Vrae -
So sorry, as I was stumbling to bed at an unholy hour, I decided on impulse to check NT and see there are a couple of threads going for which I've been remiss in not responding earlier. Yours is own of them
I'm aware of one new paper suggesting a direct link between gut-bacteria and CRPS, Establishing a Relationship between Bacteria in the Human Gut and Complex Regional Pain Syndrome, Reichenberger ER, Alexander GM, Perreault MJ, Russell JA, Schwartzman RJ, Hershberg U, Rosen G.,
Brain Behav Immun. 2012 Dec 18 [Epub ahead of print]:
Abstract
Complex Regional Pain Syndrome (CRPS) is a serious and painful condition involving the peripheral and central nervous systems. Full comprehension of the disorder's pathophysiology remains incomplete, but research implicates the immune system as a contributor to chronic pain. Because of the impact gastrointestinal bacteria have in the development and behavior of the immune system, this study compares the GI microbial communities of 16 participants with CRPS (5 of whom have intestinal discomforts) and 16 healthy controls using 454 sequencing technology. CRPS subjects were found to have significantly less diversity than their healthy counterparts. Statistical analysis of the phylogenetic classifications revealed significantly increased levels of Proteobacteria and decreased levels of Firmicutes in CRPS subjects. Clustering analysis showed significant separation between healthy controls and CRPS subjects. These results support the hypothesis that the GI microbial communities of CRPS participants differ from those of their healthy counterparts. These variations may hold the key to understanding how CRPS develops and provide information that could yield a potential treatment.
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PMID: 23261776 [PubMed - as supplied by publisher]
That said, I'm intimately aware if a small pilot study that was done a few year ago at USC (wherein I was a study participant) that strongly supported a hypothesis that chronic opioid use plays havoc with gut fauna, revealed both through the spectroscopy of little Mylar balloons I inflated every 15 minutes over for hours, but also in the fact that patients - included myself - got remarkably better alter an unusually intense course of the anti-biotic
Xifaxin, subject to relapsing, in my case, roughly a year later, whereupon I get another (and fairly expensive) round of Xifaxin. (Sadly, without matching industry money, the researchers were unable to secure NIH funding for the larger study they sought, and the work died on the vine.)
Which bring me back to the above-referenced study by Reichenberger et al. A friend was kind enough to send a copy of the full article to me, and I was dismayed to see that no effort was made on the part of the authors to control for opioid use among the CRPS study patients. Accordingly, I would be inclined to discount any sweeping statements arising from their study. That said, I've found that my prescribed extended course of Xifaxin (200 mg) [2 tablets 3/day for 10 days] worked remarkably well. And I would urge you to consider it, if and only if you have in fact been using opioids on an extended basis: and if need be , I'm know that one if not both of the principle researchers who ran the study I participated om are still at USC and would be happy to discuss this with your physician.
That said, there's a litany of information on gastroparesis and autonomic dysfunction, on account of which I pulled up 177 abstracts just running those terms on PubMed. See, e.g., The enteric nervous system and neurogastroenterology, Furness JB,
Nat Rev Gastroenterol Hepatol, 2012 Mar 6;9(5):286-94:
[
Abstract
Neurogastroenterology is defined as neurology of the gastrointestinal tract, liver, gallbladder and pancreas and encompasses control of digestion through the enteric nervous system (ENS), the central nervous system (CNS) and integrative centers in sympathetic ganglia. This Review provides a broad overview of the field of neurogastroenterology, with a focus on the roles of the ENS in the control of the musculature of the gastrointestinal tract and transmucosal fluid movement. Digestion is controlled through the integration of multiple signals from the ENS and CNS; neural signals also pass between distinct gut regions to coordinate digestive activity. Moreover, neural and endocrine control of digestion is closely coordinated. Interestingly, the extent to which the ENS or CNS controls digestion differs considerably along the digestive tract. The importance of the ENS is emphasized by the life-threatening effects of certain ENS neuropathies, including Hirschsprung disease and Chagas disease. Other ENS disorders, such as esophageal achalasia and gastroparesis, cause varying degrees of dysfunction. The neurons in enteric reflex pathways use a wide range of chemical messengers that signal through an even wider range of receptors. These receptors provide many actual and potential targets for modifying digestive function.
PMID: 22392290 [PubMed - indexed for MEDLINE]
All of which is to say, it appears to be something of a general consensus among folks who have successfully used tDCS as a maintenance for any length of time has been in the remission of those symptoms most associated with sympathetic dysrythmia - at least when the signal is applied to the dominant motor cortex, rather than pain relief
per se. (Although I've also heard of phenomenal relief from fixed dystonia.) And this is, of course, in addition to cognitive improvements that may had through the separate stimulation of the "dorsolateral prerfrontal cortex" . . .
Accordingly, in the untoward event that uncontrolled vomiting becomes more than a passing fancy, I can easily put you in touch with Dr. James E. Fugedy, a pain specialist initially trained in psychiatry nut is now perhaps the leading figure in the clinical use of tDSC. (You fly out on a Thursday, spend much of a Friday with him, and fly home that night or the next morning and thereafter maintain contact with him through phone and email, kinking your own treating physicians into you hopefully coordinated care along the way.) I mention this only for what it's worth, hopefully without "too much" of in way of hucksterism on my part.
Hope you're feeling better soon,
Mike