Author Topic: Understanding Peripheral Neuropathies  (Read 41682 times)

[Buddie]

Understanding Peripheral Neuropathies
« on: February 17, 2012, 03:01:33 pm »
Understanding Peripheral Neuropathies

While it is known that diabetes, certain viruses, alcoholism, and some commonly prescribed medications (e.g. Fluoroquinolones, Flagyl, anticonvulsants) can cause peripheral neuropathies, there is a lack of literature in the medical world properly explaining the neuropathy-like symptoms associated with Benzodiazepine usage and subsequent withdrawal.  The symptoms incurred from Benzodiazepine usage seem to mimic peripheral neuropathy, which would tend to indicate faulty and possibly hyper-active signaling within the peripheral pathways of the nervous system.  Professor Ashton hypothesized about a possible Neuropathy connection in this paper she wrote in 1984:

“It is not impossible that the paraesthesiae, muscle weakness, and fasciculation, which are so prominent in withdrawal, might be due to a benzodiazepine induced toxic neuropathy.” (14)

However, since the nerves have not been proven to incur ‘structural’ damage by Benzodiazepine use, as proven by nerve conduction and imaging tests, the term ‘toxic’ may not apply.  She brought this subject up again later in the revised 2002 Ashton Manual, where these symptoms were said to “puzzle neurologists,” and that “nerve conduction studies in patients with such symptoms revealed nothing abnormal - for example, there was no evidence of peripheral neuritis.” (8 )  This is most likely due to the fact that disturbances in other functional mechanisms involved in the transmission of signals are affected by Benzodiazepines, namely neurotransmitters, which would not be detectable by these types of tests.  Since most Neurologists do not hold a specialty in Functional Neurology and main stream Neurologists generally test for structural abnormalities, it is easy to see why these professionals would be “puzzled.”

There are 3 proposed stages of neuropathy:
1)   Functional neuropathy: This stage is without pathology but with biochemical alteration in nerve function. It is reversible.
2)   Structural neuropathy: This stage involves the loss of structural change in nerve fibers. It may be reversible.
3)   Nerve death: There is critical decrease in nerve fiber density and neuronal death in this stage. It is irreversible. (11)

Obviously nerve conduction tests would not catch the first stage, Functional neuropathy, as the ‘hardware’ is still intact and only the ‘software’ (e.g. neurotransmitters) is altered.  As stated before, the average Neurologist will most likely not look for problems here...the best type of doctor to diagnose and treat Functional neurological problems would perhaps be a Neurologist who holds a specialty in Functional Neurology.

What are Peripheral Neuropathies?

Most peripheral neuropathies occur when the nerves connecting your spinal cord and brain to other parts of your body (peripheral nerves) become damaged (3).  With that said it is important to make a distinction between damage to neurons and functional anomalies.  While it is true that most peripheral neuropathies involve a structural change to the nerves involved, Benzodiazepines have NOT been shown to cause this type of nerve damage.  Rather Benzodiazepine usage causes functional, or chemical, changes that can potentially disrupt proper nerve signaling.

There are several types of peripheral neuropathy.  Mononeuropathy involves a single nerve; multiple mononeuropathy involves to two or more nerves; polyneuropathy involves many nerves throughout the body. The symptoms of these three types of neuropathy are similar. (3)

How the Peripheral Nervous System works.

The nervous system is classified into two parts: the Central Nervous (CNS) and the Peripheral Nervous System (PNS). The CNS is made up of the brain and the spinal cord, and the PNS is composed of the nerves that lead to or branch off from the CNS.  Nerves in the PNS have 3 types of functions:  motor, sensory, or autonomic. (1)

* motor nerves carry messages from the brain to the body and are responsible for the ability to move any part of the body (e.g., hands, feet).

* sensory nerves carry information from organs to the central nervous system where it is processed into sensation (e.g., touch, temperature changes, and vibrations).

*nerves that control autonomic (involuntary) functions including heart rate, blood pressure, breathing, digestion, and bladder function. (12)

Signals sent from the PNS to the Central Nervous System (CNS) are called afferent signals.  Conversely, signals sent from the CNS to the PNS are called efferent signals.

When afferent nerve cell endings, called receptors, are stimulated, they release neurotransmitters. These neurotransmitters relay a signal to the brain, which interprets it and reacts by releasing other neurotransmitters. (1)

Some of the neurotransmitters released by the brain are directed at the efferent division of the PNS.  The efferent nerves control voluntary movements, such as moving the arms and legs, and involuntary movements, such as making the heart pump blood. The nerves controlling voluntary movements are called motor nerves, and the nerves controlling involuntary actions are referred to as autonomic nerves. (1)

The afferent and efferent divisions continually interact with each other.  For example, if a person were to touch a hot stove, the receptors in the skin would transmit a message of heat and pain through the sensory nerves to the brain (afferent).  The message would be processed in the brain and a reaction, such as pulling back the hand, would be transmitted via a motor nerve (efferent). (1)

Nerve cells are the basic building block of the nervous system.  In the PNS, nerve cells can be threadlike—their width is microscopic, but their length can be measured in feet.  The long, spidery extensions of nerve cells are called axons.  When a nerve cell is stimulated the message is carried along the axon, and neurotransmitters are released within the cell. (1)

An analogy of how nerves impulses travel can be made to electrical cord.  Axons can be compared to the individual wires within the cord.  While electrical wires have a plastic coating to both protect the wire from damage and to preserve the signals being transmitted from outside interference-- axons are surrounded by sheaths made of myelin for the same purpose.  Schwann cells then wrap around myelinated and unmyelinated axons, similar to the external encapsulating insulation layer of the electrical cord. (1)

‘Neuropathy’ is defined as a functional disturbance or pathological change in the peripheral nervous system. (13)  Therefore, Neuropathies occur when the signals are not communicating properly as they travel from point A to point B across this network.  Disruption of travelling signals can occur structurally from faulty ‘wiring’ (e.g. Axons, myelin sheaths, or Schwann cells), or functionally from the disruption of proper neurotransmitter functioning.  Therefore, any disruption of proper signaling could possibly manifest in neuropathic type symptoms

The Possible Role of Benzodiazepines

We know that benzodiazepine usage has a negative effect on multiple neurotransmitter systems.  Benzodiazepines cause a decrease in norepinephrine (noradrenaline), serotonin, acetylcholine, and dopamine. (2)  We also know that Benzodiazepines cause other changes, such as the reduction of the number of GABA receptors. (2)  Neurotransmitters are vitally important in the signaling pathways of the PNS, as stated above; therefore it makes sense that disruption to multiple neurotransmitter systems could likely be one of the underlying causes for these types of symptoms.

Similarity in Symptoms

The following is a list of symptoms resulting from peripheral neuropathies that are also common to Benzodiazepine usage and withdrawal.  As you can see, there are striking similarities:


- Numbness, tingling, prickling, or pain in the toes, feet, legs, hands, arms, and fingers (6)
- Sensation that shoes are too tight or their feet are swollen (4)
- Muscle weakness (5)
- Painful cramps and fasciculations (uncontrolled muscle twitching visible under the skin) (5)
- Muscle loss (5)
-bone degeneration (5)
- changes in the skin, hair, and nails (5)
-feeling as if you are wearing gloves and stockings even when you are not. (5)

-Inability to recognize by touch alone the shapes of small objects or distinguish between different shapes. (5)

-Loss of position sense often makes people unable to coordinate complex movements like walking or fastening buttons, (5) or loss of balance and leg coordination. (6)

-Pain receptors in the skin can also become oversensitized, so that people may feel severe pain (allodynia) from stimuli that are normally painless (for example, some may experience pain from bed sheets draped lightly over the body) (5) or  extreme sensitivity to touch, even light touch. (6)

-Inability to sweat normally, which may lead to heat intolerance. (5)  This can also cause profuse sweating at night or while eating. (6)

- Loss of bladder control, which may cause infection or incontinence. (5)

-Inability to control muscles that expand or contract blood vessels to maintain safe blood pressure levels.  A loss of control over blood pressure can cause dizziness, lightheadedness, or even fainting when a person moves suddenly from a seated to a standing position (a condition known as postural or orthostatic hypotension). (5)

-Problems eating or swallowing. (5)

-Nerves affected in the gastrointestinal tract make it harder to move food during digestion (decreased gastric motility). (7)  This can lead to ileus, diarrhea, constipation, (5) and Gastroparesis. (6)

-Weight loss without trying. (7)
-Feeling full after only a few bites (early satiety). (7)
-Nausea after eating. (7)
-Swollen abdomen (7)
-Shortness of breath with activity or exercise (7)

There are many, many other symptoms as well…too many to list here…but here are a few links to a website that provides more symptom descriptions you can review:

http://www.livestrong.com/article/39682-symptoms-complications-peripheral-neuropathy/

http://www.livestrong.com/article/161390-long-term-effects-of-peripheral-neuropathy/


The good news is that no matter what the actual cause, Peripheral nerves have the ability to regenerate, as long as the nerve cell itself has not been killed. (5)

Lipoic Acid Therapy for Peripheral Neuropathies

I began to wonder if approaching these symptoms in reverse might help support the Functional hypothesis.  Perhaps If a different approach was taken, say the severity of symptoms diminished after administering a common natural therapy used to treat neuropathy, such as Alpha Lipoic Acid, this might bring us one step closer to understanding what is really happening.  After all, many of the drugs currently being used to treat people in Benzodiazepine withdrawal are also used to treat peripheral neuropathy, including: antiepileptic drugs such as gabapentin and carbamazepine; and some classes of antidepressants, including tricyclics such as amitriptyline. (5, 8 )
Alpha Lipoic Acid has been used for Peripheral Neuropathy in many clinical human trials with subjective improvement. (9,10)  As a matter of fact, Germany has approved Lipoc Acid for the treatment of diabetic neuropathies and is available by prescription. (9)  Therefore, in my opinion Alpha Lipoic Acid and R-Lipoic Acid should be considered as possible alternative treatments for the Neuropathic type symptoms of Benzodiazepine Withdrawal.  The ‘R’ form may be more suitable for people experiencing gastrointestinal symptoms, as the ‘S’ form appears to be associated with a higher rate of gastrointestinal side effects.


References

1) http://medical-dictionary.thefreedictionary.com/peripheral+neuropathy
2) http://en.wikipedia.org/wiki/Benzodiazepine_dependence
3) http://www.pdrhealth.com/diseases/peripheral-neuropathy/diagnosis
4) http://www.aidsetc.org/aidsetc?page=cg-801_pain
5) http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm#183583208
6) http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/#symptoms
7) http://www.nlm.nih.gov/medlineplus/ency/article/000776.htm
8 ) http://www.benzo.org.uk/manual/bzcha03.htm#8
9) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657658/?tool=pubmed
10) http://www.altmedrev.com/publications/11/4/294.pdf
11) http://www.medscape.com/viewarticle/426917
12) http://www.neuropathy-info.com/2009/landinge.php?gid=NR021&?a=a&assoc=Google&keyword=peripheralneuropathy
13) http://medical-dictionary.thefreedictionary.com/neuropathy
14) http://www.benzo.org.uk/ashunfi.htm
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Understanding Peripheral Neuropathies
« Reply #1 on: February 17, 2012, 04:06:44 pm »
Quote
-Inability to control muscles that expand or contract blood vessels to maintain safe blood pressure levels.  A loss of control over blood pressure can cause dizziness, lightheadedness, or even fainting when a person moves suddenly from a seated to a standing position (a condition known as postural or orthostatic hypotension). (5)

Perserverance - you are amazing! Thank you!

I just wanted to comment on the above as it seems to apply to me. Blood tests have isolated low renin and low aldosterone (that we have talked about before).  He endocrinologist thinks it might be the clonidine I've been on for 14 months.

I know my fluid balance is awry as a dose or sea salt can clear the blackness before my eyes, especially when I stand up.  There are whole websites devoted to this topic under POTS. Many of the members are on a benzodiazepine.

This one is particularly tricky; how to we strengthen  muscles that seem to be controlled by the parasympathetic nervous system?  A wasted arm can be helped by lifting weights, however tremulously.  I don't know how to control the muscles that regulate fluid volume. 

I didn't mean to make this about me. I wanted to say thank you for the work you do and for sharing it with us!
 :smitten:
[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Understanding Peripheral Neuropathies
« Reply #2 on: February 17, 2012, 06:04:25 pm »
[...],

I found what you said about many people on the POTS forums taking Benzos to be quite interesting...hmm....perhaps they need to come to this forum?
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Understanding Peripheral Neuropathies
« Reply #3 on: February 18, 2012, 01:23:53 am »
[...], thank you for this valuable piece of research. I shall show it to the pain specialist at my upcoming appointment at the pain clinic.

So there seems to be hope that the painful prickling, burning and fasciculations in my feet and toes will be reversible, as my nerve conduction studies were clear.

I feel some hope now.  :)
Much love and appreciation
[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Understanding Peripheral Neuropathies
« Reply #4 on: February 18, 2012, 03:11:37 pm »
[...],

I am always happy to see people educating their doctors.  Doctors are not taught Benzos in med school and anything we can do to get the word out helps create awareness that may potentially help prevent misdiagnoses and poly-drugging.  Good luck at your appoinment.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Understanding Peripheral Neuropathies
« Reply #5 on: February 25, 2012, 12:40:52 am »
hello dear one - just saying hi and let u know i am thinking of you.  man oh man u r just too smart for me....smile.  just read thru some of your new info.
i made it thru another week of teaching teens.  your notes helped me get thru;  hope is so critical for us when the grand slams hit.
have u in my prayers angel girl :angel:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Understanding Peripheral Neuropathies
« Reply #6 on: February 26, 2012, 01:11:01 am »
Hi [...]-

I am going to be starting r-LA probably next week to see if it helps with cognitive function (still suffering from [...] severe cog fog at 9 months- also am just barely off birth control, and 3 weeks off gabapentin, so some of it could be from those things too). I also have neuropathic pain in my spinal cord from an injury- [...] severe, lately. Anyway, a forum search brought this thread up and I was glad to see it discussed! I've ordered Doctor's Best r-LA, 100mg (I think- 150, maybe??). Do you have any other advice? I think it should be taken twice a day on an empty stomach. I'm sure I'll start slowly, once a day, and move up. Would love any advice you may have!

Thanks,

[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Understanding Peripheral Neuropathies
« Reply #7 on: February 26, 2012, 02:22:20 pm »
[...],

Most human trials were performed using either Alpha Lipoic Acid (ALA) or a racemic mix which contains a 50/50 mix of the R and S forms.  I myself was so impressed by the trial results I decided to give it a whirl.  I first tried Twinlab Alpha Lipoic Acid 50 mg 3 times a day taken on an empty stomach.  I was surprised at how well it worked on my benzo wd related nerve pain, however I did encounter one of the unwanted side effects of abdominal cramping.

The results were so dramatic I decided to try switching to the R Lipoic Acid, and as a matter of fact, I took the very one you have ordered- the Doctors Best.  I took it once a day with my main meal.  While I did not get the abdominal cramping, I also did not experience any dramatic change in the nerve pain with this one.

I decided to wait and try the ALA again, but this time take it with food and start at only 50 mg a day.  However after the positive turn in my nerve pain since taking the original ALA, I no longer feel the need to continue taking any supplement.  Whether the ALA had anything to do with this turn of events is curious.

It is difficult to sort out whether positive results are coincidence in BW, as the sx's wax and wane so frequently.  The best way to determine any real benefit would be through a double blind placebo controlled study, of course.

The bioavailability is better if it is taken on an empty stomach, however you can take it with food if you experience gastrointestinal discomfort, just less will be absorbed as it competes with food.

Since there are currently no studies done on BW and Lipoic Acid, any results- good or bad- which you experience while trying this supplement would benefit the benzo community, and I would appreciate it if you would share your experiences on this thread.

It goes without saying that it is always best to check with your doctor before taking any supplement. :)

Best wishes to you.


Modified to correct spelling errors.
« Last Edit: February 26, 2012, 04:55:00 pm by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Understanding Peripheral Neuropathies
« Reply #8 on: February 26, 2012, 04:20:14 pm »
Thanks for this thread.  ;)
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Understanding Peripheral Neuropathies
« Reply #9 on: February 26, 2012, 05:26:04 pm »
Thanks [...]! I will certainly come back and update this thread once I know if the r-LA is helping or not. If it's not, before I give up I will most likely try the brand you tried at first, and see how that goes.

What a ride, eh?

[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.