Study results general

Chronic-pain-science

Investigation results.

The Philips Thermograph as used in 1980-1989.

The camera weighed about 40 kilos and was developped for defense objectives by Bofors. The measuring sensor was cooled by liquid nitrogen.

Investigation results.

General.

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Background

During the years 1980-1989 in a general practice in Den Helder a number of investigations has been performed using infrared thermography.

That measuring technique had been developed for a large scale screening of breast cancer. All big electronics concerns developed equipment in that time with prices varying from 150.000 till 350.000 guilders.

Unfortunately this expensive equipment appeared to be less suitable. X-ray equipment appeared to be more effective and cheaper. A stubborn general practitioner got the idea to use the equipment for “measuring pain” after he followed a course about “alternative” treatment.

During that course it was demonstrated how a group of various pain complaints could be treated by a local minimum dose of local anesthetics in the skin.

In regular medical science nothing was known about the skin as a source of chronic pain at that time. There was one German publication about temperature investigations of painful spots on the skin. In 75% of the cases these appeared to be colder than their surrounding temperature.

The course theories were tested in practice and found usable. But there was no testing investigation.

Applying this technique was the same as quackery and for that reason you had to test the operating mechanism yourself.

Philips offered an infrared thermograph for this objective.

In consultation with Professor Kloosterman who wrote an article in a Dutch medical magazine about “abdominal wall pain” a few investigations which could be carried out were formulated.

Research demands

Demands required to the investigations, they should not be an extra burden for the patients and the results had to be usable for the practice instantly.

Investigations performed.

1. Six volunteers were prepared to keep up with a body temperature curve. They came three times a week to have the temperature of the abdominal skin measured.

Goal: to see if the curve of the abdominal skin temperature would have the same variations as the body temperature curve. That would indicate that the function of the internal organs are being reflected on the abdominal wall.

2. Also a number of pregnant women had their abdominal skin temperature measured in order to see if possible pregnancy problems could be detected early in this way.

3. In order to examine the possibility of a connection between pain spots and some – formed by the body itself- pain-inducing substances an investigation was performed with micro doses “painkillers”.

For the regular medical science these doses matched the homeopathic concentrations, so they matched placebos (non-active medication).

4. In order to see if an increase of the blood circulation would give an improvement of the pain complaint, an investigation was performed with a means that theoretically could improve the circulation.

5. In order to see if there might be a connection between organic diseases and pain complaints on the abdominal skin the abdominal skin was measured during inserting IUDs.

Investigation results

1. Chronic pain spots have a significantly lower temperature than their healthy reference points. P<=0.001.

2. Abdominal wall pain can have something to do with processes that take or took place in the abdominal organs. Viscero-cutaneous reflex ways exist with man in vivo. P<=0.001.

3. There is a correlation between pain sensation and measure information found by infrared thermography. 1989: P=0.007 Spearman's rho: 0.3328.

4. Infrared thermography is a very sensitive diagnostic method (to physiological level).

5. There is a slight indication that the pain spots are influenced by the effect of prostaglandins in which case the various NSAIDs do not have a similar effect on the pain spots.

6. Pentoxyphillin has a significant positive effect on both cold and hot pain spots. P<=0.001.

7. A significant placebo effect has been found; a temperature increase at cold pain spots and a temperature decrease at hot pain spots. A possible explanation is sudden recovery in the investigation group. In that case chronic pain is not a static remainder phenomenon but a course process.

Meaning of these findings:

Chronic pain spots usually are colder than their surroundings. The difference is insufficiently to see with the naked eye. In 2014 it can only be detected by means of special measuring equipment.

A small part of the pain spots is hotter than its surroundings. No pain spots were found with an average temperature. So they are either cold or hot. That is an argument against the opinion that pain spots only exist by experience. There is something local as well. Local can have something to do with something that takes or took place in the skin or also as a result of diseases of the organs that by nerve connections to a specific area transfer reactions to that area. That transfer can be blocked by a local anesthetic.

Those reactions consist of circulation changes. The measuring equipment for this consists of a computer controlled infrared camera with processing software.

As in all other medical research equipment the use and explanation of the measuring information requires a thorough medical education.

The equipment is very sensitive, normal physiological reactions are visible on the images.

So in many cases it is very difficult to determine whether the situation measured is or is not a disease.

In most cases of chronic pain there are cold pain spots. The pain in these areas decreases at an improvement of the circulation. In other cases there is hot pain. At an improvement of this pain the circulation decreases as well.

There is medication having a pain decreasing effect and both improve the circulation at cold pain and decrease the circulation at hot pain. The effect of the circulation change is significantly similar to the pain sensation change.

As a result of that chronic pain can be influenced by biochemical way and not only by physical training and influence. The “placebo” investigation possibly indicates that chronic pain is not a rest situation but possibly a disease process which can be influenced.

For influencing abdominal wall pain with a local drug there is indeed a medical pharmacological and neurophysiological base now.

In more detailed descriptions of the investigations performed and of the literature on this site things will be further substantiated. For the aficionado references to the scientifically published investigations are mentioned in the column on the right side.

Every investigation should be performed for the benefit of the cooperating patient. There should be a decent responsibility also.

This job has been done after almost fourty years by these publications.


PHE van der Veen, retired general practitioner, December 2014.



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Introduction to this site about chronic pain.


On this site a number of chapters are placed about investigations and hypothesis develooped in the period of 1981-1986. Because of various circumstances these investigations partly have not been published yet.

Those are the private opinions of the author of this site, partly tested by means of investigation and partly rendered as theoretical hypothesis.

The differences between the articles are clealy indicated.

The sequence of publishing has no relation to the investigation sequence or to the investigation plan.

First thosse articles are rendered of which can be expected that publication on the internet will reach the target group better than by means of the traditional physical media.


How did the underlying ideas develop in the period of 1975-1981, the start of the actual investigations?


It started with Hansen and Schliack's textbook. In this book there ws a reference to the investigation by Baumann and Uckert (1954). IT was found that spots with chronic pain had a lower skin temperature than their surroundings. Objectively and measurably. Via orthosympathic sensation and sensitisation of the spinal marrow this led to the then called “Südeckse Dystrophy”, also called “Sympathic reflex dystrophy”.

Was there a connection then?

In all four cases: pain, skin temperature, sensitisation and sympathic reflexes prostaglandins could and can play a role.

In 1977 prostaglandins were described by Hoorobin and Manku as substances that can play a crucial role in a measuring and regulation technical situation in the body.


Those situations may occur at the origin of Dystrophy(Now called CRPS).

In the first place prostaglandins were discovered in liquid of the prostate gland and play an important role in the function of the genital organs.

Combined with a clinical lesson by gynaecologist Professor Kloosterman (1966) about äbdominal wall pain”that was the reason to plan a number of investigations(in consultation with him) that did not by coincidence cover the whole gynaecological domain.

Two investigations have only recently been published in 2013 and two in 2014.


Veen PHE van der, Martens EP. Viscerocutaneous reflexes with abdominal wall pain: A study conducted in 1981 on pregnant women from a general practice. Thermography international. 2013;23(2): 56-63


Available at:

http://www.uhlen.at/thermology-international/index.php



Veen PHE van der. Viscero-cutaneous reflexes in relation to abdominal and pelvic  pain. A study from 1982 in females with IUD insertions. Thermography international. 2013;23(3): 87-92


Available at:

http:// www.uhlen.at/thermology-international/index.php



Veen PHE van der. Infrared thermography for pain influenced by a Xanthine derivative: An attempt to assess chronic pain objectively.

Thermology international Vol 24 (2014), No. 2: 39-48


Available at:

http://www.uhlen.at/thermology-international/index.php


Abdominal Wall Pain:

Veen PHE van der. Effects of Placebo Measured by Infrared Thermography.

Thermology international 2014, 24(4) 157-165


Available at:


http://www.uhlen.at/thermology-international/index.php


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