Sent anonymously to SE via email:

"Chronic pain:Long-term pain resulting from trauma, like LASIK, which damages tissue and nerves is thought to be caused by The Wind-Up Phenomenon. "Wind-up was described more than 30 years ago as progressively increasing activity in dorsal horn cells following repetitive activation of primary afferent C-fibres. In humans, temporal summation of repeated painful stimuli has been regarded as a psychophysical correlate of wind-up." In simpler terms, Windup refers to a neurological pathophysiological mechanism whereby pain "begets pain".

This from the Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA;<<<<
Severe tissue or nerve injury can result in a chronic and inappropriate sensation of pain, mediated in part by the sensitization of spinal dorsal horn neurons to input from primary afferent fibers. Synaptic transmission at primary afferent synapses is mainly glutamatergic. Although a functioning excitatory synapse contains both alpha-amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid (AMPA) and N-methyl-D-aspartate (NMDA) receptors in the postsynaptic membrane, recent evidence suggests that dorsal horn neurons contain some "silent" synapses, which exhibit purely NMDA receptor-mediated evoked postsynaptic currents and do not conduct signals at resting membrane potential. Serotonin, which is released onto dorsal horn neurons by descending fibers from the rostroventral medulla, potentiates sensory transmission by activating silent synapses on those neurons, i.e., by recruiting functional AMPA receptors to the postsynaptic membrane. This phenomenon may contribute to the hyperexcitability of dorsal horn neurons seen in chronic pain conditions.
>>>>So when the doctor says it's all in you mind, he's telling the truth. Pain comes from the mind. Long after the tissue has healed, the wind-up continues to cause pain. The NMDA receptors seem to be the main activator of chronic pain. Therefore inhibiting these receptors should stop chronic pain caused by wind-up. I did a medline search and found several articles detailing the use of ketamine. Ketamine is an old anesthetic drug, used by veterinarians for decades. This article shows its resurgence in human medicine. The point of the article is that doses much lower than anesthetic dosage were helpful in this patient.<<<<
[Analgesic effect of ketamine in a patient with neuropathic pain][Article in Norwegian]Oye I, Rabben T, Fagerlund TH.Farmakologisk Institutt, Blindern, Oslo.We report the effect of a single daily dose of ketamine in a 54 year old woman with fibromyalgia and severe post-traumatic neuropathic pain. A number of different approaches for pain relief had been tried with little effect. An intramuscular test dose of 0.4 mg/kg ketamine combined with 0.05 mg/kg midazolam lead to analgesia which lasted for almost two days. Long-term analgesia was also obtained by 250 mg/kg ketamine hydrochloride taken orally in the form of capsules every night at bedtime. The patient has now used this dose for nine months. Ketamine is an NMDA receptor antagonist. A single sub-anaesthetic dose of ketamine causes a long-term depression of pain intensity in some, but not in all, patients suffering chronic pain. This effect is distinctly different from the short-lasting (10-30 min) analgesic effect in cases of acute nociceptive pain. The long-term depression of the intensity of chronic pain states may be due to a reversal of NMDA receptor-dependent long-term potentiation of synapses in central pain pathways. By giving ketamine as a single dose at night the mental side-effects are reduced or avoided.
PMID: 8999575 [PubMed - indexed for MEDLINE]
>>>>Because ketamine is known to inhibit NDMA receptors, drug companies are looking for medications that target these receptors. This also from Medline:<<<<
Can patients with chronic neuropathic pain be cured by acute administration of the NMDA receptor antagonist amantadine?Eisenberg E, Pud D.Pain Relief Unit, Rambam Medical Center, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa.The treatment of neuropathic pain remains a challenge as it rarely leads to long-term relief of symptoms. We report three patients with chronic neuropathic pain, in whom acute administration of the N-methyl-D-aspartate (NMDA) receptor antagonist amantadine resulted in complete resolution of symptoms, presumably due to termination the central 'wind-up' phenomenon.PMID: 9520249 [PubMed - indexed for MEDLINE]
>>>>
So there's hope on the horizon."

Please send this link to those suffering with chronic neuropathic pain. Thanks.

Ron Link
Executive Director
The Surgical Eyes Foundation

Hello,Ron link.
I'm gufoso from Italy.
I'm writing to help a friend of mine whose condition is terrible.
I read the article"chronic neuropatic pain after Lasik"and i hope you can help him because his problems look impossible to solve.
He had bilateral keratotomy in 2001 but unfortunately the bistoury (not laser)has gone too deep cutting nervous fibres of iris and ciliary muscles.
He has continuous pain all in the body :eyes,head,backbone,tummmy,loinsi,genitals,legs.
Doctors say that is a parasympatic epilessy due to the damage t the bistoury has done.
Nothing is sufficient to allow a "normal life" .He feels good only with close eyes.
I would like to know if we can find a solution to stop his pain.
I hope you can reply as soon as possible because he can’t go on in this way.
Thank you for your attention.

Hello Ron.I'm Gufoso.
I wrote a letter from Italy trying to explain the situation of a friend.
I would like to know,if possible, your e -mail.
In the meantime I send you the mine :stubbornn@hotmail.com