Midlands Pain Seminar

Fiona Ashworth presented the 2013 Midlands Pain Seminar on 3 October 2013 at the Maypole House in Birmingham.


She was joined by Dr Carl Grindulis, rheumatologist, and Dr George Harrison, both of Birmingham.


Dr Grindulis gave a précis of the history of fibromyalgia and in particular that in 1992 it was listed in ICD 10 at M79.7.  He described that there was a wide range of associated problems and that often patients can be sent to individual specialities without realising that the patient is suffering from one complaint.


He pointed out that there was a familial pre-disposition and genetic vulnerability to the development of fibromyalgia and sexual abuse also increased the risk of fibromyalgia.


He discussed the definition by the American College of Rheumatology in 1990 and also in 2010.  


He described that there was a substance P which is normally blocked by the brain which occurred in fibromyalgia and this gets through and is picked up as pain.  MRI scans on the brain show that the anterior cingulat cortex is overactive in fibromyalgia and there is lack of inhibition in fibromyalgia sufferers.


The pain thresholds decrease with insomnia.  Pregabolin reduces substance P.


Dr Harrison pointed out that pain is very subjective and it is impossible to show.  He described that receptors convert input into electrical pulses.  Where there is an injury there is an inflammatory response and local release of inflammatory compounds due to changes in the body.  These are transmitted along the spinal cord and released at the synapses.  It is possible that the production of proteins can change and there can be permanent changes.  Within a short time there can be changes in the spinal cord which can have long-lasting consequences.  These alter the resting state of the cell and they become easier to excite.  The level of stimulus required to cause pain is therefore less.  The cells set off spontaneously.  It is therefore possible to have pain without pathology, for example, phantom limb pain.  Fibromyalgia is recognised as being the most appropriate model to work on for a drug treatment for central sensitisation.  


It is also possible that there can be re-wiring so that a soft touch cell can behave as a pain cell.


Soft tissues involve nerves which supply muscles and the skin.  These can be very close to the facet joints.  The facet joint can be forced out of alignment and it is possible to find sensory changes.  These small nerves are not picked up by nerve conduction studies.


Fiona Ashworth described the difficulties that were faced by lawyers in spotting the evolution of chronic pain conditions.  She emphasised that the initial medical report should not be overly relied upon and is usually massively optimistic.  It is quite possible for a condition to become chronic and not to settle and further that there can be an evolution of a more widespread pain condition.


The seminar was very well attended and well received.  The satisfaction with the event was 100%, very good or excellent.

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