Patient 42: Post-herpetic Pain

1) Patient History

sex: female
birth year: 1931
weight: height: BMI: 17 lean

Recent History

post-herpetic pain treated with analgesic pills (3/4 a day)

Ferritin: 28 ug/L

Bilirubin

• Total 1,83
• Direct 0,42
• Indirect 1,41

Past History

Previous HSV infection
Gilbert's Syndrome

Familial History

2) Molecular bases of symptoms

Pain

the higher the stimulus, the higher the spikes frequency...

but we get the same results when the intracellula ATP is low....

which local conditions can affect ATP synthesis?

1. Less oxygen transport
   • anemia
   • CoHb
   • High MCV (vitamin B12, Folic Acid deficiency, MTHFR polymorphysm)
2. Less CoQ
   • low cholesterol
   • statins, red rice yeast
   • hypothyroidism
3. Less Cyt C
   • low estrogens--> low heme synthesis
   • iron deficiency
     • Herpes Virus Family Infection
   • hypothyroidism
4. Less glucose
   • diet
   • hyperinsulinism

3) Therapeutic approach aimed to correct metabolic alterations

Iron supplementation
Coenzyme Q
Complex B Vitamins

After 4 weeks

Ferritin: 48 ug/L

Night and most of the day free of pain but...

around 11 a.m. pain requiring an analgesic pill

4 Rule:Oscillating

Serum cortisol at this time is at its nadir: breakfast carbohydrates are gone. Poor gluconeogenesis and sodium retention.

Pain by glucose nerve starvation

but also by lack of Na+ (Hyponatremia)

prevention of pain with saltine crackers at 10.30

After 8 weeks

Ferritin: 76 ug/L

No pain anymore at 11 even without additional crackers