Monday, January 14, 2008

Identification and treatment of symptoms associated with inflammation

Thanks to Fred for finding this one:

[This article may be of interest because it explores
the concept of immune-to-brain communication representing
the major biological mechanism for symptom burden
experienced by medically ill patients.]



Identification and treatment of symptoms associated with inflammation
in medically ill patients.

Journal: Psychoneuroendocrinology. 2008 Jan;33(1):18-29. Epub 2007 Dec 3.

Authors: Dantzer R, Capuron L, Irwin MR, Miller AH, Ollat H, Hugh
Perry V, Rousey S, Yirmiya R.

Affiliation: Integrative Immunology and Behavior Program, 212 ERML,
1201 W Gregory Drive, University of Illinois at Urbana-Champaign,
Urbana, IL 61801, USA.

NLM Citation: PMID: 18061362


Medically ill patients present with a high prevalence of non-specific
comorbid symptoms including pain, sleep disorders, fatigue and
cognitive and mood alterations that is a leading cause of disability.
However, despite major advances in the understanding of the
immune-to-brain communication pathways that underlie the
pathophysiology of these symptoms in inflammatory conditions, little has been done to translate this newly acquired knowledge to the clinics and to identify appropriate therapies.

In a multidisciplinary effort to address this problem, clinicians and
basic scientists with expertise in areas of inflammation, psychiatry,
neurosciences and psychoneuroimmunology were brought together in a
specialized meeting organized in Bordeaux, France, on May 28-29,
2007. These experts considered key questions in the field, in
particular those related to identification and quantification of the
predominant symptoms associated with inflammation, definition of
systemic and central markers of inflammation, possible domains of
intervention for controlling inflammation-associated symptoms, and
relevance of animal models of inflammation-associated symptoms.

This resulted in a number of recommendations that should improve the recognition and management of inflammation-associated symptoms in medically ill patients

* * *

Autopsies on CFS/ME patients have shown inflammation.  I had a C-Reactive Protein test, which shows "infection or inflammation" and the doctor referred to my results as "sky high" and "off the charts".  But CRP tests are not ordinarily done -- my own PCP had never heard of it until a researcher did it on me -- so it's easy for a doctor to conclude "all tests are normal" because he hasn't done the right tests.

If more doctors were aware of the inflammation connection, and did the CRP test, they might be more accepting of the idea that CFS is real, because they would have blood test results they could put their finger on.

Too much of the public's impression of CFS and fibromyalgia (and I include non-specialist doctors in "the public") is that there is no objective evidence of either disease.  Just because there is no blood test specific to either disease does not mean that there aren't objective signs ... both can be proven with MRIs, neurological testing, and advanced tests that cover things not tested for in basic first-round blood tests.

Giving the patients PROMPT and APPROPRIATE treatment (not just pep talks and anti-depressants) can limit the damage caused by the infection/inflammation and get people back to work. 

However, according to local pain management specialist Dr. Teicheira, even 24 hours of untreated pain can cause physical changes to the nervous system; fibromyalgia is a result of untreated pain.  "If severe pain is allowed to persist for more than 24 hours, neuroplastic changes associated with the development of intractable chronic pain syndromes are evident: damaged mechano-receptor nerve grows over the nociceptor nerve after 24-48 hours; the nociceptor atrophies. This may be permanent; no one knows."  "As a result of intense pain, neurons in the spinal cord that help to prevent pain transmissions actually die. At the same time, pain-transmitting neurons grow more connectors to other nerves, become more sensitive, and react more strongly to a painful stimulus."  He says CFS/FMS "deal abnormally with pain as a memory. On a PET scan, the brain is all lit up all the time. The process is abnormal, but the pain is real."

"Intense pain can result in permanent changes in the Central Nervous System resulting in phantom pain."

Dr. Teichera's recommendation if your doctor refuses to prescribe pain medication?

HERBAL TREATMENTS SHOWN TO REDUCE MUSCULOSKELETAL PAIN

Devil's claw extract: the most effective dosage for both osteoarthritis and low back pain is 50 mg of harpagophytum procumbens daily for at least 2-3 months

Bromelain ananas comosus, pineapple shown to significantly decrease Substance P release

Turmeric root curcuma longa 1125 to 2500 mg/day

Omega 3 fatty acids: salmon, halibut, cod, herring, mackerel and tuna, flax seeds, canola oil and walnuts 1200 to 2400 mg daily

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