200 Million Illicit Drug Users Worldwide

Illicit drug usage is practiced by approximately 200 million people globally, Australian researchers reported in the medical journal The Lancet. High-income nations have the highest rates, and disease burdens related to drugs are comparable to the health toll caused by alcohol consumption.

The authors explained that expert estimates of global illicit drug usage range from 142 to 271 million people - approximately 1 in every 20 people aged from 15 to 64 years.

Authors, Professor Louisa Degenhardt, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, and the Burnet Institute, Melbourne, Australia; and Professor Wayne Hall, University of Queensland Centre for Clinical Research, Brisbane, Australia, wrote that the disease burden caused by illegal drug usage is very high in rich nations, for example, in Australia it is about the same as the burden caused by alcohol consumption, but significantly less than tobacco.

Because of the very nature of illicit drugs - they are illegal - it is difficult to gather accurate and reliable data and statistics. It is a serious challenge for health authorities and services to properly determine how many of their citizens are problem users, dependent, or being harmed by taking cocaine, amphetamines or cannabis. The authors explain that these are some of the unintentional negative consequences of making such drugs illegal.

The limitations in gathering accurate and reliable data on the related harms and health burdens attributable to inhalants, non-medical usage of benzodiazepines, or anabolic steroids means that their extents of use have never been properly estimated.

According to data the authors managed to collect, there are globally about:

• 125-203 million cannabis users
• 14-56 amphetamine users
• 14-21 cocaine users
• 12-21 opioid users
• Between 15 and 39 million problematic users of cocaine, amphetamines or opioids
• Between 11 and 21 million individuals inject their illicit drugs

Rates of illicit drug usage vary around the world:

• Cannabis usage - rates are highest in Australia and New Zealand (Oceania), with a 15% usage rate among 15 to 64 years olds
• Opioid usage (includes heroin) - rates are highest in the Middle East, with a usage rate that may be up to 1.4%
• Amphetamine usage - Oceania has the highest rate, about 2.8% of all 15 to 64 year-olds
• Cocaine - 1.9% of US citizens aged 15 to 64 year olds, the highest rate in the world
• Speed and crystal meth - Oceania has the highest rate, at about 2.8% of all 15 to 64 year-olds

The researchers emphasized that there is not one standard way of measuring illicit drug usage rates.

There are four main types of adverse health effects caused by using illicit drugs:

• The acute toxic effects - such as overdosing
• The acute effects of intoxication - such as violence or accidental injury
• The development of dependence 
• The effects on health on long-term sustained usage (sustained, chronic, regular use), such as physical disease.

Cannabis does not appear to cause overdose, blood-borne virus infections, or a noticeable number of deaths - it can cause some accidental deaths. However, dependency is widespread. The authors believe that cannabis also contributes to some mental disorders.

Opioids cause all four types of adverse health effects, the authors wrote. Approximately 1 in every 4 lifetime users develops dependency. Opioids also cause a considerable number of premature deaths, mainly due to overdosing, as well as accidents, violence, and suicides. A significant proportion of opioid users also take other drugs at the same time. The risk of developing HIV/AIDS and/or hepatitis is also higher among opioid users. An considerable number of regular opioid users become disabled, because of infections, liver disease and dependence.

Below are some more data the authors gathered from WHO (World Health Organization); in 2004, globally there were:

• 250,000 deaths attributed to illicit drug usage. This is still much lower than alcohol (2.25 million) and tobacco (5.1 million)
• Years of life lost - Illicit drug use, 2.1 million. Alcohol consumption, 1.5 million. The number is higher for illicit drug use because deaths linked to drug use occur at a much higher rate among young people, compared to death due to alcohol consumption (or even smoking tobacco).
• Disability Adjusted Life Years (DALYS) - Illicit drug use, 13 million. Alcohol consumption, 69 million. Tobacco, 57 million.

There are other burdens which are important but rarely reported, the authors stressed, such as:

• Stigma and discrimination
• The dangers of discarded drug injection equipment
• Violence between drug dealing gangs
• Violence and/or robbery/muggings that occur because of illicit drug dependence

Most reporting on the adverse events linked to illicit drug usage focuses mainly on drug dependence, and in particular, those who inject drugs.

The overall burden of illicit drug usage is considerably higher in high income countries than in developing nations

Red Wine Reduces Breast Cancer Risk

Regular alcohol consumption raises breast cancer risk, except for red wine, which has the opposite effect when consumed in moderation, researchers from Cedars-Sinai Medical Center in Los Angeles reported in the Journal of Women's Health. The authors explained that the chemicals in the seeds and skins of red grapes slightly reduce estrogen levels and raise testosterone among premenopausal females - thus reducing their breast cancer risk.

The authors stress that it is the red grape that has the beneficial compounds, and not just red wine. They suggest that women should consider red wine when choosing an alcoholic beverage to consume, rather than encouraging wine over grapes.

This study contradicts in part a widespread belief that the consumption of all types of alcoholic drinks raises a woman's chances of developing breast cancer, because alcohol raises estrogen levels, which in turn encourages the growth of cancer cells.

However, the researchers found that premenopausal women who consumed eight ounces of red wine every evening for approximately a month, had lower estrogen and higher testosterone levels. They tried out the same with another group of women, but they had to consume white wine - it did not have the same effect.

Moderate female alcohol drinkers should perhaps reassess their choices, the authors suggested.

Study co-author, Chrisandra Shufelt, MD, wrote:

"If you were to have a glass of wine with dinner, you may want to consider a glass of red. Switching may shift your risk."

There are over 230,000 new diagnoses of breast cancer each year in the USA - it is the leading type of female cancer in the country, the authors wrote. Approximately 39,000 adult females died from breast cancer in 2011, says the American Cancer Society.

The study involved 36 premenopausal females. They were randomly selected into two groups:

• The red wine group (Cabernet Sauvignon)
• The white wine group (Chardonnay)

For one month, they drank eight ounces of their designated wine every evening. During the second month they swapped groups, i.e. the women on white wine during the first one switched to red wine during the second month. Blood was collected from each participant four times, twice each month, to check for levels of hormones.

The scientists wanted to find out the ingredients of red wine might imitate what aromatase inhibitors do. Aromatase inhibitors are drugs that inhibit aromatase, an enzyme which is involved in estrogen levels. Aromatase inhibitors are used in breast cancer therapy.

They found that red wine lowers estrogen levels, which in turn should stem cancer cell growth. They added that test tube studies had indicated the same thing.

Co-author Glenn D. Braunstein, MD, explained that even though white wine (grapes) appears to lack the protective elements found in red wine (grapes), this does not necessarily mean that white wine raises breast cancer risk.

Braunstein, said:

"There are chemicals in red grape skin and red grape seeds that are not found in white grapes that may decrease breast cancer risk."

Braunstein added that a larger study is needed to determine how safe and effective red wine might be in reducing breast cancer risk.

What Is Normal Blood Pressure?

Blood pressure is primarily produced when the heart muscle contracts - it is the pressure of blood upon the walls of the blood vessels. There are two recordings, a high one (systolic) and a lower one (diastolic). The systolic pressure is measured when the heart contracts, while the diastolic one is gauged just before the heart contracts.

The heart is the muscle that pumps blood throughout the body during every second of our lives. Low-oxygen blood is pumped towards the lungs, where it becomes oxygen-rich again. Oxygen-rich blood is pumped by the heart around to body to supply tissue, muscle, organs and cells. This pumping generates blood pressure.

According to Medilexicon's medical dictionary, Blood Pressure is: 

"The pressure or tension of the blood within the systemic arteries, maintained by the contraction of the left ventricle, the resistance of the arterioles and capillaries, the elasticity of the arterial walls, as well as the viscosity and volume of the blood; expressed as relative to the ambient atmospheric pressure."

Hypertension is when our blood pressure is too high, while hypotension is the opposite; it is when our blood pressure is too low.

Taking a blood pressure measurement

Most of us have had our blood pressure taken at some time in our lives. The procedure is straightforward and provides the doctor or other health care professional with vital data regarding the condition of the patient's blood vessels and heart.

As mentioned above, two blood pressure readings are measured:

• The Systolic Pressure - this is the maximum pressure in an artery. It occurs when the heart contracts; when it is beating, and blood is being pumped through.
• The Diastolic Pressure - this is the minimum pressure in an artery. It occurs just before the heart contracts; in between heartbeats. It occurs when the heart is resting.

If either the systolic or diastolic pressure is too high, the patient has hypertension (high blood pressure). So, both readings are important.

The patient needs to be relaxed and seated or lying down comfortably when their blood pressure is taken. Their arm must be well supported.

What happens when somebody's blood pressure is taken?


Digital Blood Pressure Monitor - A 122/65 mmHg blood pressure reading, using an electronic sphygmomanometer 

A cuff is wrapped around the upper arm and is inflated. Velcro keeps it in place. With an electronic sphygmomanometer, the patient just relaxes and waits and the device does everything.


A clinical mercury Manometer

• A Clinical mercury Manometer has a cuff, a tube that leads to a rubber bulb, and another tube which leads to a reservoir of mercury. The doctor wraps the cuff around the patient's upper arm.
• The cuff is inflated by compressing the rubber bulb repeatedly.
• The doctor places a stethoscope on the patient's arm and listens to his/her pulse.
• When the doctor first hears the pulse, the systolic pressure is measured.
• Gradually the pressure on the cuff is released. As this occurs the sound of the pulse becomes fainter and fainter.
• As soon as the doctor cannot hear the pulse any more, the diastolic pressure is taken.
• Blood pressure is measured in mmHg (millimeters of mercury).

Electronic devices are becoming more commonplace, and mercury ones less.

Ambulatory blood pressure monitoring

Also known as ABPM, ambulatory blood pressure measures the patient's blood pressure at regular intervals throughout a 24-hour period. It is useful, especially with patients who suffer from white coat hypertension - raised blood pressure caused by anxiety and stress when entering a clinical setting. Put simply: some patients see doctors and nurses wearing white uniforms, they become anxious, resulting in higher blood pressure.

The patient's blood pressure is measured as they go about their daily business. They wear a portable device which records BP (blood pressure) information on a chip. The data helps the doctor determine the patient's blood pressure in a normal environment. Doctors may opt for ABPM if the patient's BP readings vary a lot, their blood pressure does not respond to medications, when the doctor suspects current treatment may be causing hypotension (low blood pressure), and for patients with suspected white coat hypertension.

What is normal blood pressure?

Normal blood pressure is generally below 120/80 (one-twenty over eighty). 120 represents the systolic measurement and 80 represents the diastolic measurement.

Desirable blood pressure is:

• Systolic - from 90 to 119
• Diastolic - from 60 to 79

High or elevated blood pressure (hypertension)

Prehypertension - this is when the reading is between 120/80 and 139/89.

Hypertension - this is when the reading is at least 140/90.

Health authorities in the UK and USA say that approximately one third of all people withhypertension do not know they have it - meaning, they probably have no symptoms. Experts say we should check our blood pressure now and again because of this, this is especially the case for people who smoke, drink alcohol regularly, are overweight, and are reaching old age.

If symptoms are felt, they may include:

• Blood in urine
• Confusion
• Dizziness
• Fatigue
• Headaches, some quite severe
• Irregular heartbeat
• Pains in the chest
• Problems with breathing
• Vision problems

Click here to read about Hypertension in more detail.

Low blood pressure (hypotension)

Anybody whose reading is 90/60 (ninety over sixty) mmHg or below has hypotension. For some seemingly healthy patients, in fact, a bit of hypotension is thought to protect them from subsequent hypertension. However, hypotension may mean there is an underlying problem.

If the hypotension is not severe, there may be no symptoms.

If symptoms are felt, they may include:

• Depression
• Dizziness
• Eyesight problems, such as blurred vision
• Light headedness; fainting is possible
• Nausea
• Pale, cold and clammy skin
• Palpitations
• Shallow panting
• Thirst
• Tiredness

Click here to read about Hypotension in more detail.

How do our arteries control blood pressure?

Our arteries control blood pressure by balancing the process that constricts the artery wall against the process that relaxes it. In some people there is more constriction than relaxation, as may be the case in atherosclerosis - thus impeding the free flow of blood.

Eicosanoids are molecules that play a key role in constricting the muscle walls. They are fat-like compounds which are made with the help of enzymes that break down polyunsaturated fats.

Researchers used to think that the eicosanoids are made from cells taken from blood; this is not the case. They are made by muscle cells in the arteries.

Experimenting with rats, researchers from Southampton University, England, deactivated two enzymes that help make the polyunsaturated fats. The result was much less arterial constriction, leading to freer blood flow, and consequently a much lower risk of hypertension.

They also discovered some "epigenetic switches" behind this process. This could explain why the arteries in some people show early signs of causing hypertension.

The researchers said that understanding exactly how arteries control blood pressure, and knowing how to modify this, could lead to better ways of treating cardiovascular diseases.

What Causes Leg Pain?

Leg pain refers to any kind of pain that occurs between the heels and the pelvis. There are many reasons for leg pain, and not all of them are caused by a problem that originates in the leg; some injuries or spinal problems can cause aches and pains in the leg(s).

Leg pain can be long-term, transitory, intermittent, acute, or slowly progressive. Pain may affect just part of the leg, such as the knee, or the whole limb. Leg pain may be felt as tingling, sharp, dull, an ache, or a stabbing sensation.

Some leg pains may be just a nuisance, in some cases the cause may never be found, other leg pains may be a sign of a more serious disease or condition, even a life-threatening one.

Leg pain caused by trauma

Trauma has a medical and psychiatric meaning. In this text, it refers to the medical meaning. Trauma is a serious injury, wound or shock, and can include broken bones, damage to bones, damage to muscles, joint injury, or a combination.

Even trauma to the back, if the sciatic nerve becomes inflamed, can cause pain that makes its way down the leg along the sciatic nerve (sciatica). Overusing some part of the leg can also lead to injuries.

• Fractures - fracture refers to any kind of break in bone, and sometimes cartilage. Not all bone fractures are caused by trauma - patients with osteoporosis may have such weak bones that they fracture with the minimum of pressure. Fractures are common causes of leg pain, and occur when nerve endings in the tissue that surround the bone (periosteum) send pain messages to the brain. Sometimes, a bone fracture can cause muscles to spasm, which further exacerbates the pain.

A runner wraps leg in ice to treat shin splints after running 8 kilometers in the 2009 Armed Forces Cross Country Championship
• Shin splints - medically known as medial tibial stress syndrome, refers to pain just behind the tibia (shinbone) or along it. Shin splints occur when too much force bears down on the shinbone and connective tissue that connect muscle to the bone. Runners and those who take part in stop-start activities, such as squash, tennis, soccer or basketball are more likely to suffer from shin splints. Symptoms may include soreness, pain or tenderness, and sometimes mild swelling in the affected area.
• Strains and/or sprains - strains are injuries to tendons or muscles, while sprains are injuries to ligaments. Strains occur when you tear, twist, or pull a muscle. People with a sprain commonly experience acute pain, weakness and muscle spasms. Sprains usually occur as a result of trauma, such as a fall. The area may bruise and the pain can be intense, especially when moving.
• Compartment syndrome - this is when an increase in pressure and swelling affects a compartment (limited space); the blood vessels, nerves and possibly also the tendons that run through the compartment are affected. Symptoms typically include tingling, numbness, sometimes severe pain, as well as loss of movement in a foot. Eventually, in time, the nerve can become compressed, there may be paralysis, contracture, and even death.
• Bleeding - an injury to the leg that causes internal bleeding can lead to pain. A build-up of blood can press against tissue, bone and nerve endings. Blood itself is irritating, and can cause inflammation, which is painful.

Other causes of leg pain

Peripheral artery disease (PAD), also known as peripheral arterial disease, orperipheral artery occlusive disease, refers to blockages in large arteries which are not located within the brain, coronary, or aortic arch vasculature. PAD can be caused byatherosclerosis, an embolism or thrombus, or any inflammatory process that leads to stenosis (narrowing of a blood vessel).

Put simply, the blood vessels to the leg become narrower, restricting the blood supply. Pain is felt with physical activity. Pain, weakness, numbness, or cramping in muscles caused by decreased blood flow is known as claudication.

Leg pain caused by arterial disease and exercise - if a patient's leg pain is caused by arterial disease, they may be able to skip treatment of the affected artery if they participate in a hospital-supervised exercise program, researchers at Erasmus MC, University Medical Center in Rotterdam, the Netherlands, reported in Radiology (February 2009 issue).

Some people with peripheral arterial disease suffer from a painful leg condition called intermittent claudication. Various treatment options are possible, including endovascular revascularization or drug therapy.

Deep vein thrombosis - also known as DVT occurs when a thrombus (blood clot) develops in a deep vein, nearly always in a leg. The clot tends to occur in leg veins, such as the femoral or popliteal veins, but can also develop within the pelvis. The thrombus can break off and make its way to the lung, causing a pulmonary embolism.

Some patients may have a DVT and not be aware of it; there are no symptoms. If symptoms do emerge, they will include swelling, pain, tenderness, and warmth in the affected area. Usually, the pain starts in the calf. In some cases the skin may go red, especially at the back of the leg below the knee. Surface veins may become engorged.

Sciatica - this occurs when the sciatic nerve is irritated. Pain radiates from the lower back, all the way down to below the knee, via behind the thigh and buttocks. Sciatica can have a number of causes, such as a herniated disc that presses directly on the nerve. The pain, which can be severe, is sometimes accompanied by numbness, muscular weakness, tingling and problems controlling or moving the leg. When the weather is very cold, pain may become worse.

Peripheral neuropathy - refers to a problem with function of nerves outside the spinal column, such as in the legs. Symptoms include burning pain (especially when lying down), problem with reflexes, numbness, pins and needles, and weakness. Peripheral neuropathy can be caused by certain medications, kidney failure, vitamin deficiency, and diabetes.

In severe cases, the patient's feet can become too sensitive to touch (even lightly touching the skin hurts). Eventually, the patient may become housebound if shoes and socks cannot be worn and the feet are too sensitive to touch the ground (extreme cases).

Diabetes - patients with diabetes have a higher risk of experiencing leg and/or foot pain - these are due to diabetes complications, such as peripheral neuropathy or some vascular problem that results in poor blood circulation.

Alcoholism - excessive alcohol can have a damaging effect on the brain, peripheral nerves and muscles. Common symptoms linked to alcoholism include (in the leg) burning pain, tingling, muscle weakness, sensitivity to heat, and tingling.

Cancer - the most common symptom of bone cancer is pain. Other cancers, such as prostate cancer that has spread (metastasized), may also cause pain in the pelvic area and upper leg area. Ovarian or cervical cancer may also cause leg pain.

Shingles - symptoms of shingles include pain in various parts of the body, including the legs.

Arthritis - affects the musculoskeletal system, especially the joints. Arthritis is the main cause of disability among individuals aged over 55 years in wealthy nations. It is not a single disease, but a term that covers over 100 medical conditions, of which osteoarthritis is the most common.

• Osteoarthritis - the cartilage loses elasticity, becomes stiff and consequently damages more easily. The cartilage will gradually wear away in some areas, causing tendons and ligaments to become stretched, resulting in pain. Joints in the leg may start rubbing against each other, causing intense pain.
• Rheumatoid arthritis - this is a form of arthritis with inflammation. The synovium (synovial membrane) is attacked, causing swelling and pain. Symptoms can come and go, and may include stiffness, swelling, and pain in the joints.
• Infectious arthritis (sebptic arthritis) - the synovial fluid and tissues of a joint become infected; usually by bacteria, but possibly by a virus or fungus. The pathogen spreads through the bloodstream of nearby infected tissue, and infects a joint. The patient may experience chills, general weakness, fever, problems moving the limb, severe pain in the infected joint, especially when trying to move. The joint will also swell and feel warm.

Myalgia - muscle pain. This could be caused by an infection, overusing or overstretching a muscle or group of muscles. Sometimes it is a symptom of chronic fatigue syndrome.

Muscle cramps - these may be extremely painful and can have many causes, such as not stretching properly, an electrolyte imbalance, exposure to large changes in temperature, ordehydration.

Hamstring injury - this occurs when one of the hamstring muscles is pulled or strained. Hamstring muscles run along the back of the thigh. In some cases, the muscle tears completely or partially. The patient may feel a sharp, sudden pain in the back of the thigh during physical activity. Some describe it as a tearing or popping sensation. A few hours after the injury, there may be some tenderness or swelling, as well as bruising.



Bruising caused by strained hamstring. The horizontal lines were caused by the bandaging 

The story of David Dow and his leg pains

David Dow thought his leg pains were due to a back problem. As you will read further on, the pain actually saved his life. David was a seemingly healthy male, aged 57. He suspected nothing serious, and thought that perhaps some back-strengthening exercises with a personal trainer would be good for him.

Workouts were done perfectly, and his back got stronger. However, the leg pain just got worse - so much so, that eventually it became a struggle to make it from his car to the grocery store entrance. David, and also his trainer wondered whether there might be something more serious going on.

He saw his doctor, who ordered some diagnostic tests. It turned out that he had blockages in the blood vessels in his legs. He was astonished to discover that the arteries that went to his lower extremities were almost 100% blocked. Why? The doctor told him that after years of regular smoking, consuming meals high in animal fats, and some other factors, cholesterol, scar tissue, and blood clots accumulated inside the blood vessels.

Most lay people do not associate clogged artery disease and/or arteriosclerosis with the legs, but rather the heart. In David's case, this was developing all over his body - he had PAD (peripheral arterial disease).

PAD can cause leg pain. In fact, experts say it is an "early warning" that a heart attack or strokeis looming.

What Is Neuropathy? Neuropathy Causes And Treatments

Neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders, and exposure to toxins. One of the most common causes of neuropathy is diabetes. 

Neuropathy can affect nerves that control muscle movement (motor nerves) and those that detect sensations such as coldness or pain (sensory nerves). In some cases - autonomic neuropathy - it can affect internal organs, such as the heart, blood vessels, bladder, or intestines. 

Pain from peripheral neuropathy is often described as a tingling or burning sensation. There is no specific length of time that the pain exists, but symptoms often improve with time - especially if the neuropathy has an underlying condition that can be cured. The condition is often associated with poor nutrition, a number of diseases, and pressure or trauma, but many cases have no known reason (called idiopathic neuropathy). 

In the United States, about 20 million people suffer from neuropathy. Over half of diabetes patients also suffer from the condition.


How is neuropathy classified?
Peripheral neuropathy can be broadly classified into the following categories:

• Mononeuropathy - involvement of a single nerve. Examples include carpal tunnel syndrome, ulnar nerve palsy, radial nerve palsy, and peroneal nerve palsy.
• Multiple mononeuropathy - two or more nerves individually affected.
• Polyneuropathy - generalized involvement of peripheral nerves. Examples includediabetic neuropathy and Guillain-Barre syndrome.

Neurophathies may also be categorized based on a functional classification (motor, sensory, autonomic, or mixed) or the type of onset (acute - hours or days, subacute - weeks or months, or chronic - months or years). 

The most common form of neuropathy is (symmetrical) peripheral polyneuropathy, which mainly affects the feet and legs on both sides of the body.

What causes neuropathy?

About 30% of neuropathy cases are considered idiopathic, which means they are of unknown cause. Another 30% of neuropathies are due to diabetes. In fact, about 50% of people with diabetes develop some type of neuropathy. The remaining cases of neuropathy, called acquired neuropathies, have several possible causes, including:

• Trauma or pressure on nerves, often from a cast or crutch or repetitive motion such as typing on a keyboard
• Nutritional problems and vitamin deficiencies, often from a lack of B vitamins
• Alcoholism, often through poor dietary habits and vitamin deficiencies
• Autoimmune diseases, such as lupus, rheumatoid arthritis, and Guillain-Barre syndrome
• Tumors, which often press up against nerves
• Other diseases and infections, such as kidney disease, liver disease, Lyme disease, HIV/AIDS, or an underactive thyroid (hypothyroidism)
• Inherited disorders (hereditary neuropathies), such as Charcot-Marie-Tooth disease and amyloid polyneuropathy
• Poison exposure, from toxins such as heavy metals, and certain medications and cancertreatments

Who gets neuropathy?

Risk factors for peripheral neuropathy include several conditions and behaviors. People with diabetes who poorly control their blood sugar levels are very likely to suffer from some neuropathy. Autoimmune diseases such as lupus and rheumatoid arthritis also increase one's chance of developing a neuropathy. People who have received organ transplants, AIDSpatients, and others who have had some type of immune system suppression have a higher risk of neuropathy. In addition, those who abuse alcohol or have vitamin deficiencies (especially B vitamins) are at an increased risk. Neuropathy is also more likely to occur in people with kidney, liver or thyroid disorders.

What are the symptoms of neuropathy?

Neuropathy symptoms depend on several factors, chiefly where the affected nerves are located and which type of nerves are affected (motor, sensory, autonomic). Several types of neuropathy affect all three types of nerves. Some neuropathies suddenly arise while others come on gradually over the course of years. 

Motor nerve damage usually leads to symptoms that affect muscles such as muscle weakness, cramps, and spasms. It is not uncommon for this type of neuropathy to lead to a loss of balance and coordination. Patients may find it difficult to walk or run, feel like they have heavy legs, stumble, or tire easily. Damage to arm nerves may make it difficult to do routine tasks like carry bags, open jars, or turn door knobs. 

Sensory nerve damage can cause various symptoms, such as an impaired sense of position, tingling, numbness, pinching and pain. Pain from this neuropathy is often described as burning, freezing, or electric-like, and many report a sensation of wearing an invisible "glove" or "stocking". These sensations tend to be worse at night, and can become painful and sever. On the contrary, sensory nerve damage may lead to a lessening or absence of sensation, where nothing at all is felt. 

Autonomic nerve damage affects internal organs and involuntary functions and can lead to abnormal blood pressure and heart rate, reduced ability to perspire, constipation, bladder dysfunction, diarrhea, incontinence, sexual dysfunction, and thinning of the skin.

How is neuropathy diagnosed?

a nerve conduction test

Peripheral neuropathy is often not easy to diagnose. It is not a single disease, but a symptom with often several potential causes. The standard diagnostic process begins with a full medical history with physical and neurological exams that will examine tendon reflexes, muscle strength and tone, the ability to feel sensations, and posture and coordination. Blood tests are also common in order for doctors to measure levels of vitamin B-12. Other common tests include urinalysis, thyroid function tests, and a nerve conduction study that includes electromyography (to measure electrical discharges produced in muscles). Physicians may also recommend a nerve biopsy, where a small portion of nerve is removed and examined under a microscope.

How is neuropathy treated?

There are a variety of treatments available for peripheral neuropathy. They range from traditional pills and creams to special diets and therapies that stimulate the nervous system.Antidepressants, especially tricyclics and selective serotonin-norepinephrine re-uptake inhibitors (SNRI's), are a favored treatment for neuropathies. They will relieve neuropathic pain in non-depressed persons.

In June 2012, researchers from the University of Michigan School of Nursing reported thatCymbalta (duloxetine), an antidepressant, can relieve the symptoms of chemotherapy-induced peripheral neuropathy.

Another class of medicines commonly prescribed for neuropathy is that of anticonvulsants. These medicines block calcium channels on neurons to limit pain. Opioid narcotic treatments for neuropathy are used as well to treat the condition, but are less favored because of the risk of dependency. However, opioids have been the most consistently effective in reducing pain. 

For some types of neuropathy, such as post-herpes neuralgia, physicians recommend treatment with a topical anesthetic such as lidocaine. Topical applications of capsaicin (the chemical that makes peppers hot) has also been used to treat neuropathic pain. 

Alternative therapies for peripheral neuropathy include cannabinoids (an class of chemicals found in marijuana), Botulinum Toxin Type A (better known as Botox), NMDA antagonists (such as ketamine), dietary supplements (such as alpha lipoic and benfotiamine), chiropractic massages, yoga, meditation, cognitive therapy, and accupuncture. 

A final class of therapies for neuropathy are called neuromodulators. These include both implantable and non-implantable technologies (electrical and chemical) such as spinal cord stimulators, implanted spinal pumps, electrodes that stimulate the motor cortex of the brain, and methods called deep brain stimulation.

How can neuropathy be managed and prevented?

There are several ways to manage neuropathy and prevent its symptoms. Good foot health is important, especially for diabetics. Patients should check feet for blisters, cuts, or calluses and avoid tight fitting shoes and socks. Doctors can recommend an exercise plan that will reduce neuropathy pain and control blood sugar levels. Patients should also quit smoking and eat healthful meals. Massages of hands and feet may also aid neuropathy management by stimulating nerves and temporarily relieving pain. Finally, it is advised to avoid prolonged pressure on knees or elbows in order to prevent new nerve damage.