Shaking down another ion channel

Who is the culprit who tortures humans, who does bad things to good people, who reduces mankind to its lowest condition, actually presaging hell, as it were? Pain is the dark side of the force, the diabolical extinguisher of hope and happiness. It was perhaps meant to protect us from injury, but going rogue, it is anything but a friend.  Existing theory points to the ion channels which permit impulses to travel along nerves via what has been called an “action potential”:, which is a sort of current flow achieved by ions of sodium and calcium moving across the nerve membrane.

Just when TRPV1 ion channel was taking all the blame, it turns out that that particular calcium ion channel might have an accomplice. The putative stalking horse goes by the name of TRPA 1 or ankyrin 1.

The transient receptor ion channels are potent activators of pain neurons. While TRPV1 has gotten most of the attention, now studies suggest another channel might well be a co conspirator. In this field, those seeking relief, the disappointed guinea pigs of pain, know not to be overenthusiastic or to start counting our chickens, but at least the new work shows researchers are still investigating. Pain research is not totally dead. Not everyone thinks anticonvulsants are all that a patient in a pain crisis unresponsive to opiates could possibly desire.

Just to make you suitably confused, investigators have reported that a new drug, ADM-09, results in “calcium-mediated binding of the carnosine residue and disulphide-bridge-forming of the lipoic acid residue accounts for the observed persistent blocking or TRPA1. Feel better? Okay, not yet, but somehow just knowing the whole business of basic pain research has not gone away entirely, that scientific gobbledygook can help keep the spirits up. That phraseology just used to snow you actually means  ADM_09 is an effective antagonist of the nociceptive sensor channel..”

Or, in other words, if we could block TRPA-1 we might be able to block pain.

This was reported in:

Sci Rep. 2013;3:2005. doi: 10.1038/srep02005.

A TRPA1 antagonist reverts oxaliplatin-induced neuropathic pain.

We listed all their names so if they read this they will know we have put aside our agony long enough to appreciate the very hard work they are doing. The Central Pain patient may not be the best to discuss his suffering in terms others can understand but he likes to think he might be able to express gratitude..
Note to researchers:
If you cure this you will definitely win the Nobel Prize and make a billion dollars. And generations of Central Pain families will name their children after you. If you had any idea how unpleasant it can be to deal with someone with Central Pain, you would take mercy on those families who have to deal with it by making the CP go away. In the meantime, thanks for trying to turn down the flame on the most severe pain state known to man.

TRAUMATIC STRESS DISORDER, PAST AND PRESENT

TRAUMATIC STRESS DISORDER AND PAIN

 

Hmmm. Something is wrong. A word is missing somewhere. Oh, there we go. The word POST is missing. POST traumatic stress disorder. According to the language, stress disorder is something the body and brain develop AFTER the stress. Apparently, during  the stress, the mind has blanket immunity to such problems. But does it really? Do our everyday experiences confirm that during a robbery, tornado, assault, etc. that our emotions are held in check, our thoughts and feelings sturdy and true, while only later does the system collapse and become dysfunctional? Is that right?

On second thought, maybe there is a larger category of which POST TRAUMATIC STRESS is a subtype. Maybe DURING the catastrophic event, we can go all wobbly and confused and frantic. Maybe some kind of hysteria can overtake us when we are actually IN the throes of a crisis, DURING the dreadful event. How long does the PRESENT last. Is it a couple of minutes, an hour, a month or even longer. How about a lifetime. WHEN exactly does the system give out and a STRESS DISORDER set in? What do we call it if we never get out of the pain in order to develop PTSD.

Take for example, CENTRAL PAIN. Does the frantic nature of severe pain somehow have a protective feature, an adrenaline rush perhaps, which shields us from the impending shutdown? If so, how much adrenaline can we count on? Does it last years?

Dr. Ron Tasker, the famous neurosurgeon who discovered that pain in the body is carried in the spinothalamic tract, has indicated that fully elaborated central pain is the most severe pain state known to man. If he is even close to being correct, and no one has more experience with pain patients, then did anybody else notice this? Well, S. Weir Mitchell, the civil war surgeon, was amazed to find his most brave officer reduced to the “TEMPERAMENT OF THE MOST NERVOUS GIRL” as soon as Central Pain set in after a bullet to the neck injured the spinal cord.

The Civil War being notably brutal and gory, things had to have been pretty bad to attract the attention of someone who had seen it all. What exactly was going on? It must have been impressive, because after treating some more Central Pain patients, Dr. Mitchell convinced Johns Hopkins Hospital to set up an entire wing for nerve injury pain patients.

Was their treatment for POST traumatic stress or was it something different because their pain was ongoing. They were actually IN PAIN, still, so one could not very well term it POST traumatic since the pain trauma was still there. Imagine, an entire ward at a top hospital full of formerly brave soldiers, acting like the MOST NERVOUS GIRLS. This was not over their paralysis, but their pain. What is up with that?

Aside from the offensive to feminist aspect of Mitchell’s choice of words, we get the picture. They were not themselves. They were different from those charging into the cannon’s mouth. They had left part of themselves on the battlefield the day they were injured. They were in fact living a life of deaths. Their real personality was no more.

Was this worse than post traumatic stress, this intratraumatic stress? Was it less? Or did it have components of two different disorders? Is chronic PAIN really identical to post traumatic stress? Can we help one but not the other?

When Riddoch, who invented the term “Central Pain” gave his report in the Lancet, he called the condition,  “A Pain Beyond Pain”. What could possibly have led him to characterize it this way? What was he talking about? There is nothing beyond pain, or is there?

These are the questions we ask. The psychiatrists and psychologists literally descend en masse on those with post traumatic stress, but they are conspicuously absent in the pain clinics. Is Central Pain too mysterious even for the psychiatrists? Does this mean the mind stays on even keel until AFTER pain has gone, at which time it flips out. Are psychiatrists only able to deal with incidents AFTER THE FACT, or can they be of assistance DURING a terrible trauma, even a long lasting one? Especially a long lasting one. Are the stresses and appalling shocks suffered by the patient’s family too remote and inaccessible even to study, much less treat? Does the condition even have a name? Is that out of reach? What are they waiting for?

Or are we assured that the human mind is durable and that the CP subject (who himself regards his pain condition as WORSE THAN THE PARALYSIS) will need no help beyond what opiates can provide during the months and years during which he is taken apart minute by minute, day by day, by an illness too terrible to describe.

If you relate to this quandary, and feel you could use some help now, you are obviously just“ a nervous girl” UNLESS, of course, the condition of pain present is really something sinister, and indescribably awful. Were the Civil War soldiers right that the pain is worse than the paralysis? Hmmm. That would make it pretty bad, now that you think about it..

 

NOTE: Due to the relentless intrusion by internet trolls, the comments function has been shut off.

Doctors and Patients are Talking Past Each Other

Why isn’ t Central Pain any better understood now than ten years ago?

On one occasion a neighbor took her sick child to the Pediatrician for an antibiotic. He told her the illness was viral and that not wanting to contribute to antibiotic resistant strains he would not give an antibiotic. He said to just keep her away from other children and the illness would have to run its course, since nothing helps viral colds. She was entirely outraged because the doctor charged the usual office fee for the visit, but did not do anything. She still had a sick child. Patients do not like to be charged for being told nothing can be done.

 

Is there anything like this in Central Pain? Absolutely. There is no satisfactory treatment, according to the National Institutes of Health. While treatments are alleged for peripheral nerve injury pain, no study has shown this to be the case for CENTRAL NEUROPATHIC PAIN. The doctor knows this but may send the patient home on successive visits with any number of drugs designed for peripheral nerve injury pain. A sedative may help a bit, but basically, the patient must learn to manage life to minimize pain because there is as yet no real treatment for the condition.

 

The doctor, knowing that no treatment is forthcoming if it is CP is not likely to press the patient to stop talking gibberish about Central Pain (what else can one do if there are no words for dysesthetic pain) and try to come up with something like an adequate verbal descriptor.  The patient is in PAIN and wants the doctor to do something right NOW.What else would a compassionate doctor do?

 

Until patients are required to be more specific, the doctor will be poor at sorting out Central Pain from other pains. Until the doctor has something real to offer, the patient will not want to pay money just to expand the database of the doctor’s knowledge. Almost invariably, the patient wants to talk about pain severity and not pain quality, because they want relief. And so, no progress is made. Only when both patient and doctor determine to do it right and take the time for a real history and physical will any of this change. In the meantime, with limited time provided by managed care, things will stay the same, with ignorance for the doctor and disillusionment for the patient. A real workup must be thought of in terms of hours or days, not minutes. Third party payers will have to do their part if things are going to move forward.