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Neuro? Logical! Forum for all neuro-things => from neuron to brain...

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Old 15-03-2012, 10:36 AM   #1
ste5e
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Default Central Post Stroke pain.

8% of stroke patients can get what is catagorised as Central Post Stroke pain. We occasionally (about 3 per year) get them in our Chronic Pain team and I do not think I do best by them.

1. What interpretation does the Neuromatrix offer for this diagnosis? As the issue is with damage to the I/O system does the model hold?

2. What treatment approaches have folk tried? I am currently at the education and mirror box stage but whilst the box has good short term effect I find any sensory input to the affected part immediately re-instates the pain output. I have looked into Graded Motor Imagery but the cost of 'Recognise' Tm is currently beyond the cash strapped team - especially as it is an annual fee - although I understand NOI to be looking at other ways of allowing access (getting our money) to this product.

Kind thoughts,
Steve
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Old 19-03-2012, 04:05 AM   #2
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Central post stroke pain (CPSP) is perhaps the hardest of all to manage and not trendy for scientists either.
Similar pain neurosignatures are known to exist as in other chronic pain states though interestingly the cingulate cortex seems to have a very strong involvement. The neuromatrix paradigm as part of modern biopsychosocialism would seem to be the best framework to attempt therapy.

Other than supportive anecdotes, we have no data yet on the application of the GMI components to the pain state, though we have been looking at left right discrimation in paraplegics. So not much help yet

Going on the "if the patient was my mother" scenario, I would trial left right discrimination exercises prioir to mirroring. Remember that even a 10% change here could be a win.

I wish to defend the cost of Recognise. The cost of an annual subscription to Recognise is minimal compared to medications. In some chronic neuropathic pain states such as CRPS, the NNTs (number needed to treat) for GMI are much better than far more expensive medications. NOI has funded 6 ongoing studies in left right discrimination from Recognise and Explain Pain revenue. Noone likes to fund research into neuropathic pains which does not involve synthetic pharmacology.
From time to time our Apps are made free to download. The recognise App (iphone only at present) for the feet is currently free. A trial Noimove is also free (google noimove). Its scratchy and need investment but might help someone with CPSP (as with the foot App)

Best of luck with a real pain problem

Cheers

David Butlerr
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Old 19-03-2012, 04:23 AM   #3
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Hi David,
We have a little tradition here of asking first time posters to start a thread about themselves in our Welcome Forum. Not that many don't already know you, but some might not, and it would be great if you would start a thread, introduce yourself, let us welcome you here properly (get a party started!).
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Old 19-03-2012, 02:02 PM   #4
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Thanks for your reply David,
I will be looking to GMI to provide a treatment approach for our next patient with CPSP and follow Lorimer's published protocol for CRPS as starting point. Unfortunately I do not hold the purse strings and will have to argue with those that do. If Recognise becomes available on a per patient basis I will find that easier to justify and the kind people at NOI will let me know if it becomes available like that. We are just with a small team we see such a small intake of patients for whom Recognise would be directly useful. The big block spend is a challenge - although it is my suspicion that if we had it we might try it with a wider group of chronic pain people.
Agreed we have access via the GPs to indefinite funds for prescribed medications of variable and questionable benefit and this approach would be better to trial. But at least we are looking and thinking and trying.
Kind thoughts and keep up the very good work,
Steve.
ps Really enjoyed the grain of sand, sandcastle and sandstone concept.
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Old 20-03-2012, 01:52 PM   #5
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Default Recognise Online

Hi Steve

Here in NB Canada, I have a workman's compensation patient who needed laterality training.

I tested him with the samples available to the public to establish a record of the deficiency.

I then made arrangements with workman's compensation to purchase her a 1 person license for 1 year--about $50 Cdn. She uses this at home.

She can log in on my computer at work and practice, and I can log in on her account (she provided me with the key) to track her progress and assiduity.

Hope this helps.

btw this was a first for WCB.

Mary
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