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Post-traumatic Hyperirritability Syndrome

Post-traumatic Hyperirritability Syndrome

This syndrome follows a major trauma, such as an automobile accident, a fall, or a severe blow to the body that is apparently sufficient to injure the sensory modulation mechanisms of the spinal cord or brain stem. The patients have constant pain, which may be exacerbated by the vibration of a moving vehicle, by the slamming of a door, by a loud noise (a firecracker at close range), by jarring (bumping into something or being jostled), by mild thumps (a pat on the back), by severe pain (a TrP injection), by prolonged physical activity, and by emotional stress (such as anger). Recovery from such stimulation is slow. Even with mild exacerbations, it may take the patient many minutes or hours to return to the baseline pain level. Severe exacerbation of pain may require days, weeks, or longer to return to baseline.

These patients almost always give a history of having coped well in life prior to their injury, having paid no more attention to pain than did their friends and family. They were no more sensitive to these stimuli than other persons. From the moment of the initial trauma, however, pain suddenly became the focus of life. They must pay close attention to the avoidance of strong sensory stimuli; they must limit activity because even mild to moderate muscular stress or fatigue intensifies the pain. Efforts to increase exercise tolerance may be self-defeating. Such patients, who suffer greatly, are poorly understood and, through no fault of their own, are difficult to help.

In these patients, the sensory nervous system behaves much as the motor system does when the spinal cord has lost supraspinal inhibition. In the latter, a strong sensory input of almost any kind can activate non-specific motor activity for an extended period of time. Similarly, in these patients, a strong sensory input can increase the excitability of the nociceptive system for long periods. In addition, these patients may show lability of the autonomic nervous system with skin temperature changes and swelling that resolve with inactivation of regional TrPs. Since routine medical examination of these suffering patients fails to show any organic cause for their symptoms, they are often relegated to “crock” status.

Any additional fall or motor vehicle accident that would ordinarily be considered minor can severely exacerbate the hyperirritability syndrome for years. Unfortunately, with successive traumas, the individual may become increasingly vulnerable to subsequent trauma. A frequent finding is a series of motor vehicle accidents over a period of several years.
Fibromyalgia

Patients with fibromyalgia are predominantly female (73-88%). Men and women are nearly equally likely to have myofascial pain syndromes. The patient with an acute myofascial pain syndrome typically can identify the onset precisely as to time and place. Usually the muscle was subjected to momentary overload, e.g. an automobile accident, a near fall, a sudden and vigorous movement (sports activity), moving a heavy box, reaching over to pick something up from the floor, or getting into an automobile, although there may be a lag of several hours to a day after the initiating event before pain appears. Patients with chronic myofascial pain may have difficulty identifying the onset so clearly. These patients are likely to have more than a single myofascial pain syndrome. In contrast, the symptoms of fibromyalgia typically develop insidiously; these patients usually can identify no specific moment in time when their symptoms began. Thus, the onset of myofascial pain characteristically relates much more strongly to muscular activity and specific movements than does fibromyalgia.
References:
Margoles M. 1983. Stress neuromyelopathic pain syndrome (SNPS): Report of 333 patients. J Neuro Ortho Surg 4(4):317-322. This is an older but very important study using the term “stress neuromyelopathic pain syndrome” for what Travell and Simons describe in their later texts as “post-traumatic hyperirritability syndrome.” The authors agree that these are the same conditions. This condition can be caused by severe or repeated trauma especially to the head, neck and back, but can also be caused by biochemical trauma. This author found that patients with this condition often have low levels of B vitamins but may not respond to oral supplements, and 30-50% of these patients have abnormally high vitamin A. Eating foods high in vitamin A could lead to a flaring of symptoms. This condition often starts locally but can spread to overlapping pain patterns. Clinical findings are clearly specified, and the fact that this can often be mistakenly diagnosed as neuropathy caused by disc problem when the disc is not the cause at all, but the metabolic changes that this syndrome has brought about.
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