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Issue No12 September 2004
NOTES by Dr C W BORLAND Consultant Anaesthetist
The management of chronic pain (pain present for more than 3 months) is a real challenge to today's science and medicine. For example, the severity of pain can be out of proportion to the injury sustained, and can long outlast any obvious tissue abnormality.
Chronic pains frequently occur when there has been direct damage to the nerves of the pain system itself. Injury to peripheral nerves should at least partially block the flow of pain information from the periphery into the central nervous system. You might expect this to cause a loss, or at least a blunting, of sensation. Yet, paradoxically, clinical experience shows that nerve injury is frequently accompanied by amplified and distorted sensations. These take various forms such as pain being provoked by light touch, and heightened sensitivity to painful stimuli. In addition electric shock-like sensations can occur, as can pain on movement and spontaneous pain. For example if you have the condition called trigeminal neuralgia, which affects 5% of MS patients, washing your face can provoke severe facial pain.
At its most extreme, trauma to nerves can create elaborate sensations where there is no painful input at all, e.g. pain in a limb which has been amputated.
The clinical tools available for managing acute pain are well developed and effective but when applied to chronic neuropathic (nerve damage) pain they are usually found to be blunt and, more often than not, ineffective.
The nerve damage in MS is due to demyelination or loss of the insulating sleeve that surrounds nerve tissues. Chronic pain can be the result of this initial injury or can be the result of later complications such as muscle spasm or posture changes.
What can be done for patients with chronic pain? Complete relief is seldom possible so measures are used to reduce pain or increase what you can do in spite of the pain. Drug treatments involve the trick of using therapies designed for other conditions. These include antidepressants such as amitriptyline and anticonvulsants (for epilepsy) such as gabapentin. The range of medications available is wide, as are the possible side effects which can result from their use. Finding the best treatment for a chronic pain problem is often a process of trial and error and a bit like shopping for new clothes. For what looks good on the shelf may be terrible once you try it for yourself!
Other avenues to explore are the application of TENS electrodes to the skin and the use of capsaicin cream, which is prepared from chilli peppers. By creating these electrical or chemical ‘smoke screens’ the brain is distracted from what is happening on the other side where pain signals are being generated.
Local anaesthetic injections into areas of pain can produce benefits which outlast the duration of action of the drug. In some cases the numbing injection, which wears off within 12 hours, can have a beneficial effect on the pain for several months. It’s difficult to understand why this should be, but a misbehaving computer programme is often the better of being shut down for a time and then re-started. Although well known for its cosmetic use, Botox injections have been used where muscle spasm is the cause of pain. The medical use of cannabis for chronic pain is under evaluation at the present time, but anecdotal evidence is of a benefit for some people.
A Chronic Pain Clinic is held at Balfour Hospital once or twice a month and in the past year there were over 50 outpatient consultations. Patients are referred to the Pain Clinic by Surgical & Orthopaedic Consultants as well as by GPs and Physiotherapists. For it is usually through the workings of a variety of treatments and specialists that inroads are made into the problem of chronic pain, whatever its cause.
Those of you with Internet access may be interested to know that search of the MS Society website with the keyword ‘pain’ will produce about two hundred articles and documents on the subject. These will include the MS Society Pain Factsheet, www.mssociety.org.uk/docs/Pain_factsheet.pdf which I can recommend as a useful source of information .
Chronic Disease Self-Management Course….
This course is presented by trained, local people with personal experience of health problems, and is designed to help people with any long-term illness.
Topics covered include:
Pain management, diet, exercise, relaxation, confidence building, dealing with anger, frustration, fear, fatigue and many more.
Booking onto the course is essential. Book early, as there are a limited number of places.
The course is being held at:
St Magnus Day Hospital
Tuesday evening for 6 weeks
26th October to 30th November
Sessions are open to anyone over 18 years of age
Tele: 0845 600 3756 to book your place. (Calls charged at local rate).
Guidance for Carers: Finding and Funding Residential Care…
None of us want to think about residential care before we really need to. Whilst a few are willing and able to plan for such a possibility, more often than not, we only realise how complex this is when we are faced with the job of finding a good quality care home.
Leaflets are available not only on things to consider when choosing a care home, but also the financial aspects of residential care too. With care homes running into hundreds of pounds a week, it pays to know a little about the different options for covering costs.
If you would like a leaflet, contact Rhona on 875152.
New Experimental Drug has fewer side effects….
An experimental Multiple Sclerosis drug looks promising in animal studies. The drug, code name LGD5552, made by Ligand Pharmaceuticals Inc. aims to reduce the side effects that limit the use of current treatments for Multiple Sclerosis.
The new drug is a nonsteroidal glucocorticoid receptor modulator. Currently, steroidal drugs such as prednisolone offer relief from Multiple Sclerosis symptoms but have side effects such as bone loss, high blood pressure, and problems with fat metabolism.
The experimental drug has been tested on animals at the Neurological Sciences Institute at Oregon Health and Science University. More studies need to be done on the drug before human tests can begin.
News release, Oregon Health & Science University.
Spasticity Helped by Cannabis Medicine….
MS patients with spacticity experienced statistically significant improvement on the cannabis drug Sativex compared to controls in recent Phase 111 trials.
Dr Geoffrey Guy, Executive Chairman of GW Pharmaceuticals, the makers of Sativex said: “This positive Phase 111 trials further supports the efficacy of Sativex in spasticity, one of the most common symptoms in MS. The effects shown in this trial are over and above those achieved by previous treatments alone.”
In addition to help spasticity, Sativex also reduced pain, reduced sleep disturbance and improved quality of life.
The trial was a multicentre, double-blind, randomised, placebo-controled group study. Patients given Sativex remained on other drugs prescribed for MS.
GW Pharmaceuticals are in the process of seeking a license for Sativex.
Press release, GW Pharmaceuticals.
Shattered! Here is a reason why….
In MS patients the brain has to work overtime to keep brain function normal.
MRI scans have shown that when MS patients move their hands in a certain way, brain activity is five times that of people without MS.
(New Scientist, 5.6.04).
No wonder MS folks get so exhausted…
From Mary Eunson.
Chairperson: Rosemme Guthrie, Rinansey, Grassick Court, Kirkwall 874596
Secretary: John Chesters, Blackhill, Blackhill Road, Kirkwall 873116
Treasurer: George Hannah, 2 Olaf Place, Kirkwall 872479
Support Co-ordinator: Perry Sutherland, Sutherleys, Grain Park, Kirkwall 874624
Editor: Rhona Elrick, 12 Hordaland, Kirkwall 875152
Betty Cameron 872140 Annie Linklater 875064
Matthew Cole 771794 John Mackie 781475
Lesley Cole 771794 Bessie Muir 875104
Evelyn Goar 871856 Olivia Taylor 831621
Lynn Groundwater 874037 George Walker 850534
Norah Harcus 870284 Shelagh Walker 850534
Sheila Konstam 872821
We hope you have enjoyed reading this Newsletter. What did you think about it? Did it enthuse you/inform you/disappoint you/bore you silly? We want to know. We welcome contributions and ideas for the future editions - please call Editor on 875152.
Remember, this is your newsletter, your branch. Use it. Get involved!
PS. please pass this Newsletter on to friends, family, non-members who have MS or anybody else you think it may interest.
Deadline for next Newsletter: 30th December 2004
‘MS News’ is published by the Orkney Branch of the MS Society. We give regular updates about MS and what is happening locally in the MS community.
All the views expressed in this publication are individual and not necessary the view or policy of the charity and its supporters.
Charity number 207495
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