- Email: [email protected]
Obtaining automated diagnostic information and pain relief
Medical Hypotheses Medical Hypotheses (1995) 45, 389-391 © Pearson ProfessionalLtd 1995
Obtaining Automated Diagnostic Information and Pain Relief H. W. COLLINS 2401 S. Summerlin Avenue, Orlando, Florida 32806, USA. (Tel" (407) 841-9458)
Abstract - - The silent confluent flow of a conglomerate of sensory related signals is automatically delegated to the total specific distribution of a single spinal nerve. This silent confluent flow may be accessed, evaluated, and modified by using intradermal saline infiltration to stimulate the sensory receptors located in the skin overlying its nerve root. An unmistakable augmented burst of infiltration pain immediately followed by profound long lasting pain relief identifies a spinal nerve monitoring peripheral pathology. The identification of a monitoring spinal nerve tentatively confirms the presence of pathology confined to the specific peripheral distribution of that specific spinal nerve. The practically unknown visceral distribution proves to be specific and visceral pathology echoes through its collated spinal nerve without patent variation. Practically cost free and without side effects or contraindications dermatomal infiltration opens a whole new chapter in the field of diagnosis as it may be used to determine the presence of pathology, to locate that pathology to the specific distribution of a specific spinal nerve or nerves, and to produce unequalled pain relief.
Observations of the results obtained by sublesional infiltration of herpes zoster At one time sublesional injection of corticosteroid was recommended for the treatment of herpes zoster (1). During the process of this treatment it was noted that if only the skin overlying the nerve root was infiltrated the infected nerve could be identified by an unmistakable augmented burst of pain from infiltration. The initial augmented burst of infiltration pain was followed immediately by profound long lasting pain relief of all of the herpetic lesions. The infiltration accomplished with saline alone produced pain relief equal to the infiltration of a corticosteroid diluted with a local anesthetic. Even when herpetic lesions were confined to the cutaneous distribution of
the fifth cranial nerve they were still found to be monitored by specific cervical spinal nerves. When chest or abdominal locations exhibited herpetic lesions some patients alluded to a deep seated discomfort that was not fully appreciated until it had been relieved by the infiltration. That this deep seated discomfort was relieved by the infiltration of an element of a single spinal nerve not only suggests that herpes zoster may have some elements that are three-dimensional but that spinal nerves have a specific sensory visceral distribution. In summary, it may be said that in the disease process of herpes zoster a spinal nerve monitoring pathology may be identified by an unmistakable burst of augmented pain during intradermal infiltration of the skin overlying its nerve root. This burst of infiltration
D a t e received 22 N o v e m b e r 1994 Date accepted 12 M a y 1995
389
390 pain is immediately followed by profound pain relief. Observations suggest that the entire sensory distribution of a single spinal nerve is specific and its peripheral distribution may contain elements that are cutaneous, somatic and visceral.
Terminology During the dream time of medicine the collated composites of numerous cases of herpes zoster plotted the dermatomes distribution. The lesions overlying the nerve root tied the dermatomes to their adjacent vertebral bodies for which they were named and numbered. The term dermatome has fallen into disuse as much of its original meaning is now expressed as the cutaneous distribution of a spinal nerve. To better express the intent of this presentation the term dermatome is resurrected and further expanded. The meaning of the term dermatome is expanded to include the automated confluent flow of a conglomerate of sensory related signals that arrive from the central and peripheral nervous system that are automatically collated and segmented to the specific distribution of single spinal nerves. Intradermal saline infiltration may be used to stimulate the sensory receptors in skin overlying its nerve root to access, evaluate, and to modify this confluent flow. Intradermal infiltration of the skin overlying the nerve root is termed dermatomal infiltration.
Theory That the dermatome's automated function is outlined by its behavior as observed in the disease process of herpes zoster. A dermatome entwined in the confluent flow of sensory related signals altered by peripheral pathology is termed to be a monitoring dermatome. A monitoring dermatome normally silent may be identified by its response to dermatomal infiltration with an obligatory burst of unmistakable augmented pain that is immediately followed by long-term profound pain relief. The identification of a monitoring dermatome tentatively confirms the presence of demonstrable peripheral pathology and fixes that pathology to be within that dermatome's spinal nerves specific cutaneous, somatic, or visceral distributions.
Methodology Intradermal normal saline infiltration of the skin
MEDICAL HYPOTHESES
overlying the nerve root is a good choice for adding stimuli to the confluent flow. This location spans the flow of sensory related impulses from the entire peripheral distribution, saline is free of specific pharmaceutical activity, it avoids deeper structures, and is easily standardized and duplicated. Dermatomes suspected of being in the monitoring mode are probed by using a syringe with a fine needle and a constant rate of infiltration to carefully produce small intradermal blebs with normal saline or if preferred a dilute local anesthetic. These intradermal blebs are placed on centers of about 1 cm and in a vertical line about 2 cm lateral to the mid-spine. To ensure that all of the monitoring dermatomes are covered infiltration is extended one bleb beyond the junction of the skin producing an augmented response. Cutaneous and somatic pathology usually is not much of a diagnostic problem because the pain arising from these locations is presented with specific location information. The selection of unilateral dermatomes to be infiltrated for cutaneous and somatic pain relief is simplified as the location of the pain may be correlated with the known peripheral distribution. Since visceral pain is presented without specific location information the specific visceral distribution of dermatomes remains largely unknown. The bilateral pairs of monitoring dermatomes to be probed for visceral pathology must be selected more or less on the basis of diagnostic intuition and trial and error. Meager clinical information that echoes from patient to patient without variation suggests that the pharynx is monitored at C 3, the heart at T 4-5, the gastric area at T 6-7, with the duodenal and renal areas being monitored at L 4-5. Monitoring dermatomes have been identified and the infiltration has resulted in pain relief in clinical situations as varied as otitis media to pyelonephritis, from peptic ulcers to myocardial infarctions, and from burns to carcinomatosis.
Dermatomal infiltration for pain relief Case report Following the removal of a cap from a hot radiator a 32-year-old robust male was in severe pain from 2% burns of his right hand and forearm. The dermatomes involved were determined by the cutaneous distribution of the burn. A total of 0.5 ml of normal saline was infiltrated unilaterally into the monitoring dermatomes. Probing of the adjacent non-involved dermatomes produced a more muted response. Relief of pain was immediate and was followed by a shock-like state alleviated by elevation of the feet. After the burns were dressed the patient was able to safely drive and
OBTAININGAUTOMATEDDIAGNOSTICINFORMATIONAND PAIN RELIEF
to complete his work day. Without the recurrence of pain recovery was uneventful.
391
Dermatomal infiltration avoided the necessity of using narcotics and the patient was able to safely complete his work day and to recover from his burn in relative comfort. The development of the shock-like picture demonstrates a side effect occasionally seen as the result of profound pain relief.
abdominal pain recurred at about weekly intervals and was relieved at each recurrence by bilateral saline infiltration of dermatomes both at T6-7 and L3--4. The infiltration of either set of dermatomes at T6-7 or L3-4 alone did not appreciably change the perceived magnitude of the pain. The patient explained that when the pain did recur the situation would change in less than 1 hour from a state of no pain to almost unbearable pain. On the patient' s third hospital admission endoscopy revealed both a duodenal and gastric ulcer.
Case report
Discussion
A 19-year-old male presented with pharyngitis, dysphagia and rather severe dehydration. Blood samples taken produced results that confirmed the diagnosis of infectious mononucleosis. Because of lack of necessary finances or insurance hospitalization was not a preferable option. Dermatomes were found to be in the monitoring mode at C-3. Bilateral infiltration produced immediate relief of the patient's pain and dysphagia. To cover secondary infections antibiotics were prescribed. The patient eagerly drank over 1 L of water before leaving the office. The patients' recovery was rapid and there was no recurrence of pain or difficulty in swallowing.
It was intriguing that pain that was thought to arise from a single pathological source was monitored by two sets of dermatomes so far apart and that just the infiltration of either set of these dermatomes alone produced little or no change in the perceived abdominal pain. There is no apparent explanation of why pain relief lasts so long or why in this case the pain of the gastric and duodenal ulcers recurred on the same time schedule. Unlike cutaneous and somatic pain visceral pathology produces pain that is presented without locating information. For this reason, as sometimes happens even with competent consultants and the best of intentions, the patient's first two admissions were concluded without a sustainable specific diagnosis. If it had been known at that time that the gastric area is monitored by dermatomes T6-7 and the duodenal area is monitored at L3-4 then perhaps endoscopy would have been performed on the patient's first hospital admission. The patient would have been spared two hospital admissions, a colon workup, two gastroenterology consultations, and three surgical consultations. In conclusion it may be said that the ability to confine the presence of pathology to the known specific visceral distribution of specific dermatomes will go a long way to make the selection of definitive and appropriate diagnostic studies more likely.
Discussion
Discussion Without the relief of pain and dysphagia the patient' s severe state of dehydration would have made hospitalization mandatory. It is doubtful that 1 or 2 days of the usual hospital therapy for dehydration secondary to infectious mononucleosis would have produced more clinical improvement than that accomplished by dermatomal infiltration in a matter of minutes.
Diagnostic potential verified Case report A surgical and gastroenterology consult was obtained on each of three hospital admissions of an elderly female suffering abdominal pain. The patient's severe
Reference 1. Epstein E. Triamcinolone injections in herpes zoster lesions. JAMA 1970; 207: 69-73.
Obtaining Automated Diagnostic Information and Pain Relief H. W. COLLINS 2401 S. Summerlin Avenue, Orlando, Florida 32806, USA. (Tel" (407) 841-9458)
Abstract - - The silent confluent flow of a conglomerate of sensory related signals is automatically delegated to the total specific distribution of a single spinal nerve. This silent confluent flow may be accessed, evaluated, and modified by using intradermal saline infiltration to stimulate the sensory receptors located in the skin overlying its nerve root. An unmistakable augmented burst of infiltration pain immediately followed by profound long lasting pain relief identifies a spinal nerve monitoring peripheral pathology. The identification of a monitoring spinal nerve tentatively confirms the presence of pathology confined to the specific peripheral distribution of that specific spinal nerve. The practically unknown visceral distribution proves to be specific and visceral pathology echoes through its collated spinal nerve without patent variation. Practically cost free and without side effects or contraindications dermatomal infiltration opens a whole new chapter in the field of diagnosis as it may be used to determine the presence of pathology, to locate that pathology to the specific distribution of a specific spinal nerve or nerves, and to produce unequalled pain relief.
Observations of the results obtained by sublesional infiltration of herpes zoster At one time sublesional injection of corticosteroid was recommended for the treatment of herpes zoster (1). During the process of this treatment it was noted that if only the skin overlying the nerve root was infiltrated the infected nerve could be identified by an unmistakable augmented burst of pain from infiltration. The initial augmented burst of infiltration pain was followed immediately by profound long lasting pain relief of all of the herpetic lesions. The infiltration accomplished with saline alone produced pain relief equal to the infiltration of a corticosteroid diluted with a local anesthetic. Even when herpetic lesions were confined to the cutaneous distribution of
the fifth cranial nerve they were still found to be monitored by specific cervical spinal nerves. When chest or abdominal locations exhibited herpetic lesions some patients alluded to a deep seated discomfort that was not fully appreciated until it had been relieved by the infiltration. That this deep seated discomfort was relieved by the infiltration of an element of a single spinal nerve not only suggests that herpes zoster may have some elements that are three-dimensional but that spinal nerves have a specific sensory visceral distribution. In summary, it may be said that in the disease process of herpes zoster a spinal nerve monitoring pathology may be identified by an unmistakable burst of augmented pain during intradermal infiltration of the skin overlying its nerve root. This burst of infiltration
D a t e received 22 N o v e m b e r 1994 Date accepted 12 M a y 1995
389
390 pain is immediately followed by profound pain relief. Observations suggest that the entire sensory distribution of a single spinal nerve is specific and its peripheral distribution may contain elements that are cutaneous, somatic and visceral.
Terminology During the dream time of medicine the collated composites of numerous cases of herpes zoster plotted the dermatomes distribution. The lesions overlying the nerve root tied the dermatomes to their adjacent vertebral bodies for which they were named and numbered. The term dermatome has fallen into disuse as much of its original meaning is now expressed as the cutaneous distribution of a spinal nerve. To better express the intent of this presentation the term dermatome is resurrected and further expanded. The meaning of the term dermatome is expanded to include the automated confluent flow of a conglomerate of sensory related signals that arrive from the central and peripheral nervous system that are automatically collated and segmented to the specific distribution of single spinal nerves. Intradermal saline infiltration may be used to stimulate the sensory receptors in skin overlying its nerve root to access, evaluate, and to modify this confluent flow. Intradermal infiltration of the skin overlying the nerve root is termed dermatomal infiltration.
Theory That the dermatome's automated function is outlined by its behavior as observed in the disease process of herpes zoster. A dermatome entwined in the confluent flow of sensory related signals altered by peripheral pathology is termed to be a monitoring dermatome. A monitoring dermatome normally silent may be identified by its response to dermatomal infiltration with an obligatory burst of unmistakable augmented pain that is immediately followed by long-term profound pain relief. The identification of a monitoring dermatome tentatively confirms the presence of demonstrable peripheral pathology and fixes that pathology to be within that dermatome's spinal nerves specific cutaneous, somatic, or visceral distributions.
Methodology Intradermal normal saline infiltration of the skin
MEDICAL HYPOTHESES
overlying the nerve root is a good choice for adding stimuli to the confluent flow. This location spans the flow of sensory related impulses from the entire peripheral distribution, saline is free of specific pharmaceutical activity, it avoids deeper structures, and is easily standardized and duplicated. Dermatomes suspected of being in the monitoring mode are probed by using a syringe with a fine needle and a constant rate of infiltration to carefully produce small intradermal blebs with normal saline or if preferred a dilute local anesthetic. These intradermal blebs are placed on centers of about 1 cm and in a vertical line about 2 cm lateral to the mid-spine. To ensure that all of the monitoring dermatomes are covered infiltration is extended one bleb beyond the junction of the skin producing an augmented response. Cutaneous and somatic pathology usually is not much of a diagnostic problem because the pain arising from these locations is presented with specific location information. The selection of unilateral dermatomes to be infiltrated for cutaneous and somatic pain relief is simplified as the location of the pain may be correlated with the known peripheral distribution. Since visceral pain is presented without specific location information the specific visceral distribution of dermatomes remains largely unknown. The bilateral pairs of monitoring dermatomes to be probed for visceral pathology must be selected more or less on the basis of diagnostic intuition and trial and error. Meager clinical information that echoes from patient to patient without variation suggests that the pharynx is monitored at C 3, the heart at T 4-5, the gastric area at T 6-7, with the duodenal and renal areas being monitored at L 4-5. Monitoring dermatomes have been identified and the infiltration has resulted in pain relief in clinical situations as varied as otitis media to pyelonephritis, from peptic ulcers to myocardial infarctions, and from burns to carcinomatosis.
Dermatomal infiltration for pain relief Case report Following the removal of a cap from a hot radiator a 32-year-old robust male was in severe pain from 2% burns of his right hand and forearm. The dermatomes involved were determined by the cutaneous distribution of the burn. A total of 0.5 ml of normal saline was infiltrated unilaterally into the monitoring dermatomes. Probing of the adjacent non-involved dermatomes produced a more muted response. Relief of pain was immediate and was followed by a shock-like state alleviated by elevation of the feet. After the burns were dressed the patient was able to safely drive and
OBTAININGAUTOMATEDDIAGNOSTICINFORMATIONAND PAIN RELIEF
to complete his work day. Without the recurrence of pain recovery was uneventful.
391
Dermatomal infiltration avoided the necessity of using narcotics and the patient was able to safely complete his work day and to recover from his burn in relative comfort. The development of the shock-like picture demonstrates a side effect occasionally seen as the result of profound pain relief.
abdominal pain recurred at about weekly intervals and was relieved at each recurrence by bilateral saline infiltration of dermatomes both at T6-7 and L3--4. The infiltration of either set of dermatomes at T6-7 or L3-4 alone did not appreciably change the perceived magnitude of the pain. The patient explained that when the pain did recur the situation would change in less than 1 hour from a state of no pain to almost unbearable pain. On the patient' s third hospital admission endoscopy revealed both a duodenal and gastric ulcer.
Case report
Discussion
A 19-year-old male presented with pharyngitis, dysphagia and rather severe dehydration. Blood samples taken produced results that confirmed the diagnosis of infectious mononucleosis. Because of lack of necessary finances or insurance hospitalization was not a preferable option. Dermatomes were found to be in the monitoring mode at C-3. Bilateral infiltration produced immediate relief of the patient's pain and dysphagia. To cover secondary infections antibiotics were prescribed. The patient eagerly drank over 1 L of water before leaving the office. The patients' recovery was rapid and there was no recurrence of pain or difficulty in swallowing.
It was intriguing that pain that was thought to arise from a single pathological source was monitored by two sets of dermatomes so far apart and that just the infiltration of either set of these dermatomes alone produced little or no change in the perceived abdominal pain. There is no apparent explanation of why pain relief lasts so long or why in this case the pain of the gastric and duodenal ulcers recurred on the same time schedule. Unlike cutaneous and somatic pain visceral pathology produces pain that is presented without locating information. For this reason, as sometimes happens even with competent consultants and the best of intentions, the patient's first two admissions were concluded without a sustainable specific diagnosis. If it had been known at that time that the gastric area is monitored by dermatomes T6-7 and the duodenal area is monitored at L3-4 then perhaps endoscopy would have been performed on the patient's first hospital admission. The patient would have been spared two hospital admissions, a colon workup, two gastroenterology consultations, and three surgical consultations. In conclusion it may be said that the ability to confine the presence of pathology to the known specific visceral distribution of specific dermatomes will go a long way to make the selection of definitive and appropriate diagnostic studies more likely.
Discussion
Discussion Without the relief of pain and dysphagia the patient' s severe state of dehydration would have made hospitalization mandatory. It is doubtful that 1 or 2 days of the usual hospital therapy for dehydration secondary to infectious mononucleosis would have produced more clinical improvement than that accomplished by dermatomal infiltration in a matter of minutes.
Diagnostic potential verified Case report A surgical and gastroenterology consult was obtained on each of three hospital admissions of an elderly female suffering abdominal pain. The patient's severe
Reference 1. Epstein E. Triamcinolone injections in herpes zoster lesions. JAMA 1970; 207: 69-73.