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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.