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Thread: Is Wiki blowing smoke on central pain

  1. #1

    Is Wiki blowing smoke on central pain

    In the past, we have questioned whether routine inclusion of central pain under the title "neuropathic pain" is a good idea. Is dimensional, topographic or quantitative consideration of no moment at all? Or will central pain become lost, as a minor player numerically (although the major one in severity) in the forest of nerve injury pain, all trees in that supposed forest being incorrectly spoken of as roughly equivalent, and realizing that a forest could be comprised of several acres of trees or cover all of Siberia. (a rat's paw in one study is not the same thing as the entire body of a human). Pain in a foot can be very bad, pain in the entire leg worse, both legs even worse and the lower half of the body worse than that, etc.

    If we created a medical category called "skin injury" and then bunched both total body burn with a cut requiring stitches, the vast difference in magnitude would make us question the validity of creating the category in the first place. Is conflation going to lead to confusion?

    Review of the term "neuropathic pain" at Wiki illustrates something of the problem.

    The Wiki author runs through what looks like some fairly scientific points on neuropathic pain. There is inclusion of central neuropathic pain in the discussion, but no real attempt to sort out the differences. It would be all too easy to think central pain is just one among many manifestations among types of neuropathic pain.

    An example is the discussion of certain treatments alleged to be applicable to neuropathic pain. One of the examples of therapy pertains to opiates. When we go to the original article, in the Journal of Pharmacology and Experimental Therapeutics), in an article by Davis et al, we find that the pain model for this study was PERIPHERAL nerve injury in the paw of a rat. In this study, done in long ago 1999, we read, after an erudite discussion of such things as "asymmetric carbon atoms", that d methadone (l methadone being the common pain reliever) has the same effectiveness of relieving hyperalgesia as dextromethorphan.

    This "very good news" leaves the impression that both dextromethorphan and d methadone could be expected to relieve central pain in humans. This is a bit like saying since we can blow out a match with a puff that a blow would be just the thing for forest fires.

    Carecure has a number of posts here which indicate dextromethorphan (commonly used in cough syrup) has no benefit for central pain. Hence, if d methadone is judged to be AS effective as dextromethorphan, it is still not effective at all. It is true enough that d methadone is AS effective, but what is not said, that dextromethorphan is itself not effective, leaving the wrong impression entirely.

    The reader gets buried in technical language which fails to convey the important thing, that there is no effective treatment for central pain in most cases. One does what one can, taking pain meds where it helps, but the remaining issue should be that there is no satisfactory treatment for severe central pain. It is not reasonable to think someone trying to read about central pain at the neuropathic pain article on Wiki would come away enlightened.

    The implication would be that a 1999 article on the paw of a rat gives reasonable hope that someone with post SCI central pain should take heart and begin to consume large amounts of cough syrup. This is the sort of irrational desperation medicine one might expect on Mr. Toad's wild ride, or while chasing wild geese.

    Wiki divides pain into muscular, visceral, and neuropathic, which is fair enough, but without addressing what these might be like, it is not particularly helpful.
    Last edited by dejerine; 02-23-2014 at 09:18 PM.

  2. #2
    As Abe Lincoln said the problem with the internet is whether the quotations or information is actually true or properly attributed. One of my pain docs read the original papers and said for the cost of a few bottles of cough medicine it was worth a try. As you suggested, like blowing out a forest fire. Useless. And Wiki has come under scrutiny more than a few times and has been scorned with a few massive and well orchestrated hoaxes over time. Invented wars, people yada yada.

    I don't write much here anymore, have given up, seems so pointless. And saddening when someone new pops up. Someday I'll just end it or hopefully will expire soon. IT Clonidine has been a 5% help in one singular pain modality and IT baclofen has helped some with spasms, the rest unchanged and grim. Nothing for the CP yet. Sigh, weary to the bone.

    Nice to see you here again.

    Kindly,

    Ket

  3. #3
    dejerine -
    are you still using a benzodiazepine occasionally? Isn't that the only med you take?
    arndog

  4. #4
    Arndog

    Hi. Yes, clonazepam is the only drug I have found which seems to help slightly. I simply cannot tell if this is due to sedation or actual pain relief. I am in the habit of mentally attributing pain relief by opiates to "sedation" although I know that opiates are not actually sedatives. Having no benefit from opiates, including very heavy IV doses, I just cannot fit my mind around the idea it is analgesic for anyone else; however, I realize this is not particularly rational, but it does fit the research results at NIH, which plainly state that opiates are ineffective in CP. Then, I read your posts, and I back off.

    I am mainly trying not to do the dance at pain clinics, where they go round robin with all the unproven meds, including some disproven ones. I object to the shotgun approach this represents. When a doc takes the time to actually consider WHICH TYPE of pain I am describing and tailors his meds to THAT SPECIFIC type of pain, I would be willing to try some of the new stuff, but there isn't much out there.

    Frankly it all reminds me of the stuff written about infectious disease before they had antibiotics. Lots of action, no benefit. My old prof at Hopkins said "Treating infection before antibiotics was like sitting in a rocking chair. Lots of action, but you didn't go anywhere". I have never forgotten that.
    Last edited by dejerine; 02-25-2014 at 04:26 AM.

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