Reddit reviews Stahl's Illustrated Chronic Pain and Fibromyalgia

Sorry for the length. You had lots of questions and thus I have lots of answers. The numbers really do not mean anything besides helping me write this.

 
 
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1. Propranolol. It is kinda like Propranolol and kind of not I will try to explain.
   
   

• Beta Norepinephrine Nerve Cells are cells mostly below the neck that operate bodily function such as your heart and lungs, your muscles, your digestive system. Some Beta Cells when exposed to higher levels of norepinephrine increase your heart rate and such. Propranolol is a beta blocker, it blocks some (but not all) of these receptors so the higher levels of norepinephrine do not trigger the higher heart rate or feelings of panic.
  
  
• Alpha 2 Norepinephrine Nerve Cells are mostly in your brain. There are multiple types of Alpha 2 receptors. A specific subtype of Alpha 2 receptors are called Alpha 2a which is located at your brainstem, your frontal lobe, your limbic system, and the cerebellum. When the Alpha2a receptor is triggered it increases electrical activity in these brain regions and clears up the electrical noise, this is the desired effect for ADHD. Alpha 2 receptors also serve another function, they tell your body when they have too much norepinephrine and to slow down or stop pumping it out. Alpha 2 agonists make these receptors easier to activate, thus you have less norepinephrine floating around to trigger things like your beta receptors which can increase blood pressure, heart rate, and feelings of anxiety.
  
   
   
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2. Alpha 2 drugs such as Intuniv have been used for ADHD since the mid 80s. During this time these uses were considered off label for things like stimulants were more effective and the FDA signaled this. It is only in the last decade that the drug company has made ER (extended release) formulations that lasts multiple hours, and the ER versions of Alpha 2 drugs are much more effective than the IR versions. Some studies show close (but not superior) effectiveness to stimulants in some but not all aspects of ADHD, thus the FDA approved these drugs as a primary treatment for ADHD and as well as used as a combination . Multiple doctors are not familiar with all the new ADHD medications since many drugs are 12 years old or less. Here is a list of new FDA approved onlabel ADHD meds and when they were approved, Link.
   Here is a list of many meds used to treat ADHD
   
    
    
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3. Yes I have an autoimmune related issue called Ankylosing Spondylitis. My body attacks my joints and causes bone to form there, even if treated it causes chronic inflammation and pain sensitivity. It is in a family of autoimmune problems called Spondyloarthropathy, including JRA, Inflammatory Bowel Disease, Crohn's, Ulcerative Colitis, inflammation of the Tendons, and many others. Many people with Spondyloarthropathy have the HLA-B27 gene, half of my extended family has one form of Spondyloarhtroapy.
   
    
    
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4. I have Sensory Processing Issues since the age of 2, 15 years earlier prior to my autoimmune issues. There are many causes of sensory issues and we are only beginning to start to understand them. Two developments in the last 10 to 15 years is we now have two new medications for specific subset of sensory issues called neuropathic pain. Neuropathic pain is when you experience painful stimuli from things that should not cause painful stimuli. There are many causes of neuropathic pain such as autoimmune I issues (like my AS), diabetes, vitamin deficiency (such as the b vitamins and the omega 3 fatty acids used to repair nerve cells), infection, fibromyalgia and a few others.
   The new developments is the use of SNRIs and two specific anti-convulsants called pregabalin and gabapentin. We have learned that specific serotonin and norepinephrine receptors modulate what is the pain threshold to go up traveling up the spinal cord, thus by using an SNRI we can change what this threshold of pain is thus weakening or eliminating certain types of pain. Oh SNRIs also do other things in the brain not spinal cord that help with pain.
   With the anti-convulsants pregabalin and gabapentin they work a different way. You have multiple types of sensory nerve fibers, and you have specialized subsections for painful nerves called Aδ. These anticonvulsants meds make the threshold to send the pain signal be higher before the pain signal goes up the spinal cord.
   Now two last important things about sensory processing. The other sensory nerve cells not related to pain have something called a myelin sheath that acts as insulation for those nerves. This sheath speeds up the nerve signal but also insulates the nerves so they do not by accident trigger the painful nerve types by crosstalk. Things like inflammation or certain nutrient deficiencies change how the body repairs this myelin sheath and thus you get far more cross talk. The most extreme form of this is Multiple Sclerosis is a condition where this myelin sheath is not repaired and you get painful symptoms and cognitive decline. I am not saying you have MS but just trying to illuminate a point by showing the most extreme form of it.
   The other part of the sensory processing is how you can modulate the nerve signals with things such as pressure (blankets and vest) and other forms of sensory input such as a TENS unit. Remember you have multiple sensory nerves, well they all come to a “gate” where they combine into one type of nerve. Well this nerve can only except one type of input at a time so it prefers to send the nonpainful signal for often this information is more important than the painful signal (things like pressure, balance, temperature etc). This is called the Gate Theory of Pain, and many OT / PT teach ways you can trigger the nonpainful versions like vests and blankets to autistic and asperger children.
   
   This book is a good explanation of treating types of painStahl's Illustrated Chronic Pain and Fibromyalgia
   Here is two samples, Chapter 2: Neurobiology of Pain and Chapter 5: Pain Drugs
   Note he has a similar one for ADHD which I reviewed here and posted sample material Link. Both of these books require some medical knowledge but not a medical degree to understand (late high school, early college level of biology). The pictures, graphs, tables and diagrams are invaluable for explaining everything.
   
   One last thing both of thoses type of meds I listed above the SNRIs and the anticonvulsants are often given to Aspergers or Austistic kids anyway for they work as mood stabilizers, depression, and many forms of anxiety such as social anxiety disorder, panic disorder, and generalized anxiety disorder. Those two types of meds reduce symptoms in about 50% of patients.
   I am personally on Cymbalta, I was put onto it this year when I switched docs for my autoimmune problem, my new doc knew this type of stuff but my old doc did not for it was far too recent for him.
   
    
    
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5. Immune problems modulate the brain. When your brain notices lots of immune triggers it thinks your body is sick and it starts doing things to conserve energy but these things are anti-productive for focus, planning, and mental flexibility.
   While some immune responses repair the brain, others when overexposed can actually be neurotoxic.
   Think of you having a cold or flu, were you really wanting to solve math problems during that time? Not all that mental grogginess is the fever talking. Autoimmune problems do not cause ADHD, they just make ADHD worse. Autoimmune problems seem to be more common in Asperger/autistic patients.
   Furthermore we know that chronic inflammation and/or chronic pain can lead to depression and depression causes changes in the brain that make ADHD worse. In fact we now have neuroimaging that if this depression or chronic pain is untreated it leads to reduction in the gray matter in the brain in specific spots and half of those spots are ADHD affected brain regions. (The brain regions connected to ADHD that are decreased are the Dorsolateral Prefrontal Cortex, the Anterior Cingulate Cortex, and the Striatum of the Basal Ganglia; non ADHD regions are the Brainstem and the amygdala which has to do with emotions, pain, fear)
   
   Good Luck with your Son.