The goal of the Acute to Chronic Pain Signatures (A2CPS) program is to develop a set of objective biomarkers that provide "signatures" to predict if chronic pain is likely to develop after acute pain. Such signatures are greatly needed as prevention of chronic pain after an acute pain event is a major challenge in pain management. For most people, acute pain resolves as the injury that caused it heals. Yet in many other people, acute pain from an injury, surgery, or disease persists beyond the initial insult, and lasts for years or throughout life. The number of people who transition from acute to chronic pain after an acute pain event is high, and this high prevalence of chronic pain in the US has in part contributed to the current opioid epidemic. A signature of the transition from acute to chronic pain could help accelerate therapy development and ultimately guide pain prevention strategies.
To develop signatures predictive of transition versus resilience to chronic pain, the program will collect data from two groups of people for six months; one group will have recently had surgery and the other will have a musculoskeletal injury. The hope is for differences between participants who transition to chronic pain and those who are resilient to reveal biomarkers associated with the transition to chronic pain. The biomarkers then could be combined into signatures predictive of the transition.
https://commonfund.nih.gov/pain
Tuesday, September 24, 2019
For some with chronic pain, the problem is not in their backs or knees but their brains - The Washington Post
After 36 agonizing years with sickle cell disease, Tesha Samuels is in complete remission — free, at least for now, of one of the most painful disorders known to medicine. Yet Samuels's body still hurts almost every day.
The question that perplexes her doctors at the National Institutes of Health is why, after her blood disorder has been vanquished, she is still in pain.
Perhaps her newly healed red blood cells are not yet bringing enough oxygen to her tissues. Perhaps the emotional toll of a lifetime of constant pain has left her prepared to feel little else. Or perhaps the pain signals that have flooded her brain for more than three decades have permanently rewired some circuits, leaving her unusually sensitive to even the slightest irritation.
There is evidence for all these theories, and more. But the truth is that no one really knows why pain persists in some people.
More than 5,000 years after the Sumerians discovered they could quell aches with gum from poppies, medical science is still uncertain about who will develop chronic pain, how to prevent it and what to do when it occurs. The reasons the same insult to the body can leave one person with short-term discomfort and another with permanent misery have eluded researchers.
"Chronic pain is incredibly complex," said Benjamin Kligler, national director of the Integrative Health Coordinating Center at the Veterans Health Administration. "It is interwoven with all kinds of psychological, emotional and spiritual dimensions, as well as the physical. Honestly, the profession of medicine doesn't have a terribly good understanding, overall, of that kind of complexity."
More ...
https://www.washingtonpost.com/national/health-science/for-some-with-chronic-pain-the-problem-is-not-in-their-backs-or-knees-but-their-brains/2019/09/23/80538660-5d5c-11e9-842d-7d3ed7eb3957_story.html
The question that perplexes her doctors at the National Institutes of Health is why, after her blood disorder has been vanquished, she is still in pain.
Perhaps her newly healed red blood cells are not yet bringing enough oxygen to her tissues. Perhaps the emotional toll of a lifetime of constant pain has left her prepared to feel little else. Or perhaps the pain signals that have flooded her brain for more than three decades have permanently rewired some circuits, leaving her unusually sensitive to even the slightest irritation.
There is evidence for all these theories, and more. But the truth is that no one really knows why pain persists in some people.
More than 5,000 years after the Sumerians discovered they could quell aches with gum from poppies, medical science is still uncertain about who will develop chronic pain, how to prevent it and what to do when it occurs. The reasons the same insult to the body can leave one person with short-term discomfort and another with permanent misery have eluded researchers.
"Chronic pain is incredibly complex," said Benjamin Kligler, national director of the Integrative Health Coordinating Center at the Veterans Health Administration. "It is interwoven with all kinds of psychological, emotional and spiritual dimensions, as well as the physical. Honestly, the profession of medicine doesn't have a terribly good understanding, overall, of that kind of complexity."
More ...
https://www.washingtonpost.com/national/health-science/for-some-with-chronic-pain-the-problem-is-not-in-their-backs-or-knees-but-their-brains/2019/09/23/80538660-5d5c-11e9-842d-7d3ed7eb3957_story.html
Monday, September 23, 2019
For Chronic Pain, Off-Label Naltrexone In Low Doses Seems To Help : Shots - Health News : NPR
Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15.
She's had endless disappointing visits with doctors. Some said they couldn't help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome.
Pinkley has taken opioids a few times after surgeries but says they never helped her underlying pain.
"I hate opioids with a passion," Pinkley says. "An absolute passion."
Recently, she joined a growing group of patients using an outside-the-box remedy: naltrexone. It is usually used to treat addiction, in a pill form for alcohol and as a pill or a monthly shot for opioids.
As the medical establishment tries to do a huge U-turn after two disastrous decades of pushing long-term opioid use for chronic pain, scientists have been struggling to develop safe, effective alternatives.
When naltrexone is used to treat addiction in pill form, it's prescribed at 50 mg, but chronic-pain patients say it helps their pain at doses of less than a tenth of that.
More ...
https://www.npr.org/sections/health-shots/2019/09/23/741783834/in-tiny-doses-an-addiction-medication-moonlights-as-a-treatment-for-chronic-pain
She's had endless disappointing visits with doctors. Some said they couldn't help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome.
Pinkley has taken opioids a few times after surgeries but says they never helped her underlying pain.
"I hate opioids with a passion," Pinkley says. "An absolute passion."
Recently, she joined a growing group of patients using an outside-the-box remedy: naltrexone. It is usually used to treat addiction, in a pill form for alcohol and as a pill or a monthly shot for opioids.
As the medical establishment tries to do a huge U-turn after two disastrous decades of pushing long-term opioid use for chronic pain, scientists have been struggling to develop safe, effective alternatives.
When naltrexone is used to treat addiction in pill form, it's prescribed at 50 mg, but chronic-pain patients say it helps their pain at doses of less than a tenth of that.
More ...
https://www.npr.org/sections/health-shots/2019/09/23/741783834/in-tiny-doses-an-addiction-medication-moonlights-as-a-treatment-for-chronic-pain
Thursday, September 19, 2019
Opioid Crisis: Medical Schools Rethink How To Teach Students About Pain : Shots - Health News : NPR
The next generation of doctors will start their careers at a time when physicians are feeling pressure to limit prescriptions for opioid painkillers.
Yet every day, they'll face patients who are hurting from injuries, surgical procedures or disease. Around 20% of adults in the U.S. live with chronic pain.
That's why some medical students felt a little apprehensive as they gathered recently for a mandatory, four-day course at Johns Hopkins University in Baltimore — home to one of the top medical schools in the country.
The subject of the course? Pain.
"I initially was a bit scared and I guess a bit wary coming into this course because of the opioid crisis," says medical student Annie Cho. "That seems like that's the only thing that people have been talking about nowadays."
She wasn't the only one aware of how fraught pain can be right now. Student Jenny Franke says she has been shadowing doctors in a clinic and has seen new patients come in with pain.
"And it seems that the therapy that they are on hasn't been working, and a lot of the time, their past primary care providers just keep prescribing the same thing over and over," Franke says. "Sometimes those patients will ask for opioids, and then it turns into kind of an awkward conversation."
More ...
https://www.npr.org/sections/health-shots/2019/09/11/756090847/how-to-teach-future-doctors-about-pain-in-the-midst-of-the-opioid-crisis
Yet every day, they'll face patients who are hurting from injuries, surgical procedures or disease. Around 20% of adults in the U.S. live with chronic pain.
That's why some medical students felt a little apprehensive as they gathered recently for a mandatory, four-day course at Johns Hopkins University in Baltimore — home to one of the top medical schools in the country.
The subject of the course? Pain.
"I initially was a bit scared and I guess a bit wary coming into this course because of the opioid crisis," says medical student Annie Cho. "That seems like that's the only thing that people have been talking about nowadays."
She wasn't the only one aware of how fraught pain can be right now. Student Jenny Franke says she has been shadowing doctors in a clinic and has seen new patients come in with pain.
"And it seems that the therapy that they are on hasn't been working, and a lot of the time, their past primary care providers just keep prescribing the same thing over and over," Franke says. "Sometimes those patients will ask for opioids, and then it turns into kind of an awkward conversation."
More ...
https://www.npr.org/sections/health-shots/2019/09/11/756090847/how-to-teach-future-doctors-about-pain-in-the-midst-of-the-opioid-crisis
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