Thursday, September 24, 2009

Shutting Down the Pain Gate Before it Shuts You Down

Dr. Rollin Gallagher, Director of the Center for Pain Medicine, Research and Policy and clinical professor of psychiatry at the University of Pennsylvania and Director of Pain Medicine at the Philadelphia VA Medical Center currently studies the treatment of pain in injured troops on the battlefield.
Pain management is no different on the battlefield today than it was during the Civil War…an injection of Morphine which provides short-term relief but does not do anything to prevent the pain from continuing long-term.

This new method of pain management Dr. Rollin Gallagher is studying not only stops the pain but it also prevents neural pathways of pain to be created, therefore addressing the chronic permanent pain many times associated with injury. This method works by placing a catheter right next to the nerves that transmit the pain information from the area of injury to the brain -- the soldier pushes a button that continuously dribbles medicine right on that nerve to paralyze the specific nerve connected to the place of injury. This new method of pain management prevents the pain signal from getting into the spinal cord where it makes those changes in the neural pathways leading to chronic severe nerve pain.
How pain works?
When injured, a signal immediately goes from the injured tissue into the nerves to your spinal cord and then it is relayed through a set of relay stations in your spinal cord to two parts of your brain, one part of the brains says it’s in my left arm and it’s bad or not so bad and the other part of the brain says this hurts and I hate it...the suffering part.
Then the brain sends a message back down to the spinal cord or the descending control mechanism that say this is really important or this is not so important.
Then you have a reaction around the tissue involved in the injury and have inflammatory cells getting activated and the inflammatory process.
Then either healing begins, if the area is stabilized or if it’s a disease process or a disease process that interferes with healing or continue to do something to activate the injury then healing won’t begin. The longer the pain goes untreated such as the actual stimulus doesn’t heal up properly then your going to have changes in the mechanics of the muscles involved in the area of injury that will continue to send signals from the periphery.
More importantly you may have changes in the spinal cord and brain that then permanently activate the pain causing Chronic Regional Pain Syndrome, where just moving, blowing on the area actually activates the pain system. In addition, from not using the area the person gets bone absorption, contractures (a shortening or distortion of muscular or connective tissue due to spasm, scar, or paralysis of the antagonist of the contracting muscle) and other problems that create new neural pathways of pain.
Studies are suggesting that early exposure (babies or children) to pain that is not controlled actually enables an overgrowth of the pain neuron system in the spinal cord so there may be people who are more reactive to the same level of stimulus based on what happened to them earlier on in life.


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