Psychological pain: A review of evidence
Steven Mee, Blynn G. Bunney, Christopher Reist, Steve G. Potkin and William E. Bunney
Psychological pain: A review of evidence
Steven Mee, Blynn G. Bunney, Christopher Reist, Steve G. Potkin and William E. Bunney
The fear of losing money can be similar to the fear of physical pain, according to a study of brain scan images.
The finding could potentially shed light on why people who make high risk financial decisions, such as stock market players, sometimes develop anxiety disorders, says Mauricio Delgado at Rutgers University in Newark, New Jersey, US.
In the new study, Delgado and colleagues invited 15 student volunteers to play a gambling game on a computer that, unknown to them, always gave a positive win of $59.
They would then be told of either a $6 loss from their $59 sum, or that the amount they currently possessed would stay the same. Different coloured screens preceded the message.
In the next part of the experiment, rather than lose $6, the students received a mild electric shock to the wrist. Again, coloured screens preceded the outcome. The players soon learned which colour represented each outcome.
Brain scans conducted on the participants as they watched the screens showed the colours associated with the $6 loss or electric shock elicited a similar amount of activation in a brain region called the striatum. Researchers have previously linked activity in this region to fear of pain.
Exercise: The Key To The Good Life
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Many people think that as we age, we tend to slow down and do less; that physical decline is an inevitable consequence of aging. For the most part, this is not true. According to The President's Council on Physical Fitness and Sports, much of the physical frailty attributed to aging is actually the result of inactivity, disease, or poor nutrition. But the good news is – many problems can be helped or even reversed by improving lifestyle behaviors. One of the major benefits of regular physical activity is protection against coronary heart disease. Physical activity also provides some protection against other chronic diseases such as adult-onset diabetes, arthritis, hypertension, certain cancers, osteoporosis and depression. In addition, research has proven that exercise can ease tension and reduce the amount of stress you feel.
To put it simply – exercise is one of the best things you can do for your health.
The exercise program described and illustrated on the following pages has been prepared specifically for you! It is a daily routine that takes 20 to 30 minutes. Take a minute to read the instructions carefully. Performing each exercise properly is as important as spending enough time on them.
J. R. was an auto mechanic of French Canadian descent with a perfectly square gap between his two front teeth and the slightly off-kilter face of a retired boxer. Soon after I met him on the surgical ward, after he had been found to have cancer, he developed a habit of planting himself in front of me whenever I got within 100 feet of his room, to spin stories about his life, wax poetic about his girlfriend, and offer free auto-repair advice.
I thought we had caught the tumor in J. R.’s colon early, but in the operating room we found that the cancer had grown into his pelvic sidewalls. After surgery, when I began to tell him that some of his cancer remained, he stopped me. “Hey, Doc,” he said. “I know I’m going to be fine because you did my surgery.”
J. R. sent me a Christmas card that year, but I could not bring myself to write back. I told myself that I was too busy, when in fact I was afraid to acknowledge that J. R. was dying. Patient deaths, for many doctors, represent a kind of failure, and so without really thinking, we look the other way.
I am not the only doctor who has had difficulty dealing with dying patients. Researchers who in the mid-1990s observed more than 9,000 seriously ill patients in five American teaching hospitals found substantial shortcomings in the care of the dying. More than a third spent at least 10 of their last days in intensive care. Among patients who remained conscious until death, half suffered moderate to severe pain. And fewer than half of their physicians knew whether or not their patients wanted to avoid cardiopulmonary resuscitation.
The researchers then made a multimillion-dollar effort to improve communication between patients and doctors on end-of-life care. They generated frequent reports to physicians on patients’ expected survival and hired specially trained nurses to talk with patients, families, physicians and hospital staff about prognoses, pain control and advance care planning.
WASHINGTON, Dec. 22 (UPI) -- People suffering with chronic lower back pain may want to turn to their psychologist for relief, a review of published studies suggests.
Researchers found psychological treatments, such as cognitive behavior therapy, can be effective in reducing back pain and improving patients' quality of life, depression and ability to work.
"This study provides quite compelling evidence of the effectiveness of these treatments," said lead author Robert Kerns, chief of the psychology service at the VA Connecticut Healthcare System.
The study will appear in the January 2007 issue of Health Psychology.
Kerns and colleagues used state-of-the-art analytic techniques to review 22 studies on psychological treatments and pain, which were published between 1982 and 2003. The study participants represented a broad array of people whose back pain generated from both known and unknown causes. The researchers excluded those with cancer from their analysis.
The study subjects had also experienced debilitating back pain for an average of seven years, and all had a history of trying multiple treatments in their quest for relief.
Kerns and team did not narrow their data search to one psychological approach. They included interventions a person would get in the psychologist's office, such as cognitive therapy; self-regulation, such as hypnosis, biofeedback -- using signals from the body to improve health -- and relaxation; and supportive counseling.
Self-regulation techniques and cognitive behavior therapy were the most beneficial in easing pain. Cognitive therapies could mean helping the patient manage their pain through exercise, managing their time or resting during the day.
But psychological treatments weren't limited to managing pain; Kerns was surprised to find the most robust gains came in eliminating the patients' pain intensity.
"Whereas 30 years ago we talked about these (psychological) interventions as learning to live with pain, we now have strong data that in fact these interventions are effective in reducing a person's experience of pain," Kerns said.
This is the ultimate placebo effect:
Many older adults with dementia and pain don't receive adequate drug treatment for their pain, according to a study.
Researchers who reviewed the patient records of 115 adults with dementia living in the community found that more than half (54 percent) reported noncancer-related pain "on an average day."
The caregivers of more than half of these subjects reported no use of pain medication. Of the subjects who did use a painkiller, most were taking typical over-the-counter analgesics and none were prescribed a strong prescription opioid.
Forty-six percent of all subjects had "potentially insufficient analgesia," report Dr. Joseph W. Shega, of Northwestern University, Chicago, and colleagues in the Journal of the American Geriatrics Society.http://www.sciam.com/article.cfm?chanID=sa003&articleID=597073E68FCEFAA6BDF39CA6B399C28C
What is RSD?
Reflex Sympathetic Dystrophy Syndrome (RSD) - also known as Complex Regional Pain Syndrome (CRPS) - is a chronic neurological syndrome characterized by:
Reflex Sympathetic Dystrophy Syndrome (RSD), also known as Complex Regional Pain Syndrome (CRPS) is a chronic pain syndrome characterized by severe and relentless pain that affects between 200,000 and 1.2 million Americans.
CRPS/RSD is a malfunction of part of the nervous system. Nerves misfire, sending constant pain signals to the brain. The syndrome develops in response to an event the body regards as traumatic, such as an accident or a medical procedure. This syndrome may follow 5% of all injuries.
Minor injuries can cause major problems. Minor injuries, such as a sprain or a fall are frequent causes of CRPS/RSD. One characteristic of CRPS/RSD is that the pain is more severe than expected for the type of injury that occurred.
Early and accurate diagnosis and appropriate treatment are key to recovery, yet many health care professionals and consumers are unaware of its signs and symptoms. Typically, people with CRPS/RSD report seeing an average of 5 physicians before being accurately diagnosed.
Symptoms include persistent moderate-to-severe pain, swelling, abnormal skin color changes, skin temperature, sweating, limited range of movement, movement disorders.
CRPS/RSD is 2 to 3 times more frequent in females than males.
The mean age at diagnosis is 42 years. However, we are seeing more injuries among young girls, and children as young as 3 years old can get CRPS/RSD.
This is not a psychological syndrome, but children may develop psychological problems when physicians, parents, teachers and other children do not believe their complaints of pain.
Treatment may include medication, physical therapy, psychological support, sympathetic nerve blocks and, possibly, sympathectomy, or dorsal column stimulator.
FDA Proposes Labeling Changes to Over-the-Counter Pain Relievers
The Food and Drug Administration (FDA) today proposed to amend the labeling regulations on over-the-counter (OTC) Internal Analgesic, Antipyretic, and Antirheumatic (IAAA) drug products to include important safety information regarding the potential for stomach bleeding and liver damage and when to consult a doctor. OTC IAAA drug products, commonly known as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen and ketoprofen, are used to treat pain, fever, headaches, and muscle aches.
To help ensure safe use of OTC products, and to provide consumers with the labeling necessary for them to make more informed medical decisions, FDA is proposing the following label changes:
By Francesca Lunzer Kritz
Special to The Washington Post
Tuesday, December 19, 2006
When I get a particularly nasty headache, I race for the ibuprofen bottle and down three 200-milligram tablets (a dose long ago approved by my doctor) and get on with whatever I was doing, comforted by the knowledge that I've taken action to dull the pain and that I will feel better soon. When my husband has a headache, he delays doing anything -- including telling me, for whatever comfort that might bring -- and succumbs to the ibuprofen (taking just two tablets) only when the pain is so severe he can't do much else.
Some might say our headache techniques are a manifestation of our quirky personalities -- and there may be some truth in that. But research presented at a University of Maryland Dental School conference this fall suggests my XX and my husband's XY chromosomes might also be partly to blame. While sex differences alone may not account for the variability of individual pain response, said keynote speaker Karen Berkley, a professor of neuroscience at Florida State University, growing research suggests that men's and women's nervous systems process pain information differently and act on it differently.
A lot of research, including some published just last week, has demonstrated that the human brain goes to great lengths to avoid being distracted from the task it is focusing on. Some researchers in the medical community are trying to harness that distraction-suppressing capability. These doctors hope that by focusing a patient's mind on an immersive task, the brain will suppress distractions such as the pain, fear, and discomfort caused by medical procedures and recovery.
What can provide a sufficient distraction to get a kid to ignore the pain? In one research paper (PDF), it was the combination of the game Street Luge and a set of virtual-reality goggles. The risk of a pain-free virtual road rash was apparently enough to keep kids from registering much of the pain or fear of needles involved with having an IV line inserted. In sharp contrast to their peers, kids using Street Luge didn't indicate any pain via their facial expression when having the IV put in. The study found that the VR-based distraction left everyone happy, with "significantly more child-, parent-, and nurse-reported satisfaction with pain management."http://arstechnica.com/news.ars/post/20061217-8437.html
In a discovery that has stunned even those behind it, scientists at a
Toronto hospital say they have proof the body's nervous system helps
trigger diabetes, opening the door to a potential near-cure of the
disease that affects millions of Canadians.
Diabetic mice became healthy virtually overnight after researchers
injected a substance to counteract the effect of malfunctioning pain
neurons in the pancreas.
"I couldn't believe it," said Dr. Michael Salter, a pain expert at the
Hospital for Sick Children and one of the scientists. "Mice with
diabetes suddenly didn't have diabetes any more."
The researchers caution they have yet to confirm their findings in
people, but say they expect results from human studies within a year or
so. Any treatment that may emerge to help at least some patients would
likely be years away from hitting the market.But the excitement of the
team from Sick Kids, whose work is being published today in the journal
Cell, is almost palpable.
This is the most comprehensive overview available anywhere on the broad, multi-faceted and complex topic of pain – and the rapidly evolving scientific and medical disciplines that seek to understand, assess and treat it. More than 3,000 entries provide clear, detailed and up-to-date coverage of the current state of research, and treatment of pain. Essays offer in-depth information on all aspects of nociception and pain, including substrates, causes, pathophysiology, symptoms and signs, diagnoses and treatment. 1,000 color figures enhance understanding. This three-volume reference is an invaluable tool for clinical scientists and practitioners, as well as students, teachers and interested laypersons.
About this blog
I’ve been in chronic pain since I was a year old, have paid a huge price for this, and spent the last few years reading widely on the subject. This blog contains my own essays as well as links to other writers who interest me.
Sea snail key to future of pain relief
Published: 11 December 2006
Unique research at The University of Queensland could revolutionise
the treatment of pain relief – thanks to a humble sea snail.
Dr Jenny Ekberg, a Research Fellow with UQ's School of Biomedical
Sciences, has studied a toxin produced by a marine snail found on the
Great Barrier Reef, which has the ability to precisely target chronic
pain without severe side-effects.
“Chronic pain can be caused by an initial injury that affects the
nerves, or conditions such as diabetes and arthritis,” Dr Ekberg said.
“The problem with current drugs, such as morphine, is that they
sometimes offer only marginal relief and come coupled with lots of
problems with tolerance and side-effects.
“Our research show that a natural product, a conotoxin from the
marine snail Conus marmoreus, produces pain relief without apparent
side-effects in animal models of chronic pain.”
The study, done with colleagues Professor David Adams in the School
of Biomedical Sciences, Dr Richard Lewis at UQ's Institute for
Molecular Bioscience and Professor Mac Christie at the University of
Sydney, was recently published in the Proceedings of the National
Academy of Sciences.
Dr Ekberg said with approximately one in five Australians suffering
from chronic pain at some point in their life, the potential benefit
of this research could be enormous.
She said sufferers of chronic pain can have the added problem of
being diagnosed with no reason for the pain.
“The patient experiences severe pain because their nerve cells that
are responsible for pain transmission are overactive,” she said.
“This is primarily due to abnormal activity of voltage-gated sodium
channels in the nerve cells.
“Conventional drugs, such as local anaesthetics, block all types of
sodium channels, causing severe side-effects.
“Our toxin only blocks a specific channel – the first time a toxin
like this has been shown to work – therefore providing pain relief
without severe side-effects.”
Dr Ekberg said it would be a number of years before such a treatment
would be commercially available.
Originally from Sweden, Dr Ekberg came to UQ to complete her Honours
in Biomedical Sciences and stayed to complete a PhD, from which this
research stemmed, under the supervision of Professor David Adams and
Associate Professor Phil Poronnik.
Dr Ekberg said she has since remained at UQ because of a combination
of high-class research and a wonderful environment.
There are three similar studies being conducted to evaluate the safety and effects of treatment with an investigational oral opioid pain medication compared to taking an approved opioid pain medicine.
We are seeking clinical research volunteers to join a study of an investigational pain medication for men or women between 18 and 80 years old who have osteoarthritis and are candidates for hip or knee joint surgery.
We are also seeking volunteers who are at least 18 years old with low back pain, hip or knee pain from Osteoarthritis to join a similar study of the same investigational pain medication.
These studies will last 4 weeks or 4 months or 13 months depending on your qualifications for participation and the particular study you are interested in.http://thepainstudy.com/index.html
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