Wednesday, January 16, 2008

Faulty wiring mystifies mechanics and doctors alike

My perspective

Faulty wiring mystifies mechanics and doctors alike

By Anne Louise Oaklander December 17, 2007

I was confident at the inspection station. My trusty '96 Mazda Protege was driving fine. But I got a shock that day: a black rejection sticker for emissions. "Get a tune up," I was urged

When that didn't work, the repairs began. A new battery, a new alternator, a second battery - still I failed. I began to realize that my problem was not actually emissions, which were pristine, but electrical problems that prevented storage of my auto's emissions data.

Somewhere during the garage visits, bills, and phone calls, it occurred to me that my car had the same problem as my patients with neuralgia, a type of chronic pain caused by nerve damage. They are laid low by pain in various locations, but medical exams and tests often show no cause.

Their problem is not actually where their pain is felt, but in the nerves that carry pain messages to the brain. Normally, pain neurons only fire briefly during injury or illness to signal a problem, but short-circuits can make them fire continually, just like my engine warning light that stayed lit for months.

Some neuralgia patients, whose symptoms are often triggered by common conditions such as shingles, diabetes, and osteoarthritis of the spine, are prescribed effective medications and may get pain relief. More often their "mystery pain" goes untreated as doctors fail to recognize and treat its neurological causes. And physicians, no matter how caring, must also weigh the chances of federal scrutiny when prescribing strong pain medicines for patients without sufficient explanation for their pain.

Many neuralgia patients undergo unnecessary repairs just like my Protege. These include local-anesthetic injections that help only briefly while the area is numbed. I remember the woman whose dentist tried to treat her neurological jaw pain by doggedly extracting one innocent molar after another, leaving her toothless and impoverished, and no better.

Most surgeries do not help neuralgia, and surgery causes or worsens many cases.

In addition to living with chronic pain, my patients have to cope with an unforgiving medical and disability system with little tolerance for elusive problems. My fruitless phone calls to the Registry of Motor Vehicles pale next to my patients' efforts to seek insurance coverage, disability benefits, worker's compensation, or simply to get a doctor to listen and help.

Medical tests aren't sensitive enough to detect subtle electrical problems, just as my mechanic's tests couldn't find the fault that was causing loss of my car's emission's data. Lack of evidence is interpreted as evidence of lack of a problem, and my patient's symptoms are attributed to psychological causes, character flaws, or to just plain lying to con a doctor into writing a narcotics prescription.

With each new agency, each new doctor, my patients need to retell their complicated histories to convince yet another skeptical listener. Most feel vaguely guilty for having such a difficult problem, and many wonder at some point if indeed they might be crazy. Some cry with relief when I tell them that I have seen their kind of problem before and it is caused by neurological damage, not neurosis.

Some eventually give up, traumatized twice - once by their illness and once by our system. I am haunted by the memory of a woman who killed herself last year, believing this the only way to end her suffering.

Last month, my story took a turn for the better: On a whim, Eddie, the mechanic who has worked doggedly to fix my Protege's problem, plugged it into the inspection computer. By some miracle, at that moment it held enough data for me to PASS! We shared a giddy moment.

But my lawfulness is temporary. My car's nerves are still fickle and my check engine light still goes on and off at will. I must expect rejection at my next emissions test. I've heard that Motor Vehicles is ending tailpipe-emissions testing altogether, which will leave no option for cars like mine to pass. Will we have to junk otherwise well-running cars that can't meet the new rules?

Given the complexity of our own neurological wiring, perhaps physicians, medical insurers, and disability boards should also make provisions, so that patients with chronic pain from wiring problems can still get the care and compassion they need.

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