We are not alone in nerve injury pain. We merely lack the visual markers “enjoyed” by some others. We aren’t trying to steal anyone’s thunder, but a little truth never hurt anyone.
MySA.com, a news site for San Antonio recently cited verbal descriptors for herpetic neuralgia (post shingles pain).
Beverly Dolberg, M.D.
Crozer Chester Medical Center and Riddle Memorial Hospital, August 09, 2005
“I feel like someone is putting a hot poker in my skin.”
“I feel like hundreds of knives are digging and pulsing into my skin.”
“I would cut off my thigh if it would make the pain stop.”
“I feel like electric shocks are going all the way down my leg.”
“It’s very embarrassing, but I haven’t been able to wear underwear for months.”
Sound familiar?
It ought to. Recurrent chicken pox is not the only condition which can drive people to pain madness. Herpes viruses, such as chicken pox (herpes zoster), never really leave the human body. They become dormant in nerve tissue until and if the virus reactivates and manages to grow toward the skin surface in some nerve. About twenty percent of those with shingles go on to post herpetic neuralgia. They provide yet another patient group who can tell the general public what nerve pain feels like.
Although herpetic neuralgia is classed with peripheral nerve injury, it must be remembered that these viruses are activating in the cord, or central nervous system. Thus, it is not surprising that there is some crossover in the symptoms and sensations of post herpetic neuralgia and central pain.
The reason HZ patients are believed is that they have a rash, visible to the eye, which the Doctor can see. In other words, their pain is believable because there is something that can be visualized with the naked eye. It looks red. Why question that it is painful. It doesn’t take much to satisfy the eye, but almost nothing can satisfy what the eye cannot see. “You can’t trust your eyesight if your imagination is out of focus”.–Mark Twain.
The eye is the “great monopolist of the senses” and in the case of CP, this is seriously a problem. Our lesser cousins, those with herpetic neuralgia, are favored with legitimacy and credibility while those with CP are treated like stepchildren, even if they have spinal cord injury! Instead of listening when we say the pain is much worse than the paralysis, the listener may say “Tsk Tsk, child. Go worry about your immobility, which is such a big problem that you don’t have time for fantasy ills.” Cinderellas of pain–what a terrible fix, with no happy ending. However, our handsome prince has arrived with an MRI machine and PET scanner and we FIT the image of pain perfectly.
The tide will turn and our fairy godmother at NIH will save the day, we hope. By providing an IMAGE that looks like pain, we may actually get some research to solve it.
If there were no word for “green” in the English language, good luck trying to explain what a mixture of blue and yellow look like! Many, if not most, central pain subjects experience the pain of hot and cold TOGETHER. Try fitting that into verbal descriptions. The normal brain is incapable of sensing hot and cold together (although touching dry ice is not too far away from it). The point is that you want both of them to stop, NOW. Our “x-men” sensorium is driving us crazy with pain. The mutants are in bad shape.
In contrast to herpetic neuralgia. the person with central pain, who has these same sensations, plus others unique to CP, sometimes over the entire body, is not generally believed because there is no rash, no bash, no mash, no gash and no bloody splash. None at all, only the “lash” of exciter toxicity in the cord and brain. By releasing precisely the same pain neurotransmitters as would occur in ordinary pain, thus producing precisely the same pain signals as in pain associated with tissue injury, the neuropathic central nervous system does a marvelous job of mimicking the exact sensation of tissue injuries however, and even concocts mixtures of them that are truly awful to endure and impossible to describe.
The hidden chemicals of CP are something like the poison used to kill the first of the Medici’s and his unfortunate wife. There was concern at the time but in the absence of any visible evidence to the contrary, the “pious” cardinal brother who murdered his relatives persuaded the clerics that it was all just due to poor eating habits. Only now has science unearthed the proof that there was arsenic there all along. Now that science can SEE arsenic, we simply take a look at the recently discovered liver of the unfortunate victim (preserved in a jar after an autopsy hundreds of years ago), and we SEE arsenic. The mode of death was there all along. It just needed some way to SEE it.
Sick people are expected to have something to SEE and that is why the public and medical profession are so unimpressed with central pain. What is different is at the molecular size and is missed if we are looking for a rash. Dr. Jean Dejerine, who originally linked central pain the thalamus said that no physical exam was necessary to diagnose pain of central origin because the history was so unique. Superficial surveillance misses the point. Sort of like flying over Auschwitz at high altitude. There is nothing to see, but hell is down there, hidden, and indescribable. Fortunately, we now live in the era of PET and Functional MRI when the smart people can visualize the pain centers going off in central pain. The creation of an animal model has also sealed the doom of doubters.
Herpes is usually only felt in ONE nerve on ONE side of the body at ONE level. When the observer reflects on how severe pain of this nature would feel if it were distributed over the entire body, then is becomes easier to imagine why central pain causes such suffering. Severe Central Pain is the worst pain state known to man. (The cord injury which usually goes along with CP is no picnic either, but it is not as bad as the pain).
