Upper Arm Pain

One of the TAQ submissions concerns pain. More precisely, the submission documents the discovery of pain – the incidence of left, upper arm pain experienced subsequent to the March 6th, 2011 accident.

In January / February of 2015 this pain was so severe I had great difficulty getting dressed and undressed. Donning the required winter gear to leave the house was another extreme pain point. The upper arm pain made it impossible to sleep and I was forced to “cat-nap” through the worst of it.

Something similar was experienced in the summer following the accident. During the summer of 2011 the pain was located in the same left side position and concentrated in the upper arm area. It was unpleasant and discomforting, but it did not match the intensity of the pain event during January / February 2015.

An episode of similar upper arm pain in 2014 drove me to consult Dr. N. He suspected an abnormality on my MRI results indicated a possible cervical spinal cord issue. Another MRI was scheduled. When this second MRI was reviewed, the imagery failed to confirm the observed abnormality as the likely source of the pain.

I was experiencing pain but this pain had no evident connection to any degree of physical activity, to ambient temperatures, to changes in diet, to humidity, or weather trends. Dr. H thought it might be connected to stress and the associated depletion of bodily levels of magnesium. I immediately went out and purchased a lot of expensive supplements and added magnesium rich foods to my diet: clam chowder, meals of mackerel, wild salmon and tuna, abundant leafy greens such as Swiss chard and avocado, copious amounts of dark chocolate and bananas. This additional magnesium made no difference to the pain experience. I did celebrate the fact chocolate was now a required dietary supplement, but that is another story altogether.

Since the accident, my experience of stress has been negligible (it is entirely possible that there are stress stimuli of which I am not consciously aware. I have no conscious sense of stress, or anxiety). The pain surfaced at random. It arrived during periods of warm sunny weather. It occurred at times when I had every reason to feel positive and optimistic. And then the pain disappeared as mysteriously as it had arrived. The pain was a puzzle.

Then, somewhere in my research, I encountered something described as thalamic pain. This is a form of pain which has no physical source. It is pain triggered by some action of the nerves, or by the pain centers in the brain. In this sense, it is phantom pain. But the pain is genuinely experienced by the victim. The technical term for this phantom pain is neuropathic pain. Pain caused by a known physical source is referred to as nociceptive pain.

My understanding of the March 6th accident is that my injury is due to two force components. The first force component was a compression pressure wave resulting from the abrupt acceleration – zero to sixty – not in five seconds but within 5 milliseconds. This pressure gradient would have had greatest effect on those portions of the brain toward the rear of the skull case. This includes the thalamus and the amygdala. The second force component consisted of an equally abrupt rotational acceleration as the head snapped around from near straight ahead to ninety degrees right.

This month, I found an on-line resource that provided test instruments to be used to identify both nociceptive and neuropathic pain. The first of these is the LANSS Pain Scale and the second in is the DN4 Questionnaire. Both of these tests exhibit high levels of validity and reliability. On the LANSS Pain Scale I scored 15 points and, on the DN4 Questionnaire, I scored 5 points. Both scores indicate the presence of neuropathic pain.