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I’ve just read a very interesting article in The New Yorker by Atul Gawande, entitled The Itch.  The article itself is worth reading.  Itching is a really bizarre sensation that we all get. Think of it, A touch has to be very deep and hard to cause discomfort.  But a tiny sensation like a bug’s leg or hair brushing against us can set off a really uncomfortable feeling, so uncomfortable that we claw at ourselves to experience relief.  Even more odd, we just have to THINK about a bug walking on the back of our neck, or a hair brushing against us to start itching (OK, how many of you  have the urge to scratch right now?  You’re not alone, an experiment chronicled in the article took an audience and showed them crawly videos like ticks, fleas, and feathers, then showed them benign videos.  The audiences were filmed and they definitely scratched more with the first videos).  In this way, itching seems to have more in common with hunger and sexual arousal and other sensations that we can bring on by thinking about them, rather than with pain (thinking of getting punched in the nose doesn’t make your nose hurt).
So, it is speculated that itching is actually something that happens in the brain.  Somehow, your brain gets confused into thinking that something is irritating a part of your body, and it sends out the “scratch” message.  Here’s where the article got really fascinating to me.

There are a lot of conditions that I see in patients that share the same characteristics.  Fibromyalgia, TMJ, tinnitus (ringing in ears), repetitive strain injury, chronic back or neck pains, pelvic pains and vaginal pain and a whole slew of other pain conditions.  They are what I call “hyper-vigilant” conditions. It takes only a little stimulus, or sometimes no perceptible stimulus at all, to trigger the discomfort.  Many times, these patients are hyper-vigilant generally.  They startle easily, they are sensitive to noises, smells or touch, and they are sensitive to medications, that is, tiny doses of medications (even natural ones) have major effects, sometimes toxic effects. 
 
I treat these conditions basically as if I’m treating a centralized, or global form of what used to be called “reflex sympathetic dystrophy”.  This is a condition in which local
fight-or-flight nerves get so stimulated that an area of the body (usually a limb) gets very painful, even to the lightest touch.  To my observation, many of the conditions I mentioned come from patients getting over-stimulated by something traumatic (an accident, injury, emotional or physical trauma). The brain seems to generalize this so that any stimulus, even tiny ones, set off the same fight-or-flight response, the same pain response or the same muscle spasm or inflammatory response.  Eventually, even thoughts of a stimulus trigger a response, and it doesn’t stop.
In conventional settings, many of these conditions can’t be measured or tested,  Thus, these patients are treated as if they have a psychiatric condition (although why depression would cause ear-ringing in one patient, vaginal pain on another and wrist inflammation in another is beyond me).  Or, they’re treated with local treatment (wrist splints, or muscle relaxants, or pain-relieving creams).  In my experience these measures work briefly and incompletely, if at all.

But what if all of these patients have a problem with their brain signaling, and not with the local areas?  What if the brain has gotten a message that the particular area of the body is being threatened, and it responds to the threat with pain, spasm, inflammation and other “appropriate” responses?  What if we can develop ways of quantifying the brain response, and retraining the brain to stop thinking it’s under attack?

These ideas open up all new areas of study and of therapy, even as they ask questions that are in need of answering.  In later posts I’ll touch on some of these new ideas.

And OK, I”ll say it, we’ve just scratched the surface of our knowledge of these conditions and how the brain is involved.  And I, for one, am itching to know more.

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