Was referring to these notes from a lecture I went to a few years ago, and thought it was worth a re-visit here, too.
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DAVID TEICHEIRA, M.D. Sacramento Pain Clinic
"Pain is not well understood"
The International Association for the Study of Pain defines pain as: "An
unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such damage"
ACUTE pain is an alarm system nociceptive pain
nerve impulses are translated by the limbic system if you didn't have a
limbic system, you wouldn't have emotions
PERSISTENT pain is a complex state of mind that is the result of many
people with chronic pain have trouble sleeping stimulation of
if severe pain is allowed to persist for more than 24 hours, neuroplastic changes associated with the development of intractable chronic pain syndromes are evident -- damaged mechano-receptor nerve grows over the nociceptor nerve after 24-48 hours; the nociceptor atrophies. -- This may be permanent
no one knows.
Referred pain uses the same set of nerves
Prescriptions do not take pain away, they just make it easier to ignore
You only feel your pain when you're paying attention to it when you are
thinking about your pain, that's your cue to do ANYTHING ELSE
as a result of intense pain, neurons in the spinal cord that help to prevent pain transmissions actually die. At the same time, pain-transmitting neurons grow more connectors to other nerves, become more sensitive, and react more strongly to a painful stimulus
CFS/FMS deal abnormally with pain as a memory. On a PET scan, the brain is all lit up all the time. The process is abnormal, but the pain is real.
Chronic back pain patients lose 5-11% of their cortex.
Your brain can't tell the difference between chronic pain and new injury
flares are not damage indicators
He recommends work through the pain, but don't fight through the pain
Chronic pain is different it's pathological
Neurontin wasn't a good seizure drug, but decreases rate of nerve firing, no known long-term effects
morphine and other opiates are incredibly safe.
RX doesn't make the pain go away there's a plateau where more doesn't do
more they're better than nothing
pseudo-addiction means you're undertreating if patient asks for more, it
usually means more works better
only two ways to entirely take away pain:
Saponin SP (for Substance P) FDA approved only for use on elderly
animals who'll die in a few days, because it kills all the pain nerves doing
this will cause more damage in the long run
distinct neurological pathways for acute vs. chronic pain
NNT Number Needed to Treat number of people who need to take the drug
to get one to feel better
Neurontin's NNT is 3.4 = only 1/4 will get relief
Morphine's NNT is 8 = only 1 in 8 will get relief
Ibuprofen's NNT is 5 = only 1/5 will get relief
WHY WE HAVE MEMORY PROBLEMS
both chronic pain and long term memory require the NMDA pathway for
mice with poor memory didn't develop chronic pain if they were deficient
but with 2x NMDA, they had a great memory and developed chronic pain easily
intense pain can result in permanent changes in the Central Nervous System
resulting in phantom pain this can take years to develop
chronic pain does go away for most people
chicken pox ends up in your RNA => shingles => nerve damage
reticular activating system pain and sleep are connected
HERBAL TREATMENTS SHOWN TO REDUCE MUSCULOSKELETAL PAIN
Devil's claw extract the most effective dosage for both osteoarthritis
and low back pain is 50 mg of harpagophytum procumbens daily for at least
Bromelain ananas comosus, pineapple shown to significantly decrease
Substance P release
Turmeric root curcuma longa 1125 to 2500 mg/day
Omega 3 fatty acids salmon, halibut, cod, herring, mackerel and tuna,
flax seeds, canola oil and walnuts 1200 to 2400 mg daily
Research links pain sensitivity to gene Johns Hopkins neuroscientist
George R. Uhl, M.D., Ph.D.
ABNORMAL PAIN MEMORY HELPS TO EXPLAIN FIBROMYALGIA
The symptoms of fibromyalgia may be the result of a central nervous system
that "remembers" pain sensations for an abnormally long time, according to
research presented at the American College of Rheumatology Annual
Scientific Meeting in Philadelphia. Fibromyalgia affects about 2% of the US
Researchers at the University of Florida applied heat stimuli to the hands
of healthy controls and fibro patients. Fibro patients experienced
CUMULATIVE pain, indicating abnormalities in spinal cord pain processing, and
RESIDUAL pain when the stimuli were applied at intervals. Researchers found
that the residual pain experienced by fibromyalgia patients was widespread
and not limited to a single area of the body.
"Because the effect of the first experimental stimulus does not rapidly
decay in fibromyalgia patients, the effect of subsequent stimuli adds to the
first, and so on, resulting in ever increasing pain sensations," said lead
investigator Roland Staud, M.D. "Our findings provide evidence for
abnormal central nervous system mechanism of pain in fibromyalgia patients and
have significant implications for future therapies, which need to target these
abnormal central pain mechanisms."