Friday, August 29, 2008

Emotional pain hurts more than physical pain, researchers say - Telegraph

Emotional pain hurts more than physical pain, researchers say
Pain caused by emotional distress is more deeply felt and longer lasting than that caused by physical injuries, according to a new study.
In a finding that calls into question the old saying that "sticks and stones may break my bones, but words will never hurt me", psychologists used four experiments to discover how people get over emotional or physical pain.
In their paper "When Hurt Will Not Heal: Exploring the Capacity to Relive Social and Physical Pain", the authors propose recent discoveries suggesting social or emotional pain is as real and intense as physical pain.
The researchers asked participants to relive their past painful experiences by writing in detail what had happened and how they had felt.
In the first two studies, students were asked to relive both emotional and physical pain, answering a series of questions and then recalling in detail an experience of physical injury, or an experience of betrayal by a person who was close to them, or both.
Each experience was to have occurred in the previous five years.
The students were asked to note how long ago the event happened, how much it hurt at the time, how many times they had talked about the experience, and how painful the experience felt now.
Participants in the emotional pain condition reported higher levels of pain than participants in the physical pain condition, found the researchers from Purdue University in the US and Macquarie University and the University of New South Wales in Australia.
The students also reported less pain when they relived the experience than they had reported before writing the account.
In experiments three and four participants were given cognitive tasks with different levels of difficult after reliving a socially or physically painful event.
Again, those in the emotional pain condition performed worse than those thinking about physical injury.
One of the authors, Dr Kip Williams from Purdue, said: "While both types of pain can hurt very much at the time they occur, social pain has the unique ability to come back over and over again, whereas physical pain lingers only as an awareness that it was indeed at one time painful.
"Why aren't we always suffering pain by recollections of social betrayal and other forms of social pain? Because we are pretty good at keeping these memories at bay.
"We had to induce our participants to think about the details of the social painful event in order to get them to feel pain at the present. Merely saying, 'oh yeah, my boyfriend cheated on me once...' is insufficient to cause current pain. They have to steep themselves in the memory, and that's something we don't ordinarily do."
The results are published in the August issue of the journal Psychological Science.

Wednesday, August 27, 2008

August Pain-Blog Carnival | How To Cope With Pain Blog

August Pain-Blog Carnival

In Sickness and In Health writes about why asking for help, especially from our spouse/partner, is difficult to do in Hard Conversations.

Coping with pain is also hard.  Psychology of Pain discusses why some people are more able to deal with the challenge in Is Pain All in the Mind?

HealthSkills shares a fascinating study which uses fMRI to look at the effects of hypnosis.  Are You Curious About Hypnosis?

Help My Hurt writes an informative post about identifying pain in people who can't speak or communicate discomfort in words.

Rest Ministries answers what to do when a friend just doesn't "get it."  Keep the friendship?  Try to help them understand?  Here are some answers to this friendship challenge.

Looking for a book for these last few days of vacation?  Somebody Heal Me reviews Strong at the Broken Places, which examines what it's like to live with chronic or terminal illness.

And a few valuable "how-to's"…  First, The Back Pain Blog gives some good advice about avoiding back pain at your workstation, in Prevent Back Pain with an Ergonomic Workstation.  (I loved the photos!!)

Arthritis Friend shares 3 Reasons to Keep a Food Journal to improve your health.

And Ed's Health Tips reviews how treatments including exercises and acupuncture can help frozen shoulders.

Fighting Fatigue reports on the importance of Vitamin D.

Arthritis Friend asks if this is the understatement of the day?

Sunday, August 24, 2008

Related Websites on Pain Topics

Pain Treatment Topics evaluated the Internet sites below as being essentially non-commercial and serving the information and education needs of the pain management community.

Pain Treatment Topics - Access to Clinical News, Information, Research and Education

The mission of Pain Treatment Topics is to serve as a noncommercial resource for healthcare professionals, providing open access to clinical news, information, research, and education for a better understanding of evidence-based pain-management practices. Advertising is not accepted.

Saturday, August 23, 2008

Pain Perception It's All In The Genes

Pain Perception It's All In The Genes

23 Aug 2008   

Previous studies have shown that women experience more severe postoperative pain and require more narcotics than men in the early postoperative period. A study featured in the September issue of Anesthesiology investigates women's pain perception and relief after Caesarean section and the impact of genetics on these outcomes.

The study, authored by Alex T. Sia, M.D., and colleagues at KK Women's & Children's Hospital in Singapore, evaluated 588 women who were injected with morphine in the spinal canal after delivering their children via Caesarean section.

Dr. Sia indicated that, "Information from this study could be the beginning of a systematic approach to develop a method of predicting pain threshold and morphine requirement for pain relief."

Previous studies have shown that genetic variability at position 118 of the human m-opioid receptor gene altered patients' responses to intravenous morphine. This new study included women receiving spinal injections of morphine for post Caesarean analgesia.

Based on their blood samples, women participating in the study fell into one of three genotype groups for the m-opioid receptor alleles: homozygous AA, homozygous GG, and heterozygous AG.

Pain scores, assessment of the severity of nausea and vomiting, the incidence of itching, and the total dose self-administered intravenous morphine were recorded for the first 24 postoperative hours across the study group.

The major finding was that the various genetic types correlated with a significant variability in morphine consumption after Cesarean section. Women with the AA genotype consumed the least amount of patient-controlled analgesia (PCA) morphine and had demonstrably lower pain scores than those in other genotypic groups.

The study also showed that individuals with the AA genotype had the highest risk of developing nausea (but not vomiting), despite lower consumption of PCA morphine.

From this research, it can be inferred that the AA group had a greater sensitivity to the analgesic effect of morphine injected into the spinal canal, a greater sensitivity to PCA morphine in counteracting post-operative pain, or a combination of the two. It could also be inferred that the greater analgesic sensitivity to morphine in the AA group is also related to a higher risk of developing nausea.

As a result, the study showed that various forms of the human opioid receptor has a significant effect on pain perception, analgesic requirement, and nausea for the first 24 hours after cesarean section.

That said, Dr. Sia noted that the findings likely have important implications in differences among women's pain perception in general, pain after childbirth, and narcotic use after surgery. Furthermore, the study has additional relevance to understanding the importance of genetic variation in the transition from acute to chronic pain, the development of chronic pain after surgery, and their treatment.

Thursday, August 21, 2008

'Pain treatment is a human right … We should be able to guarantee it to anyone' - News

Pain treatment is a human right … We should be able to guarantee it to anyone'

Tristan Stewart-Robertson talks to Prof Michael Bond about how to bridge the divide between the West and the developing world

YOU trip over a rock, falling to the ground and landing on your knee. You cry out in pain and look for comfort, but you are alone and there is no doctor or nurse for hundreds of miles. The superficial injury heals, but pain persists and there is no treatment for years to come.

This scenario, common in the developing world, is far removed from that experienced in more developed countries, and this divide between levels of pain treatment available around the planet is a major theme of a conference being held in Glasgow this week.

Thousands of scientists, doctors, nurses, dentists, pharmacists and patients have descended on the city for the 12th World Congress on Pain, one of the biggest conferences set for Scotland this year, with about 6,000 delegates expected to attend.

One of the major concerns for pain experts in recent years has been bridging the global divide in pain research and treatment, and getting training and support for pain relief to remote and less-developed regions.

Sir Michael Bond, emeritus professor of psychological medicine at Glasgow University, is one of the organisers of the congress and a former president of the International Association for the Study of Pain (IASP), the body that awarded the biennial event to Glasgow.

He was instrumental in turning the attention of the IASP beyond the western world, and now argues that the developing world must continue to be a prime focus.

"The IASP had always had limited programmes for people in developing countries," says Prof Bond. "But it became clear to me and others that the developing countries were falling behind the western world.

"We started a clinical programme for training people in the actual practical management of pain. We now try to ask people to set up the programmes in their own countries for a bottom-up application.

"Bringing people to the West would be costly and teach them things that are not necessarily applicable."

The so-called "brain drain" of trained practitioners from developing countries particularly to the US and Australia, is also a considerable problem.

Prof Bond admits the West takes the "best people" but the IASP scheme aims to keep the knowledge local, and health care professionals – mostly doctors – have already benefited from the programme's work in Mongolia, Laos, Thailand, Indonesia, Bangladesh and Vietnam. 

There are also programmes in Nigeria, Kenya and South Africa, but in other African countries there are huge gaps in care, says Prof Bond.

It is here where the IASP's goals differ from those of groups such as Médecins Sans Frontières and Douleurs Sans Frontières which offer immediate relief. The IASP's approach is a long-term aim to ensure more services are available in developing countries, he says.

"There are gross differences that exist in care. As an international organisation, we had a responsibility," says Prof Bond. "Pain treatment is a human right, and that comes up quite a lot in discussions. We should be able to guarantee pain treatment to anyone."

Pain in the developing world will be just one topic at this week's congress. Topics for other sessions include: stress and chronic pain; pain and suffering following torture; traumatic nerve injury and treating pain caused by cancer therapy.

Prof Bond explains that pain is now thought of on a biological-psychological social model: the physical causes of pain, the chronic affect of pain on an individual, and the way society addresses that pain.

He says there can be emotional causes of pain, and even the memory of a past pain can cause physical symptoms, which often present difficulties for doctors seeking the specific source of a patient's complaint.

Prof Bond's own work started with studies of women with advanced cancer of the cervix in the 1960s, and research continues today identifying how unique an individual's experience of pain can be, from the genetic level to the emotional and the social contexts in which they live.

For example, a rugby player's injury might not cause much stress, whereas a cancer patient could experience high levels of fear and anxiety. Both would be affected differently by the pain, and express it differently to care professionals.

Prof Bond says those fears must be dispelled, both through practical treatment and how the care is provided. And he hopes the congress will send out a message to the public that pain treatment is a serious issue being addressed on every level, from the cellular to societal attitudes as a whole.

"On a professional level this conference will bring as many people as possible together to share ideas, get new information and go back home charged up to improve their research and clinical practices.

"We want to alert the local population and beyond to the impact of good pain management. Most people think of cancer and cancer pain as the main area we know more about now than 20-30 years ago. It has improved immensely, but so has treatment of other pains. We still face difficulties and we want the public to know this is a live and active topic."

Bienvenue à l'Association quebecoise de la douleur chronique/Quebec Association for Chronic Pain

Welcome to the Quebec Association for Chronic Pain website (AQDC - Association québécoise de la douleur chronique). 

Ours is an association of patients for patients.  Nine of the twelve administrators  are patients representing the largest clinics treating chronic pain in Quebec.  We are all volunteers who want to make a difference. You too can make a positive contribution.

The site contains news, links, blogs, and videos, and patient testimonials.

French language site:

Thursday, August 14, 2008

Is pain all in the mind? - Times Online

Is pain all in the mind?

New research shows why some people are better at coping with pain than others

Pain is a simple enough concept to grasp. You stub your toe, shout, perhaps utter a few expletives, rub it better and it eventually fades. But neuroscientists are realising that pain is much more complex than anyone thought possible, comprising not just physical sensations, but emotional ones too. Pioneering studies are providing insights into why some people experience debilitating chronic pain long after an injury has healed, as well as why some are more prone to pain than others, and why certain people never recover from bereavement.

“Pain is much more than mere sensation. The psychological component is at least as important as the physiological processes giving rise to it,” says Dr Jonathan Brooks, a scientist at the Centre for Functional Magnetic Resonance Imaging of the Brain, at Oxford University. His research centre scans the brains of people with chronic pain and compares them with those of healthy people.

While most pain goes away as an injury gets better, sometimes it remains for months or even years, long outlasting its original purpose. Chronic physical pain is debilitating and can cause disability, depression and post-traumatic stress disorder. It is also very common. A group from the University of Washington reported in the journal Archives of Surgery earlier this year that 63 per cent of patients who had sustained serious trauma still had injury-related pain a year later. It was most common in the 35-44 age group and in women, and least common in those with a college education.

Other chronic pain conditions include arthritis and lower back pain. In the latter, a physical source can be identified in only about 10 per cent of cases. No one really knows why some people experience chronic pain and others do not, but recent imaging studies at Northwestern University, Chicago, have found a series of abnormalities in the brains of chronic pain sufferers in which the part linked to decision-making (the prefrontal cortex) is reduced, while an area of the prefrontal cortex linked to emotion is hyperactive. What is known for certain is that the brain changes in those with chronic pain so that they experience pain differently from the way they did before.

We all have a system for suppressing pain when necessary so that we can flee attackers even when injured. Those who suffer from chronic pain appear unable to access this and cannot use distraction as a means of suppressing pain; their brains seem to amplify pain signals rather than inhibit them.

Treatment for the condition comprises both physical and psychological interventions, says Dr Michael Platt, the lead clinician for pain services at St Mary's Hospital, London, part of Imperial College Healthcare NHS Trust, where he holds weekly pain clinics. “Most physicians realise that you have to heal the mind as much as the body. For example, if you have pain, then depression is worse, and if you have depression, then pain is worse.” He adds that gaining a better indication of which parts of the brain are involved in pain sensations may lead to better treatments for patients.

We all respond to pain differently

Scientists are increasingly realising that everyone responds to pain differently. “There are many physiological and psychological factors that determine how much pain you feel,” says Dr Brooks. “Personality, how worried a person is, and, in the case of women, the time in the menstrual cycle, can all have an effect.”

He adds that our genes can also influence our sensitivity to pain. This was first brought to the attention of scientists by the “ginger-whinger” syndrome. Anaesthetists reported that redheaded women complain of pain more than other patients, and consequently need more pain relief. Why? Not because redheads are wimps; it was later discovered that their genetic make-up makes them less sensitive to certain types of pain medication.

Neuroscience is also revealing a host of similarities between emotional and physical pain. In the same way that in some people injury can cause long-lasting chronic pain, science reveals why some will never get over heartbreak.

Professor David Alexander, the director of the Aberdeen Centre for Trauma Research, has been involved in many disasters: the 2004 tsunami; Iraq; and the recent earthquake in Pakistan. He is not surprised about the link between physical and emotional pain. “If you listen to people who are damaged emotionally, they will often translate their pain into physical similes: ‘my head is bursting, my guts are aching', and so on. The parallel is very strong.”

It is only in the past few years, however, that scientists have begun to investigate what is going on in the brain during an episode of emotional pain. The neuroscientist Mary Frances O'Connor, of the University of California, Los Angeles (UCLA), is one of the scientists who has propelled emotional pain up the research agenda. “We're at a very new time when we can use technologies to look at the brain and the heart.” Naomi Eisenberger, one of her colleagues at UCLA, has shown which parts of the brain are active when we feel emotional pain. She devised a computer game in which participants were made to feel left out. Simultaneous brain scanning revealed that the pain of being socially rejected was processed in much the same way in the brain as physical pain, and in the same area, the anterior cingulate cortex, which is located towards the front of the brain, roughly at the height of the temples.

Eisenberger theorises as to why this should be so. Pain is often interpreted as a warning, so that you take your hand away from a hot surface. Social relationships are crucial to our survival as a species. In dangerous situations, a lone human being is in peril, whereas a group may survive. “The social attachment system piggybacked on to the physical pain system to make sure that we stay connected to close others,” Eisenberger says. Being wrenched from another or rejected by a group is painful, so we learn to avoid it.

A related issue is “complicated grief”, which O'Connor estimates occurs in about 10 per cent of people, who fail to adapt to bereavement over time. Her imaging work shows that this sort of grief activates neurons in the reward centre of the brain, giving addictive-like properties to memories of the lost one. There is a strong suspicion, as yet unproven, that sufferers might also be among those who experience the greatest levels of chronic physical pain. This is an area that deserves urgent research because of its terrible emotional and physical toll.

How to deal with pain


Prolonged exercise lifts the spirits and reduces pain, as evidenced by the “runners' high”, which is driven by the naturally produced painkillers, endorphins.

Don't bottle it up

Talking about your emotions helps - one reason why women are less at risk from illness after a bereavement.

Don't self-medicate

Dulling pain with alcohol, recreational drugs or too many prescription painkillers can turn recoverable trauma into lifelong dependency or addiction.

Don't get overtired

Tiredness exacerbates pain, especially in women. Fatigue is often reported with chronic pain, though less so in men, whose higher testosterone levels make their muscles more resistant to fatigue.

Try mindfulness meditation

By concentrating on your moment-to-moment experience, you can - through repeated practice - achieve a greater sense of control and enhanced emotional wellbeing.

Case study

For the chronic pain patients who arrive at the pain management centre at St Mary's Hospital, in Paddington, West London, this clinic is their last resort.

One such patient is Ursula Madden, who lives in London with her 12-year-old son. Madden works as a radiographer at St Mary's, but her chronic pain turned her from employee to patient. She initially dismissed her painful feet as a side-effect of her busy job. But when she to lie down every night after work because of an unbearable burning sensation across the tops of her feet, she decided it was time to see her doctor.

Getting a diagnosis was not easy. It took two years, with long spells off work because she couldn't walk, and Madden became very depressed.

“None of the doctors was accepting the fact that I was in agony,” she says. Madden was eventually referred to the pain clinic where it was discovered that the pain in her feet was caused by a combination of arthritis and faulty nerves sending pain signals to the brain. The diagnosis made a big impact. “When you have something that people can't see, unlike, say, a broken arm, recognition is a very big part of it.”

The doctors at the clinic use a variety of approaches, from psychological intervention such as counselling and life coaching, to more physical treatments, such as pain killers, acupuncture and super-hot chilli pepper cream. The latter works to desensitise the nerves.

“The first time I used the cream I was jumping around with pain, but it worked brilliantly,” says Madden, who believes that attending the clinic has helped her enormously, both physically and psychologically.

While visiting her sister in ireland recently she managed to go on a four-mile walk along the coast that she wouldn't have been able to do two years ago. “I was thinking, 'Sod the pain; I'm going to put on my boots and do it'. Yes, it was painful. But I still really enjoyed it; it was wonderful.”