Monday, February 16, 2009

Neuropathic Pain

As said before, I've spent many years as a medicinal chemist. At the most basic level, most of my job consisted of me being a glorified cook e.g. putting molecules together to form new molecules to be tested as possible drugs. A lot of my time would be spent trying to purify what I made. We would have regular project meetings consisting of us chemists, biochemists, pharmacologists, metabolism experts and later toxicologists to discuss our findings. This work would be considered 'preclinical' and our whole purpose would be to identify an agent and several back-ups to move up to the next level. We always had a target approach to a given disease like 'serotonin re-uptake-inhibitors for the treatment of depression". That isn't something that I worked on, just a very common project many drug companies had. We were interested in how a drug worked at the cellular level. We were very far removed from the actual patient that would take our potential drug although that was the whole purpose of our job. We would attend lectures from clinicians occasionally about how the disease impacts the patient. Of course number of patients, what our market share would be, etc would be very important to the company (any company). Malaria for instance, affects more patients world-wide than any other disease but sadly not much of a market as these patients on the whole, can not pay for drugs. Hyperlipidemia however is widespread among people who could pay and is a chronic condition so the patients would have to take the drug for the rest of their lives so this is a 'good' target.

One of the areas I did work on targeted neuropathic pain. Basically, as I was told, there are two categories of pain: nociceptive pain which they categorize as 'good' pain and neuropathic pain
'bad pain'. You put your hand on a hot object and experience nociceptive pain. Your decayed tooth develops an abscess and inflames a near-by nerve. More nociceptive pain. This pain serves a purpose and can be readily eradicated (most of the time) by several classes of drugs. Neuropathic pain serves no purpose and is thought to due to damage to the nerve itself. It is also very difficult to treat. An example of neuropathic pain is 'phantom limb syndrome'. The patient still feels intense pain in his amputated leg even though the limb is gone. It is due to damage of the nerve itself. The most common form of neuropathic pain is thought to be a major component of fibromyalgia, a disease one of my cousins has and it greatly complicates and diminishes the quality of her life. It is poorly misunderstood and since it strikes mainly women, some clinicians are skeptical about its existence. Pain in general is hard to prove. If you have a broken arm or an abscessed tooth, they probably will believe that you have pain. But if there is no damage that they can see, who can prove you have pain or how severe it is as it is so subjective. I had severe cramps as a teenager and was very distressed to read at the time that this was a figment of my imagination-the medical thinking of the 60s. No knowledge of prostaglandins then. If it could not be explained, it did not exist.

Of the many sources of neuropathic pain, I never heard of Taxol being one of them during my time on the project, but now as a patient, indeed this is happening. Somehow Taxol is messing with my nerves and my perception of pain. My feet feel as I've been walking for miles (and in the past I've walked and/or ran for miles and have not felt this sore) but I have barely moved in the last few days. Nociceptive agents are useless. It is fortunately lessening and I have only two more poisonings to go. If the damage becomes permanent, I know what drugs to ask for. I was shocked that these drugs have not been offered to my cousin.

Josh came over yesterday morning. In return of us caring for Sunny, his hyperactive German shepherd, he will stay with Naomi the next week so that is a relief. It is a toss-up which job is more difficult. Naomi was in a good mood as she did meet up with Dontae ( I should have known that he wasn't named after the Italian poet) and he bought her lots of presents. She insisted he was there only for dinner as her friends were having a 'girls night out'.

I met up with the 'moms' for our brunch. I unfortunately selected a place that had a very long line. It was nice catching up with their travels. Sometimes though, it makes me sad as I feel some of them are uncomfortable dealing with me and they actually turn away from me when they speak. I know they don't mean to and I am just being hypersensitive but it is does happen in groups. I try not to be morbid so they won't be uncomfortable.

I then went to see Naomi play in a scrimmage against the team that won States (Grosse Pointe North) in the Class A division (ours). They did fine and it seemed Naomi was getting her game back. She has the day off today (records day-no end of holidays for these kids) No break from bball though. Generally only Saturday is free from that.

Steve and I watched more Foyle's War (Thank-you yet again Teri). Generally what I like and what he likes do not intersect but he seems to appreciate the historical aspects of the show. The last episode focused around the Nazi sympathizers in England during WWII. Foyle is a police detective solving murder cases but there are plenty of complications amidst a historic backdrop.

1 comment:

S. F. Heron said...

I'm trying to think of some simple home remedies to ease your discomfort a little. Try soaking your feet in warm water with Epsom salts. Also, heat up a little bit of hand or foot lotion in a microwaveable bowl for about 10 seconds. Use this heated lotion to massage your feet.

Are you warm enough? Add a fuzzy pair of socks. I feel my aches and pains so much more when I'm chilled.

Thinking of you,


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