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Neuralgia -
what is it?
Neuralgia = pain at the nerve
endings, usually induced by a disturbed "food" supply of a
nerve.
What is Pain all about?
1. Development of Pain
How Does Pain Begin?
Pain can develop from outside influences - heat, cold or pressure -
and through illness processes in the body itself. For exapmle: if
you injure your ankle, chemical irritants are produced right there.
This is alerting/irritating sensory cells at the end of the nerves.
These 'damage feelers' send the pain information in form of
electrical impulses to the spinal cord.
The Spinal Cord - The First 'Switch Over Center"
The pain signals are being changed in the spinal marrow into
chemical messengers. These then carry the pain impulses to the pathway
of the central
nervous system; this pathway starts in the marrow
to end in the brain.
The Brain - The Second 'Switch Over Center"
Only then, when the pain impulses have reached the brain, you are
able to feel the pain in the certain area of your body, in our case
the ankle und you will react in your typical way.
Body own opioids lower the pain experience.
In extreme situations the body can produce substances, endogenous
opioids, which lower the pain and maybe even 'turn it
off' for a short period of time. One of these is called endorphin
, which is being produced in higher quantities after an accident or
by high physical exercise. The result: you will notice stronger and
'true'/actual pain, when your body is at resting stage and therefore
less endorphins are being produced.
The process explained in another way : Even as our bodies respond to
the sensation of pain and our brains integrate that sensation with
our knowledge of the environment in which it occurs, the brain
produces chemicals - the endogenous opiods - that lessen our
perception of painful nerve signals, protecting us from fully
feeling them. The way the chemicals produce this effect is similar
to the action of some pain medications.
Opioids also play a role in feelings of pleasure
and reward, and in responses to stressful situations, and may even
be involved in the "runner's high" felt during strenuous
exercise.
More recently, specific endogenous opioids such
as the so-called endorphins and enkephalins have been found and
studied, as have the various kinds of opioid receptors that dot the
surface of brain neurons. Studies have even pieced together the
chemical cascade within a neuron that results from the binding of an
opioid molecule to its receptor and triggers the neuron to stop
sending a pain message - an effect known as antinociception.
The mu opioid receptor in particular has been
found to be a major target for both the body's own painkillers and
for drugs from outside the body, such as heroin, morphine,
methadone, synthetic pain medications and anesthetics. All are
capable of numbing pain, and, in the case of drugs of abuse, produce
pleasurable sensations during use.
The brain is controlling the controls in the spinal marrow.
From the brain nerves are reaching into the spinal marrow. This way
the brain can control the actions in the "1st switch-over
central station", with connections that carry signals from the
brain back to the spinal cord.
By constant fear, constant stress and depression the 'central
station' in the spinal marrow is being opened. Then the "pain
guard" is not active - and you will feel more intense pain.
You won't feel the pain, when the 'central station' is closed. The
"pain guard" is active and suppresses the pain impulse
from the nerves -
for example: in competition, by acute stress, by strong sudden
fears, when you are distracted or completely relaxed.
Even without the interaction of the brain.
From the 'central station' in the spinal marrow reflexes are
controlled, which the brain can't manipulate. Such reflexes one can
observe in form of muscle spasm. But as a result of pain blood
vessels can contract - with that the surrounding tissue receives
less nourishments, next to a number of other 'substances' being send
to the area in question, like protein, and voila`, a new pain rises.
Experience of pain
"Burned child shies the fire", a true idiom. Who has hurt
himself in a controllable situation, is going to be more careful the
next time. Predestined you are already, for example when someone in
your family is suffering from headaches or back pain. The you are
going to perceive and judge your own pain in this regard totally
different than a person who never had any pain like this before or
who's family is not predisposed.
There are many factors that change the way we
actually perceive pain and can make pain more intense or less
intense depending on the situation. This is also
true for other symptoms. This connection between
your central nervous system and your brain communicates with your
peripheral nervous system so nerves coming from organs, arms and
legs, and all symptoms that you may be feeling can be altered by
your nervous system either increased or decreased. That's
true of nausea or difficulty breathing or any symptom you might be
feeling. In fact, it's true of all of your senses.
Your sense of hearing, smell, taste, vision are also all interpreted
perceptions. Different factors that can alter your
perception specifically when it comes to pain include how much
attention you pay to the symptom, what the meaning of the symptom
is. For some people, pain is a good thing such as
when you've been working out and you're waiting to feel that burn
and the burn has a good context, as opposed to if you pull a muscle,
you may have exactly the same amount of tissue damage but the way
you perceive the pain is very different. Memory can affect
perception of pain. When we are awake, it takes much less stimulus
to cause pain than when we are asleep. If we were
in a coma, it would take even more, possibly we don't even
experience pain.
2. Acute, Chronic and Neuropathic Pain
Acute pain
One common type of pain is acute pain, currently defined as pain
lasting less than 3 to 6 months, or pain that is directly related to
tissue damage. This is the kind of pain that is experienced from a
paper cut or needle prick. Other examples of acute pain include:
-
Touching a hot stove or iron. This pain will
cause a fast, immediate, intense pain with an almost
simultaneous withdrawal of the body part that is being burned.
More of an aching pain might be experience a few seconds after
the initial pain and withdrawal.
-
Smashing one’s finger with a hammer. This
pain is similar to that of touching a hot stove in that there is
immediate pain, withdrawal and then “slower” aching pain.
-
Labor pains. The pain during childbirth is
acute and the cause is certainly identifiable.
The longer pain goes on the more susceptible it
is to other influences and developing into a chronic pain problem.
These influences include such things as the ongoing pain signal
input to the nervous system even without tissue damage, lack of
exercise (physical deconditioning), a person’s thoughts about the
pain, as well as emotional states such as depression and anxiety.
Chronic pain [more
in-depth information]
There are at least two different types of chronic pain problems -
chronic pain due to an identifiable pain generator (e.g. an injury),
and chronic pain with no identifiable pain generator (e.g. the
injury has healed).
Chronic pain due to an identifiable pain
generator
This type of chronic pain is due to a clearly identifiable cause.
Certain structural spine conditions (for example, degenerative
disc disease, spinal stenosis and spondylolisthesis) can cause
ongoing pain until successfully treated. These conditions are due
to a diagnosable anatomical problem.
Chronic pain with no identifiable pain
generator
This type of pain continues beyond the point of tissue healing and
there is no clearly identifiable pain generator that explains the
pain. It is often termed “chronic benign pain”.
It appears that pain can set up a pathway in
the nervous system and, in some cases, this becomes the problem in
and of itself. In chronic pain the nervous system may be sending a
pain signal even though there is no ongoing tissue damage. The
nervous system itself misfires and creates the pain. In such
cases, the pain is the disease rather than a symptom of an injury.
The term “chronic pain” is generally used
to describe pain that lasts more than three to six months, or
beyond the point of tissue healing. Chronic pain is usually less
directly related to identifiable tissue damage and structural
problems. Examples of chronic pain are: chronic back pain without
a clearly determined cause and fibromyalgia.
Chronic pain is influenced by many factors,
such as ongoing pain signal input to the nervous system even
without tissue damage, physical de-conditioning due to lack of
exercise, a person’s thoughts about the pain, as well as
emotional states such as depression and anxiety. Chronic pain is
much less well understood than acute pain.
Neuropathic pain
Neuropathic
pain has only been investigated relatively recently. In most
types of neuropathic pain, all signs of the original injury are
usually gone and the pain that one feels is unrelated to an
observable injury or condition. With this type of pain, certain
nerves continue to send pain messages to the brain even though there
is no ongoing tissue damage.
Neuropathic pain (also called nerve pain or
neuropathy) is very different from pain caused by an underlying
injury. While it is not completely understood, it is thought that
injury to the sensory or motor nerves in the peripheral nervous
system can potentially cause neuropathy. Neuropathic pain could be
placed in the chronic pain category but it has a different feel then
chronic pain of a musculoskeletal nature.
Neuropathic pain feels different than
musculoskeletal pain and is often described with the following
terms: severe, sharp, lancinating, lightning-like, stabbing,
burning, cold, and/or ongoing numbness, tingling or weakness. It may
be felt traveling along the nerve path from the spine down to the
arms/hands or legs/feet. It’s important to understand neuropathic
pain because it has very different treatment options from other
types of pain. For example, opioids (such as morphine) and NSAID’s
(such as ibuprofen, COX-2 inhibitors) are usually not effective in
relieving neuropathic pain. Treatments for neuropathic pain include
certain medications, nerve “block” injections, and a variety of
interventions generally used for chronic pain.
Examples of neuropathic pain include:
monoradiculopathies, trigeminal neuralgia, postherpetic neuralgia,
phantom limb pain, complex regional pain syndromes and the various
peripheral neuropathies.
For further reading please go here
3. What might cause neuropathic pain?
Uncountable damaging outer
influences to the nerves, spinal marrow and brain, can cause pain.
These are often accompanied by other dysfunctions, like palsy.
Instead of a detailed and complete list and explanation, which would
lead way to far, I'm going to present a simplified OVERVIEW of
CAUSES.
Mechanical, physical
Injuries like cuts, strains or bruises (f.ex. through bone
fractures) can lead to direct injury of the nerves structure. Loss
of extremities often causes a phantom pain. More specific
environmental influences with nerve damaging results are heat,
old and x-rays (tumor treatment). Pressure through a herniated
vertebral disc (slipped disc) or chronic pressure damage on joints
("carpal tunnel syndrome") often are the foundation
to neuropathic pain.
Inflamed
Infectious diseases like Borreliose (Lyme disease), Herpes Zoster
("Shingles"), or the by us on the European and American
Continents rare Leprosy, are known causes for neuropathic pain.
By inflammation in the brain or spinal marrow, as they happen during
the stages of Multiple Sclerosis, unbearable neuropathic pain
is experienced.
Metabolism Dysfunction
Diabetes mellitus is the main cause for polyneuropathy (illness of
peripheral nerves) and therefore reason to neuropathic pain.
Polyneuropathie is also a result of "internal
disease", like kidney diseases, thyroid dysfunction and vitamin
deficiency (Vitamin B1 or B12). Chemical - toxic influences through
medical drugs, especially in the tumor treatment, alcohol and drug
abuse, can lead o metabolism dysfunctions, which attack the nerve
substance.
Tumors
The growing of tumors, or its metastases can lead to pressure on the
nerve structure, or can attack the nerve directly. Also some changes
of the immune system lead to reactions on the peripheral and/or
central nervous system.
Circulatory Disturbance
After cerebral infarcts severe neuropathic pain is common. Disturbed
blood flow by arterioscleroses can lead to damages on the peripheral
nerves.
What exactly
is happening with the nerves and its cells during chronic and
neuropathic pain attacks? Next
page
prior page
References:
Physiobiolgie des Schmerzes, 1998 Urban & Vogel;
Biologische Physiology, 2002 Springer Berlin;
Schmerzmessung und Schmerzdiagnostik, Oskar B. Scholz, 1997, Karger,
Freiburg i.B.
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