Serrapeptase supplement 20,000 units

Serrapeptase is an enzyme isolated from a microorganism in silkworm, is widely used in Japan for inflammatory conditions. Outside the United States, serrapeptase is sold under a number of names including, Danzen, Aniflazym, and SerraZyme. In this country, it was introduced around 1997.

Serrapeptase side effect, danger
Q. I want to report a bad side effect from the use of of serrapeptase. I am 75 years old and in good health except for moderately high blood pressure and enlarged prostate. I took 200 mg for 9 days to reduce high blood pressure and had a very bad reaction. On the 9th day I had unusually high blood pressure, became confused and dazed and had to be rushed to the Emergency Room at the local hospital. I was in the hospital for several hours but do not remember anything that happened during that time. I had total short term memory loss during that time. I don’t know whether it had any part in the problem but on the 9th day of taking the serrapeptase I also took 25 mg of hydrochlorothiazide (HCTZ), a blood pressure prescription. In the hospital and since that time I have had a CAT scan and MRI of my head, an EKG, and ultrasound scans of my heart and carotid veins but all the tests showed nothing abnormal, although I still do not remember anything that happened during the time I was in the hospital. Otherwise I feel almost back to normal after more than a month of head aches and minor head pain since the incident. Obviously, I stopped taking the serrapeptase. I hope this information will be of assistance.
   A. This is the first report we have had of blood pressure related serrapeptase side effects. We are glad you have made a full recovery. It is not a supplement recommended as a treatment for high blood pressure.

I was wondering how often pneumonitis has occurred in people using serrapeptase? What percentage? Were there extenuating circumstances involved? Previous lung conditions that it may have worsened? I thought it was supposed to help with lung conditions.
    This has been a rare occurrence.
A case of eosinophilic pneumonia due to Nicolase (serrapeptase) after recovery from acute eosinophilic pneumonia
Nihon Kokyuki Gakkai Zasshi. 2009;.
A case of eosinophilic pneumonia due to Nicolase (serrapeptase) after recovery from acute eosinophilic pneumonia is described. A 32-year-old woman was previously admitted to another hospital because of acute onset of dyspnea accompanied by cough and fever. Chest X-ray films revealed diffuse infiltration in both lungs two days after her symptoms occurred. Her bronchoalveolar lavage fluid showed 13% eosinophils and transbronchial lung biopsy specimen also showed many eosinophils infiltrating in the lesions of the bronchial submucosa and alveolar septa. No infectious causes or related drugs were found. Acute eosinophilic pneumonia was diagnosed, and her condition improved gradually without steroid treatment. Because she recovered clinically and radiologically, she was discharged from hospital. Half a month later she was treated with Nicolase because of pharyngitis. She was admitted to the hospital again because of dyspnea, cough and fever three days after commencing to take Nicolase. Chest X-ray films also revealed diffuse infiltration in both lungs with pleural effusion, and her bronchoalveolar lavage fluid showed 37% eosinophils. When the drug lymphocyte stimulation test was performed, it was positive for Nicolase. Therefore drug-induced eosinophilic pneumonia was diagnosed. This is a very rare case of Nicolase (serrapeptase)-induced eosinophilic pneumonia after recovering from acute eosinophilic pneumonia.

I stay in India i had bought serratiopeptase from chemist had 10000 iu (5 mg) everday after 7-8 doses i had muscle pain so i left it, i been 3 days now its a good medicine to remove palque but we just cant consume it in excess, it defintely gives muscle pain. i had the same experience with papain too.

Q.  have taken serrapeptase a few different times for weeks at a time. Both times I noticed single, very itchy, hives (skin eruption) as I would introduce the substance and whenever I would increase the dose. The hives would subside after a few days to a week with steady dosage. I don't get hives otherwise.It works really well on my inflammation Crohn's disease so i'd like to keep using it if possible.
   A. This is interesting. One way to tell if it is serrapepatase causing the allergy is to try a different brand from a different manufacturer to determine if the method of preparation or other ingredients added to the capsule are causing the hives. Another possibility is the interaction with other medicines or supplements you may be taking.

Pseudogout
I have been diagnosed with osteoarthritis and CPPD. Is there any research on its effectiveness for CPPD.
   We have not seen research regarding the interaction of serrapeptase, osteoarthritis, and CPPD, also known as pseudogout.

Scar tissue
I have uncomfortable scar tissue from two surgeries and I wanted to know if serrapeptase and/or nattokinase are helpful in reducing this type of tissue. Could you let me know if they help in this regard?
   We have not seen any human research regarding scar tissue being dissolved by either serrapeptase or nattokinase.

Use with other enzyme products
Can I take serrapeptase with Wobenzym together?
   We have not seen research with its combination with Wobenzym, hence we prefer not to mix the two at this time.

Interaction with Plavix
I am interested in serrapeptase for its ability to help reduce arterial plaque and any unwanted protein forming within the arteries. Inasmuch as I had 2 stents placed in 2 coronary arteries, I am taking Plavix. Is there any contraindication on taking serrapeptase while on Plavix?
   We have not seen such studies and don't know how the blood thinning medication interacts with the enzyme. If your doctor approves you may consider using the enzyme supplement every other day for a couple of weeks to see if any problems occur.

Dosage
What is correct dosage for arthritis / inflamation?
    Not enough studies are available to know for sure and there can be wide variations between individuals.

Clinical trial
Effect of the proteolytic enzyme serrapeptase in patients with chronic airway disease.
Respirology. 2003.
The proteolytic enzyme serrapeptase is widely used in clinical practice in Japan. We investigated the effect of serrapeptase on sputum properties and symptoms in patients with chronic airway diseases. This study was an open-labelled trial with a non-treatment control group. Patients were randomly assigned to oral treatment with (n = 15) and without SER 30 mg/day for 4 weeks. Patients collected sputum samples for about 4 h in the morning on the day the trial began and 4 weeks later. We measured the amount of sputum by weighing. Part of each sputum sample was weighed and then completely dried and reweighed. The percentage solid component, viscosity and elasticity of the sputum were measured. Mucociliary transportability index was measured using ciliated bovine trachea ex vivo. Sputum smears were also prepared to count sputum neutrophils. Patients' symptoms were assessed by a questionnaire that used a visual analogue scale. After 4 weeks of serrapeptase treatment, sputum weight in the morning, percentage solid component, viscosity and elasticity of sputum, sputum neutrophil count, frequency of coughing and frequency of expectoration significantly decreased. The mean mucociliary transportability index increased from 13 to 24. Serrapeptase may exert a beneficial effect on mucus clearance by reducing neutrophil numbers and altering the viscoelasticity of sputum in patients with chronic airway diseases.

Questions
I had a mild heart attack a month ago and had a stent put in my heart. I am now taking Physician Formulas Serrapeptase and wanted to know how many times a day should I take it ( I am currently taking one a day ). I have also had severe aches and pains in my back, neck, and the whole body (to a lesser degree ) for about 10 years now. But mainly my neck is always tense, knotted and in a lot of pain, sometimes causing shortness of breath and other disorders in the body. I am hoping the Serrapeptase will help this as well. The chiropractor says my xrays show no misalignment of the vertebrae. I can turn my head fine it just always hurts a lot. How long does it usually take to efficiently clear out the arteries and system? Also, NBC News is talking about a medical miracle breakthrough injection that "cures" heart disease and cleans out the arteries very quickly. Is this a drug similar to or containing serrapeptase?
   A. We have not seen any significant human research for prolonged periods to know the ideal serrapeptase dosage, but for the time being, taking one capsule a day 5 days a week seems reasonable when done under medical supervision. Pain can be caused my many factors, and there is no way for us to predict whether serrapeptase will help reduce the pain you are experiencing. We don't think NBC news was referring to serrapeptase.

Q. I recently read an article on the Life Extension foundation website that recommends higher dosages of serrapeptase. Could you please tell me the why there is such a large discrepancy between this and your published serrapeptase dosage information. Perhaps I am reading this wrong. By the way, I love the serrapeptase product by Physician Formulas. This is what the article says, "It is important to note that not all Serrapeptase products are created equal. The enzyme activity is measured in units and clinical studies are based on the ratio of 10 mg of Serrapeptase equaling 20,000 units of activity. When purchasing the product be sure that the ratio of mg to units is 10 mg for every 20,000 units, or 5 mg for 10,000 units and so on. The average dose, therefore, is 20 mg–or 40,000 units."
   A. The serrapeptase product by Physician Formulas was developed by Dr. Ray Sahelian who is a respected doctor and always tries to minimize side effects from supplement use. Serrapeptase has not been widely used in the United States, and when a potent enzyme is taken for prolonged periods by tens of thousands or more of users, complications could happen in some people if high doses are used. In order to minimize this potential serrapeptase side effect, we prefer erring on the side of using less. Until long term human studies are done in the West, it would be unwise to have a large number of people taking high doses. Could the effects over time accumulate and cause major bleeding or other problems? In fact, Dr. Sahelian recommends taking a day or two off a week until more studies are done.

Q. I have just taken my first Serrapeptase tablet... on an empty stomach. How long should I wait before eating?
   A. Not enough is known about it to determine whether it is better to take it with food or without food. At this time we are suggesting users to take serrapeptase 10 to 30 minutes before a meal until we learn more about the ideal time to take this supplement.

Q. I would like to know something about the manufacture. Are the raw ingredients made in Arizona? The reason I ask is that just today I found out that the supplement I presently am taking is made in China and made into pill form in the US. I am trying to see if I can find a product that is manufactured in its entirety in this country (or Canada, or Japan).
   A. This serrapeptase product is made by Marlyn labs in Arizona, one of the few FDA approved manufacturers in the country. They source the material so we are not sure whey they buy it from, but since they are FDA approved we trust that it is the best material it can be.

Q. I would like to add to the experiences of taking Serrapeptase. I take a variety of supplements to help with endometriosis, candida and bladder problems (I am 46). I wanted to try Serrapeptase to deal with pain and inflammation in my muscles and joints and also to help with endometriosis. I also take a maintenance dose of Seroxat (which is Paxil) so I take the Serrapeptase away from it as I heard that Seroxat also deals with pain and inflammation. I realised the first time that I took it (60,000 iu) that it was a strong supplement so I only ever take it when I need it, sometimes only once a week, never two days following. I also experienced a whooshing in my ear (a symptom of high blood pressure?) and was very disappointed that it might be the Serrapeptase (It was temporary). I have much less pain in my joints and muscles and feel comfortable after taking the pill except on exertion, I usually take it in the evening and rest. There may be a little improvement in my varicose veins, I have not noticed them getting worse.

Q. I was so glad that I found your site online. I started taking serrapeptase 2 pills 20,000 three times a day for arthritis. I had been taking it for about a week, when I decided to check my blood pressure as my ankle looked a little swollen. My blood pressure was up. I took my blood pressure again the next day and it was still up. I stopped taking the serrapeptase and the next day my blood pressure was back to normal. I do take medication a very low dose for high blood pressure but it has always been normal with my medication. I definitely attribute the rise, which was significant, to the serrapeptase. So then I checked my husbands blood pressure, who has normal pressure always and his was up significantly also from taking the serrapeptase. I just wanted to let you know, as I saw one other person write to you about this. Maybe the dose was way to high. It was helping my husband with his back pain but I hadn't noticed any change in mine.
   A. Thanks for letting us know. We will see if others send us similar feedback. Perhaps the dosage of the serrapeptase was too high.

Q. I have read with great interest the articles discussing the benefits of systemic enzymes. I have one concern that I'd like to ask you about, however, that I have not seen addressed anywhere. Background: Alpha 1-Antitrypsinase deficiency is a genetic defect that causes a reduction in the level of a critical anti-protease enzyme. This enzyme is responsible for protecting the lungs from being dissolved by the activity of their own elastase enzyme. This anti-protease enzyme also has effects on other neutrophil based proteases. In my case, I am heterozygous for the deficient gene, which means that I have approximately half of the normal level of the enzyme. In your opinion, would there be any risk for a person with Alpha 1-Antitrypsin deficiency in taking a supplement that contains the Serrapeptase enzyme?
   A. This is beyond our range of knowledge.

Q. I have fibroid tumors and I would like to share my experience in hopes of helping someone else. I have been living with fibroid tumors for 10 years. I refused surgery from my doctor 10 years ago. I had tried garlic, and all types of supplements but nothing worked until I started using serrapeptase, and nsk-sd. I heard from another cite that (nsk-sd nattonkinaise) and serrapeptase shrinks tumors. I started off taking 50 mg of nsk-sd and 20,0000 units of serrapeptase every 12 hours. I also eliminated red meat. pork, and sugary foods from my diet for 21days..NOTE: ( I do not take any prescription medicine at all). During the first week I would feel a little light-head for 4 minutes after taking it. After the first week, I did not feel any more light-headedness. I assumed my body had got use to me taking it. During the first 2 weeks my stomach seem to swell a little bit. (The tumor has already had me looking as if I was 6 months pregnant. After 21 days I lost the swelling and some weight. I did not notice it on the scale but I noticed in the fit of my clothing. It seemed a if I was losing fat but gaining muscle. After 21 days I began to eat normally, and I increased my serrapeptase intake to 40,000 units every 12 hours.. After 60 days my stomach size decreased 50%. On month 3 (now), I increased my serrapeptase to 100,000 units every 12 hours, while still taking the 50 mg of nsk-sd. I have not experienced any side affects at all. Everyone is complimenting me on how small my stomach has become. My estimate is my stomach has shrunk 2/3. I plan to take it for 6 months at this high dose due to the size of my fibroid. After 6 months I am going to take only 20,000 units a day as a preventive. It seems as if I am losing a pound a week on the scale, also. My husband took it for a week, and he felt heavy leg cramps while working. He stopped taking them and his leg cramps went away. He tried taking it again 2 weeks later and he has not experienced any leg cramps. He had a cold. He took 40,000 of serrapeptase for two days, and the cold was gone. My friend has sinuitis. He took two 20,000 units of serrapetase only every 12 hours and he felt normal within hours. but when he stopped taking it his condition returned. No medicine would help my friend with the sinusitis at all. When he sees me he is always asking me for one of my pills. Another relative of mine had a large keloid growing on her chest. It was as wide a 3 quarter coins sitting side by side. She took 20,000 units of serrapeptase twice a day and 50 mg of nsk-sd nattokinase twice a day for a month. She noticed a reduction in size after a month. On month 2 she increased her dosage to 40,000 units
of serrapeptase twice a day and 50 mg of nsk-sd. She says she can feel the serrapeptase eating up her keloid. She feels a tightness in that area after she takes it Her keloid has shrunk approximately 66%. The keloid was dark, but after month two the color is matching her skin color. I will write you again later and keep you updated. This is truly a miracle enzyme for me.

Q. Can you please confirm for me that serrapeptase is a "non-pancreatic" enzyme? I think pancreatic enzymes are: lipase, amalyse, protease, etc.
   A. It is not a pancreatic enzyme.

Q. Can you tell me if serrapeptase can help my lung disease it is sarcoidosis stage three I have 42% lung capacity I was on Predisone but I am weaning off side affects are killing me. Will this work 200 mg a day ?
   A. We have not seen any research with its use for sarcoidosis.

Q. I am prone to uterine fibroids and had a myomectomy in 2003 for 16 fibroids including one that was 12cm. I am now 41 and want to try to have a baby but I am told my fibroids are coming back. The Dr. that did my myomectomy (very good doctor….) actually recommended FibroPlex – which its main ingredient is serrapeptase – It would be a relief to take a supplement and not have to go through surgery….obviously. I started taking it and I too, started have in joint problems – wrists, ankles etc…..however I would rather deal with it if it will help my fibroids.
   A. We looked into FibroPlex and we did not see that it had serrapeptase. Rather it has thiamine, pyridoxine hydrochloride, magnesium bis-glycinate, manganese, and malic acid.

Q. I would like to order some serrapeptase supplement but am living in South Africa. I have breast cancer which has metastasized to the pelvic bone and am in a great deal of pain so am wondering if serrapeptase will assist with pain relief. Please advise if this is the correct product to order.
   A. We are not aware of any research regarding the use of serrapeptase enzyme for breast cancer pain due to metastasized. We understand that these are very difficult times for you.

Q. I was wondering if serrapeptase pill will dissolve silk thread in the human body? When I had a vasectomy years ago I remember the doctor said he closed off the ends with silk thread. Also I had a hernia operation and wonder if silk thread was used there? I have not heard of any answer to this question and I think it it should be now.
   A. We seriously doubt serrapeptase pills will have such a function.

Q. i was told serrapeptase pills could help reduce varicose veins. what dosage, for how long, and will it actually work. I currently take Wobenzyme n.
   A. We have not seen any research regarding the role of serrapeptase pills and varicose veins.

Q. Will serrapeptase dissolve scar tissue? I have scar tissue in my neck from spinal surgery. The scar tissue has entrapped a nerve, causing tingling in my shoulder.
   A. Although there are some websites that claim serrapeptase clears scar tissue, we are not aware of any studies done with serrapeptase as a treatment for excess scar tissue.
      Q. If there are no such studies, why do some websites claim that serrapeptase dissolves scar tissue?
         A. You may wish to ask the websites to provide the studies, if they send them to you we would appreciate seeing them since we have not seen any such reports.

Q. Is the serrapeptase product by Advance Physician Formulas pharmaceutical grade?
   A. This serrapeptase product is made by Marlyn Nutraceuticals contract manufacturer in Arizona which is a FDA approved facility and one of the most respected in the country. Therefore this serrapeptase product is as good as it gets. We are not aware of any formal standards established in the nutraceutical or pharmaceutical industry regarding what constitutes pharmaceutical grade serrapeptase. Hardly any natural supplements have any formal designations or criteriaregarding pharmaceutical grade status. Pharmaceutical grade status is reserved usually for certain amino acids or vitamins but not herbs or the vast majority of natural supplements.

I've been taking 1 tablet 10,000 units per day and have been reading through your website. One similarity that I noticed with one of the people that wrote in, was a 'fullness' in my head. Almost like a light pressure. My bp has stayed the same, on the normal scale, but I have noticed that my face seems flushed. I'm going to take a break for a few days and see what I notice. My doctor thought it would be fine to try for the atherosclerosis potential but am wondering if the flush is coming from interactions with some of the meds I'm on since my bypass surgery in 2004. I don't understand how this product can be being used for so long in Europe without more concrete clinical results and reactions.

I recently purchased serrapeptase 20,000. I am a 45 year old male who recently suffered a DVT / PE event. I have been placed on Coumadin to avoid further blood clots from forming but I still have some in my left leg and lung. Is is safe for me to take this product with Coumadin and what dose should I be taking to help clear some of the clots.
   This is an area where your doctor has to decide since it is not our role to give individual advice. Nattokinase is an enzyme that focuses as an anti-clotting agent.

I have recently diagnosed with PAD,, peripheral artery disease, with diabetic neuropathy involved. Am trying the serrapeptase in connection with attempts to combat the horrific pain in feet and legs. Feet and legs now have painful areas which appear to be where skin has broken and scabs appear. Bleeding and clear liquid makes it self known. Needlessly to say, months have past with little or no sleep; this is no exaggeration. Have been prescribed narcotic medication by GP. Seems to be of miniminal effect, and the pain is worse; therefore, I choose to try this product, serrapeptase. I write to you at this point out of desperation for some positive results and relief from pain. Now I have all the symptoms of Charcot-Marie-Tooth disease. My GP has not specifically called my condition by this name, but I have a feeling he hesitates until further testing is done. From different sources, surgery is recommended, but with minimal positive results. I am not inclined to go the surgery route. I am glad to find this product and am encouraged to continue using, although in past month I cannot say there is positive results, but I am determined and will continue. Do you and your staff have research related to PAD that you could publish and make accessible to me and others who may have interest in this area. Of course pharmaceutical may have their purpose, but I much prefer supplementation, namely Advance Physician Formula. I do realize that there are many sites that depend on marketing strategies for moving their products, but I depend upon and trust this site for conveying legitimate research. I will be happy to keep you updated on my results of using this product, serrapeptase. Thank you for any comment you have to offer.
    Charcot-Marie-Tooth disease is an inherited neurological disorder. CMT, also known as hereditary motor and sensory neuropathy or peroneal muscular atrophy, comprises a group of disorders that affect peripheral nerves. The peripheral nerves lie outside the brain and spinal cord and supply the muscles and sensory organs in the limbs. Disorders that affect the peripheral nerves are called peripheral neuropathies. We don't know if serrapeptase will have an influence on your condition.

Does this supplement have any effect on any type of implants -- dental, breast, etc? Kind of a bizarre question, but never hurts to ask.
    Not that we are aware of.

What is IU units stand for Serrapeptase supplement? Can you please let me know how to calculate IU unit for serrapeptase enzyme? Can an enzyme express as IU units?
   IU stands for international units. and is the method used to determine the potency of this enzyme.

Serrapeptase is being touted as helpful for selective sound sensitivity syndrome on their message board. You have to have a Yahoo acct to access the board. They are taking 40,000 u a day 2 three times a day, now 3-4 twice a day. I notice that you advocate using a much smaller dose. 4S is a syndrome that makes people react with anger toward certain sounds, particular oral sounds from eating or nasal sounds, sniffing, etc. The reaction is extreme. Some of the people on the board are noticing help tolerating the sounds with serrapeptase. My question is this: it seems to have some anti inflammatory effects, is that true? I cannot take anti inflammatories, even Aleve or anything like that in a small dose because it bothers my bladder (I have interstitial cystitis). I don't mind using the serrrapeptase at a small dose but if this has any type of anti inflammatory effect, then it is not for me. I cannot even use ketoprofen cream rubbed onto my foot, my bladder got irritated.
    There are various types of natural and prescription anti-inflammatory medications. It does not necessarily follow that having bad reactions to one type of such medication will also lead to side effects from another type of medication, particularly if it is natural. They may have their effects in different ways.

I ordered physician formula serrapeptase ( through Amazon) and looking forward to receive and start using it. As you mentioned there is still not thorough studies on the supplement and possible side effects and where I live (Amman Jordan) doctors still do not know about and cannot reach their opinion. However I am a smoker (coud not quit ) ; and had had surgery in 1992 and extracted my lower right lobe of the lungs ( suspicion of cancer !!which never was ). I am interested in the serrapeptose as a preventive measure for lungs and clearing if any blocked arteries beside I think after surgery if any fibrosis in the lung this serrapeptose might be a cure or a preventive measure. I do not suffer from breathing problem except some times short breath if I do run and on daily basis using curcumin and cordyceps and on gluten free diet. Appreciate your advise on using Serrapeptase ( other web sites they insist on empty stomach and do not know what you think since having bit sensitive stomach.
    It is probably better to take the pills on an empty stomach.

Every time I try to swallow a serrapetase pill it lodges in the back of my throat no matter how much water I drink. Obviously I shouldn't take it with food to help me swallow it. Since it remains in the back of my throat, I wonder if it will still work, or is there something I could take with it to help me completely swallow it.
    You could try the tablets and crush them before swallowng.

Do you have any info on using it in dogs? My dog has very bad arthritis in her hind legs. She can tolerate aspirin, has been on Previcox, a canine arthritis med which can cause liver damage.
    We don't have any feedback regarding the use of these pills in dogs or cats.

i stay in india and have been reading about serrapeptase. my dad is a heart patient, can i give it to him? what are the side effects of long term use? any? why is it not prescribed by doctors if it is safe? can it be used in combination with other enzymes like nattokinase, papain, bromelain, there r products like neprinol, fibrovera which combine them. how to be on the safer side while using them, can a normal person use it too.. can i have it? did u have it too?
    It is up to your dad's doctor to decide whether this natural enzyme supplement is appropriate for him. We suggest reading the latest information on this topic. There is not enough research to determine whether it is safe to combine with other supplements and enzymes.

I wanted to know if serratiopeptase and serrapeptase are the same coz i went to a chemist shop and they have serratiopeptase available. How long can serratiopeptase be used. do u know of patients who have used it long enough and how long-years? were there side effects? i had taken papain, bromelain, and amla combination enzymes first 2- 3 days was fine later some headache also stomach upset i was better when i was having only papain that too after food no side effects and i would take it off and on i knew it instinctively that it wasnt meant to be used continously but serratiopeptase is still more powerful!i dont want something terrible happening i hope nothing very bad happens .i can handle stomaches, headaches reduce my dosage but nothing out of the world will happen? i have a fibroid and want to reduce it as much possible, also my dad is a heart pateint, i want to give it to him too, in the right dosage i dont want him getting nauseated how do i go about it?

I have recently begun taking a Serrapeptase product and it comes in 80K not 20K units. My question is this: Have you heard of anyone who actually had more neuropathy after beginning taking it? I found that, when using ProGest creme, that it created the most unbelievable leg pain, which lingers. I was hoping that the enzyme would get rid of this pain, but, it actually makes the pain worse. Of course, I stopped taking ProGest Creme months ago. (And, if you have any suggestions on how one abates this pain, it would be of great interest.)
   We have not heard of more pain or neuropathy after such use.
   

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