Central Sensitization, Nervous System, Pain Science, Quotes, Scientific Articles

Let’s give this a whirl: explaining a scientific article in plain English

Tonight, I’m going to try out a type of post I’ve been wanting to write for a while: taking a scientific journal article on central sensitization, and translating it into plain English for my readers.

I got the idea from Paul Ingraham of PainScience.com.  He has a fantastic “jargon-to-English” article on central sensitization on his site (a translation of a paper by renowned pain researcher Clifford Woolf), which I really love.

There is no reason why you, as a patient and chronic pain sufferer, should not be able to know a little bit about the scientific research being done on your condition.  You are going to need to be able to advocate for yourself, stand up for yourself, and remember there is a legitimate explanation for your pain, even if other people don’t always see it that way.  Knowing there is research to back you up helps.

Ever since I first learned of the term “central sensitization” back in 2011, I found so much comfort in reading these articles.  Even if I didn’t understand every word, just knowing there were people out there who would believe me about my pain, if I met them, provided me with the sense that I wasn’t alone.

These changes to our nervous systems are real, even if some of the people in our lives don’t always understand.

***

So anyway.  The article that I want to take a stab at tonight is “Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity” by Alban Latremoliere and Clifford J. Woolf.  (In the interest of keeping things manageable, I am just going to outline the abstract, which is basically a summary of the article).

The article discusses central sensitization, which is the name of the process through which our nervous systems learn to become more sensitive to pain.

Let’s look at it in bits and pieces:

“Central sensitization represents an enhancement in the function of neurons and circuits in nociceptive pathways caused by increases in membrane excitability and synaptic efficacy as well as to reduced inhibition…”

This basically means that the parts of the nervous system responsible for sending pain signals become more active than they were before.

“Increases in membrane excitability” means that it will take less stimulation for nerves to send a pain signal.

An increase in “synaptic efficacy” means that the nerve is going to learn to be more efficient with the neurotransmitters that it has.  So, even though the nervous system still has the same chemicals floating around in it, it is going to learn to start sending stronger and stronger pain signals with those same chemicals.

Reduced inhibition.   Your body has many intricate systems of checks and balances within it.  It is how our bodies maintain control over our internal environment.

One way our body maintains control is by “inhibiting” some of the signals our nervous system sends.  This serves a really practical purpose– we do not need to be bombarded with reminders that our socks are a little bit itchy at all times.  Your nervous system chooses to block out certain signals when they are not useful, or in emergency situations (which is why people can feel no pain when they are in shock).

But in the case of central sensitization, our body’s ability to “block out” or “turn the volume down” on pain signals is reduced, meaning we ultimately experience more pain.

“Central sensitization is responsible for many of the temporal, spatial, and threshold changes in pain sensibility…”.

There are several ways in which these changes to our nervous systems manifest themselves.

We may find that, when something happens that we find painful, we end up experiencing it as painful in a larger part of our body than we might have otherwise.

I’ve really found this to be true with back pain.  When my back pain was at its absolute worst (before I discovered pain neurophysiology education) one tight muscle or muscle knot could make my entire back hurt.

“Because central sensitization results from changes in the properties of neurons in the central nervous system, the pain is no longer coupled, as acute nociceptive pain is, to the presence, intensity, or duration of noxious peripheral stimuli.”

This means that, in a sensitized nervous system, pain is no longer an accurate measure of the presence of an injury, or the degree to which our tissues may have been damaged by an injury.  The central nervous system is now doing its own thing, and you can’t really go by the pain to know what’s wrong.

“Instead, central sensitization produces pain hypersensitivity by changing the sensory response elicited by normal inputs, including those that usually evoke innocuous sensations.”

This means that we now start to feel pain in response to things that are not harmful, and which would have felt painful to us before.

To give you an example, I once knew someone who also suffered from chronic pain, and she said there were days she simply could not bear the feeling of clothing against her skin.  Just the feeling of a lightweight sweater against the skin of her chest made it burn and throb.

This person wasn’t crazy.  She knew her clothes weren’t “hurting” her.  But her nervous system was reacting as though those clothes were somehow damaging her skin.  There was a disconnect between her rational mind, which knew it was only clothing, and the parts of her nervous system which were contributing to her pain hypersensitivity.

(So… lest I end the post on a gloomy note, not to worry.  That’s where pain neurophysiology education comes in, to try to fix this disconnect).

***

Phew.  Okay.  That was not quite as easy as I thought it would be, all the times I thought about writing this post.  But hopefully you made it through!

Everything I write on this subject is meant to be a trial, of sorts.  I’m experimenting with what types of stories and explanations make the most sense, because I really have it in my heart of hearts to develop a set of educational materials on these nervous system changes.

So I want to see what works– what makes sense, what resonates.  (And what doesn’t).

I suffered for so long, thinking I was crazy, when the whole time there were answers out there.  And there was no good reason for it, except that most people (including many medical professionals) still do not know anything about central sensitization.

So I, and my blog, and my future potential physical therapy practice, are hopefully going to be doing something about that.

Please let me know if you have any questions, or any feedback on what sorts of things would be helpful in the future!  I do take requests!

Central Sensitization, Chronic Pain, Nervous System, Pain Science, Resources

The best TED talk ever: Elliot Krane on the Mystery of Chronic pain

Tonight I’m throwing it back to this amazing 2011 lecture on chronic pain given by Dr. Elliot Krane of Stanford University.

I found his talk around the time I was first starting this blog, back in 2012, and it really inspired me to try to tell my own story with complex pain problems.

Dr. Krane is a pediatrician and an anesthesiologist.  He specializes in treating children with chronic pain disorders at the Lucile Packard Children’s Hospital at Stanford University.

In this talk, Dr. Krane outlines the case of a young girl who developed CRPS following a wrist sprain, and was successfully treated at his hospital.

He has some really great quotes and soundbites about chronic pain– things I want to remember, and things I think will be useful in trying to explain the multi-layered nature of pain to people who don’t quite get it (yet).

So here, I’m just going to take a few notes so I (and you, if you’re interested) can come back and remember some key points really quickly:

***

Most of the time, we think of pain as a symptom of a disease– the result of an infection or a tumor, an inflammation or an operation.  But about 10% of the time, after a patient recovers from one of those events, the pain persists for months or even years.  In those cases, pain can become its own disease.

Chronic pain is “a positive feedback loop…. It’s almost as if somebody came into your home and rewired yours walls so that the next time you turned on the light switch, the toilet flushed three doors down, or your dishwasher went on, or your computer monitor turned off.  It sounds crazy, but that’s what happens with chronic pain.”

Glial cells (a particular type of cell found in the nervous system) were once thought to be unimportant.  When I learned about them in my PT prerequisite classes, we thought of them as the supportive “glue” that provides a safe environment for neurons, the more interesting cells that were actually responsible for sending messages.

But, Dr. Krane explains, it turns out that glial cells can play a vital role in the “modulation, amplification and, in the case of pain, the distortion of sensory experiences.”  Once glial cells are triggered by chronic pain, they become overactive and help initiate that the positive feedback loop he mentioned.

Some other quotes:

“The nervous system has plasticity.  It changes, and it morphs in response to stimuli.”

On treatment:

“We treat these patients in a rather crude fashion at this point in time. ”

Dr. Krane describes the treatment protocol for CRPS patients at his center:

  • symptom modifying drugs (painkillers) “which are frankly, not very effective for this type of pain”
  • “We take nerves that are noisy and active that should be quiet, and we put them to sleep with local anesthetics.”
  • “Most importantly… we use a rigorous and often uncomfortable process of physical therapy and occupational therapy to retrain the nervous system to respond normally to the activities and sensory experiences that are part of everyday life.

The future is actually even brighter:

“…the future holds the promise that new drugs will be developed that are not symptom-modifying drugs that simply mask the problem, as we have now, but that will be disease-modifying drugs, that will actually go right to the root of the problem and attack those glial cells….that spill over and cause this central nervous system wind-up…”

***

It’s really interesting for me to look back on this talk, now, and see how my perspective has changed since I first watched it in 2011.  Back then, the point about glial cells largely went over my head (probably because I wasn’t invested at all in knowing what they were).

Now that I’ve taken anatomy & physiology as well as an undergraduate neuroscience course, I can actually see how groundbreaking this really is, to identify glial cells as a potential source of the problem.

It’s as though you’re looking at a telephone pole, and you realize that the wooden pole itself was sending signals, instead of just being there to hold up the electrical wires.  (If that metaphor makes sense).

Anyway, I really hope Dr. Krane is right, that we can begin to develop drugs that will target this mechanism for chronic pain.

Hope you enjoyed this talk!

My Story

The road to physical therapy school

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It occurred to me recently that I really haven’t talked much about my progress towards becoming a physical therapist on this blog.

So, if you’re curious, here’s my deal:

I have a Bachelor’s degree in the humanities.  My concentration was social theory, with an emphasis on gender studies.

My goals, when I was in college, were focused in a pretty different direction than the path I’m on now: I wanted to study social policy, and travel abroad working for various non-profits and human rights agencies.  I also wanted to become a psychotherapist.

I started down that road immediately out of college, working at a mental health agency so that I could gain experience before grad school.

Before this, I’d already had a lot of struggles with chronic pain, and had to have surgery for compartment syndrome.  Yet after college, I’d managed to reach some kind of holding pattern where pain didn’t cause me to miss work.  That was, until the awful winter of 2010, when a few things happened in a brief span of time that caused my pain levels to flare way up.

That was my breaking point– when I tried, anew, to get answers.  Finally, after months of searching, I found my physical therapist Tim, who had studied pain neurophysiology education with Neil Pearson.

***

Ultimately, I was so inspired by everything I learned from Tim that it led me to consider becoming a physical therapist.

I’d always found physical therapy to be a fascinating field.  As a high school runner, I’d had a few serious injuries where I really needed PT to get up and moving again.   I had formed some great relationships with my therapists, and hung on every word they said.  A part of me was always a little bit sad when they told me I was doing well enough that I didn’t need to come back.  I would have gladly come back back every day, just to hang out and learn.

When I was a freshman in high school, I partially tore my hip flexor during a cross-country race and was on crutches for months.  It was a physical therapist who helped me overcome my fear and eventually start running again.

Then, when I was 19 and had surgery for compartment syndrome, it was a physical therapist who got me back up and moving again.  While I’ll always be grateful to the surgeon who fixed my legs, my PT was the one who gave me the confidence to actually start using them again.

And now, when my life had ground to a complete halt at age 25 because of constant, debilitating pain, it was a physical therapist who gave me my life back again.

I’d always had so much appreciation for PT’s.  Now, the idea dawned on me: why don’t I try to become one?

***

Growing up, I didn’t really consider myself that much of a science person.  Looking back, I think a lot of that has to do with the environment at my school, and how our science classes were taught.

Once I started looking into becoming a PT– taking classes, shadowing practicing PT’s– I realized I always had been interested in health science, and exercise physiology, and human anatomy.  It had just taken a different form.

I’d always wanted to do the best thing for my body.  I loved when my running coaches talked about strengthening, building endurance, the benefits of stretching.

And I’d always been interested in nutrition, and being healthy overall.

It’s just that when I was younger, I didn’t have the healthiest mindset, and took some of these interests too far.  But my eating disorder was not all of me– it was a snapshot of a specific place I was in, at a certain point in time, at a certain age.  Although I had some distorted beliefs, that does not mean I wasn’t also genuinely interested in health and fitness at the same time.

The difference is that now, I am able to come at it in a much healthier, stable, and more grounded manner, and know that I will be able to help others with similar struggles.

***

Five years later, I can say that I ended up loving all of my prerequisite classes, and I’m so glad I made the decision to take them.

It’s been an incredibly long road.  You see, some of the classes I needed to take had prerequisites of their own.  At the same time, due to my SI joint issues, there were periods of time where I found it incredibly difficult to walk, drive, or even stand up for more than a few minutes.

Despite of all of this, I’m finally at the point now where I’ve basically taken all of the classes I need in order to apply to PT school.  (I might need to take one or two more, depending on specific programs I might try to get into, but most of my bases are covered).

And honestly, I’m so glad I made this decision.  I realized that, while the humanities will always be my first love, I am also a science person, and have been all along.   I couldn’t see it at the time, but I know it now.

Nervous System, Pain Science

Nervous System Basics

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As I’ve said time and time again, I really feel that people living with chronic pain/fibromyalgia can benefit immensely from learning about how the body works. Even the feeling that you are just beginning to understand the complex processes making up your experience of pain can help give you a sense of control over things.

And reading about the new research that is being done on pain, even if you don’t completely understand every word, can sometimes give you a reason to remain hopeful at times when you’re feeling stuck.

With that in mind, I’m going to back way up and publish a post I’ve been meaning to write for a very long time.  Here I’ll outline a few key terms and concepts about how the nervous system works. Hopefully it will be helpful to anyone who is interested in learning more about pain.

So let’s get started.

The nervous system can be divided into two main branches.

Photo courtesy of the Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.
Photo courtesy of the Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.

The central nervous system consists of the brain and spinal cord, and is shown in pink in the diagram above.

The peripheral nervous system consists of all the nerves in the body, and is shown in yellow.

The brain is the command center for your body, and it is where your experience of pain is processed. It is where you think consciously, but it also controls many unconscious functions, such as breathing, your sense of balance, and the ability to orient your body in space.

The spinal cord is the relay system for messages between the brain and the peripheral nerves. (It can also play a role in affecting how strong your ultimate experience of pain is, but we’ll talk more about that later).

The peripheral nerves have two main jobs:

Sensory: Sensory nerves send signals to the central nervous system about what you are feeling physically. When you stub your toe or get a papercut, it’s sensory nerves that send that signal up your spinal cord to your brain.

Motor: This is (to me) a kind of funny scientific word. It really just means “movement.” The motor nerves of the peripheral nervous system are what tell your muscles to move, as well as tell your organs to perform specific functions.

Pain

When people talk about how pain works, they are generally talking about the relationship between the sensory nerves, the spinal cord, and the brain. The sensory nerves send signals up to the brain about any damage that may have occurred, and the brain decides how to interpret those signals.

But Pain is a Two-Way Street

Historically, people considered this pain pathway to be a very consistent, cut-and-dry system that always worked the same way every time. If a person was in a lot of pain, they had to have a lot of physical damage/injury. If they weren’t in very much pain, they must not have a very serious physical problem.

However, scientific advances in the past few decades have shown that pain is actually much more complicated than that. It turns out that the severity of a person’s pain does not always reflect accurately the amount of physical injury they have experienced.

You can have soldiers in battle who do not even realize they’ve been shot– their peripheral nerves are sending very strong messages of “damage” up to their brains, but their brains tune those signals out because they need to focus on survival.

Conversely, you can have people with chronic pain, who– due to a number of potential factors—can experience excruciating pain in response to a very minor injury, or in fact no injury at all.

Central Sensitization

At the risk of boring my long-time readers, let me define one of my most favorite terms again.  Central sensitization is the process responsible for this last phenomenon, where people can develop an increased sensitivity to pain.

The term refers to a series of changes that can take place in the central nervous system (the brain and the spinal cord) which can ultimately make a person much more sensitive to pain.  In some cases, central sensitization can become a self-perpetuating phenomenon, in which a person continues to feel pain long after their initial injury has healed.

Central sensitization is such a fascinating topic.  There is still much research to be done on it, but so far it is believed to play a role in such seemingly-diverse conditions as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, temporomandibular disorder, and many others.

One Last Thing

When I first started trying to understand the amazing, interesting new research that’s being done in pain, I kept hitting this one term that mystified me.  The dorsal horn.  What the heck is a dorsal horn?  I was so confused by this for a long time, and it really held me back from understanding a lot of articles.

Turns out, the term dorsal horn refers to an area in the back of the spinal cord.  The back of the spinal cord is where the sensory nerves meet with the spinal cord, so their messages can continue on up to the brain.  It’s pretty simple actually– the sensory nerves connect with the back of the spinal cord, and motor nerves connect in the front.  So when people talk about the dorsal horn, they are  talking about where sensory information is entering the spinal cord and then being relayed on up to the brain.

For more info

If you want a really great overview of the divisions of the nervous system, I highly recommend this video.

Conclusion

I really hope you’ve enjoyed this post!  As you can see, it’s written in a very different tone, and for a very different target audience, than my previous post.  I’m still in the process of figuring out what type of post works best on this blog.  I really want to be able to write about advanced scientific concepts for every day people, and I’ll probably be trying to figure out the best way to do that for a while. Your thoughts/comments/suggestions are always welcome, so please let me know if you have any! Thanks!

Top photo courtesy of Geralt at http://pixabay.com/en/nerves-cells-dendrites-sepia-346928/

Inspiration, Uncategorized

Maybe everything is amazing

I first saw this Louis C.K. clip a couple of weeks ago, and I’ve been thinking about it ever since. (Be sure you watch until the 3:05 mark, which is where he really starts to make his point).

Studying anatomy and physiology and learning about the body has helped me to get to the point where I can start to appreciate just how crazy/complicated/complex our experience as human beings is.

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A lot of people seem to become intimidated when I talk about taking these classes, and say things like, “Yeah, but I’m not any good at science.”

It makes me really sad to hear people say that, because honestly—there was a time when I didn’t think I would be any good at science, either.

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I did pretty badly in science classes in high school because, well, my life was falling apart. I just couldn’t get it together enough to study enough, and when I did, nothing could really become cemented because I hadn’t really slept.

I did much better in the humanities classes, because it was easier to just wing it. I might have been to out of it to memorize chemical structures, but it wasn’t too hard to just read a novel and give my opinion.

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Then after high school: for years, in the back of my mind, I sometimes thought about becoming a physical therapist.

Originally, the idea was born more out of desperation than inspiration. I was so frustrated by the fact that there was always something hurting, all the time, and that I seemed to have a new physical therapy referral every few months. I was always really interested in the explanations the physical therapists gave me, and always did all my exercises, but it didn’t seem to be quite enough. I sometimes wondered if the only way out of this would be to take matters into my own hands, rather than relying on other people for the rest of my life.

Then I met Tim and watched Neil Pearson’s lectures, and all of a sudden my desperation turned to inspiration. There actually was a reason why I was hurting all the time—an overarching reason that I could work on, rather than targeting different parts my body, piecemeal, for the next several decades. And maybe I could help other people like me, like Tim had helped me.

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This is the point at which I actually started to look into what it would take to get into physical therapy school, and saw that I’d have to take all of the science classes I’d so carefully avoided in college.

Now I am grateful that I had to go back and take all of these classes. And I mean, we’re not really talking high level stuff here—we’re talking general chemistry, introduction to physics. The things you would take in your freshman or sophomore year of college.

Basic as they are, these classes have totally changed the way I look at things.

It’s like recognizing there are two sides to every coin. On one side, I can focus on my experience—the way a certain part of my body feels (or, in most cases, hurts).

If I want to flip to the other side of the coin, I can stop and think about the complex forces that are literally holding this part of my body together. The intricate chemical and electrical signals that sensations to travel from my the rest of my body to my brain, and then back again. And the different areas of my brain that are involved in letting me feel the pain, and determining how much of my attention is devoted to the pain, versus paying attention to other things.

And the thing is—you really don’t need to be an expert, at all, to develop this sense of appreciation. I mean honestly, I know nothing. If I wanted to go into more detail than what I just wrote above, well, I’d have to go open a textbook to make sure I didn’t tell you the wrong thing.

It’s not about mastering this information; it’s just about having been exposed to it, and having a sense of just how complex these things are. Complex, yet also orderly. Yes, we live in a chaotic universe, but our bodies have a blueprint that can be broken down into categories and understood.

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Sometimes I daydream about running a class for chronic pain patients. Not an academic class—more like a continuing ed class.

And we would just go over the very basics from anatomy and physiology. And my students could see that, when you just begin to learn about the body, it’s actually more like a language class than a science class.

Just as you would make a chart of the different parts of speech (past, present, future, etc.) you can make a chart of the major systems of the body. And then you can look at each system and break it down further; for example, you can break the skeletal system down into different types of bones, and then look at individual bones.

And then, as teacher, I would focus on the bones of the spine, since the spine is such a grave, sometimes threatening concept for anyone with back pain. I would explain that even though it looks like some kind of alien invention when you look at a diagram, the spine can actually be simple:

There are four parts of the spine. From top to bottom:

Cervical spine= 7 vertebrae that make up your neck

cervical vertebrae

Thoracic spine= 12 vertebrae in upper- and mid-back

thoracic vertebrae

Lumbar spine= 5 vertebrae in lower back

lumbar vertebrae

Sacrum= fused vertebrae at the bottom of the spine, which make up the center of the pelvis

sacral vertebrae

These terms are things that back pain patients hear all the time, and may even have explained to them. But, in my experience, there’s a big difference between having a doctor mention these things to you in passing—in an appointment where you’re scared of what he or she might diagnose you with—and learning something in a calm academic setting.

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The spine is just one example– there are so many different aspects of our physical being that sound complicated, even scary, when explained by a doctor, but look simple– and interesting– when broken down into smaller categories.

It’s helped me immeasurably to begin to understand this. Having a “second side of the coin” to flip to means it’s easier for me to change my perspective on the physical realities I sometimes can’t change.

Now I can’t think about how much something hurts without thinking about the fantastic nature of how it hurts. The fact that I have a bone, with muscles attached to it, with nerves that let those muscles communicate with this fantastic brain I have—it’s all pretty incredible.

Chronic Pain

Dealing with a Pet in Pain

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Hi everyone,

Wow, it’s been quite a while since I posted on here.  It’s been great to see some new followers roll in, and I’m looking forward to getting to know you.

One of the reasons I haven’t had much time to write recently is that Ruby, my family’s 14-year-old Lab mix, has been having a rough time.  Old age has begun to set in.  She has a large, benign tumor growing over one of her hips, as well as arthritis in her joints.  She is in pain a lot of the time, and sometimes limps and has trouble going up and down stairs.

I’ve been feeling really guilty because it took us a long time to realize how much pain she was in.  Yes, even me—someone who’s lived with pain, read about it, and written on the subject for almost a year now.  Even I missed some of the signs.

In my defense, the first symptom she showed wasn’t exactly an obvious sign of pain.  Instead, she became restless and started asking for food all of the time.  Now, Ruby’s always been a little food-obsessed (what dog isn’t?) but this was just completely beyond the pale.  It was like she never got tired, never needed to sleep anymore.  Every thought in her head seemed to revolve around getting one of us to follow her over to the treat cabinet.

We took her to the vet, thinking that instead this might be some kind of age-related neurological change– perhaps the dog version of dementia.  But what the vet told us is that, although it’s not uncommon for older dogs to start acting strangely for no apparent reason, sometimes it’s because they are in pain.

He suggested we try giving her tramadol, which is a mild opiate pain medication.  And boy, what a difference it made.  Suddenly, we had our old dog back—the dog that actually slept from time to time.   And of course, she’s still food obsessed, but now when she’s medicated, she’s the old Ruby who would only ask for treats a few times in an evening (not once every five minutes).

Napping happily.
Napping happily.

I don’t know why her pain first manifested itself as a heightened desire for food.  Maybe she just wanted something to change the way she felt, and treats are the only thing she really knows how to ask us for.  Maybe the “reward chemicals” her brain released when she got a treat—that’s a big thing for dogs– helped to block out the pain signals, and all she could do was repeat that process.  Or maybe she literally felt less pain when she was standing in front of the cabinet, anticipating the treat.  I would really love to know.

Her physical symptoms have actually gotten more pronounced since this first started, and now there’s no mistaking the fact that this dog is in pain.  She limps from time to time, and has trouble climbing stairs and getting in and out of the car.  Sometimes she starts to lie down only to pop back up, as if the way she had distributed her weight was pressing on something sore.

Now that we understand how much pain she’s in, we’re being a lot more proactive.  The vet said she had some muscle loss around her hips, simply due to the fact that she has been in too much pain to actually use those muscles.  So she will be starting aquatic physical therapy in a few weeks (yes, they have that for dogs!).

In the meantime, I have been taking her swimming a few days a week at a river near our house, hoping some non-weight bearing exercise will help her feel better.  Of course, it is Massachusetts in November, but Ruby’s Labrador ancestors were specifically bred to deal with these temperatures and she doesn’t get cold.  It’s pretty amazing to watch!

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The river where Ruby swims is just behind those trees.

We’ve also talked to our vet about additional pain medications that won’t conflict with each other.  For now we are adding gabapentin, which is technically an anti-seizure medication that can also be used to slow the nerve impulses that signal pain.  In a few weeks, if she’s still in pain, we might also add a non-steroidal anti-inflammatory (basically, dog ibuprofen).

******

Throughout this whole ordeal, I keep thinking about something I read recently, about how veterinary students receive five times more education on pain than medical students do.  (Technically speaking, this study was done in Canada, but I would bet this is a worldwide trend).

I have a lot of things to say about this disparity, but for now I will just say that I’m grateful that Ruby’s vet was able to see that she was in pain when we couldn’t.   I’m grateful that a medication like Tramadol exists, and that we were able to get it for her.

And that I wish it was always this easy for human pain sufferers.  No one asked Ruby about her mental health, or insisted she go to psychotherapy.   No one tried to give her an antidepressant instead of a painkiller.  The average human pain sufferer would be lucky to receive care that was this comprehensive and straightforward.

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Anyway, to end this post on a more cheerful note, Ruby still has plenty of good days (more so, now that her pain is being adequately treated).  As I write this, she is sacked out on the floor next to me.  We’re having some really warm weather this week, and tomorrow I will probably take her for a long walk and swim.

In the car on the way to her next adventure.
In the car on the way to her next adventure.

What do you guys think?  Have you ever had a pet in pain?

And are you surprised by the differences in the amount of training medical and veterinary students receive on the subject of pain?  What do you think the reason for that is?

Interesting Articles

Introducing the Sunlight in Winter Youtube Channel

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Ever have one of those days where you want to keep working/thinking/being productive, but your body just wants you to lie down with a heating pad?

That, unfortunately, has been happening to me quite a bit recently.   I’ve been wanting to sit at my computer and either study or work on my blog, but my neck and shoulders have just not been on board.

Trying to look on the bright side, I remembered that there were a ton of pain science-related videos on Youtube that I’ve been meaning to check out.  So I decided to use my “lying-down” time to catch up.  I started saving my favorites to playlists, so that I could just lie down and listen, and not have to worry about getting up and selecting the next video.

And then it occurred to me—maybe other people would enjoy these playlists too.   It’s a lot more relaxing to just start a playlist and let it run, instead of having to get up and go to the computer every time you want to start a new video.   It also makes taking a break a lot less frustrating, since you can keep your mind going with something productive.

So, check out my channel!  So far I’ve broken things down into a few separate playlists, some based on topic and some by speaker.  I’ll be adding to it as time goes by.  Let me know if you have any comments or recommendations for videos I should add.

To go directly to some of my favorite videos:

Lorimer Moseley: Why things hurt

Elliot Krane: The mystery of chronic pain

The evidence for physical therapy for chronic pain

Hope you enjoy!

Photo credit: Dan Barbus

My Story

30 is looming closer and closer: How should I move forward with my career?

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The work I’ve done on this blog and the positive responses I’ve received (thank you all so much!) have opened up new ideas for me.  In the month and a half since I started working on this blog, I already feel as though I’ve been able to make somewhat of a difference in others’ lives.  I know I don’t have a ton of readers (yet), but it seems as though people who’ve faced similar issues to me have really appreciated the information I’ve collected here.  I’m incredibly gratified, and inspired to do more.  But how?

I’m definitely going to keep working on this blog, and possibly purchase my own domain name and create my own website on pain science in the future.  Right now that actually seems like the best way to get information out to people.

But as age thirty looms closer and closer, it would be nice to advance along my career path as well.  I would like to make a career out of helping people who have faced similar issues to mine, but I’m not sure of the best way to go about it.

I have a Bachelor’s degree, and for years and years I’ve been considering different options for graduate school.  I’ve been holding off because I can’t quite figure out what would be the best use of my time and money.  Here are the possible career roles I have considered going back to school for:

Social Work & Psychology

Throughout most of the time I was in college, I wanted to be a social worker/mental health counselor.  But as I got more experience with the field, I realized it wasn’t the career path for me.

I have always found psychology fascinating, and have the utmost respect for the vast majority of psychologists.  But in my opinion, the field of psychology is moving in the wrong direction on the subject of pain.

Though most psychologists and social workers today would be pretty quick to dismiss the ideas of Sigmund Freud as wacky and outdated, the one area of mental health where he still seems to hold an influence is in the treatment of pain.  It was Freud who first came up with the diagnosis of conversion disorder (where a patient’s “unconscious psychological conflicts” manifested themselves as unexplained pain or numbness in the body).  If you read this article by Toni Bernhard, you’ll see that as we enter 2013, today’s psychologists haven’t strayed very far from these ideas.

Diagnoses such as “somatoform disorder” and “psychogenic pain” imply that the patient is in pain because something is wrong with his or her mind.  Not only is this mindset disempowering, but it doesn’t take into account any of the things that neuroscientists have learned about pain in the past two decades.

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Freud. Image provided courtesy of http://www.all-about-psychology.com/

In my opinion, there’s no good excuse for this, really.  It seems like people who are already established in the fields of psychology and social work haven’t done a great job of opening themselves up to research in fields other than their own.  Critiquing work done by someone trained in another field just seems to be something that “isn’t done.”  Graduate students in these fields learn about the discoveries of the psychologists and social workers who came before them; and, for the sake of their own career success, learn to follow the rules and blend in.  Future therapists must protect themselves from liability by knowing here their limits are, and they are definitely not trained to dispense medical advice.  So it appears that these inaccurate, harmful conceptions of pain and illness are passed from one generation of mental health counselors to another.

Becoming a doctor

Having ruled out a career in mental health, I sometimes think about becoming a doctor.  I have met some pain specialists and physiatrists who I believe are really brilliant, intelligent people.  But with that being said, it seems their primary role is to order tests, rule out more serious conditions, and then refer the patient elsewhere for treatment.  Whether that’s physical therapy, occupational therapy, or mental health counseling, it’s always go see someone else, and I am interested in being the person who works one on one with the patient and helps him or her over time.

Additionally, the majority of the doctors I’ve seen over the years have all seemed to be short on time.  Rush, rush, rush: the next patient is always waiting.  Many times during my appointments, I haven’t had the chance to ask any of the questions I came there with until the doctor is halfway towards the door telling me it was nice to meet me.

I have heard of doctors setting up private practices.  That seems like a way to have control over the number of patients one sees.  However, I believe that is mostly something that primary care physicians do… I’m not sure how often doctors in physical medicine and rehabilitation or pain management do the same.

Nursing

nursing
Thank you to timefornurses on Flickr for the use of this photo.

Nursing is something that seems to hold a little bit more promise.  I once had a conversation with a fascinating doctor of nursing (yes, as much of an oxymoron as that sounds, you can actually earn a Ph.D. in nursing).  We had a great conversation about everything I’m interested in regarding pain and the nervous system.  She told me that once you get to the master’s and doctorate level of nursing, much of what you do is research.  She also told me about translational medicine, which is literally a branch of medicine/nursing that attempts to bridge the gap between what researchers are discovering, and the treatments actually given to patients.  This sounds absolutely fascinating to me, and I must know more.

That being said, I believe that the majority of nurses, including nurse practitioners (those with a master’s degree) spend most of their time doing what doctors do: running tests, ruling out serious conditions, and referring the patient elsewhere for physical therapy, etc.  I’ve never heard of a nurse that meets with patients regularly just to talk; at least not about the issues that I’m concerned with. Even at the Ph.D. level, I know there is often a huge divide in the academic world between those who research and those who treat; I’m not sure how much time a translational medicine researcher would be able to spend treating patients.

Physical therapy

pt with little kid

This is the career path I am probably focused on the most.  I have met some truly amazing physical therapists over the years, and in many cases they have helped me more than the doctors that sent me to them.  I would leave their offices basically wanting to be them, because I was so blown away by their knowledge and ability to understand both the body and my fears as a patient.

Good physical therapists are able to add a bit of counseling into the mix rather than just instruct you in exercises.  In general, I feel that when a physical therapist doesn’t appear to take the time to really try to relate to a patient, it is a reflection on his or her general inability to empathize rather than the field of physical therapy in general.

Much of the research I discuss on this blog was done by physiotherapists in Canada, the UK, and Australia (this is the equivalent of a physical therapist in the US where I live).  This bodes well for me: physical therapists have provided the most answers for me personally as well as academically.

The only limitation of a career in physical therapy would be that I wouldn’t have the ability to order any diagnostic tests such as x-rays or MRIs, to order blood-work to check for inflammatory conditions or Lyme disease, or to prescribe medication.  These are all things that must be done before any kind of diagnosis can be made, and before you can make any kind of pronouncement about a patient’s degree of central sensitization.   Since the field of medicine in general really has yet to catch up on issues of pain, I am afraid I would become frustrated as a physical therapist trying to treat patients who came in having been brushed aside by their doctors.  I am a very take-charge person, and I’m afraid I would regret going down a career path where I couldn’t just order tests and prescribe medication myself.

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So there you have it.  These are pretty much the major options I am considering returning to school for, and I am very interested in any input my blogging friends can give.

Have you ever been in a similar situation?  What did you end up deciding to do, and how did you make your decision?