Tuesday, September 11, 2007

Beyond size and sensation... lol

I saw the neurosurgeon (ya, still not too bad looking… lol) today with the MRI for the thoracic and lumbar areas while the film for the cervical spine taken over 2 weeks ago is still yet to be found.

In one sentence, no surgery needed and the pains do not correspond too well with the anatomical evidence: herniated discs pinching with the one thoracic disk pressing down the space where the spinal fluid flows. Those other 4 disks in the neck.... the last time I checked... no one has seen them yet. lol

That still doesn't really answer my reported symptoms... pains, muscle spasms, as well as the resulting impacts on my mobility.

Stubborn like a donkey and five more disks after my conversion disorder, I got home and tried to google for some research associated with my atypical condition.

First thing I looked for a scientifically based article showing I am not the only person experiencing pains and disabilities more severe than what MRI results might suggest.

Following is the exact quote from an article by Karppinen et al (2001):

"finding a herniated intervertebral disc in an asymptomatic individual is clearly not an indicationfor surgery; similarly, a normal MRI in a patient with severe back and leg symptoms is not an indication of malingering or “nonorganic” pain."

Following is the link to a short description of the study:


The most recent one citing this article was publish in 2007 by Jensen et al which found that, in a 14 month MRI follow up study for patients suffering from radiating pains, the recovery from symptoms might not go hand-in-hand with that observed in improvement of disk herniation and/or nerve root compromise.

Yet, not too many more after that 2001 article addressing the same issue and I guess it might have something to do with replication is not really the thing people value too well. In addition, I have to consider the possibility that the advances in the field of radiology might have found some ways to compensate these problems.

Following is the link to another article published all the way back in 1994.


As you might expect, my congenital sense of curiosity (which could be perceived as either hypochondria or obsessive compulsive thinking) is not going to stop me here.... because of what I have been taught in school… lol

Now that physiology doesn't really always match up with symptomology.... what other mechanisms could explain these atypical symptoms involving real pains and difficulties in mobility?

Then, I came across this wonderful literature review for the biopsychosocial approach to chronic pains, which was published in the psychological bulletin (Gatchel, et al, 2007). In essence, pain is, to date, a mystical phenomena despite all the models proposed to demystify such occurrences.

As a paper published in the psychological bulletin, of course, the authors spent quite a bit of time discussing the contribution of emotions and cognitions in pains. In short, it is no good being depressed and anger; it is better being positive than pessimistic. In addition, humor, optimism and "benefit finding" are some of the resilient factors mentioned in the article.

The Nociceptive Process through which bodily events are interpreted by the brain as pains---

  1. The traditional biomedical model of disease, which assumes an isomorphic relationship between pain and physical injury
  2. The Gate Control Theory of Pain
  3. The Neuromatrix Theory of Pain--- pain is the consequence of the output of the widely distributed brain neural network rather than a direct response to sensory input following tissue injury, inflammation, and other pathologies
  4. Homeostasis, Allostatic Load, and Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation-- In short, all relevant factors contributes to the maintenance of conditions even after the original damage resolved or "in the absence of any objectively determined pathology".
And, of course, the neuroscience models of the pains.

For instance, the imbalance of neurotransmitters, neuromodulators, and their various types and subtypes of receptors, may contribute to the state of chronic pain. While much more has been written about the role of serotonin (5-HT) in Hyperalgesia (i.e., an extreme sensitivity to pain) , a recent study found that "the brain’s dopamine system is highly active while someone experiences pain—and that this response varies between individuals in a way that relates directly to how the pain makes them feel."

It is now starting to make sense to me.... to a certain degree.

Despite the resilient factors, what I have experienced as the pains and the ensuing consequences are the manifestation of a complex system involving the organic problems, the nocicepitive processes and my congenitally fucked-up serotonin and dopamine systems lol (oops... sorry, my dear serotonin and dopamine systems).

Then, when I was working on this writing.... I came to understand why the neurosurgeon thought my reported symptoms were over the limits....

Pains had intensified after the water boiling incident and got even worse after the Thoracic MRI scan last Wednesday. The humidity and rain also had not done much help....

When I woke up this morning (when the body is most stiff), I filled out the patient survey and reported what I felt then....

One of the question asked me how much work I have been able to do since the accident... I put down 90%.... since I have been out of work in June and the only thing I have done was to push through the legal documents for my immigration thing... Should have put down 100% instead actually since the only thing I have done is walking up and down the street trying to regain my walkability.... lol

When looking for the articles I found tonight, still in bad pains, I went through a lot of searches and finally narrowed down to a few of the articles... In addition, I actually read through them.

Then, this other question in the survey popped into my head... it was about how much the pains had affected my ability to read. My answer to that question was something like severely.

After going through these articles... I realized that my recall about the frequency of reading was correct since I have not done much reading since the accident.... and it might also have something to do with my dislike to be reading in English unless necessary.... lol

There goes the issue of validity and reliability of survey instruments and the annoying noises made by atypicals or outliers who think like me. lol

So, now that surgery, which was never an option for me, is absolutely out of the sight. Shall the etiology of my psychiatric do have a significant impact in intensifying my nociceptive experiences, shall it be the consequences of my trying to kick God’s ass and God’s kicking my ass back (lol)…. and, shall all other possible contributing factors, what could the professionals do to help me get myself better sooner?

It all boils down to…. for me, they are real pains, real spasms, and real problem I am facing with moving (even though, what is real? lol)


Dopamine and pain


Serotonins and pain


The mystical concept of pains

Gatchel, R.J., Peng, Y.B., Peters, M.L., Fuchs, P.N., and Turk, D. (2007) The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, Vol. 133, No. 4, 581–624.

Size and sensation (lol)

Karppinen, J., Malmivaara, A., Tervonen, O., Paakko, E; Kurunlahti, M., Syrjala, P., Vasari, P. and; Vanharanta, H. (2001) Severity of Symptoms and Signs in Relation to Magnetic Resonance Imaging Findings Among Sciatic Patients. Spine. 26(7):E149-E154.


Tue Secher Jensen, Hanne B. Albert, Joan S. Sorensen, Claus Manniche and Charlotte Leboeuf-Yde, (2007) Magnetic Resonance Imaging Findings as Predictors of Clinical Outcome in Patients With Sciatica Receiving Active Conservative Treatment, Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 2, Pages 98-108.

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