What can be done for elderly patients with peripheral neuropathy to prevent serious injury from falls?

Elderly people with type-2 diabetes mellitus(T2DM) and diabetic peripheral neuropathy (DPN) may be more prone to suffer severe injuries due to tripping and falling.

A startling statistic reveals an older adults are admitted to hospitals every 13 seconds, on average, due to falls, while one death results from a fall every 20 minutes.

A recent paper addressed that issue and concluded,

“Falls prevention programs with a component of weight-bearing exercises are effective in decreasing future falls in the elderly. However, weight-bearing exercise was only recently recommended in guidelines for exercise for people with T2DM and DPN. Since then, there have been an increasing number of studies to evaluate the effectiveness of falls prevention programs on this targeted population.”

“Interventions included lower limb strengthening, balance practice, aerobic exercise, walking programs, and Tai Chi.”

National Council On Aging lists several Evidence-Based Falls Prevention Programs on its website.

NCOA elderly falls prevention programsInfographic credit: NCOA

A Matter of Balance

FallScape

The Otago Exercise Program

Stay Active and Independent for Life (SAIL)

Stepping On

Tai Ji Quan: Moving for Better Balance

Can legalized marijuana use help relieve pain from neuropathy?

medical cannabisPhoto credit: Mary Pahlke

The proposals for legalized marijuana use in the 2016 elections garnered wide support according to CULTURE magazine.

“Another election has come and gone, and no matter which way you voted, it is clear that cannabis came out on top, winning seven of the nine initiatives on the ballot, with another one too close to call, but on the precipice of passing.”

The winners joined several other states that allow legal possession of marijuana, also known as cannabis. 29 states and Washington, D.C. now allow its use for medical purposes.

  1. Alaska
  2. Arizona
  3. Arkansas
  4. California
  5. Colorado
  6. Connecticut
  7. Delaware
  8. Florida
  9. Hawaii
  10. Illinois
  11. Louisiana
  12. Maine
  13. Maryland
  14. Massachusetts
  15. Michigan
  16. Minnesota
  17. Montana
  18. Nevada
  19. New Hampshire
  20. New Jersey
  21. New Mexico
  22. New York
  23. North Dakota
  24. Ohio
  25. Oregon
  26. Pennsylvania
  27. Rhode Island
  28. Vermont
  29. Washington
  30. Washington, DC

North of the border, “The courts in Canada have ruled that the federal government must provide reasonable access to a legal source of marijuana for medical purposes.”

“Your [Canadian]health care practitioner may have authorized the use of cannabis (marihuana, marijuana) for the relief of one or more of the following symptoms associated with a variety of disorders which have not responded to conventional medical treatments. These symptoms (or conditions) may include: severe refractory nausea and vomiting associated with cancer chemotherapy; loss of appetite and body weight in cancer patients and patients with HIV/AIDS; pain and muscle spasms associated with multiple sclerosis; chronic non-cancer pain (mainly neuropathic); severe refractory cancer-associated pain; insomnia and depressed mood associated with chronic diseases (HIV/AIDS, chronic non-cancer pain); and symptoms encountered in the palliative/end-of-life care setting.”

Scientific studies in the United States and worldwide have yet to conclusively prove cannabis relieves neuropathic pain, despite its common use by scores of people.

A Canadian Agency for Drugs and Technologies in Health study writes the cannabis-based buccal spray, Sativex®, “is approved for use in Canada as an add-on therapy for adult patients experiencing muscle spasticity caused by multiple sclerosis (MS), and it has received a Notice of Compliance with conditions for MS-related central neuropathic pain and the treatment of cancer pain unresponsive to opioids.”

An Indiana University researcher, Andrea Hohmann, highlighted the promise of medical cannabis when she said, “The most exciting aspect of this research is the potential to produce the same therapeutic benefits as opioid-based pain relievers without side effects like addiction risk or increased tolerance over time.”

A member of her team pointed out an overlooked aspect of other potent painkillers, “The fact that deaths associated with prescription opioid abuse have surpassed cocaine and heroin overdose deaths combined is a significant factor in exploring cannabinoids as an alternative treatment for pain.”

A 2013 study found low-dose vaporized cannabis significantly improves neuropathic pain, “The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (1.29%) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome.”

A more recent trial performed in Germany concluded, “Cannabinoids were marginally superior to placebo in terms of efficacy and inferior in terms of tolerability.”

In sum, medical marijuana may receive a lot of publicity for relieving pain from neuropathy, but funds for major clinical trials are lacking to provide definitive proof of its effectiveness.

Since most production is done by small-scale operators with limited budgets, the true picture of cannabis’ medical use will remain in question until enough data is collected for a clearer picture.

Topical ambroxol possible treatment of neuropathic pain

ambroxol-3D
Recent research from Europe indicates the potent cough syrup ingredient ambroxol could be effective in alleviating neuropathic pain when used as a cream applied to the skin.

The German scientists concluded that, “[Ambroxol] is therefore considered to be a useful, simple concept for pain management with few side effects. In the case reports presented in this article, this concept was successfully implemented, for the first time, in the form of topical ambroxol 20 % cream in patients with severe neuropathic pain.”

However the European Medicines Agency published an advisory regarding possible complications in the use of ambroxol. They note that, “The risk of anaphylactic reactions and SCARs with ambroxol or bromhexine is low. Frequencies of these side effects are unknown.”

They go on to caution, “Anaphylactic reactions and severe cutaneous adverse reactions (SCARs), including erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis and acute generalised exanthematous pustulosis, have been reported in patients receiving ambroxol.”

With those warnings out of way, the researchers made these claims based on findings on five of the people they treated, “Four patients with no improvement after lidocaine 5 % and one patient with no response to capsaicin 8 % nevertheless experienced a pain reduction with topical ambroxol.”

Widely available in tablet form, the 20% cream was prepared exclusively for this study by combining the following ingredients, “ambroxol cream 20 %, 50.0 g: ambroxol 10.0 g, dimethyl sulfoxide 5.0 g, made up to 50.0 g with Linola cream.”

Ambroxol is the active ingredient of medications marketed commercially as Mucosolvan, Mucobrox, Mucol, Lasolvan, Mucoangin, Surbronc, Ambolar, and Lysopain. Not available as a cream, it’s sold as a cough syrup, in tablets, pastilles, dry powder sachets, inhalation solutions, drops, ampules as well as effervescent tablets.

As noted in Wikipedia, “Many state-of-the-art clinical studies have demonstrated the efficacy of ambroxol in relieving pain in acute sore throat, with a rapid onset of action, with its effect lasting at least three hours. Ambroxol is also anti-inflammatory, reducing redness in a sore throat.”

Though known as a pain reliever since the 1970’s, it’s use in a topical (locally through the skin) form could offer promise for people where other methods have not been effective.