December 7, 2005

Neuropathy News: Getting Off the Pain Train

Burning feet, tingling hands, numb toes—the symptoms of HIV-related peripheral neuropathy can be torture. Just ask the 30% of people with HIV who suffer from PN—often misdiagnosed as depressed because the pain is so bad and scrambling daily to piece together scant relief from topical creams and pills. Some PN is caused by the virus itself, while other cases are from HIV med side effects. But either way, it’s “the 500-pound gorilla in the room whenever HIV is discussed,” says neuropsychologist David Dorfman, MD, of Mt. Sinai Hospital in New York, whose medical school is studying these four promising remedies:

1.  Self-hypnosis
This exercise, which involves training your mind to feel peace and comfort in place of pain, has had some success with chemotherapy patients. The Mt. Sinai study, already underway, starts with a six-week observation of how each participant handles PN pain—in order to avoid what Dorfman calls “the experimenter effect,” the placebolike process whereby “participating in a study itself [often] relieves symptoms.” Subjects receive training and a CD to take home with them—and upload to their iPods, if they like. “It’s basically a form of guided meditation,” Dorfman explains. Then they are monitored for seven weeks to gauge the effect of hypnosis on their pain—and whether people keep up with the sessions.

2. Lyrica
This little pill is already approved for diabetic PN. Diabetic and HIV-related PN have somewhat different roots, though, so researchers aren't quite sure how Lyrica will fare with the HIV variety.

3. epoetin
Can this anemia drug stop the ache? The researchers are betting it can. “It’s thought that EPO [is] a neuro-protective agent,” says Mt. Sinai’s Mary-Catherine George. It binds to cells and blocks pain signals from being sent to the brain in the first place. The study, now being reviewed for approval by the FDA, would be a first.

4. capsaicin patches
At an upcoming AIDS conference, the Mt. Sinai group will present promising anti-pain results from an especially successful study completed earlier this year on high-dose capsaicin patches—featuring the spicy stuff in hot red peppers.

For information on enrolling in any of the above neuropathy studies, call Alexandra Nmashie at 212.241.0762 or visit www.clinicaltrials.gov.

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