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Intuitive Eating with Gina & Erin | #balancewithbabz

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Jan 2022 Lymphedema Nutrition School Live Weekly Classes

In this program you will be learning all about the research that has been published about lymphedema nutrition, you will discover the triggers for your lymphedema and set and achieve goals to improve your lymphedema and your health.

You want to know what foods increase lymphedema

You want to know what the research really says about lymphedema diet and supplements

You want to identify your personal lymphedema triggers

You want to get your cravings and your weight under control

You want to set and achieve your nutrition goals

You want to improve your overall health and nutrition

You want to meet others with lymphedema that are making a positive change

You want to use all tools available to manage your lymphedema included guided meditation

After taking Lymphedema Nutrition School I now feel so well informed and I understand what I need to do to help myself. In the past I have found myself overwhelmed with information by looking at different sources that I ended up not engaging. Lymphedema Nutrition School and Jean's style of teaching has made everything fall into place. I particularly like how she explains in layman's terms how our bodies work and her approach in encouraging us to watch our own bodies and learn from what is happening. It's also really helpful how Jean talk's about making our own decisions, for example, I can have takeaway if I want, but I need to decide if it's worth it or not. Listening to each other's experiences and Jean's feedback and tips are a great way of improving knowledge and inspires me to apply the knowledge. Also, the guided hypnotherapy at the end of each class is great!

I was very overwhelmed when I made the decision to enroll in Lymphedema Nutrition School. Overwhelmed with life , all the info I was reading and various medical perspectives. I knew I was missing an important "key" and was tired of working so hard and only keeping the lymphedema almost managed and not losing weight. Lymphedema Nutrition School has been life changing for me. My MLD therapist noticed a big change in me, physically and emotionally. When we are done I will sign up with Jean for one on one weight loss sessions to continue my journey. I was sitting in the middle of a forest and couldn't see the pathway. I wanted someone to drag me out of the forest. You have lit up the pathway so that I can find my way out. I have to do it and with the awareness you and the group are sharing I finally have the hope that I see the clearing.

At first, I was thinking, "what?! No eating plan?" And now, I'm just so grateful. Because you give us all the tools to make empowered choices. And clearly, for me, the last 2 weeks have been so helpful. I'm learning so much -- this really is an awesome course! I feel like you're giving us great info in bite-sized pieces so it's not too overwhelming. Also, I love the group format. I've learned so much from my fellow attendees.

This program was so valuable! Instead of listening to other lymphedema patients say "you should eat this", "don't eat that", "this diet will help" - here was the one place where I could focus on me. With a complete, comprehensive approach to many aspects of nutrition, Jean guided us through a path of learning, understanding, watching/feeling our individual bodies and making choices/decisions that work for me. Not only is my "lymphie leg" happy, my whole body is smiling at the improvements made!! So worth the time and money invested for Lymphedema Nutrition School.

Tuesdays

Beginning January 25th, 2022 1:00 pm - 2:30 pm ET/10:00-11:30 am PT

Registered Dietitian and Author

Jean LaMantia

Jean LaMantia is a registered dietitian, cancer survivor, author and speaker. In 2019 she published The Complete Lymphedema Management and Nutrition Guide and presented her findings at both the Canadian and American National Lymphedema Conferences. She is passionate about helping you to achieve your goals and using nutrition to improve lymphedema and overall health. As well as lymphedema, she also specializes in cancer risk reduction and intermittent fasting.

Email

Yes. I Want To Join!

I want to join the Lymphedema Nutrition School and learn how what I eat can affect my lymphedema. To get my lymphedema, my cravings and my weight better controlled.

Included! A signed copy of The Complete Lymphedema Management and Nutrition Guide

If you live in Canada or the U.S. I will send a signed copy of my book to you from my home. If you live somewhere else, your copy will be unsigned and will be shipped from a local bookseller.

Time Limited Bonuses!

Join Before January 15th (Space permitting)

Bonus #1. Digital Download of the Cancer Risk Reduction Guide

The Cancer Risk Reduction Guide was created by me to provide specific food and lifestyle guidelines to reduce the risk of a first cancer or a recurrence. It includes a section on the anti-inflammatory diet which is critical for lymphedema management.

Bonus #2. Use coupon code "Jan15" at check-out before Sept 7th.

Class is limited to 20 students.

I would like to acknowledge that the land on which I live and conduct my business is the traditional territory of the Wendat, the Chippewe, the Anishnabeg, Haudenosaunee, Métis, and the Mississaugas of the New Credit First Nation. Today, this place is still the home to many Indigenous people from across Turtle Island and I am grateful to have the opportunity to live and work on this land.

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When you have lymphedema, what you eat matters. In this program, you will learn about the nutrition research on lymphedema, and set goals for yourself. This is a 10 week group coaching program that can be done either live or as a self-study program.

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Self Manual Lymph Drainage (arm) | #balancewithbabz

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Jean LaMantia - Registered Dietitian in Toronto, ON

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Manual Lymph Drainage (LEG) | #balancewithbabz

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Jean LaMantia - Registered Dietitian in Toronto, ON

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Jean LaMantia - Registered Dietitian - Nutrition Counselling

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Jean LaMantia, Registered Dietitian in Toronto, offers diet and nutrition counselling to achieve weight goals, reduce lymphedema, and reduce cancer risk.

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Klose Helpful Videos for MLD and bandaging 

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Klose Helpful Videos for MLD and bandaging 

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Living With Lymphedema | #balancewithbabz

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Intro To The Lymphatic System & Lymphedema | Balance With Babz

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The lymphatic system has three primary functions. First of all, it returns excess interstitial fluid to the blood. Of the fluid that leaves the capillary, about 90 percent is returned. The 10 percent that does not return becomes part of the interstitial fluid that surrounds the tissue cells. Small protein molecules may "leak" through the capillary wall and increase the osmotic pressure of the interstitial fluid. This further inhibits the return of fluid into the capillaries, and fluid tends to accumulate in the tissue spaces. If this continues, blood volume and blood pressure decrease significantly and the volume of tissue fluid increases, which results in edema (swelling). Lymph capillaries pick up the excess interstitial fluid and proteins and return them to the venous blood. After the fluid enters the lymph capillaries, it is called lymph.

The second function of the lymphatic system is the absorption of fats and fat- soluble vitamins from the digestive system and the subsequent transport of these substances to the venous circulation. The mucosa that lines the small intestine is covered with fingerlike projections called villi. There are blood capillaries and special lymph capillaries, called lacteals, in the center of each villus. The blood capillaries absorb most nutrients, but the fats and fat-soluble vitamins are absorbed by the lacteals. The lymph in the lacteals has a milky appearance due to its high fat content and is called chyle.

The third and probably most well known function of the lymphatic system is defense against invading microorganisms and disease. Lymph nodes and other lymphatic organs filter the lymph to remove microorganisms and other foreign particles. Lymphatic organs contain lymphocytes that destroy invading organisms.

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The lymphatic system has three primary functions. First of all, it returns excess interstitial fluid to the blood. Of the fluid that leaves the capillary, about 90 percent is returned. The 10 percent that does not return becomes part of the interstitial fluid that surrounds the tissue cells.

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Centers for Disease Control and Prevention

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Cancer or cancer treatment can cause lymphedema. We answer common questions about lymphedema and offer tips for managing it.

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Lymphedema - how do I reduce my risk? |#balancewithbabz

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Lymphedema Prevention

People who have had surgery to remove lymph nodes in the armpit should be aware of those activities that put too much pressure on the affected arm. Protective measures to avoid injury and infection include:

Maintaining Proper Hygiene

Clean the skin of the affected arm daily and apply lotion. When drying the arm, be gentle but thorough.

Take proper care of the fingernails and avoid cutting cuticles.

Clean all cuts with soap and water, and then apply antibacterial ointment and a sterile dressing.

Staying Fit

Do exercises regularly to improve drainage, but first consult with your doctor or physical therapist.

Eat a well-balanced, low-sodium diet.

Keep the arm elevated when possible.

Taking Precaution with Everyday Activities

Protect your fingers from needle pricks and sharp objects. Use a thimble when sewing.

Avoid vigorous, repetitive movements against resistance, such as scrubbing, pulling or pushing, with the affected arm.

Avoid sunburns and other burns to the affected arm.

Use an electric shaver when shaving underarms.

Wearing the Right Attire

Wear gloves when gardening and when using strong household detergents.

Do not wear nightgowns or clothing with elastic cuffs.

Carry your handbag or heavy packages in the unaffected arm.

Speaking Up at Your Doctor's Office

Make sure that all injections are given and blood tests are drawn in the unaffected arm.

If at all possible, have all blood pressure tests done on the unaffected arm.

Avoid extreme hot or cold temperatures on the affected arm, such as heating pads or ice packs.

Notify your doctor immediately of any signs of infection, such as redness, pain, heat, increased swelling or fever.

Talk with your doctor about what you can do to try to prevent lymphedema from happening to you. If lymphedema does develop, let your doctor know right away. There are things you can do to try to keep it from getting worse.

Lymphedema Causes

Lymphedema occurs as a result of a blockage in the lymphatic system. This is most often caused by a traumatic event, such as sports injuries or deep cuts and bruises, as an aftereffect of surgery or cancer treatment. More rarely, lymphedema can occur as birth defect or symptom of infection.

Lymphedema Diagnosis

There are no specific diagnostic tests for lymphedema. The doctor will complete a medical history and physical examination. The medical history may include questions regarding the following:

Past surgeries

Problems following the surgeries

Onset of symptoms (When did the swelling appear?)

History of edema (severe swelling)

Current medications

Other medical conditions, such as high blood pressure, heart disease or diabetes

Stages

Upon diagnosis, your doctor will identify which stage best characterizes your lymphedema and diagnose treatment accordingly. Depending on how the swelling has progressed, your doctor will identify the following stages:

Stage 1: Abnormal flow in the lymphatic system. No signs or symptoms

Stage 2: Accumulation of fluid with swelling. Swelling resolves with elevation. Pressing on the area may leave a dent

Stage 3: Permanent swelling that does not resolve with elevation. Pressing on the area no longer leaves a dent. Changes in the skin with scarring and thickening

Stage 4: Elephantiasis (large deformed limb), skin thickening with "wart-like" growth and extensive scarring

Lymphedema Treatment

Decongestive Therapy for Lymphedema

Treatment for lymphedema depends on the severity and extent of the condition. Prevention and controlling lymphedema play an important role with this condition since there is no cure.

Decongestive treatment is commonly recommended for the first two stages of lymphedema. Treatment options may include:

Exercise. Exercise helps to restore flexibility and strength, and it improves drainage. Specific exercises will be recommended by your doctor and/or physical therapist.

Bandage. Wearing a customized compression sleeve or elastic bandage may help to prevent an accumulation of fluid.

Arm pump. Applying an arm pump often helps to increase the fluid flow in the lymphatic vessels and keeps fluid from collecting in the arm.

Diet. Eating a well-balanced diet and controlling body weight is an important part of treatment.

Keep the arm raised. Keeping the arm raised above the level of the heart, whenever possible, allows gravity to help drain the accumulated fluid.

Infection Prevention. It is important to follow preventive measures, such as good skin care, to protect the affected arm from infection and skin breakdown.

Lymphedema Surgery | Q&A

Surgical Treatment of Lymphedema

Once lymphedema has progressed to stages 3 or 4, surgical intervention may be recommended. Surgical options include both physiological and excisional procedures. Both procedures aim to restore lymphatic flow. However, physiological procedures involve rewiring the lymphatic system within the limb, while excisional procedures focus on removing diseased tissue.

Physiological Procedures (may be recommended for stages 3 and 4)

Vascularized lymph node transfer. The surgeon transfers healthy lymph nodes to the affected area and rewires the lymphatic system to reduce swelling.

Lymphaticovenous anastomosis (also referred to as lymphovenous bypass). The surgeon rewires the lymphatic system by connecting lymphatic channels directly to tiny veins nearby. This is an outpatient procedure with very small and minimal incisions and very little blood loss.

Excisional Procedures (may be recommended for stages 3, 4 or 5)

Liposuction. The affected tissue can be removed.

Charles procedure. The surgeon will remove affected tissue and use a part of it as skin grafts to repair the area. This is a more invasive procedure, typically recommended for stages 4 and 5.

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People who have had surgery to remove lymph nodes in the armpit should be aware of those activities that put too much pressure on the affected arm. Protective measures to avoid injury and infection include: Clean the skin of the affected arm daily and apply lotion. When drying the arm, be gentle but thorough.

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One of the cheapest most effective ways to #movethatlymph for lymphedema self management is dry brushing. I personally started dry brushing in 2015 and love it.

This is a technique using soft strokes against the skin to stimulate your lymphatic system with a body brush. It is not skin exfoliation, but rather a unique, gentle twist on performing self manual lymphatic drainage. Another potential tool in our lymphedema toolbox which may or may not work for you.

Skincare is of upmost importance with lymphedema. This short blog post is my personal patient perspective followed up with two references to professionals with expertise in the lymphatic world.

I also answer a hidden trivia question posted on my page. See if you can find it.

Patient to Patient Tips

You can buy a dry brush at any drug store or big box retailer for less than $10. It is best to feel it first. I once bought an expensive brush online, and it was very coarse. What might feel coarse to me may not feel coarse to you, so find a brush you like and then reorder online when you have to replace it.

You want your brush to be soft and non abrasive enough to use on your skin every morning or as frequently as needed.

I have had many types. Some with the long handle and some with no handle. I'm a short person, and for some reason I find the ones with the handle very cumbersome because my arms are not very long. Your preference might be different. I love the round brush with no handle like this one from Amazon.

Lymphedema Dry Brushing

It is generally recommended to do first thing in the morning before showering and donning your compression. However, some people who shower at night may dry brush then too. Remember to moisturize afterwards.

Most people start at their feet. The difference for me is I would start brushing to clear the trunk first, just like your Certified Lymphedema Therapist would for manual lymphatic drainage and follow the same pathways but with the brush instead of your hands.

Do it very lightly. In this instance, less pressure is more.

Professional How To

Below you will find two medical professional resources from incredibly knowledgeable people in the lymphatic community. I am honored to know both of them personally and have had both speak in my groups to share their expertise.

One is for those of us who are visual learners, and the other is for those of us who prefer a book. Use either or both resources like I do!

Videos

Check out Natural Health Resources YouTube Channel for videos on lymphatic dry brushing and its benefits.

Dr. Melissa Gallagher is a naturopathic doctor who shares a variety of videos, some of which relate directly to the lymphatic system.

Books

Check out Swollen, Bloated and Puffy in paperback by Kathleen Lisson CMT, CLT. A manual lymphatic drainage therapist's guide to reducing swelling in the face and body.

There's a chapter on dry brushing and more tips on self management of swelling. Another book is the Lipedema Treatment Guide.

Dry Brush Maintenance

Since you are sloughing dead skin cells off your body, you need a proper brush maintenance schedule. I had to look up recommendations.

Cleaning The Brush

"..After each dry brush, spritz the bristles with an organic tea tree spray and leave to hang in a well ventilated area. For a great clean, wash in hot soapy water with a Tea Tree Oil Soap once a week and leave in the sun to dry or a well ventilated area, with bristles facing down."

Replace brushes every 6-12 months.

Cleaning Schedule Guide

"As a guide, if you dry brush daily, it is best to clean your brush once a week.

If you dry brush every 2nd to 3rd day, it is best to clean your brush once a fortnight and if you dry brush once a week, it is best to clean your brush once a month." (Via bodecare.com)

I hope you found the above quick blog post useful, or at the very least have a starting point to look further into it. If you are an existing dry brush user, share your tips in the comments below.

Wishing you great lymphatic health,

Lymphie Strong

#drybrush #drybrushing #bodycare #lymphaticdrainage #lymphedema #lymph #lymphedemaawareness #lymphiestrong #movethatlymph

Learning more and connecting with others can be a source of support and comfort.
Visit our lymphedema groups to find what's right for you.

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One of the cheapest most effective ways to #movethatlymph for lymphedema self management is dry brushing. I personally started dry brushing in 2015 and love it. This is a technique using soft strokes against the skin to stimulate your lymphatic system with a body brush. It is not skin exfoliation, but rather a unique, gentle...

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NLN March 16, 2021 - Self-MLD for Lymphedema in One Leg and in Both Legs

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Jeannette Zucker, Executive Director of National Lymphedema Network (NLN), provides a demonstration of self-MLD (manual lymphatic drainage) for lymphedema in one leg and for lymphedema in both legs.

© 2021 National Lymphedema Network. All rights reserved.

Disclaimer - Inclusion of sponsored products and/services in this webinar does not constitute the National Lymphedema Network's endorsement, guarantee of quality, or claim of value made by the manufacturer, distributor, owner, or service provider. The National Lymphedema Network aims to simply connect patients and health care professionals to information they may find useful when exploring treatment options, educational opportunities, and current information related to lymphedema and related conditions. The views and opinions included in this webinar, including any research article references, are those of the author(s) and do not necessarily reflect the official policy or position of the National Lymphedema Network. The information is provided solely for general education and informational purposes. Use of the advice and information contained herein is at your sole choice and risk. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. Always consult your physician or healthcare provider before beginning any nutrition, therapy, or exercise program. If you choose to use this information without prior consent of your physician, you are agreeing to accept full responsibility for your decisions and agreeing to hold harmless the National Lymphedema Network.

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0:00 / 2:11•Watch full video

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Compression Garments For Arm, Leg & Chest/Breast Lymphedema | Balance With Babz

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NLN March 21, 2021 - Compression Garments for the Leg, Donning & Doffing

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© 2021 National Lymphedema Network. All rights reserved.

Disclaimer - Inclusion of sponsored products and/services in this webinar does not constitute the National Lymphedema Network's endorsement, guarantee of quality, or claim of value made by the manufacturer, distributor, owner, or service provider. The National Lymphedema Network aims to simply connect patients and health care professionals to information they may find useful when exploring treatment options, educational opportunities, and current information related to lymphedema and related conditions. The views and opinions included in this webinar, including any research article references, are those of the author(s) and do not necessarily reflect the official policy or position of the National Lymphedema Network. The information is provided solely for general education and informational purposes. Use of the advice and information contained herein is at your sole choice and risk. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. Always consult your physician or healthcare provider before beginning any nutrition, therapy, or exercise program. If you choose to use this information without prior consent of your physician, you are agreeing to accept full responsibility for your decisions and agreeing to hold harmless the National Lymphedema Network.

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Yoga For Lymphatic Drainage (live) | #balancewithbabz

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15 Best Lymphatic Cancer Books of All Time

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15 Best Lymphatic Cancer Books of All Time

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The 15 best lymphatic cancer books, such as LYMPHATIC DIET COOKBOOK, Reflexology Lymph Drainage and A Kingdom of Tender Colors.

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What is the Lymphatic System? (Part 1: Anatomy and Physiology)

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Lymphatic System: Crash Course Anatomy & Physiology #44

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NLN March 17, 2021 - Intimacy & Emotions in the Setting of Lymphedema

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Erica Rodas, Occupational Therapist, discuss intimacy and emotional health in the setting of lymphedema. 

© 2021 National Lymphedema Network. All rights reserved.

Disclaimer - Inclusion of sponsored products and/services in this webinar does not constitute the National Lymphedema Network's endorsement, guarantee of quality, or claim of value made by the manufacturer, distributor, owner, or service provider. The National Lymphedema Network aims to simply connect patients and health care professionals to information they may find useful when exploring treatment options, educational opportunities, and current information related to lymphedema and related conditions. The views and opinions included in this webinar, including any research article references, are those of the author(s) and do not necessarily reflect the official policy or position of the National Lymphedema Network. The information is provided solely for general education and informational purposes. Use of the advice and information contained herein is at your sole choice and risk. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. Always consult your physician or healthcare provider before beginning any nutrition, therapy, or exercise program. If you choose to use this information without prior consent of your physician, you are agreeing to accept full responsibility for your decisions and agreeing to hold harmless the National Lymphedema Network.

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BalanceWithBabz@gmail.com

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Klose Training Website with helpful information 

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Klose Training Website with helpful information 

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Print FriendlyWhat is Lymphedema? Lymphedema is the swelling of a body part, most often the extremities. It can also occur in the face, neck, abdomen or genitals. Lymphedema is the result of the abnormal accumulation of protein rich edema fluid in the affected area. Remarkably, even though

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About Lymphedema

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What is lymphedema?

Lymphedema is a term used to describe the accumulation of protein-rich fluid (called lymph) in a particular part of the body, resulting in swelling of the affected area(s). The lymphatic system is made up of a network of lymphatic vessels, lymph nodes and other lymph tissue. It forms part of both the circulatory and immune systems, and is essential for both the transport of lymph and the body's immune function. Lymphedema occurs either because the lymphatic system isn't working properly, or there is simply too much fluid for a normal lymphatic system to process.

Types of lymphedema

Traditionally, there are two types of lymphedema, primary and secondary. Primary lymphedema occurs as a result of congenital abnormalities of the lymphatic system. Symptoms may be present from birth or appear later in life. Secondary lymphedema occurs due to damage to a previously intact lymphatic system. A common cause of secondary lymphedema is cancer or its treatment.

Signs and symptoms of lymphedema

Lymphedema is not easy to diagnose because sometimes first symptoms occur after many years. Nevertheless, it is important to get the accurate diagnose and treatment as soon as possible.

feeling of heaviness, tightness or fullness

aching of the affected area

clothing or jewellery feeling tighter

visible swelling

First signs of lymphedema include:

feeling of heaviness, tightness or fullness

aching of the affected area

clothing or jewellery feeling tighter

visible swelling

Diagnosis of lymphedema

Diagnosis of lymphedema requires assessment by a doctor or healthcare professional who has undergone specialist training in lymphedema assessment and its management. Early diagnosis is essential to facilitate timely treatment. Receiving lymphedema risk-reduction education is also important for those at risk of the development of secondary lymphedema. See also, Diagnosis.

Stages of lymphedema

Following an accurate diagnosis, lymphedema may be classified into different stages. While there are a number of different staging systems utilised internationally, the International Society of Lymphology (ISL) Lymphedema staging system is commonly used, as outlined in the table below adapted from the Lymphedema Framework, 2006.

A subclinical state where swelling is not evident despite impaired lymph transport.

This stage may exist for months or years before edema becomes evident.

This represents early onset of the condition where there is accumulation of tissue

fluid that subsides with limb elevation. The edema may be pitting at this stage.

Limb elevation alone rarely reduces swelling and pitting is manifest.

There may or may not be pitting as tissue fibrosis is more evident.

The tissue is hard (fibrotic) and pitting is absent. Skin changes such as thickening,

hyperpigmentation, increased skin folds, fat deposits and warty overgrowths

develop.

Treatment for lymphedema

While lymphedema is a chronic condition with no cure at this time, there are many treatment options available. Treatment plans should be holistic, multidisciplinary and coordinated. The goals of lymphedema treatment should be to optimise lymph flow, reduce (and maintain) swelling and improve skin condition. Achieving these goals will also reduce the risk of cellulitis (also called, erysipelas).

While mild lymphedema may be managed with exercise, skin care and compression stockings, more advanced lymphedema may require a course of complete decongestive therapy (CDT). CDT is considered the 'gold standard' of lymphedema treatment, and consists of an initial reductive phase, followed by a maintenance phase.

CDT consists of a combination of:

manual lymphatic drainage (MLD)

multi-layer compression bandaging followed by compression stockings

exercise

skin care

education

Additional treatments may include intermittent pneumatic compression therapy (IPC), laser or lymph taping. A number of surgical interventions are also available for the management of lymphedema, all of which require long-term post-surgical compression therapy.

Discover our Products for Lymphedema

that might interest you as well

Compression Socks for Exercise

If you want to lead a healthy and active lifestyle while effectively managing your venous problems , then JOBST Sport is the perfect fit.

Varicose Veins what exactly are Varicose Veins?

Varicose veins are bluish blood vessels, often visible at the back of the knee, or on the lower leg and ankle. They are fairly common and, in the long term, many people will develop them at some point.

Lymphoedema Framework. Best Practice for the Management of Lymphoedema. International consensus. London: MEP Ltd, 2006.

Wounds UK Best Practice Statement (2015) Compression hosiery (2nd edn). London: Wounds UK. Available to download from: www.wounds-uk.com.

BSN medical

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What is lymphedema? Lymphedema is a term used to describe the accumulation of protein-rich fluid (called lymph) in a particular part of the body, resulting in swelling of the affected area(s). The lymphatic system is made up of a network of lymphatic vessels, lymph nodes and other lymph tissue.

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Overview

Lymphedema refers to swelling that generally occurs in one of your arms or legs. Sometimes both arms or both legs swell.

Lymphedema is most commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment. It results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.

While there is presently no cure for lymphedema, it can be managed with early diagnosis and diligent care of your affected limb.

Symptoms

Lymphedema signs and symptoms, which occur in your affected arm or leg, include:

Swelling of part or all of your arm or leg, including fingers or toes

A feeling of heaviness or tightness

Restricted range of motion

Aching or discomfort

Recurring infections

Hardening and thickening of the skin (fibrosis)

The swelling caused by lymphedema ranges from mild, hardly noticeable changes in the size of your arm or leg to extreme changes that make the limb hard to use. Lymphedema caused by cancer treatment may not occur until months or years after treatment.

When to see a doctor

Make an appointment with your doctor if you notice persistent swelling in your arm or leg.

If you already have the diagnosis of lymphedema of a limb, see your doctor if there is a sudden dramatic increase in the size of the involved limb, as it may suggest a new process is occurring.

Causes

Your lymphatic system is crucial to keeping your body healthy. It circulates protein-rich lymph fluid throughout your body, collecting bacteria, viruses and waste products. Your lymphatic system carries this fluid and harmful substances through your lymph vessels, which lead to lymph nodes. The wastes are then filtered out by lymphocytes - infection-fighting cells that live in your lymph nodes - and ultimately flushed from your body.

Lymphedema occurs when your lymph vessels are unable to adequately drain lymph fluid, usually from an arm or leg. Lymphedema can be either primary or secondary. This means it can occur on its own (primary lymphedema), or it can be caused by another disease or condition (secondary lymphedema). Secondary lymphedema is far more common than primary lymphedema.

Causes of secondary lymphedema

Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. Causes include:

Surgery. Removal of or injury to lymph nodes and lymph vessels may result in lymphedema. For example, lymph nodes may be removed to check for spread of breast cancer, and lymph nodes may be injured in surgery that involves blood vessels in your limbs.

Radiation treatment for cancer. Radiation can cause scarring and inflammation of your lymph nodes or lymph vessels.

Cancer. If cancer cells block lymphatic vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessel could enlarge enough to block the flow of the lymph fluid.

Infection. An infection of the lymph nodes or parasites can restrict the flow of lymph fluid. Infection-related lymphedema is most common in tropical and subtropical regions and is more likely to occur in developing countries.

Causes of primary lymphedema

Primary lymphedema is a rare, inherited condition caused by problems with the development of lymph vessels in your body. Specific causes of primary lymphedema include:

Milroy's disease (congenital lymphedema). This disorder begins in infancy and causes lymph nodes to form abnormally.

Meige's disease (lymphedema praecox). This disorder often causes lymphedema around puberty or during pregnancy, though it can occur later, until age 35.

Late-onset lymphedema (lymphedema tarda). This occurs rarely and usually begins after age 35.

Risk factors

Factors that may increase your risk of developing lymphedema after cancer, from cancer treatment or from other secondary causes include:

Older age

Excess weight or obesity

Rheumatoid or psoriatic arthritis

Complications

Lymphedema in your arm or leg can lead to serious complications, such as:

Infections. Possible infections that can result from lymphedema include a serious bacterial infection of the skin (cellulitis) and an infection of the lymph vessels (lymphangitis). The smallest injury to your arm or leg can be an entry point for infection.

Lymphangiosarcoma. This rare form of soft tissue cancer can result from the most-severe cases of untreated lymphedema. Possible signs of lymphangiosarcoma include blue-red or purple marks on the skin.

Prevention

If you have had or you are going to have cancer surgery, ask your doctor whether your procedure will involve your lymph nodes or lymph vessels. Ask if your radiation treatment will be aimed at lymph nodes, so you'll be aware of the possible risks.

To reduce your risk of lymphedema, try to:

Protect your arm or leg. Avoid injury to your affected limb. Cuts, scrapes and burns can invite infection. Protect yourself from sharp objects. For example, shave with an electric razor, wear gloves when you garden or cook, and use a thimble when you sew. If possible, avoid medical procedures, such as blood draws and vaccinations, in your affected limb.

Rest your arm or leg while recovering. After cancer treatment, exercise and stretching are encouraged. But avoid strenuous activity until you've recovered from surgery or radiation.

Avoid heat on your arm or leg. Don't apply ice or heat, such as with a heating pad, to your affected limb. Also, protect your affected limb from extreme cold.

Elevate your arm or leg. Whenever possible, elevate your affected limb above the level of your heart.

Avoid tight clothing. Avoid anything that could constrict your arm or leg, such as tightfitting clothing and, in the case of your arm, blood pressure cuffs. Ask that your blood pressure be taken in your other arm.

Keep your arm or leg clean. Make skin and nail care high priorities. Inspect the skin on your arm or leg daily, watching for changes or breaks in your skin that could lead to infection. Don't go barefoot.

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Lymphedema refers to swelling that generally occurs in one of your arms or legs. Sometimes both arms or both legs swell. Lymphedema is most commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment. It results from a blockage in your lymphatic system, which is part of your immune system.

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Overview

Lymphedema refers to swelling that generally occurs in one of your arms or legs. Sometimes both arms or both legs swell.

Lymphedema is most commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment. It results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.

While there is presently no cure for lymphedema, it can be managed with early diagnosis and diligent care of your affected limb.

Symptoms

Lymphedema signs and symptoms, which occur in your affected arm or leg, include:

Swelling of part or all of your arm or leg, including fingers or toes

A feeling of heaviness or tightness

Restricted range of motion

Aching or discomfort

Recurring infections

Hardening and thickening of the skin (fibrosis)

The swelling caused by lymphedema ranges from mild, hardly noticeable changes in the size of your arm or leg to extreme changes that make the limb hard to use. Lymphedema caused by cancer treatment may not occur until months or years after treatment.

When to see a doctor

Make an appointment with your doctor if you notice persistent swelling in your arm or leg.

If you already have the diagnosis of lymphedema of a limb, see your doctor if there is a sudden dramatic increase in the size of the involved limb, as it may suggest a new process is occurring.

Causes

Your lymphatic system is crucial to keeping your body healthy. It circulates protein-rich lymph fluid throughout your body, collecting bacteria, viruses and waste products. Your lymphatic system carries this fluid and harmful substances through your lymph vessels, which lead to lymph nodes. The wastes are then filtered out by lymphocytes - infection-fighting cells that live in your lymph nodes - and ultimately flushed from your body.

Lymphedema occurs when your lymph vessels are unable to adequately drain lymph fluid, usually from an arm or leg. Lymphedema can be either primary or secondary. This means it can occur on its own (primary lymphedema), or it can be caused by another disease or condition (secondary lymphedema). Secondary lymphedema is far more common than primary lymphedema.

Causes of secondary lymphedema

Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. Causes include:

Surgery. Removal of or injury to lymph nodes and lymph vessels may result in lymphedema. For example, lymph nodes may be removed to check for spread of breast cancer, and lymph nodes may be injured in surgery that involves blood vessels in your limbs.

Radiation treatment for cancer. Radiation can cause scarring and inflammation of your lymph nodes or lymph vessels.

Cancer. If cancer cells block lymphatic vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessel could enlarge enough to block the flow of the lymph fluid.

Infection. An infection of the lymph nodes or parasites can restrict the flow of lymph fluid. Infection-related lymphedema is most common in tropical and subtropical regions and is more likely to occur in developing countries.

Causes of primary lymphedema

Primary lymphedema is a rare, inherited condition caused by problems with the development of lymph vessels in your body. Specific causes of primary lymphedema include:

Milroy's disease (congenital lymphedema). This disorder begins in infancy and causes lymph nodes to form abnormally.

Meige's disease (lymphedema praecox). This disorder often causes lymphedema around puberty or during pregnancy, though it can occur later, until age 35.

Late-onset lymphedema (lymphedema tarda). This occurs rarely and usually begins after age 35.

Risk factors

Factors that may increase your risk of developing lymphedema after cancer, from cancer treatment or from other secondary causes include:

Older age

Excess weight or obesity

Rheumatoid or psoriatic arthritis

Complications

Lymphedema in your arm or leg can lead to serious complications, such as:

Infections. Possible infections that can result from lymphedema include a serious bacterial infection of the skin (cellulitis) and an infection of the lymph vessels (lymphangitis). The smallest injury to your arm or leg can be an entry point for infection.

Lymphangiosarcoma. This rare form of soft tissue cancer can result from the most-severe cases of untreated lymphedema. Possible signs of lymphangiosarcoma include blue-red or purple marks on the skin.

Prevention

If you have had or you are going to have cancer surgery, ask your doctor whether your procedure will involve your lymph nodes or lymph vessels. Ask if your radiation treatment will be aimed at lymph nodes, so you'll be aware of the possible risks.

To reduce your risk of lymphedema, try to:

Protect your arm or leg. Avoid injury to your affected limb. Cuts, scrapes and burns can invite infection. Protect yourself from sharp objects. For example, shave with an electric razor, wear gloves when you garden or cook, and use a thimble when you sew. If possible, avoid medical procedures, such as blood draws and vaccinations, in your affected limb.

Rest your arm or leg while recovering. After cancer treatment, exercise and stretching are encouraged. But avoid strenuous activity until you've recovered from surgery or radiation.

Avoid heat on your arm or leg. Don't apply ice or heat, such as with a heating pad, to your affected limb. Also, protect your affected limb from extreme cold.

Elevate your arm or leg. Whenever possible, elevate your affected limb above the level of your heart.

Avoid tight clothing. Avoid anything that could constrict your arm or leg, such as tightfitting clothing and, in the case of your arm, blood pressure cuffs. Ask that your blood pressure be taken in your other arm.

Keep your arm or leg clean. Make skin and nail care high priorities. Inspect the skin on your arm or leg daily, watching for changes or breaks in your skin that could lead to infection. Don't go barefoot.

# data[].attributes.attachment_link.description
Lymphedema refers to swelling that generally occurs in one of your arms or legs. Sometimes both arms or both legs swell. Lymphedema is most commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment. It results from a blockage in your lymphatic system, which is part of your immune system.

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Find out more about this potentially serious skin infection and how a few simple skin care tips can help prevent it.

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Incorporating pelvic floor exercises in complete decongestive therapy for females with lower extremity lymphedema with and without genital involvement, to improve volumetric and quality of life outcomes

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Abstract

Millions of people are diagnosed with lymphedema, a treatable condition that may be considered disabling to those inflicted. The research available on lymphedema treatment, outcomes from the treatment, and overall the impact the condition has on individuals is significantly limited. There has been little advancement in the standard physical therapy treatment since the 1970s. There is a need for increased attention in the medical community on lymphedema* especially on how the edema is measured, how quality of life is affected and on possible modifications to the current treatment. Water displacement is the gold standard for the quantitative documentation of volume of those with lymphedema. A study was completed comparing the gold standard to the truncated cone method and found an excellent relationship between the two method for lower extremity edema. The study also found excellent intertester reliability with the truncated cone method. The Quality of Life Index (QLI a quality of life (QOL) tool was completed by 20 females with lower extremity lymphedema. The study showed that lymphedema do impact the overall QOL of females with lower extremity lymphedema as compared to the general population. No difference in the overall QLI scores was found when comparing those with to those without one of the symptoms of interest: pain, urinary incontinence, or sexual dysfunction. The small sample size did provide initial data related to QOL using the QLI. Overall, the study showed a need for the medical community to address QOL when treating lymphedema. A final study was completed to compare the current Casley-Smith complete decongestive treatment (CDT) method for lymphedema and a modified form of treatment incorporating the pelvic floor muscles. The focus was on volumetric reductions and improvement in quality of life (QOL) for females with lower extremity lymphedema, with and without genital involvement. Ten females participated. All participants showed a reduction in volume and improvement in QLI scores post treatment. The study also showed there was a significant difference in these changes when the control and experimental groups were compared. The modified CDT with the addition of pelvic floor muscle contractions had a greater impact on the volume and QOL changes. There needs to be additional research in the future with larger populations. This research should not only further investigate the addition of the pelvic floor muscles with CDT for the lower extremities of female * it should also consider different muscle group that may improve lymphedema in other area and should look at both gender . Those treating lymphedema should continue to search for additional understanding of the condition and for way to improve the efficiency and efficacy of treatment.

# data[].attributes.attachment_link.title
Incorporating pelvic floor exercises in complete decongestive therapy for females with lower extremity lymphedema with and without genital involvement, to improve volumetric and quality of life outcomes

# data[].attributes.attachment_link.description
Abstract Millions of people are diagnosed with lymphedema, a treatable condition that may be considered disabling to those inflicted. The research available on lymphedema treatment, outcomes from the treatment, and overall the impact the condition has on individuals is significantly limited. There has been little advancement in the standard physical therapy treatment since the 1970s.

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Efficacy of manual lymphatic drainage and intermittent pneumatic compression pump use in the treatment of lymphedema after mastectomy: a randomized controlled trial - PubMed

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Efficacy of manual lymphatic drainage and intermittent pneumatic compression pump use in the treatment of lymphedema after mastectomy: a randomized controlled trial - PubMed

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We concluded that the pneumatic compression pump did not contribute to the reduction of lymphedema. In addition, gauging dermal thickness using USG may prove to be a useful measurement method in the evaluation of lymphedema.

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Ten skin care tips for individuals with lymphedema | Main Line Health

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Skin Hygiene & Lymphedema

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Ten skin care tips for individuals with lymphedema | Main Line Health

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Individuals with lymphedema need to pay particular attention to skin care, as they are significantly more prone to infection.

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404 - Page Not Found | hartfordhealthcarerehabnetwork.org | Hartford HealthCare Rehabilitation Network | CT

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Learn more about 404 - Page Not Found at hartfordhealthcarerehabnetwork.org

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Www.Facebook.com/balancewithbabz

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Peppermint Pedango Foot Cream, 4 oz, Pump Bottle, Special Free Shipping

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Peppermint Pedango Foot Cream, 4 oz, Pump Bottle, Special Free Shipping

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Gently calm and cool tired legs and feet.

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Cancer treatment-related neuropathic pain: proof of concept study with menthol-a TRPM8 agonist - Supportive Care in Cancer

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Abstract

Purpose

Effective treatment of neuropathic pain without unacceptable side effects is challenging. Cancer sufferers increasingly live with long-term treatment-related neuropathic pain, resulting from chemotherapy-induced peripheral neuropathy (CIPN) or surgical scars. This proof-of-concept study aimed to determine whether preclinical evidence for TRPM8 ion channels in sensory neurons as a novel analgesic target could be translated to clinical benefit in patients with neuropathic pain, using the TRPM8 activator menthol.

Patients and methods

Patients with problematic treatment-related neuropathic pain underwent a baseline assessment using validated questionnaires, psychophysical testing, and objective functional measures. The painful area was treated with topical 1 % menthol cream twice daily. Assessments were repeated at 4-6 weeks. The primary outcome was the change in Brief Pain Inventory total scores at 4-6 weeks. Secondary outcomes included changes in function, mood and skin sensation.

Results

Fifty-one patients (female/male, 32/19) were recruited with a median age of 61 (ranging from 20 to 89). The commonest aetiology was CIPN (35/51), followed by scar pain (10/51). Thirty-eight were evaluable on the primary outcome. Eighty-two per cent (31/38) had an improvement in total Brief Pain Inventory scores (median, 47 (interquartile range, 30 to 64) to 34 (6 to 59), P < 0.001). Improvements in mood ( P = 0.0004), catastrophising ( P = 0.001), walking ability ( P = 0.008) and sensation ( P  < 0.01) were also observed.

Conclusion

This proof-of-concept study indicates that topical menthol has potential as a novel analgesic therapy for cancer treatment-related neuropathic pain. Improvements in patient-rated measures are supported by changes in objective measures of physical function and sensation. Further systematic evaluation of efficacy is required.

Introduction

CIPN affects up to 96 % of patients who receive potentially neurotoxic chemotherapy (e.g. platinums, taxanes, vinca-alkaloids and bortezomib), resulting in dose reduction or early cessation of treatment for up to 50 % [ 7- 10]. Symptoms are commonly in a glove and stocking distribution and include spontaneous pain, paraesthesia, allodynia (nonpainful stimuli causing pain), hyperalgesia (increased sensitivity to painful stimuli), hypoaesthesia (numbness) and impaired proprioception, causing difficulty with day-to-day functioning such as fastening buttons, handling coins, walking and driving. In our centre, 50 % of colorectal cancer patients still had symptoms of neuropathy 12 months after completing treatment with curative intent [ 5].

Treatment of neuropathic pain relies on early identification, understanding of the initiating and sustaining pathophysiological mechanisms and use of a range of therapeutic approaches [ 16]. Evidence is accumulating which suggests that the neurosensory characteristics of the pain may be the most important factor in predicting a treatment response, rather than the underlying aetiology [ 17, 18]. Current systemic therapy is mainly oral antidepressants or anticonvulsants; however, treatment often requires titration over months and is limited by variable efficacy and unacceptable side effects [ 19]. Nontoxic therapies, which reduce pain with minimal side effects, are needed.

Aims

The primary aim of this study is to determine whether 4-6 weeks of topical 1 % menthol in aqueous cream provided effective analgesia for neuropathic pain in a proof-of-concept study (assessed using the Brief Pain Inventory).

The secondary aims of this study is to determine whether mood and surrogate clinical measures (biomarkers) of neuropathic pain (physical function and quantitative sensory testing) improved after 4-6 weeks of topical 1 % menthol in aqueous cream.

Methods

This was an open-label proof-of-concept study. After obtaining research ethics committee approval and written informed consent, suitable patients were recruited from the Edinburgh Regional Cancer Centre. For inclusion, patients had to meet the following criteria: chronic neuropathic pain (diagnosed by a palliative medicine or pain medicine specialist); stable pain, not expected to change within the following 6 weeks; an average pain severity of ≥/4 on a 0 to 10 scale; aged 18 years or over; and either had tried conventional anti-neuropathic agents or these were contraindicated/declined. Patients were excluded if they had any medical or psychiatric condition that would confound the study objectives. Patients underwent a comprehensive assessment of pain and its impact on function immediately prior to treatment and after 2 and 4-6 weeks of treatment, as recommended by the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT) [ 25]. Standard demographic data were collected. The 1 % (−) menthol (levomenthol) in aqueous cream was used topically. Each patient was instructed on how to apply the cream to the affected area and corresponding dermatomal region of spine, twice daily on a regular basis.

Each assessment comprised:

1. 1.
Validated self-report questionnaires to assess the sensory, cognitive and affective components of pain, with higher scores representing more severe symptoms:

1. a.
The short-form Brief Pain Inventory (BPI): an 11-item assessment using a 0 (no pain/interference) to 10 (worst pain/interference) rating scale of pain intensity and its impact (interference with general activity, mood, walking ability, normal work, relations with others, sleep and enjoyment of life over the last week). The total BPI is the sum of all 11 items (ranging from 0 to 110), the interference subscale is the total of the seven interference items (ranging from 0 to 70) [ 26].

2. b.
Hospital Anxiety and Depression scale (HADS): with a range of 0-21 for both anxiety and depression [ 27].

3. c.
Pain Catastrophising scale: This measures rumination, magnification and helplessness. Range of 0-65, with values of >30 thought to be of clinical significance [ 28].

4. d.
Leeds Assessment of Neuropathic Symptoms and Signs (LANSS): is a validated screening tool for neuropathic pain (range 0-24, score ≥12 is indicative of neuropathic pain) [ 29].

2. 2.
Surrogate clinical biomarker measures of neuropathic pain:

1. a.
Objective measures of functional performance:

1. i.
Walking ability was assessed using a GAITRite® walking mat to measure gait velocity (cm/s) and cadence (steps/min) [ 30].

2. ii.
Hand dexterity. Patients were instructed to fill a five-by-five slotted board with grooved pegs in an ordered fashion. The time taken (s) to do this with the dominant and nondominant hands was recorded [ 31, 32].

2. b.
Quantitative Sensory Testing (QST) was conducted using our well-established protocol that has been used successfully in frail patients [ 33]. Skin overlying the affected area and an unaffected control area were assessed (either the equivalent contralateral dermatomal region, or for patients with bilateral peripheral neuropathy, a more proximal unaffected area). Testing was carried out in a quiet environment with the patient relaxed and took 20-40 min. All researchers underwent standardised QST training to use the following protocol:

1. i.
The affected area was mapped using a calibrated brush (Senselab 0.5 mN Somedic, Sweden) moving from normal to affected areas. Areas of abnormal sensation were marked out on the skin. The patient was asked to describe how this sensation compared with the control area (hyperaesthesia, hypoaesthesia or unchanged) and, if painful, it was rated on a 0 to 10 numerical rating scale (NRS). The area of abnormal sensation was measured using tracing paper (recorded in cm ² for patients with scar pain) or distance (cm) measured from the middle finger tip or great toe for peripheral neuropathies. For the latter, the percentage of the limb affected was calculated as a proportion of the distance from the finger tip/great toe to the olecranon/inferior patella border.

2. ii.
Thermal sensory mapping was conducted in a similar way using warm (40 °C) and cool (25 °C) rollers (Rolltemp, Somedic, Sweden).

3. iii.
Mechanical Detection Threshold (MDT) and Mechanical Pain Threshold (MPT) were assessed with 17 von Frey monofilaments of varying thickness, calibrated according to the force required to make them bend (0.026 to 110 g, Somedic, Sweden). Using the Method of Levels the monofilaments were applied to the skin in ascending order and the MDT noted when felt consistently (detecting three out of five applications). MPT was the force when the stimulus became unpleasant and rated using a NRS from 0 to 10.

4. iv.
Mechanical pain sensitivity (hyperalgesia) was tested using noxious pin prick stimulus (Neurotips TM Owen Mumford) and rated using an NRS from 0 to 10.

5. v.
Temporal summation was assessed using five rapidly repeated pin prick stimuli and a NRS rating. The wind up ratio was calculated as the NRS score (repeated stimuli)/NRS score (single stimulus) [ 34].

Statistical analysis

Data were displayed as mean (standard deviation (SD)), median (interquartile range) or proportions as appropriate. Continuous variables at baseline and 4-6 weeks were compared using the Wilcoxon signed rank test or paired t test as appropriate. The primary variable of interest was the change in pain as assessed by the total BPI. Responders were defined as a ≥30 % reduction in total BPI, which is considered to be a clinically meaningful improvement [ 35]. Responders and nonresponders were compared, to define any patient characteristics associated with a treatment response, using the Mann-Whitney U test or two-sample t test as appropriate. This was an exploratory analysis and a P value of <0.05 was considered statistically significant with no correction for multiple testing.

Results

Fifty-one patients entered the study. The median age was 61 (ranging from 20 to 89), and the majority were female (32/51, 63 %). Most had been treated for cancer (41/51, 80 %) and the majority of these were recurrence free (33/41, 80 %). The commonest neuropathic pain aetiology was CIPN (31/51, 61 %), followed by scar pain (10/51, 20 %, most frequently post-mastectomy) and miscellaneous reasons (10/51, 20 %) (Table 1). Thirty (59 %) patients had tried a range of standard analgesics and anti-neuropathic agents. During the study period 7 (14 %), patients were on a variety of standard analgesics, with no relevant medication change during the study period. Forty-four (86 %) patients were on no analgesics during the study period.

Table 1 Patients' characteristics at baseline

Forty of fifty-one patients completed 4-6 weeks of treatment. Ten patients discontinued the topical menthol treatment early for the following reasons: disliked the cream ( n = 2), found cream application difficult ( n = 2), developed brain metastases ( n = 1), felt no benefit ( n = 1), pain worsened ( n = 2), (resolved to baseline levels within 2 weeks of stopping menthol) or withdrew from the trial without giving a reason ( n = 2). One patient only attended at 10 weeks after baseline, so did not complete the 4-6-week assessment. Thirty-eight patients had complete evaluable outcome data. All completing patients used very similar quantities of menthol cream over the study period (1000× g, i.e. 10 g menthol).

Change in pain scores and other patient-rated outcomes

Eighty-two per cent (31/38) of evaluable patients had an improvement in their pain scores. The median total BPI improved from 47 (interquartile range, 30 to 64) to 34 (6 to 59), P < 0.001. There were also significant improvements in 'worst pain' and the pain interference subscales (Table 2). The mean total BPI decrease was 11 (SD 16). Fifty per cent (19/38) were responders, with 11 % (4/38) having complete pain relief. All the statistically significant improvements in pain were also clinically significant [ 21]. Along with the improvement in pain scores, there were also statistically significant improvements in HADS total score, HADS anxiety score and catastrophising (Table 2). The LANSS scores, as expected, did not demonstrate any significant treatment effect. Patients who were taking other regular pain medication remained on the same dose throughout the 6 weeks.

Table 2 Comparison of measures at baseline and after 4-6 weeks of menthol

Change in quantitative sensory testing (QST), objectively measured walking ability and hand dexterity

As well as an improvement in subjectively rated pain, there was also an improvement in objectively measured physical function and some QST parameters. Both walking velocity and cadence improved over the treatment period, although there was no significant improvement in hand dexterity (Table 2). QST showed a decrease in the mechanical detection threshold (became less numb), and for the CIPN patients, the percentage of the distal limb skin which had abnormal sensation in response to brush, cool and warm stimuli decreased and moved distally (Table 3; Fig. 1).

Table 3 Quantitative sensory testing (QST) and proportion of distal limbs with abnormal sensation to brush, cool and warm stimuli at baseline and 4-6 weeks

Outline of how abnormal sensation in response to warm stimulus (40 °C) decreased and moved distally after 4-6 weeks of menthol in patients with chemotherapy-induced neuropathy. ** P  < 0.01 by Wilcoxon-matched pairs test

Comparison of responders and non responders at 4-6 weeks

Responders had a significantly greater degree of improvement than nonresponders in catastrophising and dominant hand dexterity but not on other variables (Table 4).

Table 4 Comparison of the mean difference (change) between baseline and 6 weeks for responders and nonresponders (statistically significant P values are set in bold)

Discussion

Main finding

This is, to our knowledge, the first clinical study to report an analgesic benefit from the application of topical menthol to treat CIPN and Post-mastectomy Pain Syndrome (PMPS). Eighty-two per cent of evaluable patients had an improvement in their total pain scores after 4-6 weeks of treatment. Fifty per cent had a clinically relevant reduction in pain scores of at least 30 %.

Importantly, there were also improvements in objectively measured physical function. The significant increase in walking velocity and cadence are important read-outs of increased function. Such objective improvements in function increase the likelihood that we are seeing a genuine response to treatment. In addition, QST showed a shrinkage of the skin area with abnormal sensation to several different stimuli (warm, cool and mechanical). The associated changes in mechanical detection threshold and response to warm and cold between baseline and study endpoint again reinforce the evidence for an objective improvement in pain as the key outcome of this study.

Comparison with other studies

Cooling of injured areas by for example, cold compresses/icepacks or application of menthol for pain relief has a long history in medicine. The analgesic effect of menthol was reported in 1870 by Wright et al. [ 36], and its beneficial properties were known to the Ancient Greeks. More recent case reports demonstrated potential increased efficacy for neuropathic pain. While the mechanism of these traditional treatments has long been obscure, our recent demonstration that TRPM8 activation acts through central inhibition of nociceptive input provides a scientific rationale for a new generation of analgesics targeting TRPM8 [ 22]. In fact, several members of the TRP super family have emerged as important targets for new drugs, especially analgesics, due to their expression in sensory neurons and their critical role in nociception, particularly in chronic pain states [ 37, 38].

The effective use of menthol depends on the understanding that at higher doses of menthol, there may be off-target effects as it is known to interact with other potentially nociceptive TRP channels and voltage-sensitive channels [ 39, 40]. Very high concentrations of topically applied menthol (40 %) are overtly noxious and have been used to produce clinical pain models [ 41], but there are likely to be numerous nonspecific actions at this level.

In this study of topical menthol as an anti-neuropathic agent, the effect was rapid with no dose titration required, which, combined with no apparent side effects, is a clear potential advantage over other neuropathic agents [ 19].

1. 1.
Patients were recruited from one specialist cancer centre and findings may not apply to similar patients treated elsewhere

2. 2.
It is possible that some patients may have had a spontaneous improvement in pain and function. However, this is unlikely to have happened in the 6-week study timescale in this patient group, who all had stable, established chronic pain of at least 6 months duration.

The underlying neuropathic pain aetiology varied, however there is accumulating evidence that aetiology is not the driving factor in a treatment response, rather it is the neurobiological changes in any individual, as characterised by QST, which will determine response [ 45]. These characteristics were examined in detail in this study, using QST. The resolving numbness along with normalisation of response to brush, cold and warm, all moving in synchrony with resolving pain compared with baseline, were important neurosensory biomarkers of response. In this patient sample, it was not possible to identify neurosensory predictors of response: this should be explored in future studies.

It is important when investigating new treatments to examine in detail the characteristics of those who respond versus those who do not respond. Analgesic studies are often dismissed as negative, when in fact there is an important group of responders hidden in the final result. It is accepted that not all patients will respond to a treatment, no matter how promising that treatment. It is crucial however that relevant biomarker data are used to further identify and understand the characteristics of a response. This approach makes identification of responders more scientifically robust and acceptable. In a randomised controlled trial of menthol, both study assessments and a responder analysis will be facilitated by continuing the biomarker work established in this proof of concept study.

Implications for practice

Chronic established neuropathic pain is particularly difficult to treat and represents a largely unmet therapeutic need. Although progress has been made in curing and prolonging life in patients with cancer, there are a number of long-term treatment-related problems (such as CIPN and PMPS) which can limit further palliative chemotherapeutic options or impact significantly on the patient's quality of life despite being cured of cancer.

The discovery of the TRP channels has provided an opportunity for the development of analgesics, which are potentially more specific for certain pain syndromes and have a better side-effect profile than other interventions. TRP channels are being investigated as novel targets for drug discovery; they have a major advantage over more widely distributed voltage-sensitive ion channels, in their potential for achieving analgesia without overwhelming side effects in neuropathic pain [ 38]. This translational work with topical menthol, a TRPM8 agonist, shows significant promise, and points to the need for further validation through a phase 2 double-blind efficacy study.

If this preliminary work translates into positive further phase 2/3 studies, then it could have a significant impact on quality of life of both many patients being treated for cancer and survivors of cancer.

Acknowledgments

CJW was supported in this work by NHS Lothian through the Health Services Research Unit, Edinburgh.

Conflict of interest

None

Author information

Affiliations

1. Edinburgh Cancer Research Centre (IGMM), University of Edinburgh, Edinburgh, EH4 2XR, UK

M. T. Fallon, D. J. Storey, A. C. Scott & L. A. Colvin

2. Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK

A. Krishan

3. MRC Hub for Trials Methodology Research, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK

C. J. Weir

4. Centre for Integrated Physiology, University of Edinburgh, Edinburgh, UK

R. Mitchell

5. Centre for Neuroregeneration, University of Edinburgh, Edinburgh, UK

S. M. Fleetwood-Walker

Corresponding author

Correspondence to M. T. Fallon.

Additional information

Where presented in part elsewhere: Chemotherapy induced neuropathy subgroup presented at ASCO 2011

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Fallon, M.T., Storey, D.J., Krishan, A. et al. Cancer treatment-related neuropathic pain: proof of concept study with menthol-a TRPM8 agonist. Support Care Cancer 23, 2769-2777 (2015). https://doi.org/10.1007/s00520-015-2642-8
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Keywords

Menthol

TRPM8

Neuropathic

Pain

Cancer

Chemotherapy

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Cancer treatment-related neuropathic pain: proof of concept study with menthol-a TRPM8 agonist - Supportive Care in Cancer

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Purpose Effective treatment of neuropathic pain without unacceptable side effects is challenging. Cancer sufferers increasingly live with long-term treatment-related neuropathic pain, resulting from chemotherapy-induced peripheral neuropathy (CIPN) or surgical scars. This proof-of-concept study aimed to determine whether preclinical evidence for TRPM8 ion channels in sensory neurons as a novel analgesic target could be translated to clinical benefit in patients with neuropathic pain, using the TRPM8 activator menthol.

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Cellulitis is a bacterial infection of the skin and tissues under the skin, which is a common complication of lymphoedema. In the recent International Lymphoedema Framework (ILF) LIMPRINT study, 36% of people who had lymphoedema of the leg had experienced at least one episode of cellulitis since they had had lymphoedema. It can occur in all types of lymphoedema and in both adults and children. The LIMPRINT study has also shown that it is more common in those who have wounds, are obese, have diabetes, have midline lymphoedema (e.g. head and neck, breast or genital lymphoedema) and in men. Some people with lymphoedema experience recurrent episodes of cellulitis, which can pose a significant problem and be a source of great anxiety. The failure of lymph drainage, which causes lymphoedema also results in an impaired local immune response in the area affected by the lymphoedema. This results in the vulnerability to developing cellulitis. In addition, cellulitis itself can result in damage to the lymphatic vessels. This can make the lymphoedema worse and in turn predisposes to further episodes of cellulitis. Some people develop lymphoedema following an episode of cellulitis but it is now recognised that this may indicate a pre-existing problem with lymphatic drainage, which may predispose to cellulitis but may have not yet resulted in overt swelling. The damage to the lymphatics caused by the cellulitis may, therefore, tip the situation over into persistent lymphoedema.

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Cellulitis is a bacterial infection of the skin and tissues under the skin, which is a common complication of lymphoedema. In the recent International Lymphoedema Framework (ILF) LIMPRINT study, 36% of people who had lymphoedema of the leg had experienced at least one episode of cellulitis since they had had lymphoedema.

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We are passionate about supporting charities in the lymphoedema community and our founder, Matt Hazledine, has personally raised almost £20,000 for various causes so far. Lymphoedema United Ltd pledges to donate 25% of annual pre-tax profits to lymphoedema charities and organisations, to aid them in continuing their work in helping people with this lifelong condition.

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