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.
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