Prospects for Pain

I saw orthopedic specialists. I also attended a lot of physical therapy. Within a couple of months, what was an acute pain morphed into more frequent discomfort. In the course of two years, it morphed into neuropathy. The pain was in my feet. particularly, my feet swelled. Then the pain began to increase in my body. It was a rising pain. It affected my ankles, my thighs. It was able to move to my hands and shoulders. It worked my legs.

It was also the beginning of a lengthy journey. The trip involved visiting 20 different doctors in one of the best institutions in America.

The time this happened was when I was by profession as a lawyer and banker. I was between my careers and had three daughters, and it happened, and the experience quickly changed my life.

I was prescribed medication. I was taking morphine, I was also on gabapentin as well as Lyrica, as well as Cymbalta. These antidepressants have proven to help nerve pain. I did not experience any relief. The treatment that was offered to me did not have any result on the pain in any way whatsoever.

I would often sleep. My wife had a pillow over the door, which read, “Baby sleeping.” And for a couple of years, I was Rip Van Winkle. I would sleep through my daughter’s graduation. I was unable to perform on any level as the medical professionals I visited typically had no clue. It was simply not understood what was going on with this neuropathy.

When I was rushing between doctors and between physical therapy and the gym, I was working to go back to what my previous normal was. I would spend hours in pools. I was an athletic athlete. I would attempt, and whenever I exercised, it would take me into a dark, painful place because of the discomfort.

Then I began to believe that this was all mental and I was insane. I went to several psychologists as well as one psychiatrist. It was similar to, “Well, this guy’s middle-aged. He’s fast, is a type A, so the reason he’s suffering from a breakdown like an emotional breakdown.”

After some time, I began to believe in it. I’m sure my family also began to believe in it. However, it didn’t make any sense to me since everything was brought on by an injury to the back. This is what I went back to time and time. There’s something happening there that we can’t detect, that we aren’t able to pinpoint it even remotely.

Over the course of a few months, the pain got so severe that I felt like I could not bear it. My feet were on the edge of burning, and they were red and bright, and I’d struggle to walk. I used to have a Relax the Back chair that I set up on the back of our porch, and I used it to sleep frequently. I was unable to wear shoes.

I grew to be awestruck by an entirely new language which is what I call the pain language. There is severe pain or chronic neuropathy, and lancinating pain. It’s a horrible feeling, similar to being stabbed with an Ice pick. The pain is throbbing, itching, burning, pulsing, and most importantly extreme pain that’s caused by even the slightest contact.

In the midst of my suffering, My wife would accidentally fall over during the night and only barely rub against me. I would emerge from the bed after a long night of deep sleep and scream to the highest of voices.

However, I discovered that I was unable to find relief with medication. The toughest part about the neuropathy is that it’s nearly impossible to cure.

I’ve been meditating, and then I entered an extremely deep zone of contemplation because when my pain was getting worse, I’d have to lie down in the fetal position and remain in that position for a long time. In the wake of this, I began writing poems. And then, I went back to college and completed an MFA in poetry. I found different methods to get through the day.

When pain is a factor for the majority of people, it forces them to an extremely inner space. I write poetry. I am very busy with my family, including my immediate family, and with my grandchildren and children. The world around me, in many ways, diminished, but my inner world was larger.

So I think of it this way. I do my best to minimize stressful situations. I don’t overexercise. I stay away from social situations that can be stressful. I take a few medications, including certain antidepressants from the past, as they work on calming the nerves that are hyperactive. However, I don’t actually use a lot of medication. I live my life, and then, when discomfort comes up, I allow myself to feel it to stay with it.

I’ve realized now that it will go away. If you remain in the present, you’re fine, regardless of how severe the pain is. If you continue to think about it in your head until the next day, the pain could turn into an unstoppable monster that can’t be defeated.

Rachel Gotbaum: This is “Intention to Treat” from the New England Journal of Medicine. I’m Rachel Gotbaum.

I’m now joined by Dr. Stephen Waxman. He’s the director of Yale’s Center for Neuroscience and Regeneration Research at Yale University. He’s here to discuss the publication of a study within The Journal, which describes the most innovative approach to the treatment of pain.

Dr. Waxman, what’s currently in our arsenal? why should we be hoping for the development of a new class of medication?

Stephen Waxman Stephen Waxman: We have opiates. We have NSAIDs as well as GABAoid drugs. If you visit the office of a neurologist or walk around the wards at hospitals, you’ll find a huge gap in the treatment of neuropathic pain as well as inflammatory pain.

These drugs can be effective, but they’re never 100% efficient. They have a lot of adverse negative effects. They also have a pressing need to develop innovative, more efficient non-addictive pain treatment.

Rachel Gotbaum: Opiates are a major issue for many people.

Stephen Waxman opioids comprise a significant class of drugs, but they also cause GI adverse consequences. When they’re taken in the highest doses, they reduce the effects of mentation. In some kinds of pain, they’re only effective in a limited way and have a high potential for addiction. I don’t need to speak to you about the opioid crisis.

This leaves a huge demand for a different class of drugs that do not trigger adverse effects on the central nervous system consequences and doesn’t have the potential to become addictive. And that’s where this specific study comes into play since it’s a totally innovative mechanism that works, a totally new class of drugs that does not impact the central nervous system.

Rachel Gotbaum: Let’s discuss this study about the effects of these drugs and what makes them different.

Stephen Waxman: One of the mainstays of neurophysiology is the fact that sodium channels, small molecular batteries, are vital to generate neuronal impulses and muscles, as well as also in pain-signaling peripheral neurons that supply our body with energy.

The significance of this discovery is that it is a research study of the effects of the sodium channel, which isn’t present in the heart, and isn’t found in the nervous system’s central part, also known as the brain.

What transpired when the molecular revolution began to take shape was that it became apparent that there was not one kind of sodium channel. There are several kinds. When it became evident that there were several types of sodium channels, the following question was whether there was one sodium channel or a number of sodium channels that were essential in the firing and functioning of the peripheral pain-sensing neuron; however, they did not play an important role within the heart, or central nervous system?


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