This piece is technical, but so important we have gone to some pains to simplify to enable laymen to understand the essence of it. For those of you who are slow to write to your Senator, we hope this up close look at what needs to be done will motivate you to write to your elected reps.
It is worth the effort for all CP sufferers to read the new article in Nature. This breakthrough article by Jeffrey Coull et al may reveal what is killing you. Neuropathic pain is not usually front page news, but this one made the national press and most of the internet portals gave it front page coverage as well. Write your U.S. Senators and ask them to fund more research on basic pain mechanisms. Coull has done his hard work. Now, you do yours.
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Here we are folks, at the Central Pain Olympics. This is N.M. D
Although we have lost the reference, a nursing pain specialist wrote an article where she commented on the fact that so many Central Pain patients giggled or smiled when she interviewed them. About one third did this. Another author made similar comments about some of the Viet Nam boat people. What do you do when you are nobody, and somebody is interviewing you. They were embarassed about the loss of humanity which their torture and/or rape had inflicted. They were not sure how the doctor would feel about them, listening to what they had been through, the degredation. They were hoping not to be rejected as human beings.
The smile does not reflect well being. It has meaning but is meaningless as far as a measure of what severe chronic pain is like. Recently I observed an innocent child who had gone into a bedroom where someone was asleep. His mother, not wanting him in the sleeping area, challenged him and asked,
If you have severe CP, and you read articles about coping, dealing, medicating, or whatever, you might wonder if you are in the right group. To you, Central Pain is by its nature unbearable. What are these people talking about when they discuss what medications work? Have they not read that NOTHING helps Central Pain, and your own experience certainly bears this out. What place could you possibly have here?
First of all, it is true that there is no satisfactory treatment for Central Pain. The more severe the pain, the less satisfactory the treatment. Is ANY treatment worth taking then, or should you just let the whole thing drop rather than get your hopes up where they will be dashed ONCE AGAIN. You are already crushed by the weight of the pain, and even reading the tales of others feels like a heavy weight. If you have lost your identity, you may feel there is no point in wandering around since you are not going to find yourself.
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This is a general article on CP for the public and for the families of those with CP. Why have handicap parking spaces been deliberately and clearly painted on the parking lots of businesses. Is it that the public is so rude it does not care. NO. It is because they were unaware, not informed, and unable to gauge what would be an appropriate deference to those whose loss of mobility required special arrangements. Society does little enough for the handicapped, and it is also a way of saying,
With special thanks to Nobel Laureate, Dr. Francis Crick, for his contribution to this article on the insular cortex, and to suggestions by Dr. Carl Saab at Yale for information on the sodium channels.
This is another research article addressed primarily to those who send in highly sophisticated questions to painonline, or who seek enablement to read the medical literature. If you are a professional, you will handle this easily, but if a layperson, this article should be read in two or three sittings.
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This is another of the technical articles, which will have limited readership. Amazingly, we do get questions on long term potentiation. What is happening is that CP sufferers are increasingly following our advice to go to PubMed on the internet, at the National Library of Medicine, and are encountering terms which lack meaning. Many of you are too sick to digest high grade material, so we try to simplify as much as possible. However, if you are going to be a savvy reader of PubMed, this article can give you background on the increasingly interesting subject of long term potentiation.
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Feel like you need psychiatric help to deal with severe pain? Here are some thoughts.
Once again, it is necessary to point out the spectrum on which Central Pain occurs. There are both degrees and flavors of Central Pain. Flavor here refers to which of the pain components are present. For example, there is a remarkable, but not exclusive, concentration of visceral (gut, bladder) pain in quadriplegics, who may experience touch CP, also known as mechanical allodynia, or dysesthetic burning, with the burning perhaps only in one portion of the body, the remainder of the body being completely denervated by complete cord injury.
Central Pain requires an intermediate injury. The sensory apparatus must retain SOME function to transmit pain signals along the nerve pathways. So a common quadriplegic CP patient may have predominately gut CP, where overfulness and nausea are agonizing, but may have the burning to touch in only one area of the body, perhaps a hand, part of the back, or wherever.
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INTRODUCTION:AND BACKGROUND
This article discusses the periaqueductal gray, an area known to inhibit pain. Painonline has, or will have, many pages devoted to the areas and chemical pathways which inhibit pain.
Presumably one or all of these systems of inhibition does not operate properly in Central Pain. This is in addition to the known abnormalities in pathways which stimulate pain.
You may wonder why we tax you with this information. The answer is that many who visit this site are researchers. The rest of you can at least begin to understand why scientists need a great deal money from the National Institutes of Health (ie. the US Senate which funds NIH) to study pain.
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INJURY
Pain is the process of chemicals being activated in the nerve cells of the pain system. Like all cells, each pain nerve cell (neuron) has a full set of chromosomes which are inherited from the parents of an individual. While every cell has ALL the chromosomes, only certain portions of the chromosomes are turned on in any given cell.
That portion which is switched on determines what kind of a cell that particular cell becomes. For example, cells from the adrenal cortex, if grown on a glass slide and subjected to acid, convert into nerve cells. The switching on and off of portions of the chromosomes is done by little
