Ever feel like government is not taking notice of the pain problem. Think about the cultural realities.
Recently, we received comment from a high government official, at Health and Human Services, initially a Reagan appointee, now retired, who is familiar with the political processes of research funding. Is politics a factor in funding? It is apparently the ONLY factor. In other words, the squeaky door gets the grease, and NUMBERS are important. That is why it is essential to combine ALL pain under one banner, to convince the government that there is sufficient public interest to merit funding of basic pain research. It is absolutely unhelpful to talk of SCI pain, MS pain, cancer pain, AIDS pain and the like. One in five Americans will contract a chronic pain condition. The problem is how to get them all together.
The topic of discussion was how to marshal public support for research into pain. If only these people would contract their pain state when they are STILL in office and able to do something. It was his opinion that it could not be done, because nerve injury pain is invisible. The best you can hope for is that money devoted to spinal cord injury will somehow be diverted into research into sensory neurons. He then made a comment of surprising insight. He said, “in India, the poor are so poor that they break their children’s legs and maim them so that they will look more pitiful and they will make more money from begging. It sounds like central pain is too invisible to muster public support and outrage. It is probably one of America’s shames that they are too blind to see that disorders of this kind should receive the highest priority.”
This illustrates the perfect evil of Central Pain. It recruits the genes in a person’s body to manufacture pain exciters which then saturate the nodes of activity, namely the dorsal root ganglia near the spine, the dorsal horn where sensory nerves enter the cord and central nervous system, and at the nuclei of the brain where relays are being coordinated, sorted, and prioritized. The local resident pain molecules are basically acids, ie. cytokines, prostaglandins, and related acidifiers, fatty acids and the lipids which relate to fatty acids.
Tominaga and Tominaga have recently proven (Pflug Arch Jun 22 05) that the TRPV1 receptor responds to acids (proton activity ie. acid presence), and certain lipids and fatty acids. TRPV-1 is the channel of capsaicin, which duplicates one component of central pain. Dr. Patrick Wall and Dr. Kenneth McHenry have commented on how the predominant verbal descriptor of burning dysesthesia, which is “like acid under my skin” or “like a burning chemical in my flesh”, resembles real mechanisms. Central Pain is not bizarre, it is just unusually “ACID”. The acid factories in the genes refuse to shut off. Something is driving them. It is their job to signal pain and signal is what they do after INCOMPLETE injury, unremittingly, and without mercy or meaning. It is fairly well shown that those with CP dysesthesia simply have an overabundance of these acids, which drive the pain nerves wild with pain. Most of the burning quality seems to be carried in the anterior cord in the ventral spinothalamic tracts, although the lateral spinothalamic tracts may become hyperpathic as well, as may nearly any nerve fiber or bundle relating to sensation, since interneurons can link up any sensation to pain. A researcher in Arizona has shown that certain light grids will cause pain with vision. (see at painonline.org) ANY sensation can become neuropathic and no one does it better than CP patients.
Other pains exist in CP, to be sure. There are the very frequent “lightning pains” (also called “lancinating pains”) which are electric shocks which travel via the posterior cord, and generally give a prolonged latency on somatosensory evoked potential testing. Insufficient work has been done yet to determine whether the vermis, a cerebellar midline roof nucleus (nucleus= any collection of nerve cell bodies) lights on ONLY in Central Pain sufferers with lightning or other muscle pains or whether it attempts to suppress ALL the central pains. However, the cerebellum is thought to control motor coordination, so it is anticipated that the vermis will be uniquely associated with muscle pains and posterior cord types of central pain.
Burning pain on the face is even trickier, since theoretically, according to most anatomy texts, it is impossible to have pain on the face from a cord injury. However, the texts are simply wrong. The nucleus for sensation on the face is indeed in the brain, but the nucleus for PAIN on the face is located in the cord, in the spinal trigeminal nucleus, or STN. This tract leaves the brain and goes DOWN to the cord, where it connects via interneurons with body pain neurons coming up in the Substantia Gelatinosa, or Rexed Layer II of the cord. MJ Fischer, etal (J Neuroscience Jun 05) have just completed careful studies of the spinal trigeminal nucleus to show that CGRP blockers applied to it stop facial pain (CGRP is calcium gene related peptide, which is being studied in migraine). Those with dural Central Pain report a chronic headache, and now are being shown NOT to be malingering. If only they had had a massive head wound to create credibility!!!
Visceral central pain is trickier. We don’t completely understand how this is getting to the brain. Some think such pain leaves the cord and travels along autonomic branches outside the cord, such as the Vagus nerve. The autonomic or “Unconscious” nerve system is mysterious. It seems rather plastic. Theoretically the parasympathetic which has its nerve bodies next to organs, and the sympathetics which gather their nerve bodies in the ganglia just outside the cord OPPOSE each other. However, in cord injury, switching has been observed. If sexual function in the parasympathetics is severed, the sympathetics have been discovered to be taking over some of the function. Whether the correct function can actually be assumed is unknown, but some kind of nerve activity is being devoted to the missing functions. There is also the theory that the “pins and needles” of central pain move along visceral afferents which travel with the blood vessels, OUTSIDE the cord.
NONE of these modalities are visible. NONE of them would evoke publish sympathy. NONE of them are anything more than molecular and genetic aberrations. Molecular disease is hard to detect and requires a full out technological search. Cancer is an example of this. It is very hard to detect even with high technology science until a mass forms. This mass is the ultimate vindication that cancer is something real, and the ensuing death seals the validation.
NOTHING of this kind ever occurs in central pain. Right up to the time of death and even beyond, NO technology exists to detect it. It must be inferred from the chemical derangment which is found with careful examination of lab animals in whom central pain has been induced by laser or mechanical cord injury. We known the pain exciters are drowning the neurons in the hubs and connection points, the relays and the synapses. However, there is nothing visible to the naked eye. The pain itself has no verbal descriptors which are accurate. Language is not much good as a precursor and can only remind the human mind of an idea or concept which already has some basis in the imagination of the brain. Central Pain is beyond the imagination of humans. It is as Riddoch declared, “A pain beyond pain”. It therefore does not really exist. Sit on the corner asking for research money and you will not appear pitiful. You will appear to be malingering. “I have severe pain which cannot be seen”. Give us a break. You would have better luck holding up one of the cardboard signs that says, “Traveling through. Stranded. Vet. Will work for food. God bless” that we see at the major intersections where panhandlers collect money for booze.
Thus, we see the problem. Intellect has not yet reached the level where truth can be observed at the molecular level. The only answer to this problem is education. Educatioh in the high schools, colleges, and professional schools. This site exists for EDUCATION of you and the professionals which come here. Please continue to respect yourselves enough to write to elected officials to ask for research funds. Mike Leavitt, the current head of HHS, needs to hear from you about Central Pain. You can see your broken body, even if others cannot. Maiming at the molecular level is still maiming.