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And I refer to this as chronic pain being a disease in its own right.NARRATION: Laura occupied her days as best she could, studying to keep her mind off the pain.Laura Black: I'd been on crutches by that time for two and a half years and been terrified that it would spread to my left leg because there was that knowledge that spread to my left would put me in a wheelchair. NARRATION: Now the intense pain has spread to her entire body. Michael Cousins: Now there's only one way that could happen and that is due to the involvement of the brain.It can't happen at the spinal cord level, but it can happen at a brain level.I ended up on crutches for about fifteen months with my ankle looking like this the entire time. Michael Nicholas: Studies done elsewhere have reported change in brain activity after these sorts of interventions, when people start moving again, the symptoms settle, then changes have been seen along the measures like FMRIs. And it appears that the longer those changes are present, the more severe they become and the harder it is to intervene. Prof Michael Cousins [email protected] Management Research Institute Royal North Shore Hospital St Leonards NSW 2065 A/Prof Michael Nicholas [email protected] Pain Management Program Royal North Shore Hospital St Leonards NSW 2065 Pain Management Research Institute ADAPT Pain Management Program Australian Reflex Sympathetic Dystrophy Support Group National Institute of Neurological Disorders and Stroke (USA) Complex Regional Pain Syndrome Fact Sheet Mayo Health Insite Chronic pain Better Health Channel Pain management ^ top Everyone with RSD/CRPS should go to which is the best website and used by doctors as well as patients all over the world.Dr Maryanne Demasi: Now this looks really painful, was it as painful as it looks? NARRATION: Like Laura, Ketamine drips, epidurals and spinal nerve blocks failed to relieve Kates pain. NARRATION: Its also a mental training exercise intended to undo the neuro-plastic changes in the brain caused by years of persistent pain. NARRATION: This brain rewiring is now thought to be a major contributor to Complex Regional Pain Syndrome. To Laura: Has Laura considered a morphine pump implant?

But in the years that ensued, Lauras worst fears were confirmed.

Laura Black: Ah, the worst ones can be hours and hours. Laura Black: I was hiking with some friends and it was just sort of basic teenage clumsiness I guess, I fell over a rock. But the pain persisted for months even though her injury had healed. Dr Maryanne Demasi: What did the doctor say to you? It feels like somebody's got a red hot corkscrew and they're they're twisting it through my bones. Nerve fibres in the spinal cord release neurotransmitters that send messages to thalamus in the brain. The thalamus triggers other areas of the brain and returns messages to nerve cells in order to diminish pain signals.

You know I've gone from sort of you know a very happy person, I knew what I wanted to do with my life, to somebody who's trapped inside. Dr Maryanne Demasi: Pain is essential for survival. Now if I wave my hand over this flame, it hurts and the pain warns me to stop.

NARRATION: Functional MRIs have shown that chronic pain actually causes changes in the wiring of the brain, This ability to change is known as neuro-plasticity.

The brain continues to send pain messages long after the injury has healed.Dr Maryanne Demasi: So these are the pictures of your ankles are they? Michael Cousins: Lets just have a look and see how things are going. Michael Cousins: One of the key issues really is early diagnosis and early intervention. I've started going out and socialising again and hanging out with my friends.Kate Ross: Yeah these photos were taken about six years into the CRPS. Because we know now that there are neuro-plasticity changes in the brain. There's definitely a lot to be said about how much the power of the mind can really help you through it. Laura Black: I just want to get on top of this enough to be able to do something with my life. I mean I've got the degree, I know that I'm not going to be able to go into practice but you know I want to be able to use that degree, you know, not let this win.I've been through most of the medications, I've been through sympathetic nerve blocks, um, ketamine infusion Dr Maryanne Demasi: Ketamine infusions? NARRATION: The lack of success with treatment has made life unbearable at times for Laura.