com

See detail, click the link:

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www.ChineseMedicineDoctor.US

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Peripheral Neuropathy and Chinese medicine therapies–by Dr.Arthur Yin Fan, the Greater Washington DC

We received many calls about the inquiry of Chinese medicine / acupuncture for Peripheral Neuropathy treatments in recent months due to our patients and MDs’ referrals.

We have treated such condition since 1989 when Dr.Fan started a Chinese medicine neurology in Nanjing, China.

The reasons of Peripheral Neuropathy are complicated, many patients have that because they have diabetes, the Peripheral Neuropathy is a complication of Diabetes.  Some of other patients get that after chemotherapies, or using some chemical medications, or just after vaccine injection, such as flu Shot.  And, many of other patients may have “no reason”.

The acupuncture for Peripheral Neuropathy is very effective, basically, needs 8-24 sessions. the burning pain, tingling, nubness may be attenuated immidiated after initial acupuncture.

Using Chinese herbal “tea”-decoction, and a special capsule, the effectiveness could be more stable.

We have more than 60 patients treated by the integrative methods of acupuncture with Chinese herbology, all of patients got effectiveness, 70% of patients got clinical cure–under the control, when they under the treatments.

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Guillain-Barre Syndrome (GBS) could be improved by Acupuncture and Chinese Medicine, by Dr.Arthur Fan 樊蓥

Guillain-Barre Syndrome (GBS) is one of common illnesses in neurology, generally it may be related to auto immuno inflammation in peripheral nerves, GBS usually also called Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP), occationally GBS also has chronic condition, called Chronic Inflammatory Demyelinating Polyradiculoneuropathy(CIDP). Acupuncture and Chinese Herbology are very effective therapies in GBS acute stage and recovery stage.

Here are several case studies or patients’ testimonies.

Patient 1. Mr. J.A.A. 49 years old.
(He aggreed to publish this case study, and he said we could use his real name, but we still use his name’s initial here).

First visit (10/15/2005): Main complain are weakness and tingling in both legs 8 month. Patient had spleen removal surgery last year because he had continuous decreasing in white blood cells and platelet. In the early Janurary patient had left-sided facial weakness and apparent facial droop, as well as numbness and tingling in hands and feet. One month late, the facial palsy recovered, the numbness, tingling worse in hands and feet, since Feburary patient has obvious weakness in both legs, couldn’t walk normally. He was admitted in hospital and had five dose of IVIG treatment because of his acute neuropathy consistent with Guillain Barre syndrome. He felt the treatment improved his weakness about 5%.

When patient saw Dr. Fan, patient just could walk 50 feet with the help of his wife. He had difficulty to move in or out of his car, he had steppage gait. Both hands and feet numbness, tingling and tight. Taking pain killer to ease the multiple-site muscle pain. There were obvious muscle weakness at right upper back and four extremities. Sometime patient dropped the dishes or other stuff because the hand weakness and short of sensation (esp. right hand no. 3, 4 fingers and inner side of forearm). There was a muscle cramp at right leg almost everyday. Patient still took Vitmine B1, B2, B6 and shoot B12. PE: Tendon reflexion disappeared in four extremities; Muscle tone (++-); Sensation: pain-exist, touch-generally exist. Muscle force: both leg 4+. Hands 3+. Treatment: Acupuncture.

No.2 visit (10/18/2005): After initial acupuncture, patient felt the sensation at left hand and right foot seemed better. However, during next two days, the sensation still bed-numbness, tingling and pain. Right leg still cramp, esp.at waking up in the morning. There was a obvious purple marks at the front and sides of the the tongue surface, his pulse was string and slippery. Starting Chinese “herbal tea” (herbal decoction, the method of tonifying the Qi and dispelling the blood stagnant) with the electroacupuncture.

No.3 visit (10/25/2005): The weakness and numbness was “much less”. If the initial weakness as 100%, immediate after the no.3 acupuncture treatment, patient felt recovered 30%.

No.6 visit (11/02/2005): The sensation recoveral rate reached 40-60% (there was 20% fluctuation in different days). The recovery of right leg was a slight quicker than that of other extremities. Left hand still hard to hold the dish, often dropping dishes.

No.10 visit (11/15/2005): Patient felt he had more energy and could walk more longer distance ever. However, when he felt tired the weakness and nubness/tingling seemed worse than before. Continue the Chinese herbal tea and electroacupuncture.

No.12 visit (11/22/2005): Patient felt Dr.Fan’s treatment was very successful. Currently he could walk independently over one mile (at initial visit, he just could walk 50 feet with other’s help), could conduct almost every daily personal work, such as fastening the shoes’ tie. Could left 15 Lb (initial visit 2 Lb).

No.13 visit (11/27/2005): Currently, patient has one full-time job Monday to Friday, also has another part-time job in weekends. In weekdays evening, he also takes course in a college. These would be a big challege to him. Today after 8 hours working, patient felt very tire and felt glove sensation at hands and feet. Initially he just could work as part-time worker. But anyway, patient felt much better than before, he has more energy, could squat down and up freely (at initial visit, patient couldn’t do that). Patient quited all medications (such as vitmins and Licara which is for neuropathy). And patient’s sensation is more allert, now he could feel electrical sensation when acupuncture.

No.15 visit (12/03/2005): Patient danced into my clinic, which showed his improving in movement and balance, as well as in a good emotion. Continue electroacupuncture and Chinese herbal tea.

No.16 visit (12/06/2005): Patient evaluated his condition–has improved 65% (65% normal) since 10/15/2005.

No. 17 visit (12/10/2005): Patient danced into my office, he and his wife were very happy. His recovery rate reached 70% today. However, still had some numbness at fingers or/and toes. The tightness and tingling sensation at left foot bottom became occationally. Patient had more energy. Muscle force at both legs: 5. hands 5-. Muscle tone (++). Tondon reflex still poor(+-). The improvents were at: (1) Balance;Gait; (2) Muscle force; (3) Sensation; (4) Daily activities and fine work; (5) Working. (Note: Patient signed above evaluation and agreed to publish his case study.)

Patient 2. Ms. S. J. 43 years old.

First visit (11/24/2006): Main complain is Dyspnea, both legs weakness for two month. Patient had Guillain barre syndrome two month ago, initially she had dyspnea, heavy on chest, swollow difficulty and both legs couldn’t walk, tingling below the chest. Currently she could walk about one mile per day total half hour, but the gait abnormal, felt tired and short of energy. Hands shaking, couldn’t type the keyboard of computer, just could using three fingers. There was still heavy sensation in chest/breathing difficulty, couldn’t breath deeply. Basically patient’s muscle force: 4. Tendon Reflex (+-); Treatments: Acupuncture and Chinese herbal tea.

No.2 visit (11/28/2006): Felt better, could walk longer.

No.3 visit (12/02/2006): Big improvement, recovered 30% (baseline: initial visit as 100% weakness). Hands no shaking aleady 48 hours, both legs’ Touching sensation recovered, breathing almost normal,still had slight heavyness in chest.

No.4 visit (12/06/2006): Could walk 2.5 miles per time. Using fingers normally, esp. typing was normalized. The gait much better.

No.5 visit (12/09/2006): Hands no shaking, typing keyboard already normal. “Definit improved!” Patient said.

No.6 visit (12/12/2006): Much better. (1) whole condition, mainly the ability of movement: 70% recovered. If the score at first vist was 10, now 3. Could walking 3.5 miles in one hand half hour; (2) Sensation: arms sensation- recovered 80%, if at first visit it was 10, now 2. And from constant numbness/tingling to occationally, just in night; legs sensation- recovered 90%, score 10 dropped to 1. When acupuncture, patient could feel more sensative than before. (3) Chest heavy or breathing difficulty, recovered 80%, score 10 dropped to 2. (Note: Patient signed for above evaluation.)

No.10 visit (12/30/2006): Much better. Feel almost normal. But right leg is weeker than left.

No.12 visit (01/09/2007): Tendon reflex recovered good, currently: both elbows (+ to ++), knee (++), ankles (+- to +). Feels tired due to catching a cold. Sensation recovering is good, already amost normal.

Patient 3. Mr. W. W. 58 years old.

First vist (12/04/2006): Main complain is pain in both hands and feet, low energy for 3 years. Patient had GBS 3 years ago, at that time he couldn’t move and stayed in hospital for IVIG treatment 3 weeks, after that he also had 2 month treatments in a rehab center. Then his movement is recovered. But the pain, tingling and numbness in both hands/palms, and feet bottoms do not disappear. And the problem is even worse when he gets tired or short of sleeping. The pain, tingling and numbness would increase and spread up to elbows and knees. Also, when he gets tired, the movement also becomes poor. The issue is he is very easy to get tired and short of energy. The neurological examination generally is normal, included in both movement and sensation, except the tendon relexion(-) at extremities. Treaments: acupuncture and Chinese herbal tea.

No.2 visit (12/07/2006): much better.

No.3 visit (12/11/2006): almost hasn’t any pain, tingling and numbness in hands and feet bottoms. Seems have more energy.

No.4 visit (12/14/2006): no any symptom in hands, but there is numbness at feet bottom. “Due to some reason, today my energy is lower than the day before”. Tongue purplish, pulse thin. We modified the formula in Chinese herbal tea.

No.8 visit (01/02/2007): no any symptom and feels good, although slept late in new year patient didn’t feel low energy and tingling, nubmness and weekness on extremities. Patient decides terminate acupuncture and continue the Chinese herbal tea for stablizing his condition.

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Neuropathy, Burning Pain Treated by Acupuncture, Chinese Medicine in Dr Arthur Fan’s Office

Neuropathy and severe pain

 07/09/2007

 I started going to Dr. Yin Fan for acupuncture to treat neuropathy caused by severe nerve damage to my spinal cord. Modern medicine alone was not treating the associated neurogenic pain. After several sessions, I had a very noticeable decrease in pain. I also gained a noticeable amount of positive sensation. Feeling that I had lost to the injury had begun to return. During this time my energy level also increased. Overall it made a significant difference in my life / recovery.

A. L.

Norfolk, Virginia

Neuropathy, Burning Pain 

I came to Dr. Fan for neuropathy in my neck, shoulder, and arm. I have a bone spur in my neck that was causing a lot of severe burning pain and sensation discomfort. After 12 sessions (acupuncture), the burning sensation is barely there, the first few times the pain level was up and down, but the last month the discomfort is almost all gone and the remains very low. I feel much, much better and encouraged. Dr.Fan is very gentle and kind and I thank him very much for help me.

S.D.

Fairfax, Virginia

Arthur Fan note:

For neuropathy, although the original causes may be complicated, acupuncture and Chinese medicine is a very effective therapy.

We have one herbal formula which was approved by Chinese FDA (jiangsu province) as hospital use, very good for Neuropathy and pain,called LIU JUN SAN.

 

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