The odyssey against a rare cause of pain

Rare diseases occur frequently, explains chance. There is a risk that there is an unusual error in at least one of the thousands of genes in at least one of our billions of cells; an opportunity that is renewed with every new cell.

Poisons, toxins, radiation and microorganisms are scattered everywhere, which, unfortunately for you, can find you and almost no one else. It is estimated that 3.5 to 6% of the world’s population will be affected by a rare disease. Half of the people in this large group will never receive a proper diagnosis. The other half with a different fate will likely endure an epic journey of unnecessary tests and useless treatments until the correct diagnosis is made.

Odysseus is an ordinary man who takes on a common role and prepares for his wedding ceremony, for which there will be a common script. He caught a cold, as we all get sick one day and will get sick again the next day. But this time something is different. After healing, he felt persistent pain behind his right nostril. The pain worsened and spread to the right side of the face and forehead.

The young man became a fixture in clinics and emergency rooms. Surrounded by promises of healing, I received injections or prescriptions for medication, but frustration always came. He was treated twice for sinusitis, although no tests suggested this complication.

Months of pain passed. There is no patience that can resist. He agreed to be hospitalized, receive new treatments, be given new dosages and quickly undergo the tests deemed necessary. The test results were interpreted as normal and it was not discovered what was going wrong in Ulysses’ head. Nevertheless, the pain was relieved by the effects of the drug oxycodone, which he began taking daily. Oxycodone was the siren song.

Like morphine, this drug belongs to the pharmacological class of opioids. A category of painkillers that has resulted in an incredible number of overdose deaths in the United States; an estimated 165,000 this century. In the late 1980s and early 1990s, it was argued “mainly on moral grounds” that opioids should be prescribed for chronic pain. The application model was inspired by the success of opioids in treating acute and endoflife pain.

The American Pain Society released a highly influential and historic statement in 1996 stating that opioids were safe and effective for the treatment of chronic pain and that the risk of addiction was negligible. However, this company received almost $1 million in salaries from corrupt pharmaceutical companies for its purposes. The American Pain Society was accused of contributing to the worst drug epidemic in the United States and closed its doors in 2019.

But Ulysses felt nausea and dizziness from the medicine, in fact he no longer noticed the strong painkilling effect as he had in the first few days of treatment and gave up the pill. Nauseous and angry, he was taken to another hospital for the second time. It didn’t take long before a doctor on the team treating him came to the conclusion that the pain was psychological in nature and that a psychological examination was therefore useful.

The psychiatrist Alice enters the scene. When she was assigned the case, she assessed Ulysses and made her judgments. When he left his room, he met the neurologist responsible for the patient: “I’m in a hurry, I’m going to the restaurant to have tea and biscuits, and then I’m going to the practice, there’s already a patient waiting.” me. Come with me so I can tell you about Odysseus. And it disappeared quickly.

The neurologist followed her with long strides, the only reason he didn’t lose sight of her was because he could see the rabbit on his colleague’s bag, until Alice disappeared down the stairs. The neurologist found her in the restaurant. She remembered that Odysseus had plans and desires and spoke with joy about his past. Something that is lost on depressed people. When the neurologist heard this, he felt small and didn’t pay attention to Alice’s every sip of tea and every word. The psychiatrist said goodbye: Find the cause of the pain and treat it accordingly.

The next day, the doctor opened his email to an editorial from a neurology journal; By a rare coincidence, one of the topics contained a description of a clinical case that reminded him of Odysseus’ situation. Finally the diagnosis. Odysseus had a frequent change in his nasal septum, a bony callus. This minimal and common abnormality almost never causes symptoms. It is possible that the cold changed the local sensitivity and caused the pain. Why this particular cold caused the pain is an unanswered question.

An ENT doctor operated on him and fixed the problem. Odysseus was healed of a rare pain caused by common things.