May 2005 Peripheral Neuropathy

May 2005
Ouch!
HIVers can be forgiven a collective snore at the media’s newest medical obsession: the excruciatingly vague science of pain relief. Suddenly, pain afflicts the front cover of Time, the New York Times’ science section and scores of TV news segments. It all began when Vioxx was bumped off the market last December. Along with Celebrex and Bextra—other Cox-2 inhibitors in the class of NSAIDs (non-steroidal anti-inflammatory drugs)—the blockbuster painkiller significantly raised heart-attack and stroke risk. Typically missing from the press frenzy was any mention of what Cal Cohen, MD, research director of Boston’s Community Research Initiative of New England, calls the “additional burdens in diagnosing and treating pain” that HIV—and its treatments—place on patients and providers. POZ took a look at how HIV pain experts shoulder those burdens, offering a short list of HIVers’ most common hurts—and tips on top treatments. Plus, HIVers contribute remedies that aren’t on Doc’s formulary. “Many drugs are useful in treating HIV-associated pains even if they’re not approved for that purpose,” says Howard Rosner, MD, med head at LA’s Cedars Sinai’s Pain Center. (You may have to go way off-label—and mix and match remedies—to keep your pain from going off the chart.) As for the Cox-2 newsmakers, most HIV docs say they will prescribe ’em for headaches and joint, muscle and back pain—but mostly for short-term use.BIG PAIN #1: Peripheral Neuropathy (PN)WHY IT HURTS: PN’s nerve damage numbs or inflicts a burning sensation on the hands and feet of about 30 percent of HIVers. Linked to “d” nukes—d4T (Zerit), ddI (Videx) and ddC (Hivid)—it can also result from HIV itself. WHAT HELPS: David Simpson, MD, director of clinical neurophysiology at Mt. Sinai in New York City, both studies and treats HIV-related PN. He usually starts HIVers on the least invasive treatment, such as Lidoderm, a lidocaine patch for post-herpetic neuralgia (a painful shingles after-effect; see “What Else Hurts,” below). • Second choice: antidepressants like the new Cymbalta or anticonvulsants like the new Lyrica (or the older Neurontin). • If you’re still hurting, Doc might try narcotics like percodan, vicodin or Tylenol with codeine. Studies show that drugs like the tricyclic antidepressant Elavil may soothe diabetic PN, which stems from impaired bloodflow and high blood sugar, but might not ease HIV PN, which has a different cause. • Some HIVers swear by acupuncture; others try exercise, yoga, marijuana, hypnosis and anodyne infrared-light therapy. Ray, a 44-year-old New Yorker, says he got PN from Zerit. His doctor recommended B-12 injections. “It took over a year, but that was the only thing that helped,” he says.WHAT’S COMING: Simpson is planning studies of Cymbalta and Lyrica (both FDA-OK’d for diabetic PN) on HIV PN. He warns that the body uses the same route to process Cymbalta and HIV protease inhibitors, so doses might need adjustment when the two are paired. • Trials of one pain-relief hope, Prosaptide, have been halted—at least for now—but high-dose capsaicin patches and carnitine are still in the running. (To find a carnitine study: http://www.clinicaltrials.gov, 312.572.4545.)
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About Friar Timothy, Franciscan Urban Mission, INC.

Disciple of Jesus Christ with a Progressive Message, Author, Franciscan Friar, Musician, Social Activist, and Urban Missionary View all posts by Friar Timothy, Franciscan Urban Mission, INC.

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