Chronic Hand Pain

Chronic Hand Pain

Question:

> BTW, until you’ve exhausted EVERYTHING reasonably available to you > (in Arnoff and Bianchi), DO NOT TRY TREATMENTS THAT ARE UNPROOVEN! > (I know several homeopaths that will claim that they can help. Yes, > carpul tunnel syndrome can appear to be ‘healed’, that is, a patient > becomes asymptomatic. However, one must ask how long have they > followed their patients?) Also, there is NO DOCUMENTABLE EVIDENCE > that the alternative medicines, except for accupuncture are > effective for relieving CTS.

Once again, your bugaboo. First off, this is not a dangerous illness, so alternative therapies carry next to no risk (especially compared to pinhead ideas like taking TCA’s for wrist pain). Secondarily, your idea of documentable evidence is statistical in nature, not based on direct science. Where is there any DOCUMENTABLE EVIDENCE that any of the conventional treatements are more than marginally effective? Carpal tunnel syndrome is a symptomatic category, so the idea that "healing" involves something other than symptom relief (ignoring holistic views) is contradictory. Since no organic disease is at fault, removal of pain <is> cure, as the conventional paradigm understands it. I guess only if an MD eliminates the pain, is it considered a cure, by this rationale. Try separating biomechanical disorders from infectious or progressive chronic diseases when you’re posting your hysterical conservatism about alternative healing.

Response:

> Another remedy that’s available over the counter is Capsacian cream. > It’s basically the heat of jalopeno peppers. It’s trade-name is > Zostrix cream. It’s expensive. Start with the low dose, and work up. > Apply this cream to where you feel the pain. You will feel some > burning sensation as it dries. However it DOES have some rare side > effects. I experienced a severe burning after it dried, when I > swetted over the region where I applied the cream. It’s believed to > be a substance-p depletor.

Capsicum cream? There are a host of liniments that could be used, but I am interested in what you mean by a "substance-p depletor." Please elaborate.

Response:

> > Another remedy that’s available over the counter is Capsacian cream. > > It’s basically the heat of jalopeno peppers. It’s trade-name is > > Zostrix cream. It’s expensive. Start with the low dose, and work up. > > Apply this cream to where you feel the pain. You will feel some > > burning sensation as it dries. However it DOES have some rare side > > effects. I experienced a severe burning after it dried, when I > > swetted over the region where I applied the cream. It’s believed to > > be a substance-p depletor. > > Capsicum cream? There are a host of liniments that could be used, but I am > interested in what you mean by a "substance-p depletor." Please elaborate. > First of all, I shall give my cites. Bonicia wrote a text, "The Management of the Chronic Pain Patient". Arnoff wrote a similar text on chronic pain. Both texts go into a description of the physiology of chronic pain, and into this hypothesis. When a nerve experiences pain (as I am in right now), it is hypothesized that the nerve emits essentially a chemical signal (into the synapse) to signal the presence of pain. So far, the physiologists haven’t been able to properly describe this substance, all they’ve been able to do is to verify that such a substance is probably emitted. What capsacian is believed to do is interfere with the transmission of substance-p. Now, I know this is a case where practice is ahead of theory. All the pharmacologists can really tell you is that it works and they’re beginning to perhaps understand why.

Response:

Paul, EVERYTHING contains an element of risk. What I promote is for people to UNDERSTAND what the risks and benefits are. Well, the risk of homeopathy is that someone may delay seeking out more appropriate medical treatment. I have personally witnessed this. There’s another risk, that of the pocketbook. Money, time and patience are limited resources. I might waste money pursuing an alternative therapy that has no prooven benefit for my condition, while not pursuing one that does. (In fact, I did just that. I saw a homeopath for a year, with absolutely no results, for I continued to deteriorate dramatically. I read in a medical textbook on the management of chronic pain about the use of accupuncture, and tried it. I knew what the risks were and (infection), how to avoid the risks and was able to objectively measure it’s benefits. (In fact, I’m quite mad at my homeopath, because he never really sat down with me and explained the risks of homeopathy. Nor did he refer me to accupuncture, despite the fact he was well aware of it’s use for people like me. He referred me to an accupuncturist ONLY when it was obvious that I was no longer going to see him. The person he referred me to was someone who lived 8 hours drive away, that I could not possibly get to. There happened to be two master Chinese accupuncturists within three miles of my house.) People DO need to know about the risks and benefits of a practice. They do need to get information on conventional AND alternative practices. They do need to know what’s experimental and what’s not. What I’m asking for Paul, is truth in advertising. I’m not condoning homeopathy per se, I’m asking that those promoting it fairly and accurately represent their case. The same goes for TCM, chiropractic AND conventional medicine. Paul, know what your talking about before you open your big trap and fairly and accurately represent your POV.

Response:

> >Paul, know what your talking about before you open your big trap and >fairly and accurately represent your POV. > Hey Paul, I gotta agree with Quadruple Zero here. Get yourself a > subscription to the pre-eminent academic journal of this era, > Consumer Reports, before you post again.

Unfortunately, although I’m a finch-breeder, the great need for cage-lining materials is handled by my newspaper habits. Thanks for the recommendation, though. BTW, is there a Chinese version? Maybe then I’d at least <learn> something. – "How deeply the cry of a bird can move us–any cry that is cried out whole." -Ranier Marie Rilke

Response:

>shape. When it comes to carpal tunnel surgery, people are very much better >off delaying treatment, since this surgery is in the process of being >abandoned as ineffectual.

Paul, now long term readers here will confirm that I do not jump in like ole 000000 to demand data when people post about alternative therapies. I agree that such posts become trying. However, when people make empiric claims comparing alternative tehrapy with some OTHER therapy or critical assessments of allopathy, I believe, as the lawyers say, you have "opened the door to a line of questioning". You claim here that CT release surgery is in the "process of being abandoned as ineffectual". Is this true? Really? On what do you base this empiric claim. I say you’re full of it. I think in appropriate cases it is highly effective and, if anything cases are on the rise.

Response:

> However, when people make empiric claims comparing alternative tehrapy > with some OTHER therapy or critical assessments of allopathy, I believe, > as the lawyers say, you have "opened the door to a line of questioning". > You claim here that CT release surgery is in the "process of being > abandoned as ineffectual". Is this true? Really? On what do you base > this empiric claim.

I base this tidbit on the information I have received from my sister, who is an OT and a certified hand therapist, bud. She has attended the latest conferences, and it is being recognized that chiros and PT’s and OT’s have been right–the problem is often in the shoulders, not the CT. Not only that, but CT surgery has a miserable record of success. The old bromide applies: when all you have is a hammer, the whole world looks like a nail. Look before you leap. – "Most people listen in the wrong direction." -Martin Heidegger

Response:

>I base this tidbit on the information I have received from my sister, who is >an OT and a certified hand therapist, bud.

Well, there you have it. I stand corrected . . . NOT. Outcome of carpal tunnel surgery in Washington State workers’compensation. American Journal of Industrial Medicine, 1994 Apr, 25(4):527-36 "Relief of pain was complete or modest in 86% (124/145) and only 14% of cases reported no improvement in symptoms." [after CT surgery] Results of treatment of severe carpal tunnel syndrome. Journal of Hand Surgery. American Volume, 1992 Nov, 17(6):1020-3. 14/15 hands with SEVERE CTS (muscle atrophy) had improvement with return of muscle function and bulk. Long-term results of carpal tunnel decompression. Assessment of 60 cases. Journal of Hand Surgery. British Volume, 1993 Aug, 18(4):471-4. "The results were generally favourable with a variable degree of improvement in 86% [of 60] cases." >She has attended the latest conferences, and >it is being recognized that chiros and PT’s and OT’s have been right–the >problem is often in the shoulders, not the CT. Not only that, but CT >surgery has a miserable record of success.

This is clearly false. It may be the case that people are realizing (as always happens) that a once homogeneous disease is really several disorders and that only some of those may respond to CT release. But "miserable record of success" – I think not . . . BUD. Perhaps she could say who made these erroneous statements at the conferences and on what they based their conclusions about the efficacy of CT surgery. I hope they had more to go on than their sister’s say so. >The old bromide applies: when all you have is a hammer, the whole world looks >like a nail.

This is absolutely TRUE. That’s why we need good research to sort out people who can really help vs. those who are just going around with their favorite hammer . . . no matter how dilute that hammer may be.

Response: