PAD – Intermittent Claudication – Natural Options

Intermittent claudication (Latin: claudicatio intermittens) is a clinical diagnosis given by muscle pain (pain, cramp, numbness, or a feeling of fatigue), typically in the calf muscles, that occurs during exercise and is relieved by brief rest period.

The term claudication comes from the Latin for ‘limping’. This is exactly what this condition forces someone to do: limp to a stop.

Affected individuals describe intermittent claudication as a throbbing or cramp-like pain, accompanied by tightness or fatigue in the muscles of the legs or buttocks. For some, this pain arises only during strenuous activity; for others, it turns on after walking a few meters. The key factor is that the pain stops within a few minutes of resting.

Claudication affects people with peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD). In people with PAD, the arteries in the extremities (the feet, legs, hands, and arms) harden or harden (a process called atherosclerosis). This in turn obstructs blood flow.

Peripheral arterial disease has, as its primary lesion, the same initial plaque that is responsible for other conditions associated with atherosclerosis, for example, coronary artery disease and cerebral vascular insufficiency. In the lower limbs, the posterior tibial artery at the ankle and the anterior tibial artery at its origin are the most commonly affected arteries with atherosclerosis.

Arterial blockage or narrowing causes reduced blood flow during exercise or at rest. The clinical symptoms are caused by the consequent ischemia. The most common symptom of peripheral arterial disease is pain on exertion: intermittent claudication. The pain usually occurs in the calf and is described as cramping, tightness, or severe fatigue. The pain is usually bilateral. The cause of pain is not only a reduced supply of oxygen, but also an increased production of toxic metabolites and cellular free radicals. These free radicals accumulate and react with the lipid constituents of the cell membrane.

Rest pain indicates a severe reduction in resting blood flow. It is obviously a sign of serious illness. The pain may be localized to one or more toes, or it may have a sock-like distribution. The character of the pain is often described as burning or stabbing and is often worse at night. Cyanosis or paleness of the extremity is usually evident. In moderate to severe narrowing of the artery, trophic changes occur, including dry, scaly, shiny skin. Hair may disappear, and toenails may become brittle, rough, and misshapen.

The standard medical approach for peripheral vascular disease and intermittent claudication includes avoidance of tobacco (which causes vasoconstriction), a regular exercise program consisting of walking, and/or a prescription of pentoxifylline (Trenal). Surgery is also an intermittent claudication, it is not necessary to take this risk.

When walking/exercising, the muscles demand more oxygen, when in fact in this case less is distributed due to the restriction of atherosclerosis.

The pain develops because there is a narrowing or blockage in the main artery that carries blood to the leg due to hardening of the arteries (atherosclerosis). Over the years, cholesterol and calcium build up inside the arteries. This happens much sooner in people who smoke and those with diabetes or high blood cholesterol.

Blockage in the arteries means blood flow is reduced. At rest there is enough oxygen in the blood reaching the muscles to prevent any symptoms. When walking, the calf muscles need more oxygen, but because blood flow is restricted, the muscles cannot get enough oxygen from the blood and cramps occur. This is improved by resting for a few minutes. If you put more stress on the muscles, such as walking uphill, the pain comes on more quickly. Many patients also find that if they are carrying heavy bags, the pain sets in sooner because the leg muscles have to work harder.

In some patients, blood flow to the legs may be so restricted that barely enough oxygen reaches the tissues, even at rest. In these patients, severe pain may develop particularly at night and is only relieved when the leg hangs down over the edge of the bed. When this happens and tests show reduced blood flow, then critical limb ischemia has developed and the leg is at risk of amputation.

Blockages in the arteries never reopen on their own. Fortunately, locks themselves are not dangerous. It is only the symptoms they cause that are important. Many people live for many years with blocked arteries that never cause serious problems.

Often when patients develop claudication, their symptoms may worsen in the first few months. This is because the body needs time to adjust to the restricted blood flow. After 2 or 3 months, the situation may improve because smaller arteries (collateral circulation) open up and carry more blood around any blockage. The smaller blood vessels, although not the main blood vessels of the leg, usually carry enough blood to prevent serious disability. In general, about a third of claudication patients will improve, a third will remain stable, and a third will deteriorate. In most patients (>65%) symptoms will remain stable or improve. Patients whose symptoms worsen are usually those who continue to smoke.

Additional improvements in walking form can be achieved by taking regular walks. This seems to build fitness in the affected muscles (just like in an athlete). A formal exercise program can be a very effective way to improve mileage.

Regarding treatment, the first step is to eliminate all controllable risk factors;

The main risk factors for intermittent claudication include: diabetes, high cholesterol, smoking, high blood pressure, lack of physical activity, high levels of a chemical called homocysteine, family history of arterial disease.

Without exception, numerous clinical studies have shown that exercise can prolong pain-free walking distance and total walking distance in patients with intermittent claudication. Although studies have shown a wide range of improvement (eg, 88% to 190%), typically the degree of improvement in pain-free walking distance is about 50% after 12 weeks and 100% after 12 weeks. 24 weeks.

Despite the tremendous benefits of exercise in this condition, few doctors prescribe it. Walking may be the best recommendation doctors can make to patients with peripheral arterial insufficiency and intermittent claudication. Although other activities have been recommended or incorporated into exercise programs for claudication, they have not been shown to produce the same degree of benefit as walking. Strength training (weight lifting), bicycling, stair climbing, and other activities, while beneficial for overall cardiovascular function, do not appear to improve intermittent claudication as well as a walking program.

The optimal walking program should be supervised, performed at least three times per week, and last for a total of at least one hour. In a supervised program, the patient typically walks on a treadmill at a steady pace of about 1.5 to 2.0 miles per hour or a level just below the claudication threshold. When pain occurs, the patient is instructed to rest for a couple of minutes until the pain subsides and then resume walking.

Patients can walk on their own, but according to several trials, adequate measures must be taken to ensure patient compliance if unsupervised programs are to be successful.

Pentoxifylline (trenal) has become the “drug of choice” in the standard medical treatment of intermittent claudication. Pentoxifylline was first introduced in Germany twenty years ago. It is the most investigated drug for intermittent claudication. A total of seventeen placebo-controlled trials could be retrieved from the world literature. Most of these studies show that pentoxifylline will prolong total and pain-free walking distance in patients with intermittent claudication. However, the level of improvement (approximately 65% ​​for pain-free walking distance) is less than that achieved with exercise or Ginkgo biloba extract.

Pentoxifylline is believed to work by reducing the viscosity of the blood: increasing the flexibility and distensibility of red blood cells and preventing the aggregation of red blood cells and platelets.

Pentoxifylline is generally quite well tolerated, and the extended-release tablet is much better than the immediate-release capsule. Minor side effects include drowsiness, headache, dizziness, and gastrointestinal irritation. However, there are some important precautions with pentoxifylline.

The natural choice and successful alternative is Gingko biloba extract.

Gingko biloba extract (GBE) standardized to contain 24% ginkoflavon glycosides may be the world’s leading herbal medicine. GBE is now among the top prescription drugs in both Germany and France. Extracts represent 1.0% and 1.5% of total prescription sales in Germany and France, respectively. Although GBE has been most extensively studied and used in the treatment of cerebral vascular insufficiency, it is also of great benefit in the treatment of peripheral vascular insufficiency.

GBE has been extensively studied as it has been the subject of more than 300 scientific articles. GBEs exert profound and widespread tissue effects, including membrane-stabilizing, antioxidant, and free radical scavenging effects. Its vascular effects are primarily the result of direct stimulation of the release of endothelial-derived relaxing factor (EDRF) and prostacyclin. Furthermore, GBE inhibits enzymes in a way that leads to relaxation of smooth muscle cells in the vessel wall. GBE also exerts a beneficial effect on platelet function, including inhibition of platelet aggregation, adhesion, and degranulation.

GBE is extremely safe and side effects are rare. In 44 double-blind studies involving 9,772 patients taking GBE, the number of side effects was extremely small. The most common side effect, gastrointestinal upset, occurred in only 21 cases, followed by headache (seven cases) and dizziness (six cases).

In this case, the natural choice is safer, more effective and cheaper. Since pain is the biggest motivator, you need to realize that your body is telling you to take better care of yourself: it could also be a sign that you are developing cardiovascular disease.