Good pain study, horrible title that could set us back a while

***icnmgrjill*** · 12-15-2011, 07:04 AM

How many years have we spent trying to bring legitimacy to IC? To break the mistaken belief that IC is imaginary or "all in their heads?" This study below is superb BUT THE TITLE IS AWFUL! Yes, I do believe that for some of us, IC is a central nervous system pain processing/sensitivity disorder thus explaining the many other disorders that some of us struggle with. But, really, REALLY, you have to give a title that doesn't explain the research and creates an air of "doubt" about IC being real. A more correct title would be "maybe it is all in their nervous system." Luckily, this journal isn't exactly the People Magazine of the medical community so maybe not to many people will see it. OMG! - Jill

Central pain mechanisms in chronic pain states - maybe it is all in their head - Abstract
Wed, 14 December 2011

University of Michigan, Ann Arbor, MI, United States.

Mechanisms underlying chronic pain differ from those underlying acute pain. In chronic pain states, central nervous system (CNS) factors appear to play particularly prominent roles. In the absence of anatomical causes of persistent pain, medical sub-specialities have historically applied wide-ranging labels (e.g., fibromyalgia (FM), irritable bowel syndrome, interstitial cystitis and somatisation) for what now is emerging as a single common set of CNS processes. The hallmark of these 'centrally driven' pain conditions is a diffuse hyperalgesic state identifiable using experimental sensory testing, and corroborated by functional neuroimaging. The characteristic symptoms of these central pain conditions include multifocal pain, fatigue, insomnia, memory difficulties and a higher rate of co-morbid mood disorders. In contrast to acute and peripheral pain states that are responsive to non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, central pain conditions respond best to CNS neuromodulating agents, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and anticonvulsants.

Written by:
Phillips K, Clauw DJ. Are you the author?
Reference: Best Pract Res Clin Rheumatol. 2011 Apr;25(2):141-54.
doi: 10.1016/j.berh.2011.02.005

**ICNLesa** · 12-15-2011, 08:09 AM

Oh U of M....how I love you but be SMART in your synopsis. I'm always suspect of those who approach medical research in a prove/fail direction. It's never that clear cut. Seeing is believing doesn't apply in many, many medical conditions. Of course, the CNS plays a roll in chronic pain....it is, after all, the central nervous system. I disagree that there is an "absence of anatomical causes"...more accurately I would say there has been an inability to identify an anatomical cause at this point. Why does our CNS do what it does in any circumstance? I think there are as many possibilities as there are nerve endings in our bodies. Perhaps it's a response to something else happening in our system, perhaps it's a misfire within the CNS. Isolation of a common response 'picture' in chronic pain sufferers doesn't feel groundbreaking to me. It seems obvious. Either way, "all in their heads" is an irresponsible serve to something that is legitimately impacting the lives of so many.

***Julie B*** · 12-15-2011, 08:21 AM

I don't like it as a title because there is no room for a caveat, but I actually say that exact same thing when I talk to dietitians about IC when explaining the nervous system aspect. It emphasizes the fact that IC patients have been belittled all these years, but yet, there is something to the emotional/nervous system connection.

I think they stole it from me. I did speak to Michigan Dietetic Association in Ann Arbor in May. ;-)

**Sprockets** · 12-15-2011, 12:42 PM

Of course it's all in our heads, but so is every perception.

We won't see many articles about IC until drug companies are marketing something new. The pharmaceutical companies pay the doctors to write papers.

**imwood** · 12-16-2011, 03:28 AM

You mean my brain can cause me to have mast cells and high white blood cell counts in my urine in the absence of infection? WOW? And it can cause me to break out in tiny hemhorrages all over the inside of my bladder upon hydrodistension under anesthesia, which is a time during which my brain is communicating absolutely NO pain signals whatsoever?? Double-WOW? The power of the MIND!!

Oh, and some people's sick sick brains can even cause them to develop Hunner's ulcers, just by sheer willpower and sending too many pain signals? OMG triple WOW-WOW-WOW! That must be one unhealthy brain right there I tell ya! Lock them up and throw away the key!

I would disagree with one key point to this.. my little brother has Crohns and ankylosing spondylitis, and taking SSRIs/SNRIs HAS helped his pain to quite a degree, because with ANY chronic pain condition, quality of life, depression and constant pain become a cycle and feed off each other.. the lower your quality of life due to pain, the higher your depression, thus the greater your sensation of pain due to depression, thus the lower your quality of life, and so the cycle continues.

This study lacks critical thinking. I'm 29 and didn't get 2 semesters of college under my belt and found some pretty giant flaws in their thought processes. It's making me angry.

**Sprockets** · 12-16-2011, 05:06 AM

Originally Posted by imwood

You mean my brain can cause me to have mast cells and high white blood cell counts in my urine in the absence of infection? WOW? And it can cause me to break out in tiny hemhorrages all over the inside of my bladder upon hydrodistension under anesthesia, which is a time during which my brain is communicating absolutely NO pain signals whatsoever?? Double-WOW? The power of the MIND!!

The article didn't say that. The phrase "In the absense of physical symptoms" doesn't mean the author believes there are no physical symptoms.

**Sprockets** · 12-16-2011, 05:12 AM

Originally Posted by Sprockets

The article didn't say that. The phrase "In the absense of physical symptoms" doesn't mean the author believes there are no physical symptoms.

Suddenly the edit option is turned off, so I'm quoting myself in order to correct the statement above.

I should have said the phrase "in the absense of anatomical causes of persistent pain" doesn't mean the author believes there are no physical symptoms associated with IC or the other conditions mentioned.

**krs72** · 12-17-2011, 10:35 AM

I read this the other day and the title does really bother me. I find it to be highly insensitive. I have to say, though, that I had a very poor understanding of how people with chronic pain are treated by some members of the medical community, until I became one of them. It has been a struggle to find caregivers who are truly caring and compassionate, and willing to work with someone who has a poorly understood condition that so greatly affects ones quality of life.