Sunday, June 26, 2011

Sit Up Straight to Avoid Back Problems -

EVERYONE wants to avoid back trouble, but surprisingly few of us manage to escape it. Up to 80 percent of Americans experience back pain at some point in their lives, and each year 15 percent of all adults are treated for such problems as herniated discs, spinal stenosis or lumbar pain.

But back pain is notoriously difficult, and expensive, to remedy.

"The treatments are varied, and we don't have great science showing what works best for particular patients," said Brook I. Martin, an instructor of orthopedic surgery at Dartmouth Medical School. "There are questions about the safety and efficacy of a surprising number of therapies, including some types of surgery."

Those with back pain inevitably end up with higher overall medical costs than those without, studies suggest. Dr. Martin has found that patients with back pain spend about $7,000 annually on health care, while people without back pain spend just $4,000 a year. (Insurers will pay the majority of these costs, but patients often bear some of these expenses in the form of insurance co-payments and deductibles.) These estimates don't include costs for lost work days or diminished productivity.

Some back problems, of course, can't be avoided. Over time, spinal vertebrae naturally degenerate and spinal facets become inflamed, causing stress and discomfort.

"The majority of back pain is the result of muscle and ligament strain or weakness, and can often be prevented by developing core strength and proper posture," said Dr. Daniel Mazanec, associate director of the Center for Spine Health at the Cleveland Clinic.

Maintaining good posture not only helps you look better (there's a reason inept people are called slouches), it improves muscle tone, makes breathing easier and is one of the best ways to stave off back and neck pain, not to mention the dreaded dowager's hump of old age.

"Posture is the key," said Mary Ann Wilmarth, chief of physical therapy at Harvard University Health Services. "If your spine is not balanced, you will inevitably have problems in your back, your neck, your shoulders and even your joints."

Sitting a little straighter now? Good. Here's some advice that will help you make it a daily habit and stave off expensive back problems to boot.

THE D.I.Y. APPROACH First, try correcting your slouching habits on your own. Stand up and lift your chin slightly; align your ears over your shoulders and your shoulders over your hips. Place your hands on your hips and pitch forward about two inches.

There should be a slight inward curve in your lower back, an outward curve in your upper back, and another inward curve at your neck. Maintain this posture and sit down.

When you are sitting or driving for long periods of time, place a cushion or rolled-up towel between the curve of your lower spine and the back of your seat. Supporting your lower back will maintain the natural curve of your spine; when the back is supported, the shoulders more naturally fall into place, said Dr. Wilmarth.

Maintaining good posture requires abdominal and back strength. "It's not enough to just sit up straight if your core muscles are weak," said Dr. Praveen Mummaneni, a spine surgeon at the University of California, San Francisco. Consider taking a Pilates class, which focuses on developing one's core — the muscles and connective tissues that hold the spine in place — or hire a physical therapist to create a personalized exercise plan.

A CUBICLE CURE If you sit at a desk all day, ask your human resources department if they have an ergonomics expert on staff (some large companies do) who can assess your work area. An ergonomist can make sure your chair, desk and keyboard are at the optimal height and can adjust your sitting posture.

If no expert is on hand, make adjustments yourself. The center of your computer screen should be at eye level, and the desk height should allow your forearms to rest comfortably at a 90-degree angle. Work with your feet flat on the floor and your back against the chair.

Whether you work in an office or at home, get up and stretch every 30 to 60 minutes. Sitting for long periods puts pressure on discs and fatigues muscles. And most workers spend the majority of their days sitting down. A recent study published in The European Heart Journal found that Americans are sedentary for an average of 8.5 hours a day.

"Stretching helps break bad patterns and allows your muscles to return to neutral," said Dr. Wilmarth.

Stand up and place your hands on your lower back, as if you were sliding them into your back pockets. Gently push your hips forward and slightly arch your back. Sit back down and circle your shoulders backward, with your chin tucked, about 10 times.

Not likely to remember? Set your phone or computer alarm to remind you to stand up and stretch each hour. An iPhone app called Alarmed has a feature that allows you to create regular reminders throughout the day.

AN EXERCISE PLAN Habits are hard to break. A physical therapist can show you how to align your spine and provide you with exercises to both strengthen your core and loosen up stiff neck, back, arm and leg muscles (tight hamstrings can contribute to back pain).

The American Physical Therapy Association's Web site ( offers a simple tool that lets you search for physical therapists by ZIP code and specialty.

Most insurers cover physical therapy, although some may insist that you get a referral from a physician before they will authorize a visit.

If you decide to go out of network or to bypass your insurer, you'll pay $150 to $250 for an initial assessment. Follow-up visits will be $50 or so less. Most experts say you can address basic posture issues in just one to three sessions.

A CLASS IN POISE If you want a more systematic, long-term approach to posture change, consider the Alexander technique, a method that teaches you how recognize and release habitual tension that interferes with good posture.

Not all doctors in the United States are familiar with the technique, but recent research suggests that it can help with lower back pain as well as posture. A study published in The British Medical Journal found that lessons in the technique helped patients with chronic back pain. A 2011 study published in Human Movement Science concluded that the Alexander technique increased the responsiveness of muscles and reduced stiffness in patients with lower back pain.

Try one session to see if it's for you. If so, consider committing to 10 lessons. Individual lessons cost $60 to $125, depending on the teacher's experience. Insurers will not reimburse you; group lessons may be more affordable. To find a teacher, go to the Web site of the American Society for the Alexander Technique.

Still slouching? A study published in The European Journal of Social Psychology found that subjects who were told to sit up straight with good posture gave themselves higher ratings and had more self-confidence on a given task than those who were told to slouch.

Moral: Sitting pretty yields immediate, not just long-term, benefits.

Saturday, June 25, 2011

In pain? Crossing your arms may help | Reuters

Crossing your arms across the middle of your body confuses the brain and helps reduce the intensity of pain, according to research published on Friday.

Scientists from University College London (UCL) who reported the finding in the journal Pain said they think the reason for the phenomenon is conflicting information between two of the brain's maps -- one for the body and one for external space.

"In everyday life you mostly use your left hand to touch things on the left side of the world, and your right hand for the right side of the world," Giandomenico Iannetti of UCL's department of physiology, pharmacology and neuroscience, said in a statement about the research.

He said this means the brain areas that hold the map of the right body and the map of right external space are usually activated together, leading to very effective pain processing.

"When you cross your arms these maps are not activated together anymore," he said, leading to less effective processing meaning that stimuli such as pain can perceived as weaker.

In the study, scientists used a laser to generate a four millisecond pin prick of "pure pain" -- in other words pain without touch -- on the hands of a group of eight participants. This was then repeated with arms crossed.

Participants rated their perception of the pain intensity, and their electrical brain responses were also measured using electroencephalography (EEG). Results from both participants' reports and the EEG showed that the perception of pain was weaker when the arms were crossed.

"Perhaps when we get hurt, we should not only 'rub it better' but also cross our arms," Iannetti said.

The researchers hope their discovery could lead to the development of new drugs and therapies to reduce pain that exploit the brain's way of mapping the body.

Thursday, June 23, 2011

Little Progress Seen in Treating Chronic Pain - MedPage Today

Treatment of chronic pain today remains strikingly inadequate, despite better understanding of the underlying pathology and an ever-widening range of therapeutics, according to an overview of the literature.

For all the treatment modalities surveyed, only about half of treated patients had a response -- and the reduction in pain was only about 30%, reported Dennis C. Turk, MD, and colleagues from the University of Washington in Seattle.

"A general conclusion about the treatment of chronic noncancer pain is that the results presented are sobering," the researchers wrote in the June 25 Lancet.

Worldwide, one in five people report chronic pain, according to World Health Organization estimates.

Many factors influence patients' experience of pain, including cognitive and emotional elements, history, and pathology -- all of which need to be addressed for successful pain control.

To review the empirical evidence for common approaches to chronic pain, the researchers surveyed the literature for systematic reviews, meta-analyses, and guidelines on osteoarthritis, neuropathic pain, fibromyalgia, and low-back pain.

They found that opioids were the most commonly prescribed drugs, with sales that increased by more than 175% between 1997 and 2006 -- yet these agents were associated with only small improvements in pain and function.

In general, opioids were not recommended as first-line therapy for osteoarthritis and fibromyalgia, though they could be considered during specific clinical situations such as exacerbations of neuropathic pain.

Side effects such as constipation and drowsiness can be significant with opioids, and a small number of patients taking these drugs long term develop hyperalgesia.

Opioids also are widely misused, with studies suggesting that almost half of long-term users may be misusing the drugs and placing themselves at risk for overdose and death.

Other options include nonsteroidal anti-inflammatory drugs (NSAIDs), which can help in osteoarthritis and rheumatoid arthritis, although less is known about potential benefits for fibromyalgia or neuropathic pain.

Acetaminophen is widely used for analgesia as an alternative to NSAIDs, which can cause serious gastrointestinal adverse effects, but concern has been growing about toxicity and hepatic failure with acetaminophen and warnings have been added to the drug's labeling.

Antidepressant drugs, particularly the tricyclics, have various effects that could contribute to pain relief, such as interfering with the reuptake of noradrenaline and serotonin -- but these drugs can cause hypotension and arrhythmias.

Nonetheless, a recent systematic review determined that evidence for efficacy exists for the use of tricyclic antidepressants in several pain syndromes, including fibromyalgia and neuropathic pain.

The newer selective serotonin and noradrenaline reuptake inhibitors duloxetine (Cymbalta) and milnacipran (Savella) have been found effective in fibromyalgia and neuropathic pain, but more studies are needed to assess their effects in other conditions, according to Turk and colleagues.

Anticonvulsants also exert a number of actions that can interfere with pain, such as binding to a calcium-channel protein in the brain and spine, and inhibiting neurotransmitter release.

Studies have shown that gabapentin and pregabalin (Lyrica) are beneficial for neuropathic pain and fibromyalgia, although troublesome side effects include fatigue and weight gain.

Aside from pharmacotherapy, the researchers also reviewed several interventional approaches such as injections and surgery, finding some evidence for the use of epidural steroid injections in patients with radiculopathy associated with prolapsed lumbar discs.

A recent systematic review found some benefit for lumbar fusion for back pain, but many patients report worsening over time after the surgery.

"High complication rates and repeat procedures are realities of spinal surgery as well," the researchers observed.

Psychological techniques such as cognitive-behavioral therapy can have "modest benefits," they found, but long-term outcomes are uncertain, and individual patients may respond better to different types of psychological therapies.

Evidence also varies for complementary approaches, being "promising" for acupuncture in fibromyalgia.

Turk and colleagues noted that they would have liked to include a table summarizing their conclusions and comparing the various modalities, but were unable to do so because of the wide variety across studies in diagnostic criteria, outcome measures, and health systems.

They concluded that none of the widely used treatments are adequate for eliminating pain and improving function in most chronic pain patients.

They recommended that combinations of various types of treatment be evaluated, and also advised that helping patients maintain realistic expectations is vital.

In addition, they called for more clinical exploration into chronic pain.

"A great need exists for research that goes beyond asking the questions of whether a particular treatment is effective, to addressing what treatment is effective for which patients, on what outcomes, under what circumstances, and at what cost," they stated.

Current treatments for chronic pain do not generally eliminate pain or restore function

The majority of patients with chronic pain do not get proper pain relief or the restoration of function from their current treatment, researchers from the University of Washington, Seattle, revealed in the journal The Lancet today. This article is part of a second The Lancet Series on pain.

Dennis C Turk and team set out to evaluate how effective most commonly used therapies are for the treatment of chronic pain over the last ten years. They wrote that overall effectiveness remains poor and inconsistent, despite major advances in understanding the mechanisms that underlie pain.

The authors wrote:

"Of all treatment modalities reviewed [drugs, surgery, interventional, behavioural, rehabilitation, and alternative], the best evidence for pain reduction averages roughly 30% in about half of treated patients, and these pain reductions do not always occur with concurrent improvement in function."

Approximately 1 in every 5 people worldwide has chronic pain. In the USA alone, over $210 billion annually are spend on treating chronic pain - annual costs in the UK for just back pain are estimated to be between $26 and $49 billion.

As current treatment on their own do not appear to provide adequate relief from pain and improvements in physical and emotional functioning, the authors believe future research should concentrate on combining different drugs, drugs with psychological therapy, as well as medications with somatic treatments.

Few studies have evaluated combinations of therapies.

Treatment should have a multi-faceted approach, involving the whole person. For treatment to be effective, the researchers say that the effectiveness of physical and emotional functioning should be assessed, data from patients should be gathered, as well as adverse events - instead of just focusing on how severe the pain is.

The researchers stress:

"A great need exists for research that goes beyond asking the questions of whether a particular treatment is effective, to addressing what treatment is effective, for which patients, on what outcomes, under what circumstances, and at what cost.

Conclusion: These results suggest that none of the most commonly prescribed treatment regimens are, by themselves, sufficient to eliminate pain and to have a major effect on physical and emotional function in most patients with chronic pain...There is a crucial need for assessment of combination treatments, identification of treatment response, and the assessment of the benefit of matching of treatments to patient characteristics."

Patients Continue To Receive Inadequate Pain Relief After Surgery, But Innovative Techniques Could Aid Pain Management - The Lancet Series On Pain

Despite new standards, guidelines, and educational efforts, acute pain after surgery continues to be undertreated worldwide, with up to 75% of surgical patients in the USA still failing to receive adequate post-op pain relief, according to the first paper in The Lancet Series on pain. The findings also reveal that chronic pain after surgery is a bigger problem than previously recognised, affecting up to half of patients undergoing common operations. However, new pain medications and techniques under development could help improve symptom relief for patients. 

In the paper, Christopher L Wu and Srinivasa Raja from John Hopkins University and School of Medicine, Baltimore, USA review the progress made in treatments for postoperative pain over the past decade and stress that despite advances in pain management, a high percentage of patients continue to experience moderate-to-severe pain after surgery. Inadequate post-surgical pain management is not just limited to adults, with a study from the USA reporting as many as 86% of children experiencing significant pain on the first day home after undergoing routine tonsillectomy. 

Recent research also shows that the development of chronic pain after surgery, known as persistent postsurgical pain [PPP], is a frequent outcome of surgery. As many as 30-50% of patients undergoing common operations such as mastectomy, thoracotomy, hernia repair, and coronary artery bypass have to cope with PPP. 

They authors say: "Why there has been little progress in the treatment of acute postoperative pain is unclear, but the causes might be multifactoral, including the continued paucity of pain assessment and documentation, heightened awareness and increased number of audits or surveys leading to increased identification of undertreatment of pain...deficiencies in educational pain management programmes for health-care workers, underuse of effective analgesic techniques, and poor adherence to available guidelines." 

However, some interventional techniques have had a substantial impact on pain control over the past decade. In particular, regional analgesic techniques (such as epidural analgesia and peripheral nerve catheters using local anaesthetics) have been associated with significantly lower pain scores, earlier mobility, and reduced length of hospitalisation compared with the use of systemic opioids. Furthermore, such techniques eliminate the risk of addiction. 

Other promising interventions still under development include the transdermal patch for the patient-controlled delivery of pain medication (fentanyl) providing a needle-free effective alternative to the intravenous pump; extended-release local anaesthetics to prolong the action of commonly used local anaesthetics; and disposable devices to allow infusion of local anaesthetics on an outpatient basis reducing the need for opioids and their adverse effects (nausea, constipation, respiratory depression). 

They conclude: "Additional studies on predictors of postoperative pain and persistent postsurgical pain, efficacy of multimodal analgesic regimens [using more than one class of pain medication or technique], and growth of promising new technologies might lead to substantial gains in the treatment of acute postoperative pain and potential reduction in the development of persistent pain states [a not uncommon outcome of surgery]."

Wednesday, June 22, 2011

The Brain: A Tiny Key to a Terrible Lock | DISCOVER Magazine

The Brain: A Tiny Key to a Terrible Lock

Scientists have traced chronic pain to a defect in one enzyme in a single region of the brain. Could this be a decisive turn in the battle against pain?

by Carl Zimmer

For tens of millions of Americans, pain is not just an occasional 
nuisance—a stubbed toe, a paper cut—but a constant and torturous companion. Chronic pain can be focused on an arthritic knee or a bad back, diffused throughout the body, or even located virtually in an amputated limb. It can linger for years. And it can transform the world so that merely the light brush of a finger is an agonizing experience. The daily devastation can be so intense that people with chronic pain are up to six times as likely as those who are pain-free to report suicidal thoughts.

Despite the toll, chronic pain has been relatively neglected by 
doctors. Perhaps that's because it seems less real to them than other, more tangible medical disorders. With no equivalent of a stethoscope 
or thermometer to measure pain objectively, they have had to rely 
entirely on their patients' testimony.

As neuroscientists learn more about the biological basis of pain, the situation is finally beginning to change. Most remarkably, unfolding research shows that chronic pain can cause concrete, physiological changes in the brain. After several months of chronic pain, a person's brain begins to shrink. The longer people suffer, the more gray matter they lose.

With that bad news, though, comes a message of hope. In documenting the damage that chronic pain causes, neuroscientists are also beginning to decipher how it comes to exist in the first place. Those insights suggest better treatments and cures.

Normally, pain is triggered by a set of danger-sensing neurons, called nociceptors, that extend into the organs, muscles, and skin. Different types of nociceptors respond to different stimuli, including heat, cold, pressure, inflammation, and exposure to chemicals like cigarette smoke and teargas. Nociceptors can notify us of danger with fine-tuned precision. Heat nociceptors, for example, send out an alarm only when they're heated to between 45 and 50 degrees Celsius (about 115 to 125 degrees Fahrenheit), the temperature at which some proteins start to coagulate and cause damage to cells and tissues.

For all that precision, we don't automatically feel the signals as pain; often the information from nociceptors is parsed by the nervous system along the way. For instance, nociceptors starting in the skin extend through the body to swellings along the spinal cord. They relay their signals to other neurons in those swellings, called dorsal horns, which then deliver signals up to the brain stem. But dorsal horns also contain neurons coming down from the brain that can boost or squelch the signals. As a result, pain in one part of the body can block pain signals from another. If you stick your foot in cold water, touching a hot surface with your hand will hurt less.

Once nociceptor signals enter the brain, they wend their way through a labyrinth of connections. Neuroscientists have recently started to use brain imaging machines to track this journey. In a study published last year, Irene Tracey of the University of Oxford and her colleagues had 16 volunteers lie in an fMRI scanner. The researchers then trained a laser at the right foot of each volunteer and fired tiny pulses. Though all the pulses were of equal strength, volunteers reported that some of them felt like pinpricks while others were painless. The team found that a whole constellation of regions located throughout the brain became more active when the volunteers reported that the laser hurt.

Further investigation has shown that no one region in this pain network is solely responsible for making us feel pain; it is their collective activity that makes us wince. Tracey and her colleagues explored this process by studying the connectivity between specific regions of the pain network. In some people, the neurons in the regions studied fired in unison. In other people, they weren't so tightly linked. The more in sync a person's pain network was, the more likely he or she was to report that a laser pulse felt painful.

Our sensation of pain also depends on outside sources of information beyond the nociceptors. The Oxford team demonstrated this effect with another experiment. They told a group of volunteers that they were part of a study to test the safety of a laser, which would zap their feet. Each zap would hit one of six spots. Some of the spots had already been approved as safe, the subjects were told; others had been approved only with reservation; yet others had not been approved at all because they were susceptible to harm. Asked 
to pay close attention to how the laser felt, the subjects knew which spot would be zapped next by looking at a monitor as they lay in an fMRI scanner.

In reality, the experiment was entirely safe. Yet the volunteers tended to report that the unapproved spots hurt more than the approved ones. The knowledge they got from the scientists influenced their sensation of pain. The fMRI scans revealed that when the subjects saw they were about to be zapped on an unapproved spot, a region of the pain network called the anterior insula became active. The researchers concluded that the anterior insula was integrating information about the experiment with the sensations from the foot, priming the pain network to feel a little stab.


Experiments like Tracey's show that pain is much more than a direct response to a stimulus. That makes sense when you think about the biological function of pain. Pain helps us defend ourselves from harm, and deciding what's harmful and what isn't can require some careful—if unconscious—deliberation. Pain protects us long after we are hurt. If we suffer a bruise or a broken bone, it can remain painful for days or weeks. That prolonged agony may be unpleasant, but it can aid our survival by forcing us to let wounds heal. And pain protects us by stim ulating and strengthening neural connections in the brain, forcing us to associate the sensation with the memory of what we did to cause it. As time passes, we store the memory of the pain without vividly reliving it every day.

But for millions of people the memory doesn't fade and the pain doesn't go away. To 
A. Vania Apkarian, a neuroscientist at Northwestern University, the connection between the living memory and the never-ending pain suggests a glitch in the brain. Ordinary pain might turn chronic, he hypothesizes, when inflammation caused by conditions like arthritis or nerve damage provokes an abnormal rush of signals from nociceptors. When these aberrant signals reach the pain network in the brain, Apkarian argues, they overwhelm it. The brain doesn't get a chance to forget the pain. Instead it learns to feel it continuously. Eventually the neural connections become so strong that we no longer need the original stimuli anymore. The network begins to sustain itself, continually relearning its pain. It can also send signals back down into the body, turning previously painless sensations into painful ones.

Apkarian's theory may soon be confirmed in the most meaningful way possible, with a new treatment for chronic pain. The drugs currently used to treat chronic pain—aspirin and morphine along with other opiates—don't work very well and are often addictive. To develop better drugs, scientists are trying to move beyond trial and error and to base their research on our growing knowledge of what causes pain.

To that end, Min Zhuo, a neuroscientist at the University of Toronto, has been testing out potential painkillers on mice. But first he had to give the animals chronic pain, by crimping a nerve in one of their legs. In a matter of days, the mice developed many of the symptoms—and even some of the brain alterations—seen in people with chronic pain.

Zhuo and his colleagues then sought out compounds that could interfere with the learning that goes on during chronic pain. They focused on the behavior of neurons in a region of the brain called the anterior cingulate cortex, which shows especially intense activity in scans of people with chronic pain. The cingulate cortex contains an abundant amount of an enzyme called AC1. Zhuo wondered if the neural learning that leads to chronic pain was accelerated when levels of the enzyme were high.

As a test, Zhuo's team genetically engineered mice so that they could not make enzyme AC1. The animals turned out almost entirely normal. They could even sense regular types of pain. But when Zhuo tied off a leg nerve, the mice didn't develop chronic pain.

Once Zhuo recognized that AC1 is essential for chronic pain, he started the hunt for a drug that could interfere with it. He grew cells that produced enzyme AC1 in culture and then added hundreds of different compounds, hoping that one would latch on to the enzyme and thus block its action. Eventually he and his team found one that did, naming it NB001. When scientists gave an oral dose of NB001 to rats suffering from chronic pain, the animals were rid of their symptoms in just 45 minutes. By latching onto AC1, it seems, the drug prevented the neuronal activity that makes chronic pain possible.

NB001 shows a lot of promise. With its focus on the pain engine in the cingulate cortex instead of the entire brain and nervous system, it is particularly targeted. And there are no obvious side effects in labora tory animals; the rats suffered no harm to their memory or their ability to learn. Zhuo hopes to launch clinical trials in humans soon.

There is no guarantee that NB001 will work as intended, since people and rats have major biological differences. Tinkering with the anterior cingulate cortex—one of the human brain's supreme multitaskers, involved not just with pain but also with the regulation of emotion and decision-making—is a delicate process. Unforeseen side effects could easily emerge. 
 Yet even if this specific drug doesn't reach the marketplace, NB001 represents a milestone. It shows that scientists fighting pain are, at long last, leaving the guesswork behind. Now we know where chronic pain lives.

Monday, June 20, 2011

PAINWeek - The National Conference on Pain for the Frontline Practitioner

September 7-10, 2011, Las Vegas

The PAINWeek conference is intended for physicians, nursing professionals, physician assistants, dentists, pharmacists, psychologists, podiatrists, and many other healthcare practitioners. Approximately 1400 attended the 2010 annual conference.

100+ hours of continuing medical education will be presented in the following areas: addiction, complementary and alternative medicine, geriatrics, health coaching, hypnosis, medical/legal, neurology, pain & chemical dependency, palliative care, pediatrics, pharmacology, physical medicine & rehabilitation, primary care, regional pain syndromes, and rheumatology.

The mission of the PAINWeek conference is to provide a comprehensive and open national forum for frontline practitioners, pain professionals, and pain societies to share their experience, knowledge, and resources with clinicians who provide pain management services. The PAINWeek conference is an opportunity for both professional and patient-focused organizations to demonstrate their collective commitment to linking collaborative education with better healthcare outcomes.

Participating Organizations

Treat The Pain

We are passionate about pain relief and ensuring that adequate treatment is available and accessible to all those who are in need of it. The disparities in access to pain treatment worldwide are staggering. Cancer deaths are expected to double by 2030 and many of those deaths will be in developing countries with little to no access to adequate pain treatment. The World Health Organization estimates that each year there are 5.5 million terminal cancer patients living countries with low or no access to controlled medicines and who are suffering in pain. We believe that too many people worldwide are living with treatable pain and that a solution is available and attainable. Our goal is for effective pain control measures to be available to all cancer patients in pain. And we invite you to join us in our Campaign and stop unnecessary suffering worldwide.

Treat the Pain is a campaign administered by the Union for International Cancer Control (UICC) to advocate for high-quality pain treatment for all who need it throughout the world, and to connect those who would like to join the fight with meaningful actions. The Campaign will use the resources and voices of its members to promote and advocate for universal access to adequate pain relief.

YouTube - LIFE Before Death Channel

LIFE Before Death is a documentary project comprising a feature film, a one-hour television program and 50 short films.

The project is broadly about terminal patients, their families and the remarkable health care professionals fighting to change the culture of medicine to be focused on care, rather than exclusively on cure.

LIFE Before Death will include 50 short films themed around pain control and end of life issues, releasing one a week for a year from May 2011.

A feature film will be released in late 2011, followed by the release of a television documentary in early 2012.

International Association for the Study of Pain (IASP) - Facebook

International Association for the Study of Pain | LIFE Before Death Documentary Series

In May 2011, the Lien Foundation launched a campaign to promote a series of 50 short films produced by Moonshine Movies themed around the global crisis of untreated pain and other end-of-life issues. The Moonshine production team filmed in India, Uganda, Singapore, Canada, China, USA, South Africa, Australia, Georgia, Ireland, and Hong Kong. Through interviews with doctors, patients, and their families, they explored a diverse range of cultural perspectives on pain, death and dying.

One short film in the LIFE Before Death series by Moonshine Movies will be released each week for a year, with a feature film and a one-hour television documentary appearing in late 2011. The videos are available here, as well as on the LIFE Before Death YouTube channel. This incredible project was funded in part by IASP, along with the MayDay Fund, Union for International Cancer Control, and The Institute for Palliative Medicine at San Diego Hospice International Programs.

International Association for the Study of Pain | Meetings

All Pain-Related Meetings

At IASP we strive to keep our members and the public informed about what's happening in the world of pain research and treatment. Below, you will find a list of pain-related conferences, symposia, seminars, workshops, and educational programs taking place all around the world. Choose a region from the left-hand menu to see meetings taking place in that region only.

Wiley: Clinical Pain Management: A Practical Guide

Clinical Pain Management: A Practical Guide
Editors: Mary E. Lynch, Kenneth D. Craig, Philip W. H. Peng

Clinical Pain Management takes a practical, interdisciplinary approach to the assessment and management of pain. Concise template chapters serve as a quick reference to physicians, anesthetists and neurologists, as well as other specialists, generalists, and trainees managing pain. Based on the International Association for the Study of Pain's clinical curriculum on the topic, this reference provides to-the-point best-practice guidance in an easy-to-follow layout including tables, bullets, algorithms and guideline

List of contributors.

Foreword (Ronald Melzack).

Part 1 Basic Understanding of Pain Medicine.

1 The challenge of pain: a multidimensional phenomenon (Mary Lynch, Kenneth D. Craig & Philip W.H. Peng).

2 Epidemiology and economics of chronic and recurrent pain (Dennis C. Turk & Brian R. Theodore).

3 Basic mechanisms and pathophysiology (Daniel J. Cavanaugh & Allan I. Basbaum).

4 Psychosocial perspectives on chronic pain (Kenneth D. Craig & Judith Versloot).

5 Identification of risk and protective factors in the transition from acute to chronic post surgical pain (Joel Katz & M. Gabrielle Pagé).

6 Placebo/nocebo: a two-sided coin in the clinician's hand (Antonella Pollo & Fabrizio Benedetti).

Part 2 Assessment of Pain.

7 Clinical assessment in adult patients (Christine Short & Mary Lynch).

8 Measurement and assessment of pain in pediatric patients (Jennifer N. Stinson & Patrick J. McGrath).

9 Laboratory investigations, imaging and neurological assessment in pain management (Pam Squire, David Walk, Gordon Irving & Misha Backonja).

10 Psychological assessment of persons with chronic pain (Robert N. Jamison & Kenneth D. Craig).

Part 3 Management.

11 Introduction to management (Mary Lynch).

12 Managing chronic pain in primary care (Blair H. Smith, Alexander J. Clark & Beverly Collett).

Part 4 Pharmacotherapy.

13 Nutrition and pain management: dietary soy as an analgesic modality (Alexis Codrington, Stéphanie Chevalier & Yoram Shir).

14 Antidepressant analgesics in the management of chronic pain (C. Peter N. Watson).

15 Anticonvulsants in the management of chronic pain (Nanna Brix Finnerup, Cathrine Baastrup & Troels Staehelin Jensen).

16 Opioids (Dawn A. Sparks & Gilbert J. Fanciullo).

17 Topical analgesics (Jana Sawynok).

18 Other pharmacological agents (Philip W.H. Peng & Mary Lynch).

Part 5 Interventional.

19 Diagnostic and therapeutic blocks (Boris Spektor, Padma Gulur & James P. Rathmell).

20 Neuromodulation therapy (Krishna Kumar & Sharon Bishop).

21 Neurosurgical management of pain (Diaa Bahgat, Ashwin Viswanathan & Kim J. Burchiel).

Part 6 Physical Therapy and Rehabilitation.

22 Physical therapy and rehabilitation (Maureen J. Simmonds & Timothy Wideman).

Part 7 Psychological.

23 Pain self-management: theory and process for clinicians (Michael McGillion, Sandra M. LeFort, Karen Webber & Jennifer N. Stinson).

24 Psychological interventions: cognitive behavioral and stress management approaches (Heather D. Hadjistavropoulos, Amanda C. de C. Williams & Kenneth D. Craig).

25 Pain catastrophizing and fear of movement: detection and intervention (Michael J.L. Sullivan & Timothy H. Wideman).

Part 8 Complementary Therapies.

26 Complementary and alternative medicines (Mark A. Ware).

Part 9 Specific Clinical States.

27 Chronic low back pain (Eugene J. Carragee & Don Young Park).

28 Fibromyalgia syndrome and myofascial pain syndromes (Winfried Häuser, Marcus Schiltenwolf & Peter Henningsen).

29 Clinical pain management in the rheumatic diseases (Mary-Ann Fitzcharles).

30 Headache (Stephen D. Silberstein).

31 Orofacial pain (Barry J. Sessle, Lene Baad-Hansen & Peter Svensson).

32 Visceral pain (Klaus Bielefeldt & Gerald F. Gebhart).

33 Pelvic and urogenital pain (Anjali Martinez & Fred M. Howard).

34 Neuropathic pain (Maija Haanpää & Rolf-Detlef Treede).

35 Complex regional pain syndrome (Michael Stanton-Hicks).

36 Cancer pain management (David Hui & Eduardo Bruera).

Part 10 Special Populations.

37 Pain in older persons: a brief clinical guide (Thomas Hadjistavropoulos, Stephen Gibson & Perry G. Fine).

38 Pain in children (Tonya M. Palermo, Jeffrey L. Koh & Lonnie K. Zeltzer).

39 Pain in individuals with intellectual disabilities (Tim F. Oberlander, Chantel C. Burkitt & Frank J. Symons).

40 Pain and addiction (Roman D. Jovey).

41 Pain and psychiatric illness (Harold Merskey).

Pfizer, Acura Say FDA Clears Painkiller Oxecta -

Pfizer Inc. and Acura Pharmaceuticals Inc. say the Food and Drug Administration approved a powerful painkiller that is designed to be harder to abuse.

The FDA cleared marketing of Oxecta as a treatment for acute or moderate-to-severe pain. The drug also contains niacin, which causes irritation and flushing if patients take extra doses to get high.

Shares of Acura surged $2.02, or 52.2 percent, to $5.89 in premarket trading.

Acura and King Pharmaceuticals developed Oxecta under the name Acurox. Pfizer later acquired King and changed the name of the drug.

Oxecta is similar to Purdue Pharma LP's OxyContin, the top-selling painkiller in the U.S. Regulators and health officials have pushed hard to get alternatives on the market after reports showed millions of people were abusing OxyContin and other prescription painkillers.

1st conference for Structural Plasticity and Reorganization in Chronic Pain, 19-20 September 2011, Heidelberg

Neural plasticity is a key mechanism underlying chronic pain. Although functional changes in pain states have been the focus of many studies and symposia, less attention has been paid to the fact that tremendous potential for plasticity exists at the level of structure, connectivity and representation of pain. Importantly, structural plasticity can occur at various anatomical and temporal scales and can account for the very long-term nature and persistence of pain observed in pathological states. Therefore, there is a need for bringing together international experts to discuss changes in structure, connectivity and representation of pain in chronic pain states. This symposium aims to discuss latest insights on structural changes and reorganization at all anatomical levels of pain pathways and will span novel data in patients and animal models.

Saturday, June 18, 2011

First clinical trial of gene therapy for pain reported by U-M neurologists

Ann Arbor, Mich. — In the first clinical trial of gene therapy for treatment of intractable pain, researchers from the University of Michigan Department of Neurology observed that the treatment appears to provide substantial pain relief.

In a study published online in the Annals of Neurology last week, the researchers showed that the novel agent NP2 is safe and well-tolerated. In addition, measures of pain in the treated patients suggested that NP2 may provide a substantial analgesic effect.

NP2 is a gene transfer vector that expresses the naturally-occurring opioid peptide enkephalin. In preclinical work in animals, David Fink, M.D., Robert Brear Professor and chair of the Department of Neurology and his coworkers, had demonstrated that injection of NP2 into the skin reduces pain in models of pain caused by nerve damage, inflammation, or cancer.

In the clinical trial, 10 patients with unrelenting pain caused by cancer were injected with the gene transfer agent in the area of skin related to the location of pain.

"The concept underlying this therapeutic approach is that injection of NP2 into the skin results in uptake into the nervous system and the production and release of a pain-relieving chemical in a controlled site in the pain pathway," says Fink.

"In the study, patients who received the low dose of vector showed little reduction in pain; patients receiving the higher doses showed a greater than 80% reduction in pain over the course of 4 weeks following treatment."

Fink's laboratory has been working on the use of modified herpes simplex virus-based vectors that are taken up by sensory nerves following skin injection to develop therapies for diseases of the nervous system for more than 20 years. Patents related to this technology have been exclusively licensed by Diamyd Medical, a publicly-traded Swedish biotechnology company that sponsored the trial, and the human-grade vector NP2 was produced by Diamyd, Inc, the US subsidiary of Diamyd Medical.

The recombinant replication defective HSV approach represents a platform technology – a nerve targeting drug delivery system (NTDDS) - that can be used to deliver and express any one of a number of genes in the nervous system. A related NTDDS vector, NG2 reduces pain-related behaviors in preclinical models of neuropathic pain from nerve injury and diabetes.

NTDDS gene transfer to the DRG to express neurotrophins locally prevents the progression of polyneuropathy in relevant preclinical models, suggesting that the NTDDS platform may be used to treat degenerative polyneuropathies as well.

"This is an example of translational research in which we have moved from laboratory bench studies through animal models into new treatment that we are testing patients. There was no placebo control in this phase 1 study, but the apparent dose-dependent pain relief was encouraging to us," Fink says.

A phase 2 trial to compare NP2 to a placebo control has already been initiated under sponsorship from Diamyd.