Congenital Insensitivity to Pain with Anhidrosis (CIPA): Patient ko Dard nhi hota

CIPA (Congenital Insensitivity to Pain with Anhidrosis) is an extremely rare genetic disorder characterized by two primary features: the inability to feel pain and changes in temperature, and the reduced or absent ability to sweat (anhidrosis). This disorder is also known as Hereditary Sensory and Autonomic Neuropathy Type IV (HSAN IV). Let’s use a popular Hindi movie dialogue to help explain CIPA:

Movie Dialogue: "Mard ko dard nahi hota."

In Hindi cinema, there’s a famous dialogue, “Mard ko dard nahi hota,” which translates to “Men don’t feel pain.” This dialogue is often used in action-packed scenes where the hero of the movie displays bravery and toughness in the face of danger. It implies that a real man is so strong that he doesn’t experience pain.

Now, let’s relate this dialogue to CIPA:

CIPA is a condition where individuals truly do not feel pain (Patients ko Dard nhi hota), unlike the movie dialogue where it’s used metaphorically. People with CIPA lack the ability to perceive pain, so they may not react to injuries or discomfort the way most people do. While the movie dialogue celebrates bravery, in the context of CIPA, it highlights a real medical condition where the absence of pain perception can be a significant challenge.

In reality, not feeling pain can be dangerous. Pain serves as a protective mechanism that alerts us to potential harm or injuries. Without the ability to feel pain, individuals with CIPA are at a higher risk of unintentional self-injury and may not notice when they are hurt. For example, they might accidentally bite their tongues, lips, or fingers without realizing it, and this can lead to severe injuries. Some might even experience spontaneous amputation of affected body parts due to self-inflicted harm.

So, while the movie dialogue suggests that being impervious to pain is a symbol of strength, in the case of CIPA, it underscores the challenges and risks associated with not being able to feel pain, which is a medical condition rather than a heroic attribute.

Introduction to Congenital Insensitivity to Pain with Anhidrosis (CIPA)

Understanding CIPA: What Is It?

CIPA, or Congenital Insensitivity to Pain with Anhidrosis, is a rare genetic disorder characterized by two hallmark features: the inability to perceive pain and temperature, along with diminished or absent sweating, a condition known as anhidrosis. This disorder is also referred to as Hereditary Sensory and Autonomic Neuropathy Type IV (HSAN IV). In this article, we will delve deep into the world of CIPA, exploring its causes, symptoms, and the challenges faced by those living with this condition.

The Early Onset of CIPA

The signs and symptoms of CIPA manifest early in life, typically at birth or during infancy. However, with proper medical care and attention, individuals affected by CIPA can lead relatively long lives, even into adulthood.

The Complexities of Living with CIPA

The Consequences of Insensitivity: Frequent Injuries

One of the most striking aspects of CIPA is the inability to feel pain or changes in temperature. Paradoxically, this leads to a higher propensity for severe injuries. Individuals with CIPA often engage in unintentional self-injury, commonly biting their tongues, lips, or fingers. In some cases, this self-inflicted harm can even lead to spontaneous amputation of the affected body parts. Moreover, CIPA patients exhibit delayed wound healing, making them susceptible to chronic skin and bone injuries. Repeated trauma may result in conditions such as osteomyelitis or Charcot joints, characterized by the destruction of bones and surrounding tissues.

Congenital insensitivity to pain with anhidrosis
Charcot joints are shown in this boy with CIPA.
CausesGenetic mutations

The Cooling Mechanism: Sweating and CIPA

Sweating plays a crucial role in regulating body temperature. However, in those with CIPA, anhidrosis disrupts this natural cooling process, causing recurrent and dangerously high fevers, medically termed hyperpyrexia. High temperatures can also trigger febrile seizures, posing additional health risks to individuals with CIPA.

Body temperature isn't a set number - here's what's considered normal and  what's a fever | Business Insider India
The inability to sweat makes overheating a danger for people with CIPA.

Beyond the Basics: Additional Symptoms

In addition to the primary characteristics, CIPA can present with various other signs and symptoms. Many affected individuals develop thick and leathery skin, a condition known as lichenification, primarily on the palms of their hands. Misshapen fingernails or toenails are also common. Some may experience patches of hair loss on their scalps, referred to as hypotrichosis. Behavioral issues are prevalent, with approximately half of CIPA patients displaying signs of hyperactivity or emotional instability. Moreover, many individuals with CIPA may face intellectual disabilities. While some may exhibit weak muscle tone, this tends to improve as they grow older.

Four photographs of people with congenital insensitivity to pain. A) In CIPA, children often lose fingertips due to injuries, poor wound healing, and infections.B) Self-biting can lead to the loss of parts of the lower lip in CIPA individuals.C) CIPA can cause severe joint problems, like chronic dislocations, leading to reduced mobility.D) Pressure applied to the nail bed is used to test pain perception in diagnosing CIPA.
Four photographs of people with congenital insensitivity to pain. A) In CIPA, children often lose fingertips due to injuries, poor wound healing, and infections. B) Self-biting can lead to the loss of parts of the lower lip in CIPA individuals. C) CIPA can cause severe joint problems, like chronic dislocations, leading to reduced mobility. D) Pressure applied to the nail bed is used to test pain perception in diagnosing CIPA.

Understanding the Rarity and Causes of CIPA

The Rarity of CIPA

CIPA is an exceedingly rare condition, and its prevalence remains unknown. This rarity makes it crucial to raise awareness and understanding of the disorder.

The Genetic Basis: Mutations in the NTRK1 Gene

CIPA is primarily caused by mutations in the NTRK1 gene. This gene provides instructions for the creation of a receptor protein that binds to another protein called NGFβ. The NTRK1 receptor is particularly crucial for the survival of nerve cells, also known as neurons.

The Role of NTRK1 Receptor in Sensory Neurons

Sensory neurons, which are responsible for transmitting pain, temperature, and touch sensations, prominently feature the NTRK1 receptor. When NGFβ binds to this receptor, it initiates signals within the cell, promoting growth, division, and cell survival. Mutations in the NTRK1 gene result in a non-functional receptor that cannot transmit these vital signals. Consequently, sensory neurons die through a process known as apoptosis. This loss of sensory neurons is the primary cause of the inability to perceive pain experienced by individuals with CIPA. Additionally, the lack of functional nerves leading to sweat glands contributes to the development of anhidrosis in affected individuals.

Inheritance Patterns of CIPA

Autosomal Recessive Inheritance

CIPA follows an autosomal recessive inheritance pattern. This means that both copies of the NTRK1 gene in each cell must have mutations for an individual to develop the condition. Parents of an individual with CIPA each carry one copy of the mutated gene, but they typically do not exhibit any signs or symptoms of the disorder.

Alternative Names for CIPA

CIPA by Any Other Name

CIPA is known by several alternative names, reflecting its various aspects and characteristics:

  • Hereditary Insensitivity to Pain with Anhidrosis
  • Hereditary Sensory and Autonomic Neuropathy Type IV
  • Hereditary Sensory and Autonomic Neuropathy, Type 4
  • HSAN Type IV
  • HSAN4

Living with CIPA

Living with CIPA presents significant challenges and requires specialized care. Given the inability to perceive pain and temperature, individuals with CIPA are prone to accidents and injuries that may go unnoticed. Therefore, early diagnosis and vigilant medical attention are crucial for managing this condition effectively.

Medical Care

Medical care for individuals with CIPA often involves:

 Pain Management

While individuals with CIPA do not experience pain in the same way as others, it is essential to address any injuries promptly to prevent complications. Pain management in CIPA patients typically focuses on treating injuries, preventing infections, and managing pain-related complications.

 Temperature Regulation

Since individuals with CIPA cannot regulate their body temperature through sweating, it is essential to monitor and manage their body temperature carefully. This may involve cooling techniques and medications to prevent hyperpyrexia and associated seizures.

 Skin and Wound Care

Due to the slow healing of skin and bone injuries, meticulous care of wounds and skin lesions is crucial. This includes the prevention of infections, timely wound dressings, and monitoring for any signs of osteomyelitis.

Psychological Support

Living with CIPA can be emotionally challenging, particularly for children and adolescents who may exhibit hyperactivity and emotional instability. Psychosocial support, including therapy and counseling, can help individuals and their families cope with the emotional aspects of this condition.

 Education and Adaptation

Many individuals with CIPA have intellectual disabilities, and tailored educational plans are often necessary. As they grow older, their muscle strength and tone may improve, allowing them to adapt to their condition and lead more fulfilling lives.

 Current Research and Future Prospects

Ongoing research in the field of genetics and neurology continues to shed light on CIPA. Scientists are exploring potential treatments and interventions that could improve the quality of life for individuals with this condition. While there is no cure for CIPA at present, advancements in medical science may offer hope for the future

Conclusion: Navigating Life with CIPA

In conclusion, Congenital Insensitivity to Pain with Anhidrosis (CIPA) is a rare and complex genetic disorder that profoundly impacts the lives of those affected. With a lack of pain and temperature sensitivity, along with the challenges posed by anhidrosis, individuals with CIPA face unique hurdles. Understanding the genetic basis and inheritance pattern of CIPA is crucial for both medical professionals and affected individuals and their families. Increased awareness and research are essential steps toward improving the lives of those living with this condition.


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