Understanding Peripheral Neuropathies

[[Li...]]

Wanted to chime in too. I had planned to start r-LA a month ago but my order never showed up. Called the company, they resent it, arrived yesterday. I took one 100mg ALA on an empty stomach and didn't notice much of anything yesterday until I went to bed- I was tired but could NOT fall asleep for hours. However, I have a LOT of personal stress going on (nasty breakup with boyfriend of four years over the weekend, wrapping my head around some things that were said, etc). So unsure whether r-LA amped me up (took pill around 4pm) or whether it was just a fluke. Certainly I have usually one night a week like that anyway, pre-r-LA. Anyhow, I took one this morning on an empty stomach and my back and neck pain is significantly less than it was when I woke up. Keep in mind I have a spinal cord injury, so it is neuropathic pain. Also I went to physical therapy yesterday for the first time in 8 months, and ended up a little battered due to having some really tight spots that needed coaxing to unwind. It's going to be very difficult to tell what is causing what given the upheaval in my life as well as just the regular windows and waves of benzo and gabapentin and birth control w/d, but I am going to do my darndest to document it for those that follow. I am VERY hopeful it will help both pain and cog-fog. (Ha. I am also very hopeful having the negative ex gone from my life will help just about everything. LOL)

 

Have a blessed day, all-

 

Libby

[[an...]]

Hey Libby,

It sounds like with all that going on time is gonna be your best friend. Stay patient and alert...keep taking good care of yourself!

~stasia

 

[[Li...]]

Stasia, I couldn't agree more!! Time is my buddy. Indeed. Thank you for the wise words.

 

Libby

[[Pe...]]

Thank you Libby, and again to anastasiarobyn, for your willingness to share your experiences here.  I understand how difficult it is to sort things out due to all the various factors involved.  However, your input is invaluable and greatly appreciated!

[[bu...]]

]Understanding Peripheral Neuropathies[/u]

 

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[/size]

[[an...]]

Thank you for sharing this information. Three years out from my cold turkey and I still feel small nerve zaps and am living with an annoying twitch in my left big toe area. I don't know if the cell was damaged.

[[Mo...]]

Bump....interesting !

[[pr...]]

bumpety bump bumpety!

[[Th...]]

bump, interesting. Anyone can say that neuropathy type of symptoms have gone over the time?

[[Sa...]]

bump, interesting. Anyone can say that neuropathy type of symptoms have gone over the time?

I’d like input on this

[[pr...]]

i still have a lot of neuroapthy throughout my legs and feet and it's been a very long running symptom and not sure if it will ever go away - but i sure hope that it will at least improve.

[[Ma...]]

I did not read the whole thread but it seems like ALA has treated peripheral neuropathies where structural damage has occurred to the nerves in the areas effected, Whereas the suggestion in benzo's is the GABA receptors. ALA is good stuff however so what the heck

 

On another tact I am getting my neurotransmitters checked by both my naturopath and a biofeedback therapists. Can adjusting neurotransmitters, especially while I have only had my neuropathy a few months, possibly make a difference? I think I can lead a reasonably happy life with the neuropathy I have Yes But it sure would be nice to at least have improvement. I tend to be thinking of it much of the time