Saturday, April 22, 2017

How a Single Gene Could Become a Volume Knob for Pain—and End America's Opioid Epidemic | WIRED

On a scale of 1 to 10, how would you rate your pain? Would you say it aches, or would you say it stabs? Does it burn, or does it pinch? How long would you say you've been hurting? And are you taking anything for it?

Steven Pete has no idea how you feel. Sitting in Cassava, a café in Longview, Washington, next to a bulletin board crammed with flyers and promises—your pain-free tomorrow starts today; remember: you're not alone in your battle against peripheral neuropathy!—he tells me he cannot fathom aches or pinches or the searing scourge of peripheral neuropathy that keep millions of people awake at night or hooked on pills. He was born with a rare neurological condition called congenital insensitivity to pain, and for 36 years he has hovered at or near a 1 on the pain scale. He's 5′ 8″, with glasses and thinning brown hair, and he has a road map of scars across his body, mostly hidden beneath a T-shirt bearing the partial crests of Batman, Green Lantern, Flash, and Superman. Because he never learned to avoid injury, which is the one thing pain is really good for, he gets injured a lot. When I ask how many bones he's broken, he lets out a quick laugh.

"Oh gosh. I haven't actually done the count yet," he says. "But somewhere probably around 70 or 80." With each fracture, he didn't feel much of anything—or even notice his injury at all. Whether he saw a doctor depended on how bad the break appeared to be. "A toe or a finger, I'd just take care of that myself," he says, wagging a slightly bent index finger. "Duct tape."

What about something more serious? Pete pauses for a moment and recalls a white Washington day a few years ago. "We had thick snow, and we went inner-tubing down a hill. Well, I did a scorpion, where you take a running start and jump on the tube. You're supposed to land on your stomach, but I hit it at the wrong angle. I face-planted on the hill, and my back legs just went straight up over my head." Pete got up and returned to tubing, and for the next eight months he went on as usual, until he started noticing the movement in his left arm and shoulder felt off. His back felt funny too. He ended up getting an MRI. "The doctor looked at my MRI results, and he was like, 'Have you been in a car accident? About six months ago? Were you skydiving?' "

"I haven't done either," Pete replied.

The doctor stared at his patient in disbelief. "You've got three fractured vertebrae." Pete had broken his back.

Throughout his body today, Pete has a strange feeling: "a weird radiating sensation," as he describes it, an overall discomfort but not quite pain as you and I know it. He and others born with his condition have been compared to superheroes—indomitable, unbreakable. In his basement, where the shelves are lined with videogames about biologically and technologically enhanced soldiers, there is even a framed sketch of a character in full body armor, with the words painless pete. But Pete knows better. "There's no way I could live a normal life right now if I could actually feel pain," he says. He would probably be constrained to a bed or wheelchair from all the damage his body has sustained.

His wife, Jessica, joins us at the café. She is petite and shy, with ice-blue eyes traced in black eyeliner. When I ask her what it's like to live with a man who feels no pain, she sighs. "I worry about him all the time." She worries about him working with his power tools in the basement. She worries about him cooking over a grill. She worries about bigger things too. "If he has a heart attack, he won't be able to feel it," she says. "He'll rub his arm sometimes, and I freak out: 'Are you OK?' " She looks over at Pete, who chuckles. "He thinks it's funny," she says. "I don't think it's funny."

More ...

https://www.wired.com/2017/04/the-cure-for-pain/?

Sunday, April 16, 2017

In pain? Many doctors say opioids are not the answer - Salon.com

Those of you who have experienced pain, especially gnawing, chronic pain, know that it affects your happiness, outlook and ability to function.

In the past couple of years, the treatment of chronic pain has undergone an earthshaking transformation as opioid addiction continues to claim — and ruin — lives.

Many primary care doctors no longer liberally prescribe opioid painkillers such as oxycodone, fentanyl and hydrocodone for back pain, migraines and other chronic conditions. Instead, they are increasingly turning to alternative medications and non-drug options such as acupuncture and physical therapy.

"Most primary care doctors are afraid to do pain management because of the opioid backlash," says Michael McClelland, a health care attorney in Rocklin, Calif., and former chief of enforcement for the state Department of Managed Health Care. "Either they don't prescribe anything, and the patient remains in pain, or they turn them over to pain management specialists so someone else is writing that prescription."

As a result, McClelland says, "people in genuine pain are going to find it more difficult to get medicine they may well need."

More ...

http://www.salon.com/2017/04/16/in-pain-many-doctors-say-opioids-are-not-the-answer_partner/

Thursday, March 30, 2017

How the opioid epidemic became America’s worst drug crisis ever, in 15 maps and charts - Vox

With all the other news going on, it can be easy to lose track of this fact. But it's true: In 2015, more than 52,000 people died of drug overdoses, nearly two-thirds of which were linked to opioids like Percocet, OxyContin, heroin, and fentanyl. That's more drug overdose deaths than any other period in US history — even more than past heroin epidemics, the crack epidemic, or the recent meth epidemic. And the preliminary data we have from 2016 suggests that the epidemic may have gotten worse since 2015.

This situation did not develop overnight, but it has quickly become one of the biggest public health crises facing America. To understand how and why, I've put together a series of maps and charts that show the key elements of the epidemic — from its start through legalpainkillers prescribed in droves by doctors to the recent rise of the highly potent opioid fentanyl.

More ...

http://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts

Sunday, March 26, 2017

Chronic pain and depression are linked by brain gene changes | New Scientist

People who have chronic pain are more likely to experience mood disorders, but it's not clear how this happens. Now a study in mice has found that chronic pain can induce genetic changes in brain regions that are linked to depression and anxiety, a finding that may lead to new treatments for pain.

"At least 40 per cent of patients who suffer from severe forms of chronic pain also develop depression at some point, along with other cognitive problems," says Venetia Zachariou of the Icahn School of Medicine at Mount Sinai in New York.

To see if there might be a genetic link between these conditions, Zachariou and her team studied mice with damage to their peripheral nervous system. These mice show symptoms similar to chronic pain in people – they become hypersensitive to harmless touch, and avoid other situations that might also cause them pain.

Until now, pain behaviour in mice had only been studied for at most a week at a time, says Zachariou, whose team monitored their mice for 10 weeks. "At the beginning, we saw only sensory deficits and pain-like symptoms. But several weeks later, the animals developed anxiety and depression-like behaviours."

The team then examined gene activity in three regions in the mouse brains we know are associated with depression and anxiety. Analysing the nucleus accumbens, medial prefrontal cortex, and periaqueductal gray, they found nearly 40 genes where activity was significantly higher or lower than in mice without the nervous system damage.

More ...

https://www.newscientist.com/article/2125680-chronic-pain-and-depression-are-linked-by-brain-gene-changes/

Sunday, March 19, 2017

Rapid Shift to Long-term Opioid Use After Initial Prescription - Medscape

For patients who need an initial opioid prescription, supplying 3 or fewer days' worth of medication reduces the likelihood of long-term opioid use, new data show.

In a large representative sample of opioid-naive, cancer-free adults who received a first prescription for opioid pain relievers, the likelihood of long-term opioid use increased with each additional day of medication supplied, starting with the third day, the study team found.

"Knowledge that the risks for chronic opioid use increase with each additional day supplied might help clinicians evaluate their initial opioid prescribing decisions and potentially reduce the risk for long-term opioid use," the authors, led by Bradley Martin, PharmD, PhD, at the University of Arkansas for Medical Sciences in Little Rock, write.

"Discussions with patients about the long-term use of opioids to manage pain should occur early in the opioid prescribing process," they advise in the Morbidity and Mortality Weekly Report of March 17.

More ...

http://www.medscape.com/viewarticle/877354

Friday, March 03, 2017

NYTimes: How to Block Out Pain

Pain is a personal experience, and success comes from self-management," says David Tauben, clinical professor in the department of pain medicine at the University of Washington. Respond to pain calmly — worry and fear activate the neural pathways through which pain travels and can amplify the sensations that cause it in the first place. Because pain has both mental and physical components, some researchers who study it combine psychology with the physical effects. "Be careful of negative thoughts and worrying," Tauben says. "If it's difficult to control them, find a professional to help you, like a psychologist or counselor."


More ...


Tuesday, February 28, 2017

Is a new class of painkillers on the horizon? | Science | AAAS

Scientists are chasing a new lead on a class of drugs that may one day fight both pain and opioid addiction. It's still early days, but researchers report that they've discovered a new small molecule that binds selectively to a long-targeted enzyme, halting its role in pain and addiction while not interfering with enzymes critical to healthy cell function. The newly discovered compound isn't likely to become a medicine any time soon. But it could jumpstart the search for other binders that could do the job.

Pain and addiction have many biochemical roots, which makes it difficult to treat them without affecting other critical functions in cells. Today, the most potent painkillers are opioids, including heroin, oxycodone, and hydrocodone. In addition to interrupting pain, they inhibit enzymes known as adenylyl cyclases (ACs) that convert cells' energy currency, ATP, into a molecule involved in intracellular chemical communication known as cyclic AMP (cAMP). Chronic opioid use can make cells increase the activity of ACs to compensate, causing cAMP levels to skyrocket. When opioid users try to stop using, their cAMP levels remain high, and drugs that reduce those levels—like buprenorphine—have unwanted side effects.

More...

http://www.sciencemag.org/news/2017/02/new-class-painkillers-horizon

Tuesday, February 14, 2017

NYTimes: Lower Back Ache? Be Active and Wait It Out, New Guidelines Say

Dr. James Weinstein, a back pain specialist and chief executive of Dartmouth-Hitchcock Health System, has some advice for most people with lower back pain: Take two aspirin and don't call me in the morning.

On Monday, the American College of Physicians published updated guidelines that say much the same. In making the new recommendations for the treatment of most people with lower back pain, the group is bucking what many doctors do and changing its previous guidelines, which called for medication as first-line therapy.

Dr. Nitin Damle, president of the group's board of regents and a practicing internist, said pills, even over-the-counter pain relievers and anti-inflammatories, should not be the first choice. "We need to look at therapies that are nonpharmacological first," he said. "That is a change."

More ...

https://www.nytimes.com/2017/02/13/health/lower-back-pain-surgery-guidelines.html?

Sunday, February 05, 2017

Welcome to Pain Researcher

Welcome to Pain Researcher, a community forum for anyone involved or interested in the study of pain. 

The major purpose of this forum is to facilitate discussion around any and all topics related to the pain research. One important gap that this forum aims to fill involves the sharing of knowledge needed to properly execute pain studies such as detailed protocols, technical tips, tool development, methodological considerations, etc. It is these crucial details that determine the quality and validity of the findings of pain studies, and so we hope that giving a space to discuss such details will improve pain research globally.

More ...

http://forum.painresearcher.net/t/welcome-to-pain-researcher/8

Tuesday, January 24, 2017

A Bright Future for Brain Imaging of Pain | Pain Research Forum

Irene Tracey, University of Oxford, UK, summarized the contributions of neuroimaging to pain research, and directions for future investigations, during "Translating Neuroimaging Discovery Science for Patient Benefit," a plenary lecture held at the IASP 16th World Congress on Pain, which took place September 26-30, 2016, in Yokohama, Japan. Her take-home message was that findings from neuroimaging will lead to a brighter outlook for patients suffering from chronic pain. "The aim, ultimately, is to use metrics [discovered by imaging studies] to guide diagnosis and therapies," she said. Tracey called for neuroimaging work to help bridge scientific knowledge from cells to systems and across species in order to meet the unmet clinical need for new pain treatments.

More...

http://painresearchforum.org/news/76295-bright-future-brain-imaging-pain

Wednesday, January 11, 2017

I’ve seen the opioid epidemic as a cop. Living it as a patient has been even worse. - The Washington Post

A year ago, I woke in the night with pain so severe I was crying before I was fully aware what was going on. A 50-year-old cop sobbed like a child in the dark.

It was a ruptured disc and related nerve damage. Within a couple of months, it became so severe that I could no longer walk or stand. An MRI later, my surgeon soothingly told me it would all be okay. He would take care of me; the pain would end.

After surgery, I never saw that surgeon again. A nurse practitioner handed me a prescription for painkillers — 180 tablets, 90 each of oxycodone and hydrocodone.

I was lucky: I already knew how easily opioid addiction could destroy a life. I'd arrested addicts and helped people suffering from substance abuse. So as soon as I could, I weaned myself off the medication. Still, I fell into the trap when my pain returned months later, and I started taking the pills again.

Since then, I've been stuck like a growing number of people in a system that leaves patients beholden to terrible health policy, the horrific consequences of federal drug policy, uninformed media hysteria about an opioid epidemic and an army of uncoordinated medical professionals bearing — then seizing — bottles of pills.

I asked repeatedly for alternatives, but I was told none were available. I started physical therapy and sought treatment at an authorized pain management clinic. My first pain management doctor was terse as she prescribed more hydrocodone for daytime and oxycodone for the night, when my pain was worse. To her, I was just another person in a day of people receiving identical treatment. Later she'd say she had little choice: Insurance companies routinely deny even slightly adventurous prescriptions.

A nearby chain pharmacy refused to fill it, saying, "You can't mix hydrocodone and oxycodone." As my prescription testified, I was receiving the required "close monitoring" by a doctor when taking that particular combination. When I called the pain clinic for help, the staff berated me for bothering them. They asked whether I was seeking drugs. I was — the ones they had prescribed.

More ...

https://www.washingtonpost.com/posteverything/wp/2017/01/11/ive-seen-the-opioid-epidemic-as-a-cop-living-it-as-a-patient-has-been-even-worse/?

How much does it hurt? | Mosaic

One night in May, my wife sat up in bed and said, "I've got this awful pain just here." She prodded her abdomen and made a face. "It feels like something's really wrong." Woozily noting that it was 2am, I asked what kind of pain it was. "Like something's biting into me and won't stop," she said.

"Hold on," I said blearily, "help is at hand." I brought her a couple of ibuprofen with some water, which she downed, clutching my hand and waiting for the ache to subside.

An hour later, she was sitting up in bed again, in real distress. "It's worse now," she said, "really nasty. Can you phone the doctor?" Miraculously, the family doctor answered the phone at 3am, listened to her recital of symptoms and concluded, "It might be your appendix. Have you had yours taken out?" No, she hadn't. "It could be appendicitis," he surmised, "but if it was dangerous you'd be in much worse pain than you're in. Go to the hospital in the morning, but for now, take some paracetamol and try to sleep."

Barely half an hour later, the balloon went up. She was awakened for the third time, but now with a pain so savage and uncontainable it made her howl like a tortured witch face down on a bonfire. The time for murmured assurances and spousal procrastination was over. I rang a local minicab, struggled into my clothes, bundled her into a dressing gown, and we sped to St Mary's Paddington at just before 4am.

The flurry of action made the pain subside, if only through distraction, and we sat for hours while doctors brought forms to be filled, took her blood pressure and ran tests. A registrar poked a needle into my wife's wrist and said, "Does that hurt? Does that? How about that?" before concluding: "Impressive. You have a very high pain threshold."

More ...

https://mosaicscience.com/story/how-much-does-it-hurt-pain-agony-acute-chronic?

Friday, January 06, 2017

Snapshots of an Epidemic: A Look at the Opioid Crisis Across the Country - The New York Times

Opioid addiction is America's 50-state epidemic. It courses along Interstate highways in the form of cheap smuggled heroin, and flows out of "pill mill" clinics where pain medicine is handed out like candy. It has ripped through New England towns, where people overdose in the aisles of dollar stores, and it has ravaged coal country, where addicts speed-dial the sole doctor in town licensed to prescribe a medication.

Public health officials have called the current opioid epidemic the worst drug crisis in American history, killing more than 33,000 people in 2015. Overdose deaths were nearly equal to the number of deaths from car crashes. In 2015, for the first time, deaths from heroin alone surpassed gun homicides.

More ...

http://www.nytimes.com/2017/01/06/us/opioid-crisis-epidemic.html?