Woolf thus began to explore the many ways in which neurons in different brain regions communicate; how they form a greater number of synapses, linking regions that are not normally hot-wired to work in concert; and how those neural changes lead to the perception of pain. He saw that the regions of the brain that responded to acute, experimental pain were different from the regions that were involved in chronic pain. Over the next three decades, Woolf explored the relationship between specific gene phenotypes and chronic pain, looking for potential targets for drug therapy.
It would be slow-going, in part because pharmaceutical companies were profitably selling opioid analgesics. B rain activity in subjects with chronic pain was different from the nociception perception of harm evident in patients with experimentally induced pain, for instance, a hot poker placed on a sensitive part of the arm. The prefrontal cortex dictates higher-level thinking, including goal-setting and decision-making, while the limbic regions, including the hippocampus and the nucleus accumbens, govern memory, motivation and pleasure.
In those who had suffered for five years, both the hippocampus and the prefrontal cortex were structurally transformed, sacrificing 5 to 11 per cent of their grey matter density.
That was important because the prefrontal cortex, in concert with the hippocampus, dictates how optimistic or depressed patients feel about their prospects, how well they can cope and make decisions about treatment. The brain of a person with lower-back pain looks different from that of a person with a repetitive-stress injury. Subsequently, more than 50 studies, most from other investigators, have documented regional decreases in grey matter density, volume or thickness.
Beyond that, the neuronal network of the remaining grey matter is rearranged, in patterns that are specific to chronic-pain conditions. That means, for instance, that the brain of a person with lower-back pain will look different from that of a person with a repetitive-stress injury. At least one other aspect of brain activity is transformed in people with chronic pain. This much-enhanced level of communication between the two regions represents a profound reorganisation of neuronal connections.
Both environmental and hereditary factors are likely involved, Woolf has found. Woolf hopes that once the nerve cells are established, they will be valuable for pre-screening patients to see who has the physical and biochemical traits that make it likely they will develop chronic pain. Scientists suspect that shared genetic background is the reason that pain hypersensitivity often runs in families. The enzyme catechol-O-methyltransferase COMT is essential to the production of several stress-related neurotransmitters, including dopamine, norepinephrine and epinephrine, each of which is involved in modulating mood and cognition.
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One variant of COMT produces a slower-acting enzyme that leaves a flood of dopamine intact within the synapse, a condition that is associated with a very high level of stress. People who inherit that slow-acting COMT variant can be especially emotional and pain-sensitive. At least one study has shown that patients with this pain-busting biology recover much more successfully from spine surgery than their ultrasensitive brethren.
The most significant change in evaluating chronic pain, observes Tracey, is the understanding that chronic pain is a different animal from nociceptive pain. Now we think of chronic pain as a shift to another place, with different mechanisms, such as changes in genetic expression, chemical release, neurophysiology and wiring.
One explanation for the phenomenon of central sensitisation is that when an injury has afflicted some aspect of the peripheral nervous system, neurons in the central nervous system can also become agitated. This bumped-up signal-to-noise ratio can result in increased activation of calcium channels, the molecular pores that govern the flow of calcium ions across the cell membrane.
This boosts the number of chemical messages travelling between nerve cells. A final hypothesis suggests that central sensitisation reflects a type of neurobiological learning disorder: essentially, the brain is misinterpreting pain messages, which are never dismissed, but continue to travel endlessly from PNS to CNS, leaving the brain unable to set a new course. Some researchers have remarked that central sensitisation can be understood as a form of classical conditioning: just as the Russian physiologist Ivan Pavlov conditioned his dogs to salivate when a bell was paired with food, and then to salivate when the bell alone was heard, the body that has learned to experience pain in response to insult or injury continues to experience it in response to inconsequential stimuli.
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Recent research has revealed what many patients know all too well: chronic back pain is often accompanied by other types of pain, including headaches, other musculoskeletal disorders, temporomandibular joint disorders, fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome. People who develop central sensitisation can also find light, noise or smells unusually disturbing, or display hypervigilance.follow
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Anxiety, stress and depression are problems for an estimated 30 to 45 per cent of patients with chronic back pain, and an even higher percentage of back-pain patients who experienced early childhood adversity. If you wish to get past the terror, you are going to have to follow pain deep into its lair. One would think that opioid analgesics would be helpful in calming an agitated and dysregulated nervous system, but this premise has been debunked.
Historically, NIH has dedicated only 1 per cent of its research budget to pain science-related investigations. But with opioid treatment on the skids, and profits sinking, finding new therapeutic targets is suddenly very attractive. D rug targets are still on the horizon. But many pain psychologists and rehab specialists believe that central sensitisation can be successfully treated with a combination of cognitive behavioural therapy CBT and graded, non-pain-contingent exercise.
While researching my book Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery , I listened to hundreds of back-pain patients explain their chronic pain: they spoke of degenerative disc disease, herniated discs, pinched nerves, sciatica, spondylolisthesis, scoliosis and spinal stenosis. Madrid had the same number of academy players on the pitch as Ajax at kick-off on Tuesday night.
The great cash-flashing short-termists have more home-grown first-team players than Manchester City, Liverpool and Manchester United. Outsourced stars, self-generated talent, brand building: Madrid are simply a high-functioning model, driving elite club football from the front seat since the s. But this is still recognisably a football club owned, like Ajax, by its members, an entity that exists simply to play and to win, not to enrich third parties or act as a soft power tool.
Football needs them, too. Madrid give us an absolute. We cherish these pantomime villains. Ramos may resemble the impossibly handsome fitness instructor who seduces your wife and daughters just so he can steal your favourite pair of socks — and then throw them away as he zooms off on his Vespa laughing. Real Madrid are not the enemies of football.
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Boredom and entropy are the enemies of football. As are corrupt administrators, publicity-seeking political entities. Madrid, by contrast, are heat and light, an undying fascination. These are changing times too. That wonderful Ajax team will be pulled apart before long, and not only by Madrid themselves. The Fiver: sign up and get our daily football email. Part of the attraction was public address announcer Jeff Pope. At least Pope was able to stay in the arena.
Real Madrid’s reign is over: now is the time to salute, not mock them
Those are just a few of that many special moments for the franchise that endeared the orange-and-blue to their fans. Through the years rooting for the team, Saddlemire became friends with Frank Orton of Ontario via Chino. The auction for game-worn jerseys is quite a tradition.
Several times a year, the Reign partners with local charities and the fans respond.
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Remember Colton Teuber? And, without a doubt, it was Pope, in a tuxedo, that created the furor at the auction that drove the price up. By far, it was a goal by Colton Yellow Horn that many fans recall as the most special moment.