Mard ko dard nahi hota: Congenital insensitivity to pain – CIP Dr kk Agrawal

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CIP or congenital analgesia is one or more rare conditions in which a person cannot fe el (and has never felt) physical pain. CIP is an extremely dangerous condition and it is common for people with the condition to die in childhood due to injuries or illnesses going unnoticed. Burn injuries are among the more common injuries.
Features
1.    Cognition and sensation are otherwise normal
2.    Patients can still feel discriminative touch (though not always temperature)
3.    There are generally no detectable physical abnormalities.
4.     Children with this condition often sustain oral cavity or fractures to bones.
5.    Unnoticed infections and corneal damage due to foreign objects in the eye are also seen.
Two types of non-response
1.    Insensitivity to pain means that the painful stimulus is not even perceived: a patient cannot describe the intensity or type of pain.
2.     Indifference to pain means that the patient can perceive the stimulus, but lacks an appropriate response: they do not flinch or withdraw when exposed to pain.
Causes
1.    Increased production of endorphins in the brain.
2.    In this case, naloxone may be a treatment
3.    Voltage-gated sodium channel SCN9A (Nav1.7) disorder. Patients with such mutations are congenitally insensitive to pain and lack other neuropathies.
Epidemiology
Congenital insensitivity to pain is found in Vittangi, a village in Kiruna Municipality in northern Sweden, where nearly 40 cases have been reported.
Congenital insensitivity to pain with anhidrosis (CIPA), or hereditary sensory and autonomic neuropathy type IV Is an extremely rare inherited disorder of the nervous system which prevents the sensation of pain, heat, cold, or any real nerve-related sensations (including feeling the need to urinate); however, patients can still feel pressure.

CIPA is the fourth type of hereditary sensory and autonomic neuropathy (HSAN), known as HSAN IV.A person with CIPA cannot feel pain or differentiate even extreme temperatures and does not sweat.In the absence of sweating these people can have dangerous dehydration

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