AlaimoChiropractic.com

79 year old man gets relief from chronic pain in 3 treatments! Listen to this!

by Joe Di Duro, DC DABCN MS

Using data from the 1999-2004 National Health and Nutrition Examination Survey,

researchers found that 33.5 million older Americans (men age 50 years and older

and women age 60 years and older) are currently taking a statin drugs (24.4%).

That’s a lot of people taking drugs!

While the FDA has deemed statins to be safe to use for their intended purpose –

lowering cholesterol — no drug is totally without side effects in susceptible

individuals. As the use of statin drugs continues to increase, and people have been

taking statins for a prolonged period that is significantly longer than the time period

required for testing drugs, the side effects of statins affect more people than ever

before.

Since the drug companies that manufacture statins have become aware of the

incidence of serious side effects, they’ve added a warning to statin advertising that

was not present early on. This warning states, “Unexplained muscle pain and

weakness could be a sign of a rare but serious side effect and should be reported

to your doctor right away.” People who take statin drugs need to heed this warning

immediately because in extreme cases the side effects of statins can be fatal.

The major side effects of statin drugs

Neuropathy, muscle pain, and muscle weakness are three of the main side effects

of statin drugs. Chiropractors are directly in line to visit patients with these side

effects. Chronic pain and pain not relieved by medical means drives millions of

people to the chiropractic office. Unknowingly, these chiropractors may face

clinical failure in cases that are caused not predominately from spinal malfunction,

but by toxic neuropathy.

Other symptoms of neuropathy include: pain, numbness, tingling, and pricking

sensations; burning pain (especially at night); and/or sensitivity to touch. If left

undiagnosed, neuropathy can lead to deterioration of the muscles and paralysis.

Remember that we all need throat muscles to swallow, chest muscles to breathe,

and that the heart is a muscle. In the extreme, severe neuropathy as a side effect

to statin use can lead to death.

Some researchers estimate the 1 in 10 people who take statin drugs will

experience a mild form of neuropathy where the symptoms may be pain or even a

feeling of tiredness, difficulty in arising from a low chair or getting out of bed,

shortness of breath or difficulty walking. Isolated cases of statin-associated

neuropathy have been reported since 1994 [1].

Statin drugs and neuropathy

Statin-induced neuropathy is increasingly described in the scientific literature.

Proposed mechanisms include an alteration in cholesterol synthesis, producing a

disturbance in the cholesterol-rich neuronal membrane, or in the activity of

ubiquinone (coenzyme Q10), a mitochondrial respiratory chain enzyme inhibited by

statins leading to neuronal damage. [1] Statins are hydroxymethyl glutaryl

coenzyme A reductase (HMGCoA reductase) inhibitors, this action is responsible

for the lipid-lowering effect but can also explain the nervous toxicity. Statins

interfere with cholesterol synthesis that may alter myelin and nerve membrane

function and they prevent mitochondrial respiratory chain enzyme synthesis which

may disturb neuron energy use. [2] The entire class is implicated, and both

polyneuropathy and mononeuropathy have been described. [3]

Epidemiological and case-control studies from the U.K. suggest elevated odds

ratios (ORs) of 2.5 times (95% CI 0.3–14.2) the risk of developing neuropathy while

on statin drug therapy. [4]

Small countries like Demark or Iceland are great for studying medical conditions.

Because the population is genetically similar as opposed to the vast melting pot of

the United States, it is easier to conduct a controlled study. A famous Danish

study of neuropathy [5] as a side effect to statin drug use concluded that

individuals who were current statin users were four times more likely to have

developed peripheral neuropathy than nonusers. Among patients diagnosed with

“definite” peripheral neuropathy, current statin users had 16 times the risk of

nonusers. In addition, more years of statin use was associated with higher risk of

developing peripheral neuropathy. Typically, long-term use of statins is defined as

two years or more but neuropathy can occur even after just a few days of use in a

susceptible individual.

Doctor awareness is low

More surprisingly, in a study by Dr. Beatrice Golomb [6] at UCSD, patients

reportedly spoke to their physician about the possible connection between statin

use and their symptom. Patients reported that they and not their doctor most

commonly initiated the discussion regarding the possible connection of the statin

drug to their symptoms — 98% v 2% cognition survey, 96% v 4% neuropathy

survey, 86% v 14% muscle survey; p < 10(-8) for each. Physicians were reportedly

more likely to deny than affirm the possibility of a connection between statin drug

therapies and patient symptoms. Doctors even rejected a possible connection for

symptoms with strong literature support for a drug connection, and even in patients

for whom the symptom met presumptive literature-based criteria for probable or

definite drug-adverse effect causality.

Chiropractors should become aware of the damaging effects of statin drugs on their

patients’ health and their own clinical outcomes. With the high percentage of

people taking statin drugs in the general public and in those entering the

chiropractic clinics, proper diagnosis and treatment of drug-induced neuropathies

is essential.

The topic of neuropathy as it relates to diabetes or cholesterol drugs is far more

extensive than can be covered in this short article. To learn more, call

910-251-1620

References

1. Jacobs MB: “HMG-CoA reductase inhibitor therapy and peripheral neuropathy.”

Ann Intern Med. 1994 Jun 1;120(11):970.

2. Formaglio M, Vial C: “Statin induced neuropathy: myth or reality?” Rev Neurol

(Paris). 2006 Dec;162(12):1286-9.

3. de Langen JJ, van Puijenbroek EP: “HMG-CoA-reductase inhibitors and

neuropathy: reports to the Netherlands Pharmacovigilance Centre.” Neth J Med.

2006 Oct;64(9):334-8.

4. Law M, Rudnicka AR: “Statin safety: a systematic review.” Am J Cardiol. 2006

Apr 17;97(8A):52C-60C.

5. Gaist D, Jeppesen U, et al: “Statins and risk of polyneuropathy: a case-control

study.” Neurology. 2002 May 14;58(9):1333-7.

6. Golomb BA, McGraw JJ, Evans MA, Dimsdale JE: “Physician response to

patient reports of adverse drug effects: implications for patient-targeted adverse

effect surveillance.” Drug Saf. 2007;30(8):669-75.

Dr. Alaimo is currently a member of the Neuropathy Treatment Centers of America.

Clinical topic
    Evidence-Based Spine Surgery 2009; 5: 17-33
DOI: 10.1055/s-0028-1100858

© Georg Thieme Verlag KG Stuttgart · New York

Lumbar radiculopathy
Epidural injection of steroid and pain medication versus placebo

Summary

Epidural steroid injections for treatment of sciatica did not confer
significant additional benefit over placebo injection in patients who
had had symptoms for less than one year. While steroid injections may
afford short-term improvements in pain and movement, this beneficial
effect was transient, and there was no statistical difference between
active and placebo treatments after 4 weeks of follow-up. Treatment of
sciatica with epidural steroids has exhibited no significant
functional benefit, nor does it reduce the need for surgery. Outcomes
varied minimally by injection site across studies, not based on direct
comparisons.