Pain in Your Brain

SSTattler: There are many ways of a definition of "Pain" or "Pain Syndrome" especially after a stroke. We will take two definition from Wikipedia: 1) "Central Pain Syndrome", 2) "Chronic Pain" - A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."

SSTattler: The last two YouTube, "Intramuscular Electrical Stimulation for Post-Stroke Pain" and "Pain and the Brain", are excellent lectures but it takes 1 hour and a half  each -- I think most people will like it.

Central Pain Syndrome from Wikipedia, the Free Encyclopedia.

Central pain syndrome is a neurological condition caused by damage or malfunction in the Central Nervous System (CNS) which causes a sensitization of the pain system. The extent of pain and the areas affected are related to the cause of the injury, which can include trauma, spinal cord injury, tumors, stroke, Multiple Sclerosis, Parkinson's disease, or epilepsy. Pain can either be relegated to a specific part of the body or affect the body as a whole.

Symptoms

Pain is typically constant, may be moderate to severe in intensity, and is often made worse by touch, movement, emotions, and temperature changes, usually cold temperatures. Burning pain is the most common sensation, but patients also report pins and needles, pressing, lacerating, aching, and extreme bursts of sharp pain. Individuals may have reduced sensitivity to touch in the areas affected by the pain. The burning and loss of touch are usually most severe on the distant parts of the body, such as the feet or hands.

Treatment

Treatment includes pharmacological interventions (amitriptyline, mexiletine, lamotrigine) followed by neuromodulation (cortical stimulation, intrathecal drugs such as midazolam and clonidine). Opioids are scarcely effective for CPS and should be reserved to highly selected cases. Ziconotide is sometimes effective but patients should find experienced physicians for treatment.

See the original article Central Pain Syndrome from Wikipedia, the Free Encyclopedia.

Chronic Pain from Wikipedia, the Free Encyclopedia.

Chronic pain is pain that has lasted for a long time. In medicine, the distinction between acute and chronic pain has traditionally been determined by an arbitrary interval of time since onset; the two most commonly used markers being 3 months and 6 months since onset, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."

Classification

Chronic pain may be divided into "nociceptive" (caused by activation of nociceptors), and "neuropathic" (caused by damage to or malfunction of the nervous system).

Nociceptive pain may be divided into "superficial" and "deep", and deep pain into "deep somatic" and "visceral". Superficial pain is initiated by activation of nociceptors in the skin or superficial tissues. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain. Visceral pain originates in the viscera (organs). Visceral pain may be well-localized, but often it is extremely difficult to locate, and several visceral regions produce "referred" pain when damaged or inflamed, where the sensation is located in an area distant from the site of pathology or injury.

Neuropathic pain is divided into "peripheral" (originating in the peripheral nervous system) and "central" (originating in the brain or spinal cord). Peripheral neuropathic pain is often described as “burning,” “tingling,” “electrical,” “stabbing,” or “pins and needles.”

Pathophysiology

Under persistent activation nociceptive transmission to the dorsal horn may induce a wind up phenomenon. This induces pathological changes that lower the threshold for pain signals to be transmitted. In addition it may generate nonnociceptive nerve fibers to respond to pain signals. Nonnociceptive nerve fibers may also be able to generate and transmit pain signals. In chronic pain this process is difficult to reverse or eradicate once established.

Chronic pain of different etiologies has been characterized as a disease affecting brain structure and function. Magnetic resonance imaging studies have shown abnormal anatomical and functional connectivity, even during rest involving areas related to the processing of pain. Also, persistent pain has been shown to cause grey matter loss, reversible once the pain has resolved.

These structural changes can be explained by the phenomenon known as neuroplasticity. In the case of chronic pain, the somatototic representation of the body is inappropriately reorganized following peripheral and central sensitization. This maladaptative change results in the experience of allodynia and/or hyperalgesia. Brain activity in individuals suffering from chronic pain, measured via electroencephalogram (EEG), has been demonstrated to be altered, suggesting pain-induced neuroplastic changes. More specifically, the relative beta activity (compared to the rest of the brain) is increased, the relative alpha activity is decreased, and the theta activity both absolutely and relatively is diminished.

Management

Complete and sustained remission of many neuropathies and most idiopathic chronic pain (pain that extends beyond the expected period of healing, or chronic pain that has no known underlying pathology) is rarely achieved, but much can be done to reduce suffering and improve quality of life.

Pain management is the branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners. Acute pain usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of the treatment team.

The emergence of studies relating chronic pain to neuroplasticity also suggest the utilization of neurofeedback rehabilitation techniques to resolve maladaptive cortical changes and patterns. The proposed goal of neurofeedback intervention is to abolish maladaptive neuroplastic changes made as a result of chronic nociception, as measured by abnormal EEG, and thereby relieve the individual's pain. However, this field of research lacks randomized control trials, and therefore requires further investigation.

Epidemiology

In a recent large-scale telephone survey of 15 European countries and Israel, 19% of respondents over 18 years of age had suffered pain for more than 6 months, including the last month, and more than twice in the last week, with pain intensity of 5 or more for the last episode, on a scale of 1(no pain) to 10 (worst imaginable). 4839 of these respondents with chronic pain were interviewed in depth. Sixty six percent scored their pain intensity at moderate (5–7), and 34% at severe (8–10); 46% had constant pain, 56% intermittent; 49% had suffered pain for 2–15 years; and 21% had been diagnosed with depression due to the pain. Sixty one percent were unable or less able to work outside the home, 19% had lost a job, and 13% had changed jobs due to their pain. Forty percent had inadequate pain management and less than 2% were seeing a pain management specialist.

In a systematic literature review published by the International Association for the Study of Pain (IASP), 13 chronic pain studies from various countries around the world were analyzed. (Of the 13 studies, there were three in the United Kingdom, two in Australia, one each in France, the Netherlands, Israel, Canada, Scotland, Spain, and Sweden, and a multinational.) The authors found that the prevalence of chronic pain was very high and that chronic pain consumes a large amount of healthcare resources around the globe. Chronic pain afflicted women at a higher rate than men. They determined that the prevalence of chronic pain varied from 10.1% to 55.2% of the population.

In the United States, the prevalence of chronic pain has been estimated to be approximately 30%. According to the Institute of Medicine, there are about 116 million Americans living with chronic pain. The Mayday Fund estimate of 70 million Americans with chronic pain is slightly more conservative. In an internet study, the prevalence of chronic pain in the United States was calculated to be 30.7% of the population: 34.3% for women and 26.7% for men. These estimates are in reasonable agreement and indicate a prevalence of chronic pain in the US that is relatively comparable to that of other countries.

Personality

Two of the most frequent personality profiles found in chronic pain patients by the Minnesota Multiphasic Personality Inventory (MMPI) are the conversion V and the neurotic triad. The conversion V personality, so called because the higher scores on MMPI scales 1 and 3, relative to scale 2, form a "V" shape on the graph, expresses exaggerated concern over body feelings, develops bodily symptoms in response to stress, and often fails to recognize their own emotional state, including depression. The neurotic triad personality, scoring high on scales 1, 2 and 3, also expresses exaggerated concern over body feelings and develops bodily symptoms in response to stress, but is demanding and complaining.

Some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels. Self-esteem, often low in chronic pain patients, also shows striking improvement once pain has resolved.

Effect on Cognition

Chronic pain's impact on cognition is an under-researched area, but several tentative conclusions have been published. Most chronic pain patients complain of cognitive impairment, such as forgetfulness, difficulty with attention, and difficulty completing tasks. Objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks. In 2007, Shulamith Kreitler and David Niv advised clinicians to assess cognitive function in chronic pain patients in order to more precisely monitor therapeutic outcomes, and tailor treatment to address this aspect of the pain experience.

See the original article Chronic Pain from Wikipedia, the Free Encyclopedia.

Understanding Pain: 

       What to Do About It in Less Than Five Minutes?

New evidence based approaches to chronic pain management. For more detailed information visit the Hunter Integrated Pain Service website http://www.hnehealth.nsw.gov.au/pain


Creative Commons Attribution license @ Hunter Medicare Local

A Message from Hell

This film has been entered into the 2012 Neuro Film Festival from the American Academy of Neurology Foundation at www.neurofilmfestival.com. Let's put our brains together and support brain research. A message from the Central Pain Syndromes sufferers of the CPS Alliance. Central Pain Syndrome is the worst pain known to man. It effects approximately one and a half million Americans, most of whom don't know that CPS is the name of the diseases ruining their lives. We want you to recognize that Central Pain exists: what are its symptoms, it treatments, its effects, and its astonishing frequency. We want you to support research into the causes, treatments and cures of CPS, and to demand that America respect it citizens who are living in Hell on Earth.


Standard YouTube License @ centralpainsyndrome's channel

Central Pain Syndrome "Message from Hell #1: How Are You?"

As a Central Pain Syndrome survivor I suffer constant intense pain. I am on the Board of Directors of the newly-formed Central Pain Syndrome Foundation: http://centralpainsyndromefoundation.com/


Standard YouTube License @ Doug Sharp

A Day in the Life of Central Pain Syndrome

While this term/diagnosis might be unfamiliar to many of you... the symptoms or complaints are possibly painfully familiar. Central pain syndrome remains a bit like a "mystery diagnosis", in that there are few doctors identifying this syndrome. There are likely greater numbers of survivors suffering in pain alone because doctors have failed to identify CPS. Even once the culprit of the pain is identified, there are few treatment options today. :( My dear friend, Patti G, is not only afflicted with multiple cavernous angiomas but she also has been afflicted with this monster and she is doing her best to "get the word out"...so that CPS will not longer be such a mystery... and hopefully some day there will be a solution to this terrible pain. Please help spread awareness by sharing the fantastic video that she put together. Watching this really puts my fatigue in perspective.  As much as I hate being tired all the time...at least I can escape it while sleeping. Pain is truly the worst deficit imaginable to me.

replicantplanet I live in England and have had CPS almost 10 years now after a massive stroke aged 42 I did try to cope but after many visits to my doctor i've ended up having a DBS implant only last year to reduce my symptoms, it has helped but only by 20% which is amazing in it's-self but I then get really bad headaches from the DBS when I switch it on so Devil and deep blues sea situation, steam cell is the way forward but I don't think in my lifetime, God bless everyone who has this condition. 

Kirsty Hartland I have had CPS 5 years in my left side the next time someone asks how I feel, I will be directing them to this fantastic video. Its the ME I cant put into words for others. Thank you. 

..... and many more comments on YouTube.

Standard YouTube License @ MrsPattiG1

The Anatomy and Function of the Parietal Lobe (Pain)

• Making Biology Fun

In this video, Leslie Samuel talks about the regions within the parietal lobe and how they function. The parietal lobe is involved in perceiving and processing somatosensory events like touch, temperature, body position and pain. It also receives input from the visual and auditory cortices and contains the Wernicke's area, which is involved in understanding spoken language.


Standard YouTube License @ Interactive Biology TV

Mary: Post Stroke Pain (Post Trial Occipital NeuroModulation)

Fifteen years of pain and failed treatments would make a skeptic out of anyone. After her successful one-month trial, Mary describes her experience on the eve of her implant surgery. She does not go along with the suggestion that it's a placebo response. She enjoyed a renewed relationship with her children, as well as renewed energy.

"It is the best thing I have done in my entire life."

This procedure is performed by Dr. Joshua Greenspan at the PainCare Somersworth NH facility.

For more information, visit www.painmd.com.


Standard YouTube License @ PainCare

Dr P Neuromodulation Desktop

Standard YouTube License @ johnpetraglia's channel

Intramuscular Electrical Stimulation for Post-Stroke Pain

October 10, 2008

The Cleveland FES Center and the APT Center
FES Seminar - John Chae, M.D., M.E.

SSTattler: This video is about 1 hour and 15 minutes, i.e. very long, but it is excellent lecture. 


Standard YouTube License @ Case Western Reserve University

Pain and the Brain

Jan 3, 2008 Take a look into our current understanding of the function of the human brain and some of the important diseases that cause nervous system dysfunction. On this edition, Allan Basbaum, UCSF department of anatomy, explores pain and the brain. Series: "UCSF Mini Medical School for the Public"
SSTattler: This video is about 1 hour and 27 minutes, i.e. very long, but it is excellent lecture. 


Standard YouTube License @ UCTV, University of California Television