Seeing Pain New approach to diagnosing and treating nerve damage Chris McCurdy TEDxUM
When I was a young child I lost my favorite uncle to alcohol abuse. It made me wonder why does this happen? How can someone be consumed by a substance that’s around us all the time? So, I made it my life’s mission to become a drug expert, and I went to pharmacy school. I went to pharmacy school to understand what it is about drugs.
That can make us heal or can hurt us. When I was in pharmacy school, I found out I fell in love with the research. Not only did I fall in love with the research I fell in love with this passion to educate others. And so, knowing that, I had to move forward. I had to move forward with my education so that I could carry those things out of my future;.
And I went on and earned a ate in medicinal chemistry; that’s drug design not designer drugs. (Laughter) That enabled me to move forward and really pursue some of the basis of drug abuse and addiction. Here I am now, a professor of medicinal chemistry and pharmacology. And I’ve dedicated my career to solving problems in drug abuse and actually finding better pain medications.
Because after all, pain is the most common reason that individuals seek medical care. It’s also the most common reason that we end up with drug abuse and addiction. Moving from there, I’ve been able to establish a laboratory here, at the University of Mississippi, where we’ve done a lot of groundbreaking work that I’ll get to in a little bit to move us forward in those endeavors.
Now, how many people here have had to seek medical treatment that resulted in pain prescription? Yes, most all of us. How many of you ended up getting something like morphine, or codeine, or Hydrocodone, or Oxycontin? Yeah. Any of you had to take that for more than 2 or 3 weeks, maybe a month, maybe a couple?.
If so, there’s a high likelihood your body became physically dependent. So why does that mean? What do we mean when we talk about physical dependence and drug abuse? Let’s define these things a little more clearly. So drug abuse is simply the concept that you take a drug out of the context that it was prescribed. So, every now and then, all of us are guilty of taking a little more ibuprofen, or something, than it says on the bottle.
That’s drug abuse. If you’ve had to take chronic pain medications, particularly, opioidbased medications, over time, your body doesn’t respond as effectively, and you have to increase the dose to relieve the pain. That”s a phenomenon called tolerance. Tolerance: when it occurs, actually means that our body has become now physically changed and dependent.
Small Fiber Neuropathy Symptoms Diagnosis and Treatment
Small fiber neuropathy is really an interesting condition because it consists typically of just burning, numbness, pain of the feet, sometimes the hands later on without necessarily having any abnormalities on your EMG or nerve conduction study. So what I tell patients and actually residents or students who train under us is that a normal nerve conduction study does not exclude a neuropathy. And we will confirm this by doing additional testing, specifically the nervous the the examination at the bedside asking patients about their symptoms, for example, loss of sensation to cool or or hot temperatures, loss of pain sensation and also doing skin biopsies where we look at nerve densities in the skin both.
From the calf and the thigh as well as doing a special test that looks at sweat function both in your foot in in the legs as well as the feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typically will progress unless the underlying cause is identified and reversed. Diabetes of course being the most common cause is always screened for. But once the more common causes are excluded and the focus becomes on excluding any underlying secondary disease process but also controlling pain because if patients’ symptoms of pain are generally controlled they tend to do pretty well and really have no other major functional deficits. I’ve really become interested over the years is how interconnected neurology.
And rheumatology are and one thing I often do on patients who have unexplained small fiber even autonomic neuropathy is have them see rheumatology or get evaluated for connective tissue disorders like lupus or Sjogren’s or sarcoid and sometimes even if we are not directly involved in treating the patients, this can be the first sign of an underlying connective tissue disorder that can then be brought to the attention of rheumatology and addressed from their standpoint.