Tuesday, April 26, 2011

Lorimer Mosely posted a series on "neuroimmunology for dummies" or various other names.

In his first "mutterings" Dr Lorimer Moseley on his website, Body in Mind, raises the point that " immune mediators that are upregulated by nociceptive activation have real time effects on the way our brain works." This helps to explain why people with chronic pain might feel they can't think straight.

 Part 1, which follows the introductory post, discusses the immune system and learning and memory -  the role of  T cells and T cells derived IL-4. Lorimer points out that "thinking increases T cells" in particular those T cells which can  produce an anti-inflammatory cytokines. He relates some evidence from experiments and poses an interesting question relating to T cell, inflammation and chronic pain.

Part 2 moves on to the role of inflammatory cytokines in particular IL-1, IL-6 and TNF-a. It seems that
"learning in a fear paradigm increases IL-1 manufacture which  induces an inflammatory-like process, at least in the hippocampus." Interestingly Lorimer says IL-1 can also facilitate learning and critically all of the data on IL-1 involves spatial memory tasks, which are thought to rely on hippocampus function. Without hippocampus function he says dosing with IL-1 has no affect. Further into this post it is indicated that  IL-6 production seems to be associated with improved memory but there is more to this IL-6 (possible implications for surgery?) (Has this anything to do with the Netherland's research in prevention of development of CRPS post surgery). Finally Dr Mosely goes on to talk about prostaglandins which are said to enhance spacial learning. He finally makes the point that the interconnectiveness of all these things and implications is far from simple or straight forward.

Part 3 goes on to discuss the immune system in neuroplasticity. Dr Moseley first discusses some research in this area and then makes the point, "the role of IL-1 is not just limited to the hippocampus and to spatial and related memory formations. IL-1 expression is associated with LTP in the dorsal horn, specifically at spinal nociceptors – the spinal projection of C-fibres". He speculates about a possible role of IL-6 in switching off LTP. He talks about a possible "window of opportunity" time frame for IL-6 to be used to
reduce the likelihood of LTP in the nociceptive system after acute injury, or in the circuits that subserve post traumatic stress syndrome.
This is a fascinating series of posts, most of which I don't pretend to grasp. However what is abundantly clear is that funding is vital to keep our great minds of science working in an enviroment that encourages questioning and embraces a quest for answers. I recommend this series of posts on Body in Mind.

Saturday, April 16, 2011

Pain and the immune system - a really interesting article.

Dr Nancy Sajben writes about the activation of glia and the immune system in her article "Pain and the immune system" This article fits neatly with my post about a promising new treatment for CRPS/RSD.

Dr Sajben says that the study of glia is early days but shows promise for development of drugs that can "distinguish activated glia for targeted treatment, new methods of visualizing glia, nefunds for research in thew sites for possible medicines and nanotechnology to deliver medication directly to the inflammation."

She also mentions the very real need for research in the area of pain in the USA. We have a similar problem here with reports recently of cuts to science.

Monday, April 11, 2011

Re my last post - UK Scientists under Dr Andreas Goebel find promising new treatment for CRPS/RSD.

Unfortunately my last post isn't showing properly in emails. Please click this link to see the post fully. I tried to fix this but was unable to do so. My appologies.


UK Scientists under Dr Andreas Goebel find promising new treatment for CRPS/RSD.

Andreas Goebel is a Senior Lecturer at the University of Liverpool, and Consultant in Pain Medicine at the Liverpool Walton Centre Hospital, one of the largest pain teams in the UK.

A small but significant randomized, double-blind, placebo-controlled crossover trial has shown that treating the immune system of patients with CRPS/RSD can significantly relieve pain. 
The study, published in the February 2010 issue of the journal Annals of Internal Medicine, found that a single, low dose infusion of intravenous immunoglobulin (IVIG) significantly reduced pain in just under 50 percent of patients treated, with few adverse effects

In unresolved CRPS of more than a year (nCRPS) they question whether there is an inflammatory or autoimmune condition. They think that nCRPS is an inflammatory or autoimmune condition, at least in some cases. In separate laboratory studies, the researchers and others have since discovered that many patients with nCRPS have antibodies directed against their own nerves (=’autoantibodies’) suggesting that CRPS could be ‘autoimmune’.

Research has shown that the affected limb's representation in the brain changes with nCRPS. Because of the described changes in the brain and the success of ‘brain training’, ( Lorimer Moseley, mirror therapy, Professor Minh Zhuo links ) people have started to think that whatever biological cause initially elicits CRPS is perhaps not so important later – that nCRPS is essentially sustained by the brain. However Dr Goebel's research suggests that this may not be the case. I don't quite agree with this. I don't think this conclusion follows logically on. However I have no training or knowledge other than my own observation.

Dr Goebel says,  
"there is something odd about our patients’ responses to IVIG: most patients respond to unusually low doses (0.5g/kg), and they respond much quicker than people suffering from other IVIG-responsive conditions. Equally unusual is that our patients very likely do not respond to treatment with steroids, the panacea of things going wrong with the immune system. I would not be surprised if the way by which the immune system causes CRPS is different from that by which is causes other conditions."
He asks if brain retraining can override the immunological processes in some patients. Moseley's research suggests this is so.

These are now my ovservations for what they are worth. Because I have had CRPS and have had remission twice after more than 10 years of constant whole body pain and symptoms I have made observations along the way.

  • Whether it is a pre existing inflammation or an inflammatory response we know that something associated with this triggers CRPS.
  • Dr Andreas Goebel's research suggests that treating the immune system can reduce pain. This fits neatly with Dutch research.
  • Mirror Therapy has worked for me to reduce both pain and symptoms of CRPS and also other pain
  • From my observation of my own response brain retraining reduces pain and symptoms of CRPS (and other pain)

  • It appears to me that much of what we do, think etc can be shown by fMRI to change the brain. No matter what method you use (brain retraining techniques, medication, vitamins, surgery that reduce local symptoms etc) a change is produced in the body. This change produces (as I understand it) a change in the brain.  Isn't it true that as change affects the brain, then at the time of an inciting event that the brain would change. I believe it is time we stopped measuring the change and just conclude that change in the brain is a fact. This is an exciting development in my opinion as it would seem that we are able to effect beneficial changes to our well being by doing, thinking etc things that we now know to produce beneficial brain changes. This change can also be produced, I think, by many means, such as physical exercises, thought training, meditation, taking medicine, immuno suppressants, vitamins etc. I suspect anything that elicits a body response may be shown to change the brain.
 I have no qualifications and no training in this area so I'm aware what I've written here is quite simplistic. However it appears to me that, in general, the least invasive, least likely to cause side effects method of treatment would be the most desirable or the method proven to produce greatest benefit for least cost, financially and physically. I hope now and into the future these dedicated researchers get adequate funding to keep asking questions and searching for answers.

Thursday, April 07, 2011

NOI Group calling for volunteers.

A team consisting of Jane Bowering - physiotherapy honours student at the University of South Australia, Ian Fulton (MAppSc) and Lorimer Moseley (PhD) from the School of Health Sciences at the University of South Australia, David Butler (EdD) from the Neuro Orthopaedic Institute in Adelaide, and Halton Stewart - software research and development have come together to conduct a research project about back laterality.

The research hopes to answer the question:
Are the accuracy and response times for a person to judge whether a pictured model has their trunk turned or flexed to the left or right altered in people with a low back pain?

 Contact: Ian Fulton - Ian.Fulton@unisa.edu.au

Sunday, April 03, 2011

Neurotropian on Mirror Therapy - brilliant series of post from Matthias Weinberger

Matthias Weinberger has the blog Neurotropian. He is a Physiotherapist extraordinaire in my opinion, is passionate about the new science of pain management and promotes awareness and educates in this brilliant blog. Matthias is also a very talented photographic artist. I encourage you to bookmark his site and visit often. I go back and read his posts several times as there is so much information and good sense in them.

Neurotropian blog has a series of invaluable posts about
"mirror therapy". Mirror therapy has been proven to create new neural pathways, retraining the brain, important for those with CRPS. I recommend you watch the video of Ramachandran before Mirror Box Therapy Part I.

  • Mirror Box Therapy Part I describes how easily the brain can be changed by vision. Click on rotating spiral to show you how. He presents the science of "Somatosensory maps being re-modeled so that the pain is gone (forever)" because the brain is restructured. Please note that from my observation, if pain returns as soon as you stop mirror therapy, there may be an ongoing pathology or mechanical problem which needs addressing. Note the fantastic results with Iraq veterans in Walter Reid trials.

  • Mirror Box Therapy Part II talks again of the brain's plasticity. With his gift for making the difficult seem simple Mathias helps us understand just how our brain can change in ways that benefit us.
  • Mirror Box Therapy Part III talks about the virtual body in the brain and distortion of images. In my case if I've had pain for a long time my image of my body part becomes distorted eg I become convinced that my leg is swollen. Measuring shows me that it's not but in my mind it is. Mirror therapy stops the pain and returns the image in my brain to normal. Again this section is interesting and explained in such a way that it is easy to understand.
  • Mirror Box Therapy Part IV specifically talks about CRPS and mentions the limb laterality left/right recognition problem. This is the best explanation I've found about this. In previous posts I talked about Noi Group's Recognize program. I think the cards they now have would have been much better for me as I have a big problem with recognizing left and right hands. This post is devoted to feedback from the body to the brain and is most important. I recommend you take time and read this section.
  • Mirror Box Therapy Part V has some really good links. Hubmed is brilliant. I've bookmarked a number of other links thanks to Neurotopian.
  • Mirror Box Therapy Part VI - as the expression goes "from pain to possibilities". This section is just fascinating. Read it and bookmark "Neurotopian" in your favourites. I'll be checking regularly and hope at some point there will be the opportunity to get updates by email as you can with Blogger.
  • Mirror Box Therapy Part VII covers frequently asked questions. It provides answers about side effects, lengths of sessions, where to get boxes and what to do.

Saturday, April 02, 2011

Mirror Therapy Case Study

Matthias Weinberger of Neurotropian posted this video. He has a brillliant series of posts on this topic on his blog. Recommended.

Mirror Therapy

Matthias Weinberger of Neurotropian posted this video. He has a brillliant series of posts on this topic on his blog. Recommended.
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