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Thread: Question to Dr. Wise

  1. #1

    Question to Dr. Wise

    Hello Dr. Wise,

    What tells you neuropathic pain in the paralyzed segments after a spinal cord injury about the condition of the spinal cord?? Can you say that when you dont have any pain the spinal cord is totally destroyed? Can you say that when you have pain in your paralyzed legs that the communication for pain is available but nothing else? I know that this system is very complex but I just dont get it......

    Please tell me if my thoughts are right or wrong that when you have no pain at all that the axons are disruppted completely?!

    Thanks

  2. #2
    Answer please Dr. Wise

  3. #3
    Quote Originally Posted by KK11 View Post
    Hello Dr. Wise,

    What tells you neuropathic pain in the paralyzed segments after a spinal cord injury about the condition of the spinal cord?? Can you say that when you dont have any pain the spinal cord is totally destroyed? Can you say that when you have pain in your paralyzed legs that the communication for pain is available but nothing else? I know that this system is very complex but I just dont get it......

    Please tell me if my thoughts are right or wrong that when you have no pain at all that the axons are disruppted completely?!

    Thanks
    I'm certainly not Dr Wise Young, but I'll take a stab at your question until hopefully he can chime in. Pain signals and muscle signals travel on different neuron pathways. Its possible for damage to affect each differently. Generally speaking, neuropathic pain below the injury level in a spinal cord injury indicates an incomplete injury to the pain neurons. Motor neurons can have impaired signal or no signal at all in an SCI. Does that clear things up for you at all?

  4. #4
    Quote Originally Posted by KK11 View Post
    Hello Dr. Wise,

    What tells you neuropathic pain in the paralyzed segments after a spinal cord injury about the condition of the spinal cord?? Can you say that when you dont have any pain the spinal cord is totally destroyed? Can you say that when you have pain in your paralyzed legs that the communication for pain is available but nothing else? I know that this system is very complex but I just dont get it......

    Please tell me if my thoughts are right or wrong that when you have no pain at all that the axons are disruppted completely?!

    Thanks
    I am not Dr. Wise Young. But - I am two out of three. I'm a doctor, I am wise, but alas, I am not young.
    I hope you don't mind my poor attempt at humor.
    I will try to answer your excellent questions.
    1. The presence or absence of of neuropathic pain tells you nothing about the condition of the spinal cord. It just doesn't.
    2. No. Refer to answer #1, the presence or absence of neuropathic pain does not tell you anything about the condition of the cord.
    3. If you have pain in your paralyzed leg, it doesn't tell you anything about the integrity of the cord.. Some 'lucky' SCI people don't have neuropathic pain, and some unlucky people do. Some people who have their leg cut off, have neuropathic pain in the missing limb, and others with the same injury don't. They both have no injury to their spinal cords.
    Some people who get herpes of the spinal nerves , Shingles, get neuropathic pain and others don't.
    I don't know if there is a language barrier but I will tell you this. If you have neuropathic pain,and are a new injury, and somehow hopeful that there is at least some silver lining to having neuropathic pain, hoping that there is less injury to your spinal cord, there is some sobering and bad news for you -that neuropathic pain may be with you for the totality of your life span and you won't get any other beneficial function back ( like motor control or sensory). There is no silver lining to having the curse of neuropathic pain.
    This is a hard pill to swallow and there are many newly injured folks who are , say, in their twenties and it hits them that they are going to have this horrendous almost untreatable problem all throughout their life. There are people getting a surgical Drez procedures to try to cut the neuropathic pain out of their cord, sacrificing a few levels of motor function sometimes to be free of this burden.

    In sum, there is nothing to read into the presence or absence of neuropathic pain regarding your injured spinal cord. You can be hopeful for return from a SCI injury for 2 years. The chance of significant improvement drops off after that. Your functional capability will continue to improve although your motor and sensory functions cease to improve. You learn how to transfer better and more efficiently, you organize your life better, thing get easier .
    But this new uninvited guest, neuropathic pain, may be your new companion for a long time well after you realize your injury has stabilized and no more return will occur. I hope this helps answer your question.

  5. #5
    Quote Originally Posted by arndog View Post
    I am not Dr. Wise Young. But - I am two out of three. I'm a doctor, I am wise, but alas, I am not young.
    I hope you don't mind my poor attempt at humor.
    I will try to answer your excellent questions.
    1. The presence or absence of of neuropathic pain tells you nothing about the condition of the spinal cord. It just doesn't.
    2. No. Refer to answer #1, the presence or absence of neuropathic pain does not tell you anything about the condition of the cord.
    3. If you have pain in your paralyzed leg, it doesn't tell you anything about the integrity of the cord.. Some 'lucky' SCI people don't have neuropathic pain, and some unlucky people do. Some people who have their leg cut off, have neuropathic pain in the missing limb, and others with the same injury don't. They both have no injury to their spinal cords.
    Some people who get herpes of the spinal nerves , Shingles, get neuropathic pain and others don't.
    I don't know if there is a language barrier but I will tell you this. If you have neuropathic pain,and are a new injury, and somehow hopeful that there is at least some silver lining to having neuropathic pain, hoping that there is less injury to your spinal cord, there is some sobering and bad news for you -that neuropathic pain may be with you for the totality of your life span and you won't get any other beneficial function back ( like motor control or sensory). There is no silver lining to having the curse of neuropathic pain.
    This is a hard pill to swallow and there are many newly injured folks who are , say, in their twenties and it hits them that they are going to have this horrendous almost untreatable problem all throughout their life. There are people getting a surgical Drez procedures to try to cut the neuropathic pain out of their cord, sacrificing a few levels of motor function sometimes to be free of this burden.

    In sum, there is nothing to read into the presence or absence of neuropathic pain regarding your injured spinal cord. You can be hopeful for return from a SCI injury for 2 years. The chance of significant improvement drops off after that. Your functional capability will continue to improve although your motor and sensory functions cease to improve. You learn how to transfer better and more efficiently, you organize your life better, thing get easier .
    But this new uninvited guest, neuropathic pain, may be your new companion for a long time well after you realize your injury has stabilized and no more return will occur. I hope this helps answer your question.
    Thanks for the answer

  6. #6

    Cp

    arndog thanks for posting what i couldn't

    And for some central pain folks there is no relief. Alan, myself too exhausted to remember the crew sorry. Almost 13 years tried virtually everything, trialing prialt, the end of the line.

    So sorry. Fwiw the higher the function it seems the higher the likelyhood of CP or bad neuro pain.

    So sorry, but wish someone had the stones to tell me this 12 years ago. Many find some relief try EVERY cocktail of meds offered and research for any they miss.

    No doc just full blown CP.

    Ket
    Kindly,

    The Ketamine Kitty

    All the tears, all the pain, all the rage through the night (apolgies to the rewrite) RR

    Next time I die make sure I'm gone,
    don't leave 'em nothing to work on JT

    And I ain't nothin but a dream JM

  7. #7
    I think there is another dimension to pain in general that is easily dismissed as being "in your head". Pain creates agitation which creates anxiety which amplifies the feedback from pain which keeps escalating until it drives you literally mad.

    Then people who can't relate say well just get away from it and problem solved. But that's the rub, sometimes you can't get away from this vicious circle.

    I'm a c7 complete with minimal pain so this isn't necessarily a first hand account and should probably be taken with a grain of salt. I do follow the stories of many here on CCC with extreme CP and this is just what I've come away with.

  8. #8
    I have truly gone mad, and there is no escape. Reduce stress when it is the primary cause? It kills me when they say reduce the stress in your life

    I have no answers I meditate, practice mindfullness, pray, drink, take, drugs.

    I'm alive and I am dead and wish my body would catch up to my soull that is long gone and in the wind.

    ket
    Kindly,

    The Ketamine Kitty

    All the tears, all the pain, all the rage through the night (apolgies to the rewrite) RR

    Next time I die make sure I'm gone,
    don't leave 'em nothing to work on JT

    And I ain't nothin but a dream JM

  9. #9
    Quote Originally Posted by KK11 View Post
    Hello Dr. Wise,

    What tells you neuropathic pain in the paralyzed segments after a spinal cord injury about the condition of the spinal cord?? Can you say that when you dont have any pain the spinal cord is totally destroyed? Can you say that when you have pain in your paralyzed legs that the communication for pain is available but nothing else? I know that this system is very complex but I just dont get it......

    Please tell me if my thoughts are right or wrong that when you have no pain at all that the axons are disruppted completely?!

    Thanks
    A lot of people don't get it. But, let me give you some facts and let you deduce the rest.
    1. If you transect the spinal cord, the likelihood of neuropathic pain is high, probably greater than 50%. There is no evidence that that painful activity is coming from the spinal cord below the injury site. This means that the neuropathic pain is likely to be coming from above the injury site.
    2. Neuropathic pain occurs when sensory signals are removed, i.e. after amputation, spinal cord injury, and even multiple sclerosis where sensory signals are no longer coming into the brain due to demyelination.
    3. Transection of the spinal cord usually does not improve the neuropathic pain.
    4. The drugs that are showing some effects on neuropathic pain are anti-epileptic, i.e. reduce abnormal excitability of neurons. So, this suggests that neuropathic pain is occurring as a result of increased excitability of denervated neurons above the injury site.

    Wise.

  10. #10
    Senior Member Axle's Avatar
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    Quote Originally Posted by Wise Young View Post
    2. Neuropathic pain occurs when sensory signals are removed, i.e. after amputation, spinal cord injury, and even multiple sclerosis where sensory signals are no longer coming into the brain due to demyelination.
    Isn't a DREZ essentially demyelination?

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