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Side Effects Mild & Brief With Single Antidepressant Dose of Intravenous Ketamine

https://neurosciencenews.com/ketamine-side-effects-depression-15222/

Side effects mild and brief with single antidepressant dose of intravenous ketamine

NEUROSCIENCE NEWSNOVEMBER 18, 2019

Summary: The side effects of administering ketamine to treat major depressive disorder are mild and persist for no longer than four hours, researchers report. Most of the side effects peaked within an hour of treatment, and many patients reported the effects as being significantly reduced two hours post ketamine administration.Source: NIH/NIMH

National Institutes of Health researchers found that a single, low-dose ketamine infusion was relatively free of side effects for patients with treatment-resistant depression. Elia Acevedo-Diaz, M.D., Carlos Zarate, M.D., and colleagues at the NIH’s National Institute of Mental Health (NIMH) report their findings in the Journal of Affective Disorders.

Studies have shown that a single, subanesthetic-dose (a lower dose than would cause anesthesia) ketamine infusion can often rapidly relieve depressive symptoms within hours in people who have not responded to conventional antidepressants, which typically take weeks or months to work. However, widespread off-label use of intravenous subanesthetic-dose ketamine for treatment-resistant depression has raised concerns about side effects, especially given its history as a drug of abuse.

“The most common short-term side effect was feeling strange or loopy,” said Acevedo-Diaz, of the Section on the Neurobiology and Treatment of Mood Disorders, part of the NIMH Intramural Research Program (IRP) in Bethesda, Maryland. “Most side effects peaked within an hour of ketamine administration and were gone within two hours. We did not see any serious, drug-related adverse events or increased ketamine cravings with a single-administration.”

The researchers compiled data on side effects from 163 patients with major depressive disorder or bipolar disorder and 25 healthy controls who participated in one of five placebo-controlled clinical trials conducted at the NIH Clinical Center over 13 years. While past studies have been based mostly on passive monitoring, the NIMH IRP assessment involved active and structured surveillance of emerging side effects in an inpatient setting and used both a standard rating scale and clinician interviews. In addition to dissociative (disconnected, unreal) symptoms, the NIMH IRP assessment examined other potential side effects – including headaches, dizziness, and sleepiness. The study did not address the side effects associated with repeated infusions or long-term use.

Out of 120 possible side effects evaluated, 34 were found to be significantly associated with the treatment. Eight occurred in at least half of the participants: feeling strange, weird, or bizarre; feeling spacey; feeling woozy/loopy; dissociation; floating; visual distortions; difficulty speaking; and numbness. None persisted for more than four hours. No drug-related serious adverse events, cravings, propensity for recreational use, or significant cognitive or memory deficits were seen during a three-month follow-up.

Credit: NIMH.To overcome the limitations associated with side effects and intravenous delivery, ongoing research efforts seek to develop a more practical rapid-acting antidepressant that works in the brain similarly to ketamine. These NIMH researchers, in collaboration with the National Institute on Aging, and the National Center for Advancing Translational Science, are planning a clinical trial of a ketamine metabolite that showed promise as a potentially more specific-acting treatment in pre-clinical studies. Meanwhile, the U.S. Food and Drug Administration earlier this year approved an intranasal form of ketamine called esketamine, which can be administered to adults with treatment-resistant depression in a certified doctor’s office or clinic.

ABOUT THIS NEUROSCIENCE RESEARCH ARTICLE

Source:
NIH/NIMH
Media Contacts:
Jules Asher – NIH/NIMH
Image Source:
The image is credited to NIMH.

Original Research: Closed access
“Comprehensive assessment of side effects associated with a single dose of ketamine in treatment-resistant depression.”. Acevedo-Diaz EE, Cavanaugh GW, Greenstein D, Kraus C, Kadriu B, Zarate CA Jr, Park LT.
Journal of Affective Disorders doi:10.1016/j.jad.2019.11.028.

Abstract

Comprehensive assessment of side effects associated with a single dose of ketamine in treatment-resistant depression.

Background
Concerns about ketamine for treating depression include abuse potential and the occurrence of psychotomimetic effects. This study sought to comprehensively assess side effects (SEs) associated with a single subanesthetic-dose intravenous ketamine infusion. A secondary aim was to examine the relationship between Clinician-Administered Dissociative States Scale (CADSS) scores and dissociative symptoms reported on a comprehensive, clinician-administered SE questionnaire.

Methods
Data from 188 participants were pooled from four placebo-controlled, crossover ketamine trials and one open-label study (n=163 with either treatment-resistant major depressive disorder or bipolar disorder and 25 healthy controls). SEs were actively solicited in a standardized fashion and monitored over the time-course of each study. Statistical analyses assessed the effect of drug (ketamine, placebo) on SEs and measured the relationship between CADSS total score and SEs contemporaneously endorsed during structured interviews.

Results
Forty-four of 120 SEs occurred in at least 5% of participants over all trials. Thirty-three of these 44 SEs were significantly associated with active drug administration (versus placebo). The most common SE was feeling strange/weird/loopy. Most SEs peaked within an hour of ketamine administration and resolved completely by two hours post-infusion. No serious drug-related adverse events or increased ketamine craving/abuse post-administration were observed. A positive correlation was found between dissociative SEs and total CADSS score.

Limitations
The post-hoc nature of the analysis; the limited generalizability of a single subanesthetic-dose ketamine infusion; and the lack of formal measures to assess ketamine’s cognitive, urological, or addictive potential.

Conclusions
No long-lasting significant SEs occurred over the approximately three-month follow-up period.

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For more: https://madisonarealymesupportgroup.com/2019/04/18/ketamine-reduces-depression-related-behaviors-in-mice-limits-bb-in-vivo-relieves-chronic-pain/

It’s also been shown to limit borrelia in vitro: https://madisonarealymesupportgroup.com/2018/03/10/ketamine-limits-bb-in-vitro/

And its’s been shown to relieve chronic pain, improve quality of life, reduce depression and suicidal ideation, and reduce opioid consumption: https://madisonarealymesupportgroup.com/2017/09/14/iv-ketamine-in-ptls/

https://madisonarealymesupportgroup.com/2019/04/26/fda-approves-ketamine-nasal-spray-for-depression/

https://madisonarealymesupportgroup.com/2019/09/20/the-chemical-imbalance-myth-and-antidepressant-harm/

Category:

Lyme, Pain Management, research, Treatment

‘Don’t Punish Pain’Bill Unanimously Approved by RI House

https://patch.com/rhode-island/cranston/dont-punish-pain-bill-unanimously-approved-ri-house

‘Don’t Punish Pain’ Bill Unanimously Approved By RI House

The bill known as “Claudia’s Bill” is expected to be approved by the full General Assembly before the end of the legislative session.

By Rachel Nunes, Patch Staff

Jun 20, 2019

“Claudia’s Bill” was unanimously passed by the Rhode island House of Representatives on Wednesday. (Shutterstock )

Chronic pain sufferers in Rhode Island celebrated a victory on Thursday night when the House of Representatives unanimously passed “Claudia’s Bill,” which would exempt them from federal limits on opioid painkillers. The bill’s sponsor, Rep. Gregg Amore, said the Senate will likely greenlight the bill before the end of the legislative session this month.Claudia Merandi, who wrote the bill with Amore, said its passage will act as “a beacon of hope” for people in pain across the country.

“The unseen victims of the opioid crisis are people with pain,” Merandi said. “Punishing people with pain will never curb the overdosing epidemic, it will simply create a greater epidemic: an under-prescribed country.”

Rep. Amore said he believes the bill will pass in the Senate.

“We need to deal with pain on a case by case basis and let physicians care for their patients,” The East Providence Democrat said. “Patients in chronic pain have been unintended collateral damage in a well intentioned public policy attempt to battle the opioid crisis.”

The bill is now headed to the Senate for consideration.

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For more: https://madisonarealymesupportgroup.com/2019/11/08/dea-issues-warning-over-counterfeit-prescription-pills-from-mexico-contining-fentanyl/

https://madisonarealymesupportgroup.com/2017/10/16/washington-post-congress-engineered-dea-racket-to-protect-opioid-drug-giants/

Now, thanks to the Washington Post’s investigation, we learn that the DEA directly negotiated with the drug industry to grant opioid manufacturers selective immunity from criminal seizure and prosecution. Is anyone really surprised? This has been the DEA’s business model for decades.

The following graphic (see link above), published by the Washington Post, reveals that at least 56 DEA and Justice Dept. officials left their government jobs to work for the pharmaceutical industry.

Category:

Activism, Pain Management

New Research Shows Spinal Stimulation May Work Better Than Medication For Long-term Pain Reduction

https://advancingthescience.mayo.edu/2019/10/24/new-research-shows-spinal-stimulation-may-work-better-than-medication-for-long-term-pain-reduction/?

October 24, 2019

New research shows spinal stimulation may work better than medication for long-term pain reduction

By Elizabeth Zimmermann

In a recent study, a team of Mayo Clinic researchers examined the effectiveness of spinal stimulation for pain control, compared to medical therapy or multiple surgeries for patients with long-term spine or limb pain.

They found spinal stimulation was significantly more likely to reduce pain than medication for patients with intractable pain. Their findings were published in Mayo Clinic Proceedings.

“Intractable pain, or refractory pain is pain that occurs when multiple evidence‐based treatments have been tried and the patient has not reached treatment goals,” says study first author Tim Lamer, M.D., an anesthesiologist, pain management, and spine care specialist at Mayo Clinic. “Typically this means they have not achieved satisfactory pain reduction and/or functional improvement.”

According to the National Institutes of Health, “almost 11 million U.S. adults have ‘High Impact Chronic Pain,’ that is, pain that has lasted 3 months or longer and is accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores.”

Because back and/or limb problems are the commonest pain complaints, Dr. Lamer says it made sense to try and determine the most effective ways to help patients.

The research

In this meta-analysis (analysis of a collection of relevant studies), the team study used a random-effects model to compare any type of spinal stimulation to medical therapy. They also compared newer stimulation technologies such as high frequency spinal cord stimulation and dorsal root ganglion stimulation to conventional spinal stimulation.

“This kind of research (random-effects) incorporates uncertainties due to differences between the settings of the studies, like patient or provider characteristics,” says senior author M. Hassan Murad, M.D., a preventive medicine physician and health services researcher at Mayo Clinic. “It’s a common tool in meta-analyses.”

After conducting a search of peer-reviewed publications, they found 17 manuscripts, from 12 clinical trials comparing medical therapy or repeated surgeries to either conventional or new spinal stimulation for pain control.

Physical therapy doctor discusses spine model with patient.

The researchers also employed the indirect comparison technique. “If studies compare treatments A vs B, and B vs C, we can indirectly compare A and C,” explains Dr. Murad.

“Because we found no studies comparing new spinal stimulation technologies to medical therapy, we needed to indirectly compare them.”

Although there are some limitations, Dr. Murad says this kind of research can help lead to the best possible outcomes for patients.

“The estimates we provide should be used to support shared-decision making,” he says. “Other factors, such as patient’s values and preferences, feasibility and accessibility of treatment also need to be considered when making treatment decisions.”

Publishing the meta-analysis in and of itself may prove to be helpful for patients, as it calls attention to the option of spinal stimulation for pain control.

“Many non-pain specialists are not generally aware of spinal cord stimulation,” says Dr. Lamer, “and how effective it can be for properly selected patients with difficult to manage chronic pain.”

He says that this includes patients with complex spinal pain syndromes, painful neuropathies including diabetic neuropathy, and post-traumatic pain syndromes such as complex regional pain syndrome.

“Patients who are not responding to conventional conservative measures such as medications and physical therapy should be referred to a qualified interventional pain specialist to be evaluated for spinal cord stimulation candidacy.”

Dr. Murad leads knowledge synthesis research like this meta-analysis, in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. He also is the director of the Evidence-based Practice Center.

Related resources:

Implantable spinal cord stimulator (video news item)
____________________More on other pain treatments: DMSO/MSM: https://madisonarealymesupportgroup.com/2018/03/02/dmso-msm-for-lyme-msids/

LDN: https://madisonarealymesupportgroup.com/2016/12/18/ldn/, https://madisonarealymesupportgroup.com/2017/06/12/ldn-reduced-pro-inflammatory-cytokines-in-fm-after-eight-weeks/

Magnetic Fields: https://madisonarealymesupportgroup.com/2018/08/15/treating-pain-with-magnetic-fields/

Laser Therapy: https://madisonarealymesupportgroup.com/2018/02/27/march-2018-support-group-laser-therapy/, https://madisonarealymesupportgroup.com/2018/04/08/class-iv-laser-therapy/

Heat: https://madisonarealymesupportgroup.com/2018/09/28/hotter-bodies-better-at-fighting-disease/

CBD:
https://madisonarealymesupportgroup.com/2018/10/08/thc-vs-cbd-for-pain-the-differences-interactions/

Ketamine:
https://madisonarealymesupportgroup.com/2019/04/18/ketamine-reduces-depression-related-behaviors-in-mice-limits-bb-in-vivo-relieves-chronic-pain/

Acupuncture:
https://madisonarealymesupportgroup.com/2018/11/06/acupuncture-beats-injected-morphine-for-pain-groundbreaking-study/

Category:

Inflammation, Pain Management, research

DEA Issues Warning Over Counterfeit Prescription Pills From Mexico Contining Fentanyl

https://www-masslive-com.cdn.ampproject.org/c/s/www.masslive.com/news/2019/11/dea-issues-warning-over-counterfeit-prescription-pills-from-mexico-containing-fentanyl.html?

DEA issues warning over counterfeit prescription pills from Mexico containing fentanyl

Posted Nov 04, 2019

DEA Counterfeit Fentanyl Pill Warning release final Nov 2019

By Douglas Hook | dhook@masslive.com

The U.S. Drug Enforcement Administration has issued a warning about large amounts of counterfeit prescription pills containing fentanyl coming from Mexico.

Mexican drug cartels are manufacturing and importing mass quantities of pills and, based on a sampling of tablets seized nationwide between Jan. and Mar. 2019, the DEA found that 27% contained potentially lethal doses of fentanyl.

“Capitalizing on the opioid epidemic and prescription drug abuse in the United States, drug trafficking organizations are now sending counterfeit pills made with fentanyl in bulk to the United States for distribution,” said DEA Acting Administrator Uttam Dhillon. “Counterfeit pills that contain fentanyl and fentanyl-laced heroin are responsible for thousands of opioid-related deaths in the United States each year.”

According to the Centers for Disease Control and Prevention, fentanyl is used as an opioid pain reliever, treating severe pain like some forms of cancer.

“It is 50 to 100 times more potent than morphine,” states the CDC on their website. “It is prescribed in the form of [adhesive] patches or lozenges.”

DEA Special Agent in Charge Brian D. Boyle highlights that fentanyl and other highly potent synthetic opioids are the primary problems behind the opioid crisis in New England.

“Fentanyl [is] involved in more deaths than any other illicit drug,” said Boyle.

Massachusetts has been ranked among the top ten states with the highest rates of drug overdose deaths involving opioids with 1,913 drug overdose deaths involving opioids in 2017. Opioid deaths in Massachusetts are twice as high at the national average, according to the National Institute on Drug Abuse.

According to the DEA, a lethal dose of fentanyl is estimated to be just two milligrams but can vary based on an individual’s body size, tolerance, and amount of usage.

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**Comment**

Similarly to the false climate change narrative regarding the spread of ticks and Lyme disease, there is another false mantra – that those requiring pain medications are behind the “opioid crisis.” Nothing could be further from the truth.

This article from The Guardian, states that the upsurge in prescription opioids was in response to an under prescription crisis and that those suffering with severe and chronic pain were left to “writhe in pain” until policies changed in the 70s and 80s. The author points out that the opioid scare campaign of today mimics a scare campaign of history: https://www.theguardian.com/commentisfree/2017/nov/07/truth-us-opioid-crisis-too-easy-blame-doctors-not-prescriptions

You know something is wrong when a stage four cancer patient is sent home with Tylenol.

For more: https://madisonarealymesupportgroup.com/2017/10/16/washington-post-congress-engineered-dea-racket-to-protect-opioid-drug-giants/

Now, thanks to the Washington Post’s investigation, we learn that the DEA directly negotiated with the drug industry to grant opioid manufacturers selective immunity from criminal seizure and prosecution. Is anyone really surprised? This has been the DEA’s business model for decades.

The following graphic (see link above), published by the Washington Post, reveals that at least 56 DEA and Justice Dept. officials left their government jobs to work for the pharmaceutical industry.

Category:

Activism, Pain Management

The Aches & Pains of Tick-borne Illnesses

https://globallymealliance.org/the-aches-and-pains-of-tick-borne-illnesses/

The Aches and Pains of Tick-borne Illnesses

by Jennifer Crystal

The first time I saw the award-winning Lyme documentary Under Our Skin, I was seated in the theater. In the film, a doctor who doesn’t believe in chronic Lyme was asked what might otherwise be causing the symptoms of the more than 427,000 people afflicted by tick-borne illness every year. He suggested it could just be the normal aches and pains of getting older.

With that bit of ignorance so baldly stated, everyone in the theater let out a collective groan.

There is a big difference between the aches and pains that come with tick-borne illnesses and those associated with every day life.

To be fair, those who haven’t wrestled with tick-borne illnesses might be confused by the generic descriptor “aches and pains.” That’s because it’s like so many other nebulous descriptions,—like “fatigue”—that could be the result of any number of illnesses. Let me explain.

In my former athletic life, I was a hard-core skier. In college I skied almost every winter day, and after I graduated and moved to Colorado, I skied every Saturday and Sunday from November to April. Often my muscles were sore after these workouts. Sometimes I’d even wake up with an aching back, but only because I’d worked my arms too hard the day before. These aches and pains were akin to those anyone might feel after working out at the gym, going for a run, or weeding the garden. The muscles get overworked, and you feel residual soreness.

Unless this type of soreness is indicative of a larger injury, it usually can be alleviated with gentle stretching, rest, ice and ibuprofen. Generally, the soreness dissipates within a few days, and you can continue with daily life—sometimes even exercising moderately—while these aches and pains heal. They are a nuisance but they’re not debilitating.

The same is true for what I know of the aches and pains of getting older. Granted, I am only 41, so I can’t speak yet to the pain my older readers feel when their bones start to complain or they develop arthritis. For me, the aches and pains of getting older mean that my knees creak when I crouch down to talk to a child. My back twinges more than it used to when I pick up a heavy bag or box and I’m more susceptible to a pulled muscle. When I fall down skiing, the bruises hurt a little more, I’m having more soreness the next day than when I was younger, and I tend to need more ibuprofen.

These aches and pains are tolerable. I might complain about them to a friend, but then I go on with my day. These pains don’t have me bedridden for months or years.They aren’t all over my entire body, just at the stressed joints. They don’t make me feel like I have a perpetual flu.

The aches and pains of Lyme disease do cover the entire body. When you have Lyme, you feel like your whole body is weighed down with a thick coating of molasses. It takes a slow, exhausting effort to lift your limbs. Your joints ache not in a post-work-out way, but in a way that feels like that molasses is pooling in your elbows, knees and toes. I’ve often felt a pulling sensation in these areas, like someone was gripping and yanking at my joints.

And the pain was not only in my joints. Because Lyme is a systemic inflammatory infection, I felt aches and pains all over my body. Think about how your ankle swells when you twist it badly. That’s because of inflammation. Now imagine that type of inflammation all over your entire body. That’s Lyme disease.

Different Lyme patients feel pain in different areas, depending where the Lyme bacteria (spirochetes) are gathered, and depending on which areas the infection has spread to. Some have migraine headaches. Some Lyme sufferers have back and neck pain that makes it hard to move. My worst aches were in my forearms and shins. I felt a deep pain in those bones, which would bruise to the touch. Returning to the molasses analogy, sometimes my forearms felt so weighted down that I could not type. I could hand write one sentence and then had to lie down.

These aches and pains went on for months, until antibiotics and prescription anti-inflammatory medication killed enough Lyme bacteria that the molasses feeling blissfully dissipated. The pain could not have been alleviated with ibuprofen or ice, because it was the result of a bacterial infection that was deep in my body. It wasn’t just a nuisance; it made daily life impossible.

Now, when I get “normal” aches and pains—when I’m sore from skiing, or my calves hurt from walking around the city in bad shoes, I know it’s not Lyme-related, because it’s not as deep or painful. It goes away on its own in a few days. When I less frequently feel a pulling sensation in my joints, shins or forearms, or when I can actually feel the spirochetes buzzing under the skin in those areas,–when I put my hands on my skin, I can feel a buzzing underneath, like electricity–then I know it’s a Lyme-related problem.

If only Lyme patients could show others what’s inside—if only we could demonstrate our infection the way we see illustrations of a smoker’s lungs. Perhaps then people who don’t have Lyme would better understand. To reiterate, Lyme pain is not the same as the typical aches and pains of aging, and it needs to be treated seriously, by a Lyme Literate Medical Doctor (LLMD). You can find one here.

Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. She has written a memoir, One Tick Stopped the Clock, for which she is seeking representation. Contact her at: lymewarriorjennifercrystal@gmail.com.

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For more: https://madisonarealymesupportgroup.com/2019/06/18/somethings-wrong-im-in-pain-lyme-disease-sufferers-worry-doctors-lack-knowledge-of-disease/Excerpt:

“My diagnoses they came up with here was (that it was) just a pain syndrome,” she said. “I was put on Oxycodone and told to seek a psychologist. At this point I was using a cane. I was in so much pain even the Oxycodone wasn’t working.”

“I kept saying ‘Somethings wrong, I’m in pain,’ ” Fraser said. “Everyone’s telling you ‘You’re not in pain, it’s all in your head.’ ”

https://madisonarealymesupportgroup.com/2019/06/25/it-felt-like-the-flu-it-took-10-doctors-a-year-and-60000-to-get-an-answer/

https://madisonarealymesupportgroup.com/2019/01/10/fatigue-joint-pain-and-low-testosterone-had-lyme-podcast/

https://madisonarealymesupportgroup.com/2019/02/25/bystander-activation-of-t-cells-may-be-cause-of-persistent-arthritis-in-lyme-disease-why-this-study-is-incomplete/

https://madisonarealymesupportgroup.com/2019/06/19/breakthrough-paves-way-for-new-lyme-disease-treatment/

I recently read an extremely disheartening account of how stage three (terminal) cancer patients are now being told to take a Tylenol for their pain: http://nationalpainreport.com/have-pain-take-a-tylenol-8840582.html

I’m not sure there’s as much of an opioid crisis as much as there is a fear of opioids crisis.

Category:

Inflammation, Pain Management

What You Need to Know About Neuralgia Caused by Lyme/MSIDS

Many Lyme/MSIDS patients suffer with neuralgia, a twenty dollar word for pain due to irritated or damaged nerves. The following articles do a great job explaining it. I was elated to see that the first article written this month attributes Lyme disease to causing it, along with other infections. My guess is Bartonella, Babesia, Mycoplasma, Brucella, and possibly other tick-borne illnesses, including viruses, could all play a part. Because the CDC/NIH/IDSA do not accept the fact this is often times a polymicrobial illness (infected with far more than just Lyme), and many of the coinfections are not reportable, authorities have absolutely no idea about prevalence.

My guess is there are many diagnosed with neuralgia that have an undiagnosed Lyme/MSIDS infection.

https://www.medicalnewstoday.com/articles/325331.php

What to know about neuralgia

Last reviewed Thu 30 May 2019

By Jamie Eske

Reviewed by Seunggu Han, MD

Neuralgia refers to severe, shooting pain that occurs due to a damaged or irritated nerve. Neuralgia can affect any part of the body, causing mild to severe pain. Certain medications and surgical procedures can effectively treat neuralgia.

Severe neuralgia can interfere with a person’s ability to perform everyday tasks and may impact their quality of life.

Neuralgia has many possible causes, including:

infections, such as shingles, Lyme disease, or HIV
pressure on nerves from bones, blood vessels, or tumors
other medical conditions, such as kidney disease or diabetes
aging

Types of neuralgia

Healthcare professionals divide neuralgia into categories depending on the areas of the body it affects. The following are some common types of neuralgia:

Trigeminal neuralgia

TN can cause shooting pain in the face.

Trigeminal neuralgia (TN) involves the trigeminal nerve in the head. It has three branches that send signals from the brain to the face, mouth, teeth, and nose.

TN falls into two subdivisions: type 1 and type 2.

Type 1 TN causes a painful burning or electric shock-like sensation in parts of the face. People with type 1 TN experience irregular episodes that come on suddenly.

The duration of these episodes varies among people but can last up to 2 minutes, according to the National Institute of Neurological Disorders and Stroke.

Type 2 TN produces a constant, dull aching sensation in the face.

The exact cause of TN remains unclear. However, pressure from an enlarged blood vessel can irritate or even damage the trigeminal nerve.

Multiple sclerosis (MS) can give rise to TN. MS is a neurological disorder that causes inflammation that damages the myelin sheath surrounding nerve fibers in the central nervous system.

Postherpetic neuralgia

Postherpetic neuralgia (PHN) is a painful condition that affects the nerves in the skin.

According to the Centers for Disease Control and Prevention (CDC), PHN is the most common complication of shingles, affecting about 10–13% of people who develop it.

Shingles is a viral infection that causes blisters and a painful skin rash. The varicella-zoster virus, which causes chickenpox, remains dormant in the nervous system and reactivates later in life, causing shingles.

When the virus reactivates, it can cause inflammation in the nerve fibers. This inflammation can lead to permanent nerve damage that causes pain, even after the infection subsides.

Occipital neuralgia

This form of neuralgia affects the occipital nerves, which originate in the neck and send signals to the back of the head.

Occipital neuralgia causes a throbbing or shooting pain that starts near the base of the skull and radiates along the scalp. Occipital neuralgia pain can flow to the back of the eyes.

Occipital neuralgia has numerous potential causes, including:

sudden head movements
tense neck muscles
lesions or tumors in the neck
inflamed blood vessels
infections
gout
diabetes
neck injuries

Peripheral neuralgia

Difficulty eating or swallowing are potential symptoms of peripheral neuralgia.

Difficulty eating or swallowing are potential symptoms of peripheral neuralgia.

Peripheral neuralgia, or peripheral neuropathy, refers to pain that occurs due to nerve damage in the peripheral nervous system. This includes all nerve fibers outside of the brain and spinal cord.

Peripheral neuralgia can affect a single nerve or entire nerve groups.

Sustaining damage to the peripheral nervous system can affect nerves that control muscle movements, transmit sensory information, and regulate internal organs.

Peripheral neuralgia can cause pain or numbnessin the hands, feet, arms, and legs. Other symptoms may include:

involuntary muscle twitching or cramping
loss of coordination
difficulty performing complex motor tasks, such as buttoning a shirt or tying shoelaces
hypersensitivity to touch or temperature
excess sweating
gastrointestinal problems
difficulty eating or swallowing
difficulty speaking

Intercostal neuralgia

Intercostal neuralgia affects the nerves that sit just below the ribs. Doctors call the muscles in this area the intercostal muscles.

Several potential factors may contribute to intercostal neuralgia, such as:

injuries or surgical procedures that involve the chest
pressure on the nerves
shingles or other viral infections

Intercostal neuralgia causes a sharp, burning pain that affects the chest wall, upper abdomen, and upper back. Certain physical movements, such as breathing, coughing, or laughing, can worsen the pain.

Additional symptoms may include:

tightness or pressure that wraps around the chest
tingling or numbness in the upper chest or upper back
muscle twitching
loss of appetite

Diabetic neuropathy

Diabetic neuropathy is the most common complication of diabetes. Because diabetes affects so many people, rates of peripheral neuropathy are now beginning to rise.

Symptoms include loss of balance and numbness, tingling, and pain. The best way to prevent diabetic neuropathy is to bring blood sugar levels within a suitable range.

Symptoms

In general, neuralgia causes intense and distinct symptoms, including:

sudden episodes of extreme shooting or stabbing pain that follows the path of a damaged or irritated nerve
persistent aching or burning pain
tingling or numbness
muscle weakness
loss of muscle mass, or atrophy
involuntary muscle twitching or cramping

Treatments

Treatment options for neuralgia vary depending on the type and severity of the condition.

Topical ointments, local nerve block, and steroid injections may offer temporary pain relief for mild neuralgia.

Treating severe neuralgia pain may require prescription medications, surgical procedures, or both.

Medications

A doctor may prescribe medication to treat neuralgia.

A doctor may prescribe medication to treat neuralgia.

Pain relievers tend not to be very effective at controlling neuralgia pain. Medications that can treat the underlying causes of neuralgia include:

anticonvulsants, such as carbamazepine, topiramate, and lamotrigine
antidepressants, such as amitriptyline
muscle relaxants, such as baclofen
membrane-stabilizing medications, such as gabapentin

Surgery

Some surgical procedures can help relieve neuralgia pain when the condition does not respond to medication.

Examples of surgical procedures that can help treat neuralgia include:

Microvascular decompression: This helps remove an enlarged blood vessel pressing on a nerve. The procedure involves placing a soft pad between the blood vessel and the affected nerve.
Stereotactic surgery: This is a noninvasive procedure that delivers highly concentrated radiation beams to the root of a damaged nerve. The radiation disrupts the transmission of pain signals to the brain.
Balloon compression: This involves inserting a small balloon into the affected nerve. The balloon inflates, resulting in controlled, intentional nerve damage. This procedure prevents the affected nerve from sending pain signals to the brain. However, the effects of the procedure usually wear off after 1–2 years.

Outlook and takeaway

Neuralgia causes painful symptoms that vary in duration and severity. As well as pain, neuralgia can cause numbness, muscle weakness, and hypersensitivity.

If a person does not receive treatment, neuralgia can interfere with their ability to perform daily tasks.

People can work with a healthcare provider to establish the best course of treatment for their specific symptoms. If the condition does not respond to initial treatments, a healthcare provider may refer the person to a pain management specialist.

____________________

**Comment**

They don’t list antimicrobial treatment as a treatment for this, but it is. Again, if Lyme/MSIDS is behind it, the only thing that’s going to squash this pain at the root is to eradicate the pathogens behind it. Nothing touched this pain for me but long-term antimicrobials. While some of the listed treatments may help, they are bandaids. I talk more about this further down. Keep reading….

https://www.medicalnewstoday.com/articles/320143.php

What you need to know about occipital neuralgia

Last reviewed Sun 26 November 2017

By Danielle Dresden

Reviewed by Alana Biggers, MD, MPH

Occipital neuralgia is the term for a headache that starts in the upper neck or back of the head and spreads or radiates behind the eyes, forehead, and up to the scalp.

Headaches are one the world’s most common health problems, with 80-90 percent of Americans experiencing a “tension headache” at some point in their lives.

More painful migraine, cluster, and other headaches are a leading cause of doctor or emergency room visits.

Although headaches are a common health problem, occipital neuralgia is a specific type of headache. According to the American Migraine Foundation, it is also rare, affecting only 3.2 people out of every 100,000 a year.

Fast facts on occipital neuralgia:

It is called occipital because it affects the area around the occipital bone.
Pain associated with occipital neuralgia is often sudden and severe.
Symptoms can be alarming, but they are not usually associated with any life-threatening health conditions.

How is it different from other headaches?

man holding the back of his neck

Occipital neuralgia is a headache that begins in the upper neck or back of head.

Headaches due to occipital neuralgia are frequently quite painful, starting with a sharp, stabbing pain, but most people with this condition respond well to treatment and most recover.

Occipital neuralgia is different from other types of headaches in two ways:

The cause of the condition.
The specific places where individuals feel pain.

Other headaches have more general causes, which can range from sinus infections to high blood pressure to medications and many other potential triggers.

But occipital neuralgia only develops when the occipital nerves are irritated or injured. These nerves are found at the second and third vertebrae of the neck.

Occipital neuralgia pain will only develop in areas touched by the greater, lesser, and third occipital nerves.

With one on each side of the head, the occipital nerves run from the spine to the scalp, and sensitivity can develop anywhere along this route.

What is causing this headache?

What is causing this headache?

There are many types of headache, learn more about them and their most effective remedies here.

What are the main symptoms?

lady touching side of face whilst lying in bed

The pain from occipital neuralgia may spread to the sides of the head or behind the eyes.

For most people, the pain strikes on only one side of the head. It also tends to spread, usually from where the skull meets the neck, and then traveling up the back of the head and to the sides or behind the eyes.

In many individuals, the scalp can be affected, especially where the occipital nerves connect.

It can feel sore or extremely sensitive.

Light may also irritate the eyes.

Occipital neuralgia is described as coming in bursts of pain that come and go, lasting for a few seconds or minutes. At times, individuals may experience a lingering ache between more extreme bouts of pain.

Small movements can trigger an outburst of pain from occipital neuralgia. These movements include:

turning the head to the side
putting the head down on a pillow
brushing or washing the hair

The pain can be quite intense, which can prompt some individuals with the condition to say it is like a migraine or a cluster headache, even though these are different types and require different treatments.

What causes it?

Different conditions and circumstances can irritate the occipital nerves, which then give rise to occipital neuralgia.

Injury

Injuries to the neck area, such as whiplash from a car accident or some other sort of trauma, can damage the occipital nerves and lead to this condition.

Muscular problems

Tight muscles in the neck and the back of the head can put the squeeze on occipital nerves and pinch or entrap them, which can also lead to occipital neuralgia.

Back issues

Problems with the spine, such as arthritis, degenerating discs, or spondylosis, are possible sources of pressure on the occipital nerves, as are tumors.

Other causes

Other conditions that can play a role in developing occipital neuralgia include:

diabetes
gout
systemic infection

In many cases, it is not possible for someone to identify a single factor that damaged or irritated the occipital nerves.

How is it diagnosed?

doctor examining women's head and neck

During an examination the doctor may see if pressing on the occipital nerve area causes pain.

A doctor taking a medical history and conducting a physical exam diagnoses occipital neuralgia.

This condition causes extreme tenderness along the occipital nerves. So, during a physical exam, the doctor may press on these areas to see if the pressure generates pain.

It is not always easy to diagnose occipital neuralgia because it has similar characteristics to many other kinds of headaches.

After initial exams, a doctor may order more involved tests.

One way to diagnose occipital neuralgia can also provide relief.

If a nerve block injected between the C2 and C3 vertebrae makes the symptoms go away, it is a strong indication of occipital neuralgia.

Deadening the nerves with anesthetics and corticosteroids helps individuals feel better, although the effects are temporary, only lasting about 12 weeks. However, injections into the vertebrae and numbing nerves are involved procedures, so a doctor will often pursue less invasive treatments first.

Can it be prevented?

For some people, antiepileptic medications and tricyclic antidepressants can prevent bouts of pain due to occipital neuralgia.

Treatments

Doctors will usually recommend straightforward treatments when individuals are first diagnosed with occipital neuralgia. These include:

warm compresses
massage
anti-inflammatory medications
physical therapy

The aim is to provide many people with relief by relaxing and releasing the muscles that are putting pressure on the occipital nerves.

Other medications, such as muscle relaxants and anticonvulsants, can help offset symptoms.

Nerve blockers

Nerve-blocking injections, which are used to diagnose the condition, can also be used to prevent pain.

Pulsed radiofrequency

Pulsed radiofrequency may be employed to stimulate the occipital nerves to keep them from sending pain signals. Although this procedure is more invasive than massage and medication, it does not damage any nerves or nearby tissue.

Surgery

Surgery is reserved for the most painful and difficult cases. Through a process called microvascular decompression, doctors eliminate pressure on the nerves by moving encroaching blood vessels out of the way.

Home remedies

Home remedies can do a lot to relieve the pain when tight muscles, injury, and stress cause occipital neuralgia.

Rest, massage, and warm compresses can help individuals work out the kinks that are creating pressure in their necks.

Physical therapy can help individuals work through the crisis phase of their occipital neuralgia and provide them with exercises they can do to prevent a recurrence of this painful condition.

___________________

**Comment**

Again, they don’t state that proper antimicrobials addressing the systemic infection causing this as a treatment, but it is. And for Lyme/MSIDS patients, it’s an extremely important treatment because as I stated before, all the others are mere bandaids.

This occipital neuralgia was my Achilles Heel and thorn in my side for years due to Lyme/MSIDS. I even had a MRI to rule out Chiari, which can be the result of a systemic infection. I met 3 people in the same week with a Lyme/MSIDS diagnosis who also had Chiari: https://madisonarealymesupportgroup.com/2016/04/02/chiari/

One of the best drugs for me was minocycline, due to its ability to cross the blood, brain barrier: https://madisonarealymesupportgroup.com/2017/06/04/minocycline-for-ms-and-much-more/

I’m certain there are plenty more patients with this symptom who have an undiagnosed Lyme/MSIDS infection.

Home remedies wouldn’t touch this pain with a 10 foot pole, much less NSAIDS. I would caution the use of corticosteroids as these will suppress your immune system. The caveat would be if you are on an antimicrobial regimen and your practitioner is monitoring you. I also caution the use of NSAIDS as taking massive doses of Ibuprofen about shut my husband’s liver down.

This pain may be the person’s first acknowledged symptom of Lyme/MSIDS. Often men will suffer and self medicate and deny a real problem. This is where spouses, friends, and family need to be educated about the possibility of a tick borne illness so they can mention it to the suffering person. If you are popping NSIDS like candy, something’s wrong. Getting them to an open-minded, trained practitioner who will consider tick borne illness is your next job. Contact your local support group for a list of ILADS-trained doctors.

Also, this pain for me radiated to the right side of my head from the occipital area to the right temple. There were times my right shoulder was involved with pain and numbness going all the way down my arm into my right pinkie finger. The finger would also move on its own. This can happen anywhere in the body.

https://www.medicalnewstoday.com/articles/321513.php

The following neurological conditions may be responsible for headaches on one side:

Occipital neuralgia: This occurs when nerves running from the top of the spinal cord to the scalp (occipital nerves) become damaged or inflamed. Symptoms include sharp pain in the back of the head and neck, pain behind the eye, and sensitivity to light.
Temporal arteritis: Arteries in the head and neck become inflamed with temporal arteritis. Along with muscle pain, it causes a severe headache on the side of the head. Other symptoms include fatigue, jaw pain, and tender temples.
Trigeminal neuralgia: This causes intense pain in the face and head. The pain usually affects only one side at a time. It is caused by disruption to the trigeminal nerve at the base of the brain.

Lyme/MSIDS infections can be behind all of this. Spread the word.

Category:

Inflammation, Lyme, Pain Management, research, Treatment

What To Do When You Hit a Plateau In Treatment

https://globallymealliance.org/hit-plateau-treatment/?

By Kerry Heckman

My numbers won’t budge. Every month I go in for a blood test and every month I get an email from my doctor stating that my inflammatory markers are the same. The numbers are not so high to cause a panic, but they’re not low enough to signal any real improvement either. I’ve tried everything from meditation to medication, but nothing seems to work. Each month I pray the numbers will drop and I’m devastated when month after month they stay the same.

I’ve put in all the work; there’s been no stinting. I’ve been in treatment for three years. I’ve changed my lifestyle, my diet, and most difficult of all, my mindset. But I keep coming up short. There’s no doubt I’m better. My bedridden days are mostly in the past, and the pain that keeps me up at night (painsomnia, I call it) happens once or twice week instead of every day. Another marker of my improvement is after treatment my herxheimer reactions are greatly diminished. These are positive trends, but still I am not where I want to be. I want clinical proof that my recovery is real. I want to know unequivocally that I’m heading toward remission. I’ve been at this dreaded plateau for months waiting to break free. I anxiously await the day when my inflammatory markers take a dramatic drop.

Your plateau may be different than mine. Maybe you, too, made big improvements in the beginning and now it’s tapering off, or maybe you’re stuck waiting for any minuscule improvement at all. Either way the lack of progress may be the hardest thing to bear.

All this was weighing heavily on me. Then one day I started thinking about actual plateaus in nature. Consider for a moment you are climbing up a mountain and reach a plateau. You’ve done the grueling work of going up the mountain and now you are walking on level ground. You are still moving forward, that hasn’t changed, but you’re not increasing your elevation. Maybe that’s what plateaus are in treatment—a leveling off that doesn’t feel like progress, because you aren’t climbing anymore. But you have achieved an incremental improvement in your recovery.

This bit of visualization changed the way I thought about my lack of headway, though there were still some questions I needed to ask myself— questions you may need to ask yourself as well:

Q: Have I really plateaued or is my progress just going slowly?

A: With Lyme disease the improvement can be slow . . . very slow. As they say, any progress is good progress. If you feel comfortable with your treatment protocol, you may need to practice patience and remember you are getting better. However, sometimes the progress is too slow and even if there is incremental improvement you may want talk to your doctor about exploring ways to speed up your treatment plan.

Q: Have you hit a plateau before? What helped jumpstart my healing?

A: If this has happened before, what was it that made the difference? Maybe it’s a new supplement or an increased dose of medication. Maybe your thyroid or adrenals are out of balance and need attention. Try to remember back to what helped you before and try it again. It may help to keep a journal about what you think is and isn’t working for you.

Q: Do I need to change my treatment or ride it out?

A: As I said, with Lyme getting better takes time. Ask yourself if you think your current treatment plan is sufficient to to get you better. This is a good place to use your intuition. If you feel skeptical every time you meet with your doctor that might be your body telling you something.

Q: If I plan to stay the course when will I know it’s time to adjust?

A: Give yourself a timeline—six months, nine months—for when you want to reevaluate. Verbalize your timeline to your doctor, so she or he knows what you’re thinking. Ask if there is a test that can be run at that time to compare where you were before to where you are now.

Q: Am I testing too often?

A: If you’re like me and your numbers aren’t budging, maybe it’s time to put more space between tests. This depends naturally on what is medically advisable. But I I did realize that the constant testing was causing me frequent disappointments, which weren’t good for my healing. I have since decided to go from once a month to once every other month for my bloodwork and focus on other things in the meantime.

Q: Is there something else I could do to move forward?

A: A plateau is the perfect time to reevaluate your habits. Perhaps it’s time to add more nutrients to your diet or increase detox. Have you always wanted to try a complementary therapy? Now may be the time. Or are there other options?

Q: Is this a good time for a healing pause?

A: Have no doubts, recovery from Lyme treatment is a full-time job. It seems like there’s always something else you can try, but is that the best thing for your body? This could be an indication that it’s time to take a break from all the intensity and let your body rest at the top of the mountain.

Take some time and ask yourself these questions. Get quiet and let your intuition speak. There are few doctors, medications, or therapies that can give us as much insight as our own common sense. Remember the image of the mountain and keep walking forward on the level ground of the plateau—the uphill slope may be only a few steps ahead.

Opinions expressed by contributors are their own.

Kerry J. Heckman is a licensed therapist and author of the healing and wellness blog Words Heal. She was diagnosed with chronic Lyme disease in 2016.

______________________

**Comment**

Great article to begin meaningful dialogue.

Not sure what tests she keeps having done but I’ve heard mixed opinions about the CD-57 test which some docs swear by and others like my own say it’s a general, very basic indicator of immunity and unless you have the number before you were sick and then taken at regular intervals throughout treatment, it’s just a number. https://www.tiredoflyme.com/cd57.html
Inflammation is a definite bad-boy. One thing I discovered to eventually help me was MSM; however, I didn’t notice the help taking it while in treatment, only after treatment did it seem to really crush pain and inflammation: https://madisonarealymesupportgroup.com/2018/03/02/dmso-msm-for-lyme-msids/. This article also shows it’s good for the gut: https://madisonarealymesupportgroup.com/2018/01/03/the-invisible-universe-of-the-human-microbiome-msm/
Another thing that helped this inflammation/pain for me was systemic enzymes: https://madisonarealymesupportgroup.com/2016/04/22/systemic-enzymes/ There are many brands out there. You might have to try a few to find one that works. I’ve tried different variations of Wobenzym as well as a brand my doctor sells. (I’m not affiliated with any companies)
LDN was also a game changer: https://madisonarealymesupportgroup.com/2016/12/18/ldn/ I use a compounded form with only olive oil as an additive.
For many, Lyme/MSIDS causes imbalances and deficiencies in the body. Finding out what those are and supplementing can make all the difference. For instance, most patients struggle with thyroid dysfunction (as well as other hormones) and magnesium deficiency (magnesium can help depression and 1,000 other things): https://madisonarealymesupportgroup.com/2018/01/16/magnesium-an-invisible-deficiency/ (In the comment section I give the kind my LLMD sells in his office and it’s been particularly successful. Again – no monies are exchanging hands) https://madisonarealymesupportgroup.com/2018/03/12/the-importance-of-vitamin-d-k-and-magnesium-for-lyme-msids-patients/ Most of us Northerners are deficient in vitamin D.
I’ll never forget the ranger in the documentary, “Under Our Skin,” state that he never could have imagined that his greatest improvement would come AFTER three years of treatment. This has been my experience and my husband’s as well. I must add that after 4.5 years of treatment for us, and two relapses requiring 2-3 month stints of treatment, we got better EACH TIME we treated. This very well could be the “cycling” approached discussed by Dr. Burrascano here: https://madisonarealymesupportgroup.com/2018/12/28/the-history-of-lyme-disease-dr-burrascano/ In brief: he found that cycling 3-4 times typically worked for most patients. Ironically, the 3rd cycle yielded the worst herx. Pam Weintraub wrote about this in, “Cure Unknown: Inside the Lyme Disease Epidemic,” way back in the 90’s, yet few doctors do this. Cycling just means that after you are symptom-free for 2-3 months you quit ALL treatment. If and when symptoms return, you hit hard with antibiotics until symptoms leave again. You do this 3-4 times. Burrascano states his symptoms never returned and many of his patients had the same experience.
Sometimes diet has made all the difference for some patients – like cutting out gluten or dairy or both. For some, herbs or treatments for inflammation made all the difference or help with sleep. I’ve also known patients who got better only after they treated for worms/parasites: https://madisonarealymesupportgroup.com/2017/10/03/removing-parasites-to-fix-lyme-chronic-illnesses-dr-jay-davidson/
When I hit a plateau after years of treatment yet still had symptoms, I called another LLMD I knew and asked if he’d be willing to do a phone consultation with me, not as a treating physician, but as a second ear to hear what I’ve done to give me ideas for any omissions he saw. That phone call was worth every penny as he carefully listened to what I’d done and gave me ideas for things to try. Very helpful. I then took that knowledge to my LLMD and he was smart enough to implement them at my request based on another experienced practitioner’s wisdom.
Lastly, I’ve found surrounding myself with experienced patients and doctors to be extremely helpful. You learn a lot by sharing your experiences and always come away with something you haven’t tried before. Don’t let this information bog you down. Only try 1 thing at a time so you can track any changes. Support Group is a great place to do this. Always run things by your practitioner as there might be drug interactions or things you need to consider or can’t try at all based on your specific issues/drug interactions.

I’ve learned the most from patients who are on the same journey. Don’t isolate yourself.

Category:

diet and nutrition, Gut Health, Inflammation, Lyme, Pain Management, Treatment

Archive for the ‘Pain Management’ Category

Side effects mild and brief with single antidepressant dose of intravenous ketamine

‘Don’t Punish Pain’ Bill Unanimously Approved By RI House

The bill known as “Claudia’s Bill” is expected to be approved by the full General Assembly before the end of the legislative session.

By Rachel Nunes, Patch Staff

Jun 20, 2019

New research shows spinal stimulation may work better than medication for long-term pain reduction

The U.S. Drug Enforcement Administration has issued a warning about large amounts of counterfeit prescription pills containing fentanyl coming from Mexico.

The Aches and Pains of Tick-borne Illnesses

There is a big difference between the aches and pains that come with tick-borne illnesses and those associated with every day life.

I’m not sure there’s as much of an opioid crisis as much as there is a fear of opioids crisis.

My guess is there are many diagnosed with neuralgia that have an undiagnosed Lyme/MSIDS infection.

What to know about neuralgia

Types of neuralgia

Trigeminal neuralgia

Postherpetic neuralgia

Occipital neuralgia

Peripheral neuralgia

Intercostal neuralgia

Diabetic neuropathy

Symptoms

Treatments

Medications

Surgery

Outlook and takeaway

What you need to know about occipital neuralgia

Fast facts on occipital neuralgia:

How is it different from other headaches?

What are the main symptoms?

What causes it?

Injury

Muscular problems

Back issues

Other causes

How is it diagnosed?

Can it be prevented?

Treatments

Nerve blockers

Pulsed radiofrequency

Surgery

Home remedies

I’m certain there are plenty more patients with this symptom who have an undiagnosed Lyme/MSIDS infection.

Lyme/MSIDS infections can be behind all of this. Spread the word.

Q: Have I really plateaued or is my progress just going slowly?

Q: Have you hit a plateau before? What helped jumpstart my healing?

Q: Do I need to change my treatment or ride it out?

Q: If I plan to stay the course when will I know it’s time to adjust?

Q: Am I testing too often?

Q: Is there something else I could do to move forward?

Q: Is this a good time for a healing pause?

I’ve learned the most from patients who are on the same journey. Don’t isolate yourself.

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