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• Adhesive Arachnoiditis in lumbar-sacral region
• Multiple degenerated and protruding intervertebral discs  
• Arachnoiditis/neuropathy of cervical region 

• Post-acute viral infection of Epstein Barr or other viruses 
• Mixed connective tissue disease 
• Systemic Lupus Erythematosus 

• Ehlers Danlos Syndromes (EDS)
• Ankylosing spondylitis
• Scoliosis   

• Reflex Sympathetic Dystrophy (Chronic Regional Pain Syndrome, or CRPS)
• Metabolic, including severe diabetes. 
• Post trauma
• Vascular occlusion 

• Accident
• Stroke 
• Infection 

• Vertebral 
• Joint  

* Degenerative arthritis as referred to here is not the “garden variety” osteoarthritis caused by normal wear, tears, and aging, but severe degeneration of bone coverings and the bone, itself.

• Porphyria 
• Marfan Syndrome
• Wilson's Disease 
• Scleroderma
• Abdominal adhesions
• Others 

In recent years, specific disease treatments have made the following diseases uncommon causes of IP: 

• Interstitial Cystitis 
• Sickle Cell Anemia 
• Rheumatoid arthritis
• Psoriatic arthritis
• Ulcerative colitis 
• Regional enteritis 
• Cancer
• Osteoporosis 

• Many individuals may have multiple interconnecting and overlapping causes of IP. For example, Ehlers Danlos Syndromes (EDS) may cause Adhesive Arachnoiditis, neuropathies, degenerative arthritis, and autoimmunity.
• Viral autoimmunity may cause a variety of IP conditions, including fibromyalgia, arthritis, neuropathies, irritable bowel, migraine, and SCIDS. 
• Degenerated protruding discs may produce spinal canal stenosis and nerve compression pain. 

"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 

• 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. 

• 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.

• 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. 

• 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. 

• 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. 

• 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. 

• 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."

• 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." 

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

• 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. 

   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.