Science a GoGo's Home Page Forums General Discussion General Science Discussion Forum Pain - Why Are There Nothing But Theories

G'day all,

This is a query that only probably has relevance if you are studying medicine or the processes of brain function etc.

I suffer from chronic pain syndrome. Fancy name for terrible pain all the time often unrelated to the current clinical condition of the body part. In my case, I even have bizarre problems such as cold water burns my lower legs.

But back to pain. I've always thought that the brain itself must have some mechanism that kicks in after a few weeks to repeat pain that may or may not have any organic cause left. Take a compressed neural exit for instance. In my case it might cause bladder and bowel failure (or that might be the spinal cord damage but at least some of the bladder problems is a neural exit problem) and it causes pain down my leg in areas that are totally undamaged. Why?

Never been a great fan of the gate theory of pain because it might describe how pain works to some extent but it certainly doesn't seem to provide a real model for what is going on.

Anyway, I am wondering if there are any new theories out there or anyone with some knowledge in this area would like to provide any explanations.


Regards


Richard

Hi Ric:

After reading your plight I searched around the internet a little but found nothing worth while. I was a defense trial attorney for Insurance Carriers and self insured employers in California for 32 years. You had a lot to do with medicine in order to deal with the complex injuries and the medical profession. I never came accross a symtom complex as unique as yours and that includes people trying to convince us of some strange stuff.

Your leg effect with cold water interests me. If you take that in context with the rest of your problem my guess is that some clever physician may find the key to the situation. Unfortunately physicians are like many scientists and discard stuff that was not a proper school topic. I had a woman testify that after her neck injury it caused her hair to give her great pain when she combed it. No one gave any credit to the symptom due to its inprobility of being organic. They finally found a slightly cracked vertebra and she eventually got better, hair and all. Some people are afraid to recite some symptoms due to the unreceptive looks they get from the doctor.

Unfortunately I have nothing to offer you for improvement. A very good friend of mine has been suffering with back pain for years and has tried just about everything medicine has to offer, except surgery, which the doctors have ruled out. I use to know a lot about back problems and I feel confident his medical advice is good. So there it sits. While many scientists are busy buying whoppingly expensive toys to bounce atoms and search for dark matter the ones closest to us, and the ones we need most, are in the dark on what is killing the rest of us.

You are. I think, experiencing a kind of nerve reversal causing the messages to the brain to be changing a no message into a pain message. I am not a doctor but I suggest you ask your doctors if such a thing is medically possible. No harm done in asking. Good luck.
jjw

RicS ...

What you describe is quite common in pain research and is not entirely unrelated to the phantom pain experienced by those who have lost an extremity.

One of the lessons learned in advanced pain treatment is that once serious pain has been experienced it is far harder to combat than if you can prevent it from happening. It seems, perhaps, that the extreme pain, and some accidents/surgeries, can create an effect causing the nerves to generate pain signals at some location unassociated with the original pain.

This is just a guess on my part but possibly similar to how tinitus creates the appearance of sound in the ears/head when no sound exists. And it too is incurable ... just usually more tolerable.

Have you checked these out?
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

http://www.brighamandwomens.org/paintrials/

http://www.nida.nih.gov/pdf/monographs/download36.html

You might want to see if you can find someone willing to run FMRI and PET scans on you and determine the source.

hi DA:

I looked at your links and I think the third offer may have something for Ric if he gets to read the entire article- I did not read it all.

Phantom pain for amputees gets a lot of attention but I can vouch for being involved with many amputations,and extremities and parts thereof, and phantom pain was not a problem. It was especially not a problem causing disability. Some tried to fake it but it did not work with my clients. Give a doctor a legitimate case of phantom pain and he will write it up.

I do not want to contemplate that Ric's doctors have not run every possible test on him.
jjw

Assuming RicS lives in any one of a large group of western countries ... his insurance won't pay for it and neither will his government.

He would most likely need personal cash or a researcher willing to do it as part of a study.

RicS:

Current research into chronic pain appears to be now focussed on the undamaged nerves rather than those nerves affected by disease or injury. The following is the full article from the following link:

http://www.hon.ch/News/HSN/530545.html

"WEDNESDAY, Jan. 25 (HealthDay News) -- In a finding that could alter pain treatment, British scientists have found that undamaged nerve fibers, not injured ones, cause ongoing spontaneous pain.

The unexpected finding that may help in the development of new treatments for back problems and other conditions that involve chronic pain. Previous research into chronic pain focused on nerve fibers damaged due to injury or illness, and largely overlooked intact nerve fibers.

The cause of this ongoing pain and why it arises spontaneously was not understood before," Sally Lawson, of the University of Bristol, said in a prepared statement. Now that we know the type of nerve fibers involved, and especially that it is the undamaged nerve fibers that cause this pain, we can examine them to find out what causes them to continually send impulses to the brain. This should help in the search for new analgesics that are effective for controlling ongoing pain.

The findings appear in the current issue of the

Journal of Neuroscience.

Lawson and her colleagues identified nerve cells called nociceptors (damage detectors) that, when activated by disease or injury, send out electrical impulses that are sent to the brain. The faster these undamaged nociceptors fire electrical impulses, the stronger the ongoing pain.

The firing of these nociceptors seems to be caused by inflammation within the nerves or tissues, caused by dying or degeneration of the injured nerve fibers within the same nerve, the researchers said."

The above link also provides links to useful resources which includes the following to an interactive text on "clinical symptom research." Certainly of interest from a scientific point of view with the added advantage that it is useful for treating insomnia too.

Further to my previous post, here is the link to the "clinical symptom research."

http://symptomresearch.nih.gov/scien_literature.htm

G'day all,

Thank's for the posts.

Very Long Reply - Sort of Addressing Whatever Issues Were Raised, I hope

To Te Urukehu, the info you posted was along the lines of what I was looking for. I always suspected that it was undamaged nerves rather than the damaged ones that sent pain signals.

"Chronic Pain Syndrome" by the way can mean two different things. One is the continuation of pain after the reason for it is absent or when used by pain doctors it means the long term intractable pain. I fall into both categories.

My back produces pain signals that probably should not be there but since I have every vertebra below T12 damaged, five blocked or mostly blocked neural exits, three sites of CSF leaks including a current one, scaring around operation sites, catheter sites etc and have managed to even damage my spinal cord at C3-C4, that makes any attempt to distinguish just why pain is there problematic.

There is a cure by the way. They disable part of the brain that receives the pain messages. It is done experimentally and I managed to get approval by the ethics committee even though it would cause paralysis but it was in another country, the funding was withdrawn and I could not afford the cost.

To jjw, the question was academic, just seeing if they had developed any better theories yet, rather than therapeutic. I've had enough operations, scans, tests, and the like to fund a small country. Dan Morgan was not quite right. I've made no secret of the fact that I'm Australian in other posts. Australia's health care system is considerably better than the US system. It costs me nothing if a doctor decides to do an MRI. They did that to me not all that long ago and I have pain treatment monthly and medication that in the US would drive someone bankrupt within weeks or months.

But our system is far from perfect and priorities are assigned. I cannot get an operation on my neck for instance because the surgeons that could do it won't operate in public hospitals currently because of a problem with equipment levels.

Thanks for the comments, Dan. Considering our differences in many threads, they were thoughtful and appreciated.

Oh and jjw, your views on pain have probably been coloured by who you represented for such a long time (I appreciated your comments by the way and don?t mean this is being any criticism of you, only an observation because of long experience). I too worked for insurers as a consultant. My job was determine what happened with major incidents and to avoid them ever going to court if possible. Thus, I didn't have to take an adversatorial view. Mostly the matters I dealt with were engineering but since I once was in charge of a State Fatal Motor Vehicle Investigation unit (all two of us!) a long time ago, I would sometimes be sent complex accident claims. A quadriplegic can end up costing an insurer about $8 million in Australia, pretty much all medical costs, and our system of motor vehicle accidents, worker's compensation etc is mostly fault based. Most often I'd get these matters because there was an argument between insurers.

The ones that were very often argued about and went to court were the ones where there was some mobility but pain was limiting usefulness. They generally did poorly in courts because even doctors like to be able to point to an MRI and say, there's a neural exit occluded. That is causing the problem. Trouble is pretty much all research into back pain other than severe trauma indicates that pain is unrelated to observed damage. There a great numbers of people walking around without a trouble in the world that their MRIs show as having serious problems and there are people that cannot walk because of pain that have nothing on their MRI. I don?t have the reference but a major study was done in Sweden on this with MRIs performed on a large group of people.

I find it strange that everyone expects me to have severe pain in my neck because the damage there is clear even on a simple x-ray yet so many doctors had trouble with me having any pain in my lower back or legs because it took about four years before someone managed to do a good enough MRI over a large enough area to show up significant damage (and that was only because a bone scan previously showed a number of vertebrae, my knees and ankles getting almost no blood supply). Now MRIs show a great deal of damage but that is a few more years later. Oh, if if anyone is wondering how do you get a neck injury and a back injury, all you need is to have a back injury that causes the loss of motor function and a fall the wrong way (well, after about 100 not so serious ones).

Since I also moderated a rather large pain site for a few years, I can say that I have come across symptoms far more complex than mine. Mine is relatively simple because it is easily understood in the context of the multiple spinal injuries. Fibromyalgia isn't yet the pain can be totally devastating.

The best way to find out how much pain a claimant is in is to see how they are going a couple of years AFTER their claim is over. Compensation neurosis accounts for quite a bit of pain in many people, not to mention the frauds, the exaggerations. Phantom limb pain is a little complex. Because it is now well understood in the context of what damage seems to cause it, amputations are now done very specifically to avoid phantom limb pain. A great deal of the time that works. I have a friend in South Africa who had most of her leg ripped off, a few crushed vertebrae and other injuries. The phantom limb pain was sufficient for her to attempt suicide and to contemplate it pretty much every day. She has no court case pending, nor ever had any claim in relation to the incident.

And Dan Morgan is quite right about serious pain being much harder to combat than prevent. That is why you get so much pain treatment when first in hospital now whereas even 20 years ago, the pain was treated as secondary. It is my understanding that the body can ?turn off? pain if it does not continue for more than about six weeks. After that, the percentages of those that will eventually be pain free drop dramatically. I?ve always thought this was an evolutionary thing. It takes about that time to recover from a broken bone. So you are still of use to a tribe with a broken arm or leg but if the injury is too complex and takes much longer than that to heal your usefulness in the future is quite doubtful. It seems logical that mechanisms would develop to do everything possible to heal the body within a certain period but the trade-off would be that after a certain period the body has used up those resources.

The question about the theory of pain was not that much to do with practical issues at all, otherwise I would have included much more info in the first place. Like most things, if it has a bearing on myself or my family, I tend to study it. So I tried to read everything I could on pain when it stopped me from being me basically. I was astounded that there was no theory to explain how pain is processed by the spinal cord and the brain, only supposition based on studies. I was wondering if there had been much of an improvement in this field.


Regards


Richard