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Can Analgesic Electrotherapy Quell The Pain?
A young scientist buddy of mine that I call “Kenni” showed up on my doorstep late last night and I had to admit I was initially taken aback. We were in the middle of a horrible storm (it was really a slight drizzle but that is a storm in Arizona) and it was late for a weeknight for anyone to be out, let alone my mischievous little erudite buddy. “What in the hell are you doing here?” I impolitely asked while motioning her through the door.
“I came across this great machine and I had to get your opinion of it,” she shot back, clutching a relatively small sized box in her hands.
“What is it supposed to do?” I asked.
Looking over her shoulder, as if someone was following her, she shut the door quickly. “It is a morphine machine and I bought it on the Internet.”
“Equine feces,” I exclaimed with the greatest amount of incredulity, throwing my hands up in the air. “Get the hell in here and tell me. What are you talking about? First, there is no such thing and if there were, it would be illegal,” I scolded her. “Secondly, how could you be taken so foolishly of your money?”
She sat the box down on the kitchen island and shot me that smile that revealed her inner glee in maybe finally getting something over on the old neurodog. “Open it up and see for yourself,” she condescendingly commanded. Now I had to admit that my central executive (that’s the little man in the center of your mind believed to be ensconced in the prefrontal cortex that is the ultimate novelty junkie) was piqued. That bad boy lit up quicker than you can say one-Mississippi.
Pulling her wet coat off, she started to tell me about it. “It cost me $250 and it is completely legal. In fact, it will perpetually manufacture morphine as long as you plug it into an AC outlet every so often to give it some juice.” She tossed her coat aside. “I knew you had low back pain and I thought you might want to try it.”
Then she added, “The first treatment is free.”
Now she had gone from a young scientist to a neurotransmitter pusher. Nice. “Will it hurt?” I asked.
“Only if you believe it will,” she said before going on a discourse about nocebos. “It’s all charged and ready to go.”
To show her I was not scared, I moved over to the barstool and pulled up my pant leg with aplomb. Grabbing the device, I placed the electrode over my proximal calf with it centered over my common fibular nerve. I will admit I had a little trepidation as she started to calibrate the device. “Okay, you will feel a little tingle,” she noted. “I want to increase it gradually until it is a strong sensation, but one that is comfortable and tolerable.”
She continued her monitoring and at the same time told me how peripheral nerve stimulation of the sensory nerves will cause an effect in the center of my brain — specifically the periaqueductal gray and the rostroventral medial medulla — and that this stimulation would subsequently activate the descending tracts, mitigating pain perception. So diffusely inhibiting pain transmission in the dorsal spinal cord greatly inhibits nociception.1
Now I am starting to noodle this a little more and self-admitting that this is very cool. Think about this for a minute. The pain is still there but the brain does not recognize it. I wonder if they could build a model for mothers-in-law, pain-in-the-butt spouses, whining kids, etc.?
“So what about the morphine you mentioned?” I inquired.
“How do you think the descending inhibition occurs?” she shot back.
“Neurotransmitters and probably GABA and 5-HT.” (I didn’t want to just say serotonin because I was starting to lose this neuroscience cage fight badly and I needed a rabbit punch to her ears as even a weak counter.) But then the punch came right back at me with the speed of a formula one racecar, and popped me right between the orbits. “The endogenous opioids, silly.”
By then I was flat out on the mat. While my eyes were swollen and nearly shut, they were open just enough to catch a glimpse of what I thought was her raising her stiletto shod foot and aiming for the final parry. Somehow, I managed enough strength to roll quickly away from the descending death dagger.
Popping up with renewed vigor, I landed a huge roundhouse kick on her temporal region, causing her to reel back when I said, “Yeah, that is right but as I recall, these endogenous opioids bind to the δ-opioid receptor and not the μ so they will not counteract the exogenous opioids the patient is taking.”
Pow! Zowie! Boom! I was still a contender in this neuroscience pugilistic endeavor.
Feeling like I had just heard the bell ring for a break in the rounds and that the “cut” man had temporarily stopped the bleeding, I got another jab.
“The stimulus has to be intense enough to cause a strong sensation and cannot be more than 60 minutes because then CSF (cerebrospinal fluid) levels of the opioids start to drop.” That is some damn cool stuff right there and I did not know that. So, I thought to myself, you can measure that with a simple spinal tap. As if a spinal tap is simple. In fact, just saying that gives me the willies and full-blown piloerection on the back of my neck.
So she got the device calibrated to the point where I felt a fairly intense stimulation but nothing intolerable. About 20 minutes later, I noticed that my L4-L5 herniation was no longer talking to me. Well, in truth, it was probably shouting its usually painful cacophony but my brain could not hear it. I had no pain. Wow!
Well, I thought to myself that it had to be a placebo so I slept with the damn thing and woke up the next morning completely pain-free. I took it off for the rest of the day as I had to deal with the Transportation Security Administration that morning. I knew they would slow me down in the line staring at my new little morphine machine like those apes did with the TV in Stanley Kubrick’s 2001: A Space Odyssey. Guess what? My noggin-noodle started to hear the L4-L5 again and I had pain. So when I got back from my trip, I strapped the morphine machine back on, hit the button and watched the blinking light for a few seconds. About 15 minutes later, my central executive couldn’t hear a word those spinal bastards were saying. I had no pain.
I tried this over and over several times with the same result. The morphine machine works.
Now, it is not really called a morphine machine. I think the company was too smart to name it that but they call it “Quell.” Catchy little name, I guess. Good thing I am not in their marketing department because I would have called it something a whole lot cooler than that, maybe the “Pain-o-nater.”
Financial disclosure: I have no financial interest in Quell (NeuroMetrix) but I sure would like to so if any of you corporate folks read this blog, give me a call at 1-800-SHUT-UP-L4-L5.
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