Brain is rewired in patients with chronic pain syndrome
 

This is a really important study. Here's the PubMed abstract:

The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions in Emotional and Autonomic Regions.Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV. Neuron. 2008 Nov 26;60(4):570-81.

Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.

Chronic complex regional pain syndrome (CRPS) is a debilitating pain condition accompanied by autonomic abnormalities. We investigated gray matter morphometry and white matter anisotropy in CRPS patients and matched controls. Patients exhibited a disrupted relationship between white matter anisotropy and whole-brain gray matter volume; gray matter atrophy in a single cluster encompassing right insula, right ventromedial prefrontal cortex (VMPFC), and right nucleus accumbens; and a decrease in fractional anisotropy in the left cingulum-callosal bundle. Reorganization of white matter connectivity in these regions was characterized by branching pattern alterations, as well as increased (VMPFC to insula) and decreased (VMPFC to basal ganglion) connectivity. While regional atrophy differentially related to pain intensity and duration, the strength of connectivity between specific atrophied regions related to anxiety. These abnormalities encompass emotional, autonomic, and pain perception regions, implying that they likely play a critical role in the global clinical picture of CRPS.

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Separately in a CBC News story distributed by the RSDSA, the authors suggest that:

"This is the first evidence of brain abnormality in these patients," said the study's lead investigator, Vania Apkarian, a professor of physiology at Northwestern University's Feinberg School of Medicine in Chicago.

* * *

"The new anatomical findings could provide targets for potential drug treatments . . ."

http://www.rsds.org/electronic%20ale...12008_147.html

And for what it's worth, Vania Apkarian is probably the leading neuroscientist in the world on matters relating to pain, so I take his comments from the CBC News story as significant in their own right.

Mike

got the article
 

A friend of mine just sent me the article:

The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions in Emotional and Autonomic Regions.Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV. Neuron. 2008 Nov 26;60(4):570-81.

It is exceptionally well illustrated, if neccesarily technical. Because it's too large to post here or send by PM, if you want to look it over just drop me a PM with your email address and I'll send it on out: for personal use only, please. It might be something worth sharing with your pm docs.

Mike

Thanks
 

Thank you! I will send you a pm with my email. I am also curious as to the effects HBOT has on the brain. I have been doing a little research on that. I still have a lot to learn after all these years.
Di

Don't we all? What I was particular struck by the other day was a NY Times piece that Jim Broach of the RSDSA distributed the other day on his eminence Dr. Rodolfo Llinás treatment of thalamocortical dysrhythmias as the basis for virtually all known neurological conditions. I remember seeing stuff on that when I was doing some research last winter and spring on RUL ECT as a treatment for CRPS-1. (A frustrating tale, as I have since learned that a ballot proposition in California passed after One Flew Over the Koo Koo's Nest, severely restricting the use of ECT to basically defined psychiatric conditions.) But there it was again. Please check it out: http://www.rsds.org/electronic%20ale...22008_148.html

Mike

In correspondence with a member this morning, I remembered that I had not been explict with respect to the relationship between thalamocortical dysrhythmias and the topic at hand, CRPS.

Basically, if you take up the invitation to read the article, you have to bear in mind the key metaphor for the structures of the brain, they are empty, just as the tornado is only wind. But that does not make it nothing. (And the references throughout the article to Eigenvalues are just a term from linear algebra relating to values of normal occillation.)

In fact, there are a lot of folks who think that all creation is vibration, the only thing fixed and static are the definitions we construct, each of which must relate to another term or concept to define them, hence they are called relational. But I go on . . . .

Mike

Diana -

I seem to recall something about how it was believed that HBOT's mechanism of action was it's effect of the brain, and perhaps specifically the thalamus. Can you bring us up to date?

Mike

Thank you for posting this - it is great news if it is true and brings us all hope!

I'm going to speak to my PM Doctor about it and see what he says - sometimes we find interesting articles that he has never seen before!

Mike
 

I think that you are much better at the researching than I am. Maybe you could take some time and pull up a few sites that might be of interest to all of us. I have some listed in my favorites, but I am just not sure how to get them on the post. There seems to be a lot more research and research studies, requesting people for clinical studies on the govtrials.com web site as well. I am currently doing a series of dives at home 2.2ata and just not up to the task. I don't want to misquote by just throwing out what I have read about HBOT and the effects on the brain. There are also a few new Utube sites on HBOT and Brain injury, effects etc. Maybe you could help present some of this information. If not, I'll get back to you I just am short of hours. 1 1/2 hours in the am and pm for dives. I'll try to get someone to do this for me if you can't help at this time. I do think we would all find this very interesting. I'll get back to you. ;) Diana

Hi Guy,

Just came across your post. Bumping up because I am very interest in the white and grey matter volume in the brain. The why and what is what is bothering me. Bless You Mike for caring. Roz

OT but what the heck
 

Okay. I'll admit to being pretty lethargic and ignoring responsibilities on the board over the last couple of weeks. To answer Diana's question about researching HBOT as a treatment for CRPS, I went to my "usual sources" and didn't come up with much. Going first to my the easiest reference page of all, the RSDSA Medical Articles Archive page at http://www.rsds.org/2/library/articl...ive/index.html we get one lone article from 1995:

Hyperbaric oxygen and the reflex sympathetic dystrophy syndrome: a case report. Peach G, Undersea Hyperb Med. 1995 Dec; 22(4): 407-8.

Hyperbaric Medicine Department, University of Baltimore Medical Center, Maryland, USA.

ABSTRACT: A patient suffering from acute smoke inhalation also had a long medical history that included reflex sympathetic dystrophy syndrome of the left foot and ankle. The entire foot and ankle were tender and cool to palpation; range of motion was severely reduced. She was referred for hyperbaric oxygen therapy, and 15 min into the the first treatment (46 min at 60 fsw) she reported a lessening of the pain in her foot; moreover, the foot was less cyanotic and warmer to the touch. Subsequent treatments continued to improve her conditions and for longer periods of time.

A pdf photocopy of the article is available on the through RSDSA page at http://www.rsds.org/2/library/articl...Hyperbaric.pdf

I then ran the article through PubMed - http://www.ncbi.nlm.nih.gov/pubmed/ - an online collection of medical articles and their abstracts maintained by the NIH, often with extensive cross-referencing, but found that the article in question was apparently never cited thereafter. :frown: At that point. I was left just running searches on PubMed. Doing that, I came up with a few abstracts, which are listed below. Unfortunately, none of these article are currently free, so you would have to (1) go to a medical library, (2) make the acquaintance of someone with access to a research university computer system, or (3) if you're lucky, once you've called up the individual article abstracts on PubMed you can then follow the available links to the publisher sites, which would in turn sell you copies of the article from anywhere from $20 to $35 each. In any event, here's what I came up with, and please note the distinctive international flavor in what follows:

1. Hyperbaric oxygen therapy in chronic pain management.Yildiz S, Uzun G, Kiralp MZ. Curr Pain Headache Rep. 2006 Apr;10(2):95-100.

Department of Undersea and Hyperbaric Medicine, Gulhane Military Medical Academy Haydarpasa Training Hospital, 34668 Kadikoy, Istanbul, Turkey. senoyildiz@yahoo.com

Chronic pain is one of the frequently encountered clinical problems that is difficult to cure. Hyperbaric oxygen (HBO) therapy has been reported in chronic pain syndromes with promising results. In this review, we focus on the effectiveness of HBO in fibromyalgia syndrome, complex regional pain syndrome, myofascial pain syndrome, migraine, and cluster headaches. HBO may be beneficial if appropriate patients are selected. HBO is a reliable method of treatment. However, physicians performing HBO must be aware of oxygen toxicity. Another problem regarding HBO is the scarcity of centers administering it. Further research is required focusing on the optimal treatment protocol, the cost/benefit ratio, and the safety of HBO in chronic pain management.

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

2. Effectiveness of hyperbaric oxygen therapy in the treatment of complex regional pain syndrome. Kiralp MZ, Yildiz S, Vural D, Keskin I, Ay H, Dursun H. J Int Med Res. 2004 May-Jun; 32(3):258-62.

Department of Physical Therapy and Rehabilitation, Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey. mkiralp@hotmail.com

In this double-blind, randomized, placebo-controlled study we aimed to assess the effectiveness of hyperbaric oxygen (HBO) therapy for treating patients with complex regional pain syndrome (CRPS). Of the 71 patients, 37 were allocated to the HBO group and 34 to the control (normal air) group. Both groups received 15 therapy sessions in a hyperbaric chamber. Pain, oedema and range of motion (ROM) of the wrist were evaluated before treatment, after the 15th treatment session and on day 45. In the HBO group there was a significant decrease in pain and oedema and a significant increase in the ROM of the wrist. When we compared the two groups, the HBO group had significantly better results with the exception of wrist extension. In conclusion, HBO is an effective and well-tolerated method for decreasing pain and oedema and increasing the ROM in patients with CRPS.

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

3. Post-traumatic reflex sympathetic dystrophy in the ankle and foot: a study of 32 cases. Bacchini M, Vaienti E, Soncini G. Chir Organi Mov. 1999 Apr-Jun;84(2):189-96. [Article in English, Italian]

Istituto di Clinica Ortopedica e Traumatologica, Università Parma.

The etiopathogenesis of reflex sympathetic dystrophy is still undefined, and diagnosis and treatment are difficult. It is the purpose of this study to propose precise diagnostic and therapeutic criteria for post-traumatic reflex sympathetic dystrophy of the ankle and foot. Diagnosis is pre-eminently clinical. Clinical progression of the disease occurs in three stages: acute, dystrophic, chronic. Radiographic examination cannot be used to classify the stage of the syndrome. Bone scan with Tc 99M methylendiphosphonate aids diagnosis, and helps establish the prognosis of the disease. Clinical symptoms and instrumental tests (x-ray, bone scan, CT scan, MRI) are discussed in relation to differential diagnosis with other pathologies of the ankle and foot. Furthermore, the effective use of drugs, physiokinesitherapy, and hyperbaric oxygen therapy is discussed. The authors present a study of 32 patients, paying close attention to early clinical signs of the disease. X-ray examination and bone scan were routinely carried out in established diagnostic protocols.

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

4. [The treatment of a complex regional pain syndrome][Article in Russian] Tuter NV, Danilov AB, Poliakova LV.Zh Nevrol Psikhiatr Im S S Korsakova. 1997;97(11):33-5.

35 patients with complex regional pain syndrome (CRPS) were treated by hyperbaric oxygenation (HBO) and caffetin preparation. A significant decrease of pain was observed in all the patients after the treatment course. Intensity of pain was diminished according to visual analogous scale. Meanwhile considerable regression of autonomic disorders and weakening of anxious and depressive manifestations was noted too. The tendency to normalization of evoked skin potentials was also found. Some elevation of the threshold of nociceptive reflex was conditioned by displacement toward general increase of antinociception after the treatment. Effect of HBO therapy persisted during 6 months in 87% of the patients. Efficiency of caffetin was restricted by the time of its administration. The conclusion was made about possibility of successful treatment of CRPS patients by both methods.

http://www.ncbi.nlm.nih.gov/pubmed/9...ubmed_RVDocSum

Pretty slim pickings overall, and none of the four abstracted articles listed above are even linked for online purchase at that, although I haven't tried accessing the publishers directly. Perhaps someone else will have better luck.

Mike

Thanks Mike!
 

Thank you for taking your time! It seemed to me the abstracts all had favorable results for HBOT and RSD/CRPS. I was wondering did you come across anything on HBOT and the effects on the brain? As a long time user of HBOT, I'm beginning to wonder about long term use, the benefits or side effects.
Thanks again, Mike. I really appreciate you giving me your time. All the best Di

Di -

I think this abstract might then be of greater interest:

Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism, Rossignol DA, Med Hypotheses, 2007;68(6):1208-27. Epub 2006 Dec 4.

University of Virginia, Department of Family Medicine, P.O. Box 800729, Charlottesville, VA 22908, USA. dlross7@hotmail.com

Autism is a neurodevelopmental disorder currently affecting as many as 1 out of 166 children in the United States. Numerous studies of autistic individuals have revealed evidence of cerebral hypoperfusion, neuroinflammation and gastrointestinal inflammation, immune dysregulation, oxidative stress, relative mitochondrial dysfunction, neurotransmitter abnormalities, impaired detoxification of toxins, dysbiosis, and impaired production of porphyrins. Many of these findings have been correlated with core autistic symptoms. For example, cerebral hypoperfusion in autistic children has been correlated with repetitive, self-stimulatory and stereotypical behaviors, and impairments in communication, sensory perception, and social interaction. Hyperbaric oxygen therapy (HBOT) might be able to improve each of these problems in autistic individuals. Specifically, HBOT has been used with clinical success in several cerebral hypoperfusion conditions and can compensate for decreased blood flow by increasing the oxygen content of plasma and body tissues. HBOT has been reported to possess strong anti-inflammatory properties and has been shown to improve immune function. There is evidence that oxidative stress can be reduced with HBOT through the upregulation of antioxidant enzymes. HBOT can also increase the function and production of mitochondria and improve neurotransmitter abnormalities. In addition, HBOT upregulates enzymes that can help with detoxification problems specifically found in autistic children. Dysbiosis is common in autistic children and HBOT can improve this. Impaired production of porphyrins in autistic children might affect the production of heme, and HBOT might help overcome the effects of this problem. Finally, HBOT has been shown to mobilize stem cells from the bone marrow to the systemic circulation. Recent studies in humans have shown that stem cells can enter the brain and form new neurons, astrocytes, and microglia. It is expected that amelioration of these underlying pathophysiological problems through the use of HBOT will lead to improvements in autistic symptoms. Several studies on the use of HBOT in autistic children are currently underway and early results are promising.

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Forgive me if I had lost track of what you were really looking for. (This is one of the articles that you can link to the publisher through the PubMed site if you want to buy it in full text, if you don't have ready access to a medical school library.) I imagine that the citations alone in the article could very well prove to be worthwhile in their own right.

Mike

Thanks Again
 

Mike,
This I find very interesting. I think it will take a bit for me to digest it. So far it seems there are many advantages of HBOT, but I still wonder in the back of head will there be negative side effects for long term use. I also wonder what were the percentage of oxygen, nitrogen and other gases say, 100 years ago or more. I asume we are all receiving less oxygen now with the air we breathe at 21% oxygen and 79% nitrogen and other gases, than maybe we were years past. I just always do better at sea level, oh, its not an excuse to dive, just the truth, altitude is a killer for me now that I have rsd and I have climbed almost every 14 er in Colorado. Mike, thanks again...I'm rambling so I'll say bye...Di

Hi Mike,

I find this area of research on the brain and pain quite interesting. I just stumbled across this article posted on the American Academy of Pain Management newsletter, Currents.


Pain is in the eyes of the beholder
November 25, 2008 [Source: Current Biology]
By manipulating the appearance of a chronically achy hand, researchers have found they could increase or decrease the pain and swelling in patients moving their symptomatic limbs. The findings—reported in the November 25th issue of Current Biology, a Cell Press publication—reveal a profound top-down effect of body image on body tissues, according to the researchers.

http://www.bio-medicine.org/biology-...older-6044-1/#

Additionally there was a very interesting documentary on CBC TV "The Nature of Things" show a couple of weeks ago. The special was titled "The Brain that Changes Itself " about the new research going on in the science of "neuroplasticity" - a concept that expands not just our knowledge of how our brains work, but how we use them. While it is not necessarily about chronic pain, I found the research shows great promise for those of us who do suffer from pain moving forward. http://www.cbc.ca/documentaries/natu...hangesitself/#

MsL