dejerine
10-22-2005, 10:38 AM
For quite some time, there has been heavy emphasis in the literature on the relation of inflammation and pain. For example, in peripheral neuropathic pain, the spinal cord neurons have been studied in DNA arrays and been found to have markedly and chronically increased levels of messenger RNA for inflammatory chemicals. These chemicals typically come from astrocytes, one of the groups of "glial" cells around the neurons. Other scientists thought this idea would be premature if applied to central pain. Since a lot of work was going on in peripheral nerve injury pain, it was felt too early to assume the neurons of the astrocytes would be doing the same in central pain. Recently, Claire Hulsebosch in J Neurosci Oct 05 and related scientists showed that astrocytes behave the same way in central pain. It has also recently been shown that the GABA system in the thalamus of CP monkeys is pretty much shut down even though the GABA neurons are still alive. GABA suppresses pain excitation in the cord, it is not known for sure what GABA does in the brain. The main significance of these studies is that we simply do NOT have to convince people we are in pain. They can and should simply read the literature. Even if they can't see it, even if the observer has a medical degree, if monkeys given SCI develop this stuff, then it would almost certainly be in us as well. This means our pain may be invisible but we do not have to apologize for saying we have it. It is time for people to stop doubting us and simply begin listening to us and accept that pain after SCI is a very real thing. What is amazing is that Hulsebosch considers central pain the NORMAL response to cord injury and she has identified a percentage of the rat population which have genes which PREVENT the development of CP.
In the past here, I asked in a survey how many had heavy trauma associated with CP, thinking a weakened hippocampus might have made us more vulnerable. This study by Hulsebosch suggests that SCI people who do NOT get central pain probably have some kind of genetic structure preventing it. I wish doctors would read this stuff. It would save 95% of the time we spend in the office trying to convince them. If it is present in monkeys, they can just assume we have it and stop grilling us. There appear to be different levels of susceptibility to CP among different people.
Gratitude goes to these PhD scientists who are demolishing the old skepticism of the physicians (NOT ALL WERE SKEPTICAL, THANK GOODNESS) about whether we are really in pain. There is still a disconnect betweeen ALL pain researchers who can produce CP without any difficulty, and the office docs who can accept that it exists only with the greatest difficulty. Someone is NOT reading the literature. If they refuse to read the literature, shouldn't they really give us a refund for the money they charge to "evaluate us". If they don't know what they are looking for, how will they recognize it when they see it. What is wrong with med schools that they don't teach this stuff. EVERY one of the big pain scientists works in a med school, yet the neurologists at the same institutions seem oblivious to the work that is coming out of their OWN school. Pain science is very complicated. So what. The bills we get for it are big enough to justify a little expertise. I don't think the average neurosurgeon really even knows what it is, so they should stop evalutating it until they read the literature. There are many surgeries which the average neurosurgeon will not do, as it is specialized stuff for a limited number. Seventy percent of money made by neurosurgeons now is routine disc surgery. Few of them are really ready to do complicated stuff. Yet, they ALL presume to know EVERYTHING about pain. After all, what is there to know. THEY have had pain themselves.
There was never really any evidence that SCI people had no pain anyway, just the vague question of how they could if they lacked feeling. That idea was NEVER scientific, but now it is positively stupid. Laser a rat's cord, and most of them will squeal if you stroke their fur with a brush, or move away if they are sitting on a warm surface. 1+1=2. Yet, 1500 bucks at the doctors office may get you little more than a condescending smile from the doc, which always makes me want to choke him. He has never read a thing on the topic, yet because HE is in the white coat, it makes him the GOD of pain. I guess the fact he is getting paid by disability firms all the time to say people are well enough to work must have warped his conscience and his brains in general. Most disability policies sold now require 100% disability. If you want a good laugh, read the percentages of disability assigned to various injuries. For example, cord injury with double amputation is rated 70% disability. We should strangle them for such nonsense with our remaining 30%. I think you have to be blind as well to get to 100%. Probably need to have lost your tongue as well so you can no longer lick envelopes lifted to your mouth. Get this! Cover your body with capsaicin and you won't be doing anything at all except trying to remember reasons NOT to use the shotgun. That is what severe central pain is. Severe pain is bad, very bad, very very very bad, so bad you can't imagine it. It is 100% BAD. If you don't believe this, give me an extra large vial of capsaicin, a tuberculin syringe and let me go to town on you. Before I have even gotten to your torso, you will have become a believer, and there is always your genitals, your mouth, your corneas, your sinuses and a lot of other gruesome places which CP seems to find out with no trouble. As a matter of fact, your productivity will go to zero before I have even gotten to 5% of your body. So what about that 100% of the body goal. It should be interesting to see you revise the percentages as we go. The nation has convulsions of guilt over men being stripped naked in prison (not that I condone that in the least, esp the sexual abuse), but they sit comfortably while CP people have ACTUAL torture. Coincidentally, does anyone know how they do preinduction physicals in the army. Picture a room full of naked guys standing there while a doctor walks along the line and has you cough and you get the idea. This is so much humiliation, but not in the same universe as central pain.
Today I discovered three parallel bloody cuts on my left arm with dried blood streams about two inches and long gashes. Something had rubbed across the arm and cut it. I had no awareness I had been injured there. It surprised me. Yet, this arm has spontaneous burning, burns extra to prolonged light touch all the time, and cool air. I have lost the benefit of protective pain and gained the disadvantage of nonprotective pain.
In the past here, I asked in a survey how many had heavy trauma associated with CP, thinking a weakened hippocampus might have made us more vulnerable. This study by Hulsebosch suggests that SCI people who do NOT get central pain probably have some kind of genetic structure preventing it. I wish doctors would read this stuff. It would save 95% of the time we spend in the office trying to convince them. If it is present in monkeys, they can just assume we have it and stop grilling us. There appear to be different levels of susceptibility to CP among different people.
Gratitude goes to these PhD scientists who are demolishing the old skepticism of the physicians (NOT ALL WERE SKEPTICAL, THANK GOODNESS) about whether we are really in pain. There is still a disconnect betweeen ALL pain researchers who can produce CP without any difficulty, and the office docs who can accept that it exists only with the greatest difficulty. Someone is NOT reading the literature. If they refuse to read the literature, shouldn't they really give us a refund for the money they charge to "evaluate us". If they don't know what they are looking for, how will they recognize it when they see it. What is wrong with med schools that they don't teach this stuff. EVERY one of the big pain scientists works in a med school, yet the neurologists at the same institutions seem oblivious to the work that is coming out of their OWN school. Pain science is very complicated. So what. The bills we get for it are big enough to justify a little expertise. I don't think the average neurosurgeon really even knows what it is, so they should stop evalutating it until they read the literature. There are many surgeries which the average neurosurgeon will not do, as it is specialized stuff for a limited number. Seventy percent of money made by neurosurgeons now is routine disc surgery. Few of them are really ready to do complicated stuff. Yet, they ALL presume to know EVERYTHING about pain. After all, what is there to know. THEY have had pain themselves.
There was never really any evidence that SCI people had no pain anyway, just the vague question of how they could if they lacked feeling. That idea was NEVER scientific, but now it is positively stupid. Laser a rat's cord, and most of them will squeal if you stroke their fur with a brush, or move away if they are sitting on a warm surface. 1+1=2. Yet, 1500 bucks at the doctors office may get you little more than a condescending smile from the doc, which always makes me want to choke him. He has never read a thing on the topic, yet because HE is in the white coat, it makes him the GOD of pain. I guess the fact he is getting paid by disability firms all the time to say people are well enough to work must have warped his conscience and his brains in general. Most disability policies sold now require 100% disability. If you want a good laugh, read the percentages of disability assigned to various injuries. For example, cord injury with double amputation is rated 70% disability. We should strangle them for such nonsense with our remaining 30%. I think you have to be blind as well to get to 100%. Probably need to have lost your tongue as well so you can no longer lick envelopes lifted to your mouth. Get this! Cover your body with capsaicin and you won't be doing anything at all except trying to remember reasons NOT to use the shotgun. That is what severe central pain is. Severe pain is bad, very bad, very very very bad, so bad you can't imagine it. It is 100% BAD. If you don't believe this, give me an extra large vial of capsaicin, a tuberculin syringe and let me go to town on you. Before I have even gotten to your torso, you will have become a believer, and there is always your genitals, your mouth, your corneas, your sinuses and a lot of other gruesome places which CP seems to find out with no trouble. As a matter of fact, your productivity will go to zero before I have even gotten to 5% of your body. So what about that 100% of the body goal. It should be interesting to see you revise the percentages as we go. The nation has convulsions of guilt over men being stripped naked in prison (not that I condone that in the least, esp the sexual abuse), but they sit comfortably while CP people have ACTUAL torture. Coincidentally, does anyone know how they do preinduction physicals in the army. Picture a room full of naked guys standing there while a doctor walks along the line and has you cough and you get the idea. This is so much humiliation, but not in the same universe as central pain.
Today I discovered three parallel bloody cuts on my left arm with dried blood streams about two inches and long gashes. Something had rubbed across the arm and cut it. I had no awareness I had been injured there. It surprised me. Yet, this arm has spontaneous burning, burns extra to prolonged light touch all the time, and cool air. I have lost the benefit of protective pain and gained the disadvantage of nonprotective pain.