Friday, May 9, 2008

A painful reminder: drugs aren't always the answer

I have two reasons for writing this post this morning.

First of all, I spend a couple of hours a day reading new research on psychiatric medications, and it seems that there is a real trend toward throwing all kinds of medications at people with neuropathic pain. If you're the head of marketing at a major pharmaceutical organization, and you're looking at the health statistics in this country, and you see how many people are overweight and headed toward a diagnosis of diabetes...well...anyone looking at you sitting at your desk looking at those numbers is going to see a gazillion dollar signs in that cartoon bubble floating over your head.

To put it another way, anyone who can come up with a sure-fire way to treat neuropathic pain is sitting on a pile of money.

My second reason for posting this is a lot more personal. I have a private client, not overweight at all, whose bulimia has progressed to the point where she has developed diabetes. She got herself into big trouble with her medications because the one she wanted to use, insulin, was the only one she felt controlled her neuropathic pain. Her physician didn't see eye to eye with she decided to use both his meds and hers. We almost lost her over the conflict.

I know why the physician is holding his ground, and I support his choice. But I also have compassion for the physical pain this person must be enduring, which must be a constant reminder, thanks to the ruthless negative voices in her head, that she's really screwed up this time.

So...I've been researching some other options that would allow her to manage her pain, allow her to focus on recovering from the eating disorder, and make the doctor happy.

Enter alpha-lipoic acid. This is an anti-oxidant that isn't all that easy to find in foods, but is right there in the health food store. Not only does it help to regulate diabetes, it's turning out to be very effective in addressing neuropathic pain.

A European study looked at a group of 443 patients who had successfully managed their neuropathic pain with alpha-lipoic acid for at least 5 years. About 300 of them were switched to gabapentin (Neurontin), and 150 of them with no acute symptoms went without any treatment at all during this period of time.

Seventy-three percent of the untreated group started experiencing pain as early as two weeks after discontinuing alpha-lipoic acid. In the gabapentin group, 45% had to stop taking the drug because they could not tolerate its side effects. Fifty-five percent of those using the drug, even though they had done well with alpha-lipoic acid, did not respond to gabapentin. They ended up requiring another medication...which in this study ended up being pregabalin, carbamazepine, amitriptyline, tramadol, and/or morphine .

The researchers commented on the cost of using alpha-lipoic acid as compared to a prescription medication. Not only was there the direct medication cost, but those on medication had almost twice as many office visits during the three months of the study as those who were on the supplement. Not mentioned but important to consider, was the likely additional costs of treating the medication side effects.

The moral of the study? Drug companies, the better mousetrap has already been built. Let's do the right thing and, rather than looking at those dollar signs, get it into the nerves of people like my client who deserve to not have to live like this anymore.

Ruessmann HJ; on behalf of the German Society of out patient diabetes centres AND (Arbeitsgemeinschaft niedergelassener diabetologisch tätiger Ärzte e.V.). Switching from pathogenetic treatment with alpha-lipoic acid to gabapentin and other analgesics in painful diabetic neuropathy: a real-world study in outpatients. J Diabetes Complications. 2008 Apr 8

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