Thursday, December 28, 2006

Psychological pain: A review of evidence

This paper defines a symptom construct termed psychological pain and reviews clinical and neuroimaging evidence relevant to it. The psychological pain associated with severe depression is often perceived as worse than any physical pain that the individual has experienced and could be a critical component of suicidality that could be systematically assessed in potentially suicidal patients. Converging evidence from brain imaging studies suggests overlapping patterns of brain activation induced by both psychological pain and by physical pain. Future research on the role of psychological pain and its interaction with nociceptive pathways may provide novel clues to the understanding and treatment of depression and other psychiatric illnesses.

Psychological pain: A review of evidence

Steven Mee, Blynn G. Bunney, Christopher Reist, Steve G. Potkin and William E. Bunney 

Volume 40, Issue 8 , December 2006, Pages 680-690

Wednesday, December 27, 2006

Proof that losing money really is scary - New Scientist

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.

The President's Council on Physical Fitness and Sports - Exercise: The Key To The Good Life

Exercise: The Key To The Good Life

The exciting news from recent scientific studies is that exercise benefits everyone – regardless of age. Exercise can help you take charge of your health and maintain the level of fitness necessary for an active, independent lifestyle. This booklet is designed to help you start a fitness program of exercise so you can maintain or improve your physical health.

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.

Tuesday, December 26, 2006

The Most-Avoided Conversation in Medicine - New York Times

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.

Saturday, December 23, 2006

Psychotherapy effective against back pain

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.

See also:

Friday, December 22, 2006

Women's Bioethics Blog

This is not your typical blog. We have recruited scholars and public policy analysts from around the world to provide daily news and commentary on the implications of bioethical issues for women. We hope you’ll bookmark this page and let us know what you think: just click on the comment link at the bottom of each post to join the discussion. To sign up for the WBP newsletter, visit our homepage at

The Daily Headache


A candid look at managing and living with headaches

Another collection of medical blogs

Sham Acupuncture More Effective Than Sugar Pill in Easing Arm Pain (click here)

In a duel between two placebos for treating self-reported arm pain,
the better placebo emerged victorious, Harvard researchers have found.

During the first two weeks of the comparative study, there was little
difference between sham acupuncture and a sugar pill, investigators
reported in BMJ Online First. However, differences began to emerge
during the following weeks showing that sham acupuncture produced
a more enhanced and surprisingly lasting placebo effect.

The study by Dr. Kaptchuk and colleagues showed that the patients
who reported improvements in symptoms were also those who
believed they were getting an active treatment. At two weeks, 75% of
the participants in the sham acupuncture group said they were
receiving an active treatment compared with only 48% of the sugar
pill group, indicating that believing may be key to feeling better.

All itches not created equal -- Different parts of brain activated depending on cause

Intense itching and the urge to scratch are symptoms of many chronic skin ailments. A new study conducted by Oxford University researchers has found that different reactions in the brain to two common allergy triggers -- allergens (pollen and dust) and histamine (allergy cells within the body caused by foods, drugs or infection) -- may shed some light on the itch-scratch cycle.

After examining the data obtained at the different itch sites, the different itch scales, and the gender differences between the study populations, the researchers determined that extensive commonalities existed between allergen- and histamine-induced itch. Among them was the extensive involvement of the brain’s motivation circuitry in response to both types of itches.

Researchers also observed differences, including:

* allergen-induced itch intensity ratings were higher compared to histamine;

* perception of itch and changes in blood flow were significantly greater when allergen induced;

* itch intensity perception and the changes in blood flow occurred significantly later in response to allergen, and while the sensations took longer to appear, they were perceived to exist for significantly longer periods;

* itch elicited by allergens activated different parts of the brain, specifically the supplementary motor and posterior parietal areas; and

* the differences found in the orbifrontal regions of the brain imply a compulsion to so something (i.e., scratch) that is very strong in the allergen group. This is presumably due to the heightened intensity of the itch. There are similarities to the activity in this area of the brain and other disorders that display compulsive behavior. This might help to explain why eczema sufferers scratch to the point of harm because they are compelled to do so and cannot help themselves.

The Frontal Cortex : Placebos and Fake Pregnancy

This is the ultimate placebo effect:

Pseudocyesis, or false pregnancy, is rare, occurring at a rate of 1 to 6 for every 22,000 births. Though scientists are still largely baffled about what causes it in humans, recent case studies and studies of similar conditions in animals are beginning to provide insight, exploring the role of hormones and psychology.

Those who suffer from the disorder present a constellation of symptoms that mystify even seasoned practitioners. Not only do they fervently believe they are pregnant, but they also have bona fide symptoms to back up their claims, like cessation of menstruation, abdominal enlargement, nausea and vomiting, breast enlargement and food cravings.
A few patients with pseudocyesis even test positive on pregnancy tests, said Dr. Paul Paulman, a family practitioner at the University of Nebraska Medical Center.
"Every sign and symptom of pregnancy has been recorded in these patients except for three: You don't hear heart tones from the fetus, you don't see the fetus on ultrasound, and you don't get a delivery," Dr. Paulman said.

The mechanism seems to be a mind-body feedback loop, in which thoughts of pregnancy trigger very real changes in hormone levels, which can cause physical symptoms like abdominal swelling and milk excretion. In this sense, false preganancy is just an exaggerated form of the typical placebo effect, in which the mind is able to alter both its mental representation of the body and the body itself. The definitive paper on this subject was done by the lab of Jonathan Cohen, which imaged the brain of people alleviating their pain with a sugar pill:
In two functional magnetic resonance imaging (fMRI) experiments, we found that placebo analgesia was related to decreased brain activity in pain-sensitive brain regions, including the thalamus, insula, and anterior cingulate cortex, and was associated with increased activity during anticipation of pain in the prefrontal cortex, providing evidence that placebos alter the experience of pain.

Thursday, December 21, 2006

Pain often untreated in elderly with dementia

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. Improving pain treatment through education

The topics for PainEDU were developed with input from pain management professionals. The information included at this site was chosen based on clinician interests, best practices in the field and a desire to deliver health education in an interactive manner. We seek to provide ideas and strategies that help educate clinicians and improve the overall treatment and care of pain.

Imaging could furnish proof of chronic pain - The Boston Globe

Imaging could furnish proof of chronic pain
Emotional, legal boost for patients
By Carey Goldberg, Globe Staff  |  December 19, 2006

Researchers foresee a day when people tortured by chronic, unexplained pain will be able to prove that they really hurt -- evidence that could help sufferers be taken more seriously and could even lead to better treatments.

Recent studies suggest that prolonged, ongoing pain leaves a signature in the brain that can be detected using advanced imaging techniques. In other work, researchers at Massachusetts General Hospital and elsewhere have found that excruciating nerve damage can be detected in bits of skin the size of a pinhead. And genetic tests may someday prove useful, researchers believe: Certain genes appear to be linked to lower pain thresholds and a tendency to develop chronic pain.

Reflex Sympathetic Dystrophy Syndrome (RSD), also known as Complex Regional Pain Syndrome (CRPS)

What is RSD?

Reflex Sympathetic Dystrophy Syndrome (RSD) - also known as Complex Regional Pain Syndrome (CRPS) - is a chronic neurological syndrome characterized by:

  • severe burning pain
  • pathological changes in bone and skin
  • excessive sweating
  • tissue swelling
  • extreme sensitivity to touch


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.

Complex Regional Pain Syndrome: Treatment Guidelines

This new edition of the guidelines has been edited by R. Norman Harden, MD, Director, Center for Pain Studies, Addison Chair, Rehabilitation Institute of Chicago; Associate Professor, Physical Medicine & Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL.

People's responses to placebo or 'dummy' pain relief varies according to their way of thinking

40 pain-free volunteers took part in an experiment funded by the Arthritis Research Campaign using an artificial pain stimulus, and were led to expect reduced pain after the application of a cream which was actually a placebo. 

Lead researcher Alison Watson said: "Any medical treatment involves a placebo element; the psychological suggestion that it is going to work. So we theorised that a proportion of any treatment's effectiveness would relate to how much we wanted it to work, believed in it or trusted the person administering it. 

"Doctors and nurses can transmit a lot of information about a treatment and its effectiveness through their words and gestures. We know that when people visit their preferred GP the treatment or advice they receive will be more effective than that given by a GP they prefer not to see. Similarly, red pills have been shown to be more effective than green ones; so we wanted to test whether all this was due to expectations of successful treatment and trust in the person giving it." 

24 of the volunteers initially received a moderately painful heat stimulus to both arms. The placebo cream was then applied to the skin, but they were led to believe that the cream on one of their arms may be a local anaesthetic. 

After the application of the cream, the intensity of the heat stimulus was turned down on one arm without informing the volunteer. Subsequently the intensity was returned to its previous level, but - in contrast to the 16 people in the control group - 67% of the treatment group continued to perceive the heat as less painful.

Tuesday, December 19, 2006

FDA Proposes Labeling Changes to Over-the-Counter Pain Relievers

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:

For Products Containing Acetaminophen
  • To require new warnings which would highlight the potential for liver toxicity, particularly when using acetaminophen in high doses, when taking more than one product with acetaminophen, and when taken with moderate amounts of alcohol;
  • To require that the ingredient acetaminophen be prominently identified on the product's principal display panel (PDP) of the immediate container, and the outer carton (if applicable).
For Products Containing NSAIDs
  • To require new warnings for products that contain an NSAID which would highlight the potential for stomach bleeding in persons over age 60, in persons who have had prior ulcers or bleeding, in persons who take a blood thinner, when taking more than one product containing an NSAID, when taken with moderate amounts of alcohol, and when taking for longer time than directed; and
  • To require that the name of the NSAID ingredient and the term "NSAID" be prominently identified on the product's PDP of the immediate container and the outer carton (if applicable).

Not Feeling Each Other's Pain -

Not Feeling Each Other's Pain
Men and Women Hurt Differently -- and Some of The Difference May Really Be in Their Heads

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.

Monday, December 18, 2006

Game away the pain

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."

Sunday, December 17, 2006

Neurontic - Psychology for the Modern Mind

The brain, as noted neuroscientist V.S. Ramachandran says, is "the most complexly organized form of matter in the universe." We all carry this miraculous piece of machinery with everywhere we go, but most of us know next to nothing about how it works.

Neurontic is designed to give laypeople a window into the inner workings of the human mind. Understanding a little about the symphony of neural activity occurring in our brains on a daily basis gives us a new vantage point on ourselves. Popping the proverbial hood and taking a peak at the mechanics of the mind has made me marvel at the elegance of the human psyche. I hope Neurontic does the same for you.

Orli Van Mourik is presently earning her Masters in Journalism at NYU. Neurontic is designed to give laypeople a window into the inner workings of the human mind.

Friday, December 15, 2006

Diabetes breakthrough,Toronto scientists cure disease in mice

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.

Nice commentary:

Thursday, December 14, 2006

The mutation that takes away pain - Studies of rare disorder shed light on pain mechanism.

Imagine being unable to feel any pain at all. For a tiny handful of people, that is the reality — and medical researchers have now pinpointed the mutation that removes their ability to perceive painful sensations.

The study began when doctors in northern Pakistan examined a remarkable group of related families in which several individuals seem entirely unaffected by pain. Their attention was first attracted by one member of the clan, a locally famous boy who performed street theatre involving walking on burning coals and stabbing his arms with knives.

Although it sounds like a party trick, the condition is devastating, as sufferers don't learn to know their limits. The street-performing boy killed himself on his fourteenth birthday after jumping off a house roof. The researchers studied six of his relatives, aged between 4 and 14 years. All had suffered many cuts and bruises, and injuries to lips and tongue caused by biting themselves; several had fractured bones without noticing.

This shows the importance of pain for our health and survival, notes Geoffrey Woods of the Cambridge Institute for Medical Research, UK, who led the study. "Pain is there for a jolly good reason — it stops us damaging ourselves," he says. For example, the pain from a broken arm or sprained ankle encourages us to rest that body part while it recovers.

The children in the study had no such safety check, causing them to be both graceless and reckless. "One girl was continually knocked down in the playground and just didn't mind at all," Woods says.

The researchers compared DNA samples from the six children and found that they all share a mutation in a gene called SCN9A, which is strongly expressed in nerve cells. They report their results in Nature.

Google Patents - search through 1147 pain related patents

Google has expanded the scope of its search activities once again with the beta launch of Google Patent Search. The patent search engine allows users to search through the full text of over 7 million patents issued by the US Patent and Trademark Office and works much like Google's Book Search.

Wednesday, December 13, 2006

Open Letter To Normals About Fibromyalgia

These are the things that I would like you to understand about me before you judge me...

Please understand that being sick doesn't mean I'm not still a human being. I have to spend most of my day flat on my back in bed and I might not seem like great company, but I'm still me stuck inside this body. I still worry about school and work and my family and friends, and most of the time I'd still like to hear you talk about yours too.

Please understand the difference between "happy" and "healthy". When you've got the flu you probably feel miserable with it, but I've been sick for years. I can't be miserable all the time, in fact I work hard at not being miserable. So if you're talking to me and I sound happy, it means I'm happy. That's all. I may be tired. I may be in pain. I may be sicker that ever. Please, don't say, "Oh, you're sounding better!". I am not sounding better, I am sounding happy. If you want to comment on that, you're welcome.

Please understand that being able to stand up for five minutes, doesn't necessarily mean that I can stand up for ten minutes, or an hour. It's quite likely that doing that five minutes has exhausted my resources and I'll need to recover - imagine an athlete after a race. They couldn't repeat that feat right away either. With a lot of diseases you're either paralyzed or you can move. With this one it gets more confusing.

Please repeat the above paragraph substituting, "sitting up", "walking", "thinking", "being sociable" and so on ... it applies to everything. That's what a fatigue-based illness does to you.

Please understand that chronic illnesses are variable. It's quite possible (for me, it's common) that one day I am able to walk to the park and back, while the next day I'll have trouble getting to the kitchen. Please don't attack me when I'm ill by saying, "But you did it before!". If you want me to do something, ask if I can and I'll tell you. In a similar vein, I may need to cancel an invitation at the last minute, if this happens please don't take it personally.

Please understand that "getting out and doing things" does not make me feel better, and can often make me seriously worse. Fibromyalgia may cause secondary depression (wouldn't you get depressed if you were stuck in bed for years on end!?) but it is not caused by depression. Telling me that I need some fresh air and exercise is not appreciated and not correct - if I could do it, I would.

Please understand that if I say I have to sit down/lie down/take these pills now, that I do have to do it right now - it can't be put off or forgotten just because I'm doing something. Fibromyalgia does not forgive.

Please understand that I can't spend all of my energy trying to get well. With a short-term illness like the flu, you can afford to put life on hold for a week or two while you get well. But part of having a chronic illness is coming to the realization that you have to spend some energy on having a life now. This doesn't mean I'm not trying to get better. It doesn't mean I've given up. It's just how life is when you're dealing with a chronic illness.

If you want to suggest a cure to me, please don't. It's not because I don't appreciate the thought, and it's not because I don't want to get well. It's because I have had almost every single one of my friends suggest one at one point or another. At first I tried them all, but then I realized that I was using up so much energy trying things that I was making myself sicker, not better. If there was something that cured, or even helped, all people with Fibro then we'd know about it. This is not a drug-company conspiracy, there is worldwide networking (both on and off the Internet) between people with Fibro, if something worked we would KNOW.

If after reading that, you still want to suggest a cure, then do it, preferably in writing, but don't expect me to rush out and try it. If I haven't had it suggested before, I'll take what you said and discuss it with my doctor.

Please understand that getting better from an illness like this can be very slow. People with Fibro have so many systems in their bodies out of equilibrium, and functioning wrongly, that it may take a long time to sort everything out.

I depend on you - people who are not sick - for many things.

But most importantly, I need you to understand me.

A quasi-random selection of the huge number of medical and healthcare blogs

Tuesday, December 12, 2006

Gate control theory of pain - Wikipedia, the free encyclopedia

Encyclopedia of Pain - 2007 - $1,250

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.

Written for:
Clinical scientists and practitioners in academia, health care and industry, as well as students, teachers and interested laypersons

Monday, December 11, 2006

Pain: A blog by Tony Cole

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.

Recent Entries

Smokers 'suffer more knee pain'

Smokers 'suffer more knee pain'

Osteoarthritis of the knee is more painful and more damaging in smokers, a study reports.

Men who smoked had more progressive disease and reported higher levels of pain, a US team found.

Around a million people suffer from osteoarthritis in the UK - a condition causing inflammation and loss of cartilage in the joints.

The study in Annals of Rheumatic Diseases supports previous research showing smokers feel more back pain.

The researchers followed 159 men with symptomatic osteoarthritis of the knee for 30 months.

Overall, 12% of the participants were current smokers.

MRI scans of the knee showed that the smokers had a more than two-fold increased risk of loss of cartilage in the knee joint - a process that occurs as the disease progresses.

Men who smoked also had higher pain scores than men who didn't smoke throughout the study.

The greater amount of pain was unlikely to be due to increased cartilage loss as cartilage does not have pain fibres.

Study author Professor David Felson, professor of medicine at Boston University Medical School said there were a few potential explanations for the pain finding but it could be explained by changes in pain thresholds in smokers.

"There is data elsewhere that shows smokers feel more pain. It's not unique to knees, there's a strong relationship with smoking and worse back pain.

"My guess is it's a general increase in musculoskeletal pain and that something in cigarette smoke sensitises people to lower pain thresholds," he said.

Osteoarthritis is much more common in women but there were too few women smokers in the study to measure the effect on them.

However Professor Felson said the results would probably be the same: "There's no reason it would be different in women as I don't think the biology is likely to be different but we can't be sure."

"It's an additional reason to stop smoking as it may lessen the pain and rate of cartilage loss," he added.

Dr Peter Stott, a GP in Tadworth, Surrey and member of the scientific advisory committee of the National Osteoporosis Society said it was hard to be categorical about the findings as the research was preliminary but it was another reason to stop smoking.

"It's interesting but there could be a number of reasons for the findings which are unrelated to smoking.

"One is that smokers are different emotionally as they have a tendency to be addicted and to need things that give them relief such as cigarette smoke.

He added: "The finding that needs to be looked at in another study is the cartilage loss because other studies have shown smoking is protective."

Origin Of Inherited Pain Disorder Pinpointed

Origin Of Inherited Pain Disorder Pinpointed

The genetic basis for a rare inherited disorder that causes severe burning pain with no warning has been pinpointed by researchers. They found that paroxysmal extreme pain disorder (PEPD) is caused by specific mutations in porelike sodium channels in peripheral nerve cells--a discovery that they said emphasizes the role of such channel disorders in inflammatory pain. Such findings of abnormal function in disease also provide insights into the normal function of such channels, they said.

R. Mark Gardiner, of University College London, and his colleagues published their findings in the December 7, 2006, issue of the journal Neuron, published by Cell Press.

So-called "voltage-gated sodium channels" are central to the neuron's ability to propagate a nerve impulse. In response to voltage changes in a nerve cell caused by a nerve impulse, these channels snap open, allowing sodium to flow across the cell membrane, further propagating the nerve impulse. Rapid, precise activation and inactivation is key to their normal operation.

In their studies, the researchers sought to understand the basis of PEPD, which is characterized by abrupt paroxysms of pain in the rectum, eye, and jaw. They first performed a detailed genetic comparison of affected and unaffected members of one large family that showed inheritance of the disease. That analysis revealed that mutations that compromise the gene for a component of one particular sodium channel, called SCN9A, were the likely culprit. Further analysis of the gene in 11 affected families and two sporadic cases, indeed, revealed that mutations in SCN9A are responsible for the disease in at least two-thirds of PEPD cases.

Analysis of these mutations revealed that they all disrupted the ability of the sodium channel to rapidly snap shut, prolonging activation of the peripheral nerves in which the channels functioned. What's more, the researchers found, the drug carbamazepine--known to be effective in PEPD--acts to correct this abnormality in cultures of neurons.

The researchers also compared PEPD with another inherited pain disorder, primary erythermalgia (PE) that is not alleviated by carbamazepine. PE is also caused by mutations in SCN9A and is characterized by pain in the extremities triggered by exercise or temperature change. In contrast to PEPD, which is caused by mutations that disrupt inactivation the sodium channel, PE arises from mutations that lower its activation threshold.

The researchers concluded that their findings "further emphasize the critical role of [this sodium channel] in human inflammatory pain and explain the differential drug sensitivity of PEPD and PE."

Sea snail key to future of pain relief

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.

Saturday, December 09, 2006

Osteoarthritis Study

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.

  • One of the studies includes a group taking capsules not having the opioid medication, however, this study allows your usual non-opioid pain medication to be taken throughout the study
  • The other studies evaluate the safety and effects of treatment with the 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.

Friday, December 08, 2006

The Frontal Cortex

Jonah Lehrer is an editor at large for Seed Magazine. His first book, Proust Was A Neuroscientist, will be published by Houghton-Mifflin in 2007.

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