Nerdy stuff: menstruation, hormones, pregnancy, and pain

This is a brain-dump and research-blurch I just did for a compatriot. These are issues that come up occasionally — every 28 days, for many — and always deserve good answers. Lots of links to scientific articles here.

Mouse brain neurons, two pairs, stained flame yellow against red background
Image by neurollero on flickr, CC share-alike attribution license.
There has been little research on women’s experiences of CRPS in terms of menstruation and pregnancy & breastfeeding. Gee, surprise surprise!
So I’m working to come at the issue sideways: looking for info on hormonal changes during menstruation & during pregnancy, and the effects that those hormones have on deep or central pain. Tedious, but possible. 
Also, I only have access to those articles which are publicly available. Many are kept under wraps because it’s one way that labs protect their intellectual property, sigh. 
PAIN & CHEMICAL-MESSENGER BASICS

Pain-related cytokines (this is old information, so these studies are old, but still informative):
“Recent findings on how proinflammatory cytokines cause pain”
https://www.sciencedirect.com/science/article/abs/pii/S0304394003013879
This article specifically cites 3 main culprits in neuropathic pain: IL-1beta (interleukin 1-beta), IL-6 (interluekin 6), and TNF-alpha (tumor necrosis factor alpha, which does a lot more than kill tumors!)

The publicly-available articles on cytokines’ role in pain are abundant from the early part of the millenium (1999-2010) but seem to disappear after 2013. I assume a lot of patentable activity is going on about it now, and given the usual lead-time on drug development, may not be available even for human trials for at least 5 more years.
Your pain specialist should be able to pull up more recent articles to share with your OB-GYN about that.

“Oxytocin – A Multifunctional Analgesic for Chronic Deep Tissue Pain” 2015
https://www.ingentaconnect.com/content/ben/cpd/2015/00000021/00000007/art00008

“Oxytocin and the modulation of pain experience: Implications for chronic pain management” 2015
https://www.sciencedirect.com/science/article/pii/S0149763415001177

MENSTRUAL CYCLE

Pain-related cytokine & hormonal changes around menstruation:
“Impact of Gender and Menstrual Cycle Phase on Plasma Cytokine Concentrations”
https://www.karger.com/Article/Abstract/107423
Women always have more pain cytokines than men, but they have more still during the luteal phase of the cycle, right after the egg is released (a.k.a. premenstrual phase) and leads to menses.

Since there’s so little science on menstruation in those with pain disorders, I include an article on menstruation & cytokines which explicitly draws a conclusion that *menstrual tissue itself* is the cytokine trigger (and endometriosis is basically an exaggeration of it), a conclusion which does support our experience of higher levels of CRPS pain with menses:
“Menstruation pulls the trigger for inflammation and pain in endometriosis”
https://www.sciencedirect.com/science/article/abs/pii/S0165614715000449

PREGNANCY & BREASTFEEDING

Breastfeeding confers protection against noxious brain chemistry:
“A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health”
https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-2-6
Has loads of references. It’s from 2007, but it’s so approachable I want you to have it anyway. Besides, the chemistry of our bodies hasn’t changed, only our understanding has increased.

Here’s an update by the same original author:
“The new paradigm for depression in new mothers: Current findings on maternal depression, breastfeeding and resiliency across the lifespan” 2015
https://search.informit.com.au/documentSummary;dn=283392990281695;res=IELHEA
It may be risky to include this, depending on your OB/GYN, because of the brutalizing confusion and ignorance around depression — widely seen as a character flaw and sign of weakness, when it’s just an overwhelming neurochemical state, and incidentally overlaps significantly with the overwhelming neurochemical state of neurogenic/central pain. In short, things that alleviate/mitigate depression also usually alleviate/mitigate central pain. It’s very simple.

GOOD TO KNOW

Let me give you two names to pass on to doctors willing to learn, for great info on CRPS: R.J. Schwartzmann, who retired in 2012 but whose work remains the most intelligent and articulate among CRPS researchers; and currently Breuhl and van Rijn are doing good work too.
More articles listed here by a trained 2dary researcher: https://elleandtheautognome.wordpress.com/crps-frequently-asked-questions-faq/

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Query: where have all the good studies gone?

I wonder why so much money gets thrown at the same basic studies over and over again. My personal hair-puller is the ones that call for subjects “with chronic CRPS, with only one affected limb.” They must be testing the same dozen people over and over and over again. Wait, they can’t, because if the subjects have chronic CRPS with only one limb affected, they’re either about to get better or much worse.

It’s all very well to keep re-proving a treatment until a level of acceptance is reached, but there are more effective and cheaper avenues — and much richer ones — that are passed by, in favor of flogging a handful of horses who are, at best, unconscious.

It has been too long since significant effort has gone into much more basic research: by and large, we’re still working with the scientific equivalent of the horse collar, when it comes to pain management — not the Ferrari. In fact, it’s unclear to me why we’re still fixated on management, when we need to think in terms of cure. Most chronic pain is needless.

If we knew more about the relevant neurochemistry and cellular metabolism, we’d be in a MUCH better position to figure out when NSAIDS, lido, shock, acupuncture, spinal cord stim, or ketamine comas will work, and when they’ll just be another doorway into hell.

Can you imagine how much money — and misery, and time — it would save to have a short list of things to try, based not on each doctor’s semi-religious leanings or equipment contracts, but based on each body’s signal framework and chemical signature?

Dreaming is free. Studies require funding. Follow the money, and unfortunately the reasons behind all this brutal silliness become clear.

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File-sharing ~= sex, fecal transplants, and bacterial cognition

This is the richest, most fascinating article I’ve read about life, the biosphere and everything:

http://www.miller-mccune.com/science-environment/bacteria-r-us-23628/

Now that’s a writer with ADD, putting all that into one contiguous piece — but also she’s got one hell of a gift, to make it so coherent and approachable. I want to be like Valerie when I grow up!

I’m completely blown away. I’m going to go for a bus ride so I can explain to the air how thrilling bacteria are. After all, I have to take the bus ride anyway, so I might as well scare people off.

I am in paroxysms of bio-geek delight!

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Scientific method & infant studies

Further thoughts on this article which revealed, to every parent’s astonishment I’m sure, that babies remember what upsets them and learn to hope for less in the future:
http://www.physorg.com/news201964561.html
My first, suppressed response was a huge internal “WTHF??? Who’d do
that deliberately??”
But I was a nurse for years — I know what people will do deliberately and I won’t go into it here, especially since I just had a tasty breakfast.
My second thought was the one reflecting my training, which tells me that if it isn’t repeated in a number of controlled scientific experiments, it’s not accepted medical knowledge (document, document, document!), and if it’s not accepted scientifically, it won’t be accepted as good parenting practice.
grrrrrrrrrrrrrrrrrrrr… But I digress.
On the one hand, I’m glad that a few OBs might suggest that parents hang onto their infants instead of handling them like awkward, smelly little responsibilities to be managed with as little face-time as possible.
On the other, I find it profoundly, horribly wrong to tell young parents to walk away from their screaming baby and stay there while we stab or slash the kid to get a few blood samples, and then come back again later to do it all again.
Because heaven knows you can’t just watch the painful reality of life unfold naturally. That would require the assumption, antithetical to scientific method’s assumptions, that observation and empathy in a real-world setting (where sometimes kids get put down for real reasons) is a valid basis for drawing conclusions.
I could go on about psychogenic shock, neurological development, early bonding, the isolationist shift in child-rearing advice over 30 years, the current puzzlement among psychologists about the staggering proportion of young adults who are incapable of empathy, the weirdness of the fact that most of the world is toilet-trained by ~2 but here we’re rarely trained by 4… And so on.
But that could take awhile and my iPhone is starting to make my fingertips sting.

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Lovely note to start on

Pisses me off that almost all the studies done on CRPS insist on recruiting subjects (that is, patients) who have only one affected limb!  This specifically precludes a huge proportion of us. Unrealistic & stupid.

Happily (and never was the word less apt), RSDS.org is doing a 20-year study on the natural history of CRPS.  With luck, that might change the general focus to something more realistic. It only takes practice about, oh, 10-15 years to catch up with the data.

Frkn one-affected-limb-only.  Sheesh.  Bloody amateurs.

If I had a massive gift to endow, I’d create scholarships for people with CRPS to get all the support & equipment they need to complete medical school, medically-related advanced degrees, whatever it takes.

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