Shoreline

The same can happen if post op pain is not treated and the patient sufffers terribly, or in war often care came very late and eventual ampuation removed the injured leg but didn't stop the nuero chemical process of sendng that signal that your in pain. It's not just chemical changes that occur, but an entirley different part of your bran starts recieving and interpreting those pain signals

So the gates stay open even after the problem is corected, They may never close or you may develop RSD where your entre nervous system starts going nuts and you have pain where you never even had an injury an your brain is prodcung so many neuro toxic agents you develop a shingle like condition that an be seen , can't be touched without extreme pain and although RSD or CRPS is still controversial, you can't argue with what you see in front of you as far as discolerinng, inflamation and the shingle like leasions caused by neurotransmitters that actually cause inflamation of all the nerves in an affected area.

This isn't something unique that just happened to your deb r Jen, Acute pain that isn't treatd orlast for a rpolonged cange eventually becomes chronic and all the changes occue that I mentioned and the article mentioned, The article is a must read and has diagrams of noormal and chronic pain pathways and exlains in detail what the difference is, how it occurs and why it occurs. Ecerone with itractable pain with a problem that can't be fixd will rech this point of completely diffrntesponses to pain that acute pain would cause. With those gates open, you also able to interpret and process mor than one pain genertor. Acue pain s overrridden by te most painfl injury other injures will go un noticed until the owst problem is adressed. Bt CP patints can feel and interpret mor than onepain generator and acutepain focuses on that one big Ouchie that's sending the loudest sugnal to yorur barin.

But everyne with CP goes through these changes, so ymany of us have pain engrained into nerve tissue, have all the negativ consqunces of chronc painhapening and have the ability to percieve mor than one source of pain. The artcile is realy mportant to read, reread and understand for all this to make sense.

Evn though pain has been engraind and our gates stay open and we create thenurtransnittes and transformation that occurs with CP, It doesn't mean it can't be treatd. Thre are sevral methods, starting with anti depressants and anti seizure drugs to reduce substance P and to distrt the pain signal.
The test you had done sound lietrials ofor an implanted intrathecal pump to deliver meds drctly to th sit of pain, but lack of response really shows it's mor f a nerve problem thatay be better suitd for nrve stimiulation. Doa seacrg on nerve stim, there are 3 vbasic types, the spinal cord stim where a specific nerve root is wired to distort the pain signal, It's a much more adbvanced method of TENS. There is also Vega nrve stim which would handle aproblem like pancriatitis and other maladies caused by organ problams that use the vega neere to transmit the pain signal. The Veag nerve runs down through the toracic cavity and why heart attacks and reflux can be hard to distnguish alone via sympyoms, they both send the signal op the vag nerve and our grain doe's knowq if it's your hard, stmoach or pancreas. Th implant a device like a pacemaker and rap a lead around the Vga nerve and ou have the ability to contol the strnght, duration and amplitude of the elctrical signa l your using to drown out apain carrid by the veaga nerve. The thrid stim unit is s the same acemaker but leads are implanted in your brain and while your awake tthey test diffeent sites to drown out the pain and stop the formayion of the chemicals assciated with CP.

Brain surgery to implant this device has it's own set of risks, the brain has no feeling itself do being awake is neccesary to report changes and crect lead placement. That's abut the most radical method of dealing with intractable pain that won't repond to any other method of pain relief.

But imprinting can be fooled and the gates can be closed with drugs lie Ketamine where they place you in a comma for a few days and this is supsed to reset those gates and your threshold and tolerance to pain.

Th fact you didn't repond well to epidural opiates doesn't suggest an intrathecal morphine pump is the way to go. Yu really ned t reach 50% relief with the pump trials or you may be wasting your time . There is another poster waiting to have her pump removed but she never had a succesful trial. At best one test showed sligt imporvment, that's a long way from 50% in ost eples book and the pump never shuld have beenimplanted without asuccesful trial. That's what they did, a pump trial testing different opiates in the epi space.

As faras the total block, obviously you can't funtion with a block from the nipple line down. could do a TKR after that bolck and you wouldn't ave flinched because evrything was numbd with bupivicaine, marcaine o lidocaine, same stuff they use to numb teeth before an extraction.

I would imagine the next tests would be for tha spinal cord stim, try to isolate what nevr root the pain is traveling through and disrupt th signal wit electral impulses. Nerve pain simply dosn't respond to opiates as well as say somatic ain or incisional pain, Neoro pain is the hardest to treat.

I didn't quite folow all the numbers, was the scond numbe te pain score after the injection, a 5 should represent a 5% reduction in pain if your constantly floating betwen *09 I rarely use 10 because most of the time the pain I experince isn't the worst pain I have ever expereinced.

But ain imprintin is something many CP patients have to dal with along with the changes froma cute to chronic the article explans, please read it and likly the understanding light bulb will go off. something doesn't make sense or you don't undertsand, just ask.

Hang in ther, the doc hasn't condemened you to a life of pain, ZZPain imprintin can be dealt with and overcome, the neurochemical changes can be controlled with other meds like baclofin and clonodine, but the testing of meds you went thogh via the epidural space was simply a trial they do for all perspective pump patients. But not getting significant relief means they either need to use much higher doses or you may not be a candidate for the pump but still a candidate for one of the nerve stim techniqes.

Do stay away from unguided needles into your spine, there is just too much risk and if the dc doesn't have a fluro he can send you somewhere that does, It's greed and arrogance for that 1100 hundred dollar ESI that has him taking a chance on your spine.

Simply ask him what the next step is, stronger epi meds/doses or an SCS stim trial of the nerve roots. But they need to be able to isolate what nerve root is involved for an SCS to be succesful. Again the goal is 50% reduction in pain, Pumps and stims aren't cure alls, just one of many tools.
Goodluck and let me know what you thought of the article.
Take care, Dave

PS also checkout TKs thread regarding surgery not an option. There must have been a PM conference somwhere that suddenly all these docs are using the corect terms and explainng the gateway theory and nerve memeory and engraining all in one week.