Thursday, June 22, 2017

The opioid crisis changed how doctors think about pain - Vox

WILLIAMSON, West Virginia — This town on the eastern border of Kentucky has 3,150 residents, one hotel, one gas station, one fire station — and about 50 opiate overdoses each month.

On the first weekend of each month, when public benefits like disability get paid out, the local fire chief estimates the city sees about half a million dollars in drug sales. The area is poor — 29 percent of county residents live in poverty, and, amid the retreat of the coal industry, the unemployment rate was 12.2 percent when I visited last August— and those selling pills are not always who you'd expect.

"Elderly folks who depend on blood pressure medications, who can't afford them, they're selling their [painkillers] to get money to buy their blood pressure drug," Williamson fire chief Joey Carey told me when I visited Williamson. "The opioids are still $5 or $10 copays. They can turn around and sell those pills for $5 or $10 each."

Opioids are everywhere in Williamson, because chronic pain is everywhere in Williamson.

Dino Beckett opened a primary care clinic there in March 2014, on the same street with the hotel and the gas station. A native of the area with a close-cropped beard and a slight Southern drawl, Beckett sees the pain of Williamson day in and day out.

He sees older women who suffer from compression fractures up and down their spines, the result of osteoporosis. He sees men who mined coal for decades, who now experience persistent, piercing low back pain. "We have a population that works in coal mines or mine-supporting industries doing lots of manual labor, lifting equipment," he says. "Doing that for 10 to 12 hours a day for 15 to 20 years, or more, is a bad deal."

Beckett sees more pain than doctors who practice elsewhere. Nationally, 10.1 percent of Americans rate their health as "fair" or "poor." In Mingo County, where Williamson is, that figure stands at 38.9 percent.

Williamson has some of West Virginia's highest rates of obesity, disability, and arthritis — and that is in a state that already ranks among the worst in those categories compared with the rest of the nation. An adult in Williamson has twice the chance of dying from an injury as the average American.

This is why the opioid crisis is so hard to handle, here and in so many communities: The underlying drugs are often being prescribed for real reasons.

More ...

https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-west-virginia

Tuesday, June 13, 2017

Neurobiology of Pain - Journal - Elsevier

Neurobiology of Pain is an international journal for the publication of basic and translational research on the mechanisms of acute and chronic pain. It focuses on experimental studies of pain mechanisms at every level from molecular and cellular to brain imaging and behavioural. The journal primarily publishes original basic and translational studies, but will consider clinical studies which address mechanistic aspects of pain based on experimental approaches in human subjects.


The scope of the journal addresses all areas of pain neurobiology, including:

  • Molecular substrates and cell signaling
  • Genetics and epigenetics
  • Spinal and brain circuitry
  • Structural and physiological plasticity
  • Developmental aspects
  • Laboratory models of pain
  • Brain imaging
  • Neuroinflammation
  • Pain and cognition
  • Pain and emotion

https://www.journals.elsevier.com/neurobiology-of-pain/

Wednesday, June 07, 2017

Your mind can be trained to control chronic pain. But it will cost you - STAT

There was plenty to blame: the car wreck that broke his back. The job pouring concrete that shattered his spine a second time. The way he tore up his insides with cigarettes, booze, cocaine, and opioids.

It all amounted to this: Carl White was in pain. All the time. And nothing helped — not the multiple surgeries, nor the self-medication, not the wife and daughter who supported him and relied on him.

Then White enrolled in a pain management clinic that taught him some of his physical torment was in his head — and he could train his brain to control it. It's a philosophy that dates back decades, to the 1970s or even earlier. It fell out of vogue when new generations of potent pain pills came on the market; they were cheaper, worked faster, felt more modern.

But the opioid epidemic has soured many patients and doctors on the quick fix. And interest is again surging in a treatment method called biopsychosocial pain management, which trains patients to manage chronic pain with tools ranging from physical therapy to biofeedback to meditation. It helped Carl White, a 43-year-old social worker from Leroy, Minn.

The catch? It can take weeks and cost tens of thousands of dollars — and thus remains out of reach for most patients with chronic pain.

"We've been banging our heads on the wall, and banging our fists on the door, trying to get insurers to pay for this," said Dr. Bob Twillman, executive director for the Academy of Integrative Pain Management. "For the most part, they will not."

Chronic pain affects nearly 50 million Americans, according to the American Pain Foundation. The largest drivers include migraines, arthritis, and nerve damage — but in many cases, emotional trauma also contributes to the sense of misery.

"We have a lot of people in this country who are unhappy, isolated, and hurting," said Jeannie Sperry, a psychologist who co-chairs the division of addictions, transplant, and pain at Mayo Clinic. "Depression hurts. Anxiety hurts. It's rare for people to have chronic pain without one of these co-morbidities."

Indeed, chronic pain has a substantial psychological element: Being in pain often leads to self-imposed isolation. That loss of a social network then leads to anxiety, depression, and a tendency to catastrophize the pain — so that it's all a patient can think about.

More …

https://www.statnews.com/2017/05/30/chronic-pain-management/

NIH Releases Federal Pain Research Strategy Draft Research Priorities - American Society of Anesthesiologists

On May 25, the Interagency Pain Research Coordinating Committee (IPRCC) and the Office of Pain Policy of the National Institutes of Health (NIH) released draft Federal Pain Research Priorities, which were presented and discussed at a forum and public comment period on June 1. The forum immediately followed the Annual NIH Pain Consortium Symposium, where presentations highlighted multidisciplinary strategies for the management of pain. Following the open public comment period, written comments will be accepted until June 6.

The Federal Pain Research Strategy (FPRS) is an effort to oversee development of a long-term strategic plan for pain research. This is especially important, as most analgesics and anesthetics are used, despite known side effects and no new pharmacologic treatments for pain have emerged in recent years. The draft priorities acknowledge this and encompass this as one of the priorities, stating, "Given the adverse effects, risks of tolerance, dependence, and addiction, associated with opioids, new safer and more effective pharmacologic and non‐pharmacologic approaches for pain management are needed."  ASA is pleased to see this as a focus, as chronic pain effects millions of Americans and the ongoing struggle to address the opioid epidemic persists.

The draft research priorities are a culmination of a diverse and balanced group of scientific experts, patient advocates, and federal representatives working together for nearly two years to identify and prioritize research recommendations. The process included a steering committee to report back to the broader IPRCC and five workgroups based around the continuum of pain: prevention of acute and chronic and pain; acute pain and acute pain management; transition from acute to chronic pain; chronic pain and chronic pain management; and disparities. The workgroups identified research priorities within their respective areas and together, in the areas where there was overlap, developed cross-cutting research priorities to incorporate their recommendations.

ASA members Steve Cohen, M.D. and David Clark, M.D. were part of the chronic pain and chronic pain management workgroup and were involved in developing research priorities to answer questions about the gaps in understanding around the mechanisms of chronic pain, effective treatments and self-management strategies.

The cross-cutting research priorities fall into these broader areas of research:

• Novel drugs and non-pharmacological treatments for pain
• Screening tools and outcome measures for assessments across the continuum of pain
• National registries, datasets and research networks
• Effective models of care delivery for pain management
• Precision medicine methodology to prevent and treat pain

More ... 

http://asahq.org/advocacy/fda-and-washington-alerts/washington-alerts/2017/06/nih-releases-federal-pain-research-strategy-draft-research-priorities

Document:

Monday, May 29, 2017

The opioid epidemic could be cured with virtual-reality worlds that let patients escape their pain — Quartz

"It's like a crawly feeling inside," says Judy*. "You get hot, then chilled, and you feel like you want to run away." The 57-year-old has short dark-grey hair and a haunted expression. She's breathless and sits with her right leg balanced up on her walking stick, rocking it back and forth as she speaks.

Judy explains that she suffers from constant, debilitating pain: arthritis, back problems, fibromyalgia and daily migraines. She was a manager at a major electronics company until 2008, but can no longer work. She often hurts too much even to make it out of bed.

She's taking around 20 different medications each day, including painkillers, antidepressants, sedatives and a skin patch containing a high dose of the opioid drug fentanyl, which she says did not significantly help her pain and which she's now trying to come off. Her physician has been tapering the dose for months, so in addition to her pain she suffers withdrawal symptoms: the chills and crawling dread. Then her clinic announced that it would no longer prescribe any opioids at all, the unintended result of new, stricter measures aimed at clamping down on opioid abuse. Faced with losing access to the drug on which she is physically dependent, she has come to another clinic, Pain Consultants of East Tennessee (PCET) in Knoxville, desperate for help.

Ted Jones, the attending clinician, calls patients like Judy "refugees". He says that he sees "tons" of similar cases. Over 100 million Americans suffer long-term pain. Now they find themselves at the epicentre of two colliding health catastrophes in the USA: chronic pain and opioid abuse.

More ...

https://qz.com/973605/the-opioid-epidemic-could-be-cured-with-virtual-reality-worlds-that-let-patients-escape-their-pain/

Friday, May 26, 2017

The Federal Pain Research Strategy - NIH

The Federal Pain Research Strategy is an effort of the Interagency Pain Research Coordinating Committee and the Office of Pain Policy of the National Institutes of Health to oversee development of a long-term strategic plan for those federal agencies and departments that support pain research. A diverse and balanced group of scientific experts, patient advocates, and federal representatives identified and prioritized research recommendations as a basis for this long-term strategic plan to coordinate and advance the federal pain research agenda. The key areas of prevention of acute and chronic pain, acute pain and acute pain management, the transition from acute to chronic pain, chronic pain and chronic pain management, and disparities in pain and pain care provided the framework for development of the strategy. In addition, a set of cross-cutting research priorities were identified by the task force in topic areas for which similar research recommendations were developed across multiples work groups and merged. 

https://iprcc.nih.gov/docs/DraftFederalPainResearchStrategy.pdf

Saturday, May 20, 2017

Even short-term opioid use can set people up for addiction risks | Science News

Even though a sprained ankle rarely needs an opioid, a new study of emergency room patients found that about 7 percent of patients got sent home with a prescription for the potentially addictive painkiller anyway. And the more pills prescribed, the greater the chance the prescription would be refilled, raising concerns about continued use.

The research adds to evidence that it's hard for some people to stop taking the pills even after a brief use. State officials in New Jersey recently enacted a law limiting first-time prescriptions to a five-day supply, and other states should consider similar restrictions, says Kit Delgado, an assistant professor of Emergency Medicine and Epidemiology at the University of Pennsylvania.

"The bottom line is that we need to do our best not to expose people to opioids," Delgado says. "And if we do, start with the smallest quantity possible." The research was presented May 17 at the Society for Academic Emergency Medicine's annual meeting in Orlando.

Previous research has found that the more opioids such as hydrocodone and oxycodone are prescribed, the more likely patients are to keep taking them. But previous studies have been too broad to account for differences in diagnoses — for instance, whether people who received refills kept taking the drug simply because they still were in pain, Delgado says. He and colleagues limited their study to prescriptions written after ankle sprains to people who had not used an opioid in the previous six months. Usually, those injuries aren't serious and don't require opioids.

About 7 percent of 53,222 people who visited ERs with ankle sprains in 2011 and 2012 were sent home with an opioid prescription, the researchers found. Patients' experiences varied by state: Less than 2 percent treated in Delaware were prescribed an opioid compared with 16 percent in Mississippi.

The number of pills obtained within a week of those visits also varied greatly, from as few as five to more than 60. Typical prescriptions were for 15 to 40 pills. Those who received prescriptions for 30 pills or more were twice as likely to get refills as those with prescriptions for 15 or fewer, Delgado and colleagues found.

"Because these are patients who have a uniformly minor injury, it emphasizes how much arbitrariness there is in how physicians prescribe opioids," says Michael Barnett, an emergency physician at Brigham and Women's Hospital in Boston, who was not involved in the study.

More ...

https://www.sciencenews.org/article/minor-injury-opioid-painkiller-addiction-risks?tgt=nr

Saturday, May 13, 2017

Pain in Animals Workshop 2017 – Creating a Research Roadmap for measuring chronic pain in dogs and cats

Despite recent advances, chronic pain is one of the most poorly understood, under diagnosed, and under treated medical problems facing veterinary medicine today. One of the most frustrating parts of chronic pain therapeutic development in veterinary medicine is the lack of validated methods to measure chronic pain in different species and diseases.

In parallel, translational success has come under the spotlight. Numerous reviews have highlighted a lack of translation of basic research into new approved therapeutics for treatment of persistent pain in humans. The use of spontaneous painful disease in companion animals has been highlighted as one of the changes that could be made to help improve translation of basic science to new therapeutics, acting as a bridge between preclinical and clinical studies, with the goal of reducing the failure rates of human clinical trials, thus accelerating the approval of new therapeutics. Aspects that will undermine the utility of the 'spontaneous disease pain' model are the lack of valid outcome measures and the lack of knowledge of opportunities.

More ...

https://paw2017.com/

Wednesday, May 10, 2017

The ACTTION–APS–AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions - The Journal of Pain

As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions.

http://www.jpain.org/article/S1526-5900(17)30464-9/fulltext?

Tuesday, May 02, 2017

The opioid epidemic could be cured with virtual-reality worlds that let patients escape their pain — Quartz

"It's like a crawly feeling inside," says Judy*. "You get hot, then chilled, and you feel like you want to run away." The 57-year-old has short dark-grey hair and a haunted expression. She's breathless and sits with her right leg balanced up on her walking stick, rocking it back and forth as she speaks.
Judy explains that she suffers from constant, debilitating pain: arthritis, back problems, fibromyalgia and daily migraines. She was a manager at a major electronics company until 2008, but can no longer work. She often hurts too much even to make it out of bed.
She's taking around 20 different medications each day, including painkillers, antidepressants, sedatives and a skin patch containing a high dose of the opioid drug fentanyl, which she says did not significantly help her pain and which she's now trying to come off. Her physician has been tapering the dose for months, so in addition to her pain she suffers withdrawal symptoms: the chills and crawling dread. Then her clinic announced that it would no longer prescribe any opioids at all, the unintended result of new, stricter measures aimed at clamping down on opioid abuse. Faced with losing access to the drug on which she is physically dependent, she has come to another clinic, Pain Consultants of East Tennessee (PCET) in Knoxville, desperate for help.
More ...
https://qz.com/973605/the-opioid-epidemic-could-be-cured-with-virtual-reality-worlds-that-let-patients-escape-their-pain/?

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?