[Kenjhee]

If you are unbelievably tired and/or ache all the time since your head injury, you may find this of interest...

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I was asked in the other thread muscle chills to explain a bit more on some of my theories concerning TBI and its relationship to fatigue & pain.

Two medical problems I've battled since my TBI 35 years ago (passenger in a car wreck) are Chronic Fatigue Syndrome and Myalgia. I believe they are related beyond the fact that both started soon after the accident. Briefly:

CFS: A medical disorder still poorly understood by the medical community. There are dozens of possible symptoms, making research and diagnosis frustratingly difficult (the "chronic fatigue" is only one such symptom, therefore the disorder is even named poorly).

My theory: CFS is inappropriate functioning of the Immune System. If you look at the major symptoms, they are basically the same as happens when you have a bad flu: fatigue, muscle aches, chills, coughing, sneezing, sore throat. These are not random reactions, but specific tactics used by the body to deal with the infection. Take fatigue. What does a sick animal do when it is tired? It rests, of course, and thus allows more metabolic energy to be diverted to immune system functions such as anti-body production. Under normal conditions fatigue is beneficial and confers an adaptive advantage to the species in question.

With the disorder Chronic Fatigue Syndrome conditions are anything but normal. I believe that there is a normal triggering of the immune response, but subsequent failure to disable the response. For example, a person catches a flu virus, initiating the cascade of symptoms collectively known as the immune response. The victim experiences any or all of the symptoms mentioned above. But unlike a normal situation, the symptoms continue for weeks, months, even years without abatement, long after the original trigger (the infection) has been eviscerated. In effect, the “OFF” switch has been neutralized.

(Incidentally, this explains why so much research into CFS ends up ineffectual and misguided. Researchers keep looking for a singular cause for CFS, when there is no single causative factor. Typically funding and effort pours into research targeting this virus or that, and in the end fails at establishing a universal link. One year it’s Epstein-Barr virus, the next year focuses on traumatic brain injury, just today I heard of a failed research effort singling the XMRV retrovirus. CFS is not a specific disease, but an illness syndrome that resides in the human genome much like the disorder we call the common cold, which is actually any one of over a hundred syndromes caused by as many viruses. CFS is not a specific disease so much as it’s a mechanism.)

Pain: Muscle symptomology follows a similar course as fatigue. Fibromyalgia, myalgia, chills, general aches and pains are all I.S. responses. When an animal feels pain in its muscles, the natural reaction is to curtail activity as much as possible- the organism gets the much-needed rest it needs to heal. Pain itself is conferred adaptive value. Except in the case of CFS, where it is needless suffering for an extended time period. (Incidentally, my own muscle pain has been diagnosed as simple myalgia, which just means “muscle pain”. As I lack one of the currently accepted markers for fibromyalgia, I forego even the simple dignity of a long, fancy-sounding Latin name.)

The link to Traumatic Brain Injury: All my medical problems started soon after a vicious head injury in an automobile accident. What could be the link between TBI and CFS/myalgia? My own experience immediately suggests a general mechanism that is based on an analogy. Let me explain...

I have yet another common symptom of TBI: anger. Many TBI survivors, even members of this forum, have reported this rather unexpected fallout from their head injuries. I have battled nearly uncontrollable bouts with intense anger frequently over the past 35 years. It almost seems like a switch gets thrown in my head, self-control goes out the window, and the best I can do is give myself a “time-out” until the feeling goes away. The mechanism is actually well-known: primitive emotions such as anger, fear, and aggression generally originate in the developmentally more primitive areas of the brain, located in and around its geographic center. Known collectively as the limbic system, it has the responsibility of generating these feelings as survival responses, mounting an emotional counter-attack to perceived threats from the organism’s environment. Thus, this is the cognitive counterpart to the hormonally-based “fight or flight” mechanism, using brain algorithms instead of adrenaline. We’re talking very primitive parts of the vertebrate brain.

Fast-forward to today...humans now live in supposedly ordered societies, with most of our biological survival mechanisms willfully supplanted by social contract, both written and tacit. In the more recent evolutionary additions to the human brain- the cerebral cortices- reside equally important cognitive mechanisms, namely the executive control function known as “Impulse Control”. This is the ability to countermand the signals from the limbic system. Our primitive brain will say “that guy’s a threat...kill him”; Impulse Control steps in and says “killing is unnecessary; all he did was cut us off in traffic”.

Note that the entire algorithm is asymmetric, not a simple reverse process. In other words, the “On” switch is different from the “Off” switch. Think of a modern computer- the specific processes that constitute a bootup are completely different from the shutdown sequence. How much more complex is our own brain.

Now, what happens in a Traumatic Brain Injury is truly insidious. The brain’s cortices are located in the very vulnerable outer perimeter of the cranial cavity. As such they are significantly more susceptible to physical damage than the more centrally-located limbic system. So that the classic frontal lobe injury leaves the survivor with impaired impulse control, with the primitive survival emotions sailing right through. A person becomes angry, with no way to modulate or terminate the violent thoughts. This is why the classic case of a frontal injury survivor is an uncontrollably angry individual who habitually acts out their rage.

Which leads me to postulate that the suppression mechanism for the immune response resides to at least some degree in the cortex. When that off-switch is damaged, there is no way to shut down the immune response. The body continues to wage an immunological war against an opponent that is long gone.

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I believe that fatigue and pain are far more common symptoms of the post-TBI experience than is typically discussed, even amonsgst the people who have them. All we know is that we are very tired, and hurt all the time, and have trouble getting anyone to even believe how bad it is.