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The Anatomy of Chronic Pain – PART 1

Are you in pain? Have you been looking for ways to be pain-free? Do you understand your pain?

A profound understanding of chronic pains requires an in-depth deconstruction of the nervous system. The nervous system is very complicated; nerves make it possible for the nervous system to send messages to and from the medulla/brain.

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The central nervous system consists of the brain and the spinal cord. The peripheral nervous system is somewhat like a branch-off of the spinal cord, and the peripheral and central nervous systems can be affected by neuropathic pain.

The type of pain that arises as a result of a malfunction in the nerves is referred to as neuropathic pain. The peripheral nervous system has 31 roots that spread from the spinal cord to various parts of the body.

These nerves make it possible for us to feel and move; those responsible for feelings are the sensory nerves, while those responsible for movement are the motor nerves. The spinal cord has various levels, and each has multiple spinal nerves attached.

The cervical level has eight pairs, the thoracic has 12 pairs, the lumbar has five pairs, the sacral has five pairs, and the coccyx has just a pair. The peripheral nervous system is further broken into two categories, namely the somatic and autonomic nervous systems.

The autonomic nervous system is responsible for controlling involuntary actions in the body, making it possible for the heart to function effectively and for us to digest our food without having to think about it.

The somatic nervous system, on the other hand, has nerves that pass to the skin and the musculoskeletal network: bones, ligaments, tendons, muscles, etc. These nerves allow us to feel pain.

If any nerve in our body is sprained or damaged, we develop chronic pain; damaged nerves send an unending stream of pain messages to the brain.

Another essential part of our nerves known as a nociceptor. Understanding certain types of chronic pains requires knowledge about these nociceptors, which are located at our nerve endings activated whenever something triggers pain.

If, peradventure, you got your fingers closed in the car door, the nociceptors in your fingers would be and send a message of pain to the spinal cord and brain through the peripheral nerves.

However, seconds before you slammed your fingers, the nociceptors weren’t activated—why? Because there was no stimuli (or injury) to make the nociceptors respond.

Taking this information into account allows the conclusion that one primary cause of chronic pain is malfunctioning nociceptors; even when there are no direct causes for the pain, nociceptors can still send continuous pain messages to the brain.

Let’s consider the example we used earlier; assume the fingers that got slammed by the car doors were healed, but for some strange reason, you’re still feeling a lot of pain. It may be that the nociceptors located in your hand are malfunctioning.

That is, they’re still sending continuous pain messages to the brain, which could bring about chronic pain.


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Why the World’s Highest Virus Death Rate Is in Europe’s Capital

In an art-deco building in the heart of Brussels, Belgium’s leading scientists gather daily to announce the country’s coronavirus toll. It’s been grim reading.

Despite having only 11 million people, the country has reported more deaths from the disease than China. With some 57 fatalities per 100,000 inhabitants, it has the highest per-capita death rate in the world — almost four times that of the U.S.

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Belgian Toll

Europe’s highest coronavirus death rates are in tiny Belgium


Source: ECDC, data as of April 24

According to Belgian officials, the reason for the grisly figures isn’t overwhelmed hospitals — 43% of intensive-care beds were vacant even at the peak of the crisis — but the country’s bureaucratic rigor.

Unlike many other countries, the home of the European Union’s top institutions counts deaths at nursing homes even if there wasn’t a confirmed infection.

“We often get criticism — oh, you’re making Belgium look bad — we think it’s the opposite,” Steven Van Gucht, head of the viral disease division at the Sciensano public-health institute, said while maintaining the requisite distance of 1.5 meters (5 feet). “If you want to compare our numbers with a lot of other countries, you basically have to cut them in half.”

Clearer Picture

About 95% of Covid-19 deaths in elderly care homes haven’t been diagnosed, yet Belgium makes the decision to register them based on the symptoms shown and who the people have been in contact with. The goal is to get a clearer picture of the outbreak and better target hot spots.

At the start of each briefing at the Residence Palais, a stone’s throw from the European Commission, Belgian officials detail the day’s statistics in French and Dutch. They draw particular attention to those who die outside of hospitals — typically around half the total.

The impact of the disease on vulnerable care-home residents is a growing issue. While Europe knew it would need more ventilators and intensive-care capacity once the virus spread beyond China, the impact on nursing homes was unexpected, according to Agoritsa Baka, a senior expert at the European Centre for Disease Prevention and Control.

“It’s a disaster,” she said. “We did not realize how devastating Covid would be if it entered these populations.”

Excess Mortality

Yet not all European countries are measuring the impact in the same way, meaning that the numbers of coronavirus deaths are likely thousands higher than the official count of more than 110,000.

The consequence of uneven practices was evident in France. When the country reported data from some nursing homes for the first time in early April, those fatalities were almost double the number of people that died in hospitals.

Last week, Spain had to adjust its historical data after Catalonia started including people who had symptoms but didn’t test positive. This week a local radio broadcaster reported that more than 6,800 elderly died in Spanish nursing homes with symptoms but weren’t recorded in official data.

Germany’s unusually low mortality rate may be helped by the fact that the country only counts deaths that have a positive virus test.

Such discrepancies show up in a concept called “excess mortality,” the number of extra fatalities above typical trends. In Belgium, just over 300 people normally die every day, but this year, it’s jumped to nearly 600.

A project called euroMOMO, originally developed for gauging the scale of flu epidemics, is now being used to track the impact of the coronavirus in Europe.

Good Surveillance

Belgium’s practice means that nearly all deaths are accounted for in a given week, while neighboring Netherlands has around 1,000 undefined fatalities. Some countries’ virus deaths are around a sixth of their excess mortality rates.

Better tracking could help improve Europe’s response to outbreaks, especially as the region gradually eases lockdown restrictions, raising the prospect of second-wave outbreaks. Coordinated procedures could also defuse tensions as Europe grapples with recovery efforts.

“We are still in a situation where within the EU we do not count the same way, which could lead to political misunderstandings,” said Pascal Canfin, chair of EU Parliament’s environment and health committee. “It leads to different perception awareness of the crisis.”

In the meantime, the world’s eyes shouldn’t be focused on Belgium because at least the extent of the problem is known, according to Van Gucht.

“When you have a good surveillance system, you report a lot of cases,” he said. “It’s the countries that are not reporting or that are reporting very low numbers, you should be more worried about.”


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