Tuesday, August 31, 2010

Experts are in for a world of pain - Montreal Gazette

Decades after McGill University psychologist Ronald Melzack's pioneer collection of 78 "pain words" became the McGill Pain Questionnaire -burning, stabbing, flickering, pulsing, radiating, piercing, squeezing, nauseating, tearing, to name a few -scientists still puzzle over why some people go on to develop chronic pain while others are spared.

About 6,000 leading experts have gathered in Montreal this week for the 13th World Congress on Pain at the Palais des congres - dubbed the "Olympics of Pain" by Jeffrey Mogil, scientific committee chair of the conference. Yesterday, participants said the mystery of chronic pain continues to deepen.

One in five people suffer pain that lingers beyond three months, and up to 50 per cent will endure chronic pain in their lifetime, making the condition a throbbing public health issue.

Researchers are investigating how environmental and genetic factors, gender and age differences and lifestyle factors are linked to pain. They are also making inroads on regenerating nerves and preventing nerve damage.

"A lot of this conference is soul searching about what's going on in order to make it better," said Mogil, professor of pain studies at McGill. "Ultimately, I think it comes down to the fact that pain is deeply complex -complex in ways that no one realizes."

A disadvantage of the research, Mogil added, is that "pain is fundamentally subjective and there's no objective way of measuring it."

It is often also seen as a symptom rather than as a disease itself. Mogil contends that compared to other fields, pain research is grossly underfunded, even though it should be considered the No. 1 health problem. "There are more pain sufferers in the world than cancer, diabetes and heart patients combined," he said.

It is widely believed that pain affects men and women differently. Women experience chronic pain longer, more intensely and more often than men.

"The differences are dramatic," Mogil said of neural networks that moderate pain.

Human drug trials are under way to determine what works for men vs. women. That means eventual targeted therapies, Mogil said: "There will be blue pills and pink pills."

The next 20 years will see a revolution in pain management, according to Gerald Gebhart, president of the International Association for the Study of Pain. "We're just at the beginning of understanding the genetics of pain," he said.

New discoveries are coming, but not as fast as some would like, said Gebhart, director of the Center for Pain Research at the University

of Pittsburgh School of Medicine.

When Melzack and colleague Patrick David Wall proposed the gate control theory of pain in 1965 (which suggested that pain is gated, or filtered by neural gates in the spinal cord, and is affected by past experiences), it ushered in a new era of pain research.

Now the pharmaceutical industry is aggressively seeking new treatments, Gebhart said.

"But what we've learned over the years is that pain is more complicated," he said. "It's not a simple problem of finding a better drug, but of finding a better strategy based on the understanding of the causes and mechanism of pain."

Also, drugs are often accompanied by unwanted side effects, he added. "The more we understand, the harder it is to go forward."

Pain is a useful tool that teaches survival and protection, said Eija Anneli Kalso, professor of pain research and management at the University of Helsinki. It's a different story when pain persists long after the initial injury heals, Kalso said (adding that magnetic resonance images of people with prolonged pain shows changes to the brain, including shrinking grey matter, although that's reversible with effective pain management).

All the more reason to focus on prevention and early treatment, said Universite de Montreal clinical researcher Manon Choiniere. Patients often waste months or years going from doctor to doctor while their pain worsens and becomes more difficult to treat, she said.

"And finally they are referred to a pain clinic, but there's a wait of up to two years to get in."

The Voices of Migraine - NYTimes.com

Almost 30 million Americans suffer from migraines — severe, recurring headaches that may occur along with symptoms of nausea, light sensitivity or weakness. In today's Patient Voices segment, Karen Barrow, a producer with The New York Times, speaks to six men and women who share the challenges of living with migraines.

Some of them expressed frustration at the lack of understanding about the severity of migraine pain.

"A migraine for some people has become almost a generic term for headache," said Skip Masland, 56, of Casselberry, Fla. "I think to myself, they have no idea what a migraine is."

Vickie Martin, 49, of Mason, Ohio, learned that her migraines were tied to her menstrual cycle. After years of suffering, Ms. Martin discovered she had uterine fibroids and an ovarian cyst. After a full hysterectomy to remove them, her migraines have significantly declined.

"It's really difficult to function when you're in that much pain or you're that dizzy or you're that nauseous," she said. "In all truthfulness, I felt like I was gutting it out alone. I didn't personally know anybody else who was down for the count quite as much as I was."

She added, "It was almost like I was disabled."

William Carr, 51, Bartlesville, Okla., was suffering migraines every few days. He underwent an experimental treatment in which a neurostimulator was implanted to send electrical impulses to his spine to thwart the migraine pain. The treatment has helped, and now he suffers migraines about every 10 days.

"The common phrase is, 'Oh, you have a headache,'" Mr. Carr said. "Yes, migraines are headaches, but if you've never experienced one you can't understand. When you have migraines, it hurts to walk. Light hurts. Many people, if they have not had personal experience with it, they kind of look at you like you're faking, that you're just trying to get out of doing something."

To hear more, listen to all the Voices of Migraine by clicking this link.

Migraines in Children Are Often Overlooked - NYTimes.com

For kids around the country it's back-to-school time. But for many of them, it's also the return of headache season.

Doctors say frequent headaches and migraines are among the most common childhood health complaints, yet the problem gets surprisingly little attention from the medical community. Many pediatricians and parents view migraines as an adult condition. And because many children complain of headaches more often during the school year than the summer, parents often think a child is exaggerating symptoms to get out of schoolwork.

Often the real issue, say doctors, is that changes in a child's sleep schedule, including getting up early for school and staying up late to study, as well as skipping breakfast, not drinking enough water and weather changes can all trigger migraines when the school year starts.

"In many areas people just don't think kids can get migraines," says Dr. Andrew Hershey, professor of pediatrics and neurology and director of the headache center at Cincinnati Children's Hospital Medical Center. "But kids shouldn't be missing activities and having trouble at school because they're having headaches. If it happens, it shouldn't be ignored."

Migraine is an inherited neurological condition characterized by severe, often disabling headache pain. During a migraine attack, a number of changes occur throughout the brain causing dilation of blood vessels; severe pain; increased sensitivity to lights, sounds and smells; nausea and vomiting; and other symptoms. It's estimated that about 10 percent of young children and up to 28 percent of older teenagers suffer from migraines. (Hormonal changes during puberty can also be a trigger.)

But childhood migraine often doesn't show up the same way as an adult migraine. While adult migraines often last four hours or more, in a child, the duration of a migraine can range from as little as one hour up to 72 hours. In adults, migraines typically settle on one side of the head, but in children migraine pain is often felt across the front of the forehead or on both temples rather than on just one side. As a result, childhood migraines are often dismissed as sinus headaches.

More ...

Monday, August 30, 2010

Marijuana effective in reducing pain, study shows - The Globe and Mail

A team of Montreal researchers has lent scientific credibility to the view that smoking marijuana can ease chronic neuropathic pain and help patients sleep better.

People suffering from neuropathic pain often turn to opioids, antidepressants and local anesthetics, but those treatments have limitations and the side effects can be punishing. Many physicians and policy-makers, however, are reluctant to advocate the use of cannabis since there has been little scientific research into its effectiveness, even though patients champion its use.

The study, published Monday in the Canadian Medical Association Journal, found that pain intensity among patients decreased with higher-potency marijuana. It is one of a handful of scientific attempts to determine the medicinal benefits of the drug.

"We're not saying that this is the final solution for chronic pain management. As with any pain strategy, especially with chronic pain, we know that the best approach is a multidisciplinary one," said lead author Mark Ware, director of clinical research at the Alan Edwards Pain Management Unit of the McGill University Health Centre. "All that this does is open the door to the cannabinoid being another tool in the toolbox in treating chronic pain."

Twenty-one adults with post-traumatic or post-surgical chronic pain took part in the study and were randomly assigned to receive marijuana at three different potencies: with a tetrahydrocannabinol (THC) content of 2.5 per cent, 6 per cent and 9.4 per cent, and a placebo. THC is the active ingredient in the cannabis plant. Participants inhaled a single 25-milligram dose through a pipe three times daily for the first five days in each cycle, followed by a nine-day period without marijuana. They continued this over two months, rotating through all four strengths of THC.

The researchers measured pain intensity using a standard scale, with study subjects reporting the highest-strength drug was the most effective at reducing the pain and allowing them to sleep.

The study does not address questions about the long-term efficacy of using the drug to treat chronic pain, the researchers acknowledge. Also, there were some adverse effects among participants, including dizziness, numbness and a burning sensation in areas of neuropathic pain.

Dr. Ware said further research will build upon this study.

"As a cannabis user, it can be really hard to get people to take you seriously," said Amy Brown, 28, a Toronto woman who was not a subject in the study but uses marijuana to relieve chronic pain and swelling in her wrist, which was injured in a car crash five years ago.

"To me, this study is vindication."

For her, cannabis has been more effective than chemical painkillers, which had unpleasant side effects. "I wasn't me any more, I was a drone, I was robot-like," she said. "[When I started cannabis], I made a complete 180. I know what's going on now. I have a clear head."

The federal government has given authorization to almost 5,000 people to possess dried marijuana, and 3,500 people hold personal use production licences, according to Health Canada. A doctor's authorization is required before a licence is issued. Several court judgments forced Health Canada to get into the marijuana business a few years back, so that patients would not have to rely on the black market for their supplies.

But despite Health Canada's regulations, Dr. Ware said many in the medical community are not open to the use of marijuana to relieve pain.

"There's a lot of resistance from physicians, and in fact some of the policy-makers, that there isn't much evidence to support this. I know some of the Colleges and the CMA want to see evidence behind these claims before they will consider supporting or endorsing the regulations," he said. "[This study] should provide some support to the fact that there is evidence now out there to support these claims."

Henry McQuay, a professor at Balliol College at the University of Oxford, said the study adds to three previous investigations of smoked cannabis in coping with neuropathic pain, two of which involved patients with HIV. He noted, however, that the participant size of the study was small, the trial was short and it remains to be seen if marijuana can yield greater analgesia with fewer adverse effects than conventional drugs.

"The current trial adds to the trickle of evidence that cannabis may help some of the patients who are struggling at present," Prof. McQuay wrote in an accompanying commentary.

Sunday, August 29, 2010

Medical Use of Marijuana Costs Some a Job - NYTimes.com

Residents in 14 states and Washington can now appeal to their doctors for prescriptions for medical marijuana to help them with their pain.

Their employers, however, may not be so understanding.

In some cases, workers have been fired for failing drug tests despite having prescriptions saying, in effect, that what they are doing is legal according to the laws of their states.

Though the number of such cases appears to be small, they are exposing a new legal gray area, with workers complaining of rights violations and company officials scratching their heads over how to enforce a uniform policy for a drug that the federal government has not recognized as having a legitimate medical purpose.

"The current state of affairs puts employers in a very difficult situation," said Barbara L. Johnson, an employment lawyer in Washington. "But the reality is that there are no federal guidelines like there are when dealing with other types of prescription medications."

Some workers have learned about this legal quandary first-hand, at the cost of their jobs.

Nick Stennet, 20, has a congenital disorder called Poland's syndrome, which left him without a chest muscle on the right side of his body and with a right hand with fingers substantially shorter than those on his left.

Doctors prescribed one or two inhalations of marijuana each night before bed to relieve severe muscle stiffness and shooting pains in his arms.

Mr. Stennet said he told the human resources manager at the Home Depot in Hilo, Hawaii, about his prescription when he was being hired. But after his drug test came back positive for tetrahydrocannabinol, or THC, the active chemical in marijuana, he was out a job.

"Why would they send me down there when they know I am going to test positive?" he said. "I feel like they put me through ridicule when it was so avoidable."

Steve Holmes, a Home Depot spokesman, said the company followed federal guidelines for its drug policy. Employees are allowed to take a leave if they choose to use marijuana to combat the side effects of treatment for a serious ailment. When they return, however, the THC must be out of their systems.

"It's a safety issue for us," Mr. Holmes said.

Cynthia Estlund, a professor of labor and employment law at New York University, said that only one state that had legalized medical marijuana had taken the additional step of saying explicitly that it was unlawful to fire someone for using a lawful substance.

At the same time, Ms. Estlund said, "Nothing in the law tells employers what to do, so they don't have to fire them under federal law."

That is the objection raised by Scott Michelman, a lawyer for the American Civil Liberties Union, on behalf of his client, Joseph Casias.

In 2008, Mr. Casias, a father of two who medicates with marijuana to relieve the pain of inoperable brain and sinus cancer, was named associate of the year at the Wal-Mart in Battle Creek, Mich. But when he injured his knee last year, company policy required a drug test. The positive result cost him his job.

In June, the A.C.L.U. filed a complaint in state court on his behalf, citing wrongful termination. He is seeking reinstatement and damages.

"The cancer is not what's keeping him from earning a living — Wal-Mart is," Mr. Michelman said. "There's actually no law to require Wal-Mart to do what they did."

Greg Rossiter, a spokesman for Wal-Mart, said: "This is obviously an unfortunate situation all around. But we have to consider the overall safety of our customers and our associates."

On the broader legal question, Mr. Rossiter added: "As more states allow this treatment, employers are left without guidelines."

More ...


Saturday, August 28, 2010

Position Statement on Access to Pain Care - American Pain Foundation

Pain is a serious and costly public health issue — together, acute and chronic pain significantly and negatively affects the lives of an estimated one out of every four Americans, costing more than $100 billion each year in medical claims, disability payments, lost wages and lost productivity.i This figure does not begin to cover the physical, emotional and economic strain of pain on the individual and his or her family members and friends.

Unfortunately, many barriers exist in our society and culture that place access to pain management out of reach for many Americans. Barriers are multifaceted and entrenched, ranging from a lack of pain providers who are knowledgeable and willing to provide appropriate pain care, to financial affordability, disparities and discrimination, and unnecessarily restrictive regulation. Furthermore, unintended consequences exist in policy, third-party payer rulings and professional conduct based on fear and stigma that continue to erode access to effective pain management among those who are suffering.

The effects of pain on the individual and society can be alleviated or managed with proper medical attention. Early intervention can reduce health care costs, limit disability and dramatically improve the lives of people living with pain and their loved ones.

The American Pain Foundation (APF) advocates for improved access to effective pain care as a guiding principle and integral part of its mission. People experiencing pain have a basic human right to timely, appropriate and effective treatment of pain.

Access to care is a difficult and burdensome barrier for people with pain in receiving appropriate pain care and for our society at large, and requires an elevated collaborative effort to overcome.

APF views the goal of access to care as:

  • Timely and appropriate pain care that includes access to the full range of legal, safe and effective treatment options for all individuals, regardless of race, ethnicity, gender, age, socioeconomic or insurance status, to lessen pain, promote recovery, restore function and improve quality of life.
  • Individual comprehensive multimodal pain management plans devised by the person with pain and his/her health care team. Such plans will address complex factors, such as the patient’s health status, clinical and social circumstances, pain condition, severity and functional impact of pain, patient preference, provider experience and availability.
  • Use of multimodal treatment approaches tailored to the individual living with pain, including reasonable access to medically appropriate options such as pharmacotherapy, psychosocial intervention, physical rehabilitation, integration of complementary and alternative medicine (CAM), injection and infusion therapies, implantable devices and surgical intervention. Treatment options must include access to medications, including controlled substances, as necessary for an individual’s pain treatment. Such medications should be used according to FDA-approved indications or other uses justified by research and clinical experience.

It is a moral imperative to help people living with pain achieve a standard of life deemed worthy of living — one that permits individuals to enjoy their family members and friends, as well as contribute to our society and economy. To this end, all people in pain have a right to timely, appropriate and effective pain care.

APF believes access to care can be improved by:

  • Educating the medical community and the public that chronic persistent pain is a disease state that requires medical attention and expertise. 
  • Adapting disease management principles to guide primary care and appropriate specialty referral.
  • Implementing standards and monitoring practices within all health care systems and ensuring that transparency of pain care is an indicator in satisfaction surveys and other institutional quality ratings (e.g., National Committee for Quality Assurance, Joint Commission on Accreditation of Healthcare Organizations).
  • Developing and implementing state specific report cards on practice and access using the Pain & Policy Studies Group (www.painpolicy.wisc.edu) model for state policy report cards.
  • Identifying and eliminating regulatory and third-party payer policies and medical practices that usurp the “doctor-patient” relationship or deny pain care access to vulnerable groups or those policies that are primarily developed for cost savings that may supersede the best interest of patient care and serve as an inappropriate and unacceptable form of health care rationing.
  • Ensuring that reimbursement is compatible with the time required for effective pain assessment and treatment and that it includes multi-disciplinary/multimodal practice of care.

APF calls on the professional medical community, regulators and all concerned stakeholders to partner with people living with pain in taking action. Organizational leaders and members alike must reaffirm the ethical commitment to the care of people living with pain and re-energize collaborative efforts to strategically address the problems related to accessing pain care and the barriers preventing care. Medical, governmental, non-profit and private sector parties must work together to improve clinical and economic outcomes associated with acute and chronic pain. The overwhelming evidence of harm resulting from inaction serves as an irrefutable call to action.


Research Examines The Biomedical Diagnosis Of Pain - Medical News Today

Is the science of diagnosing pain causing a number of pain sufferers to defend their honor? Research out of the University of Cincinnati is examining the diagnosis of pain that evades scientific testing, and the additional emotional suffering that can result for the patient.

The research by Elizabeth Sweeney, a doctoral candidate in UC's Department of Sociology, was presented at the 105th annual meeting of the American Sociological Association in Atlanta. The paper, "Defining Reality: How Biomedical Researchers Determine the Existence of Pain," analyzed more than 20 articles randomly selected from the peer-reviewed international academic journal, PAIN ®, the official publication of the International Association for the Study of Pain.

Sweeney examined the journal's content to determine how pain is measured and defined in terms of type of pain, location of pain, its causes, severity, duration, response to treatment, methods of detection and symptoms. Because of these evidence-based diagnostic tests, the paper states that sufferers of chronic pain - conditions that frequently cannot be localized or pointed out on a scan or test - are often put in the position of defending the legitimacy or the reality of their condition.

Examples of these chronic pain sufferers of unexplained or "contested" illnesses can include patients with Chronic Fatigue Syndrome, Complex Regional Pain Syndrome (CRPS), fibromyalgia and Gulf War Syndrome.

"It is apparent from this research that the missing link in much of biomedical research is any viable attempt to understand the subjective experience of pain," Sweeney writes.

"A diagnosis, simple though it may seem, constitutes not only the legitimacy of one's illness, but also the validation of one's sanity and honor - evidence that the patient is not psychologically unstable and is not 'faking' it," says Sweeney.

The paper details that the journal, PAIN®, which for more than 30 years has focused on the study and research of pain, is considered one of the world's premiere sources of biomedical research on pain. The articles that were analyzed were published between May 2008 and May 2009.

Demonstrating the challenges that pain and chronic pain pose to Western medicine, Sweeney concludes that deconstructing biomedical research on pain will better pave pathways of understanding in diagnosing and treating chronic pain sufferers.


Pain - Dispatches from the brave new world of hurt | National Post

Ken Prkachin, a psychologist at the University of Northern British Columbia, knows what pain looks like. His research shows that the facial reaction to pain involves four distinct muscular actions. The eyebrows lower and are drawn in; the muscles around the eye contract, narrowing the eye and producing crow's feet; the muscles in mid-face contract, wrinkling the nose and raising the upper lip; and the eyes often just close.
There are other reactions, such as stretching the lips into a wince, he said, but this appears to be only reliably associated with extreme pain, such as that suffered by soldiers in battle. Even without this detail, he assumed other people knew what pain looked like, too, so he was surprised to discover a constant tendency to underestimate. His test subjects watched video of people in pain, taken at a sports medicine clinic, and consistently pegged it much lower on a number scale than the actual sufferer did.
What he found most "disturbing," though, was that this effect was stronger in health-care workers, suggesting that exposure to pain can dull sympathy. In fact, according to research he is presenting at the 13th World Congress on Pain, which starts today in Montreal, this underestimation can be experimentally induced and strengthened, just by priming people with a few pictures of others in pain.
After that, their judgment skews reliably to the unsympathetic.
"We would have expected that more experience would have made you a better judge," he said.
Pain is a strange thing, unlike any other sensation, and several items up for discussion at the Congress point to its ineffability, and the mental illusions that can bring relief.
Pain is best described in metaphor, such as the broken glass in the throat from a strep infection, or the handyman's vise around the head of a migraine sufferer.
It is awkward to define, although the International Association for Pain Studies, which hosts the meeting of scientists, has made an effort, saying pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."
Philosophers puzzle over it, this "qualia" that is an irreducible part
of the human experience. It comes in many flavours: sting, ache, throb, burn. It is one of few things that straddles the philosophical distinction between mass nouns and count nouns; you can have some pain, or you can have three pains.
The word itself derives from a Latin root meaning penalty, the association being with pain inflicted as punishment, and it is used as slang for a threat. It seems negative by nature, but it can also be mildly pleasant, such as scratching an itch, sexually attractive as in masochism, or spiritually purifying, as in a marathon or other ascetic rituals.
Pain is subjective, and each of us is its only judge, or the only accurate one at least, given Prof. Prkachin's findings. But as judges, we are easily fooled. Pain is a creation, a communication between nerves and brain that can be disrupted, as in the "thermal grill" illusion, in which interlaced warm and cold stimuli on the skin cause a sensation of burning, or the "mirror treatment" for pain in the "phantom limbs" of amputees, which tricks the brain into believing the amputated limb has been re-created, and feels fine, just like the intact one it actually sees in reflection.
Some theories about why pain evolved seem obvious. Acute pain, such as a bee sting, makes you avoid noxious stimuli. Chronic pain, such as a broken arm, punishes you for moving it and interrupting the healing.
But as Prof. Prkachin describes it, pain also seems to be a system that evolved to let other people know we are suffering, and yet science has ignored its emotional component until only recently.
He calls this a "tragic error," to think pain is just a sense like vision or hearing, unconcerned with thoughts and feelings. How then to explain the research that shows having a doting spouse makes pain seem worse?
An unemotional pain is almost nonsensical. Jeffrey Mogil, a professor of pain studies at McGill University and chair of the Congress's scientific committee, said it would take a very rare type of brain lesion from a stroke to produce one, known as pain asymbolia, in which a person can feel a pain's intensity, but does not seem to mind it.
That is the historical error the IASP definition corrected, by recognizing pain as a fundamentally emotional faculty.
"Ultimately, our response to whatever impinges on our senses is an interpretation by our brain," said Gerald Gebhart, president of the IASP and d irector of the Center for Pain Research at the University of Pittsburgh School of Medicine. "With pain, the interpretation is coloured by past experience, emotional content, gender, genetics, setting in which it occurs."
Smashing your thumb with a hammer might be excruciating, he said, but it will not kill you, and you have no one else to blame, whereas mild chest pains can be emotionally terrifying.
"My sense is that the vast majority of the pain that we experience -- although it's coloured by past experience, and gender and genetics and cultural expectations -- is initiated and driven by some event in the periphery, in the tissue," he said.
That explanation is especially complicated in his field of visceral pain disorders, such as irritable bowel syndrome, which do not have any definite pathological cause.
It is these disorders that are reflected in the curious last clause of the IASP definition. It says pain is associated with not only tissue damage, but potential tissue damage, to reflect the fact that a knife point
In piecing together its impression of the surrounding world, the human brain has a tendency to give priority to vision, said Terry Borsook, PhD candidate in psychology at the University of Toronto.
"What the brain sees, it will believe," he said.
That preference opens the possibility of tricking the brain, of using illusions to relieve certain kinds of pains, from common arthritis to the rare pain in the "phantom limbs" of amputees.
In his presentation on Artificial Feedback Therapy, Mr. Borsook describes "mirror therapy," in which a patient with phantom limb pain lays the intact limb on a mirror and moves it around, while looking at the reflection and imagining it is the amputated one.
By bolstering the imagination's ability to create its own internal reality with the mirror's visual feedback, Mr. Borsook said this creates the "uncanny impression" that the severed limb is resurrected, and feels fine. "That's the magic."
He also describes current experiments on arthritis patients, in which the key step is getting them to attribute their pain to a cause that can be manipulated. To that end, he uses an "augmented reality" system, which is similar to virtual reality except that it uses real life as a backdrop. The arthritis patient watches a live video of himself, on which flames have been superimposed on his painful joints. Once that association is made, the flames are virutally doused, and the patient feels relief.
"We're assisting the person's imagination" he said. THIS WON'T HURT A BIT
University of Montreal PhD student Daniele Laverdure-Dupont is expecting her first child the day after her scheduled presentation about sleep's role in strengthening the placebo effect, so it is possible she will be a last-minute scratch. Nevertheless, her poster describes her CIHR-funded research into this mysterious effect, in which the expectation of relief becomes the cause.
The placebo effect, named for the Latin for "I shall please," has a bit of a bad reputation, because it is deceptive. Ethics boards struggle with proposals to lie to people, to make them expect relief from a sugar pill. So it is hard to study it on truly sick people. Thankfully, lying to healthy undergraduates is much less controversial.
Bunking for the night in a University of Montreal lab, they were told that the device strapped to their arm would get hot enough to cause them pain in the middle of the night, the kind of pain you might rank about a five out of 10.
On the first night, they were given a cream to put on their arm, and told (falsely) it was a proven painkiller. The next night, they got the same cream, and were told it was inert.
As Ms. Laverdure-Dupont explained, the placebo effect works even in sleep. Not only did the expectation of relief from the useless cream make the subjects describe the pain as much less intense the next morning, but they woke up less frequently when the pain was actually happening.
will hurt the skin before piercing it. But neuropathic pain, such as fibromyalgia, does not involve any tissue damage at all, or if it does, it is long since healed, but the pain remains. Therefore, IASP says, pain is also any sensation that is "described in terms of such damage."
The recent history of pain drug development has been poor, Prof. Mogil said, with several promising animal models failing to translate into human applications. Others, such as Vioxx, worked fine but had dangerous side effects.
His research is on the genetic aspects of pain, and he thinks it is only a matter of time before a new pain drug is developed that works only on men or women, reflecting the growing research into sex-specific pain genes.
"I'm more sure than ever that male and females have different pathways to pain," he said. "One day there will be sex-specific drugs."
In the meantime, a bold proposal at this pain conference aims to ease a global inequality in the availability of pain drugs that are already well proven and safe, especially the politically dangerous opioids.
The first global Pain Summit, a meeting of scientists and policymakers, is to take place in Montreal next week, closing the conference with an aim to promote pain management as a universal human right.

Friday, August 27, 2010

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

Welcome to the August Pain-Blog Carnival, some of this month's great writing related to pain from other blogs and websites.  I hope you enjoy the selections!

Going Down Swinging shares a wonderful article, A Message to Spouses and Partners of Those with Pain.  She also reports about her ketamine treatment.

The Truth about JRA suggests how to still exercise if you're stuck in bed.

Phylor's Blog has some great suggestions about improving the doctor-patient relationship in I Have My PCP on Speed Dial.

365 Pain Free Days explores the balance between being cheerful and telling it like it is.

Chronic Babe has been offering some great carnivals lately.  Check out her themes such as Interacting with Health Care Providers and Who's on Your Support Team.

CRPS/RSD A Better Life shares a video series about mirror treatment for pain.

Psychology of Pain offers a link to fMRI research on pain (scroll to the 8/10 article).

Nickie's Nook writes about how creativity and art projects help her cope with pain.

Rest Ministries is getting ready for this year's Invisible Illness Week.  Check out what'll be happening Sept 13-19 and how you can participate.

In Sickness and in Health writes an interesting article about couples where both partners have a chronic illness.


Up to 1 in 4 patients report more physical problems a year after surgery than before | Science Blog

One in seven patients experience more pain, physical and emotional problems a year after surgery than before their operation and a quarter have less vitality. Those are the key findings of a research study of more than 400 patients published online by the British Journal of Surgery.

Researchers from The Netherlands spoke to 216 women and 185 men with an average age of 54, who had undergone planned surgery, ranging from plastic surgery to orthopaedic surgery.

They used the SF-36 health survey to measure pain, physical functioning, mental health and vitality before surgery and six and 12 months after each patient’s operation. The researchers also asked patients how far they had moved towards a 100% recovery, six and 12 months after surgery.

“Our study showed poor recovery was relatively frequent six and 12 months after surgery and could be partly explained by various physical and psychological factors” says Dr Madelon Peters from the Department of Clinical Psychological Science at Maastricht University. “These included acute postoperative pain and presurgical anxiety.”

Key findings included:

  • More than half of the patients (53%) said that their pain levels had improved 12 months after their operation and 29% said they were stable, but 17% reported greater pain.
  • Most patients had better (43%) or similar (43%) functional abilities at 12 months, but 14% said their functional abilities had reduced.
  • At 12 months, 34% of patients had better mental health, 50% did not change and 16% had poorer mental health.
  • Vitality increased in 39% of patients, remained the same in 37% and fell in 24% at 12 months.
  • When it came to overall recovery, patients reported that their average level of recovery was 79% at six months and 82% at 12 months. Only 47% of patients had achieved near optimal recovery – defined as 90% or more – at 12 months, with 15% perceiving their recovery at 50% or less.

“Our research found that 15% of patients were still reporting pain and physical and emotional problems a year after surgery and 24% felt they had less vitality than before their operation” says Dr Peters.

“The strongest predictor of pain intensity at follow-up was the level of pain in the first four days after the patient’s operation. Higher levels of acute postoperative pain were also associated with poorer long-term physical functioning and overall perceived recovery.

“We also found a significant association between patients who were worried before their operation about the consequences of surgery and lower than average improvements in physical functioning and vitality at follow-up.

“Most of the changes in health-related quality of life occurred during the first six months after surgery, after which the patients’ conditions appeared to remain stable.

“It is clearly important to monitor how patients recover during this period as an initially poor recovery may have lasting consequences.”


Tuesday, August 24, 2010

New York Law Encourages Frank Talk on Palliative Care - NYTimes.com

Legislators have begun to recognize the medical, humanitarian and economic value of helping terminally ill patients and their families navigate treatment options as they approach the end of life.

Last week, over the objections of New York State's medical society, Gov. David A. Paterson signed into law a bill — the New York Palliative Care Information Act — requiring physicians who treat patients with a terminal illness or condition to offer them or their representatives information about prognosis and options for end-of-life care, including aggressive pain management and hospice careas well as the possibilities for further life-sustaining treatment.

The Medical Society of the State of New York objected, saying that the new law would intrude "unnecessarily upon the physician-patient relationship" and mandate "a legislatively designed standard of care."

A similar provision in the original federal health care overhaul proposal, which would have reimbursed doctors for the time it takes to have such conversations, was withdrawn when it was erroneously labeled by conservatives as a "death panel" option.

Also last week, a study in The New England Journal of Medicine reported that among 151 patients with newly diagnosed metastatic lung cancer, those who received palliative care, which is care focused on symptoms, along with standard cancer therapy had a better quality of life, experienced less depression, were less likely to receive aggressive end-of-life care and lived nearly three months longer than those who received cancer treatment alone.

The New York law was sponsored by Assemblyman Richard N. Gottfried and Senator Thomas K. Duane, both Democrats of Manhattan, at the request of Compassion and Choices of New York, an organization that seeks to improve end-of-life comfort care and reduce the agony often associated with dying in this era of costly can-do medicine.

The organization said the law addresses "a major concern for terminally ill patients and their families, who often face the most important decision of their lives — how to live their final days — without being informed of their legal rights and medical options." The law obligates health care providers to volunteer information on a complete menu of care options — if patients want to know about the options.

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Monday, August 23, 2010

'Pain Chronicles': Understanding Pain As A Disease : NPR interview

Years ago, writer Melanie Thernstrom developed a pain in her neck that poured through her right shoulder, down into her arm and into her hand. It never got better.

After a long period of denial, she went to doctors, one after another, and eventually concluded that there was no surgery, no manipulation, no magic-bullet cure. She believes we need to reconsider our definition of pain.

Most of us tend to think that pain is what happens when you break a bone or cut yourself. When it heals, you feel better. But for many millions pain does not go away. It's not a reaction to a sprain or a fever, it's a disease of its own.

Melanie Thernstrom joins us from Palatine Studios in Portland, Oregon. Her new book is "The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering." Nice to have you with us today.

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