dejerine
04-26-2004, 09:03 PM
Aquitaine said he writes programs to educate doctors and maybe we can give him a little material to work with in CP. This is a unique opportunity to classify ourselves a little and improve our sense of what applies to us and try to fit ourselves into categories upon which reason can act.
Many of you have lamented the lack of objective tests for CP. Gilbert Gonzeles, at Mayo's, has actually published one way to objectively test for Central Pain. However he is no longer doing this testing and has left Mayo's. Gonzales showed that CP people have tactile illusions. He used little points, like kid's connect the dots, to outline a number. In CP people, after the machine is turned off, the patients continue to "feel" the numbers, so much that when the next numbers are applied, the old one continues to be superimposed over the new. This is just the hypersensitivity of their nervous system. Gonzales called this the "phi" phenomenon.
What was obvious in his report is that CP patients are heterogenous, we are not all the same.
Gonzales split the Central Pains into TWO varieties. The first, called spinothalamic pain, pertains to the diffuse burning, carried in the front of the cord. The second group of pains are called leminiscal pain, and include BOTH the shooting electric pains carried in the fasciculus gracilis and cuneatus, AND the sensation of muscle cramping, which comes from the muscle spindle. It is posterior pain.
Why is this differentiation important. It is because the shooting pains tend to respond to anticonvulsants, whereas the burning pain may respond to nothing.
If we were a little more prescise about WHICH Central Pain we have and WHICH medicine benefits WHICH pain, I think things would make more sense.
So if it is convenient, maybe we could say ST neuropain (burning) or posterior cord neuropain (lightning pain and muscle spindle pain), so others will know which pain is relieved by which medicine in us. There are other neuropains like pins and needles, gut and bladder cramping/burning, and more elaborate muscle pains.
I am fascinated by the posts, but would like to know WHICH pain is getting relief, or not.
Many of you have lamented the lack of objective tests for CP. Gilbert Gonzeles, at Mayo's, has actually published one way to objectively test for Central Pain. However he is no longer doing this testing and has left Mayo's. Gonzales showed that CP people have tactile illusions. He used little points, like kid's connect the dots, to outline a number. In CP people, after the machine is turned off, the patients continue to "feel" the numbers, so much that when the next numbers are applied, the old one continues to be superimposed over the new. This is just the hypersensitivity of their nervous system. Gonzales called this the "phi" phenomenon.
What was obvious in his report is that CP patients are heterogenous, we are not all the same.
Gonzales split the Central Pains into TWO varieties. The first, called spinothalamic pain, pertains to the diffuse burning, carried in the front of the cord. The second group of pains are called leminiscal pain, and include BOTH the shooting electric pains carried in the fasciculus gracilis and cuneatus, AND the sensation of muscle cramping, which comes from the muscle spindle. It is posterior pain.
Why is this differentiation important. It is because the shooting pains tend to respond to anticonvulsants, whereas the burning pain may respond to nothing.
If we were a little more prescise about WHICH Central Pain we have and WHICH medicine benefits WHICH pain, I think things would make more sense.
So if it is convenient, maybe we could say ST neuropain (burning) or posterior cord neuropain (lightning pain and muscle spindle pain), so others will know which pain is relieved by which medicine in us. There are other neuropains like pins and needles, gut and bladder cramping/burning, and more elaborate muscle pains.
I am fascinated by the posts, but would like to know WHICH pain is getting relief, or not.