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Thread: lithium helping chronic neuropathic pain in SCI ?

  1. #1

    lithium helping chronic neuropathic pain in SCI ?

    I was reading a thread in the cure forum and learned from Wise that his trials with lithium in chronic SCI surprisingly found improvement in NP (central pain) and I hoped he could expound on this here. Dejerine, what do you know about this?

    Here is a quote from his thread, "regarding the trial... animal data indicates the lithium is alone is beneficial but when given in acute spinal cord injury. We tested a 6 week course of lithium in people with chronic spinal cord injury and only assessed the patients at 6 weeks and 6 months after the a 6 week period of treatment. To our surprise it, it reduced neuropathic pain in the patients with severe neuropathic pain. It did not change motor and sensory scores. We did not know whether lithium alone would have any effect but we had to test it rigorously to make sure that this is so.

  2. #2
    Hi Arndog,

    Greeting to Reno and its leading, though most reluctant, expert on central pain. Thanks for the heads up.

    Well, I know nothing about it. But hearing about it makes me wonder a couple of things. You must remember that Wise now groups all neuropathic pain together. The confusion and indescribable symptoms of CP have given cause to pain treatment people to abandon the term central pain. I have already said I do not agree with this, due to the clinical sign of Mitchell's delay. I come from an era when the taxonomy people at IASP strongly believed in the term, Central Pain. Mitchell's delay is the twenty or thirty second delay in evocation of dysesthetic burning by light touch in Central Pain which is not seen in PNI, where evocation by light touch is instantaneous.

    CP does sometimes evoke instantaneously from a cold blast of air in sharp contrasts, (such as very cold blasts from car air condition on the legs in summer), but at more moderate temperatures, it may be that evocation is slower initially in CP there also. In fact cool air can be very soothing in a hot ambient temperature. It is the exaggerated temperature differnce which empowers cold as an evoker. Ir is relative to the ambient temperature. Epicritic (subtle differences in touch and temperature in fine sensation) characteristics are closely linked to CP, and subtle temperature differences take time, but they do result in increased pain. A cool room does not hit the CP person at once, but eventually a four or five degree temperature lowering will enhance dysesthetic burning if the threshold for cold sensation is already near. This single test can differentiate pain of central origin from peripheral nerve injury pain. Carl Saab's work (now at Yale) on the vermis in the cerebellum shows that attemptes at inhibition of central pain by the vermis also kick in at about twenty or thirty seconds after the stimulus is applied. The majority of the pain community rejected Saab's paper at the Ninth World Congress on Pain, and Pat Wall's support for Saab caused a majority of the members to dislike Wall, just as a majority are now claiming no difference between central and peripheral nerve injury pain. If we cannot come up with words, THEY cannot think of any difference. Studies on atopoesthesia (loss of sense of the location in 3D space of the skin surface, in dysesthetic areas) in central vs peripheral pain are lacking but are relevant to the discussion.

    Lithium is used primarily for depression. In the past it made an appearance in related to uric acid metabolism. Today, it is on the decline in depression due to side effects. Its main toxicity is on the kidney. It is also used a little in hyperthyroidism. These matters would make us ask:

    1) Is thyroid function altered in central pain
    2) Is there an as yet unrecognized linking between depression and central pain. Of course those in chronic pain states are not reeking with happiness. So we then wonder about cause and effect. Is pain CAUSING depression; or, given Wise's findings, is there something primarily contributing to pain which also contributes to depression. I can't think of any possibility since theory today has lost interest in anatomical tracts and is focused entirely on neuroinflammation.

    Having said that, if the results are proven out, and Wise is a careful investigator, who thinks innovatively, we may have something. If you watch someone on Lithium, it really slows them down. There is a heavy component of agitation in severe central pain. Adrenalin is directly linked to angiotensin, and angiotensin is linked to the fatty acids, and fatty acids are the primary acidifier which is inflaming pain nerves in central pain. The article at about Eicosanoids gives some further information about the chemical linkage between fatty acid metabolism and neuroinflammation (that site has been hamstrung by the outside hiring of the programmer, who was a volunteer).

    All in all, I would have to speculate that consequences of Lithium on angiotensin, which is linked to prostaglandins, which is linked to inflammation would be ultimately the place to look for an explanation of possible benefit to central pain by Lithium

    In other words, your guess is as good as mine.
    Last edited by dejerine; 06-09-2010 at 05:12 PM.

  3. #3
    Senior Member Broknwing's Avatar
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    Mar 2004
    Central Florida

    I don't typically read the pain forum, but this thread title caught my attention....Your post has some very interesting points & some good questions...I think I might be able to point you to some reading that you may find interesting in regard to your questions and the correlation between depression, pain and the thyroid...

    Hypothyroidism is far under-diagnosed because the testing for thyroid function is flawed...The thyroid is main hormone generator for the entire body, if it's off, everything else is off...this in turn can cause depression, depression causes pain, pain causes more's an evil circle...I learned all of this when trying to find proof for my HORRIBLE HORRIBLE thyroid dr who didn't believe me when I continued to tell him for over 6 months that the medicine he put me on made me gain weight & made me feel like I'd been run over by a truck...He told me that was impossible...As soon as I quit the med I started feeling better...He didn't believe what I told him about what I discovered, I decided not to return to him again...I don't need a dr contradicting what I know my body is doing...Most of the time I feel better, the last couple months have been kind of a back-slide on feeling good, but I'll get back to "normal" again soon...

    anyway, the site I mentioned is
    that site is enlightening on how the thyroid is SO inter-connected and how it affects everything...I'd be curious how Lithium reacts with the may be one drug that could treat multiple things for me...HMMM...
    L-1 inc 11/24/03

    "My Give-a-Damn's Busted"......

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