Neuropathic Pain

Neuropathic Pain

There are a whole host of haunting pains that torment us for reasons we do not understand and that arrive from we know not where – pains without return address. Lord Nelson, the British admiral, los his right arm in an attack on Santa Cruz de Tenerife in 1797. Soon afterward, Ramachandran points out, he vividly began to experience the presence of his arm, a phantom limb that he could feel but not see. Nelson concluded that its presence was “direct evidence for the existence of the soul,” reasoning that if an arm can existe after being removed so then might the whole person exist after the annihilation of the body.

Phantom limbs are troubling because they give rise to a chronic “phantom pain” in 95 percent of amputees that often persists for a lifetime. But how do you remove a pain in an organ that isn't there?

Phantom pains torment soldiers with amputations and people who lose limbs in accidents, but they are also part of a larger class of uncanny pains that have confused doctors for millennia, because they had no known source in the body. Even after routine surgery, some people are left with equally mysterious postoperative pains that last a lifetime. The scientific literature on pain includes stories of women who suffer menstrual cramps and labor pains even after their uteruses have been removed, of men who still feel ulcer pain after the ulcer and its nerve have been cut out, and of people who are left with chronic rectal and hemorrhoidal pain after their rectums were removed. There are stories of people whose bladders were removed who still have an urgent, painful chronic need to urinate. These episodes are comprehensible if we remember that they too are phantom pains, the result of internal organs being “amputated”.

Normal pain, “acute pain,” alerts us to injury or disease by sending a signal to the brain, saying, “This is where you are hurt – attend to it.” But sometimes an injury can damage both our bodily tissues and the nerves in our pain systems, resulting in “neuropathic pain,” for which there is no external cause. Our pain maps get damaged and fire incessant false alarms, making us believe the problem is in our body when it is in our brain. Long after the body has healed, the pain system is still firing and the acute pain has developed an afterlife.

The phantom limb was first proposed by Silas Weir Mitchell, an American physician who tended the wounded at Gettysburg and became intrigued by an epidemic of phantoms. 

Physicians have long known that a patient who expects to get pain relief from a pill often does, even though it is a placebo containing no medication. Illustration by Megan Jorgensen.

Civil War soldiers' wounded arms and legs often turned gangrenous, and in an age before antibiotics, the only way to save the soldier's life was to amputate the limb before the gangrene spread. Soon amputees began to report that their limbs had returned to haunt them. Mitchell first called these experiences “sensory ghosts,” then switched to calling them “phantom limbs.”

They are often very lively entities. Patients who have lost arms can sometimes feel them gesticulating when they talk, waving hello to friends, or reaching spontaneously for a ringing phone.

A few doctors thought the phantom was the product of wishful thinking – a denial of the painful loss of a limb. But most assumed that the nerve endings on the stump end of the lost limb were being stimulated or irritated by movement. Some doctors tried to deal with phantoms by serial amputations, cutting back the limbs – and nerves – farther and father, hoping the phantom might disappear. But after each surgery it reemerged.

Ramachandran had been curious about phantoms since medial school. Then in 1991 he read the paper by Tim Pons and Edward Taub about the final operations on the Silver Spring monkeys. Pons mapped the brains of the monkeys who had had all the sensory input from their arms to their brains eliminated bu deafferentation and found that the brain map for the arm, instead of wasting away, had become active and now processed input from the face – which might be expected because, as Wilder Penfield has shown, the hand and facial maps are side by side.

Ramachandran immediately thought that plasticity might explain phantom limbs because Taub's monkeys and patients with phantom arms were similar. The brain maps for both the monkeys and the patients had been deprived of stimuli from their limbs. Was it possible that the face maps of amputees had invaded the maps for their missing arms, so that when the amputee was touched on the face, he felt his phantom arm? And where, Ramachandran wondered, did Taub's monkeys feel it when their faces were stroked – on their faces, or in their “deafferented” arm?

Pain, like the body image, is created by the brain and projected onto the body. This assertion is contrary to common sense and the traditional neurological view of pain that says that when we are hurt, our pain receptors send a one-way signal to the brain's pain center and that the intensity of pain perceived is proportional to the seriousness of the injury. We assume that pain always files an accurate damage report. This traditional view dates back to the philosopher Descartes, who saw the brain as a passive recipient of pain. But that view was overturned in 1965, when neuroscientists Ronald Melzack (a Canadian who studied phantom limbs and pain) and Patrick Wall (an Englishman who studied pain and plasticity) wrote the most important article in the history of pain. Wall and Melzack's theory asserted that the pain system is spread throughout the brain and spinal cord, and far from being a passive recipient of pain, the brain always controls the pain signals we feel. 

Their “gate control theory of pain” proposed a series of controls, or “gates”, between the site of injury and brain. When pain messages are sent from damaged tissue through the nervous system, they pass through several “gates”, starting in the spinal cord, before they get to the brain. But these messages travel only if the brain gives them “permission,” after determining they are important enough to be let through. If permission is granted, a gate will open and increase the feeling of pain by allowing certain neurons to turn on and transmit their signals. The brain can also close a gate and block the pain signal by releasing endorphins, the narcotics made by the body to quell pain. How much pain we feel is determined in significant part by our brains and minds – our current mood, our past experiences of pain, our psychology, and how serious we think our injury is.

When a mother soothes her hurt child, by stroking and talking sweetly to her, she is helping the child's brain turn down the volume on its pain. Illustration by Megan Jorgensen.

Constrained-Induced Therapy

Constrained-Induced Therapy

The principles of constraint-induced therapy have been applied by a team headed by Dr. Friedemann Pulvermüller in Germany, which worked with Dr. Taub to help stroke patients who have damage to Broca's area and have lost the ability to speak. About 40 percent of patients who have a left hemisphere stroke have this speech aphasia. Some, like Broca's famous aphasia patient, “Tan”, can use only one word; others have more words but are still severely limited. Some do get better spontaneously or get some words back, but it has generally been thought that those who didn't improve within a year couldn't.

What is the equivalent of putting a mitt on the mouth or a sling on speech? Patients with aphasia, like those with arm paralysis, tend to fall back on the equivalent of their “good”arm. They use gestures or draw pictures. If they can speak at all, they tend to say what is easiest over and over.

The “constraint” imposed on aphasiacs is not physical, but it's just as real: a series of language rules. Since behaviour must be shaped, these rules are introduced slowly. Patients play a therapeutic card game. Four people play with thirty-two card, made up of sixteen different pictures, two of each picture. A patient with a card with a rock on it must ask the others for the same picture. At first, the only requirement is that they not point to the card, so as not to reinforce learned nonuse. They are allowed to use any kind of circumlocution, as long as it is verbal. If they want a card with a picture of the sun cnd can't find the word, they are permitted to say “The thing that makes you hot in the day” to get the card they want. Once they get two of a kind, they can discard them. The winner is the player who gets rid of his cards first.

Therapy is always useful. Illustration by Elena.

The next stage is to name the object correctly. Now they must ask a precise question, such as “Can I have the dog card?” Next they must add the person's name and a polite remark: “Mr. Schmidt, may I please have a copy of the sun card?” Later in the training more complex cards are used. Colors and numbers are introduced – a card with three blue socks and two rocks, for instance. At the beginning patients are praised for accomplishing simple tasks; as they progress, only for more difficult ones.

The German team took on a very challenging population – patients who had had their strokes on average 8.3 years before, the very ones whom most had given up on. They studied seventeen patients. Seven in a control group got conventional treatment, simply repeating words; the other ten got CI therapy for language and had to obey the rules of the language game, three hours a day for ten days. Both groups spent the same numbers of hours, then were given standard language tests. In the ten days of treatment, after only thirty-two hours, the CI therapy group had a 30 percent increase in communication. The conventional treatment group had none.

Based on his work with plasticity, Dr. Taub has discovered a number of training principles: training is more effective if the skill closely relates to everyday life; training should be done in increments; and work should be concentrated into a short time, a training technique Dr. Taub calls “massed practice,” which he has found far more effective than long-term but less frequent training.

Many of these same principles are used in “immersion” learning of a foreign language. How many of us have taken language courses over years and not learned as much as when we went to the country and “immersed” ourselves in the language for a far shorter period? Our time spent with people who don't speak our native tongue, forcing us to speak theirs, is the “constraint.” Daily immersion allows us to get “massed practice.” Our accent suggests to others that they may have to use simpler language with us; hence we are incrementally challenged, or shaped. Learned nonuse is thwarted, because our survival depends on communication.

(Midnight Resurrections, The Brain That Changes Itself, by Norman Doidge, M.D., excerpt).

I can see what you want to say. Illustration by Elena.

Love, Grief and Neurology

Love, Grief and Neurology

Love creates a generous state of mind. Because love allows us to experience as pleasurable situations or physical features that we otherwise might not, it also allows us to unlearn negative associations, another plastic phenomenon.

The science of unlearning is a very new one. Because plasticity is competitive, when a person develops a neural network, it becomes efficient and self-sustaining and, like a habit, hard to unlearn. Recall that Merzenich was looking for “an eraser” to help him speed up change and unlearn bad habits.

Different chemistries are involved in learning than in unlearning. When we learn something new, neurons fire together and wire together, and a chemical process occurs at the neuronal level called “long-term potentiation”, or LTP, which strengthens the connections between the neuros. When the brain unlearns associations and disconnects neurons. When the brain unlearns associations and disconnects neurons, another chemical process occurs, called “long-term depression,” or LTD (which has nothing to do with a depressed mood state). Unlearning and weakening connections between neurons is just as plastic a process, and just as important, as learning and strengthening the, If we only strengthened connections, our neuronal networks would get saturated. Evidence suggests that unlearning existing memories is necessary to make room for new memories in our networks.

Unlearning is essential when we are moving from one developmental stage to the next. When at the end of adolescence a girl leaves home to go to college in another state, for example, both she and her parents undergo grief and massive plastic change, as they alter old emotional habits, routines, and self-images.

Love creates a generous state of mind. Illustration by Elena.

Falling in love for the first time also means entering a new developmental stage and demands a massive amount of unlearning. When people commit to each other, they must radically alter their existing and often selfish intentions and modify all other attachments, in order to integrate the new person in their lives. Life now involves ongoing cooperation that requires a plastic reorganization of the brain centers that deal with emotions, sexuality, and the self. Millions of neural networks have to be obliterated and replaced with new ones – one reason that falling in love feels, for so many people, lie a loss of identity. Falling in love may also mean falling out of love with a past love; this too requires unlearning at a neural level.

A man's heart is broken by his first love when his engagement breaks off. He looks at many women, but each pales in comparison to the fiancée he came to believe was his one true love and whose image haunts him. He cannot unlearn the pattern of attraction to his first love. Or a woman married for twenty years becomes a young widow and refuses to date. She cannot imagine she will ever fall in love again, and the idea of “replacing” her husband offends her. Years pass, and her friends tell her it is time to move on, to no avail.

Often such people cannot move on because they cannot yet grieve; the thought of living without the one they love is too painful to bear. In neuroplastic terms, if the romantic or the widow is to begin a new relationship without baggage, each must first rewire billions of connections in their brains. The work of mourning is piecemeal, Freud noted; though reality tells us our loved one is gone, “its orders cannot be obeyed at once.” We grieve by calling up one memory at a time, reliving it, and then letting it go. At a brain level we are turning on each of the neural networks that were wired together to form our perception of the person, experiencing the memory with exceptional vividness, then saying good-bye one network at a time. In grief, we learn to live without the one we love, but the reason this lesson is so hard is that we first must unlearn the idea that the person exists and can still be relied on.

In grief, we learn to live without the one we love. Photograph by Elena.

Acquiring Tastes and Loves. By Norman Doidge.

Intelligence and Judgement

Intelligence is not information alone but also judgement

Please, be polite

You, people, live on a moving platform, the Earth, a lovely and more or less placid place. Most of you respect the Humans and treat them as your equals or almost.  But some of the immigrants on the Earth prefer insult every native-earth-born-creature hey meet and position themselves and superior beings.

But why do you disrespect the Earthlings? In fact, human beings are rather good in understanding the world. It may seem to you that their logic is deficient (and in part it may be true, I grant you this), but they were able to hunt game and build fires to survive. And they figured out how to build a wheel. And they always watched the stars and the flowers.

Remember that in the great Cosmic Ocean there are countless stars and planets, inhabited by millions of civilisations both younger and older than this one, the Human civilisation which has developed in this solar system. 

Yeas, there is a million worlds in the Milky Way Galaxy alone that at this same moment is inhabited by beings who are very different from each other (and many of them much more advanced than the Earth).

But all these worlds have one characteristic in common: they change. And almost all of them change for the better. If you lived on a planet where nothing ever changed, there would be little to do. So if you don’t like Humans because they are ignorant and they do not know a lot about the Universe, you are wrong!

Remember that knowing a great deal is not the same as being smart. Intelligence is not information alone but also judgement, so be polite and respect the Humans! Help them to overcome their difficulties so one day in a very distant future they might be able to help your home world…

Thank you and be polite!

You’ll find below some advice about how to explain to the Humans the external World. If you are a new resident on the Earth, you may find these advice useful.

Don’t forget to register as Newcomer at the Milky Way Galaxy Office for Aliens on the Earth (MWGOAE). Some fees apply.

Signed: Megan Jorgensen, expat on the Earth, born on the star R-1876642-12, Large Magellanic Cloud, representative of the MWGOAE in this Solar system).

Over the dying embers of the campfire, on a moonless night, Humans watched the stars and the flowers. Image : © Megan Jorgensen.

Astronomy for the Astrologer

Astronomy and Astrology

Astronomy for the Astrologer

Are the zodiacal signs real heavenly bodies? Are there other bodies in our solar system that we should know about?

One of the most common and constant complains from the astrological fraternity is that astronomers simply will not even try to understand them. The astrologers assert that the astronomers refuse to examine their evidence. For the most part, astronomers refuse to reply, though in the past some of them have shucked their cloak of dignified silence and made boobs of themselves by trying to disprove statistically “astrological tenets” that no reasonable astrologer ever held in the first place. Thus Dr. J. Allen Hynek, associated with UFO research in the press, upon hearing that astrologers linked Mercury with intellectual activity, set to work with scientific thoroughness and showed there was no significant correlation between a high I.Q. and a strong Mercury position in the horoscope. But then, on the other hand, what astrological theorist ever claimed that there was?

The contention by astrologers that astronomers refuse to review their claims is, to a great extent, true. But there is something to be said for the astronomers, too. To them, the universe contemplated by the astrologer is as much out of date as the physiology known to Hippocrates and Galen. There can be no real objection to looking at the Earth as the center of the solar system, considering the fact that Albert Einstein postulated that what is seen by an observer is, in a relative sense, true for him. But astrologers must ever remember that their view-point is no more than relative and that astronomers are quite justified in asserting that practically no astrologer knows even the rudiments of astronomy.

In these times, advanced astrologers and cosmobiologists are accumulating more and more evidence to support most of the claims made for their ancient science. One particularly important discovery is the one suggesting that forces originating outside of the solar system can have an effect upon chemical substances found in human cellular issue. Evidence such as this is lost upon the astrologer who has no understanding of the cosmos as viewed by an astronomer. This article intended for the astrologer who wants to get up-to-date of what science knows about the physical universe he uses as the basis for his interpretations.

Although the Earth creates an elliptical path around the Sun as far as our solar system is concerned, in relation to the galaxy its actual path is something like that of a corkscrew. This means that at certain seasons of the year, the Sun tends to be between the Earth and the sources of Energy which arise in the galaxy.  Since the blocking effect of the Sun is constant from one year to another, it means that the rate of chemical reactions of the type referred to will vary according to different seasons of the year. It is thought that this may be the fundamental basis for astrology.

If the Sun has such an effect, it is quite likely that the planets do also, perhaps by creating a turbulence in whatever field of energy is being emitted in the Milky Way. That such turbulence exists is evidenced by the fact that RCA Communications has for years been using planetary positions to compute the effect upon their international network.

Most serious astrologers long ago gave up the idea that the planets exert any direct influence on mundane events, but the exact rationale of astrology has remained somewhat of a mystery. For some time, consideration was given to Jung’s theory of synchronism, that is that two events may be related by time instead of causality. With the discoveries now being made, however, it seems that the nature of astrological forces resembles a field effect. By this is meant a situation where two bodies have an effect upon one another, not by virtue of their inherent qualities, but because of the nature of the field in which they exist. In the gravitational theory proposed by Einstein, for instance, two bodies are attracted to one another, not because of their own natures, but because their time-space field makes attraction the path of least resistance for them.

Astrologers used to play big role throughout the history of mankind. Photo by Elena.

To see how this works, take a sheet of cloth and suspend it by its four corners so it is approximately flat. Now put two steel marbles on it. No matter where you place them they will be attracted towards one another. This attraction is due to the depression which they make in the sheet, not because of any direct effect of the marbles upon one another.

Field effect astrology – if we may coin a term – would depend upon an analogous phenomenon. Assume a field of energy originating in our galaxy that has a profound effect upon certain chemicals in the human system. From time to time during the year, the Earth is exposed to varying strengths of that energy due to the shielding effect of the Sun. At the same time, the field is further modified by the presence of planetary bodies orbiting the Sun. In total, the astrological effect is caused not by the action of the planets upon the Earth but by field turbulences of which they serve as signals.

Aside from the astrological effect, there are also astronomical effects, and these can be attributed to the influence of other bodies in the solar system. A well-known instance of this is the sunspot cycle with its period of eleven years. Sunspots are fields of turbulence on the surface of the Sun. Their appearance is accompanied by the emission of large quantities of radiation. It has been shown time and time again the as the level of that energy increases, the Earth’s population as a whole begins to get more and more anxious.

During periods of radiation increase, there is a correlative increase in the number of riots, homicides, and wars. Communications are disturbed. The rate of plant and animal growth is altered. The sunspots increase to their maximum in 11 years. At the end of that time they suddenly subside and begin once more to increase again. There is some evidence that the sunspot cycle may be associated with Jupiter’s period of revolution around the Sun. If this is true, there is another direct effect to be considered.

There is a direct influence of the Moon upon the Earth. It is common knowledge that it causes tides in the oceans. What is not so well known is that it also causes tides on land surfaces as well. The point on Earth directly under the Moon is pulled upwards to a distance of two feet.

Though research at Northwestern University has shown that there is a correlation between the Moon’s phases and certain events in the life cycles of lower animals, there is still considerable debate about its direct effect upon humans. There is a body of empiric knowledge based upon reports of police and fire departments as well as mental hospitals and saloon managers that the Full Moon coincides with a period of aberrant sociological phenomena. So far there is disagreement among researchers who have conducted scientific inquiries into this. There has been at least one report that female admissions to mental hospitals reach their peak on the Full Moon; male admissions peak on the New Moon.

It would appear that phenomena correlating with human behaviour fall into two distinct groups. In the one, there is a direct astronomical influence as in the case of the Sun and Moon. In the other, there is the field effect in an energy stream which is occasioned by planetary positions and the position of the Earth with reference to the source of that energy in the galaxy.

The vernal equinox point, that is where the Sun crosses the equator on its way north is the point at which the zodiac begins. For this reason it is known as the first point of Aries. From this point the zodiac is divided into 12 signs of 30 degrees each.

As you probably know, the constellation that identified the original signs of the zodiac have shifted out of the positions that the held back during the days when astrology was becoming formalized, a period around the second century B.C. This is sometimes advanced as an argument against traditional astrology. Actually it is not. It is quite apparent that it is the division of the ecliptic into 12 equal signs that is important. The fact that certain constellations served to identify those signs a couple of thousand years ago was merely a matter of labelling. As a matter of fact, , we are not even certain at what time the constellation of Aries actually coincided with the segment  of ecliptic now known by that name. Estimates of the exact time made by both astronomers and astrologers range from 317 B.C to 321 A.D. Probably the figure determined by Cyril Fagan – 220 A.D. – is most nearly correct for the time at which the first point of the constellation coincided with the first point of Aries on the fixed or ecliptic zodiac. Since the first point moves backwards, this would mark the time that it was on the verge of moving into Pisces. It will, according to this calculation, move into Aquarius in about 300 years.

Can Astrologers predict the future? Illustration by Elena.

Measuring Positions in the Sky

The Earth turns on its axis at a regular rate, on revolution per day. For convenience geographers divided the Earth into 360 divisions along the equator. Those are called degrees of longitude pass by given point in 24 hours. This is at the rate of 15 degrees per hour or one degree every four minutes.

The particular degree on which you are situated is called your meridian. It is also the highest point that the Sun will reach any day. This is the location of the medium coeli (M.C) or Midheaven. The meridian passes through the zenith or the point in the sky directly over your head. The zenith is always the same number of degrees above the equator which gives them their ship’s latitude.

Sometimes astrologers become confused over the difference between celestial latitude – the distance the body is above or below the ecliptic – and declination. Declination is the number of degrees a body is above or below the celestial equator. The celestial equator is an imaginary line that runs across the heavens directly above the Earth’s equator. If you stand on the Earth’s equator, your zenith is located on the celestial equator.

Another method of measuring positions in the sky is by their hour angle. We saw that the Earth moved at the rate of one degree every four minutes. For us, that means that the heavenly bodies seem to move over our heads at the same rate. We can locate a body by saying how long it will take to reach our meridian or by how long it has been since it passed our meridian.

For instance, let us say that a body is located 15 degrees to the east of our meridian. We know that at the rate of four minutes for each degree, it will take 4 times 15 minutes or one hour to come to our meridian. Thus we say that the body has an hour angle of one hour east. If it had passed the meridian and was 15 degrees away, we would say it was one hour west.

Still one more way of locating celestial bodies is by their right ascension. This term, obscure to most astrologers, means no more than the number of degrees measured east from the first point of Aries to the meridian on which a body lies. This measurement is taken along the celestial equator, however, and not the zodiac or ecliptic. Thus is does not always agree with zodiacal measurement. For instance, a body at 15 degrees of Taurus would be 45 degrees away from the first point of Aries if measured on the ecliptic, but its right ascension, along the celestial equator, would vary with the time of year. Some astrologers use tables of the Sun’s apparent right ascension in progressing horoscopes; they feel that the Sun’s movement in right ascension for one day gives a better correlation with a year of life than does the standard “one-degree” method.

Has astrology anything to do with the real world? Illustration: Megan Jorgensen.