Monday, November 05, 2012

Tailing Trout at Little Pine Lagoon this morning.

Only a light northerly blowing as I fished Tailers Shore.
Trout were tailing but illusive. Two other anglers landed fish, one a good 21/2lb. The rest of us (and there were many) just enjoyed the magnificent day.

Friday, September 14, 2012

Howard Black's September newsletter focuses particularly on research regarding drug treatments for CRPS/RSD. Recommended.

As usual Howard Black's newsletters are compelling reading. September 2012's offering is particularly important as there has been so much recent interest in the opioids and there relevance for treatment of chronic pain syndromes. Of significance to me is the research concerning Tramadol. The first dose I took worked like a miracle but, although it is supposed to be non addictive, I developed a tolerance of the drug very quickly and after three weeks my body withdrew from it. For an horrific 30 hours I shook, ached almost unbearably etc. This was many years ago before medication became no longer an option. I agree with Howard's comment that it is surprising that it's not a controlled substance in some countries.

I encourage you to also read the comprehensive section on RSD Drugs and Treatments.

It pays to remember that the brain drives the pain message no matter what the cause. Treating the cause instead of the symptoms seems to me a more logical way to go. Much food for thought again here Howard.

Sunday, August 19, 2012

Consequences of the inflamed brain and its relation to chronic pain.


Steven F. Maier, Ph.D. and Linda R. Watkins, Ph.D., University of Colorado at Boulder report on Consequences of the inflamed brain.

Inflammation in the body can lead to inflammation in the brain. Inflammation is part of the immune system’s response to defend you. If the acute inflammatory response goes on too long eg more than a few days,  it can  lead to outcomes that nature did not intend. This could lead to "cognitive impairment instead of brief memory disruption, depression instead of reduced mood, fatigue instead of inactivity, and chronic pain instead of acute pain." "That is, physiology can become pathology when a set of processes designed to be relatively brief becomes prolonged."

Peripheral inflammation is highly complex and involves many immune cells and their products. At present our existing anti-inflammatory drugs often target only one of these. Hopefully studies such as this will lead to the  development of more effective anti-inflammatories which better target the these complex mediators of inflammation.

Friday, August 17, 2012

NOI Group "Explain Pain" now available as an ebook.

Noi Group has just made their highly regarded book, "Explain Pain" available as an ebook. Written by Dr David Butler and Dr Lorimer Moseley "Explain Pain aims to give clinicians and people in pain the power to challenge pain and to consider new models for viewing what happens during pain."

Oxygen, or lack of oxygen is involved in chronic pain pathways.

CRPSUK July Update about the Role of Oxidative Stress in Complex regional Pain Syndrome addressed the question of "whether there is a potential role for Nrf2 (activated by pharmacological or nutritional activators) in alleviating the clinical features of CRPS or preventing its progression." Nrf2 induces the expression of various genes including those that encode for several antioxidant enzymes, and it may play a physiological role in the regulation of oxidative stress. Investigational drugs that target NFE2L2 or Nrf2 are of interest as potential therapeutic interventions for oxidative-stress related pathologies.

Oxygen, or lack of oxygen is involved in chronic pain pathways. Substance p is one of many neurotransmitters involved in clinical pain syndromes such as Complex Regional Pain Syndrome. Neurotransmitters transmit information across synapses. When released neurotransmitters either help or hinder electrical impulses along nerve fibers.

Substance p's relationship with oxygen deficit is well known. Oxygen deficit triggers the release of substance p. Experiments have shown that decreasing tissue oxygen concentrations increases release of substance p. The amount of substance p is relative to the level of hypoxia or put simply, the lower the amount of oxygen, the higher the amount of substance p.

It is already known that tissue hypoxia and an increase in skin lactate levels occur in Complex Regional Pain Syndrome. Oxygen free radical scavengers (or antioxidants) such as vitamin C reduce the pain of CRPS and bring about local oxygen homeostasis, inhibiting the release of substance p. Topical capsaicin
cream (made from chilies) inhibits the release of substance p by increasing oxygen delivery. This, in essence, is merely a simplified explanation. Dr Majid Ali's Oxygen view of pain explains this well.


Dr Majid Ali recommends what he calls limbic breathing which he describes as a "vigorous type of breathing with a long out breath". My physiotherapist and my intergrative medicine doctor also recommend a the type of breathing where the out breath is longer or twice as long as the in breath. This type of breathing, I believe, activates the parasympathetic nervous system bringing about a sense of calm and thus helping us to better
cope with pain. Now I also realize that this style of breathing has the added benefit of encouraging increased oxygen intake.

For chronic pain sufferers it's important to remember to breathe.

Friday, August 10, 2012

New Graded Motor Imagery Website

NOIGROUP has a new Graded Motor Imagery Website. It's a further resource to support the
Graded Motor Imagery Handbook that was launched this year.

Could a simple seed hold promise for treatment of CRPS?

My last post mentioned oxidative stress as a component of Complex Regional Pain Syndrome. Antioxidants deal with oxidative stress. Research into fenugreek, a traditional food used in Ayuvedic medicine, has shown it to be a powerful antioxidant. I haven't found specific research about its use for treating CRPS but suspect that its efficacy may hold promise. I am not recommending adding it to your diet. As with many things fenugreek consumption may have side effects including changing the effect of medication so seek medical advice.

Georgia Health Sciences University's Dr Bobby Thomas and colleagues reported that  a powerful class of antioxidants may be a potent treatment for Parkinson's Disease. "A class of antioxidants called synthetic triterpenoids blocked development of Parkinson’s in an animal model that develops the disease in a handful of days". They used "the drugs to bolster Nrf2, a natural antioxidant and inflammation fighter." "They are now looking at the impact of synthetic triterpenoids in an animal model genetically programmed to acquire the disease more slowly, as humans do."

Shang Mingying;Tezuka Y;Cai Shaoqing, et al. (Department of Pharmacognosy, Beijing University of Medical Sciences, Beijing 100083) reported on Studies on Triterpenoids from Common Fenugreek(Trigonella foenum-graecum). Seven triterpenoids were isolated for the first time from the ethanol extract of seed of common fenugreek.

Fenugreek shows antioxidant and anti-inflammatory potential according to US and Arabic researchers.
The Journal of Food Biochemestry reported on this study showing the antioxidant effect of fenugreek.
Medical News Now with more about fenugreek from University of Queensland School of Medicine.

Thursday, August 09, 2012

CRPS research update from Richard Stace of CRPS UK

Richmond Stace is a physiotherapist with a special interest in Complex Regional Pain Syndrome. He created his website to share current research on this hard to treat condition. Of particular interest in his July Update is the role of oxidative stress in triggering and its involvement in clinical symptoms of CRPS. I follow Richmond's posts via email subscription and appreciate his efforts to keep the CRPS community informed.

First suggested by Sudeck in 1942, Dutch researchers' studies supported the theory that oxygen derived free radicals are possibly the mediators of mechanisms leading to some of the neurological symptoms of CRPS. They found
  • high oxygen supply with tissue hypoxia in CRPS extremities;
  • a diminished oxygen availability to the skeletal muscle tissue affected by chronic CRPS;
  • and several deficiencies in the skeletal muscles of CRPS sufferers.
Studies in Holland have centered around free radical scavengers as treatment for CRPS. There are many ongoing studies with DMSO, NAC in Holland.

This is supported by research in Israel serum and salivary oxidative analysis in complex regional pain syndrome.

Monday, June 11, 2012

I've been using a large mirror for single sized lower abdominal pain caused by adhesions and infammatory bowel pain in a similar manner to what you have shown. I massage and prod the area on my good side while watching the mirror image, and yes it does work. The abdominal pain had triggered CRPS symptoms in the leg of the same side so I used the large mirror for that as well. The CRPS symptoms are settling and the abdominal pain eased. The abdominal pain will return. My goal is managing the pain now I know the cause.

Thursday, May 10, 2012

"The Graded Motor Imagery Handbook" a much anticipated addition to NOI Group's "Explain Pain".

 This new Noigroup publication is born of a firm conviction that, as Lorimer Moseley says, "people in pain do better if they are given the resources to master their situation". To this end The Graded Motor Imagery Handbook builds on and extends much further the knowledge that  Explain Pain began. A persistent theme is that treatment requires patience and persistence, courage and commitment. I have to agree with that. Lorimer sums this up beautifully on page 37.

The book is divided into five sections - knowledge, background, treatment, stories and tool boxes.
David Butler in the first section tells us about this exciting new era in rehabilitation powered by the neuroscience revolution of which Graded Motor Imagery is an important part. David explodes some myths and builds on the plain common sense of Explain Pain. He offers suggestions and encouragement, including encouragement to share your experience and thoughts. This open mindedness is refreshing.
David explains that Graded Motor Imagery (GMI), unlike a program is not preset. It's a series of novel treatment strategies which remind us that representation of body in the brain should be considered in all patients. Importantly he says that patients cannot be just passive recipients of treatment. They need to self manage and understand that gaining knowledge is part of treatment - knowledge is power - knowledge can be therapy. "If you have knowledge of GMI you have skills to know why it hurts so much today and how to deal with it."

In the second section of The Graded Motor Imagery Handbook Lorimer Moseley gives us the science underpinning the concept of Graded Motor Imagery. He also explains such things as delayed reaction time in left/right hand judgements and why sometimes even imagined movements make some feel pain. He gives a great explanation of possible mechanism of spreading pain which can manifest as imprecise movements or dystonia. Lorimer explains the pattern of primary sensory cortex (outermost layer of brain) activation caused by stimulating different points on the skin. Using this method of brain activation a representation of the body in the brain has been drawn called sensory humunculus (humunculus means little man). Page 27 has a simplified 2D  illustration of the body in the brain. The picture looks grotesque, out of shape. This is due to the richness of innervation of different body areas.  As I actually gained remission finally twice from Yamamoto New Scalp Acupuncture I was excited to learn that it utilizes this same sensory homunculus. Curiouser and curiouser.

Interestingly Dr Moseley (page 50) describes comparison between patients who used imaginary and mirror therapy with those who used the three step Graded Motor Imagery approach (that is left/right judgements followed by imagined movements and then mirror therapy). In his results with ungraded motor imagery "patients tended to get worse in those phases but improved when left/right judgements were used and then further improved when the next steps were followed. " I'm putting this here because what I like about this book is that the authors don't pretend to know it all. I did not have the benefit of left/right judgement before I began mirror work, nor did I know anything about imagined movements as therapy. I read about mirror therapy, worked out what might work and experimented. With persistence, a very little and often over a long period I improved. I suspect that keeping the training very short prevented worsening of symptoms as described. The important message here is that beyond doubt, pain can be reduced by brain retraining methods. 

Tim Beames authors the third and no less important section on treatment. He goes much further into the practical aspects of treatment, the stages, adaptive techniques, how to use Recognise, implicit and explicit motor imagery and on to mirror therapy This is a valuable section for clinicians as many examples are given. Telling photos of mirror therapy in practice will be an asset for both therapists and patients. There's a great "how to mirror therapy" table on page 89. Each section is clearly summarized and on page 92, Timothy brings it all together and encourages us to be creative and "not be satisfied with just managing pain." I like his attitude.

David takes the fourth section to a new level. I like the way he cuts to the chase, a no nonsense approach explaining how stories and metaphors can "get us through". He has a great knack of keeping it simple and really getting his message across. I like too the analogy on page 114 of our brain being "our own drug cabinet". I agree with what he says at the end, "Basically, knowledge is the greatest pain liberator of all. The key is in your hands."

Now to the final section written by Thomas Giles. I'll call him Tom. Tom describes himself as the nerdy one. It's one thing to tell us what, but he's the one who shows us how to access and use the tools to make it work. It's refreshing to see this depth of information and practical support. From system requirements and connecting to Recognize to making your own resources, Tom explains it all simply and logically. He encourages us to share our ideas. Just contact NOI Group. Many people with CRPS contact me asking where they can find out more, who can help them, where there's someone in their area.  Now I can suggest they go to their local clinician. If the clinician/physical therapist is unfamiliar with Graded Motor Imagery this link and this wonderful book will provide the answers. Ignorance of something new isn't a problem. It's an opportunity.

At the end of his section Dr Moseley asks "Does Graded Motor Imagery work?" I'm reviewing this book because I know this works. I believe The Graded Motor Imagery Handbook  is a great resource for patients but I consider it is a must for those who treat people in pain. I add my encouragement for clinicians who use it to document what you do and add to the growing body of evidence by sharing your results and experience. This book gets a big thumbs up from me.

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