Friday, November 20, 2009

Pain Relief Through Photography - Well Blog -

Can looking at the photograph of a loved one make pain go away?

Numerous studies show that strong social connections have benefits for health. People who have active social lives seem to live longer than those who are isolated, and married cancer patients have a better outlook than divorced cancer patients. Now, a study [pdf] suggests that merely looking at a photograph of a loved one can relieve the sensation of physical pain.

Psychologists at the University of California, Los Angeles, recruited 25 women who had steady boyfriends. Using a tool that applied heat to the women's forearms, they turned up the temperature until it was slightly uncomfortable and asked the women to rate the pain they experienced on a scale of one to 20.

The researchers manipulated the heat and recorded the women's reactions under different conditions: while she was looking at a photo of her boyfriend, or a photo of a complete stranger and a chair. They also had the women rate the pain while they held the hand of a stranger hidden behind a curtain, and as they held their boyfriend's hand or a squeeze ball.

"We saw lower pain ratings on average when the women were holding their partner's hand compared with a stranger's hand or an object," said Sarah L. Master, the lead author of the paper, who did the study at U.C.L.A. as part of her doctoral research.

When the women looked at photographs of their boyfriends, they rated the pain lower than when they were staring at a photo of a stranger or a chair. Surprisingly, they even ranked the pain lower than they had while holding their boyfriend's hand.

"It's interesting that a physical sensation can actually become more manageable by just looking at a photo of someone you find supportive," Dr. Master said. The study appeared in the November issue of the journal Psychological Science.

Under certain circumstances, Dr. Master suggested, looking at a photo may have an even stronger effect than having the person physically present. "Having the actual person there might not be a good thing if the person is in a bad mood or not being supportive at that moment. A picture could be a better solution," she said.

Dr. Master said the mere reminder of the loved one may engender feelings of support, possibly by prompting the release of endogenous opioids, chemicals in the brain that have pain relief effects.

Friday, November 13, 2009

Who says love hurts? Romantic partners alter our perception of pain

My mother used to say, "there's somebody out there for everybody." It sounds sweet, I know, but when you realize she would say this only in jaw-dropping astonishment at seeing a loving couple out in public in which both partners were, shall we say, aesthetically shortchanged in some eye-catching way, my dearly departed mother somehow doesn't sound like such a Polyanna anymore. But she got it basically right. When two people are in love, the world whittles away to them alone, and as new research findings suggest, a mere reminder of that other person can make everything seem a little more manageable—even, as it turns out, physical pain.

In a study published this month in Psychological Science, psychology graduate student Sarah Master of the University of California, Los Angeles, and fellow researchers invited 25 couples into their laboratory for a study on pain perception. The females—in this study, anyway—got to be the recipients of the experimentally induced pain stimuli. While the male partner was away in another room having his photographs taken for later use in the study, the woman was instructed to place her arm through an opaque curtain. An experimenter on the other side of the curtain first assessed each woman's "pain threshold" for thermal stimulation, which produces a sharp, acute, prickling pain sensation within about a tenth of a second.

 Once the investigators determined each woman's subjective pain threshold for moderate discomfort—operationalized as a score of "10" on a pain-rating scale of 0 to 20—they proceeded to the experiment, in which the women were subjected to 84 further pain trials. Ouch! Unbeknownst to the female participants, half of these thermal stimulations were administered at the women's individually predetermined pain threshold levels, and half were set at 1° C above these moderate discomfort levels. In other words, 42 randomly spaced trials during the course of the experiment involved a degree of pain that exceeded the women's earlier self-reported tolerance for discomfort. This means that at least half of the trials really would have been more than a little painful under normal, all-else-being-equal, baseline conditions.

As in the assessment trials, the participants were again asked to verbally rate each trial's "unpleasantness" on a sliding scale. And here's where the romantic partner comes into the picture. The 84 experimental trials were further divided into seven different conditions of six pain stimulation episodes. That is to say, during each painful trial, the woman was either:

(1) holding the hand of her partner (as he sat behind a curtain)

(2) holding the hand of a male stranger (again, with the man behind a curtain)

(3) holding a squeeze ball

(4) viewing her partner's photographs—the ones taken earlier—on a computer screen

(5) viewing photographs of a male stranger

(6) viewing photographs of a chair

(7) viewing a fixation crosshair

Curiously, the women reported experiencing a slightly greater reduction in pain while viewing their partners' photographs than they did even for the partner hand-holding condition (although I should point out that the difference between these two experimental conditions was statistically non-significant). More importantly, pain felt under both of these "partner" conditions was significantly less than for all of the other conditions.

It's unclear from these findings exactly why viewing a photo of a loved one ameliorates pain—perhaps even more so than actually holding that same person's hand. Master and her coauthors interpret these data as an example of cognitive priming. Seeing a photo of one's partner stirs up pleasant mental representations of that person, thoughts that have a measurable palliative effect on pain. Unfortunately, the authors do not speculate as to why physical contact with a loved one pales in comparison to simply viewing that person's photo. One possibility may be that, when a loved one is physically present, the sufferer can become distressed by the other person's worrying. A photo of a smiling partner, in contrast, is stripped of those unsettling emotional cues and more easily transports the sufferer to a happier place.

The researchers thus conclude:
The findings suggest that bringing loved ones' photographs to painful procedures may be beneficial, particularly if those individuals cannot be there. In fact, because loved ones vary in their ability to provide support, photographs may, in some cases, be more effective than in-person support.

Fascinating indeed. I must say, however, that I am a bit skeptical about the generalizing of these findings to all romantic relationships. Unfortunately, the researchers do not tell us about the quality of the relationships in the couples used in the study. But I can certainly imagine some instances where, due a strained marriage or some rankling issue such as infidelity, seeing the face of a loved one could actually intensify pain. What a clever clinical test of relationship dissatisfaction that would be.

I, for one, would largely prefer a photo of my dog beside me during a root canal.

Wednesday, November 04, 2009

A Call to Revolutionize Chronic Pain Care in America | Mayday Fund Special Committee on Pain and the Practice of Medicine


"Epidemic" of under-treatment affects more than 70 million Americans suffering from persistent back pain, headaches, joint pain; disproportionately affects minorities and low income 

WASHINGTON, DC (November 4, 2009)-- Warning that patients shouldn't assume their doctor has enough knowledge to treat their pain, a national panel of experts today called on medical schools to train doctors and nurses on the basics of pain care, reform the nation's reimbursement system, and address pain as a public health crisis. The group insists that without health reforms and better training to diagnose and treat pain properly, people with untreated pain may face a lifetime of pain as a chronic illness – which could lead to job loss, depression and in some cases, even suicide. 

"Doctors, who don't lack for compassion or medical skills, often offer only limited treatments to patients disabled by chronic pain," said Lonnie Zeltzer, M.D., co-chair of the panel, and the director of the Pediatric Pain Program at the University of California, Los Angeles. "With little or no specific training in pain management, and working in systems that make it much easier to treat common conditions like high blood pressure than a complex problem like pain, doctors may intend to help but leave most patients under-assessed and under-treated. Minorities, children and women often faced the highest risk of under-treatment." 

The panel, convened by the New York City-based Mayday Fund, included anesthesiologists, neurologists, primary care doctors, pediatricians, emergency physicians, nurses, psychologists, pharmacists and patient advocates (the full Committee is included below). After a conference in Washington D.C. and deliberations that lasted over several months, the panel's report, A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform, says pain is a huge public health problem. They developed several recommendations for government agencies, Congress and the medical community to address. 

The report and recommendations have been endorsed by more than 30 organizations, including the American Academy of Family Physicians, American Academy of Pediatrics, The Joint Commission, American Nurses Association, American College of Emergency Physicians, and the American Academy of Neurology (the list of current signatories is below). 

"As we get closer to the possibility of health care reform, the frontlines of medicine - adult and pediatric primary care - could face enormous strains from millions of new patients seeking care for pain," says Russell K. Portenoy, M.D., panel co-chair and the chairman of Pain Medicine and Palliative Care at the Beth Israel Medical Center in New York. "Primary care is the first stop for people in pain, and both the training received by clinicians and the system of care should facilitate best practices in pain care, but this is not the way it is." 

The Mayday Fund Special Committee on Pain and the Practice of Medicine writes that chronic pain should be reframed as a chronic illness since "the burden of chronic pain is greater than that of diabetes, heart disease and cancer combined." People in chronic pain have longer hospital stays, and many duplicative tests and unproven treatments—all of which drive up the nation's health care spending, the panel said. 

Chronic pain costs the nation more than $100 billion a year in lost productivity and direct medical costs, the report says. "This is a wasteful system," Portenoy adds. "Major reforms in the health care system are needed if we want to improve the quality and cost effectiveness of care for chronic illnesses, and pain is as much a chronic illness as diabetes and heart disease." Although the impact of pain on patients and on society is among the most serious of public health concerns, chronic pain has been largely left out of the current national debate on health reform, the panel writes. 

According to the report, about "one-third of people in pain report that their pain is disabling and has a high impact on their ability to function in daily life. Research suggests that the high cost of under-treated pain includes lost productivity. Pain is the second-leading cause of medically-related work absenteeism, resulting in more than 50 million lost workdays." 

The authors pay particular attention to the numerous studies that suggest low-income populations, minorities, women and children are more likely to be under-treated for pain or not receive pain care at all. If doctors do not recognize chronic pain as a serious illness, or as serious as others, or they perceive that pain complaints cannot, or should not, be treated, persistent pain results. In some cases, such as pain in young children and adults with dementia, patients may not report their pain, and under-assessment drives under-treatment. 

"The tragedy of this system is that it leaves many people suffering from unrelenting pain," says Zeltzer. "Pain that goes untreated may permanently change the body's nervous system and may lead to pain that can be managed but never goes away." 

Federal policymakers have recognized the impact pain has on individuals and the health care system and have included provisions of the National Pain Care Policy Act 2009 (NPCPA) in health reform proposals. That bill calls for an Institute of Medicine Conference on Pain; increased funding for the National Institutes of Health to collaborate across institutes to find more effective treatments for pain and to better understand the biology of pain; a grant program to improve health professionals' understanding of and ability to assess and treat pain; and better public education so that consumers understand the danger of letting pain go untreated. 

"Remarkably, less than one percent of the NIH budget was devoted to pain in 2008," Zeltzer said. "This amount is not commensurate with a public health problem of this magnitude." 

In addition to medical school reforms and expanded funding for pain management training programs, the panel cited specific measures that would ease this public health crisis. Among them: 

  • Health care providers, insurers and government agencies should eliminate disparities in access to pain care related to race, gender, age and socioeconomic status. All Americans in pain, including low-income Americans, should be offered timely and effective treatment for their pain.
  • Government, health care payors and providers should develop coordinated health information technology (IT) systems to track pain disorders and treatments. Computerized IT systems can boost physicians' knowledge about the best treatment for pain by providing them with best practice information quickly.
  • The Department of Health and Human Services should reform payment to eliminate the current incentives that drive pain care toward procedures or unproven treatments. Primary care doctors should be reimbursed for the time it takes to provide comprehensive pain care to patients who are disabled by chronic pain—a system that can cost a little more up front, but often reduces the cost of treating pain over the long haul.
  • The Surgeon General should mount a public education campaign to inform the public about the risks associated with under-treated pain. Consumers should understand that if they wait too long to treat acute pain they run the risk of developing a chronic syndrome, one that's costly to treat and potentially disabling.

"Reducing the burden of uncontrolled chronic pain is a societal necessity, a medical challenge and an economic requirement," the panel says.


Monday, November 02, 2009

Suddenly, What Ails Them Is What Medical Marijuana Is Good For -

Like other states, Colorado is trying to figure out how to deal with the United States Department of Justice's announcement last week that users and providers of medical marijuana will not be prosecuted when they are in compliance with state law. Here in Colorado, local officials say that a big concern is a surge in new users of the drug, which Colorado's top health official, James B. Martin, called "an abuse of the system."

In recent months, he said, thousands of young men in their early 20's have applied to doctors and, by complaining of severe or chronic pain, received cards to put in their wallets that allow them to legally buy high-quality marijuana. Marijuana is an itemized category of treatment for those symptoms under an amendment to the Colorado Constitution passed by voters in 2000.

"It is exceedingly unlikely that there's an epidemic of chronic pain among young male adults," said Mr. Martin, the executive director the Colorado Department of Health and the Environment, which administers the state's system for medical marijuana.

Figures from the department also show that issuing medical marijuana cards has become something of a medical specialty. Based on figures through mid-August, nearly three-fourths of the 10,003 marijuana permits issued in the state had come from just 15 doctors. One doctor alone was responsible for about one-quarter of the total.

More ...

Help for Headaches

Help For Headaches is a non-profit organization, and a registered Canadian charity that is committed to educational services for those suffering from and treating headaches. Our charity focuses mainly on Ontario. We firmly believe that being an 'informed patient' will:

  • Make it easier for you to prepare for your physician's appointment  
  • Give you additional options that may be able  to help you – as you search for an effective treatment with your physician

Our focus is to educate the community on the severity and symptoms of headaches and migraines and rare headaches.

Understanding your headache-type will always be your first step.

Our vision is to assist headache sufferers in their quest for relief. We believe that since headaches are diagnosed - and ultimately treated according to a particular classification - understanding and communicating these symptoms to your doctor or headache specialist  can have dramatic results.

Our belief is that through education, resources become apparent, silent suffering can be eliminated and awareness can foster treatment directions.

Sunday, November 01, 2009

She Had Countless Diagnoses but None Were Right -

"They took out my ovaries," the 46-year-old woman told the doctor. "And my appendix, and most of my colon. I had several exploratory surgeries where the doctors were just trying to find out what was wrong." Dr. Thomas Chelimsky listened attentively. "I've had, like, 13 surgeries," the woman reported, her voice edged with sadness. "It's really been a nightmare." For the past 23 years, this slender, middle-aged woman was tormented by these intermittent attacks of abdominal pain and fever that lasted sometimes for weeks. None of her doctors had been able to figure out what was causing the strange episodes of devastating illness that prompted all these surgeries and dozens of hospitalizations.

But that was not why her doctor sent her to Chelimsky. She'd been losing feeling in her hands and feet for the past couple of years. It started off as a tingling sensation that came and went. Now her hands and feet were always numb. She could barely hold a pen, and she often stumbled because she couldn't really feel the ground under her feet.

Chelimsky was a neurologist at University Hospitals Case Medical Center in Cleveland. The patient was there to have her hands and feet examined by EMG — electromyography — a test that looks for damaged nerves by sending tiny shocks through the muscle to the delicate strands that connect it to the spinal cord and brain. A change in the speed at which the electricity moves up the nerve indicates whether there is damage and, if so, where. As Chelimsky gently inserted the slender needle into the patient's muscle, he continued to ask questions about these unexplained attacks.

The first came when she was 23, she told him. She had this pain in the left side of her stomach. It felt like a knife stuck deep into her gut. Her temperature soared to 102 degrees. Her blood pressure rose to a level that frightened her doctors. She was delirious. She vomited uncontrollably. Her legs were so weak she couldn't walk.

The doctors in the hospital suspected it was her appendix, but when they took it out, the organ looked normal. After the surgery, the pain intensified. She stayed in the hospital for more than a week, and the pain slowly subsided but her doctors never figured out where the pain came from.

She had had other mysterious medical problems as well. At times her heart would beat so rapidly she would become lightheaded. Her cardiologist suspected that her heart had difficulty pacing itself, but repeated interventions failed to fix her heart's natural pacemaker. She had chronic constipation and what seemed to be frequent urinary-tract infections that were so severe she wasn't able to urinate at all. Other times, her joints and bones would hurt so awfully that she could barely get out of bed. There was never any redness or swelling of the joint, just this dull ache.

She had been given countless diagnoses — one doctor thought it was lupus; another told her it was multiple sclerosis. Repeated testing for these diseases was negative. Still another thought it was ovarian cysts — but the pain persisted even after first one ovary, then the other was removed. Some of the doctors she saw told her it was all in her head and suggested stress-reduction techniques.

Four years earlier, she found an internist whom she trusted, and together they tried to figure out the cause of each of the many problems she had. But she felt as if they were no closer to finding answers than they were when they started. Her internist was a kind man, she told Chelimsky, but it just seemed as if every time he'd come up with some theory about what was going on and treat that, another symptom would pop up. It was like the arcade game her children played, whack-a-mole — you get rid of one problem, but then it would pop back up, along with another and another.

As Chelimsky ran his tests on her hands and feet, it was clear that there was significant nerve damage. The most common cause of this kind of damage was diabetes, but this patient didn't have that. A pinched nerve in the neck could also cause this kind of injury; so could a deficiency in vitamin B-12. But what caught Chelimsky's attention was the possibility that the disease had affected not just the nerves he was testing — those that carry information back and forth between the brain and the voluntary muscles of the body — but also the type of nerves he couldn't test by EMG, autonomic nerves, which innervate the organs like the heart, the stomach, the urinary tract. Many of her other symptoms — the rapid heart rate, being unable to urinate, abdominal pain with no visible cause, even her constipation, which had been so severe that six months before much of her colon was removed — could be caused by damage to the autonomic nervous system. All that added up to just one likely diagnosis.

"Has anyone ever mentioned the word porphyria to you?" he asked. She'd never heard of it. He wasn't certain that's what she had; he hadn't examined her or reviewed her medical records, but the involvement of both types of nerves suggested this rare disease, and he thought she should discuss the possibility with her doctors.

When the patient got home that afternoon, she told her husband that Chelimsky said that she might have something called porphyria. Together the patient and her husband, a pediatrician, went to his library of medical books and began reading up on this rare disease. They read that porphyria was the name of a group of diseases caused by a genetic defect in the way that one part of the red blood cell is made. The oxygen-carrying portion of blood, known as heme, is a complicated molecule made in the liver and the bone marrow. Porphyria is caused when one of the pieces of the anatomical machinery that makes heme is missing. This is the disease that may have given birth to the American Revolution. It's thought that King George III was suffering from porphyria as he fiddled while the colonies were ablaze with the drive for independence.

As the patient read about the most common symptoms of the disease — episodes of abdominal pain, nausea, vomiting or constipation, weakness, confusion, rapid heart rate, the inability to urinate — it was as if she were reading her own medical history: her entire life seemed to be there on the page of these old medical textbooks. All the strange and terrible symptoms she suffered through, had surgery for, been considered crazy for, were there on the pages she read. Tears flowed down her face. Her husband cried, too. They had, she felt certain, finally found the answer.

It took more than three months for the patient to get a definitive diagnosis. If figuring out this disease was difficult, testing for it was equally so. But eventually, porphyria was confirmed.

Porphyria is a disease of the nervous system. Thus, everything in the body is affected. The patient's hardworking doctors had been chopping down the trees one by one, treating each ailment in isolation. Dr. Chelimsky, a neurologist, was finally able to step back and see the entire forest.

The children of a person with porphyria have a 50 percent chance of inheriting the disease. Recently the patient's brother was given a diagnosis of porphyria. And she now realizes that her father, who died six years ago, probably had it as well. It's painful for her to think of his suffering for all those years without the diagnosis that could have saved his life.

There is no cure for porphyria, but it can be treated. Episodes of pain can be shortened by providing the body with the heme it needs. The patient learned that she could prevent many of the attacks by avoiding the disease triggers — certain drugs and hormones, stress, illness, skipping meals. She told me recently that she has worked hard to make these lifestyle changes. And, she added proudly, she hasn't had an attack in more than a year.