Complications

Intractable pain. The way forward.

Complications of IP

IP has numerous, severe complications which can shorten life and incapacitate an individual. Totally untreated IP will cause death within days to weeks once it starts. This occurrence has been observed following injuries to soldiers who could not obtain morphine or other potent pain relievers.

Death from IP is due to either heart stoppage or adrenal failure. IP is perhaps the most stressful entity that may affect the human body. From the day IP begins, cardiovascular complications will be evident. The key to recognizing IP is a person who presents with constant pain, a history of traumatic injury or inflammatory disease, and episodes of tachycardia (elevated pulse rate) and hypertension. IP causes most of the pathologic complications by over-stimulating the cardiovascular, endocrine (hormone), and metabolic-immunologic systems.

IP may cause any of the following CV complications:

High Blood Pressure (hypertension

Elevated pulse rate (tachycardia)

Arteriosclerosis

Congestive heart failure

Angina pectoris

Myocardial infarction (heart attack)

Cardiac Arrhythmias

Sudden CV death (Asystole)

IP causes the pituitary-adrenal-gonadal axis to over-stimulate. The result is an excessive release of cortisol and adrenaline from the adrenals. Since IP is constant, the continuous elevation of these hormones leads to alteration in glucose and lipids. Persons with IP may show a diabetic or prediabetic profile. Lipids may elevate since the pituitary, adrenals, and gonads put out high hormone levels due to the constant stress of IP, and these glands may hypertrophy and show tumors on x-rays. Failure to recognize this development has led to unnecessary and dangerous surgical removal of these glands. In the late stages of IP, the glands can’t keep up with the stress and demands of IP. Blood levels of cortisol and these hormones may drop: pregnenolone, estradiol, DHEA, and testosterone. Cortisol levels may drop so low that Addison’s disease develops.

Cortisol has been known to drop to such a low level in IP such as to cause death. Low levels of other hormones may cause these pathologic issues:

Impaired immune system

Intestine and digestive malfunction

Depression

Failure to grow tissue.

Fatigue

Mental incapacities

The rise in cortisol followed by exhaustion of testosterone and other hormones with IP has a dramatic, deteriorating effect on bones and teeth. Over time, the hormone alterations of IP causes calcium to dissolve and be removed from the tissues of the teeth, joints, and spine. Vertebrae may become so fragile with osteoporosis that the spine may collapse in places and cause scoliosis. When calcium builds up in the joints, it causes arthritis. Your teeth may fall out and break easily. Be careful of falls as osteoporosis of the hips and knees makes them prone to fracture, and hip and knee joints often must be replaced.

The impairment of the immune system encourages infections of all kinds as well as reactivation of latent viruses, in particular the Epstein Barr Virus (EBV).

The CNS dysfunction of IP leads to what is called dysautonomia. The involvement of the nervous system is called autonomic because it functions on its own with no conscious effort by the individual. Much of the autonomic function of the body is through the vagus nerves and what are called adrenergic receptors. Physiologic, autonomic functions include blood pressure, pulse rate, blood flow, gastrointestinal digestion, skin temperature and breath rate.

One characteristic of dysautonomia caused by IP is cold hands and feet. This finding is almost always present in persons with IP. Sometimes the hands turn blue. This is often called Raynaud’s phenomenon, as it was named after the physician who discovered it. Dysautonomia may produce sudden hypotension with fainting, bloating, and pain in the intestine. Episodes of diarrhea alternating with constipation may ensue. A diagnosis of irritable bowel is commonly ascribed to IP patients.

Dysautonomia has led to a concept known as “descending pain.” Tissue damage in the brain causes abnormal bioelectric conduction. This may lead to pain signals that descend down the vagus nerve and spinal cord. While this phenomenon is incompletely understood, agents such as tizanidine and clonidine relieve pain by activating the adrenergic receptors that regulate the autonomic nervous system.

The large number and severity of IP complications is mostly unknown in both medical and lay circles. These complications, and the shortened lifespan they induce, have recently caused the California State Medical Board to exempt persons with documented IP from controlled substance guidelines. Wikipedia notes that IP is often called a “disease” in part due to its serious complications. The complications make it easy to recognize an IP patient. It is simple a person with constant pain, a history of past trauma or inflammatory disorder, elevated pulse or blood pressure, and cold hands and feet.

Intractable Pain Complications

Medical Complications of Intractable Pain

The medical complications of uncontrolled IP as defined in this study are debilitating and life-shortening. Suicide is common in uncontrolled IP. The complications, explanations, and results of uncontrolled IP on human physiology and anatomy are listed below. The medical complications of IP affect all the biologic and anatomic systems in the human body. It must, therefore, be controlled even if a non-standard or an unusual medical regimen is required.

"It is not uncommon to see a patient with intractable pain progressively deteriorate and go from cane, to walker, to wheelchair, to an untimely death."

From: Practical Pain Management, Jan 28, 2012, Forest Tennant, MD, Dr PH, Head of Arachnoiditis Research and Education Project

ENDOCRINE (HORMONE)

Adrenal glands are put in overdrive, so cortisol and other hormones deplete. The result is exhaustion, immune suppression, poor healing and recovery, malnutrition, muscle atrophy, deterioration, and wasting. Gonads become suppressed, depleting hormones, vital estrogen, and androgens. Loss of libido and healing power ensue.

RESPIRATORY

Both the rate and depth of breathing are reduced. Carbon dioxide may rise in the blood, and the body becomes oxygen-starved. The result is fatigue, exhaustion, and loss of mental abilities. Often misdiagnosed as something like sleep apnea.

GASTROINTESTINAL

Stomach acid and bowel motility (movement) are impaired. The result may be poor assimilation of food and nutrients. Alternating diarrhea and constipation along with abdominal pain may result. Often misdiagnosed as something like IBS, or diverticulitis.

CARDIOVASCULAR

Both blood pressure and pulse rate may elevate, with adverse effects on the heart and kidneys. Blood vessels constrict, resulting in cold hands and feet. Coronary occlusion and cardiac arrhythmias with sudden death may occur.

DENTAL

IP raises cortisol, which extracts calcium from bones and teeth. Open-mouth breathing occurs in an attempt to get more oxygen. The result is tooth and gum erosion. Often misdiagnosed as poor dental hygiene or poorly done prior dental work and fillings.

METABOLISM

Blood sugar may either reduce or rise with excessive and sometimes uncontrollable craving for sugar and starches. Blood sugar may also rise due to excess cortisol, causing diabetes and metabolic disorders. Cholesterol may rise and further increase the risk of heart disease. Malnutrition, muscle atrophy, deterioration, or wasting may result. Obesity or emaciation often results from changes in metabolism. Often misdiagnosed as being undisciplined, lazy, or poor eating habits.

MENTAL

All mental abilities including the 3-r’s (reading, writing and arithmetic) are impaired. Social withdrawal and depression result. Rational thinking is not possible and dementia can occur. Often misdiagnosed as early dementia or "just normal when you get a little older."

SLEEP

IP causes hyperarousal of the central nervous system, which results in inadequate sleep. The result is that the normal biologic process of sleep to make hormones, neurotransmitters, and enzymes is impaired. Often misdiagnosed as "just normal when you get a little older."

MUSCULAR

Muscle mass loss and severe deconditioning of muscles result from a sedentary, or bed-bound existence. Misdiagnosed as being lazy, or unmotivated.

SKELETAL

Movement will usually increase pain, so adequate exercise of the skeletal system does not occur. The result is an inactive existence in which walking, driving, or shopping is restricted. Osteoporosis may result from lack of weight-bearing bone strengthening exercise. Often misdiagnosed as being lazy, or unmotivated.

SPECIAL NOTE:

If you are a patient with Intractable Pain, how many of these misdiagnoses are in your medical records? Perhaps if you went over the list above and your own records with your doctor, you both might be surprised at all the misdiagnoses that have occurred.