Chronic pain: a new discovery validates sufferers’ complaints

People who suffer from chronic pain are often not taken seriously by health care providers. That’s because medical people can’t find an injury or other source of the pain. Recent discoveries have found a hard-science explanation for the pain: glial cells have run amok. Glia are scattered throughout the nervous system and take up nearly half its space. Scientists have determined that glia play a role in supporting neurons, cleaning up their waste and helping them communicate. Now, they have discovered that, instead of just supporting and responding to neuronal activity, glia often direct it. With chronic pain, glia send false and destructive pain signals that never end. In such cases, pain is not just a symptom of something gone wrong, it becomes its own disease.

Sensation of pain works in three stages. First, pain-sensitive neurons send a message to your spinal cord that triggers a reflex—say jerking your hand back from a hot surface. Next, the signal is handed off to neurons in the spinal cord (stage two), which then take the message to your brain (stage three). It’s at stage two—the handoff in the spinal cord—that things can go wrong. At this stage, a profusion of glia regulate the pain signals by amplifying or decreasing their intensity or duration. Chronic pain develops because the glia accelerate the pain system into an endless inflammatory loop that provokes the nerves into generating a perpetual pain alarm, generated in the brain.

Scientists don’t know how or why glial mismanagement develops. It can emerge after an injury or out of nowhere. Apparently, even after an injury has healed, pain signals can spread to other areas, causing more pain. (They can transmit information through dozens of communication pathways.) So far, solutions to this terrible condition have not been found. You can’t knock glia out, and current painkillers don’t help because they target neurons, not glia. Plus glia have a built-in redundancy. Even if a treatment blocks one pain signal, glia promptly find another.

At least sufferers of chronic pain now have validation that their suffering is real.

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Small bends

I get an emailed newsletter from Esther Gokhale, “the posture lady.” The latest one focused on “small bends,” the small degree of rounding you do to pick things up. If you round at the upper back instead of bending at the hip joint you produce, she says, “counter-tension in the lower back and/or pelvis to hold you there. Rather than compromise our backs, it is far healthier to keep our necks tall and bend at the hip joint. The start of a bend usually sets its trajectory. If you have a problematic start to your bend, it will likely continue that way.” 

The images below illustrate small bends--the right way on the left and the wrong way on the right.

In the image on the left, the “bend” occurs at the hips rather than at the waist. The spine remains elongated and the hip joints rotate. The spine follows the pelvis, and the back muscles and core work gently to keep the entire torso in one piece.

In the image on the right, the pelvis is fixed in a tucked position and the spine is rounded to bend forward, a movement that loads and compresses the discs. As Gokhale describes it, “With frequent repetition the microaggressions of even small bends take their toll on the discs. Rounding also overstretches the spinal ligaments, allowing for increasingly hunched posture. Even a small bend done in this way may be perceived by the brain as a threat and send the muscles into spasm, trying to prevent movement and protect against such misuse and damage.”

Easier said than done. Must pay attention!

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Ivermectin to treat Covid-19: bad idea

 You’ve probably seen news articles about people demanding Ivermectin to prevent or treat Covid-19. I didn’t pay much attention to it because I wasn’t interested. Ivermectin is approved by the FDA to treat certain intestinal parasites and lice in people. It’s also used by veterinarians as a treatment for parasites in pets and livestock—deworming, in other words. It got touted as a treatment for Covid-19 after some Australian researchers discovered that large quantities of it killed the virus in a laboratory setting—in a petri dish, that is. The scientists made it clear that the amount of the drug required to affect the virus was much higher than the amount approved for use in humans. Nevertheless, the news went viral, as they say, and people began demanding the drug.

What did interest me was a letter published in The New England Journal of Medicine submitted by three doctors associated with Oregon Health and Science University in Portland, Oregon. The letter gives real-world examples of the effects Ivermectin on some people who tried it. The Oregon Poison Center received 21 calls in August 2021, all were from people who had used Ivermectin. Eleven used the drug to prevent Covid and 10 used it to treat symptoms. Three had received their prescriptions from physicians or veterinarians; 17 purchased veterinary formulations elsewhere. The source for one wasn’t known. Six were hospitalized for the toxic effects; four were in intensive care. None died. Their ailments included gastrointestinal distress, confusion, dizziness, weakness, low blood pressure, seizure, vision problems, and rash. Note that these are just the cases called into the poison control center. Perhaps the tip of an iceberg.

I guess they were afraid to get vaccinated.

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Maryland: where health care prices are regulated

 Elisabeth Rosenthal, a former emergency room physician, now editor in chief of Kaiser Health News, was treated at Johns Hopkins Hospital for a “complicated head injury.” As she explained in the New York Times, Johns Hopkins is in Maryland, the only state in the nation that controls what hospitals can charge for services. At Johns Hopkins, her visits with top neurologists were billed at $350 to $400. Her spinal tap at Johns Hopkins was performed in an exam room by a neurology fellow. It was billed as an office visit ($300 to $400). In seeking a second opinion at a “prestigious” New York hospital, she also had a spinal tap. This one was performed in a special suite “under ultrasound guidance by neuroradiologists. It was billed as ‘surgery,’ for a price of $6,244.38. The physician charge was $3,782.”

The online version of the article allows readers to make comments. Here’s what Canadian reader (and anesthesiologist) wrote: “To address the differential costing that the author experienced, let’s get something clear. A ‘spinal tap’ or lumbar puncture is a five-minute procedure routinely done (as in Johns Hopkins) without fancy imaging. I am a pediatric anesthesiologist and for our oncology kids who need repeated LPs for monitoring and delivery of chemotherapy it takes 15 minutes per case including the anesthetic with the oncologist doing the test. The costs quoted for New York are obscene—and since we know this was not a difficult LP as done easily previously by a trainee—and unjustifiable. The doctors may not set the prices, but I would argue that they are part of the problem by colluding in such a system and collecting the dosh.”

Oh, Canada!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.