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Thread: Ten frequently asked questions concerning cure of spinal cord injury

  1. #281
    Senior Member
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    Dear Dr. Young

    Hope you will be fine.

    Let me know will any doctor be using Embryonic Stem Cells in ChinaSCINet clinical trial 2006 as i have heard that these cells have more potential for the regeneration. When and where these clinical trials are starting? Can we paticipate?

    Sincerely

    Jawaid

  2. #282
    Quote Originally Posted by Jawaid
    Dear Dr. Young

    Hope you will be fine.

    Let me know will any doctor be using Embryonic Stem Cells in ChinaSCINet clinical trial 2006 as i have heard that these cells have more potential for the regeneration. When and where these clinical trials are starting? Can we paticipate?

    Sincerely

    Jawaid
    Jawaid, there are no plans to use embryonic stem cells in ChinaSCINet in 2006. Wise.

  3. #283
    Quote Originally Posted by QuadPro
    If at least neuropathic pain can be cured completely I will be much happier.

    Can I look forward to this?
    Would you mind sharing what this entails? I had sensations of burning and such before but I don't have much pain, just discomfort. Why do some have "pain" and others do not?


  4. #284

    Neuropathic pain

    Quote Originally Posted by Le Type Français
    Would you mind sharing what this entails? I had sensations of burning and such before but I don't have much pain, just discomfort. Why do some have "pain" and others do not?
    For many years, doctors did not take neuropathic pain seriously. They use to call it "phantom limb" when it occurred after amputation so that the person apparently felt the pain in the absent limb. It turns out that neuropathic pain is a very common phenomenon that is associated with loss of sensory input to the brain. This can occur as a result of damage to a peripheral nerve (which of course occurs with an amputation or brachial plexus avulsion) but also with injury to the spinal cord or multiple sclerosis.

    Traditional pain medications such as opioids did not seem to help. Certain antidepressants seemed to take the edge off the pain but only certain classes of such antidepressants helped, particularly those of that inhibited monoamine oxidase (MAO), an enzyme that breaks down catecholamine neurotransmitters, suggesting that catecholamines since as epinephrine, norepinephrine, and serotonin may play a role.

    Several groups have shown that rats that are treated with antibodies against nerve growth factor (a neurotrophin) are less likely to develop neuropathic pain, suggesting that abnormal sprouting of remaining afferent fibers (these are fibers that carry incoming signals that were not damaged) may contribute to neuropathic pain. Recently, we discovered that methylprednisolone treatment of rats after spinal cord contusion reduced the incidence of autophagia, a behavior that is likely to reflect neuropathic pain. There is evidence that the nervous system that remains after spinal cord injury will sprout, not only during the period that immediately follow injury but for many months or even years after injury.

    Neuropathic pain can take many forms, ranging from abnormal vibratory, cold, hot, aching, pressure and other sensations (called dysesthesia) to hypersensitivity to touch or temperature (called allodynia) to very unpleasant pain. They are usually not present during the first weeks after injury but can develop several weeks, months, or even years after injury. Several surveys suggest that as many as 50% of people with spinal cord injury have some form of neuropathic pain.

    Most neuropathic pain occurs in parts of the body where sensation is abnormal or absent (e.g. below the injury site). Most neuropathic pain occur close to the neurological level. Areas that have recovered sensory function may show allodynia. Neuropathic pain can occur in deeper organs, sometimes called visceral neuropathic pain. Finally, in a small percentage of patients, neuropathic pain occurs above the injury level, often associated with abnormal spastic or movement disorders, perhaps a consequence of sprouting of both motor and sensory systems above the injury site.

    Several treatments have been found to reduce neuropathic pain in some people.
    • MAO inhibitors. MAO inhibitors have been used as anti-depressants. The first of these shown to have some effect on neuropathic pain is a drug called amitriptyline or Elavil (an MAO inhibitor anti-depressant drug but given in 20 mg/day doses that are lower than traditionally given to reverse depression). Amitriptyline, however, usually just reduces the dysesthesia.
    • Baclofen. Baclofen activates the GABA-B receptor. Although primary used to reduce spasticity, some people find that it can reduce neuropathic pain, particulary when given in very high doses intrathecally. It is often used to treat neuropathic pain that is associated with severe spasticity.
    • Gabapentin. Several anti-epileptic drugs appear to reduce neuropathic pain. The best and most frequently used of these is gabapentin or neurontin. This drug was initially controversial because people accomodated to the drug but when higher doses of as much as 4-5 grams per day were given, the effects often stabilized. Other possible anti-epileptic drugs include valproic acid.
    • Ketamine. This is a glutamate receptor blocker that has long been used to treat children. In high doses, it tranquilizes and causes amnesia. It has been used to treat cancer pain. In low doses, it may have some effects on neuropathic pain.
    • Epidural stimulation. Stimulation of the spinal cord itself may help. The electrodes are put on top of or close to the spinal cord and different frequency and amplitudes of stimulation can be tried until a combination is found that reduces neuropathic pain.
    • Opioids. Although opioids were originally thought to be ineffective in controlling neuropathic pain, it turned out that it was largely a matter of dose. Unfortunately, of course, opioids are highly addictive and have serious side effects. A number of new drugs have come out that combine both MAO inhibition and opioid effects.

    There is intense research underway around the world to find better drugs for neuropathic pain. One of the fears of regenerative therapies is that it may stimulate aberrant connections that foster the onset of neuropathic pain. To date, this has not turned out to be the case although some of the experience in OEG transplants in China have suggested that recover of sensory dermatomes close to the injury site may be transiently associated with allodynia and dysesthesias. This is something that should be closely watched for.

    In many ways, I view neuropathic pain as the flip side of the coin to spasticity and spasms. Most people know about spasticity which is abnormal muscle tone or spasms which are abnormal muscle movements. For many years, neurology textbooks taught that spasticity is a result of removal of inhibitory influences of the brain on the lower spinal cord. While disconnection of the brain from the spinal cord does release motor reflexes in the lower spinal cord, often causing conditions such as cerebrate posturing, both the time course of development and manifestations of spasticity and spasms after spinal cord injury suggest that it is more than just disinhibition and that spasticity is probably associated with aberrant reconnections of the spinal cord below the injury site. I think that neuropathic pain is a form of "sensory spasticity".

  5. #285
    Dr.Young,

    At the Society for Neuroscience conference in 2005 in Washington D.C. Drs. Plant and Hodgetts presented results from their human bone marrow stromal cell study on acute spinal cords in rats. If you were there and heard these results, could you kindly please give me your opinion about this work that was done. Thank you kindly in advance.

  6. #286
    That was quite interesting, Dr. Young.

    I do notice that my right foot and where I was cut during my operation are VERY sensitive areas. In fact, I do not like them touched at all. Sometimes I will get "pain" in the area where I was cut during my surgery. So I definitely sympathize with those who must live with that.

    It has always been a mystery to me as to whether this sensitive area under my right armpit is due to the cutting of nerves by a surgical knife or if it's due to my SPI. I'd love for the sensation to be normal again because it's quite uncomfortable trying to clean that area.


  7. #287
    Small peripheral nerve cuts can often lead to hypersensitivity in the surrounding areas. I suspect that they have to do with local sprouting in the spinal cord as well. But interestingly, most of the time they disappear and normalize, but only after many months. Likewise, many people who have had Dr. Huang's surgery also report neuropathic pain and hypersensitivity in the dermatomal zones that recover for several months but these also seem to go away. This suggests that that central nervous system have some mechanisms of their own to deal with small amounts of aberrant sensory sprouting. The mechanisms by which the spinal cord prunes such growth are not known. Wise.


    Quote Originally Posted by Le Type Français
    That was quite interesting, Dr. Young.

    I do notice that my right foot and where I was cut during my operation are VERY sensitive areas. In fact, I do not like them touched at all. Sometimes I will get "pain" in the area where I was cut during my surgery. So I definitely sympathize with those who must live with that.

    It has always been a mystery to me as to whether this sensitive area under my right armpit is due to the cutting of nerves by a surgical knife or if it's due to my SPI. I'd love for the sensation to be normal again because it's quite uncomfortable trying to clean that area.

  8. #288
    Quote Originally Posted by zokarkan
    Dr.Young,

    At the Society for Neuroscience conference in 2005 in Washington D.C. Drs. Plant and Hodgetts presented results from their human bone marrow stromal cell study on acute spinal cords in rats. If you were there and heard these results, could you kindly please give me your opinion about this work that was done. Thank you kindly in advance.
    I heard that they presented this but did not see it. Were you there? What did you think? Wise.

  9. #289
    Quote Originally Posted by Wise Young
    I heard that they presented this but did not see it. Were you there? What did you think? Wise.

    No I was not there but I heard they presented and it was said that this study has promise. The only reason that I wanted to know what you think is because they done the study on chronic rats at the same time and the recovery as good as the acute study, except I think they took a little longer to recovery. I know that throughout 2005 they have been working on chronic rats with the same type of approach but they have also been working on the scar at the same time. It is apparently showing 'remarkable promise'. They are also looking to start trials but I don't know when. I think funding is also a problem there.

  10. #290
    Quote Originally Posted by zokarkan
    No I was not there but I heard they presented and it was said that this study has promise. The only reason that I wanted to know what you think is because they done the study on chronic rats at the same time and the recovery as good as the acute study, except I think they took a little longer to recovery. I know that throughout 2005 they have been working on chronic rats with the same type of approach but they have also been working on the scar at the same time. It is apparently showing 'remarkable promise'. They are also looking to start trials but I don't know when. I think funding is also a problem there.
    Thanks. A number of years ago, I tried hard to help Australia raise more money for spinal cord injury research. In Sidney, the dedication of the proceeds of seven or more traffic cameras to spinal cord injury research should be funding a significant number of projects. I thought that there were similar programs starting in Perth, Melbourne, and Brisbane.

    Wise.

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