CRPS, Chronic Pain and Your Brain

Pain is an extremely complex issue. Complex regional pain syndrome (CRPS) is a prime example of the new understanding pain specialists are finding in the world of pain. Explaining these problems have taken years, but we are finding new information on what is happening when these conditions develop. We know now that there are peripheral issues at the site of injury, problems at the spinal cord and the equivalent of a short circuit in the brain when these conditions occur. Pain is maintained by feed-forward pain reception and feed-back sympathetic efferent loops. The brain stem, hypothalamus, limbic system and cortex all play roles.

Once an injury occurs, pain receptors in the periphery of the body, at the skin, bone and joint start sending signals to the brain. The sensory fibers first go to the periphery of the cord – the dorsal root ganglion where the sensory cell bodies are located. These cells then send signals to the cord in the dorsal horn and then to the brain. At this point, the cells in the DRG also are putting out several inflammatory chemicals IL-1, TNF, and IL-6 that promote inflammation in the periphery and increase the pain sensitivity of the spine and brain. Not only do the nerve cells become active, but glial cells, which we thought were just inert insulation, become active and produce more of these chemicals that promote inflammation. These chemicals then make the nerve cells more sensitive to pain reception and increase the number of signals going to the brain.


Pain and Brain

The brain is the master processing of all nerve and chemical signals in the body. The signals from the periphery for pain travel to the brainstem, then to the hypothalamus, thalamus, limbic system and cortex. The chemicals produced in the periphery also sensitize the brain also to pain signals. There are also an increased number of signals going to multiple areas of the brain, overwhelming certain areas and stimulating brain areas that are active for anxiety and depression in the cortex and limbic areas. Furthermore, the increase in signals also interacts with the motor inhibitory signals that are supposed to block pain signals. Thus in CRPS, there are multiple regions with increased activity, from the periphery to the spinal cord and into the brain.

The treatment of CRPS is now becoming more complex. The first obvious treatment is to try to eliminate the factors in the periphery that are stimulating the sensory signals. This means trying to correct even the small injuries that stimulate pain receptors, allow healing of the injury. During the treatment of the injury, interfering with the delivery of signals to the cord and brain is also important. This may be done with a variety of interventional techniques, physical therapy, medications, and psychological techniques. When the peripheral treatment of the injury is incomplete, then a full array of pain management techniques may need to be fully explored and treatment needs to be coordinated by a knowledgeable pain management specialist with expertise of medications and advanced interventional techniques including implantable options.

What Pain Professionals Are Saying About Marijuana

Marijuana is a controversial topic in society. Some people want it legalized while others demonize the compound. The reality in the medical field is somewhat in the middle. The first thing that needs to be understood is that in most circumstances, medical experts are primarily interested in all the compounds in marijuana except for THC. That means most medical professionals are interested in what cannabinoids or cannabidiols (CBD) compounds are present and what medical purpose they serve. The major compound that is present in almost all available marijuana is THC, which also happens to be the compound responsible for the high one receives from marijuana.

For pain professionals, there is good understanding of the action and effects of THC. Most strains available in states that have legal marijuana, including strains that are “medicinal” in use have high amounts of THC, 10% or greater in amount, and virtually no other cannabidiols, or less than 2%. In the years of the hippie generation, the 1960’s and 1970’s, THC to CBD ratio was 1:1, and averaged 1-2%, while the really good stuff was just around 5%. Now available in legalized states, most available strains are minimum of 10% with up to 30% THC.

Medical Marijuana

Medically, the best comparison of legal marijuana at this time, is to alcohol. The risk of dependence to THC is about 9%, including when using once a week (in reality this is a very strong way to become dependent), compared to alcohol which is 15%. Regular use, once a week, is known to increase depression, suicide, impulsivity, schizophrenia and psychosis, especially if use is started under the age of 20. It also leads to an 8-point loss of IQ in the young. Further, smoking does cause problems with the lungs. Recommending regular marijuana is no different for medical professionals to recommending drinking alcohol. The risks and associated problems are clearly out numbering benefits.

Need To Understand More

What we know about cannabidiols is just the beginning. In marijuana, we know there are over 100 different types. Our experience so far has found that they have some properties that may be helpful in about 30% of patients with neuropathic pain associated with MS and HIV. In low back pain, we’ve learned:

  • It has helped in anxiety but not with pain.
  • More people respond to acetaminophen then marijuana.

The future of cannabidiols is interesting for pain. It is unlikely that many professionals would be enthused to prescribe a substance that has the risk profile of THC. Once we can find the particular cannabidiols that have medical uses, it is likely that we will try to study them fully and make them commercially available for specific conditions. Cannabidiols may be helpful in the future, but we still don’t know enough right now to safely prescribe marijuana for a wide range of conditions.

Could Chili Peppers Be The Key To Chronic Pain?

Red Hot Chili Peppers isn’t just the name of a band, it could be the key to unlocking the problem of chronic pain.

According to researchers at the Institute of Physiology of the Czech Science Academy, capsaicin receptors contained in chili peppers can help quell chronic pain. Capsaicin receptors are the part of the chili pepper that makes the food spicy.

Institute spokeswoman Diana Moosová said capsaicin plays a significant role in blocking TRPV receptors, which participate in the transfer and triggering of painful stimuli. These receptors can be activated and blocked through a variety of stimuli, one of which is hot temperatures and low pH levels. Capsaicin fits that bill perfectly.

“Our experiments have proved that the TRPV1 receptors in the central projections of neurons of spinal ganglions play an important modulation role in the transfer of information provoking pain,” said Jiří Paleček, head of the functional morphology team. “By blocking these receptors’ activity, the pathologically increased sensitivity to mechanical and temperature impulses, which is a symptom of many chronic painful conditions, is considerably decreased.”

Pepper Pain

In essence, when you eat chili peppers, the compound capsaicin causes an initial excitation of nuerons inside your body. This leads to a period of enhanced sensitivity, but as Newton Third Law taught us, for every action there is an equal and opposite reaction. The firing of these neurons is followed by a “refractory period with reduced sensitivity and, after repeated applications, persistent desensitisation,” according to a similar study.

So while peppers may cause painful flare ups in the short term, over time, they might actually help you to desensitize to chronic pain.

Related source: Oxford Medicine, Prague Post

More Outrage Over Prescription Painkillers

A recent editorial by Charles Lane of the Washington Post detailed the catastrophe that prescription painkillers have caused in the United States due to opioid overdoses. According to the story, in 2013, opioids played a role in over 16,000 deaths. Since 1999, they have had a role in more than 175,000 deaths, more than the number of people killed in the Vietnam War. While traffic accident deaths have declined, opioid deaths have climbed. According to Charles Lane, the blame for this uptick in deaths is due to the government and medical professionals who over-prescribe when treating non-cancerous pain.

The article goes on to site countless statistics about how often opioids are prescribed for pain, especially in the United States compared to the rest of the world. The article clearly indicates that modern medicine is to blame for the increase in prescription painkiller overdoses. Not once in the article is it mentioned how widespread pain is in this country and the world. The complexity of pain management is never mentioned either.

Pain Misconceptions

Pain affects roughly 43 percent of the population of the United States. Pain is the number one cause of people visiting a physician. Information from the National Institutes of Health published in 2011 by Martin Cheatle indicates that 40 percent of the opioid overdose deaths may be related to pain and suicide. The conclusion drawn is that pain is widespread and not being adequately treated.

Painkiller overdose

Pain physicians are a small group of physicians who are actively trying to change and improve the management of this complex problem. Pain is a both a physical and psychological phenomenon. Every year we are developing new strategies to treat numerous conditions that cause chronic pain. Opioids have been only one small tool in the complex arena of pain management. Patients have become more sophisticated over time and everyone wants their pain to be treated immediately and completely. Most doctors do not have the sophisticated training and knowledge to deal with all the complexities of pain, so they try the easy solution prescribing opioids. Since pain is so wide spread, bad outcomes are inevitable until more people are educated about pain and more research and new solutions can come to market.

Shame on Charles Lane for throwing blame all over the place. Pain is a complex issue, as are the overdose deaths caused by opioids. Outrage should be focused on the lack of treatments available for those who have pain. Outrage should be focused on industry and the government for the lack of research spending on pain. Outrage should be focused on medical training programs that do not educate new physicians about pain management. Pain physicians and researchers are making tremendous strides in pain management, but it will take time. Mr. Lane is showing only ignorance about the problem of pain and casting irresponsible blame without looking towards a solution.

Water Therapy for Chronic Pain

People are always asking about things they can do to relieve their chronic pain on their own time. We’ve talked about plenty of home remedies on the blog before, but one avenue we haven’t explored is water therapy.

Water therapy is growing in popularity as a treatment for chronic conditions because of its numerous benefits, including:

  • Chronic pain relief
  • Reduced recovery time
  • Increased movement function
  • Decreased load bearing
  • Decompression of inflamed joints and discs
  • Relaxation
  • General exercise

What is Aqua Therapy?

Aqua therapy, otherwise referred to as pool therapy, involves preforming an exercise program or a set or exercise in the water. Oftentimes patients with chronic pain can’t preform regular exercises because the movements serve to exacerbate the pain, but aqua therapy can provide the relief they need. Because the load bearing in joints is decreased while in the water, patients can move their body without putting extra stress on painful areas of the body.

Water Therapy for Chronic Pain

Aqua therapy is beneficial for patients with numerous health conditions, including:

  • Chronic and acute pain
  • Back pain
  • Neck pain
  • Fibromyalgia
  • Arthritis
  • Nervous system disorders
  • Joint or muscle pain
  • Muscle weakness
  • Migraines or headaches

As we’ve mentioned before, chronic pain affects more than 50 million Americans every year. A chronic pain specialist can help you with injections or other hands-on treatment options, but it’s going to take some work on your own to rid yourself of your pain. If other home treatments have failed, or you simply want to explore a new exercise technique, give water therapy a try.