Pains Doctors Can't See
Yes, we doctors tend to do well with those aches and pains we can see. There, on X-ray says the chiropractor, on ultrasound says the ObGyn, on MRI says the orthopod, in this blood work says the rheumatologist. Set the broken bone, take out the cyst, replace the knee, go on a drug. But what about all those things we can't see or measure with a specific blood test? What can we do for those?
For lack of a better term, I will call these functional pains and believe me they are many, Vulvar vestibulitis, interstitial cystitis, fibromyalgia, irritable bowel disease, non-anginal cardiac pain to name a few. That hits vulva, bladder, bowels, muscles, and heart. Wow. There's lots of new research here. We actually are beginning to see, beginning to understand. It's not exclusively in your bowels, muscles, jaw, or heart. It's in the nerves supplying these organs and in the brain receiving the signals from these nerves. Take TMJ for example. Why do you clench your jaw too tight? Are the nerves to your jaw too sensitive? Is the brain misinterpreting the signal from these nerves causing you to clench rather than just close your mouth?
My answer is YES. It's "nerve" (neuronal) pain coupled with occult "brain pain". Microglia,( the brain's immune cells) get inflamed, their signals get wacky. A light touch becomes a sharp pain. And YES, we can actually see this in a functional MRI of your brain, and we can measure some types of brain inflammation with blood tests.
There's much debate as to why this happens. And also much debate about exactly what happens. When you get down to the biochemistry, is it too much of a pain signal or too little of the dampening pleasure signal. Or is it both?
Here's another example of a functional pain, a "Central Sensitivity Syndrome" as it's often called --- IBS. Or whatever incarnation of IBS you have - leaky gut, SIBO, etc.
No matter how carefully you eat, you experience way too much bloating and abdominal pain Why? No matter how carefully you explain it to numerous doctors and specialists, no matter how many procedures, CT scans, ultrasounds you do, nobody comes up with a real explanation which leads to a real cure. Even when the naturopath's stool test finally shows something, his cure doesn't help..Did you ever think that maybe it's not what you eat or what's in your gut? Could it be the nerves going to the gut and their connection to your brain which is off?
Functional pain. Normal intestinal movement hurts. Abnormal intestinal movement signals from brain inflammation gives you diarrhea or constipation. Or --- you should feel the soft touch of a Q-tip on your vulva and your brain tells you it's a needle. Or ---- Your body's muscles keep bunching up with no provocation. That's IBS, vulvodynia, and fibromyalgia. That's Central Sensitivity Syndrome.
Central sensitivity can also make other types of pain worse. You have arthritis in your knee, and inexplicably more pain than the next person. You both get the same operation, they are cured, you are left with residual pain and a normal joint. Why?
So what do we know about these functional central pain syndromes? Here's what: 1)There's often a trigger. 2) It runs in families. 3) Our usual Narcotics and NSAIDS don't work.
What are triggers? Just ask yourself what traumatic event happened just before the pain started. Bad yeast infection may yield chronic vulvar pain, a prolonged series of antibiotics may trigger IBS. Loss of a spouse leads to chronic heart pain.
It runs in families. Yes, We even know the names of the genetic variants: COMT, Serotonin Transporter Gene, Adrenergic Receptor B2 to name three. More later on these,
Narcotics and NSAIDS don't work. But there are things that do work! And you can rebuild your system. But that, my dear friends and patients, is the subject of the next post.