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Neuropathic/Central Pain

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    Neuropathic/Central Pain

    Can anyone suggest good understandable articles/information on neuropathic/central pain? It is hard to cope with every single day, so I guess I should understand it better. Everything I read is so technical my mind turns off after a few paragraphs. I would appreciate any suggestions and thanks.
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    Are you looking for information on the cause of the pain, or treatment options?


      I saw dejerine's post since I asked the question, so maybe it has the answers. I guess I don't know enough biology to ever get it. I'd like to undersand the things that make it get very hard to take, besides stress and fatigue. I have a lot of confidence in my pain management doctor and see her next week. Maybe the best I can do is ask her to increase my meds. Thanks for responding to me.
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        I would love to have that same information! Trying to explain your pain is mission impossible. Try this link:


          Dejerine is a genius. I think we all read the Dejerine posts 10 times, and still don't get it all.

          I'm very glad you have a good pain doctor. If you pain is still too much for you, I certainly hope she will do something to help.

          I recently found a website that I think is a good writeup on pain management. It is not specifically for neuropathic pain, but rather for cancer pain. However, cancer pain can be neuropathic - plus, mangement of chronic pain is approached basically the same as cancer pain. There are some other treatments not mentioned in there as well, but imo it's a pretty good discussion.

          See if this helps any

          Of course, ignore the parts specifically about cancer, chemo etc. - they do not apply to you. (oh dear, I seemed to have turned purple - ah well)

          I'm sorry, I don't entirely understand what you're getting at in your last post - are you looking or the mechanism of how neuropathic pain works? Or what effects it has on you?

          We'll be happy to help, if we can.


            Originally posted by VavaBoomer View Post
            I would love to have that same information! Trying to explain your pain is mission impossible. Try this link:

            Ah, that's a good site too.

            It's more talking about problems in the extremities though, but it certainly has some good stuff.

            I must be being a bit dumb today (too much Christmas already I think) because I'm not doing a good job at figuring out exactly what the question is (my bad).


              Here's a article posted some years ago on the forum on neuropathic pain - does this help?



                Thanks for the responses. The two shorter articles are good and understandable. I'll have to read the Cancer article tomorrow. Christmas party wore me out. TAM63, I don't mean to be confusing and thanks for going out of your way to help. Good to know I'm not the only one not quick enough to get degerene's post the first time.
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                  Oh, please don't apologize - maybe it was just me anyway. Glad if any of it helped.

                  I love Dejerine's posts - especially every fifth word that I actually understand lol. Seriously, they are very educational, but also very scientific.


                    That Cancer pain managemet atricle is very good in explaining pain management, and it's one to read more than once and keep for reference. I was very lucky in getting funtion back, but the 24/7 pain is something that is wearing me down and making me lose some function. I guess I'm just searching for the best way to manage the pain through medications and lifestyle while still actually having a life. Probably the same thing everyone else is looking for. Thanks!
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                      You're very welcome - I'm glad it helped.

                      In addition that those options discussed in the article, there are other options, including a spinal cord stimulator.

                      I'm glad you have a pain management doctor you have confidence in. If your pain is not adequately controlled, I hope you can discuss that with your doctor, and some more things can be tried.

                      There are almost always more things to try. One member on here thought nothing would work, and then found relief from Ketamine.

                      As best you can, I encourage you to keep trying things, until you hopefully get relief.



                        Pain is complicated, by design. Pain is important to survival so a great deal of brain is devoted to pain.

                        the important thing to remember is that although we talk of signal, ie some injury causing a pain signal, pain is really a chemical process.

                        Ordinary pain excites the very rapid, large A fibers. Slow pain is initiated via tiny C fibers. They lack punch, but when C fibers arrive at the cord, they have the power to cause sensitization of the large A pain fibers. The sensitization is accomplished by glia, other types of cells amongst the pain neurons.

                        The glia not only kick into high gear, they also increase in number, about four fold in central pain. The glia are releasing the chemicals which initiate attempted repair.

                        The body ordinarily puts out a do not trespass sign when repair is under way. This do not trespass is the attraction of cytokines, which are inflammatory cells. On the skin this process would cause redness, tenderness etc. T

                        The cord and brain do not react when touched, other than to constrict blood vessels. It is not painful to touch the brain. The pain signal is processed by cord and brain, and EACH STEP is hypersensitized in a fairly short time by the neuroinflammation which is basically just the creation of an acid medium around the nerve synapses. This process marches up the nervous system, sometimes rapidly and sometimes it takes years.

                        If you think what it is like to have acid on your skin, this is not far from what people with neuropathic pain feel. (They may also feel lightning pains and muscle cramps, pins and needles and any of these may be very severe).

                        The inflaming acids involved are fatty acids. The pain signal reaches the thalamus and the subthalamus, which are concentrations of cell bodies in the center of the brain.

                        Signals of now altered frequency begin to go to the cortex or grey matter atop the brain. The cortex presumably sends back inquiry if something is wrong. The thalamus and subthalamus say "Yes, Indeed. There is something terribly wrong" The cortex then generates the pain, and the degree of painfulness is controlled by an area to the side of the brain, the insula. The location of the pain is detected along the top center of the brain (SI). And the significance of the pain is served by an area just above the insula, in the parietal cortex.(SII) The emotional reaction to pain occurs in the forward areas of the brain, also in the cingulum which is forward but not all the way.

                        Attempts to remove these various brain structures have not been that successful. Some also attempt to break up the brain pattern by external electric current, but again, this is not consistently helpful. Pumps which inject medicine in and around the cord are helpful for spasticity (baclofen), but what their role is for the pain has yet to be fully known. I do know this fellow I mentioned who hangs in a cage to avoid touch, who told me morphine in his pump was helpful. Pumps may be a way to deliver potent doses without so many side effects of opiates such as constipation or addiction. However, there are a number here who did not get results from opiates in the pump.

                        The signal is jumbled so the pain does not resemble any ordinary pain, but is akin to burning. Burning with poor localization is the most durable sensation of nerves, the last to disappear before total numbness. This type of burning is called protopathic burning. It is probably very close to what people with central pain feel, although CP patients somehow get other feelings like cold, or wetness mixed in. The signal is clearly not being controlled. Perhaps the hypersensitization is so strong that the tracts carrying cold and wet get revved up also.

                        Then, it never stops. No more actual stimulus out at the nerve endings is required for spontaneous burning. The burning is continual.

                        If the distant parts of the body are touched lightly or if a cold blast is directed at them or if rough texture is rubbed, a signal is generated, which is overamplified by the hypersensitized pain system. This heightened pain is called evoked pain. It can be VERY VERY severe, unbearable. If you are wearing clothes or shoes you may have to remove them. Or you may have to get away from the air conditioner immediately.

                        I think people find the word "glia" to be confusing. It just means that the neuron, which is the mainline signal is controlled and regulated by chemical secreted from surrounding glia. Their overactivity is thought to sustain central pain. Connections within the brain also become acidified so the process is amplified in at least three synaptic locations as the signal goes up. We know that the brain attempts to decrease the pain, but this attempt is overridden because of the extreme hypersensitization.

                        Presently, there are no known meds to suppress the glia. So doctors attempt to treat central pain with anticonvulsants, the same thing they give for epilepsy. The rationale is that general suppression of brain activity will impact the specific tracts of pain. As you read at this forum, most people taking enough anticonvulsant to feel any effect on pain will also feel the suppression in undesirable side effects.

                        For myself, I don't like the side effects of anticonvulsants and prefer a sedative such as clonazepam. Some people report help from powerful opiates, such as fentanyl, or from drugs which block the reception of signal at the nerve synapse, such as ketamine. Ketamine is so powerful that it is considered an anesthetic, but in lower doses is sometimes used. With long term use, there may be cognitive slowing with ketamine.

                        One single nerve fiber doesn't go all the way to the brain. There are a number of switching stations or synapses where connections are made. Opiates suppress the action in the cord, but they do not suppress the action in the brain. They may even increase brain activity, so on balance you see people trying to detox from opiates even as others are trying to get on them. This shows we need better drugs.

                        Neuropathic pain is related to C fibers, to certain specific ion channels, and to certain brain structures which are not part of the normal "fast pain" system. Research will hopefully uncover a way to block these pain structures which normally deal with slow pain. Ion channels must open and close for transmission of a pain signal. In central pain, there is a specific sodium channel which is only seen in the fetus, but the genes for it turn on and the cell membrane of neurons becomes studded with this ion channel, which enhances firing.

                        The National Institutes of Health states there is no satisfactory treatment for central pain. They recommend avoiding stress to keep the brain quiet that way. Adrenaline and prostaglandin are linked and prostaglandin is associated with the fatty acids which participate in neuroinflammation. Coping is certainly aided by avoiding stress.

                        Hopefully this will make things a little more simple, but pain is not simple, even for doctors.

                        Notice that we are speaking of central pain (which usually means cord injury). Injury to a peripheral nerve can also cause some of the burning sensations and other bizarre sensations. (such as may remain after shingles).

                        Dr. Young has stated here that the general practice now is to just speak of neuropathic pain and not differentiate central from peripheral nerve injury pain. I think I can tell the difference in people, so I am a holdout for the old terminology. Dr. Young no doubt speaks for a much larger body of expertise than do I. You can read some of my reasons for retaining a distinction, but I obviously have some convincing to do if I am to persuade the ones who call the shots.

                        Since both groups, central and peripheral, speak gobbledygook, it may be useful for the clinician just to consider it all as nerve injury pain. There is no vernacular for central pain, and borrowing from normal pain misleads the examiner.
                        Last edited by dejerine; 13 Dec 2009, 5:39 PM.


                          Awesome as usual Dejerine.

                          Reading of the adrenaline, what do you think of the idea that alpha blockers such as phenoxybenzamine may be helpful to some?


                            Dejerine -
                            I, too, appreciate your information. I have a son who is a freshman in college who is taking 'intro to neuroscience' and is excited about it. He says it is very popular course and major these days. The last great frontier. Maybe there will be a group of young neuroscientists to push our knowledge of chronic pain further.


                              Degerine, wow. I really appreciate this information, and I appreciate everyone else's input as well. I am going to have to read it a bunch of times, but I think it is really going to help me. I have a central pain, which I guess is why I feel the wet/freezing/burning kind of pain I used to get when I played out in the wet snow all day when I was a kid. That's the best way I can kind of explain it to someone.

                              I really appreciate understanding more about why stress increases the pain. I had a very stressful job, and when I was trying to do it the burning was so bad by night that I just couldn't cope. I take the anti-convulsants, and maybe I should think about alternatives. Don't sedatives slow your brain down also and make you sleepy?

                              Well, enough whining. Thanks!
                              2012 SCINetUSA Clinical Trial Support Squad Member
                              Please join me and donate a dollar a day at and copy and paste this message to the bottom of your signature.