Wednesday, February 24, 2010

Pain-Blog Carnival, February 2010 | How To Cope With Pain Blog

Two new blogs to share…

Stress Relief Workshop has loads of tips on stress relief.

The Health Matters Show offers podcasts about health topics, especially related to Fibromyalgia and Chronic Fatigue.

Living Your Best Possible Life writes about being upset and scared when faced with illness.

Chronic Babe is now offering podcasts!  Check out the great info.

CRPS RSD A Better Life looks at immune therapy for CRPS (RSD).

Psychology of Pain shares a NY Times article on what migraine sufferers go through.

Nickie's Nook reviews an iPod application called iCounselor – now we just need iPsychiatrist so I can retire!

Rest Ministries answers the question, "My parents don't believe I'm sick – what should I do?"

In Sickness and In Health discusses the importance of caring for the caregivers, in addition to those who are sick.

The Migraine Girl relates her experiences with mindfulness meditation.

Saturday, February 20, 2010

What causes chest pain when feelings are hurt?: Scientific American

When people have their feelings hurt, what is actually happening inside the body to cause the physical pain in the chest?
Josh Ceddia, Melbourne, Australia

Robert Emery and Jim Coan, professors of psychology at the University of Virginia, reply:

terms such as "heartache" and "gut wrenching" are more than mere metaphors: they describe the experience of both physical and emotional pain. When we feel heartache, for example, we are experiencing a blend of emotional stress and the stress-induced sensations in our chest—muscle tightness, increased heart rate, abnormal stomach activity and shortness of breath. In fact, emotional pain involves the same brain regions as physical pain, suggesting the two are inextricably connected.

But how do emotions trigger physical sensations? Scientists do not know, but recently pain researchers uncovered a possible pathway from mind to body. According to a 2009 study from the University of Arizona and the University of Maryland, activity in a brain region that regulates emotional reactions called the anterior cingulate cortex helps to explain how an emotional insult can trigger a biological cascade. During a particularly stressful experience, the anterior cingulate cortex may respond by increasing the activity of the vagus nerve—the nerve that starts in the brain stem and connects to the neck, chest and abdomen. When the vagus nerve is overstimulated, it can cause pain and nausea.

Heartache is not the only way emotional and physical pain intersect in our brain. Reent studies show that even experiencing emotional pain on behalf of another person—that is, empathy—can influence our pain perception. And this empathy effect is not restricted to humans. In 2006 a paper published in Science revealed that when a mouse observes its cage mate in agony, its sensitivity to physical pain increases. And when it comes into close contact with a friendly, unharmed mouse, its sensitivity to pain diminishes. 

Soon after, one of us (Coan) published a functional MRI study in humans that supported the finding in mice, showing that simple acts of social kindness, such as holding hands, can blunt the brain's response to threats of physical pain and thus lessen the experience of pain. Coan implicated several brain regions involved in both anticipating pain and regulating negative emotions, including the right anterior insula (which helps to regulate motor control and cognitive functioning), the superior frontal gyrus (which is involved in self-awareness and sensory processing) and the hypothalamus (which links the nervous system to the endocrine system).

Although the biological pathways underlying these connections between physical and mental pain are not well understood, studies such as these are revealing how intricate the connection is and how very real the pain of heartache can be.

Tuesday, February 16, 2010

Unmet Needs in Pain Therapeutics | The New York Academy of Sciences

Chronic pain can be inflammatory, neuropathic or mixed in its etiology, but usually involves neuroplastic changes that result in hypersensitivity in the peripheral and/or central nervous system. Expression and functional changes of receptors and ion channels in neurons,and more recently in glial cells, has been the focus of much chronic pain research in recent years, but major challenges continue to exist in understanding and creating validated models for the human diseases. This symposium is intended to address both early clinical applications and validation of new pain mechanisms useful for the discovery of new treatments for chronic pain syndromes, as well as discuss the progress and barriers to developing effective preclinical models of pain, in particular fibromyalgia. The ultimate goal of developing an effective disease-modifying therapy for chronic pain conditions such as fibromyalgia have yet to be discovered, but with the establishment and validation of preclinical models this could become a reality.

Behavioral therapy improves sleep and lives of patients with pain

Cognitive behavioral therapy for insomnia significantly improved sleep for patients with chronic neck or back pain and also reduced the extent to which pain interfered with their daily functioning, according to a study by University of Rochester Medical Center researchers.

The study, published online by the journal Sleep Medicine, demonstrates that a behavioral intervention can help patients who already are taking medications for pain and might be reluctant or unable to take additional drugs to treat sleep disturbance.

"This therapy made a major difference to these patients," said Carla R. Jungquist, F.N.P., Ph.D., of the Medical Center's Sleep and Neurophysiology Research Laboratory, who is the lead author of the Sleep Medicine article. "We saw very good treatment effects."

For the study, a nurse therapist delivered the eight weeks of cognitive behavioral therapy, which included sleep restriction, stimulus control, sleep hygiene, and one session devoted to discussion of catastrophic thoughts about the consequences of insomnia.

"This study really shows that this therapy can be delivered successfully and very effectively by advance practice nurses," Jungquist said. "Training nurses in the delivery of this type of therapy will result in better access for patients. Currently, access to this therapy is limited as there are few trained therapists and most are psychologists."

Patients with chronic pain often use sleep as an escape. They seek sleep when not sleepy, sleep in places other than the bedroom, and engage in non-sleep behaviors, such as watching television and resting a painful back, in the bedroom, the researchers report.

Using behavioral therapy instead of adding to their list of medications is a healthier and safer method of treating sleep disturbance, Jungquist said.

"We establish a structure for the times or hours spent in bed," Jungquist explained. "We focus on a patient's negative thoughts about sleep and address unhealthy sleep behavior. We address habits, including use of caffeine or alcohol. We tell people to do nothing in bed except sleep or sex."

Twenty-eight patients took part in the study. They were tracked through detailed sleep diaries. Their pain and mood were measured using several standard methods throughout the study period. The patients were followed for six months after treatment. Researchers expect to report soon on the duration of the effects of the treatment.

The researchers believe that cognitive behavioral therapy is as effective as other tested treatments for insomnia and chronic pain and, in some cases, is more effective than other therapies.

The researchers have developed a unique, user-friendly manual that described each step of every treatment session. It can be used to train more therapists.

Monday, February 15, 2010

Unbelievable Pain Control: How to Heal and Recover from Chronic Pain and Fibromyalgia

My name is Michael MacDonald. I am a psychologist with a special interest in helping people with long-term or chronic pain. I love my job. I get to meet very interesting people from all walks of life. Pain and injury can affect anyone, at any point in their lives. So, I never know who will walk into my office next.

I get to spend a lot of time with each person. I this way, I can really get to know their injuries, their pain and how it has affected their lives.

It is not easy coming to see a psychologist when you have physical injuries and pain. Most people don't really know why they were referred to us. Most people are not sure there is any point to even showing up. To help them feel comfortable, I usually start by explaining what I do.

First, I explain that if you have short-term pain, you would never end up coming to see a psychologist like me. If your pain settles down within a few months, you can return to your normal life. Not much stress is involved.

If your pain and injuries continue, month after month, with little improvement, then the stress starts to build. Maybe your work is disrupted and you are having trouble getting benefits. Maybe your pain and limitations interfere with your family life and your spouse and children are having difficulties coping with the extra load on them. Worst of all, the stress caused by your injuries and limitations may be wearing you down, disrupting your sleep and making it harder for you to cope with your never-ending pain. At this point, you don't even know where to start getting your pain, and your life, back under control.

More ...

Sunday, February 07, 2010

Cost to treat pain varies significantly by chronic pain condition, AAPM meeting hears - Pharma Letter

Estimates of pain care treatment costs exceed $1 billion annually in the USA, according to two presentations at the American Academy of Pain Medicine's 26th Annual Meeting. One evaluated intrathecal drug delivery (a targeted medicine delivery system) that could save costs over time. The other analyzed the differences between the costs of treatment for chronic pain treatments.

In the first abstract, Scott Guillemette from Ingenix Consulting analyzed costs for intrathecal drug delivery (IDD). The implantable neuromodulatory device, which delivers medicine directly to the spinal cord, was used to treat pain patients suffering from failed back surgery syndrome (FBSS). The results of the analysis suggest that patients utilizing IDD moved closer to a normal lifestyle more quickly than those on conventional therapy such as oral medicines, or physical therapy. This was found to correlate to lower future medical costs, such as doctor visits and additional intervention.

"The cost effectiveness of novel interventional treatments, coupled with outcomes associated with these newer approaches, is increasingly an important part of a treatment decision," said Mr Guillemette. "Our analysis showed that, while there was a higher upfront cost, patients utilizing IDD returned to 'normal living' more quickly than conventional therapy. And, in the long term, our modeling shows it was more cost effective because they made fewer doctor visits and required less additional therapy to alleviate their pain," he noted.

Mr Guillemette studied 1,408 IDD implant cases occurring from January 2006 to January 2009. Using the cost data for patients receiving IDD and 30-year actuarial projections, the costs of IDD intervention and conventional pain therapy were compared. Costs for IDD from the month of implantation through the first year were $14,000 greater than conventional therapy.

However, the breakeven point between the methods occurred in just the second year (between months 19 and 20) following the implant. The lifetime costs for IDD patients were $12,600 less per year than patients receiving conventional therapy. Patients receiving an IDD implant will experience less cumulative medical costs relative to the anticipated costs of conventional pain therapy.

In another abstract, T Kim Le of US drug major Eli Lilly conducted a retrospective analysis of de-identified medical and pharmacy insurance claims from large employers, health plans and government organizations across the USA. Total costs including doctor visits and medicine for two years were calculated. Statistically significant results revealed that neuropathy ($39,368) was associated with higher total expenditures than musculoskeletal disorders ($23,811), inflammatory arthritis ($21,377), and migraine ($17,155).

Friday, February 05, 2010

Researchers Identify Racial Differences In Pain Treatment Outcomes

Findings from a retrospective analysis of a three-week treatment program for chronic pain revealed African Americans experienced worse outcomes compared to a matched group of Caucasians. The research was presented at the American Academy of Pain Medicine's 26th Annual Meeting in San Antonio.

"Our research showed important differences in treatment outcomes exist among African Americans with chronic pain," said Michael Hooten, MD and assistant professor of anesthesiology at the Mayo Clinic College of Medicine in Rochester, Minnesota. "The next step in this line of research will be to determine how treatment of chronic pain can be modified and targeted to achieve equal outcomes regardless of culture or race."

Previous research in chronic pain has shown cultural differences exist African Americans are more likely to report greater impairments performing the activities of daily living (physical functioning) and increased distress and depression (emotional functioning) along with suffering pain. But to date no analyses have looked at differences in treatment outcomes.

Dr. Hooten and second-year medical student Miranda Knight-Brown, a student from the University of Minnesota-Duluth, examined the outcomes from a multi-disciplinary pain rehabilitation (MDPR) program to see if there were racial differences. They looked at the self-reported scores at admission and dismissal for 40 African Americans and 120 Caucasians who participated in a three-week MDPR program at Mayo Clinic between June 2003 and June 2009. Measurements reported included depression, physical-functioning, affective distress, and pain severity.

At admission to the program, African Americans reported greater pain severity and difficulty with physical function than Caucasians, as well as more depression and affective distress. Upon dismissal from the program, the mean pain severity score of the Multidimensional Pain Inventory was eight points greater among African Americans, and the mean score of the Center for Epidemiologic Studies Depression-Scale was nearly twice as high among African Americans compared to Caucasians (20.9 vs. 12.5). In fact, on all assessed outcomes measures, African American patients reported worse scores.

"Our hope is that these preliminary observations will lead to the development of research protocols aimed at reducing disparities in treatment outcomes among African Americans with chronic pain," Dr. Hooten concluded.