Friday, October 24, 2008

American and Canadian Academies of Pain Management

The American Academy of Pain Management is an inclusive,
interdisciplinary organization serving clinicians who treat people
with pain through education, setting standards of care, and advocacy.


The Canadian Academy of Pain Management is dedicated to promoting
excellence of care for pain sufferers; through comprehensive
professional development for professionals who care for pain
sufferers; in a context of interdisciplinary collaboration; and
through adherence to the core professional attitudes and acquisition
of knowledge essential for caring for pain sufferers.

Thursday, October 23, 2008

International Association for the Study of Pain | Global Year Against Cancer Pain

I am pleased to announce that IASP is launching the 2008–2009 Global Year Against Cancer Pain to focus attention on the pain and suffering faced by people with cancer. Through this campaign, IASP seeks to provide a voice to those with cancer-related pain by "Raising Awareness, Improving Treatment, and Growing Support." We hope the program will serve as an important first step toward reducing cancer-related pain and suffering for people around the world. 

Throughout the year, IASP's members and chapters will organize various programs and events designed to highlight the issues associated with cancer pain. Specifically, these efforts will encourage and promote:

  • Proper assessment and management of cancer pain by knowledgeable clinicians
  • Increased access to appropriate treatments for cancer pain
  • More research on the underlying biology of cancer pain
  • Development of new therapies to relieve the pain and suffering of cancer patients

Wednesday, October 22, 2008

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

The mission of Pain Treatment Topics is to provide access to news, information, research, and education relating to the causes and effective management of pain. Along with that, we are dedicated to offering contents that are evidence-based, unbiased, non-commercial, and comply with the highest standards and principles of accrediting and other oversight organization.

Prescription opiates and kids: One pill can kill -

Nine-month-old Shayla Davidson was a sick little girl, and her mother had no idea why.

Pale, listless and barely breathing, the baby wouldn't wake up one day last month, even when 25-year-old Nicolle Jones rushed her to an emergency room near Cincinnati.

Medical crews were stumped, too, until they noted that Shayla's pupils were constricted, a tell-tale sign of opiate poisoning.

"They kept asking me, 'Did she get ahold of any medicine?'" Jones recalled. "I said, 'No.'"

In fact, Shayla had ingested medication, a single 60-milligram tablet of oxycontin, a powerful prescription painkiller.

But pediatric specialists at the Cincinnati Children's Hospital and Medical Center wouldn't know that until later, after they'd treated the child five times with a strong antidote and performed tests that linked Shayla's life-threatening condition to the common drug her grandfather takes for back pain.

"I about fell on the floor when they told me," said Jones, who lives with her parents in nearby Independence, Ky. "My dad keeps his medicines up high. We're thinking he dropped it."

Shayla's fine now, but she's also lucky, according to a recently released report from the nation's poison control centers. It shows a rising tide of prescription drug use is threatening unintended users: young children who accidentally ingest the powerful painkillers.

More ...

Tuesday, October 14, 2008

The Scan That Didn’t Scan -

This is a story about M.R.I.'s, those amazing scans that can show tissue injury and bone damage, inflammation and fluid accumulation. Except when they can't and you think they can.

I found out about magnetic resonance imaging tests when I injured my forefoot running. All of a sudden, halfway through a run, my foot hurt so much that I had to stop.

But an M.R.I. at a local radiology center found nothing wrong.

That, of course, was what I wanted to hear. So I spent five days waiting for it to feel better, taking the anti-inflammatory drugs ibuprofen and naproxen, using an elliptical cross-trainer, and riding my road bike with its clipless pedals that attach themselves to my bicycling shoes. By then, my foot hurt so much I had to walk on my heel. I was beginning to doubt that scan: it was hard to believe nothing was wrong. So I went to the Hospital for Special Surgery in New York for a second opinion from Dr. John G. Kennedy, an orthopedist who specializes in sports-related lower-limb injuries. And there I had another M.R.I.

It showed a serious stress fracture, a hairline crack in a metatarsal bone in my forefoot. It was so serious, in fact, that Dr. Kennedy warned that I risked surgery if I continued activities like cycling and the elliptical cross-trainer, which make such injuries worse. And I had to stop taking anti-inflammatory drugs, since they impede bone healing.

As I hobbled around the office on crutches, one of my colleagues, James Glanz, asked what had happened. As we chatted, it turned out that he had had a much more sobering experience than mine.

Jim, the Baghdad bureau chief for The New York Times, was playing touch football in New York in late 2005 when he landed hard while diving to make a catch, both elbows hitting the ground at once. The next day, his fingers and hands hurt so much he couldn't type.

But an M.R.I. showed nothing except some bulging disks in his neck that, he was told, were common in people his age, 50. He was advised to do neck exercises, and eventually he felt better.

About a year later, he fell again while playing football. His symptoms came roaring back.

The worst was when he woke up in the morning, Jim said. The two middle fingers on each hand were so stiff they would not even bend. He would massage his fingers and loosen them, but his hands and knuckles ached all day. He tried ibuprofen, to little avail.

Finally, last spring, he sought help at New York University, where he had another M.R.I. It turned out he had a nerve impingement so serious that he was warned that he risked permanent paralysis if he did not have surgery. So this summer, he had a major operation called a French-door laminoplasty, in which his surgeon, Dr. Ronald Moskovich at the N.Y.U. Hospital for Joint Diseases, opened and widened four or five vertebrae to free the trapped nerves.

How could M.R.I.'s have come to such different conclusions for both Jim and me?

Jim asked his doctors whether he could have really had nothing wrong at the time of his first scan. Unlikely, they replied, although they cautioned that no one had directly compared the two scans.

I asked Dr. Kennedy the same question and received the same answer. He explained that in my case the quality of the two images was vastly different. "It's like the difference between a black-and-white TV and HDTV," he said.

All well and good, but how was I supposed to know? The radiology center I first went to is accredited by the American College of Radiology, and there is no way I can tell a good M.R.I. image from a bad one. In fact, I never even saw the images. All I saw were the radiologists' reports.

Academic radiologists say that, unfortunately, they see patients like Jim and me all the time.

"That's the bane of our existence in an academic medical center," said Dr. Howard P. Forman, a professor of diagnostic radiology at Yale University School of Medicine.

And it's not just patients who have to deal with the problem, said Dr. William C. Black, a professor of radiology and community and family medicine at Dartmouth Medical School. Doctors do, too. Radiology centers send written reports to doctors, but the doctors may have no idea whether the M.R.I. was done well and interpreted well. "It's a huge problem," Dr. Black said.

More ...

Monday, October 13, 2008

The pepperoni pizza hypothesis | Eureka! Science News

What's the worst that could happen after eating a slice of pepperoni pizza? A little heartburn, for most people. But for up to a million women in the U.S., enjoying that piece of pizza has painful consequences. They have a chronic bladder condition that causes pelvic pain. Spicy food -- as well as citrus, caffeine, tomatoes and alcohol-- can cause a flare in their symptoms and intensify the pain. It was thought that the spike in their symptoms was triggered when digesting the foods produced chemicals in the urine that irritated the bladder.

However, researchers from Northwestern University's Feinberg School of Medicine believe the symptoms -- pain and an urgent need to frequently urinate -- are actually being provoked by a surprise perpetrator. Applying their recent animal study to humans, the scientists believe the colon, irritated by the spicy food, is to blame.

Their idea opens up new treatment possibilities for "painful bladder syndrome," or interstitial cystitis, a condition that primarily affects women (only 10 percent of sufferers are men.) During a flare up, the pelvic pain is so intense some women administer anesthetic lidocaine directly into their bladders via a catheter to get relief. Patients typically also feel an urgent need to urinate up to 50 times a day and are afraid to leave their homes in case they can't find a bathroom.

"This disease has a devastating effect on people's lives," said David Klumpp, principal investigator and assistant professor of urology at the Feinberg School. "It affects people's relationships with family and friends." Klumpp said some women who suffer from this become so depressed, they attempt suicide.

Klumpp worked with Charles Rudick, a postdoctoral fellow at the Feinberg School, on the paper, which was published in the September issue of Nature Clinical Practice Urology.

The Northwestern researchers believe the colon's central role in the pain is caused by the wiring of pelvic organ nerves. Nerves from this region -- the bladder, colon and prostate -- are bunched together like telephone wires and plug into the same region of the spinal cord near the tailbone.

People with interstitial cystitis have bladder nerves that are constantly transmitting pain signals to the spinal cord: a steady beep, beep, beep.

But when the colon is irritated by pepperoni pizza or another type of food, colon nerves also send a pain signal to the same area on the spinal chord. This new signal is the tipping point. It ratchets up the pain message to a chorus of BEEPEEPBEEPBEEP!

"It was known that there was cross talk between organs, but until now no one had applied the idea to how pain signals affect this real world disease, how the convergence of these two information streams could make these bladder symptoms worse," said Klumpp, who also is an assistant professor of microbiology-immunology at the Feinberg School.

The new model suggests the bladder pain can be treated rectally with an anesthetic in a suppository or gel. Another possibility is an anesthetic patch applied to pelvic skin. Studies in back pain show anesthetic patches applied to the skin can reduce back pain, Klumpp said.

"We imagine a similar kind of patch might be used to relieve pelvic pain, which might be the best solution of all," he noted.

Klumpp's concept is based on a 2007 study in which he showed that delivering red pepper into the colon of a mouse with pre-existing pelvic pain caused the pain to worsen. When he then delivered lidocaine into the mouse colon, "it knocked down pain just as effectively as if we put it in the bladder," Klumpp said.

"We likened it to what happens to humans," Klumpp noted. "Pepperoni pizza does nothing to most people other than heartburn, but when you give it to a person with an inflamed bladder, that will cause their symptoms to flare because the nerves from the bladder and bowel are converging on the same part of the spinal cord."

Thursday, October 09, 2008

Cell Protein Suppresses Pain Eight Times More Effectively Than Morphine

More people suffer from pain than from heart disease, diabetes and cancer combined, but many of the drugs used to relieve suffering are not completely effective or have harmful side effects.

Now researchers at the University of North Carolina at Chapel Hill School of Medicine and the University of Helsinki have discovered a new therapeutic target for pain control, one that appears to be eight times more effective at suppressing pain than morphine.

The scientists pinpointed the identity and role of a particular protein that acts in pain-sensing neurons, or nerve cells, to convert the chemical messengers that cause pain into ones that suppress it.

"This protein has the potential to be a groundbreaking treatment for pain and has previously not been studied in pain-sensing neurons," said lead study author Mark J. Zylka, Ph.D., assistant professor of cell and molecular physiology at UNC. The results of the study will be published online in the journal Neuron, on Wednesday (Oct. 8) and in the print edition the following day.

The biological basis of pain is complex. To study the transmission of painful signals throughout the body, many researchers use "marker" proteins that label pain-sensing neurons. One such marker, FRAP (fluoride-resistant acid phosphatase), has been employed for this purpose for nearly 50 years, but the gene that codes for its production was never identified.

That is, until researchers at UNC found that FRAP is identical to PAP (prostatic acid phosphatase), a protein routinely used to diagnose prostate cancer whose levels increase in the blood of patients with metastatic prostate cancer.

Previous research hinted that FRAP and PAP may have a shared identity. To determine whether or not this was the case, Zylka teamed up with Dr. Pirkko Vihko, a professor from the University of Helsinki who had genetically engineered mice that were missing the gene for PAP. When Zylka and his colleagues studied tissues from these mutant mice, they were happy to see that FRAP activity was missing. This revealed that the two proteins were in fact identical.

Further, the mutant mice proved more sensitive than normal mice to inflammatory pain and neuropathic pain, two common forms of chronic pain in humans. These increased sensitivities diminished when researchers injected excess amounts of PAP into the spinal cords of the mutant mice.

"We were really blown away that a simple injection could have such a potent effect on pain," Zylka said. "Not only that, but it appeared to work much better than the commonly used drug morphine."

The new protein suppressed pain as effectively as morphine but for substantially longer. One dose of PAP lasted for up to three days, much longer than the five hours gained with a single dose of morphine.

The next question for the researchers was how PAP suppressed pain. It is already known that when pain-sensing neurons are stimulated, they release chemicals known as nucleotides, specifically adenosine triphosphate (ATP). This in turn sets off the events that invoke a painful sensation. But if ATP degrades to adenosine, that inhibits the neurons that transmit pain signals, thus relieving pain. Through a series of experiments, the UNC researchers showed that PAP removes the phosphate group, generating adenosine. Their study is the first to identify and characterize the role of such a protein in pain-sensing neurons.

Zylka and his colleagues are now searching for additional proteins that degrade nucleotides in these neurons. They are also working to develop small molecules that interact with PAP to enhance or mimic its activity.

"It is entirely possible that PAP itself could be used as a treatment for pain, through an injection just like morphine," Zylka said. "But we would like to modify it to be taken in pill form. By taking this field in a new direction, we are encouraged and hopeful that we will be able to devise new treatments for pain."

Wednesday, October 08, 2008

E-mails suggest Pfizer tried to suppress study on drug - The Boston Globe

Top drug company marketing executives suppressed a large European study suggesting their blockbuster medication Neurontin was ineffective for chronic nerve pain, and they privately strategized about how to silence a British researcher who wanted to go public with the data, according to newly filed documents and e-mails that are part of a Boston court case.

During the same period of several years, Pfizer Inc. launched an advertising blitz promoting the purportedly positive findings of a smaller Neurontin study it had published in a major medical journal - including showing a video to airline passengers before their in-flight movie.

The widespread promotion of Neurontin turned what had been a relatively minor epilepsy drug into one of the fastest-growing blockbuster drugs in the world, one that generated more than $2 billion a year in US sales for Pfizer before a generic competitor entered the market in 2004.

Taken together, the e-mails and other internal Pfizer documents produced as part of a potential class action lawsuit against the company represent one of the most detailed looks yet at how a drugmaker controls what physicians and consumers know about a drug.

More ...

Pain expert questions insurance payout caps - Nova Scotia News

Limiting insurance payments to $2,500 for people with soft-tissue injuries perpetuates the stigma that they're exaggerating or making up their claims, a pain management specialist testified Tuesday in a lawsuit challenging Nova Scotia's insurance cap.

This falsehood often causes society to turn on victims and deny them adequate treatment for their chronic pain, said Dr. Mary Lynch of the Capital district health authority's pain management clinic in Halifax.

"It really challenges every fibre of a person's being," Dr. Lynch said of chronic pain, a condition she described as "potentially disabling."

She testified in Supreme Court in Halifax that there is a three-year wait to be seen at the Halifax pain clinic. Another 1,000 people are in line to be assessed at the clinic in Sydney.

The longer someone has to wait for treatment, she said, the greater the risk the pain will get worse and conditions such as depression will develop.

This province's Conservative government put its cap in place in 2003, when insurance companies said they were struggling and motorists' premiums were skyrocketing. The legislation included a 20 per cent reduction in premiums.

In 2005, the Nova Scotia Coalition Against No-Fault Insurance and two car accident victims from Halifax filed a lawsuit challenging the legislation, arguing the cap is unfair for certain groups of people.

On cross-examination, the province's lawyer questioned Dr. Lynch's belief that people with chronic pain are being treated unfairly by society.

"Are you seriously suggesting that everyone who gets a bruise is stigmatized?" Alex Cameron asked. Dr. Lynch disagreed, saying she's based her conclusions on what she's heard over and over again from her patients.

Mr. Cameron asked if it's difficult to know if those people are telling the truth, to which she admitted that some patients feel compelled to present their cases "in a stronger fashion than is reality."

Dr. Lynch also admitted to lawyer Jeff Galway that she is not an expert on the factors contributing to high insurance premiums.

Mr. Galway, who represents the Insurance Bureau of Canada, then drew her attention to a press release issued by his client that states the primary factor driving up costs in Nova Scotia is the high number of soft-tissue claims.

Mr. Cameron opened the province's case Tuesday afternoon with Dr. Edwin Rosenburg, a psychiatrist who specializes in post-traumatic stress disorder.

He testified that a patient's psychological state can often physically manifest itself in the form of pain, and gave the example of a soldier afraid to fire a gun developing a paralysis in his shooting arm.

That could be the case with many chronic pain sufferers, he said, some of whom also complain of stress, anxiety or depression.

But on cross-examination, lawyer Barry Mason suggested that in most cases patient's pain is real, and that it's the stigma they're trying to defraud the insurance companies that is upsetting them.

Dr. Rosenburg responded by saying he finds nothing "demeaning" in the suggestion that people with soft-tissue injuries are to blame for rising insurance costs and said he doubts such a statement would be of great concern to individual patients.

Some coma patients 'feel pain' - New Scientist

Brain scans show that coma patients that are most aware of their environment react to pain as much as healthy people.

Researchers who did the scans in Belgium say it justifies giving pain relief to all patients in this "minimally conscious state" (MCS).

"These findings might be objective evidence of a potential pain perception capacity in patients with MCS, which supports the idea that these patients need painkilling treatment," write Steven Laureys and his colleagues at the Coma Science Group of the Cyclotron Research Centre at the University of Liege in The Lancet Neurology.

But they found much less evidence that "brain-dead" coma patients in a so called persistent vegetative state (PVS) react to pain.

Laureys and his colleagues discovered after taking brain scans of patients and healthy volunteers as they received mild electric shocks.

They performed the procedure on five MCS patients, 15 healthy controls and 15 "brain-dead" patients.

'Pain matrix'

Patterns of brain activity were the same MCS patients and the healthy controls, who rated the pain they received as "highly unpleasant to painful". Blood flow increased to parts of the brain that form the so-called "pain matrix", incorporating the thalamus and various parts of the cortex activated when we feel pain.

"I think it definitely means they feel pain because they activate the whole pain matrix," Laureys told New Scientist. "But what they feel is still an open question, whether they feel it the same way we do," he says.

Conversely the activity was much reduced in the PVS patients. "The difference between patients with MCS and PVS was very striking," says Laureys.

Stuart Derbyshire, who studies the connections between neural activity and pain at the University of Birmingham in England, cautions that the brain activation patterns don't necessarily mean the patients actually experienced pain. "We cannot read subjectivity from activation patterns any more than we can read it from changes in breathing, heart rate or blood pressure," he says.

"Patients undergoing procedures with sedation might also activate cortical regions during noxious intervention, but one might hesitate before calling that pain," says Derbyshire.

He points out that patients under general anaesthetic regularly grimace, wince and flinch, and these are probably indications of reflex signals from the much more primitive brain stem that can't reach the level of conscious experience. "Having said that, this study provides good evidence that whatever is happening in MCS patients during noxious stimulation is clearly more than a brain stem response," says Derbyshire.

Reacting to environment

John Whyte of the Moss Rehabilitation Research Institute in Elkins Park, Pennsylvania, comments in the same issue of The Lancet Neurology that the study "supports the conclusion that patients in MCS have the essential neural systems required to experience pain subjectively and that patients in VS might not".

But the difficulty for nurses and doctors, he says, is identifying patients who are MCS. "They're patients who react with their environment in a way that can't be purely reflexive," says Whyte. Examples might include patients following a moving object with their eyes, or somehow responding to a spoken command.

In the absence of a definitive test, Whyte says that doctors should assume that patients might sometimes be conscious even though they can't show it, so pain relief should be given as a precautionary measure, even to PVS patients. He says that most doctors in the US do this anyway, but the Belgian results provide further justification for it. "To not give it is to assume that patients are unconscious all the time, and I don't think the data fits with that."

Whyte says that coma patients who recover seldom complain of painful events or treatment during their comatose state, but this shouldn't be taken as evidence they never felt pain, because their memories are so impaired during this time that they wouldn't remember anyway even if they did feel pain. "They often don't report having felt pain, but it doesn't mean they didn't," he says.

Derbyshire says that an experiment that could resolve some of the issues would be to take scans while patients undergo procedures under general anaesthetic. These would show whether the same "pain matrix" regions of the brain light up even thought they are spared experience of pain by the anaesthetic.

Laureys says that it will be difficult for doctors to decide how much analgesia to give patients with MCS, because too much would sedate the patients, "decreasing the chance of seeing signs of consciousness and recovery".

Saturday, October 04, 2008

An Ig Nobel prize for a study on placebo effects

Ig Nobels honor weird science.

Duke University behavioral economist Dan Ariely won an Ig Nobel for his study that found more expensive fake medicines work better than cheaper fake medicines.

"When you expect something to happen, your brain makes it happen," Ariely said.

Ariely spent three years in a hospital after suffering third-degree burns over 70 percent of his body. He noticed that some burn patients who woke in the night in extreme pain often went right back to sleep after being given a shot. A nurse confided to him that the injections were often just saline solution.

He says his work has implications for the way drugs are marketed. People often think generic medicine is inferior. But gussy it up a bit, change the name, make it appear more expensive, and maybe it will work better, he said.

"I've won quite a lot of academic awards; I can't think of one that makes me happier than this one," said Dan Ariely , a Duke University economist and author of the book "Predictably Irrational: The Hidden Forces that Shape our Decisions," who said his deserving work has been passed over year after year and is elated to finally get an Ig Nobel.

Ariely's Ig Nobel-winning work demonstrates the secret behind many of the Ig Nobel-winning scientists: that hidden in the humorous work is a legitimate scientific point.

Using Craigslist, Ariely recruited volunteers for a study, and printed fake brochures describing an invented pain-killer that was actually just a placebo pill. Some were told the drug was expensive; others were told it was cheap. The subjects were given electric shocks before and after they took the pill. Those who got the pricey fake medicine reported a bigger reduction in pain than those with the cheaper fake.

The experiment, published in the prestigious Journal of the American Medical Association, suggested that marketing and packaging of a drug may play a role in its effects.

 "Commercial Features of Placebo and Therapeutic Efficacy," Rebecca L. Waber; Baba Shiv; Ziv Carmon; Dan Ariely, Journal of the American Medical Association, March 5, 2008; 299: 1016-1017:

To the Editor: It is possible that the therapeutic efficacy of medications is affected by commercial features such as lower prices. Because such features influence patients' expectations, they may play an unrecognized therapeutic role by influencing the efficacy of medical therapies, especially in conditions associated with strong placebo responses. To investigate this possibility, we studied the effect of price on analgesic response to placebo pills.

Friday, October 03, 2008


The International Research Foundation for RSD / CRPS is a not-for-profit organization (501c3) dedicated to education and research on Reflex Sympathetic Dystrophy and Complex Regional Pain Syndrome. The primary mission of the Foundation is to establish an international research network which will help educate medical professionals and support research worldwide.

Reflex Sympathetic Dystrophy, known as RSD, is a chronic neurological disease which affects millions of people around the world. This disease is also known as Complex Regional Pain Syndrome or CRPS.

Pain Slideshows

SlideShare is the world's largest community for sharing presentations.

- Individuals & organizations upload presentations to share their ideas, connect with others, and generate leads for their businesses.
- Anyone can find presentations on topics that interest them. They can tag, download, or embed presentations into their own blogs & websites.

Wednesday, October 01, 2008

New study proves that pain is not a symptom of arthritis, pain causes arthritis

Pain is more than a symptom of osteoarthritis, it is an inherent and
damaging part of the disease itself, according to a study published
today in journal Arthritis and Rheumatism. More specifically, the
study revealed that pain signals originating in arthritic joints, and
the biochemical processing of those signals as they reach the spinal
cord, worsen and expand arthritis. In addition, researchers found
that nerve pathways carrying pain signals transfer inflammation from
arthritic joints to the spine and back again, causing disease at both

More ...

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

New Beginnings = New Treatments

Psychology of Pain has the most exciting article of the month, describing a University of Michigan study using gene therapy for severe cancer pain.  Wow!

Somebody Heal Me will be trying a new treatment, Botox, for migraine prevention.  Despite reservations and low expectations, she’ll be giving it a (ha, ha) shot.

A new contributor, Fibromyalgia Advice, takes the plunge of trying a new doctor and method.  Read about a chiropractic approach called NUCCA and how it’s working.

New Beginnings = New Outlooks

Arthritis Friend, shares a story about a man’s acceptance of his invisible illness, and how he decided to make it more visible.

How do we make each day a new beginning?  Spiritual Healing Journey looks at letting go of the old to make room for healing.

A Chronic Dose explores how our expectations can hinder our keeping an open mind.

New Beginnings = Doing Things Differently

Can’t do what you once did?  Then can you re-invent yourself?  Working with Chronic Illness creatively explores how the new world of virtual jobs can open up many possibilities.

Great advice comes from Spine Health in 5 Easy Tips for Keeping Your Family Healthy for Back-to-School.

New Beginnings = New Learning

The Back Pain Blog reviews what causes herniated discs.  Thorough and helpful.