Is Asthma a form of Pain?

Carbamazepine and Valproic acid have been found to be effective in bronchial asthma begging the question whether asthma involves neurological mechanisms similar to migraines or Trigeminal Neuralgia

These drugs are epilepsy drugs often used in trigeminal neuralgia(Carbamazepine) or chronic migraines (Valproic acid)
Initial study was done with Carbamazepine and Valproic acid:

free article here

M. Lomia, Z. Chapichadze, M. Pruidze & P. Platonov: Efficacy Of Monotherapy With Carbamazepine And Valproic Acid In Patients With Bronchial Asthma: Is Asthma A Neurological Disease?: The Internet Journal of Neurology. 2005; Volume 4, Number 1

Abstract

Antiasthmatic activity of carbamazepine and sodium valproate was investigated in 28 patients (open-label trial) with moderate and severe bronchial asthma. Stable and complete remission was achieved in 10 patients of the carbamazepine group (n=14), and in 11 patients of the sodium valproate group (n=14). A follow-up study showed high and stable antiasthmatic efficacy of carbamazepine or sodium valproate monotherapy. Based on the high efficacy of these anticonvulsants in patients with bronchial asthma we suppose that bronchial asthma can be considered as mainly neurogenic paroxysmal and inflammatory disease.

Author concluded asthma was a form of neurogenic inflammation.

Followup study was:

Bronchial asthma as neurogenic paroxysmal inflammatory disease: A randomized trial with
carbamazepine M. Lomia et al.
Respiratory Medicine (2006) 100, 1988–1996

Conclusions: Carbamazepine showed high efficacy in therapy of moderate persistent or severe bronchial asthma. Antiasthmatic activity of carbamazepine can be considered as influence on neurogenic mechanisms of asthma. We suppose that it is possible to use carbamasepine for therapy of bronchial asthma in clinical practice.

Protocol was:

“For minimization of adverse reactions dosage of carbamazepine and placebo were increased gradually:

  • first 5 days patients received 1 capsule one time per day,
  • next 5 days—1 capsule twice per day,
  • next 5 days—2 capsule twice per day,
  • and then—2 capsules three times per day till to end of study.
  • If adverse effects – go to previous tolerated dose


As you can see, results were NOT immediate and remind me of the gradual response of migraine to valproic acid. These cases had moderate – severe disease and yet 25/33 of the treatment group “showed full remission of asthma.”

Lomia wrote a summation of his research here:

    Bronchial asthma as neurogenic paroxysmal inflammatory disease: Do some antiepileptic drugs have antiasthmatic properties?.
    Medical Hypotheses, Volume 69, Issue 4, Pages 858-859
    M. Lomia
    abstract here

Comment – Dr. Chen Gunn told me of a friend dying of rapidly progressive acute respiratory distress syndrome. He used the laser commonly used in treating trigger points along the rib margins. Where he treated there was Xray resolution of widespread edema and gradual recovery. He could not convince anyone to research this further.

Dental pain is helped especially by 660 vs 830 nm laser ie the 660 red diode laser helped.

free article here
Was this the result of decreased neurogenic inflammation?

Friedman found laser application above the upper 2nd molar area could cause relief of migraine and chronic headaches.

Patent here:

“Using groups of patients with migraine (65) and facial pain (35), 59 of the migraine patients (92%) and all of the facial pain patients (100%) experienced an immediate elimination or significant reduction of maxillary apical tenderness from brief, (30 to 120 second) applications of low level (non-cutting laser). A 15 mW helium–neon laser emitting approximately 7 mW through the fiber-optic and plastic sheath was used. In another group of 20 migraine patients, the same results were achieved in 18 patients (90%) using 60 second bursts from a 5 mW laser diode.”…”Of the 108 migraine patients, 86 (83%) experienced elimination or significant reduction in headache frequency and/or intensity. Of these migraine patients, 85% were taking medication. Of the successful patients over 90% of those taking medication were able to significantly reduce or eliminate their medication. Of the 37 tension-type headache patients, 30 (81%) were successful. These figures were arrived at after two to ten weeks of treatment (from two to eight visits)” Site of found tenderness and treatment:

(He also patented the use of topical anesthetics and NSAIDS to this region.)

I have tried a laser pointer on a 9 year old with headache from the outside and to his surprize got prompt relief – haven’t tried it otherwise.

patent here

Conclusion:

So there is some evidence neurogenic inflammation can be reduced by laser. If the duck influenza spreads worldwide, conventional therapies are not going to help much given the increased resistence to Tamaflu. What will work will be anti cytokine agents (statins and ACE inhibitors do some) and anti-neurogenic lung inflammation agents like Tegretol (carbemazepine) and Depakene/Epival = (di)valproic acid in my opinion. Both these drugs are difficult to get to a good dose because of sedation. I feel Valproic acid should not be used in women unless on Depo progesterone shots because of birth defect issues. Valproic acid can cause polycystic ovaries and 1/3 get strange periods on this agent. Both need to be followed for liver problems.

 

Addendum:

It now appears that Valproic acid might be helping because of its epigenetic modifying ability to induce demethylation (it can change genes on or off):

Epigenetics. 2011 Dec;6(12):1463-70. doi: 10.4161/epi.6.12.18396.
Protective effects of valproic acid against airway hyperresponsiveness and airway remodeling in a mouse model of allergic airways disease.
Royce SG, Dang W, Ververis K, De Sampayo N, El-Osta A, Tang ML, Karagiannis TC.  free article here

Anyone have any experience with this? any comments?

This entry was posted in Pathophysiology. Bookmark the permalink.

Leave a Reply

Your email address will not be published.