From the office of Robert S. Grimshaw Jr MD FACP Internal Medicine 3535 Hill Blvd Yorktown Hts NY 914 962-3180 NEWS Recognized Provider  “With Distinction” by the American Diabetes Association/National Committee for Quality Assurance 2/99-2/02

48      January 1999

Shingles and Diabetic Nerve Pain: are a lot more treatable now with gabapentin (Neurontin).  Two articles in the Journal of the American Medical Association show a remarkable improvement in patients’ pain with the drug.  In the first report, Dr. Michael Rowbotham and colleagues at the University of California San Francisco pain center looked at 229 patients with postherpetic neuralgia (PHN) -- the pain that lingers after the shingles eruption resolves.  Shingles, of course is caused by the re-emergence of the chickenpox virus coming down the nerves from the roots where it has been in hiding since the childhood disease.   Pain scores dropped by 1/3 in the Neurontin treated group.  
In the second study of 165 patients with pain from diabetic nerve damage, Dr. M. Backonja and colleagues at the Universities of Wisconsin and Michigan report a 39% improvement in reported pain.  The doses were up to 3600 mg; side effects included sleepiness, dizziness, confusion, trouble walking and swelling feet, but only forced a few to stop the drug.
 Neurontin is, of course, not cheap. But for many, it may offer significant pain relief without narcotics.
  
More Winners: Phyllis Bassin is latest to benefit from our ongoing effort to screen for colon cancer.  She wins her own "screening" with 2 tickets to the movies at United Artists.   And because it’s the start of a New Year, we had another drawing, from all those who’ve submitted this year.  The winner is Dennis Capponi.  You can become a winner also by simply sending in your stool guaiac test!  You will help prevent cancer and we might send you to the movies.

The National Cholesterol Education Begins Its 15th year.  The NCEP coordinator, Dr. James Cleeman and National Heart Lung and Blood Institute director Dr. Claude Lenfant note that NCEP has raised cholesterol awareness, helped decrease US fat intake and cholesterol levels, and helped cut heart death.  Since the program got started, intake of cholesterol has dropped from 318 to 201 mg daily and total serum cholesterols have dropped from an average of 213 to 203 mg/dL.  The cost has averaged less than $1.5 million per year.

New For Arthritis: Celecoxib (Celebrex) has been approved for both osteoarthritis (“wear and tear”)and adult rheumatoid arthritis.  This is the first of several anticipated “COX-2" inhibitors, or “super aspirins.”  They affect only the COX-2 enzyme involved in pain and inflammation without inhibiting the COX-1, which helps maintain the normal stomach lining.  So, they won’t necessarily be any better than drugs such as Naprosyn or Motrin, but they should be safer.  Celebrex has been tested in 13,000 patients in 50 studies in 23 nations.  
Side effects include stomach upset, diarrhea, and abdominal pain, but less than 1% of patients had to stop the drug.  Patients with allergies to sulfa (Bactrim, Septra, azulfidine, etc) aspirin or other non-steroidal anti-inflammatory drugs should not take Celebrex.  And ulcers can still occur, without warning , in those who have the potential; patients and physicians need to watch for internal bleeding.  
Cost of Celebrex, which comes in 100 and 200 mg capsules, was not known at press time.