Saturday, April 22, 2017

How a Single Gene Could Become a Volume Knob for Pain—and End America's Opioid Epidemic | WIRED

On a scale of 1 to 10, how would you rate your pain? Would you say it aches, or would you say it stabs? Does it burn, or does it pinch? How long would you say you've been hurting? And are you taking anything for it?

Steven Pete has no idea how you feel. Sitting in Cassava, a café in Longview, Washington, next to a bulletin board crammed with flyers and promises—your pain-free tomorrow starts today; remember: you're not alone in your battle against peripheral neuropathy!—he tells me he cannot fathom aches or pinches or the searing scourge of peripheral neuropathy that keep millions of people awake at night or hooked on pills. He was born with a rare neurological condition called congenital insensitivity to pain, and for 36 years he has hovered at or near a 1 on the pain scale. He's 5′ 8″, with glasses and thinning brown hair, and he has a road map of scars across his body, mostly hidden beneath a T-shirt bearing the partial crests of Batman, Green Lantern, Flash, and Superman. Because he never learned to avoid injury, which is the one thing pain is really good for, he gets injured a lot. When I ask how many bones he's broken, he lets out a quick laugh.

"Oh gosh. I haven't actually done the count yet," he says. "But somewhere probably around 70 or 80." With each fracture, he didn't feel much of anything—or even notice his injury at all. Whether he saw a doctor depended on how bad the break appeared to be. "A toe or a finger, I'd just take care of that myself," he says, wagging a slightly bent index finger. "Duct tape."

What about something more serious? Pete pauses for a moment and recalls a white Washington day a few years ago. "We had thick snow, and we went inner-tubing down a hill. Well, I did a scorpion, where you take a running start and jump on the tube. You're supposed to land on your stomach, but I hit it at the wrong angle. I face-planted on the hill, and my back legs just went straight up over my head." Pete got up and returned to tubing, and for the next eight months he went on as usual, until he started noticing the movement in his left arm and shoulder felt off. His back felt funny too. He ended up getting an MRI. "The doctor looked at my MRI results, and he was like, 'Have you been in a car accident? About six months ago? Were you skydiving?' "

"I haven't done either," Pete replied.

The doctor stared at his patient in disbelief. "You've got three fractured vertebrae." Pete had broken his back.

Throughout his body today, Pete has a strange feeling: "a weird radiating sensation," as he describes it, an overall discomfort but not quite pain as you and I know it. He and others born with his condition have been compared to superheroes—indomitable, unbreakable. In his basement, where the shelves are lined with videogames about biologically and technologically enhanced soldiers, there is even a framed sketch of a character in full body armor, with the words painless pete. But Pete knows better. "There's no way I could live a normal life right now if I could actually feel pain," he says. He would probably be constrained to a bed or wheelchair from all the damage his body has sustained.

His wife, Jessica, joins us at the café. She is petite and shy, with ice-blue eyes traced in black eyeliner. When I ask her what it's like to live with a man who feels no pain, she sighs. "I worry about him all the time." She worries about him working with his power tools in the basement. She worries about him cooking over a grill. She worries about bigger things too. "If he has a heart attack, he won't be able to feel it," she says. "He'll rub his arm sometimes, and I freak out: 'Are you OK?' " She looks over at Pete, who chuckles. "He thinks it's funny," she says. "I don't think it's funny."

More ...

https://www.wired.com/2017/04/the-cure-for-pain/?

Sunday, April 16, 2017

In pain? Many doctors say opioids are not the answer - Salon.com

Those of you who have experienced pain, especially gnawing, chronic pain, know that it affects your happiness, outlook and ability to function.

In the past couple of years, the treatment of chronic pain has undergone an earthshaking transformation as opioid addiction continues to claim — and ruin — lives.

Many primary care doctors no longer liberally prescribe opioid painkillers such as oxycodone, fentanyl and hydrocodone for back pain, migraines and other chronic conditions. Instead, they are increasingly turning to alternative medications and non-drug options such as acupuncture and physical therapy.

"Most primary care doctors are afraid to do pain management because of the opioid backlash," says Michael McClelland, a health care attorney in Rocklin, Calif., and former chief of enforcement for the state Department of Managed Health Care. "Either they don't prescribe anything, and the patient remains in pain, or they turn them over to pain management specialists so someone else is writing that prescription."

As a result, McClelland says, "people in genuine pain are going to find it more difficult to get medicine they may well need."

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http://www.salon.com/2017/04/16/in-pain-many-doctors-say-opioids-are-not-the-answer_partner/

Thursday, March 30, 2017

How the opioid epidemic became America’s worst drug crisis ever, in 15 maps and charts - Vox

With all the other news going on, it can be easy to lose track of this fact. But it's true: In 2015, more than 52,000 people died of drug overdoses, nearly two-thirds of which were linked to opioids like Percocet, OxyContin, heroin, and fentanyl. That's more drug overdose deaths than any other period in US history — even more than past heroin epidemics, the crack epidemic, or the recent meth epidemic. And the preliminary data we have from 2016 suggests that the epidemic may have gotten worse since 2015.

This situation did not develop overnight, but it has quickly become one of the biggest public health crises facing America. To understand how and why, I've put together a series of maps and charts that show the key elements of the epidemic — from its start through legalpainkillers prescribed in droves by doctors to the recent rise of the highly potent opioid fentanyl.

More ...

http://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts

Sunday, March 26, 2017

Chronic pain and depression are linked by brain gene changes | New Scientist

People who have chronic pain are more likely to experience mood disorders, but it's not clear how this happens. Now a study in mice has found that chronic pain can induce genetic changes in brain regions that are linked to depression and anxiety, a finding that may lead to new treatments for pain.

"At least 40 per cent of patients who suffer from severe forms of chronic pain also develop depression at some point, along with other cognitive problems," says Venetia Zachariou of the Icahn School of Medicine at Mount Sinai in New York.

To see if there might be a genetic link between these conditions, Zachariou and her team studied mice with damage to their peripheral nervous system. These mice show symptoms similar to chronic pain in people – they become hypersensitive to harmless touch, and avoid other situations that might also cause them pain.

Until now, pain behaviour in mice had only been studied for at most a week at a time, says Zachariou, whose team monitored their mice for 10 weeks. "At the beginning, we saw only sensory deficits and pain-like symptoms. But several weeks later, the animals developed anxiety and depression-like behaviours."

The team then examined gene activity in three regions in the mouse brains we know are associated with depression and anxiety. Analysing the nucleus accumbens, medial prefrontal cortex, and periaqueductal gray, they found nearly 40 genes where activity was significantly higher or lower than in mice without the nervous system damage.

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https://www.newscientist.com/article/2125680-chronic-pain-and-depression-are-linked-by-brain-gene-changes/

Sunday, March 19, 2017

Rapid Shift to Long-term Opioid Use After Initial Prescription - Medscape

For patients who need an initial opioid prescription, supplying 3 or fewer days' worth of medication reduces the likelihood of long-term opioid use, new data show.

In a large representative sample of opioid-naive, cancer-free adults who received a first prescription for opioid pain relievers, the likelihood of long-term opioid use increased with each additional day of medication supplied, starting with the third day, the study team found.

"Knowledge that the risks for chronic opioid use increase with each additional day supplied might help clinicians evaluate their initial opioid prescribing decisions and potentially reduce the risk for long-term opioid use," the authors, led by Bradley Martin, PharmD, PhD, at the University of Arkansas for Medical Sciences in Little Rock, write.

"Discussions with patients about the long-term use of opioids to manage pain should occur early in the opioid prescribing process," they advise in the Morbidity and Mortality Weekly Report of March 17.

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http://www.medscape.com/viewarticle/877354

Friday, March 03, 2017

NYTimes: How to Block Out Pain

Pain is a personal experience, and success comes from self-management," says David Tauben, clinical professor in the department of pain medicine at the University of Washington. Respond to pain calmly — worry and fear activate the neural pathways through which pain travels and can amplify the sensations that cause it in the first place. Because pain has both mental and physical components, some researchers who study it combine psychology with the physical effects. "Be careful of negative thoughts and worrying," Tauben says. "If it's difficult to control them, find a professional to help you, like a psychologist or counselor."


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Tuesday, February 28, 2017

Is a new class of painkillers on the horizon? | Science | AAAS

Scientists are chasing a new lead on a class of drugs that may one day fight both pain and opioid addiction. It's still early days, but researchers report that they've discovered a new small molecule that binds selectively to a long-targeted enzyme, halting its role in pain and addiction while not interfering with enzymes critical to healthy cell function. The newly discovered compound isn't likely to become a medicine any time soon. But it could jumpstart the search for other binders that could do the job.

Pain and addiction have many biochemical roots, which makes it difficult to treat them without affecting other critical functions in cells. Today, the most potent painkillers are opioids, including heroin, oxycodone, and hydrocodone. In addition to interrupting pain, they inhibit enzymes known as adenylyl cyclases (ACs) that convert cells' energy currency, ATP, into a molecule involved in intracellular chemical communication known as cyclic AMP (cAMP). Chronic opioid use can make cells increase the activity of ACs to compensate, causing cAMP levels to skyrocket. When opioid users try to stop using, their cAMP levels remain high, and drugs that reduce those levels—like buprenorphine—have unwanted side effects.

More...

http://www.sciencemag.org/news/2017/02/new-class-painkillers-horizon

Tuesday, February 14, 2017

NYTimes: Lower Back Ache? Be Active and Wait It Out, New Guidelines Say

Dr. James Weinstein, a back pain specialist and chief executive of Dartmouth-Hitchcock Health System, has some advice for most people with lower back pain: Take two aspirin and don't call me in the morning.

On Monday, the American College of Physicians published updated guidelines that say much the same. In making the new recommendations for the treatment of most people with lower back pain, the group is bucking what many doctors do and changing its previous guidelines, which called for medication as first-line therapy.

Dr. Nitin Damle, president of the group's board of regents and a practicing internist, said pills, even over-the-counter pain relievers and anti-inflammatories, should not be the first choice. "We need to look at therapies that are nonpharmacological first," he said. "That is a change."

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https://www.nytimes.com/2017/02/13/health/lower-back-pain-surgery-guidelines.html?

Sunday, February 05, 2017

Welcome to Pain Researcher

Welcome to Pain Researcher, a community forum for anyone involved or interested in the study of pain. 

The major purpose of this forum is to facilitate discussion around any and all topics related to the pain research. One important gap that this forum aims to fill involves the sharing of knowledge needed to properly execute pain studies such as detailed protocols, technical tips, tool development, methodological considerations, etc. It is these crucial details that determine the quality and validity of the findings of pain studies, and so we hope that giving a space to discuss such details will improve pain research globally.

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http://forum.painresearcher.net/t/welcome-to-pain-researcher/8

Tuesday, January 24, 2017

A Bright Future for Brain Imaging of Pain | Pain Research Forum

Irene Tracey, University of Oxford, UK, summarized the contributions of neuroimaging to pain research, and directions for future investigations, during "Translating Neuroimaging Discovery Science for Patient Benefit," a plenary lecture held at the IASP 16th World Congress on Pain, which took place September 26-30, 2016, in Yokohama, Japan. Her take-home message was that findings from neuroimaging will lead to a brighter outlook for patients suffering from chronic pain. "The aim, ultimately, is to use metrics [discovered by imaging studies] to guide diagnosis and therapies," she said. Tracey called for neuroimaging work to help bridge scientific knowledge from cells to systems and across species in order to meet the unmet clinical need for new pain treatments.

More...

http://painresearchforum.org/news/76295-bright-future-brain-imaging-pain

Wednesday, January 11, 2017

I’ve seen the opioid epidemic as a cop. Living it as a patient has been even worse. - The Washington Post

A year ago, I woke in the night with pain so severe I was crying before I was fully aware what was going on. A 50-year-old cop sobbed like a child in the dark.

It was a ruptured disc and related nerve damage. Within a couple of months, it became so severe that I could no longer walk or stand. An MRI later, my surgeon soothingly told me it would all be okay. He would take care of me; the pain would end.

After surgery, I never saw that surgeon again. A nurse practitioner handed me a prescription for painkillers — 180 tablets, 90 each of oxycodone and hydrocodone.

I was lucky: I already knew how easily opioid addiction could destroy a life. I'd arrested addicts and helped people suffering from substance abuse. So as soon as I could, I weaned myself off the medication. Still, I fell into the trap when my pain returned months later, and I started taking the pills again.

Since then, I've been stuck like a growing number of people in a system that leaves patients beholden to terrible health policy, the horrific consequences of federal drug policy, uninformed media hysteria about an opioid epidemic and an army of uncoordinated medical professionals bearing — then seizing — bottles of pills.

I asked repeatedly for alternatives, but I was told none were available. I started physical therapy and sought treatment at an authorized pain management clinic. My first pain management doctor was terse as she prescribed more hydrocodone for daytime and oxycodone for the night, when my pain was worse. To her, I was just another person in a day of people receiving identical treatment. Later she'd say she had little choice: Insurance companies routinely deny even slightly adventurous prescriptions.

A nearby chain pharmacy refused to fill it, saying, "You can't mix hydrocodone and oxycodone." As my prescription testified, I was receiving the required "close monitoring" by a doctor when taking that particular combination. When I called the pain clinic for help, the staff berated me for bothering them. They asked whether I was seeking drugs. I was — the ones they had prescribed.

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https://www.washingtonpost.com/posteverything/wp/2017/01/11/ive-seen-the-opioid-epidemic-as-a-cop-living-it-as-a-patient-has-been-even-worse/?

How much does it hurt? | Mosaic

One night in May, my wife sat up in bed and said, "I've got this awful pain just here." She prodded her abdomen and made a face. "It feels like something's really wrong." Woozily noting that it was 2am, I asked what kind of pain it was. "Like something's biting into me and won't stop," she said.

"Hold on," I said blearily, "help is at hand." I brought her a couple of ibuprofen with some water, which she downed, clutching my hand and waiting for the ache to subside.

An hour later, she was sitting up in bed again, in real distress. "It's worse now," she said, "really nasty. Can you phone the doctor?" Miraculously, the family doctor answered the phone at 3am, listened to her recital of symptoms and concluded, "It might be your appendix. Have you had yours taken out?" No, she hadn't. "It could be appendicitis," he surmised, "but if it was dangerous you'd be in much worse pain than you're in. Go to the hospital in the morning, but for now, take some paracetamol and try to sleep."

Barely half an hour later, the balloon went up. She was awakened for the third time, but now with a pain so savage and uncontainable it made her howl like a tortured witch face down on a bonfire. The time for murmured assurances and spousal procrastination was over. I rang a local minicab, struggled into my clothes, bundled her into a dressing gown, and we sped to St Mary's Paddington at just before 4am.

The flurry of action made the pain subside, if only through distraction, and we sat for hours while doctors brought forms to be filled, took her blood pressure and ran tests. A registrar poked a needle into my wife's wrist and said, "Does that hurt? Does that? How about that?" before concluding: "Impressive. You have a very high pain threshold."

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https://mosaicscience.com/story/how-much-does-it-hurt-pain-agony-acute-chronic?

Friday, January 06, 2017

Snapshots of an Epidemic: A Look at the Opioid Crisis Across the Country - The New York Times

Opioid addiction is America's 50-state epidemic. It courses along Interstate highways in the form of cheap smuggled heroin, and flows out of "pill mill" clinics where pain medicine is handed out like candy. It has ripped through New England towns, where people overdose in the aisles of dollar stores, and it has ravaged coal country, where addicts speed-dial the sole doctor in town licensed to prescribe a medication.

Public health officials have called the current opioid epidemic the worst drug crisis in American history, killing more than 33,000 people in 2015. Overdose deaths were nearly equal to the number of deaths from car crashes. In 2015, for the first time, deaths from heroin alone surpassed gun homicides.

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http://www.nytimes.com/2017/01/06/us/opioid-crisis-epidemic.html?

Tuesday, December 27, 2016

How scientists are hunting for a safer opioid painkiller | Science News

An opioid epidemic is upon us. Prescription painkillers such as fentanyl and morphine can ease terrible pain, but they can also cause addiction and death. The Centers for Disease Control and Prevention estimates that nearly 2 million Americans are abusing or addicted to prescription opiates. Politicians are attempting to stem the tide at state and national levels, with bills to change and monitor how physicians prescribe painkillers and to increase access to addiction treatment programs.

Those efforts may make access to painkillers more difficult for some. But pain comes to everyone eventually, and opioids are one of the best ways to make it go away.  

Morphine is the king of pain treatment. "For hundreds of years people have used morphine," says Lakshmi Devi, a pharmacologist at the Ichan School of Medicine Mount Sinai in New York City.  "It works, it's a good drug, that's why we want it. The problem is the bad stuff."

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Sunday, December 25, 2016

Pain News Network

Pain News Network is a 501(c)(3) non-profit, independent online news source for information and commentary about chronic pain and pain management. Our mission is to raise awareness about chronic pain, and to connect and educate pain sufferers, caregivers, healthcare providers and the public about the pain experience. We reach over 100,000 people (unique readers) each month.

https://www.painnewsnetwork.org/

An opioid epidemic is what happens when pain is treated only with pills - The Washington Post

Too many opioids. Not enough opioids. Behold the opioid paradox.

The United States is in the midst of a massive opioid epidemic, as The Washington Post and other news organizations have documented extensively. In 2015, more than 33,000 people died from overdoses of opioids, meaning prescription painkillers, heroin, fentanyl or any combination. That easily keeps pace here with fatal motor vehicle accidents and gun-related deaths.

Certain states have been particularly affected. The Charleston Gazette just reported that opioid wholesalers shipped 780 million oxycodone and hydrocodone pills into West Virginia over a six-year period — enough for 433 pills for every person in the state. Meanwhile, 1,728 West Virginians died from overdoses of those two drugs.

But there's another side to the story. Opioids can be an effective treatment for chronic pain, and too many people around the world have limited access to them.

"We view pain relief as a human rights issue," Kathleen Foley, a neurologist at Memorial Sloan Kettering Cancer Center, said at a Princeton symposium on pain and opioids this month. Historically, she said, pain has been under-treated, and she is concerned that the opioid epidemic "has stigmatized all patients with pain."

Even in this country, some patients may be denied opioids because doctors are not convinced their described pain is real or fear the pills will be diverted to the illegal market. Keith Wailoo, a Princeton historian of medicine and health policy, who also spoke at the symposium, calls it a "pain gap" and says it is why African Americans with sickle cell disease, for example, have reported trouble getting prescription painkillers. "Think of it as a pain gap between the haves and the have-nots, along lines of class and race," Wailoo wrote in the Daily Beast.

https://www.washingtonpost.com/news/to-your-health/wp/2016/12/23/an-opioid-epidemic-is-what-happens-when-pain-is-treated-only-with-pills/?tid=sm_tw&utm_term=.fb49c82e397d

Sunday, November 13, 2016

Brain's Support Cells Could Explain Mysterious "Spreading Pain" - Scientific American

In people who suffer from pain disorders, painful feelings can severely worsen and spread to other regions of the body. Patients who develop chronic pain after surgery, for example, will often feel it coming from the area surrounding the initial injury and even in some parts of the body far from where it originates. New evidence suggests glia, non-neuronal cells in the brain, may be the culprits behind this effect.

Glia were once thought to simply be passive, supporting cells for neurons. But scientists now know they are involved in everything from metabolism to neurodegeneration. A growing body of evidence points to their key role in pain. In a study published today in Science, researchers at the Medical University of Vienna report that glia are involved in long-term potentiation (LTP), or the strengthening of synapses, in pain pathways in the spinal cord.

Neuroscientists Timothy Bliss and Terje Lømo first described LTP in the hippocampus, a brain area involved in memory, in the 1970s. Since then scientists have been meticulously studying the role this type of synaptic plasticity—the ability of synapses to change in strength—plays in learning and memory. More recently, researchers discovered that LTP could also amplify pain in areas where injuries or inflammation occur. "We sometimes call this a 'memory trace of pain' because the painful insult may lead to subsequent hypersensitivity to painful stimuli, and it was clear that synaptic plasticity can play a role here," says study co-author Jürgen Sandkühler, a neuroscientist also at the Medical University of Vienna. But current models of how LTP works could not explain why discomfort sometimes becomes widespread or experienced in areas a person has never felt it before, he adds.

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https://www.scientificamerican.com/article/brain-rsquo-s-support-cells-could-explain-mysterious-ldquo-spreading-pain-rdquo/

Saturday, November 12, 2016

A New Study Tests Marijuana's Potential to Replace Opioid Painkillers - The Atlantic

Emily Lindley's stash of marijuana is going to be very, very secure.

Lindley, a neurobiologist, is about to begin the first study ever to directly compare cannabis with an opioid painkiller (in this case, oxycodone) for treating people with chronic pain. She got a grant for this research two years ago, but it has taken that much time to meet all the requirements for working with a drug the federal government still considers highly dangerous.

Before it's given to patients, the marijuana will be kept inside steel narcotics lockers bolted to the wall in a room with surveillance cameras and a combination keypad on the door. Each locker has tamper-proof hinges and requires two keys—each held by a different person. If someone puts the wrong key in one of the locks, it will become inoperable and have to be drilled out.

All this is necessary to comply with rules imposed by the Drug Enforcement Agency to make sure drugs meant for research don't end up on the street, says Heike Newman, a senior regulatory manager at the University of Colorado's Anschutz Medical Campus, where Lindley's study will take place. Newman's job is to help researchers with the paperwork they need to file with various government agencies to get approval for their studies. She says the lockers and renovations to the storage room cost the university about $15,000.

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http://www.theatlantic.com/health/archive/2016/11/a-new-test-of-pots-potential-to-replace-painkillers/507200/?

Sunday, November 06, 2016

Why painkillers sometimes make the pain worse | Science | AAAS

Mark Hutchinson could read the anguish on the participants' faces in seconds. As a graduate student at the University of Adelaide in Australia in the late 1990s, he helped with studies in which people taking methadone to treat opioid addiction tested their pain tolerance by dunking a forearm in ice water. Healthy controls typically managed to stand the cold for roughly a minute. Hutchinson himself, "the young, cocky, Aussie bloke chucking my arm in the water," lasted more than 2 minutes. But the methadone patients averaged only about 15 seconds.

"These aren't wimps. These people are injecting all sorts of crazy crap into their arms. … But they were finding this excruciating," Hutchinson says. "It just fascinated me." The participants were taking enormous doses of narcotics. How could they experience such exaggerated pain?

The experiment was Hutchinson's first encounter with a perplexing phenomenon called opioid-induced hyperalgesia (OIH). At high doses, opioid painkillers actually seem to amplify pain by changing signaling in the central nervous system, making the body generally more sensitive to painful stimuli. "Just imagine if all the diabetic medications, instead of decreasing blood sugar, increased blood sugar," says Jianren Mao, a physician and pain researcher at Massachusetts General Hospital in Boston who has studied hyperalgesia in rodents and people for more than 20 years.

But how prevalent hyperalgesia is, and whether it plays a role in the U.S. epidemic of opioid abuse and overdose, is unclear. A lack of reliable testing methods and a series of contradictory papers have created believers and skeptics. A few researchers, like Mao, think hyperalgesia is an underappreciated puzzle piece in the opioid epidemic—a force that can pile on pain, drive up doses, and make it harder for chronic users to come off their drugs. Some of those researchers are looking for ways to turn down hyperalgesia, to help patients function on lower doses of their oxycodone, for example, or make it easier to taper off it altogether. Others see OIH as an oddity in the literature—real, and a powerful clue to the workings of pain pathways, but unlikely to tighten the grip of opioids on most patients. Hutchinson thinks the majority of physicians are either unaware of hyperalgesia or unconvinced of its importance. "I think if you surveyed prescribers of opioids, they would be divided probably 60–40."

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http://www.sciencemag.org/news/2016/11/why-painkillers-sometimes-make-pain-worse

Thursday, October 27, 2016

Placebos Can Work Even If You Know It's A Placebo : Shots - Health News : NPR

Placebos can't cure diseases, but research suggests that they seem to bring some people relief from subjective symptoms, such as pain, nausea, anxiety and fatigue.

But there's a reason your doctor isn't giving you a sugar pill and telling you it's a new wonder drug. The thinking has been that you need to actually believe that you're taking a real drug in order to see any benefits. And a doctor intentionally deceiving a patient is an ethical no-no.

So placebos have pretty much been tossed in the "garbage pail" of clinical practice, says Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center. In an attempt to make them more useful, he's been studying whether people might see a benefit from a placebo even if they knew it was a placebo, with no active ingredients. An earlier study found that so-called "open-label" or "honest" placebos improved symptoms among people with irritable bowel syndrome.

And Kaptchuk and his colleagues found the same effect among people with garden-variety lower back pain, the most common kind of pain reported by American adults.

The study included 83 people in Portugal, all of whom had back pain that wasn't caused by cancer, fractures, infections or other serious conditions. All the participants were told that the placebo was an inactive substance containing no medication. They were told that the body can automatically respond to placebos, that a positive attitude can help but isn't necessary and that it was important to take the pills twice a day for the full three weeks.

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http://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo?

Opioids: Last Week Tonight with John Oliver (HBO)

https://youtu.be/5pdPrQFjo2o

Wednesday, October 26, 2016

Mice smell, share each other's pain | Science News

Pain is contagious, at least for mice. After encountering bedding where mice in pain had slept, other mice became more sensitive to pain themselves. The experiment, described online October 19 in Science Advances, shows that pain can move from one animal to another — no injury or illness required.

The results "add to a growing body of research showing that animals communicate distress and are affected by the distress of others," says neuroscientist Inbal Ben-Ami Bartal of the University of California, Berkeley.

Neuroscientist Andrey Ryabinin and colleagues didn't set out to study pain transfer. But the researchers noticed something curious during their experiments on mice who were undergoing alcohol withdrawal. Mice in the throes of withdrawal have a higher sensitivity to pokes on the foot. And surprisingly, so did these mice's perfectly healthy cagemates. "We realized that there was some transfer of information about pain" from injured mouse to bystander, says Ryabinin, of Oregon Health & Sciences University in Portland.

When mice suffered from alcohol withdrawal, morphine withdrawal or an inflaming injection, they become more sensitive to a poke in the paw with a thin fiber — a touchy reaction that signals a decreased pain tolerance. Mice that had been housed in the same cage with the mice in pain also grew more sensitive to the poke, Ryabinin and colleagues found. These bystander mice showed other signs of heightened pain sensitivity, such as quickly pulling their tails out of hot water and licking a paw after an irritating shot.

The results are compelling evidence for the social transmission of pain, says neuroscientist Christian Keysers of the Netherlands Institute for Neuroscience in Amsterdam.

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https://www.sciencenews.org/article/mice-smell-share-each-others-pain?

Monday, October 24, 2016

How drugs intended for patients ended up in the hands of illegal users: ‘No one was doing their job’ - The Washington Post

For 10 years, the government waged a behind-the-scenes war against pharmaceutical companies that hardly anyone knows: wholesale distributors of prescription narcotics that ship drugs from manufacturers to consumers.

The Drug Enforcement Administration targeted these middlemen for a simple reason. If the agency could force the companies to police their own drug shipments, it could keep millions of pills out of the hands of abusers and dealers. That would be much more effective than fighting "diversion" of legal painkillers at each drugstore and pain clinic.

Many companies held back drugs and alerted the DEA to signs of illegal activity, as required by law. But others did not.

Collectively, 13 companies identified by The Washington Post knew or should have known that hundreds of millions of pills were ending up on the black market, according to court records, DEA documents and legal settlements in administrative ­cases, many of which are being reported here for the first time. Even when they were alerted to suspicious pain clinics or pharmacies by the DEA and their own employees, some distributors ignored the warnings and continued to send drugs.

"Through the whole supply chain, I would venture to say no one was doing their job," said Joseph T. Rannazzisi, former head of the DEA's Office of Diversion Control, who led the effort against distributors from 2005 until shortly before his retirement in 2015. "And because no one was doing their job, it just perpetuated the problem. Corporate America let their profits get in the way of public health."

A review of the DEA's campaign against distributors reveals the extent of the companies' role in the diversion of opioids. It shows how drugs intended for millions of legitimate pain patients ended up feeding illegal users' appetites for prescription narcotics. And it helps explain why there has been little progress in the U.S. opioid epidemic, despite the efforts of public-health and enforcement agencies to stop it.

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https://www.washingtonpost.com/investigations/how-drugs-intended-for-patients-ended-up-in-the-hands-of-illegal-users-no-one-was-doing-their-job/2016/10/22/10e79396-30a7-11e6-8ff7-7b6c1998b7a0_story.html?

The First Fentanyl Addict | VICE

If the opiate crisis has taught us anything, it's that addiction affects everyone. An unprecedented surge in fentanyl-implicated death—across all incomes and backgrounds, obviously—has sparked public health emergencies across the US and Canada. With each fentanyl overdose reported, we're seeing ignorant assumptions about who uses drugs and why finally put to rest.

But there was a time when fentanyl was almost exclusively used by a very small group, and it had nothing to do with Margaret Wente's idea of a "typical drug addict" or poverty or organized crime. What the general public is oblivious to—but the medical community knows—is how fentanyl addiction took its roots in anesthesiology before it made its way into the mainstream.

Dr. Ethan Bryson, associate professor in the anesthesia and psychiatry departments at the Icahn School of Medicine at Mount Sinai, New York, believes it was anesthesiologists who, familiar with fentanyl's pharmacology and abuse potential, first began misusing the opioid.

"If you look at the history of morphine, cocaine, and heroin, these were all drugs which were initially developed for legitimate medical purposes, but subsequently became recreational pharmaceuticals," Bryson told VICE. "They were all experimented on with people with that access. That's well documented in history."

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http://www.vice.com/read/the-first-fentanyl-addict?

Wednesday, October 19, 2016

He ate a pepper so hot it tore a hole in his esophagus - The Washington Post

A ghost pepper's heat is described in terms normally reserved for carpet bombings. Its heat is measured at 1 million units on the Scoville scale, a per-mass measure of capsaicin — the chemical compound that imbues peppers with heat — that until recently was a world record. Peppers that pass the 1 million mark are called superhot; as a rule they are reddish and puckered, as though one of Satan's internal organs had prolapsed. To daredevil eaters of a certain stripe, the superhot peppers exist only to challenge.

When consumed, ghost peppers and other superhots provoke extreme reactions. "Your body thinks it's going to die," as Louisiana pepper grower Ronald Primeaux told the AP in October. "You're not going to die."

But, demonstrated by a rare though severe incident reported recently in the Journal of Emergency Medicine, superhot peppers can cause bodily harm. A 47-year-old man, unnamed in the case study, attempted a super-spicy feat — eating a hamburger served with a ghost pepper puree — and tore a hole in his esophagus.

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https://www.washingtonpost.com/news/morning-mix/wp/2016/10/18/he-ate-an-extremely-spicy-ghost-pepper-hours-later-doctors-found-a-hole-in-his-throat/?

Tramadol: The Opioid Crisis for the Rest of the World - WSJ

GAROUA, Cameroon—Not long ago, a Dutch neurobiologist announced a surprising discovery: A root used by rural West African healers to treat pain contains an apparently natural version of a man-made opioid.

The root from northern Cameroon had such high levels of a painkiller called tramadol that mice given an extract and placed on a hot plate didn't feel their feet burning at first.

A year later, German rivals came up with a different explanation for the unusual plant. Inexpensive, imported tramadol is so heavily abused in northern Cameroon that it seeps from human and animal waste into the groundwater and soil, where vegetation absorbs it, wrote Michael Spiteller and Souvik Kusari, chemists at the University of Dortmund.

Farmers in Northern Cameroon told the researchers that they take double or triple the safe dosage, and feed tramadol to cattle to help them pull plows through the scorching afternoon sun.

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http://www.wsj.com/articles/tramadol-the-opioid-crisis-for-the-rest-of-the-world-1476887401

Thursday, October 13, 2016

The shocking pain of American men - The Washington Post

Once upon a time, nearly every man in America worked. In 1948, the labor-force participation rate was a staggering 96.7 percent among men in their prime working years.

That statistic has been steadily declining ever since. Today, about 11.5 percent of men between the ages of 24-54 are neither employed nor looking for a job. Economists say that these people are "out of the labor force" — and they don't figure into statistics like the unemployment rate.

This demographic trend has been the subject of much noise and consternation lately. Nicholas Eberstadt, a demographer at the conservative American Enterprise Institute, calls the development a "quiet catastrophe: the collapse, over two generations, of work for American men."

Eberstadt concedes that he can't pinpoint the precise causes, but he implies that the problem, at its root, emanates from some kind of moral or societal dysfunction.

"Time-use surveys suggest [these men] are almost entirely idle," Eberstadt wrote in a Wall Street Journal op-ed a few weeks ago. "Unlike in the past, the U.S. is now evidently rich enough to carry them, after a fashion," he added.

Princeton professor Alan Krueger, a former chief economist at the Department of Labor and former chairman of Obama's Council of Economic Advisers, has taken a look at the same data — but he came away with a different conclusion.

What stood out to him is that a lot of these men say they are in considerable pain.

In a recently released draft of his paper, which he will present at a Federal Reserve conference in Boston on Friday, Krueger finds that 44 percent of male, prime-age labor force dropouts say they took pain medication the day prior — which is more than twice the rate reported by employed men.

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https://www.washingtonpost.com/news/wonk/wp/2016/10/13/a-record-number-of-men-arent-working-this-might-finally-explain-why/

Wednesday, October 12, 2016

How naked mole rats conquered pain—and what it could mean for us | Science | AAAS

Although it has a face—and body—that only a mother could love, the naked mole rat has a lot to offer biomedical science. It lives 10 times longer than a mouse, almost never gets cancer, and doesn't feel pain from injury and inflammation. Now, researchers say they've figured out how the rodents keep this pain away.

"It's an amazing result," says Harold Zakon, an evolutionary neurobiologist at the University of Texas, Austin, who was not involved with the work. "This study points us to important areas … that might be targeted to reduce this type of pain."

Naked mole rats are just plain weird. They live almost totally underground in coloniesstructured like honey bee hives, with hundreds of workers servicing a single queen and her few consorts. To survive, they dig kilometers of tunnels in search of large underground tubers for food. It's such a tough life that—to conserve energy—this member of the rodent family gave up regulating its temperature, and they are able to thrive in a low-oxygen, high–carbon dioxide environment that would suffocate or be very painful to humans. "They might as well be from another planet," says Thomas Park, a neuroscientist at the University of Illinois, Chicago.

Gary Lewin, a neuroscientist at the Max Delbrück Center for Molecular Medicine in the Helmholtz Association in Berlin, began working with naked mole rats because a friend in Chicago was finding that the rodent's pain fibers were not the same as other mammals'. In 2008, the studies led to the finding that naked mole rats didn't feel pain when they came into contact with acid and didn't get more sensitive to heat or touch when injured, like we and other mammals do. Lewin was hooked and has been raising the rodents in his lab ever since. They are a little more challenging than rats or mice, he notes, because with just one female per colony producing young, he never really has quite enough individuals for his studies.

So instead of studying the whole animals, he began isolating single nerve cells from the mole rats and investigating them in lab dishes to track the molecular basis of the rodent's pain insensitivity. The pain pathway is kicked off when a substance called nerve growth factor is released by injured or inflamed cells. This factor binds to a protein on the pain-cell surface, a so-called receptor named TrkA, which relays the "pain" message throughout the cell. In us and other mammals, that message increases the activity of a molecular pore, called the TRPV1 ion channel, causing the cell to become more sensitive to touch or heat. "So the cell says 'It hurts more,'" Lewin explains.

But that doesn't happen in naked mole rats. Lewin evaluated the workings of the animal's pain pathway components by mixing them with those of standard rats and putting the combinations in immature frog eggs. For example, the naked mole rat TRPV1 channel sensitized the egg to acid and heat when the rat TrkA was put into the egg cell with it. Thus, Lewin and his colleagues narrowed down the breakdown in this pathway to the TrkA receptor itself. The naked mole rat version of TrkA failed to activate the ion channel as efficiently as the rat version of TrkA, Lewin and his colleagues reveal today in Cell Reports.

More ….

http://www.sciencemag.org/news/2016/10/how-naked-mole-rats-conquered-pain-and-what-it-could-mean-us

Saturday, October 08, 2016

Lancet Global Burden of Disease Highlights Back Pain - The Atlantic

The newest iteration of the Global Burden of Disease study, which tracks the prevalence of deaths and diseases worldwide, contains some good news: On average people are living about a decade longer than they were in 1980. But there's a catch: Health hasn't improved as fast as life expectancy overall, which means that for many, those long, final years are spent hobbled by illness and disability.

The nature of our old-age ailments has changed in recent years. The study, published this week in The Lancet and conducted by the Institute for Health Metrics and Evaluation at the University of Washington, uses a metric called "Disability Adjusted Life Years." DALYs, as they're abbreviated, combine the number of years of life a person loses if they die prematurely with the amount of time they spend living with a disability. Think of it as time you didn't spend living your #bestlife—because you were sick or dead.

In rich countries, the number one cause of these DALYs is not surprising: ischemic heart disease, which is associated with well-known Western issues like high cholesterol and obesity. But the number two condition is a little strange: plain, old-fashioned, ever-present, low back and neck pain.

Even when you include poor and middle-income countries, low back and neck pain went from ranking 12th as a cause of DALYs globally in 1990 to ranking fourth in 2015, the most recent year. In most countries, it was the leading cause of disability. DALYs from low back and neck pain increased by more than 17 percent from 2005.

The things that make us low-level miserable are now more likely to be simple aches and pains, rather than frightening, communicable diseases like diarrhea. That's encouraging, but it's still a little sad. People all over the world increasingly live long, great lives, only to spend their golden years slathered in IcyHot.

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http://www.theatlantic.com/health/archive/2016/10/how-back-pain-took-over-the-world/503243/?

Monday, September 19, 2016

Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse - National Academy of Sciences

An ad hoc committee will develop a report to inform the U.S. Food and Drug Administration (FDA) as to the state of the science regarding prescription opioid abuse and misuse, including prevention, management, and intervention, and to provide an update from the 2011 Institute of Medicine (IOM) report Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, including a further characterization of the evolving role that opioid analgesics play in pain management. The report additionally will make recommendations on the options available to FDA to address the prescription opioid overdose epidemic, from both the individual and public health perspectives, and to otherwise further advance the field.

http://nationalacademies.org/hmd/Activities/PublicHealth/AddressPrescriptionOpioidAbuse.aspx

Saturday, September 10, 2016

All Pain Is Not Equal - RELIEF: PAIN RESEARCH NEWS, INSIGHTS AND IDEAS

Thirty-one-year-old Less Henderson recently returned from a week-long hospital stay after her lung collapsed due to endometriosis, a reproductive disease in which the lining of the uterus grows in other parts of the body, causing pain. Though endometriosis usually only affects the pelvic area, in rare cases like Henderson's it can spread further, causing serious and potentially fatal complications.

While Henderson's collapsed lung was addressed quickly and she is now on the mend, she has not always been as fortunate in the health care she's received. Henderson—who is both black and working class—struggled for years to get a diagnosis for her horrible abdominal pain. Instead, she says doctors were quick to dismiss her, often accusing her of exaggerating or fabricating her pain.

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Saturday, September 03, 2016

National Pain Strategy - NIH

The objectives of the National Pain Strategy aim to decrease the prevalence of pain across its continuum from acute to high-impact chronic pain and its associated morbidity and disability across the lifespan. The intent is to reduce the burden of pain for individuals, their families, and society as a whole.

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https://iprcc.nih.gov/docs/HHSNational_Pain_Strategy.pdf

NIH Pain Consortium - Pain Information Brochures

The National Institutes of Health consists of many different institutes and centers. The following is an index to various NIH publications about pain symptoms, conditions and treatments.

https://painconsortium.nih.gov/News_Other_Resources/pain_index.html

The Interagency Pain Research Coordinating Committee (IPRCC)

The Interagency Pain Research Coordinating Committee (IPRCC) is a Federal advisory committee created by the Department of Health and Human Services to enhance pain research efforts and promote collaboration across the government, with the ultimate goals of advancing the fundamental understanding of pain and improving pain-related treatment strategies.

https://iprcc.nih.gov/index.htm

About the Pain Special Interest Group | NCCIH

The PAIN Special Interest Group (PAIN SIG) is comprised of investigators from a number of different institutes and centers at the NIH that are interested in the neurobiological mechanisms underlying pain. Our group is moderated by Drs. Yarimar Carrasquillo, Alex Chesler, and Lauren Chesler and includes students, postdocs, postbacs, staff, investigators, and clinicians. Research areas of interest span from molecular and cellular studies in model systems to clinical studies in both healthy individuals and pain patients. Our goal is to provide a forum where researchers from different backgrounds can openly exchange their ideas and perspectives as well as discuss the latest technical approaches for the study of pain.

https://nccih.nih.gov/research/intramural/sig/painsig

Review Examines Clinical Trial Evidence on Complementary Approaches for Five Painful Conditions | NCCIH

A review of evidence from clinical trials shows that a variety of complementary health approaches—including acupuncture, yoga, tai chi, massage therapy, and relaxation techniques—hold promise for helping to manage pain. The review, conducted by the National Center for Complementary and Integrative Health, was published in the journal Mayo Clinic Proceedings.

Painful conditions are the most common reasons why American adults use complementary health approaches, on which they spend more than $30 billion yearly. About 40 million American adults experience severe pain in any given year, and they spend more than $14 billion out-of-pocket on complementary approaches to manage such painful conditions as back pain, neck pain, and arthritis.

The researchers searched the MEDLINE database for randomized, controlled clinical trials published from 1966 through March 2016 and conducted in the United States or including U.S. participants. This approach was chosen because of the particular nature of the U.S. health-care system, which is relevant to "standard care" or "usual care" in trials and also to licensing requirements (where applicable) for complementary therapies.


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Saturday, August 20, 2016

In Search Of An Opioid That Offers Help Without The Risks : Shots - Health News : NPR

Once people realized that opioid drugs could cause addiction and deadly overdoses, they tried to use newer forms of opioids to treat the addiction to its parent. Morphine, about 10 times the strength of opium, was used to curb opium cravings in the early 19th century. Codeine, too, was touted as a nonaddictive drug for pain relief, as was heroin.

Those attempts were doomed to failure because all opioid drugs interact with the brain in the same way. They dock to a specific neural receptor, the mu-opioid receptor, which controls the effects of pleasure, pain relief and need.

Now scientists are trying to create opioid painkillers that give relief from pain without triggering the euphoria, dependence and life-threatening respiratory suppression that causes deadly overdoses.

That wasn't thought possible until 2000, when a scientist named Laura Bohn found out something about a protein called beta-arrestin, which sticks to the opioid receptor when something like morphine activates it. When she gave morphine to mice that couldn't make beta-arrestin, they were still numb to pain, but a lot of the negative side effects of the drug were missing. They didn't build tolerance to the drug. At certain dosages, they had less withdrawal. Their breathing was more regular, and they weren't as constipated as normal mice on morphine.

Before that experiment, scientists thought the mu-opioid receptor was a simple switch that flicked all the effects of opioids on or off together. Now it seems they could be untied. "The hope is you'd have another molecule that looks like morphine and binds to the same receptor, but the way it turns the receptor on is slightly different," says Dr. Aashish Manglik, a researcher at Stanford University School of Medicine who studies opioid receptors.

After Bohn's discovery, a number of people, including a team that includes Manglik, started looking for a drug that could connect to the mu-opioid receptor in a way that avoids the negative effects of beta-arrestin.

To do that, they mapped the receptor's structure in a computer program and started looking for chemicals that would stick to it. "We tried to look for molecules that would still bind to this 3-D structure, but are as far away from morphine and codeine as possible," Manglik says.

The team ran 3 million possibilities through the computer and picked the 23 best candidates to test in a lab. One chemical, PZM21, seems to do what they hoped: Turn the opioid receptor on without using much beta-arrestin. They report their findings in Nature on Wednesday.

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http://www.npr.org/sections/health-shots/2016/08/17/490380937/scientists-engineer-an-opioid-that-may-reduce-pain-with-less-risk?

The Connoisseur of Pain - The New York Times

Within minutes of our first meeting, and more or less in response to my saying good morning, Justin Schmidt began lamenting our culture's lack of insect-based rites of passage. He told me about the Sater√©-Maw√© people in northwestern Brazil, who hold a ceremony in which young men slip their hands into large mitts filled with bullet ants, whose stings are so agonizing they can cause temporary paralysis; when initiates pass the test, they're one step closer to becoming full members of society.

Schmidt believes we could learn something from this. By trade, he is an entomologist, an expert on the Hymenoptera order — wasps, bees and ants — but his interest in this insect ritual was not merely academic. He has two teenage boys, and, on this particular morning at least, I found him wondering whether they might benefit from a pain ritual to help introduce them to adulthood.

"I mean, it wouldn't kill them," Schmidt said. "And I think that may be the key to the whole thing: It can't kill you and yet something very real is happening."

It was a bit before 7:30 on a windy weekday morning in Tucson, and Schmidt had just dropped off his 14-year-old at school. At 69, Schmidt has a head of red hair that stubbornly refuses to go gray and a boyish face that glints of mischief. We were driving in his 1999 Toyota Corolla down a road that may have been a desert highway or a city thoroughfare: My East Coast eyes couldn't tell the difference. We pulled up to a traffic light, next to a giant saguaro cactus whose short, upturned arm gave it the look of a crossing guard gesturing us to stop.

Schmidt's new book, "The Sting of the Wild: The Story of the Man Who Got Stung for Science," weaves his theories about stinging insects through a narrative of his personal experiences digging in the dirt. For many readers, the highlight of the book will be the appendix, his celebrated Pain Scale for Stinging Insects, which rates the pain level of dozens of insect stings, an index he created mostly by firsthand experience, either by suffering stings incidentally during field research or, in some cases, by inducing them.

Because stings of the same magnitude don't necessarily feel the same, Schmidt has written haiku-like descriptions for each of the 83 sting entries:

Anthophorid bee, Pain Level 1, "Almost pleasant, a lover just bit your earlobe a little too hard."

Maricopa harvester ant, Level 3, "After eight unrelenting hours of drilling into that ingrown toenail, you find the drill wedged into the toe."

Termite-raiding ant, Level 2, "The debilitating pain of a migraine contained in the tip of your finger."

Club-horned wasp, Level 0.5, "Disappointing. A paper clip falls on your bare foot."

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Tuesday, August 09, 2016

NYTimes: Minorities Suffer From Unequal Pain Treatment

Roslyn Lewis was at work at a dollar store here in Tuscaloosa, pushing a heavy cart of dog food, when something popped in her back: an explosion of pain. At the emergency room the next day, doctors gave her Motrin and sent her home.

Her employer paid for a nerve block that helped temporarily, numbing her lower back, but she could not afford more injections or physical therapy. A decade later, the pain radiates to her right knee and remains largely unaddressed, so deep and searing that on a recent day she sat stiffly on her couch, her curtains drawn, for hours.

The experience of African-Americans, like Ms. Lewis, and other minorities illustrates a problem as persistent as it is complex: Minorities tend to receive less treatment for pain than whites, and suffer more disability as a result.

While an epidemic of prescription opioid abuse has swept across the United States, African-Americans and Hispanics have been affected at much lower rates than whites. Researchers say minority patients use fewer opioids, and they offer a thicket of possible explanations, including a lack of insurance coverage and a greater reluctance among members of minority groups to take opioid painkillers even if they are prescribed. But the researchers have also found evidence of racial bias and stereotyping in recognizing and treating pain among minorities, particularly black patients.

"We've done a good job documenting that these disparities exist," said Salimah Meghani, a pain researcher at the University of Pennsylvania. "We have not done a good job doing something about them."

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http://www.nytimes.com/2016/08/10/us/how-race-plays-a-role-in-patients-pain-treatment.html?

Wednesday, July 27, 2016

NYTimes: Naloxone Eases Pain of Heroin Epidemic, but Not Without Consequences

PORTLAND, Me. — A woman in her 30s was sitting in a car in a parking lot here last month, shooting up heroin, when she overdosed. Even after the men she was with injected her with naloxone, the drug that reverses opioid overdoses, she remained unconscious. They called 911.

Firefighters arrived and administered oxygen to improve her breathing, but her skin had grown gray and her lips had turned blue. As she lay on the asphalt, the paramedics slipped a needle into her arm and injected another dose of naloxone.

In a moment, her eyes popped open. Her pupils were pinpricks. She was woozy and disoriented, but eventually got her bearings as paramedics put her on a stretcher and whisked her to a hospital.
Every day across the country, hundreds, if not thousands, of people who overdose on opioids are being brought back to life with naloxone. Hailed as a miracle drug by many, it carries no health risk; it cannot be abused and, if given mistakenly to someone who has not overdosed on opioids, does no harm. More likely, it saves a life.

As a virulent opioid epidemic continues to ravage the country, with 78 people in the United States dying of overdoses every day, naloxone's use has increasingly moved out of medical settings, where it has been available since the 1970s, and into the homes and hands of the general public.

But naloxone, also known by the brand name Narcan, has also had unintended consequences. Critics say that it gives drug users a safety net, allowing them to take more risks as they seek higher highs. Indeed, many users overdose more than once, some multiple times, and each time, naloxone brings them back.

Advocates argue that the drug gives people a chance to get into treatment and turn their lives around. And, they say, few addicts knowingly risk needing to be revived, since naloxone ruins their high and can make them violently ill.

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http://www.nytimes.com/2016/07/28/us/naloxone-eases-pain-of-heroin-epidemic-but-not-without-consequences.html?

Wednesday, July 20, 2016

Financial Stress Hurts, Literally - Scientific American

Few things feel worse than not knowing when your next paycheck is coming. Economic insecurity has been shown to have a whole host of negative effects, including low self-esteem and impaired cognitive functioning. It turns out financial stress can also physically hurt, according to a paper published in February in Psychological Science.
Eileen Chou, a public policy professor at the University of Virginia, and her collaborators began by analyzing a data set of 33,720 U.S. households and found that those with higher levels of unemployment were more likely to purchase over-the-counter painkillers. Then, using a series of experiments, the team discovered that simply thinking about the prospect of financial insecurity was enough to increase pain. For example, people reported feeling almost double the amount of physical pain in their body after recalling a financially unstable time in their life as compared with those who thought about a secure period. In another experiment, university students who were primed to feel anxious about future employment prospects removed their hand from an ice bucket more quickly (showing less pain tolerance) than those who were not. The researchers also found that economic insecurity reduced people's sense of control, which, in turn, increased feelings of pain.

Chou and her colleagues suggest that because of this link between financial insecurity and decreased pain tolerance, the recent recession may have been a factor in fueling the prescription painkiller epidemic. Other experts are cautious about taking the findings that far. "I think the hypothesis [that financial stress causes pain] has a lot of merit, but it would be helpful to see additional rigorous evidence in a real-world environment," says Heather Schofield, an economist at the University of Pennsylvania who was not involved in the study. Given that stress in general is well known to increase feelings of pain, further research is needed to disentangle financial anxiety from other sources of pressure.

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http://www.scientificamerican.com/article/financial-stress-hurts-literally/

Friday, July 15, 2016

One striking chart shows why pharma companies are fighting legal marijuana - The Washington Post

There's a body of research showing that painkiller abuse and overdose are lower in states with medical marijuana laws. These studies have generally assumed that when medical marijuana is available, pain patients are increasingly choosing pot over powerful and deadly prescription narcotics. But that's always been just an assumption.

Now a new study, released in the journal Health Affairs, validates these findings by providing clear evidence of a missing link in the causal chain running from medical marijuana to falling overdoses. Ashley and W. David Bradford, a daughter-father pair of researchers at the University of Georgia, scoured the database of all prescription drugs paid for under Medicare Part D from 2010 to 2013.

They found that, in the 17 states with a medical-marijuana law in place by 2013, prescriptions for painkillers and other classes of drugs fell sharply compared with states that did not have a medical-marijuana law. The drops were quite significant: In medical-marijuana states, the average doctor prescribed 265 fewer doses of antidepressants each year, 486 fewer doses of seizure medication, 541 fewer anti-nausea doses and 562 fewer doses of anti-anxiety medication.

But most strikingly, the typical physician in a medical-marijuana state prescribed 1,826 fewer doses of painkillers in a given year.

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Wednesday, July 06, 2016

Pfizer agrees to truth in opioid marketing - The Washington Post

Pfizer, the world's second- ­largest drug company, has agreed to a written code of conduct for the marketing of opioids that some officials hope will set a standard for manufacturers of narcotics and help curb the use of the addictive painkillers.

Though Pfizer does not sell many opioids compared with other industry leaders, its action sets it apart from companies that have been accused of fueling an epidemic of opioid misuse through aggressive marketing of their products.

Pfizer has agreed to disclose in its promotional material that narcotic painkillers carry serious risk of addiction — even when used properly — and promised not to promote opioids for unapproved, "off-label" uses such as long-term back pain. The company also will acknowledge there is no good research on opioids' effectiveness beyond 12 weeks.

The terms of the agreement were reached with the city of Chicago, which two years ago sued five other opioid manufacturers over alleged misleading marketing of opioids. An announcement of the agreement is expected Wednesday. Pfizer has also been aiding the city's investigation and lawsuit.

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https://www.washingtonpost.com/national/health-science/pfizer-agrees-to-truth-in-opioid-marketing/2016/07/05/784223cc-42c6-11e6-88d0-6adee48be8bc_story.html

Thursday, June 23, 2016

New Ways to Treat Pain Meet Resistance - The New York Times

A few months ago, Douglas Scott, a property manager in Jacksonville, Fla., was taking large doses of narcotic drugs, or opioids, to deal with the pain of back and spine injuries from two recent car accidents.

The pills helped ease his pain, but they also caused him to withdraw from his wife, his two children and social life.

"Finally, my wife said, 'You do something about this or we're going to have to make some changes around here,'" said Mr. Scott, 43.

Today, Mr. Scott is no longer taking narcotics and feels better. Shortly after his wife's ultimatum, he entered a local clinic where patients are weaned off opioids and spend up to five weeks going through six hours of training each day in alternative pain management techniques such as physical therapy, relaxation exercises and behavior modification.

Mr. Scott's story highlights one patient's success. Yet it also underscores the difficulties that the Obama administration and public health officials face in reducing the widespread use of painkillers like OxyContin and Percocet. The use and abuse of the drugs has led to a national epidemic of overdose deaths, addiction and poor patient outcomes.

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http://www.nytimes.com/2016/06/23/business/new-ways-to-treat-pain-without-opioids-meet-resistance.html?

Thursday, June 16, 2016

Survey shows lots of people save leftover painkillers - Futurity

More than half of patients who get a prescription for opioid painkillers have leftover pills and keep them to use later, a practice that could potentially exacerbate the United States' epidemic of painkiller addiction and overdoses.

Researchers reporting in JAMA Internal Medicine also found that nearly half of those surveyed reported receiving no information on how to safely store their medications to keep them from children who could accidentally ingest them or from someone looking to get high.

One in five respondents said they had shared their medication with another person, many saying they gave them to someone with pain. Nearly 14 percent said they were likely to share their prescription painkillers with a family member in the future and nearly 8 percent said they would share with a close friend.

"The fact that people are sharing their leftover prescription painkillers at such high rates is a big concern," says Colleen L. Barry, who directs Johns Hopkins University's Center for Mental Health and Addiction Policy Research. "It's fine to give a friend a Tylenol if they're having pain, but it's not fine to give your OxyContin to someone without a prescription."

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Sunday, June 12, 2016

An E.R. Kicks the Habit of Opioids for Pain - The New York Times

Brenda Pitts sat stiffly in an emergency room cubicle, her face contorted by pain. An old shoulder injury was radiating fresh agony down to her elbow and up through her neck. She couldn't turn her head. Her right arm had fallen slack.

Fast relief was a pill away — Percocet, an opioid painkiller — but Dr. Alexis LaPietra did not want to prescribe it. The drug, she explained to Mrs. Pitts, 75, might make her constipated and foggy, and could be addictive. Would Mrs. Pitts be willing to try something different?

Then the doctor massaged Mrs. Pitts's neck, seeking the locus of a muscle spasm, apologizing as the patient groaned with raw, guttural ache and fear.

"Quick prick," said Dr. LaPietra, giving Mrs. Pitts a trigger point injection of Marcaine, a numbing, non-opioid analgesic.

Within seconds, Mrs. Pitts blinked in surprise, her features relaxing, as if the doctor had sponged away her pain lines. She sat up, gingerly moving her head, then beamed and impulsively hugged the doctor, vigorously and with both arms.

Since Jan. 4, St. Joseph's Regional Medical Center's emergency department, one of the country's busiest, has been using opioids only as a last resort. For patients with common types of acute pain — migraines, kidney stones, sciatica, fractures — doctors first try alternative regimens that include nonnarcotic infusions and injections, ultrasound guided nerve blocks, laughing gas, even "energy healing" and a wandering harpist.

Scattered E.R.s around the country have been working to reduce opioids as a first-line treatment, but St. Joe's, as it is known locally, has taken the efforts to a new level.

"St. Joe's is on the leading edge," said Dr. Lewis S. Nelson, a professor of emergency medicine at New York University School of Medicine, who sat on a panel that recommended recent opioid guidelines for the Centers for Disease Control and Prevention. "But that involved a commitment to changing their entire culture."

In doing so, St. Joe's is taking on a challenge that is even more daunting than teaching new protocols to 79 doctors and 150 nurses. It must shake loose a longstanding conviction that opioids are the fastest, most surefire response to pain, an attitude held tightly not only by emergency department personnel, but by patients, too.

Pain is the chief reason nearly 75 percent of patients seek emergency treatment. The E.R. waiting rooms and corridors of St. Joe's, where some 170,000 patients will be seen this year, are frequently pierced by high-pitched cries and anguished moans.

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http://www.nytimes.com/2016/06/14/health/pain-treatment-er-alternative-opioids.html

Tuesday, May 31, 2016

Why taking morphine, oxycodone can sometimes make pain worse | Science | AAAS

There's an unfortunate irony for people who rely on morphine, oxycodone, and other opioid painkillers: The drug that's supposed to offer you relief can actually make you more sensitive to pain over time. That effect, known as hyperalgesia, could render these medications gradually less effective for chronic pain, leading people to rely on higher and higher doses. A new study in rats—the first to look at the interaction between opioids and nerve injury for months after the pain-killing treatment was stopped—paints an especially grim picture. An opioid sets off a chain of immune signals in the spinal cord that amplifies pain rather than dulling it, even after the drug leaves the body, the researchers found. Yet drugs already under development might be able to reverse the effect.

It's no secret that powerful painkillers have a dark side. Overdose deaths from prescription opioids have roughly quadrupled over 2 decades, in near lockstep with increased prescribing. And many researchers see hyperalgesia as a part of that equation—a force that compels people to take more and more medication, while prolonging exposure to sometimes addictive drugs known to dangerously slow breathing at high doses. Separate from their pain-blocking interaction with receptors in the brain, opioids seem to reshape the nervous system to amplify pain signals, even after the original illness or injury subsides. Animals given opioids become more sensitive to pain, and people already taking opioids before a surgery tend to report more pain afterward.

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Friday, May 27, 2016

The Itch Lab — The California Sunday Magazine

The rash, which has spread from the crook of my elbow to the base of my wrist, is starting to sprout puffy, crimson welts. It's been three minutes since I rubbed a mound of coarse blond fibers onto my forearm, and what began as a mild prickling sensation has escalated into a throbbing itch. Diana Bautista doesn't seem concerned. "Will scratching make it worse?" I ask. She nods. "Yes, but it will feel really good while you're doing it."
This unsanctioned self-experiment is taking place in the kitchenette of Bautista's University of California, Berkeley, lab. The source of my discomfort is itch powder, the kind anyone can pick up at a novelty store. Its blue packet shows a cartoon man writhing in agony. Below him, in bold letters, are the words, SURPRISE THAT SPECIAL FRIEND! "It's kind of weird people can just buy this stuff on Amazon and not know what it is," Bautista says. A professor of cell and developmental biology, she's pretty sure she knows what the ingredients are: rose-hip hairs and fiberglass. Itchy stuff for sure, but there are far more distressing things in her lab.
Bautista is one of a small but growing number of researchers in the United States trying to decode the molecular secrets of itchiness. She arrived at the specialty the way many others in her field have: by studying pain. For most of medical history, itch and pain were considered variants of the same sensation — itch being just a mild form of pain. What Bautista and others have shown is that while the two share many cellular receptors and molecules, itch has its own biological infrastructure. It's these largely unmapped internal pathways that Bautista has been working to identify for the past seven years.

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https://story.californiasunday.com/itch-lab-diana-bautista?

Wednesday, May 18, 2016

The Sting of the Tarantula Hawk: Instantaneous, Excruciating Pain - Undark

Stung by a tarantula hawk? The advice I give in speaking engagements is to lie down and scream. The pain is so debilitating and excruciating that the victim is at risk of further injury by tripping in a hole or over an object in the path and then falling onto a cactus or into a barbed-wire fence. Such is the sting pain that almost nobody can maintain normal coordination or cognitive control to prevent accidental injury. Screaming is satisfying and helps reduce attention to the pain of the sting. Few, if any, people would be stung willingly by a tarantula hawk. I know of no examples of such bravery in the name of knowledge, for the reputation of spider wasps — specifically tarantula hawks — is well known within the biological community. All stings experienced occurred during a collector's enthusiasm in obtaining specimens and typically resulted in the stung person uttering an expletive, tossing the insect net into the air, and screaming. The pain is instantaneous, electrifying, excruciating, and totally debilitating.

The accompanying article is excerpted from Justin O. Schmidt's new book "The Sting of the Wild: The Story of the Man Who Got Stung for Science," published this spring by John's Hopkins University Press.
Howard Evans, the great naturalist and author of the classic book "Life on a Little Known Planet," was an expert on solitary wasps. Howard, a slight, reserved man with a shock of white hair and a sparkle in his eyes, was especially fond of tarantula hawks. Once, in his dedication to the investigation of these wasps, Howard netted perhaps 10 female tarantula hawks from a flower. He enthusiastically reached into the insect net to retrieve them and, undeterred after the first sting, continued, receiving several more stings, until the pain was so great he lost all of them and crawled into a ditch and just sobbed. Later, he remarked that he was too greedy.

I know of only two people who were "voluntarily" stung by tarantula hawks. I say "voluntarily" as both were performing their duties as part of documentary films, which, among other things, "encouraged" being stung. One was a young, handsome athletic entomologist who knew of the wasps. He deftly reached into the large cylindrical battery jar and grabbed a wasp by the wings. He had her in such a position that her sting harmlessly slid off his thumbnail. We prattled for a minute or so about tarantula hawks while the camera scanned close up to the long sting as it slid harmlessly, missing its mark. Then with a great heave the wasp pulled its abdomen back and thrust the sting under the nail. Yeee…ow (I can't recall if any expressions unsuitable for general audiences were uttered), the wasp was hurled into the air and flew off unharmed. One point for wasp, zero for human.

The other was a solidly built fellow who was apparently a master of performing pain-defying acts of bravery. For the film, I was charged with catching the wasp and delivering it to the scene. Five or six tarantula hawks were easily netted from flowers of an acacia tree; unfortunately, the net snagged on some thorns, and all but one wasp escaped. The remaining wasp appeared to be a male, so I summoned the cameraman to demonstrate how males cannot sting and are harmless. I reached in and casually grabbed "him." At this point, I realized that I was holding a "her." Yeee…ow, except this time it was me. I managed to toss her back in the net, while attempting to explain my blunder and pain on camera. As I was not in the film – perhaps fortunately – the footage was relegated to some obscure studio archive, perhaps someday to be resurrected on YouTube. That episode over, the tarantula hawk was delivered to the rightful actor. He grabbed her, was stung, and showed no reaction beyond a begrudging "Ouch, that did hurt a bit." I figured the guy had no nerves. But his director then handed him a habanero pepper, a tarantula hawk of chili peppers, which he enthusiastically bit into. He became instantly speechless, convinced fire was blasting from his mouth, nose, and ears. Apparently, he did have some nerves — sensitive at least to chili peppers.

How could such a small animal as a tarantula hawk be so memorable? Several years ago I attempted to address this question in a paper entitled "Venom and the Good Life in Tarantula Hawks: How to Eat, Not Be Eaten, and Live Long." The natural history of tarantula hawks provides some insights. Tarantula hawks are the largest members of the spider wasp family Pompilidae, a family some 5,000-species strong that prey solely on spiders. The feature of tarantula hawks that makes them so special is their choice of the largest of all spiders, the fierce and intimidating tarantulas, as their target prey. The old saying "you are what you eat" rings true for tarantula hawks: if you eat the largest spiders, you become the largest spider wasps. As with other spider wasps, the female wasp provides each young with only one spider that serves as breakfast, lunch, and dinner for its entire growing life.

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http://undark.org/article/tarantula-hawk-wasp-sting-pain/

Thursday, May 12, 2016

Treating Pain Without Feeding Addiction at ‘Ground Zero’ for Opioids - The New York Times

BRIDGEPORT, W.Va. — The doctors wanted to talk about illness, but the patients — often miners, waitresses, tree cutters and others whose jobs were punishingly physical — wanted to talk only about how much they hurt. They kept pleading for opioids like Vicodin and Percocet, the potent drugs that can help chronic pain, but have fueled an epidemic of addiction and deadly overdoses.

"We needed to talk about congestive heart failure or diabetes or out-of-control hypertension," said Dr. Sarah Chouinard, the chief medical officer at Community Care of West Virginia, which runs primary care clinics across a big rural chunk of this state. "But we struggled over the course of a visit to get patients to focus on any of those."

Worse, she said, some of the organization's doctors were prescribing too many opioids, often to people they had grown up with in the small towns where they practiced and whom they were reluctant to deny. So four years ago, Community Care tried a new approach. It hired an anesthesiologist to treat chronic pain, relieving its primary care doctors and nurse practitionersof their thorniest burden and letting them concentrate on conditions they feel more comfortable treating.

Since then, more than 3,000 of Community Care's 35,000 patients have seen the anesthesiologist, Dr. Denzil Hawkinberry, for pain management, while continuing to see their primary care providers for other health problems. Dr. Chouinard said Community Care was doing a better job of keeping them well over all, while letting Dr. Hawkinberry make all the decisions about who should be on opioid painkillers.

"I'm part F.B.I. investigator, part C.I.A. interrogator, part drill sergeant, part cheerleader," said Dr. Hawkinberry. He is also a recovering opioid addict who has experienced the difficulties of the drugs himself.

Even for people with access to the best doctors, it is hard to safely control chronic pain. Community Care is trying to do so for a disproportionately poor population, in a state that has been ground zero for opioid abuse from the very beginning of what has become a national epidemic.

Now, the difficult work of addressing the nation's overreliance on opioids, while also treating debilitating pain, is playing out on a patient-by-patient basis, including in a patchwork of experiments like this one. About 70 percent of the 1,200 patients currently in Community Care's pain management program receive opioids as part of their treatment, which may also include nonnarcotic drugs, physical therapy, injections and appointments with a psychologist.

Many had already been on opioids "for many years before they met me," Dr. Hawkinberry said, adding that his goal is to get them on lower doses, and to try other ways of managing their pain, with his own experience as a cautionary lesson.

He became addicted to the opioid fentanyl when he was an anesthesiology resident, he said, and had to wage a legal fight to stay in the program. He relapsed four years later while working at a West Virginia hospital and underwent treatment and monitoring by a state program for doctors with addiction problems. He says he has been in recovery and has not used drugs for almost nine years.

Dr. Chouinard said that Dr. Hawkinberry's experience made him "all the better positioned to know what this is like" and well-positioned to screen for drug abuse.

Patients who are prescribed opioids have to submit urine samples at each monthly appointment and at other random times, and to bring their pills to every visit to be counted. About 500 have been kicked out of the program for violations since it started in 2012.

In addition, Community Care's pain management clinic is closely monitored by the state as one of six licensed to operate under a 2012 law meant to cut down on pill mills.

The organization's primary care providers talk frequently with Dr. Hawkinberry about the patients they share with him. Because they use the same electronic medical record system, they can keep close tabs on how their patients' pain is being treated — and he on how their other health problems, like high blood pressure, are being addressed.

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http://www.nytimes.com/2016/05/12/us/opioids-addiction-chronic-pain.html?

Wednesday, May 11, 2016

Research Grants - Migraine Research Foundation

The Migraine Research Foundation (MRF) and the Association of Migraine Disorders (AMD) announce the opening of a joint Request for Proposals for migraine research grants. MRF is committed to discovering the causes, improving the treatments, and finding a cure, and AMD stimulates increased research specifically in the area of migraine disorders. We are looking for projects that will help sufferers by advancing our ability to understand and treat migraine. As a result, we provide seed money grants for transformational projects that will lead to better treatment and quality of life for sufferers of migraine and migraine disorders.

While we welcome all proposals relevant to basic or clinical migraine research, we are particularly interested in translational projects and those related to migraine variants, childhood migraine, and chronic migraine.

https://migraineresearchfoundation.org/for-researchers/rfp-and-grant-application/

Tuesday, May 10, 2016

What Does Genetics Tell Us About Chronic Pain? - Relief: Pain Research News, Insights And Ideas

When the pain comes, Alina Delp retreats to air conditioning as soon as possible. What begins to feel like a mild sunburn will, if left unattended, turn into a raging, burning pain.

"It's this turbulent, violent sensation that feels electric and stinging," Delp says, describing the pain at its worst. "I've run out of the building screaming like a lunatic before because it's been so bad."

Delp has erythromelalgia, a rare condition in which a person's body (typically the feet and the hands, though Delp experiences pain all over) reacts to mild warmth as though it is on fire. Mild exertion, even just standing, will set it off for Delp, which meant quitting her job of 15 years as a flight attendant. Two years of countless doctors' appointments finally got her a diagnosis in 2012, but current medications are unable to relieve pain in most patients.

"I'm pretty much a prisoner in my own home," she says. Her house in Tacoma, Washington, is kept at a chilly 58 degrees Fahrenheit, thanks to some special duct work that her husband, coincidentally in the heating and cooling business, was able to arrange. Delp spends most of her time reading, watching TV, or working on her computer to maintain an online erythromelalgia support group that she co-founded.

But, this horrific condition has handed pain researchers their most promising drug target in years. In 2004, a study of an inherited version of erythromelalgia pinpointed a mutation in a gene that directs the making of a sodium channel, called Nav1.7; sodium channels are proteins that help control the electrical excitability of neurons.

"The channel sets the sensitivity of pain-signaling neurons, and when you have those Nav1.7 mutations, the neurons fire when they shouldn't," says Stephen Waxman of Yale University School of Medicine, New Haven, US, and the Veterans Affairs Medical Center, West Haven, Connecticut. Waxman was the first to study the effects of Nav1.7 mutations in neurons.

Delp doesn't know if she has this type of mutation, but medicines that calm the channel may still give her relief. Multiple clinical trials are underway to test Nav1.7 channel blockers, not only in inherited erythromelalgia, but in more common conditions, like sciatica and trigeminal neuralgia, which both involve intense shooting pain in different parts of the body.

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http://relief.news/genetics-tell-us-chronic-pain/