Friday, January 30, 2009

Recent publications on pediatric pain - IASP SIG Pain in Childhood


Thursday, January 29, 2009

Science News / I Feel Your Pain, Even Though I Can't Feel Mine

In 1985, Monday Night Football fans looked on as Washington Redskins quarterback Joe Theismann was sacked. The collision was so forceful that it snapped Theismann's leg, breaking like, as one fan put it, a "stale chopstick." Most audience members likely empathized with Theismann's pain, including people afflicted with a rare disorder that prevents them from feeling pain themselves, a new study suggests.

Instead of using past experiences of feeling pain to commiserate, such people likely rely on the ability to imagine the pain of others, suggests the brain-imaging study, published online January 28 in Neuron.

"This fascinating and well-conducted study" gives new insights into the relationship between pain and empathy, comments Marco Loggia of the Athinoula A. Martinos Center for Biomedical Imaging in Charlestown, Mass.

The study suggests that multiple brain regions, including regions involved in emotions, can be recruited to feel empathy for others' pain. In future studies, Loggia says, it would be interesting to examine other cases when people are exposed to someone else's feelings without ever having felt such feelings firsthand. "How can humans empathize with a dog that hurt its tail? How can a man understand menstrual pain?" Loggia asks. The answers, he proposes, may lie in the same regions of the brain that allow pain-insensitive people to empathize with others' pain.

Study coauthor Nicolas Danziger wanted to know whether a person could empathize with an unfamiliar emotional state. Understanding other people's emotional states, such as pain, is thought to be based on a system in the brain called the mirror system. When someone sees a quarterback break a leg, specific groups of brain cells in the spectator's brain activate. These nerve cells are the same ones that would activate if the spectator broke his own leg.

Called mirror neurons, these cells are thought to prompt a kind of knee-jerk reaction in the brain in response to seeing others' pain, a phenomenon researchers call automatic resonance. Put simply, these mirror brain cells don't distinguish between monkey see and monkey do.

More ...,_even_though_I_cant_feel_mine

Wednesday, January 28, 2009

Pain-Blog Carnival January 2009 | How To Cope With Pain Blog

Chronic Babe shares a wonderful post, How I Embrace Optimism…  and You Can, Too.  When you live with chronic illness, it's easy to lose your sense of optimism.  Jenni presents 5 ways to keep your optimistic side strong.

Being Chronically Ill Is A Pill describes her evolution as a person who deals with chronic illness on a daily basis in, My Most Important Day.

In Sickness and In Health looks at how communication with our partners can suffer when we have chronic illness.  When our needs don't get met, it becomes easier to blame.  The MBTI, a psychological profile assessment tool, can help us understand our differences and talk about them constructively.

Dean Moyer at The Back Pain Blog shares some tips on how to deal with winter in a way that can make Neck Pain and the Cold seem a little less daunting.  And there's even snacks!

CRPS/RSD A Better Life provides an educational post about clinical trials for CRPS (RSD).  It's great to see so much research being undertaken.

HealthSkills looks at what people mean when they have setbacks and flare-ups, and say, "Oh no!  Here we go again."  Exploring this can reveal the meaning of pain to the person.

Chronic Illness Pain Support shares some realistic ways to celebrate yourself in the new year, despite set backs - including ones that come from chronic illness.   Lisa's article is Celebrating Yourself in 2009.

What can you say to others to help tham understand your experience with illness?  Working With Chronic Illness gives us a script in One Thing I'd Like You  Know About Living with a Chronic Illness.

Monday, January 26, 2009

Pain Management CME Education Programs Treatment | Pain Knowledge is a one-stop educational resource for healthcare professionals who treat patients with acute pain and/or chronic pain conditions including neuropathic pain, low back pain, and migraine, and manage patients on opioid analgesia. Features of include a comprehensive pain management slide library; pain CME activities, including pain newsletters and interactive case studies; physician tools; pain resources; patient handouts; and more.

Saturday, January 24, 2009

BBC NEWS | 'Clue' to sexes' pain difference

Experiments in rats may have revealed why some painkilling drugs are less effective in women compared with men.

US researchers found brain differences affecting the potency of opioids such as morphine.

The Journal of Neuroscience study also found drug effectiveness varied during the rats' menstrual cycles.

Another expert said it showed the growing importance of tailoring pain relief to match the individual needs of the patient.

Morphine remains one of the most widely used drugs to alleviate severe persistent pain and doctors have noticed that it frequently does not work as well in women.

However, the study from Georgia State University claims to be the first to pinpoint the reason why.

It looked closely at a tiny area of the brain called the periaqueductal grey area (PAG), which is important in the way that pain signals are interpreted.

Many neurons in this region have, on their surface, "receptors" designed to receive and lock onto the molecules found in opioid drugs.

These "mu-opioid receptors", when locked onto an opioid drug, send a message telling the brain to stop responding to pain signals, reducing the sensation of pain.

The Georgia State team found that, in the rat brain, females had a lower level of mu-opioid receptors in this part of the brain, suggesting that the potential potency of morphine is much reduced.

Additional tests suggested that the response to morphine varied depending on which part of the menstrual cycle the female rat was in.

Professor Anne Murphy, who led the research, said: "It is increasingly clear that morphine is significantly less potent in women compared with men - until now, the mechanism driving the phenomenon was unknown.

"Additional research with the inclusion of female subjects needs to be devoted to determining a more potent treatment for persistent pain in women."

Professor Karen Berkley, from Florida State University, described the research as "important" and called for more attention to be paid to make sure that women received adequate pain relief.

"What this research is trying to do is understand the hormonal influences on pain in women.

"Clinicians are becoming far more aware of this issue, certainly more than they were five or six years ago."

Human trials, already under way, would need to be concluded to confirm the results of this study, she said.

Thursday, January 22, 2009

Even 'fake' acupuncture helps in headaches and migraines |

Acupuncture can help people who suffer from headaches and migraines, even when the needles are put in the "wrong" place, according to a major review of medical studies.

Volunteers who were treated with the traditional Chinese technique, in which thin needles are pushed into the skin at specific points, had fewer headaches and migraines, and experienced less pain if a headache came on, researchers found.

Scientists working for the Cochrane Collaboration, which publishes gold standard reviews on the effectiveness of medical treatments, confirmed the beneficial effect of acupuncture after analysing 33 separate studies involving nearly 7,000 patients in total.

Researchers led by Klaus Linde at the centre for complementary medicine research at the Technical University of Munich, Germany, reviewed published evidence for acupuncture as a treatment for tension headaches, which usually affect both sides of the head, and migraines, which tend to affect only one side.

Eleven trials involving 2,317 patients found many experienced fewer headaches after having acupuncture, though a similar improvement was seen in those who had "fake" acupuncture, where the needles were either inserted at incorrect points or did not puncture the skin.

A further 22 trials involving 4,419 patients who suffered migraines were assessed. Again, those who had acupuncture, even when it was faked by placing the needles incorrectly, reported having fewer migraines afterwards.

"The studies suggest that migraine patients bene√ět from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists," the researchers report.

"Much of the clinical benefit of acupuncture might be due to non-specific needling effects and powerful placebo effects, meaning selection of specific needle points may be less important than many practitioners have traditionally argued," said Linde.

Overall, after an eight-week course of treatment, patients who had acupuncture and no painkillers suffered fewer headaches compared with those who were given only painkillers.

Linde said the results suggest acupuncture could be given to patients who do not wish to take drugs, but he added that more research was needed. "Doctors need to know how long improvements associated with acupuncture will last and whether better trained acupuncturists really achieve better results than those with basic training only," he said.

Thursday, January 15, 2009

New Study Examines 'A Life In Pain' - The Experiences Of Older People

It's debilitating, isolating and can lead to severe depression - yet pain is widely accepted as something to be expected and regarded as 'normal' in later life. 

Now a new study from The University of Nottingham examines older people's experiences of pain and how best Government, the NHS and social care agencies can address the issue. 

The report, Pain in older people: reflections and experiences from an older person's perspective, aims to highlight the issue of pain in older people by exploring their experiences of living and coping with persistent pain. 

Funded by Help the Aged and the British Pain Society, the study saw researchers interview older people about their experiences of pain and how it affected their lives, both physically and psychologically. Literature on pain in older people was also reviewed. 

The report - which reveals that nearly five million people over the age of 65 are in some degree of pain and discomfort in the UK - has already led to questions being asked of the Government in the House of Lords. 

By interviewing older people, the researchers identified specific themes in the way that they communicate, cope with and experience their pain. These include;
  • The stiff upper lip - "I understand my generation very well. We learned our attitude to pain from British society in general and from our families. It was: 'Don't make a fuss'."
    Claire Rayner OBE, 76, journalist.
  • Becoming a burden - "Later this year my wife and I will be celebrating our 46th anniversary. We have the opportunity to go to New York for a long weekend with family and friends. However, I simply cannot endure the flight. If I were to sit for an extended period, such as six hours, in a confined space, I would be unable to walk far for the next few days. I feel I would be too much of a burden to the others if I were to go."
    Ben Kelk, 68, retired security guard.
  • An isolating experience - "Your life tends to revolve around pain and yet, at the same time, it's not something that's seen as being something you can talk about too much. This is why I use the word 'lonely', and I think pain can make you feel lonely because you feel that you're the only one suffering and can cope with it, and that is a lonely experience." Janet Allcock, 73, retired healthcare worker.
  • Psychological effects - "I worry a lot about my pain and sometimes I think about what I have done in the past and can no longer do for myself and my family. I know that worrying can bring your health down, but I can't help worrying about it. I find it very difficult to sleep and I am not able to sleep on my side - some nights I cannot sleep at all."
    Nur Uddin, 70, lives with wife and family.
  • Response of the medical profession - "Doctors sometimes see you as an illness rather than a whole person."
    Dorothy Bristow, 68, member of BackCare: the charity for Healthier Backs.
    "I feel reluctant to keep going and pestering my doctor about my pain because when you get to my age, and especially if you're a woman, you feel he's going to think I'm being neurotic. And because pain can't be seen, it's probably not easy for him to understand how much pain I'm actually in."
    Janet Allcock, as above.
  • Not being able to do 'normal' things - "It's the little things that annoy - not being able to paint one's own toenails, essential with summer sandals! Two walking sticks mean I can't hold my grandchild's hand. Small things - yes - but they matter."
    Dorothy Bristow, as above.
    "Simple tasks like lifting a grandchild from their cot and bringing them downstairs become a cause for concern, as I'm conscious that if my knee goes an accident could easily happen."
    Ben Kelk, as above.
The report raises points for discussion and recommends ways in which agencies dealing with pain in older people - from the Government and policy-makers to the NHS and regulatory bodies - can help address this problem. These include suggestions that primary care trusts should encourage practice nurses and GPs to raise their awareness of the effect of pain in older people, and that Government should fund educational campaigns to do this; specialist pain services need to be tailored to older people and made more accessible; and including standards on pain management on recognised healthcare professional training schemes. 

Dr Nick Allcock, Associate Professor in the University's School of Nursing, Midwifery and Physiotherapy and Co-Director of the Nottingham Centre for Evidence Based Nursing and Midwifery, led the study. He said: "Pain in older people is highly prevalent and widely accepted as something to be expected and regarded as 'normal' in later life. Hence, suffering associated with persistent pain in older people often occurs without the appropriate assessment and treatment. 

"Ageist and discriminatory attitudes towards older people in pain must be challenged and ended. Pain in older people needs to be seen as a priority. It is not a normal part of ageing. Much more can and must be done to improve help and support. 

When questioned in the House of Lords on the subject of pain in older people following the release of the report, Lord Darzi of Denham, Parliamentary Under-Secretary of State in the Department of Health, responded: "As a clinician, I agree that the assessment and management of pain should be at the heart of all good clinical practice. I therefore welcome this report, which sets out the important issues relating to pain in later life and reflects older people's experiences. It will raise awareness of important issues among those responsible for meeting effectively the healthcare needs of their local population. 

"It is imperative to understand that no one, irrespective of age, should tolerate pain. I appreciate that awareness in this area is extremely important, because we are living in a century when all of us are getting older and, at the same time, there is a suggestion that pain is a symptom of ageing, which it is not. As far as concerns age discrimination, older people deserve to be treated with dignity and respect in all care settings. This important document will increase awareness among the public and patients. At the same time, it will remind clinicians that they should give higher regard to chronic pain. I take most of the recommendations and could not agree more with some of the other work that has been done in this field."