Chronic-pain-science

NEW: This is an article about coronavirus and treatment options that may be theoretically possible. It appears on the page of chronic pain, because there are striking parallels between these treatment options and the treatment options of chronic pain. The term ‘virus’ could be replaced by ‘chronic pain’ in many places.

First an important warning: this is not a scientific article. There are some underlying scientific facts, but these are not presented here in an orderly fashion. The list of scientific references is not exhaustive. This is a personal view based on the author’s knowledge and experience, not medical advice.

Coronavirus and chronic pain

It seems a bizarre combination and a similarly bizarre brainwave. The present host of publications on coronavirus reports several elements: the virus attaches to receptors deep inside the lungs, where it causes a ‘severe acute respiratory syndrome’ (SARS). There is a lot of literature on SARS: Pubmed gives 9064 hits, free full texts 3362. But what exactly is SARS? It is an acute-onset condition characterised by high fever, coughing and dyspnoea, which can easily progress into more severe health conditions. Like influenza, coronavirus can cause severe pneumonia, myocarditis and damage to the central nervous system. This has a negative effect on the circulation and leads to fluid loss and decreased blood pressure. I remember a remark by a professor of internal medicine when I was still training to become a doctor: in case of an acute cardiac or pulmonary condition, administer an injection of calcium and an injection of euphylline (generic name: aminophylline). This may seem too simple to be taken seriously, but it has saved the lives of a few patients in my practice.

Aminophylline is a scion of the Xanthine family, which also includes theophylline and pentoxifylline. In the Netherlands, theophylline is still used in pulmonary disorders, nowadays termed COPD. Pentoxifylline is used clinically to treat poor perfusion of the legs and laboratories use it for inflammatory-like conditions and shock. In 1977, two pharmacologists from Nova Scotia published studies with a substance which had been discovered in 1935 but could only be synthesised and used in pharmacological studies since the 1960s. The substance was referred to as prostaglandin.

Read more ?: Here's the free PDF. Medical knowledge is acquired for understanding.

2020 March 27

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A quite new model about the origing of chronic pain and CRPS is ready now as complete article too. This complete article is downloadable. Only comprehensible for professionals!

You need knowledge about pharmacology (prostaglandins), neurophysiology and infrared thermography. Download here

March 2018

One version has been designed to be presented in a video-presentation at the Congress of Pain: Pain Medicine 2017, titled: ““Relieving Pain. Restoring Function. Renewing Hope”. San Francisco. October, 2017.

In behalf of medical professionals this version: "A model about the origin of chronic pain and crps. (1880-2017)": 45 min ! is ready. Click here.  The video has been divided into three parts: Past, Present and Future. History, diagnostics and therapy.

2017-04-29

The model can explain, why a thermographically ”cold spot” can remain after a initially “hot” traumatic incident, it can explain why a Cold spot can become warmer after “Cold stress", why a Cold Spot can become a CRPS (Complex Regional Pain Syndrome), why a CRPS not only is looking as "Out of Control, but it really is too. It can explain, why a “Cold CRPS” contains inflammatory cytokines and why a relatively small trauma can give rise to a CRPS.

The model also can explain why a drug as Pentoxifylline, known since 1986 can be useful in treating CRPS.

Here the abstract as a preview:

CRPS= Complex regional pain syndrome PGE=Prostaglandin E1 and E2

Conclusion: It is possible for chronic pain to be detected by infrared Thermography and to be tested for the CRPS risk. There exists a pharmaceutical possibility for treatment since 30 years with pentoxifylline. The drug blocks a specific inflammatory protein: TNF-alpha.

Abstract Hypothesis: Chronic pain without a detectable substrate and CRPS are part of the same inflammatory disease process and differ only in its process phase.

Chronic pain can be seen as a chronic inflammation without the classical features rubor, calor and tumor. As the result of a biochemical transition, the clinical picture of a cold inflammation can change into a virulent situation that shows all the characteristics of an inflammation: CRPS. The transition that may cause this was already described by Horrobin and Manku in 1977, but not recognised as such. The transition itself consists of a bell-shaped dose-effect curve for prostaglandins. The sensitivity can be increased or decreased by prostaglandins that have also been described but show a plateau in the dose-effect curve. 

The background of the thought process was published earlier as: CRPS: A contingent hypothesis with prostaglandins as crucial conversion factor Med. Hypoth., Elsevier, 2015. The present article is a practical elaboration of the former publication which integrates chronic pain without a detectable substrate and CRPS in the same pathogenic process. 

The effect of the biochemical process can be observed with infrared imaging and can be biochemically analysed. Treatment has already been available for 30 years and its progress can be followed and measured. This article addresses the disease process and its phases in a process-oriented medical way. The hypothesis is supported by much evidence, the collection of which is still incomplete. This article provides an applicable model suitable for further pure scientific research as well as a practical pursuit of therapeutic initiatives. It is also an ode to the impressive and significantly underestimated research conducted by Horrobin and Manku in 1977.

Conclusion: Chronic pain and CRPS overlap each other and both develop from an inflammatory accident resulting from trauma, fracture or haematoma. Chronic pain (the kick off) comes first and CRPS (the knockdown) follows. It can explain why CRPS occurs after relatively small injuries.

Consequently, the treatment of chronic pain should be focused on blocking the target sites of PGE and selective inhibition of PGE production and/or a selective increase of the PGE concentration and/or blocking of cytokines to which PGE tends to bind. A forty-year-old pharmaceutical - with a proven positive effect on chronic pain as well as on early CRPS - could be studied again to see if it has pharmacological properties leading to the effects mentioned above. To prevent the development of CRPS after relatively simple surgical procedures, infrared thermography should be used to examine the presence of chronic pain syndrome in the area for surgery and to test the surgery-induced propensity to develop CRPS. Finally, the above-mentioned pharmaceutical can be administered as preventive preoperative treatment to patients in whom a risk of CRPS has been established, but who nevertheless need surgery.

PH(Henk)E van der Veen.

march 2018