Re: Central Pain - G from in MI

[Guest guest]

-

Critical Illness Polyneuropathy (CIP)?

Reflexive Sympathetic Dystrophy (RSD)?

I sort of feel like I came in right in the middle of a movie or novel - so

please pardon my questions. I saw your post last week - I think as a result of a

post from from Port Huron - perhaps you are both members of

another group too? Either that or she posted a response as a result of one of

your posts last week. I noticed the second " " posting, if you will, then

-because there was a post from that said " Thank you, " - I opened it

and it made no sense in light of the post that I had just sent Nan. Then I

discovered the post you submitted and some of the pieces began to fit together.

I am not really familiar with the illnesses you have posted about - at least

with regard to Rheumatology - I do know they clearly are a manifestation -

severe- of chronic pain and are related to neuropathic pain and specifically(?)

muscular pain. Many here, including myself, having had RA for long enough for it

to possibly be classified originally as JRA- can identify. I for one think some

of the pain I feel is either more or less intense because my body- even during

those periods that I would not describe as a flare- has become oversensitized by

chronic - low grade pain. I have reviewed medicals as part of my legal work-

and as a supervisor - for disability apps - for advice, referral and

representations- and must say that your diagnoses- are either underdiagnosed -

or are missed frequently.

Your post on patient self advocacy was excellent. Your professional knowledge

and contributions are most welcome- but perhaps some more of your story would be

appreciated too. As much or as little as you would like to share. We appreciate

your contributions- but we are here for you too.

The " other " - in Michigan-

-------------- Original message ----------------------

From: ANewPlanForYou@...

>

>

> Dear Friends in Pain,

>

> Some find this very indicative of the suffering we go through with RSD,

> interesting stuff...

>

> A PFD to all,

>

>

> Introduction to Central Pain

> " The Pain Beyond Pain "

>

> Central Pain is the name for a pain syndrome which occurs when injury to the

> Central Nervous System is insufficient to cause numbness but sufficient to

> cause central sensitization of the pain system.

> Reflecting the neuron of choice of the original nerve physiologists, nearly

> everything taught in medical school about basic nerve physiology derived from

> studies of motor nerves. Because sensory nerves behave almost nothing like

> motor nerves, the behavior of Central Pain may seem anti-intuitive to those

fed

> a

> diet of motor nerve physiology for most of their training.

> An injured motor nerve simply carries less current. Injured pain nerves,

> paradoxically, do exactly the opposite, they increase their signal. It is not

a

> simple increase, however. They eventually gain the power to humorally

influence

> uninjured neighbor neurons, which begin autonomous firing. (Devor's work in

> The Axon , ed.Waxman, Oxford Univ. Press, 1995).

> The process can become so violent that the thalamus, the brain pain center,

> records " bursts " of impulses from these injured nerves. After sufficient

> bombardment threatens neuron death in the thalamus, it " shuts down " . Central

> Pain

> apparently occurs at this point. Radiostimulation of the spinothalamic tract,

> which causes no sensation in people without Central Pain, recreates the

> sensation of Central Pain in those who have the condition. It is as if the

> entire pain

> system is acting like a nerve ending. Ungated pain signals thus reach the

> cortex, causing unbearable suffering.

> Pain nerves were designed to do their best work in the face of injury. This

> differs from motor nerves, which put the body to rest with injury by

decreasing

> their function. It is difficult to get some clinicians, born and bred on

> " motor think " to adjust to " pain think " . There are features of Central Pain

> which

> may seem unexpected.

> Among these unexpected features are the following:

> The stimulus which usually causes the most unbearable aspects of Central Pain

> is the evoked pain of light touch, especially light touch which is persistent

> and occlusive. Such patients may wear abbreviated clothing to avoid textures

> rubbing on the skin.

> The burning pain, which light touch evokes, does not occur when the stimulus

> is first applied, but after time, (similar to the way the pain of sunburn

> occurs well after the UV injury). This is called slow summation and is a

> temporal

> phenomenon. This evoked burning is lesser in magnitude but identical in

> quality to spontaneous burning, an omnipresent burning which may be the only

> dysesthesia (bizarre burning) present, particularly in quadriplegics. In other

> words,

> spontaneous burning is not always capable of being evoked. Evoked dysesthetic

> burning is the big brother of spontaneous burning. Especially at the

> peripherae however, (e.g. hands) evocation is usually displayed along with

> spontaneous

> burning, although the stimulus which evokes the burning varies from patient

> to patient. Such a stimulus may be light touch, texture, or heat.

> Very limited data suggest that dysesthesia (burning pain) also displays

> spatial summation, which means as larger areas are covered with touch, the

> magnitude of burning becomes greater. The dysesthesia is of a greater

magnitude

> where

> touch sensation is poorest, which is usually distally on the body.

> Central Pain also displays an hyperpathia. Sharp hyperpathia tends to occur

> most where sensation is most retained, which is generally proximally on the

> body. The location of visceral hyperpathia seems to follow more the

positioning

> of gas and digesting food in the gut. That which would be painful to people

> without Central Pain is much more painful in Central Pain, but nothing is felt

> until a greater than normal pain stimulus is applied.

> Because these patients have decreased touch sensation, including decreased

> sense to very light painful stimulus, Central Pain hyperpathia has been termed

> to have a " delay " . This is an unfortunate term since it has nothing to do with

> time. It appears to have been adopted because hyperpathia is often coexistent

> with dysesthesia, which has a true temporal delay. With hyperpathia, there is

> a level of noxious stimulus which is not perceived. This is actually a

> heightened threshold to pain, not a temporal delay. The heightened threshold

is

> very

> difficult to test for because it is so easily exceeded. Once the threshold has

> been exceeded, or when pain is first perceived, the pain response overshoots

> and responds violently. This is called delay with overshoot. The stimulus may

> be sharpness, heat, or cold. It is more common for heat to stimulate

> hyperpathic response in those with profound motor loss (plegics), while it is

> more

> common for cold or sharpness to generate hyperpathia in those who retain some

> motor function (paretics).

> " Delay with overshoot " is generally considered a synonym of hyperpathia, but

> it is not really the same since hypersensitivity to pain can occur in those

> with normal nervous systems (such as sunburn). Only those with nerve injury

can

> perceive hyperpathia long-term. The testing has not been done to determine how

> neuropathic hyperpathia (injured nervous system) is similar to or different

> from nociceptive hyperpathia (normal nervous system). Hyperpathia also occurs

> in the viscera (gut), but is displayed there as a feeling of overfulness,

> almost to exploding, like very severe distention with flatus. Similarly, a

full

> bladder can be unbearable.

> The " fullness " is evoked in an inconsistent pattern by dietary intake.

> Patients often can affect its course by choice and timing of food/water intake

> or

> elimination. Limited data indicate that the hyperpathia of Central Pain

> increases directly in areas with retention of touch sensation, which is

usually

> proximally on the body, a gradient which is exactly the opposite of the

burning

> dysesthesia, which usually increases distally. These gradients can usually be

> confirmed by careful questioning, but it is uncommon for the patient to

> volunteer

> the information since the gradients are not even and any dysesthetic pains are

> poorly localized.

> There is perhaps no more difficult area in which to obtain a correct history

> than in pain which is " indescribable " . The result of haste and imprecise

> questioning has made the literature on the subject almost incomprehensible.

The

> clinician should repeat questions several times from several angles before

> assuming the patient differs from the norm in Central Pain as described in the

> mnemonic on this website.

> That light touch which is perceived in Central Pain has a " tingly " quality to

> it. This may be thought of as similar to the " tingle " of a lip touched while

> it is returning from dental anesthesia, or like the tingle of limbs falling

> " asleep " . It is however, quite painful, " like needles " . It is the most intense

> of the central pains but does not cause the most suffering. This tingle can be

> pronounced, compelling the attention of the patient, or it can exist in a

> minor form. Patients nearly always compare it to a limb which has fallen

asleep

> and is regaining feeling. It has been called " circulatory pain " .

> A Central Pain patient who is paying very close attention may be able to

> respond fairly well to light touch, creating a false impression for the hasty

> examiner that the patient does not have diminished touch sensation. (Von Frey

> hairs can detect " subclinical " diminution of touch sensation)

> Clinicians are often impressed at what good historians normal patients can be

> regarding pain, but the opposite can be expected pertaining to pain which the

> patient knows is not normal pain, yet is severe. Central Pain, in its fully

> developed form, is persistent torture. Humans chronically tortured often

become

> alienated and withdrawn. It is so severe that, lacking a vocabulary, they may

> be very poor historians and may be reluctant to reveal the inroads the pain

> has made into their humanity. Poor verbal skills may also be impacted by the

> thalamic shutdown in this disease, making it difficult to prioritize and stick

> to the appropriate comments, with the appropriate emphasis, in the flow of

> conversation. The vagueness and strangeness of the symptoms are also factors

in

> poor descriptive performance.

>

> The Lowest Common Denominator of Central Pain

> Because the disease has so many aspects, we are indebted to Dr. Bowsher

> for finding the lowest common denominator. Of all the symptoms, he has

> identified the three which allow for simple diagnosis:

> Burning pain, often with a paradoxical component of cold, made worse by light

> touch or the rubbing of clothing.

> Central Pain has definite thermal aspects. This is usually a narrow window of

> relative comfort in ambient temperatures and onset of burning with

> temperature change, either hot or cold. Alternatively, thermal aspects may

> manifest as

> an unusual sensitivity to heat, generally at the distal parts of a limb.

> Thermal aspects are omitted from these criteria because they are also be seen

in

> ciguatera poisoning.

> In general, it appears that the more sensation retained, the broader display

> of Central Pain symptoms are manifest. Those with a greater retention of

> neural function (e.g. quadriparetics) seem more likely to display a greater

> range

> of symptoms and also seem to have more problems enduring the pain.

> Notwithstanding this, very severe pain may be found in quadriplegics, although

> it tends to

> have fewer dimensions.

> Bowsher's Criteria can make diagnosis of the Central Pain accessible to every

> doctor or professional.

>

>

> Hallenbeck~Sikorsky~ BS,RN,UM,QC

> Owner-Moderator

> " AnGeLsInPain "

> " OneVoiceInPain "

> Interqual Certified

> Published Psychiatric Researcher

> Advocate for those in CIP, HIV, Psychologic Pain

> " The Lord Will NEVER push us beyond what we can endure. "

>

>

>

[Guest guest]

-

Critical Illness Polyneuropathy (CIP)?

Reflexive Sympathetic Dystrophy (RSD)?

I sort of feel like I came in right in the middle of a movie or novel - so

please pardon my questions. I saw your post last week - I think as a result of a

post from from Port Huron - perhaps you are both members of

another group too? Either that or she posted a response as a result of one of

your posts last week. I noticed the second " " posting, if you will, then

-because there was a post from that said " Thank you, " - I opened it

and it made no sense in light of the post that I had just sent Nan. Then I

discovered the post you submitted and some of the pieces began to fit together.

I am not really familiar with the illnesses you have posted about - at least

with regard to Rheumatology - I do know they clearly are a manifestation -

severe- of chronic pain and are related to neuropathic pain and specifically(?)

muscular pain. Many here, including myself, having had RA for long enough for it

to possibly be classified originally as JRA- can identify. I for one think some

of the pain I feel is either more or less intense because my body- even during

those periods that I would not describe as a flare- has become oversensitized by

chronic - low grade pain. I have reviewed medicals as part of my legal work-

and as a supervisor - for disability apps - for advice, referral and

representations- and must say that your diagnoses- are either underdiagnosed -

or are missed frequently.

Your post on patient self advocacy was excellent. Your professional knowledge

and contributions are most welcome- but perhaps some more of your story would be

appreciated too. As much or as little as you would like to share. We appreciate

your contributions- but we are here for you too.

The " other " - in Michigan-

-------------- Original message ----------------------

From: ANewPlanForYou@...

>

>

> Dear Friends in Pain,

>

> Some find this very indicative of the suffering we go through with RSD,

> interesting stuff...

>

> A PFD to all,

>

>

> Introduction to Central Pain

> " The Pain Beyond Pain "

>

> Central Pain is the name for a pain syndrome which occurs when injury to the

> Central Nervous System is insufficient to cause numbness but sufficient to

> cause central sensitization of the pain system.

> Reflecting the neuron of choice of the original nerve physiologists, nearly

> everything taught in medical school about basic nerve physiology derived from

> studies of motor nerves. Because sensory nerves behave almost nothing like

> motor nerves, the behavior of Central Pain may seem anti-intuitive to those

fed

> a

> diet of motor nerve physiology for most of their training.

> An injured motor nerve simply carries less current. Injured pain nerves,

> paradoxically, do exactly the opposite, they increase their signal. It is not

a

> simple increase, however. They eventually gain the power to humorally

influence

> uninjured neighbor neurons, which begin autonomous firing. (Devor's work in

> The Axon , ed.Waxman, Oxford Univ. Press, 1995).

> The process can become so violent that the thalamus, the brain pain center,

> records " bursts " of impulses from these injured nerves. After sufficient

> bombardment threatens neuron death in the thalamus, it " shuts down " . Central

> Pain

> apparently occurs at this point. Radiostimulation of the spinothalamic tract,

> which causes no sensation in people without Central Pain, recreates the

> sensation of Central Pain in those who have the condition. It is as if the

> entire pain

> system is acting like a nerve ending. Ungated pain signals thus reach the

> cortex, causing unbearable suffering.

> Pain nerves were designed to do their best work in the face of injury. This

> differs from motor nerves, which put the body to rest with injury by

decreasing

> their function. It is difficult to get some clinicians, born and bred on

> " motor think " to adjust to " pain think " . There are features of Central Pain

> which

> may seem unexpected.

> Among these unexpected features are the following:

> The stimulus which usually causes the most unbearable aspects of Central Pain

> is the evoked pain of light touch, especially light touch which is persistent

> and occlusive. Such patients may wear abbreviated clothing to avoid textures

> rubbing on the skin.

> The burning pain, which light touch evokes, does not occur when the stimulus

> is first applied, but after time, (similar to the way the pain of sunburn

> occurs well after the UV injury). This is called slow summation and is a

> temporal

> phenomenon. This evoked burning is lesser in magnitude but identical in

> quality to spontaneous burning, an omnipresent burning which may be the only

> dysesthesia (bizarre burning) present, particularly in quadriplegics. In other

> words,

> spontaneous burning is not always capable of being evoked. Evoked dysesthetic

> burning is the big brother of spontaneous burning. Especially at the

> peripherae however, (e.g. hands) evocation is usually displayed along with

> spontaneous

> burning, although the stimulus which evokes the burning varies from patient

> to patient. Such a stimulus may be light touch, texture, or heat.

> Very limited data suggest that dysesthesia (burning pain) also displays

> spatial summation, which means as larger areas are covered with touch, the

> magnitude of burning becomes greater. The dysesthesia is of a greater

magnitude

> where

> touch sensation is poorest, which is usually distally on the body.

> Central Pain also displays an hyperpathia. Sharp hyperpathia tends to occur

> most where sensation is most retained, which is generally proximally on the

> body. The location of visceral hyperpathia seems to follow more the

positioning

> of gas and digesting food in the gut. That which would be painful to people

> without Central Pain is much more painful in Central Pain, but nothing is felt

> until a greater than normal pain stimulus is applied.

> Because these patients have decreased touch sensation, including decreased

> sense to very light painful stimulus, Central Pain hyperpathia has been termed

> to have a " delay " . This is an unfortunate term since it has nothing to do with

> time. It appears to have been adopted because hyperpathia is often coexistent

> with dysesthesia, which has a true temporal delay. With hyperpathia, there is

> a level of noxious stimulus which is not perceived. This is actually a

> heightened threshold to pain, not a temporal delay. The heightened threshold

is

> very

> difficult to test for because it is so easily exceeded. Once the threshold has

> been exceeded, or when pain is first perceived, the pain response overshoots

> and responds violently. This is called delay with overshoot. The stimulus may

> be sharpness, heat, or cold. It is more common for heat to stimulate

> hyperpathic response in those with profound motor loss (plegics), while it is

> more

> common for cold or sharpness to generate hyperpathia in those who retain some

> motor function (paretics).

> " Delay with overshoot " is generally considered a synonym of hyperpathia, but

> it is not really the same since hypersensitivity to pain can occur in those

> with normal nervous systems (such as sunburn). Only those with nerve injury

can

> perceive hyperpathia long-term. The testing has not been done to determine how

> neuropathic hyperpathia (injured nervous system) is similar to or different

> from nociceptive hyperpathia (normal nervous system). Hyperpathia also occurs

> in the viscera (gut), but is displayed there as a feeling of overfulness,

> almost to exploding, like very severe distention with flatus. Similarly, a

full

> bladder can be unbearable.

> The " fullness " is evoked in an inconsistent pattern by dietary intake.

> Patients often can affect its course by choice and timing of food/water intake

> or

> elimination. Limited data indicate that the hyperpathia of Central Pain

> increases directly in areas with retention of touch sensation, which is

usually

> proximally on the body, a gradient which is exactly the opposite of the

burning

> dysesthesia, which usually increases distally. These gradients can usually be

> confirmed by careful questioning, but it is uncommon for the patient to

> volunteer

> the information since the gradients are not even and any dysesthetic pains are

> poorly localized.

> There is perhaps no more difficult area in which to obtain a correct history

> than in pain which is " indescribable " . The result of haste and imprecise

> questioning has made the literature on the subject almost incomprehensible.

The

> clinician should repeat questions several times from several angles before

> assuming the patient differs from the norm in Central Pain as described in the

> mnemonic on this website.

> That light touch which is perceived in Central Pain has a " tingly " quality to

> it. This may be thought of as similar to the " tingle " of a lip touched while

> it is returning from dental anesthesia, or like the tingle of limbs falling

> " asleep " . It is however, quite painful, " like needles " . It is the most intense

> of the central pains but does not cause the most suffering. This tingle can be

> pronounced, compelling the attention of the patient, or it can exist in a

> minor form. Patients nearly always compare it to a limb which has fallen

asleep

> and is regaining feeling. It has been called " circulatory pain " .

> A Central Pain patient who is paying very close attention may be able to

> respond fairly well to light touch, creating a false impression for the hasty

> examiner that the patient does not have diminished touch sensation. (Von Frey

> hairs can detect " subclinical " diminution of touch sensation)

> Clinicians are often impressed at what good historians normal patients can be

> regarding pain, but the opposite can be expected pertaining to pain which the

> patient knows is not normal pain, yet is severe. Central Pain, in its fully

> developed form, is persistent torture. Humans chronically tortured often

become

> alienated and withdrawn. It is so severe that, lacking a vocabulary, they may

> be very poor historians and may be reluctant to reveal the inroads the pain

> has made into their humanity. Poor verbal skills may also be impacted by the

> thalamic shutdown in this disease, making it difficult to prioritize and stick

> to the appropriate comments, with the appropriate emphasis, in the flow of

> conversation. The vagueness and strangeness of the symptoms are also factors

in

> poor descriptive performance.

>

> The Lowest Common Denominator of Central Pain

> Because the disease has so many aspects, we are indebted to Dr. Bowsher

> for finding the lowest common denominator. Of all the symptoms, he has

> identified the three which allow for simple diagnosis:

> Burning pain, often with a paradoxical component of cold, made worse by light

> touch or the rubbing of clothing.

> Central Pain has definite thermal aspects. This is usually a narrow window of

> relative comfort in ambient temperatures and onset of burning with

> temperature change, either hot or cold. Alternatively, thermal aspects may

> manifest as

> an unusual sensitivity to heat, generally at the distal parts of a limb.

> Thermal aspects are omitted from these criteria because they are also be seen

in

> ciguatera poisoning.

> In general, it appears that the more sensation retained, the broader display

> of Central Pain symptoms are manifest. Those with a greater retention of

> neural function (e.g. quadriparetics) seem more likely to display a greater

> range

> of symptoms and also seem to have more problems enduring the pain.

> Notwithstanding this, very severe pain may be found in quadriplegics, although

> it tends to

> have fewer dimensions.

> Bowsher's Criteria can make diagnosis of the Central Pain accessible to every

> doctor or professional.

>

>

> Hallenbeck~Sikorsky~ BS,RN,UM,QC

> Owner-Moderator

> " AnGeLsInPain "

> " OneVoiceInPain "

> Interqual Certified

> Published Psychiatric Researcher

> Advocate for those in CIP, HIV, Psychologic Pain

> " The Lord Will NEVER push us beyond what we can endure. "

>

>

>