Tuesday, September 24, 2019

Acute to Chronic Pain Signatures | NIH Common Fund

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

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."

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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.

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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."

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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

Sunday, August 25, 2019

I became a cyborg to manage my chronic pain | Popular Science

I don't remember what it feels like to live without pain. At 15, I began feeling aching, stabbing, and burning sensations in my lower back and down my legs. Swallowing a few Aleve didn't help—in fact, nothing did. If I sit or stand for any period of time, or lift something heavy or fall, I pay for it, sometimes for weeks or months. I've slept on the kitchen linoleum, because the carpet felt too soft to stand.

For 17 years, I went to doctor after doctor, undergoing scans, physical therapy, and just about every "alternative" treatment that promised relief. Despite some amazing doctors and the expensive tests at their disposal, they could never see anything wrong, so I never got a diagnosis.

That is, until a couple of years ago, when a routine CAT scan finally caught a structural problem with my spine. Because of that, I qualified to have a spinal cord stimulator, an electronic device used to treat chronic pain, implanted into my back. Although I was scared to go under the knife, I was more than willing to become a cyborg in order to find even partial relief. And this type of therapy might also be able to help some of the 100 million Americans who suffer from chronic pain.

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https://www.popsci.com/spinal-implant-back-pain/

Friday, August 23, 2019

NPR-IBM Watson Health Poll: Pain In America : Shots - Health News : NPR

At some point nearly everyone has to deal with pain.

How do Americans experience and cope with pain that makes everyday life harder? We asked in the latest NPR-IBM Watson Health Poll.

First, we wanted to know how often pain interferes with people's ability to work, go to school or engage in other activities. Overall, 18% of Americans say that's often a problem for them. Almost a quarter – 24% — say it's sometimes the case.

The degree to which pain is a problem varies by age, with 22% of people 65 and older saying pain interferes often with their daily lives compared with only about 9% of people 35 and younger.

Once pain strikes, how do people deal with it?

The poll found that 63% of people had sought care for their pain and 37% hadn't. Younger people were less likely to have pursued care.

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https://www.npr.org/sections/health-shots/2019/08/21/753080611/poll-nearly-1-in-5-americans-says-pain-interferes-with-daily-life

Thursday, July 18, 2019

Canadian Pain Task Force Report: June 2019 - Canada.ca

The Canadian Pain Task Force was established in March 2019 to help the Government of Canada better understand and address the needs of Canadians who live with pain. Through to December 2021, the Task Force is mandated to provide advice and information to guide government decision-makers towards an improved approach to the prevention and management of chronic pain in this country. The eight Task Force members include people personally impacted by chronic pain, researchers, educators, and health professionals with experience and expertise in preventing and managing chronic pain across major professional disciplines (i.e., medicine, pharmacy, psychology, and physiotherapy). The Task Force is also supported by an External Advisory Panel that provides up-to-date scientific evidence, information, and advice to the Task Force reflecting their wide-ranging areas of expertise and experience.

In the first phase of their mandate ending June 2019, the Task Force assessed how chronic pain is currently addressed in Canada. To inform their assessment, they consulted with Advisory Panel members at a two day workshop in May. They met with representatives from eight federal government departments and agencies. They consulted provincial/territorial government representatives and targeted pain stakeholders, and they reviewed reports and the scientific literature. They also invited twelve people living with chronic pain to provide written responses to questions about their experience with pain and their hopes for the Canadian Pain Task Force. The report herein summarizes their findings from this rapid assessment of the current state of chronic pain in Canada and some of the personal responses from people living with pain. The activities undertaken to inform this report mark only the start of the Task Force's engagement of Canadians in this important work.

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https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019.html

Wednesday, June 05, 2019

What Was the Cause of the Excruciating Pain in His Shoulders and Hips? - The New York Times

As the physician prepared to leave the exam room, the patient's wife spoke up: "Doctor, my husband won't tell you this, but he is suffering," the woman said, her voice cracking. Dr. Timothy Quan, a rheumatologist in central Connecticut, looked at the 69-year-old man he'd been caring for over the past several months. The man gave a brisk nod. It was true. The past few weeks had been a nightmare of pain.

Six months earlier, the patient woke up with a sore, swollen right hand. He figured he must have injured it a few days before when he cleared out a pile of wood in his backyard. He mentioned it to his primary-care physician a couple of weeks later when he went in for a routine exam. The doctor prescribed some ibuprofen and suggested that maybe he was too old for that kind of heavy labor.

The ibuprofen helped but didn't stop the pain from spreading to both shoulders and down his hips and legs. By the time he went back to his doctor a few days later, every muscle, every ligament, every bone in his body seemed to ache. It was worse in the morning, when he was so stiff he could hardly get out of bed.

The patient lived in rural Connecticut, so his physician figured it was probably Lyme disease. He sent him to be tested but felt confident enough in the diagnosis to start him on doxycycline, the antibiotic used to treat most of the infections carried by ticks.

The antibiotic didn't help — he was still in a lot of pain. So his doctor called in a week of prednisone. The aches almost disappeared with the very first pill. They came back with a vengeance, though, when the prescription ended. He tried to tough it out, but the pain worsened every day.

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https://www.nytimes.com/2019/06/05/magazine/hip-shoulder-pain-polymyalgia-rheumatica-diagnosis.html

Friday, May 31, 2019

These Mole Rats Felt No Pain, Even From Wasabi’s Burn - The New York Times

If you've ever taken a big bite of wasabi, you know what comes next: a painful zing that creeps over your whole scalp.

You aren't the only animal that feels this way. The condiment's sinus-burning kick comes from a chemical compound called allyl isothiocyanate, or AITC, that actively damages proteins within cells. Flies and flatworms shun it, as do miceand wolf spiders. "Practically every animal you look at will avoid AITC," said Gary Lewin, a molecular physiologist at the Max Delbrück Center for Molecular Medicine in Berlin.

But there is one exception. In a paper published Thursday in Science, scientists including Dr. Lewin showed that the highveld mole rat, a rodent found in South Africa, is entirely impervious to the substance.

The study "demonstrates the power of studying naturally occurring differences in pain sensitivity," said Ewan St. John Smith, a neurobiologist at the University of Cambridge, who was not involved in the research. The work could eventually lead to more effective pain treatment in humans.

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https://www.nytimes.com/2019/05/30/science/mole-rats-pain.html

Wednesday, May 22, 2019

Millions Take Gabapentin for Pain. But There’s Scant Evidence It Works. - The New York Times

One of the most widely prescribed prescription drugs, gabapentin, is being taken by millions of patients despite little or no evidence that it can relieve their pain.

In 2006, I wrote about gabapentin after discovering accidentally that it could counter hot flashes.

The drug was initially approved 25 years ago to treat seizure disorders, but it is now commonly prescribed off-label to treat all kinds of pain, acute and chronic, in addition to hot flashes, chronic cough and a host of other medical problems.

The F.D.A. approves a drug for specific uses and doses if the company demonstrates it is safe and effective for its intended uses, and its benefits outweigh any potential risks. Off-label means that a medical provider can legally prescribe any drug that has been approved by the Food and Drug Administration for any condition, not just the ones for which it was approved. This can leave patients at the mercy of what their doctors think is helpful.

Thus, it can become a patient's job to try to determine whether a medication prescribed off-label is both safe and effective for their particular condition. This is no easy task even for well-educated doctors, let alone for desperate patients in pain.

Two doctors recently reviewed published evidence for the benefits and risks of off-label use of gabapentin (originally sold under the trade name Neurontin) and its brand-name cousin Lyrica (pregabalin) for treating all kinds of pain.

(There is now also a third drug, gabapentin encarbil, sold as Horizant, approved only for restless leg syndrome and postherpetic neuralgia, which can follow a shingles outbreak.)

The reviewers, Dr. Christopher W. Goodman and Allan S. Brett of the University of South Carolina School of Medicine, found the drugs, called gabapentinoids, wanting in most cases for which they are currently being prescribed.

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https://www.nytimes.com/2019/05/20/well/live/millions-take-gabapentin-for-pain-but-theres-scant-evidence-it-works.html?

Monday, May 20, 2019

Why Does The Brain Connect Pain With Emotions? : Shots - Health News : NPR

When Sterling Witt was a teenager in Missouri, he was diagnosed with scoliosis. Before long, the curvature of his spine started causing chronic pain.

It was "this low-grade kind of menacing pain that ran through my spine and mostly my lower back and my upper right shoulder blade and then even into my neck a little bit," Witt says.

The pain was bad. But the feeling of helplessness it produced in him was even worse.

"I felt like I was being attacked by this invisible enemy," Witt says. "It was nothing that I asked for, and I didn't even know how to battle it."

So he channeled his frustration into music and art that depicted his pain. It was "a way I could express myself," he says. "It was liberating."

Witt's experience is typical of how an unpleasant sensation can become something much more complicated, scientists say.

More …

https://www.npr.org/sections/health-shots/2019/05/20/724136568/how-the-brain-shapes-pain-and-links-ouch-with-emotion

Thursday, May 16, 2019

How Tiger Woods Won the Back Surgery Lottery - The New York Times

Few would have predicted that Tiger Woods would be playing in the P.G.A. Championship this week. He had three failed back surgeries, starting in 2014. He had taken opioids. His astonishing career seemed over.

Then he had one more operation, a spinal fusion, the most complex of all, in 2017. And last month he won the Masters, playing the way he used to.

An outcome like his from fusion surgery is so rare it is "like winning the lottery," Dr. Sohail K. Mirza, a spine surgeon at Dartmouth, said.

The idea behind spinal fusion is to remove a disk — a ring of fibers filled with a nerve-cushioning jelly that joins adjacent spine bones — and fuse the spine together, a procedure that almost inevitably means trading flexibility for stability and, the patient hopes, an existence with less pain.

That was all Woods was looking for when he decided to go ahead with fusion as a last resort — a "normal life" is how he put it. He got that and much more, including a new green blazer, though the lesson that most surgeons say Woods's experience teaches isn't that fusion surgery is a panacea but how much active rehabilitation and physical therapy the procedure requires for it to work.

"If you look at it simplistically, what does fusion do? It provides mechanical support," said Dr. Charles A. Reitman, co-director of the Spine Center at the Medical University of South Carolina. "If they are missing mechanical support and that is the pure cause of the problem, then they will get better."

People with a broken spine, for example, or scoliosis, which is severe spinal curvature, or spondylolisthesis, in which vertebrae slip out of place, tend to have terrific results, he said.

But those are a tiny minority of fusion patients. The vast majority of fusion procedures are performed on patients with one or more degenerated disks, disks that are worn out, dehydrated, stiff and friable. And when those disks move, patients' backs can ache.

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https://www.nytimes.com/2019/05/15/sports/how-tiger-woods-pga-back-surgery.html

Monday, April 29, 2019

Virtual Reality as Therapy for Pain - The New York Times

I was packing up at the end of a family vacation in Florida when my back went into an excruciating spasm unrelieved by a fistful of pain medication. As my twin sons, then 8 years old, wheeled me through the airport, one of them suggested, "Mom, if you think about something else, it won't hurt so much."

At the time, I failed to appreciate the wisdom of his advice. Now, four decades later, a sophisticated distraction technique is being used to help patients of all ages cope with pain, both acute and chronic. The method, called Virtual Reality Therapy, goes beyond simple distraction, as might result from watching television. Rather, it totally immerses the patient in an entertaining, relaxing, interactive environment that so occupies the brain, it has no room to process pain sensations at the same time.

"It's not just a distraction — it's like an endogenous narcotic providing a physiological and chemical burst that causes you to feel good," said Jeffrey I. Gold, director of the pediatric pain management clinic at Children's Hospital Los Angeles. "It's different from reading a book or playing with a toy. It's a multisensory experience that engages a person's attention on a much deeper level."

Virtual Reality Therapy is the new kid on the block for pain management, now gradually growing in use as the opioid epidemic continues to soar and the price of the needed equipment has plummeted. VR, as it is called, has been most widely and successfully used so far to help children and adults weather acute pain, as can accompany an IV insertion or debridement of burns. But it can also enhance the effectiveness of established techniques like physical therapy, hypnosis and cognitive behavioral therapy to treat debilitating chronic pain.

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https://www.nytimes.com/2019/04/29/well/live/virtual-reality-as-therapy-for-pain.html

Sunday, April 14, 2019

National Pain Report – What You Don't Know Can Hurt You

The National Pain Report is the leading online news site dedicated to the coverage of chronic pain. We feature the latest developments in the treatment of chronic pain, public policy impacting chronic pain as well comments from leading pain specialists and columns from chronic pain sufferers.

http://nationalpainreport.com/

Wednesday, April 03, 2019

Why the sexes don’t feel pain the same way

Robert Sorge was studying pain in mice in 2009, but he was the one who ended up with a headache.

At McGill University in Montreal, Canada, Sorge was investigating how animals develop an extreme sensitivity to touch. To test for this response, Sorge poked the paws of mice using fine hairs, ones that wouldn't ordinarily bother them. The males behaved as the scientific literature said they would: they yanked their paws back from even the finest of threads.

But females remained stoic to Sorge's gentle pokes and prods1. "It just didn't work in the females," recalls Sorge, now a behaviourist at the University of Alabama at Birmingham. "We couldn't figure out why." Sorge and his adviser at McGill University, pain researcher Jeffrey Mogil, would go on to determine that this kind of pain hypersensitivity results from remarkably different pathways in male and female mice, with distinct immune-cell types contributing to discomfort2.

Sorge and Mogil would never have made their discovery if they had followed the conventions of most pain researchers. By including male and female mice, they were going against the crowd. At the time, many pain scientists worried that females' hormone cycles would complicate results. Others stuck with males because, well, that's how things were done.

Today, inspired in part by Sorge and Mogil's work and spurred on by funders, pain researchers are opening their eyes to the spectrum of responses across sexes. Results are starting to trickle out, and it's clear that certain pain pathways vary considerably, with immune cells and hormones having key roles in differing responses.

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https://www.nature.com/articles/d41586-019-00895-3?

Tuesday, April 02, 2019

Acute to Chronic Pain Signatures | NIH Common Fund

This program will develop a set of objective biomarkers that provide a "signature" to predict a transition from acute to chronic pain, in order to accelerate therapy development and ultimately to guide pain prevention strategies. These biomarkers are greatly needed as the number of people who transition from acute to chronic pain after an acute pain event is surprisingly high. This high prevalence of chronic pain in the US has in part contributed to the current opioid epidemic.

A major challenge in pain management is preventing chronic pain from occurring after an acute pain event. For most people, acute pain resolves as the injury or trauma that caused it heals. Yet in many other people, acute pain from injury, surgery, or disease persists beyond the initial insult, and can last for years or throughout life. Many drugs, while effective early on, lose efficacy over time and make the transition from acute to chronic pain worse. In those who transition to chronic pain, maladaptive changes occur throughout the nervous system. Our ability to reverse these changes is very limited. Our lack of understanding of the mechanisms of transition to chronic pain is a major gap in knowledge that limits development of effective preventive therapies. The ability to identify those at risk for transitioning to chronic pain could inform future clinical trials, improve success of trials, and transform acute pain treatment approaches for prevention of chronic pain.

The Acute to Chronic Pain Signatures program will use advances in imaging, high-throughput biomedical experiments ('omics), sensory testing, and psychosocial assessments to explore a range of characteristics from patients who transition or are resilient to chronic pain. The study will follow two groups from the time of acute pain event over a period of six months. One group will have post-operative pain and the other will have musculoskeletal trauma. The key deliverable of the program is a comprehensive data set for the research communities that should reveal "signatures" predictive of transition versus resilience to chronic pain.

***

NIH seeks input from the scientific community on specific candidate molecules, tests, patient reported outcomes, psychosocial factors, health record data, and/or other characteristics that could potentially serve as high value biomarkers for predicting acute to chronic pain transition and/or resilience which should be considered for inclusion as outcome measures to collect in the studies. All recommendations should be backed up with a rationale and citations from peer reviewed literature or other justification. Potential candidates could include, but are not limited to, the following:

• Specific electronic health record information, including co-occurring conditions, prescription information, etc.
• Specific patient reported outcomes (e.g., PROMIS measures)
• Candidate psychosocial factors
• CNS or other imaging features
• Sensory tests for mechanical, temperature, or other types of pain
• Actinography for sleep and circadian rhythms and locomotor activity
• Molecules that can be obtained in patient blood, serum, or other non-invasively collected fluids
• Candidate genetic variants

https://commonfund.nih.gov/pain

Sunday, March 31, 2019

How Pain Tolerance and Anxiety Seem to Be Connected - The New York Times

An article this week about Jo Cameron, who has lived for 71 years without experiencing pain or anxiety because she has a rare genetic mutation, prompted questions from New York Times readers.

The notion that the same gene could be responsible for the way a person processes physical and psychological pain left many perplexed: Aren't they totally different? Or does her story hint that sensitivity to one type of pain might be intertwined with sensitivity to another?

Childbirth, Ms. Cameron said, felt like "a tickle." She often relies on her husband to alert her when she is bleeding, bruised or burned because nothing hurts.

When someone close to her has died, she said, she has felt sad but "I don't go to pieces." She cannot recall ever having been riled by anything — even a recent car crash. On an anxiety disorder questionnaire, she scored zero out of 21.

"I drive people mad by being cheerful," she said.

Here's a bit about what's known.

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https://www.nytimes.com/2019/03/30/health/pain-anxiety-jo-cameron.html

At 71, She’s Never Felt Pain or Anxiety. Now Scientists Know Why. - The New York Times

She'd been told that childbirth was going to be painful. But as the hours wore on, nothing bothered her — even without an epidural.

"I could feel that my body was changing, but it didn't hurt me," recalled the woman, Jo Cameron, who is now 71. She likened it to "a tickle." Later, she would tell prospective mothers, "Don't worry, it's not as bad as people say it is."

It was only recently — more than four decades later — that she learned her friends were not exaggerating.

Rather, there was something different about the way her body experienced pain: For the most part, it didn't.
Scientists believe they now understand why. In a paper published Thursday in The British Journal of Anaesthesia, researchers attributed Ms. Cameron's virtually pain-free life to a mutation in a previously unidentified gene. The hope, they say, is that the finding could eventually contribute to the development of a novel pain treatment. They believe this mutation may also be connected to why Ms. Cameron has felt little anxiety or fear throughout her life and why her body heals quickly.

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https://www.nytimes.com/2019/03/28/health/woman-pain-anxiety.html?

Monday, March 18, 2019

Opinion | Is Pain a Sensation or an Emotion? - The New York Times

The United States uses a third of the world's opioids but a fifth of Americans still say they suffer from chronic pain. The only demonstrable effect of two decades of widespread prescription of opioids has been catastrophic harm. With more than 47,000 Americans dying of opioid overdoses in 2017 and hundreds of thousandsmore addicted to them, it was recently reported that, for the first time, Americans were more likely to die of opioids than of car accidents.

This has forced many to take a step back and ponder the very nature of pain, to understand how best to alleviate it.

The ancient Greeks considered pain a passion — an emotion rather than a sensation like touch or smell. During the Dark Ages in Europe, pain was seen as a punishment for sins, a spiritual and emotional experience alleviated through prayers rather than prescriptions.

In the 19th century, the secularization of Western society led to the secularization of pain. It was no longer a passion to be endured but a sensation to be quashed.

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https://www.nytimes.com/2019/03/16/opinion/sunday/pain-opioids.html?

Sunday, March 10, 2019

Could The Cure For A Rare Chronic Pain Disorder Be ... More Pain? : Shots - Health News : NPR

There's a before, and there's an after.

In the before, it was a relatively normal night. The kind of night any 14-year-old girl might have.

Devyn ate dinner, watched TV and had small, unremarkable interactions with her family. Then, around 10 o'clock, she decided to turn in.

"I went to bed as I normally would, and then all of a sudden ... my hips... they just hurt unimaginably!" Devyn says. "I started crying, and I started shaking."

It was around midnight, but the pain was so intense she couldn't stop herself — she cried out so loudly she woke her mother, Sheila. Together, they did everything they could to neutralize the pain — stand up, lie down, hot bath, pain medication. But there was no escape, not for Devyn, and so not for Sheila.

"You go to cancer first, right? It's like, 'OK, maybe you have cancer, maybe it's a tumor?' " Sheila says.

When she was calm enough to reason with herself, Sheila decided cancer was improbable but wondered what was going on? The only thing they could think of was that the hip pain was somehow related to the minor knee surgery Devyn had gotten a few months before — she had broken the tip of her distal femur one day during dance practice.

So as usual, Sheila snapped to attention to solve the problem. It was 2016 — surely modern medicine could fix this. (NPR is not using Devyn's or Sheila's last name to protect Devyn's privacy as a minor discussing her medical treatment.)

They started by calling Devyn's surgeon, but the surgeon had no explanation for the pain. He renewed Devyn's prescription for Percocet and wrote a new prescription for tramadol. But the pain only got worse, so they lined up more appointments: their pediatrician, a naturopath, a pain specialist, a sports medicine doctor.

Every doctor's visit was the same. The doctor would ask Devyn about her pain: Where was it, and what was her pain number on a scale from 1 to 10? Then the doctor would order some tests to find the pain's cause.

But no matter where the doctors looked in Devyn, all they saw was a perfectly normal body.

"You are healthy. Nothing is wrong." Those are the words the doctors said to Devyn and Sheila over and over again. It made no sense. And it felt, paradoxically, like the more attention they gave to the pain, the bigger the pain grew.

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https://www.npr.org/sections/health-shots/2019/03/09/700823481/invisibilia-for-some-teens-with-debilitating-pain-the-treatment-is-more-pain?

Friday, February 01, 2019

Managing Children’s Pain After Surgery - The New York Times

Pain control in infants and children has come a long way over the past few decades. Experts know how to provide appropriate anesthesia when children need surgery and understand the ways that even very young children express distress when they're hurting afterward. There is a lot of evidence about reducing the pain and anxiety that can accompany immunizations and blood draws, and there is increasing expertise about helping children who struggle with chronic pain.

But today's parents may be shocked to learn that was not always the case. As recently as the early 1980s, the pain of children and infants was thought to be different from that of adults and was sometimes treated differently, or sometimes not treated at all.

Change doesn't always come easily in medicine, so there's a certain onus on parents to make sure that their children get state-of-the-art pain management around procedures, large and small. That means preparation before any planned surgery,ideally with a child life specialist, and it means careful attention to the child's pain afterward, with parents well backed up by medical specialists.

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https://www.nytimes.com/2019/01/07/well/family/managing-childrens-pain-after-surgery.html

Thursday, January 24, 2019

Spinal Fractures Can Be Terribly Painful. A Common Treatment Isn’t Helping. - The New York Times

Scientists warned osteoporosis patients on Thursday to avoid two common procedures used to shore up painful fractures in crumbling spines.

The treatments, which involve injecting bone cement into broken vertebrae, relieve pain no better than a placebo does, according to an expert task force convened by the American Society for Bone and Mineral Research.

The task force noted that the pain goes away or diminishes within six weeks without the procedure. Patients should take painkillers instead, the experts said, and maybe try back braces and physical therapy.

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https://www.nytimes.com/2019/01/24/health/spinal-fracture-treatment.html

Sunday, January 20, 2019

Repeated pain makes men more sensitive — but not women | CBC Radio

Dr. Loren Martin and his colleagues were actually investigating another question when they discovered this surprising result. They were measuring how multiple sources of pain changed pain perception.

In experiments, in mice they used a heat probe that created an mild level of heat on the mouse's feet. Then they gave the mice a dose of vinegar to upset their stomachs. The mice, unsurprisingly, didn't like it.

The suprise came when they they repeated the experiment. The male mice showed more stress when brought back to the location of the experiment, and had stronger responses to the heat stimuli - they were more sensitivity to the pain. The female mice showed no extra stress or sensitivity.

Researchers shone a mild heat probe at the mice's feet to induce a slight pain in the experiment. (Sana Khan)
They then ran a similar experiment on humans.

They used the same combination of stimuli - heat on the forearm, and an uncomfortably tight blood pressure cuff over the bicep. They left the cuff on for about 20 minutes and had the participants do arm exercises to increase the pain.

The participants came back the next day and were sent to the same environment where they wore the blood pressure cuff to repeat the heat probe experiment. This time, the men reported feeling more pain from the heat probe, while nothing changed for the women. It was the same sex difference that they'd seen in the mice.

More ...

https://www.cbc.ca/radio/quirks/jan-19-2019-tuskless-elephants-room-temperature-superconductors-how-space-changed-a-man-and-more-1.4981750/repeated-pain-makes-men-more-sensitive-but-not-women-1.4981763

Monday, January 14, 2019

Managing Children’s Pain After Surgery - The New York Times

Pain control in infants and children has come a long way over the past few decades. Experts know how to provide appropriate anesthesia when children need surgery and understand the ways that even very young children express distress when they're hurting afterward. There is a lot of evidence about reducing the pain and anxiety that can accompany immunizations and blood draws, and there is increasing expertise about helping children who struggle with chronic pain.

But today's parents may be shocked to learn that was not always the case. As recently as the early 1980s, the pain of children and infants was thought to be different from that of adults and was sometimes treated differently, or sometimes not treated at all.

Change doesn't always come easily in medicine, so there's a certain onus on parents to make sure that their children get state-of-the-art pain management around procedures, large and small. That means preparation before any planned surgery, ideally with a child life specialist, and it means careful attention to the child's pain afterward, with parents well backed up by medical specialists.

More ...

https://www.nytimes.com/2019/01/07/well/family/managing-childrens-pain-after-surgery.html

Thursday, December 20, 2018

Heroin Addiction Explained: How Opioids Hijack the Brain - The New York Times

THE OPIOID EPIDEMIC is devastating America. Overdoses have passed car crashes and gun violence to become the leading cause of death for Americans under 55. The epidemic has killed more people than H.I.V. at the peak of that disease, and its death toll exceeds those of the wars in Vietnam and Iraq combined. Funerals for young people have become common. Every 11 minutes, another life is lost.

So why do so many people start using these drugs? Why don't they stop?

Some people are more susceptible to addiction than others. But nobody is immune. For many, opioids like heroin entice by bestowing an immediate sense of tranquility, only to trap the user in a vicious cycle that essentially rewires the brain.

Getting hooked is nobody's plan. Some turn to heroin because prescription painkillers are tough to get. Fentanyl, which is 50 times more potent than heroin, has snaked its way into other drugs like cocaine, Xanax and MDMA, widening the epidemic.

To understand what goes through the minds and bodies of opioid users, The New York Times spent months interviewing users, family members and addiction experts. Using their insights, we created a visual representation of how the strong lure of these powerful drugs can hijack the brain.

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https://www.nytimes.com/interactive/2018/us/addiction-heroin-opioids.html

Thursday, November 15, 2018

This Chemical Is So Hot It Destroys Nerve Fibers—in a Good Way - WIRED

In Morocco there grows a cactus-like plant that's so hot, I have to insist that the next few sentences aren't hyperbole. On the Scoville Scale of hotness, its active ingredient, resiniferatoxin, clocks in at 16 billion units. That's 10,000 times hotter than the Carolina reaper, the world's hottest pepper, and 45,000 times hotter than the hottest of habaneros, and 4.5 million times hotter than a piddling little jalapeno. Euphorbia resinifera, aka the resin spurge, is not to be eaten. Just to be safe, you probably shouldn't even look at it.

But while that toxicity will lay up any mammal dumb enough to chew on the resin spurge, resiniferatoxin has also emerged as a promising painkiller. Inject RTX, as it's known, into an aching joint, and it'll actually destroy the nerve endings that signal pain. Which means medicine could soon get a new tool to help free us from the grasp of opioids.

More ...

https://www.wired.com/story/resiniferatoxin/

Saturday, September 29, 2018

Pain treatment complicated by doctors' opioid fears - The Washington Post

I felt a shake and opened my eyes. The clock read 1:30 a.m.

"We need to go to the hospital," my mother whispered in my ear, clutching her stomach.

She knew; it was the same pain she had experienced many times before.

We were in California, many miles from home, many miles from my father (a doctor), who always knew what to do. At the time, I was early in my medical school training, although I knew all the intricate details of my mother's medical history and realized she needed to get medical attention.

When we arrived at the local emergency room in an affluent neighborhood, my mother was placed in a wheelchair and taken to the waiting room. She curled up on the cold barren hospital floor, the only position she could find comfortable. Although my mother usually puts on lipstick and high heels to go to the grocery store, this time, her hair was unkempt and her pajamas worn out. Her knees were tucked into her chest and her belly was distended.

It should have been clear to onlookers that she was in agonizing pain, but people were hesitant, skeptical even.

"Ma'am," someone yelled. "Ma'am, we can't have you lying on the floor. Get up."

My mother lay still.

"Get up, ma'am," she was told again, again more forcibly.

They helped her back into the wheelchair.

"Help me," she said. "The pain is unbearable."

Reluctantly, they put her in a stretcher and prepared to place an IV in her arm. To convince them the pain was real, we asked them to call my father, who could fill in all of the medical details: her multiple prior hospitalizations, surgeries and diagnoses.

More ...

https://www.washingtonpost.com/national/health-science/my-mother-was-in-unbearable-pain-but-the-er-staff-didnt-seem-to-believe-her/2018/09/28/1acf1404-abae-11e8-8a0c-70b618c98d3c_story.html?

Friday, September 21, 2018

Illusions as Painkillers: the Analgesic Value of Resizing Illusions in Knee Osteoarthritis - Scientific American

Research has shown that the experience of pain is highly subjective: people feel more or less pain, in identical physical situations, as a function of their mood and attention. This flexibility showcases the potential for cognitive manipulations to decrease the pain associated with a variety of pathologies. As an example, the virtual-reality game "Snow World" (in which game in which players shoot snowballs to defeat snowman Frosty and his penguins) reportedly works better than morphine at counteracting the pain of patients in burn units. Other studies have indicated that virtual reality manipulations of the patient's own body can also help ameliorate pain: an experiment conducted by neuroscientist Maria Victoria Sanchez-Vives and her team at the University of Barcelona in Spain showed that heat applied to experimental participants' wrists felt more painful when their virtual arms turned red than when they turned blue or green.

Following on this tradition, a study published PeerJ last month showed that visuotactile illusions can help the pain experienced by patients suffering from knee osteoarthritis.

According to lead author Tasha Stanton, from the University of South Australia, the idea for the study originated from her observation that "people with knee osteoarthritis have an altered perception of their own body. [Their affected knee] often feels too big, and they also have changes to the way that touch and movement information is represented in the brain." She hypothesized that patients may "respond to illusions that change the way their knee looks."

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https://blogs.scientificamerican.com/illusion-chasers/illusions-as-painkillers-the-analgesic-value-of-resizing-illusions-in-knee-osteoarthritis/

Wednesday, September 19, 2018

Pain Narrative Videos | Pain Education and Advocacy | University of New England

UNE's Center for Excellence in Neurosciences and Interprofessional Education Collaborative have partnered to create this collection of pain narrative videos as part of a group of interprofessional training materials. These materials were crafted to aid future practitioners in providing the highest quality of care to patients experiencing chronic pain. They highlight the importance of working interprofessionally and approaching the patient as a whole person when in treatment. Included are outcomes from a project funded in part by the Maine Cancer Foundation to examine cancer pain from an interprofessional perspective and shed light on a wide variety of obstacles that cancer pain patients face over the course of their treatment and life after treatment.

The pain narrative videos collected here give unique insight into the lives of patients experiencing chronic pain. Their intended use is as educational material or for patient advocacy, in pieces or as a whole.

More …

https://dune.une.edu/pain_videos/

Too Good to Be True? A Nonaddictive Opioid without Lethal Side Effects Shows Promise - Scientific American

With nearly 50,000 drug overdose deaths from opioids last year and an estimated two million Americans addicted, the opioid crisis continues to rage throughout the U.S. This statistic must be contrasted with another: 25 million Americans live with daily chronic pain, for which few treatment options are available apart from opioid medications.

Opioid drugs like morphine and Oxycontin are still held as the gold standard when it comes to relieving pain. But it has become brutally obvious that opioids have dangerous side effects, including physical dependence, addiction and the impaired breathing that too often leads to death from an overdose. Researchers have long been searching for a drug that would relieve pain without such a heavy toll, with few results so far.

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https://www.scientificamerican.com/article/too-good-to-be-true-a-nonaddictive-opioid-without-lethal-side-effects-shows-promise/

Monday, September 17, 2018

Body in Mind - Research into the role of the brain and mind in chronic pain - University of South Australia

Here is our vision: To provide a credible and reliable channel through which clinical pain scientists can bring their scientific discoveries straight into the real world. We reckon that the communication bit of science is the bit that often drags the chain of knowledge development and transfer. We want to communicate our science better. We want to side-step, or perhaps leap-frog, the arduous journey that new discoveries make before they have the opportunity to influence the real world. We want people to share in our fascination with the fearful and wonderful complexity of the human; we want people to understand the scientific discoveries as they occur, not 20 years later, to grasp their significance and potential relevance to everyday life, but to also become astute sifters of the wheat from the chaff. We want to be a reliable go-to web space for the latest developments in the science of pain.

https://bodyinmind.org/

Friday, September 14, 2018

Most Doctors Are Ill-Equipped to Deal With the Opioid Epidemic. Few Medical Schools Teach Addiction. - The New York Times

To the medical students, the patient was a conundrum.

According to his chart, he had residual pain from a leg injury sustained while working on a train track. Now he wanted an opioid stronger than the Percocet he'd been prescribed. So why did his urine test positive for two other drugs — cocaine and hydromorphone, a powerful opioid that doctors had not ordered?

It was up to Clark Yin, 29, to figure out what was really going on with Chris McQ, 58 — as seven other third-year medical students and two instructors watched.

"How are you going to have a conversation around the patient's positive tox screen results?" asked Dr. Lidya H. Wlasiuk, who teaches addiction awareness and interventions here at Boston University School of Medicine.

Mr. Yin threw up his hands. "I have no idea," he admitted.

Chris McQ is a fictional case study created by Dr. Wlasiuk, brought to life for this class by Ric Mauré, a keyboard player who also works as a standardized patient — trained to represent a real patient, to help medical students practice diagnostic and communication skills. The assignment today: grappling with the delicate art and science of managing a chronic pain patient who might be tipping into a substance use disorder.

How can a doctor win over a patient who fears being judged? How to determine whether the patient's demand for opioids is a response to dependence or pain?

Addressing these quandaries might seem fundamental in medical training — such patients appear in just about every field, from internal medicine to orthopedics to cardiology. The need for front-line intervention is dire: primary care providers like Dr. Wlasiuk, who practices family medicine in a Boston community clinic, routinely encounter these patients but often lack the expertise to prevent, diagnose and treat addiction.

More …

https://www.nytimes.com/2018/09/10/health/addiction-medical-schools-treatment.html

Sunday, July 08, 2018

A New Arizona Law Limits A Doctor's Freedom To Prescribe Painkillers : Shots - Health News : NPR

It started with a rolled ankle during a routine training exercise.

Shannon Hubbard never imagined it was the prologue to one of the most debilitating pain conditions known to exist, called ­­­­­­­complex regional pain syndrome.

It's a condition that causes the nervous system to go haywire, creating pain disproportionate to the actual injury. It can also affect how the body regulates temperature and blood flow.

For Hubbard, it manifested several years ago following surgery on her foot. That's a common way for it to take hold.

"My leg feels like it's on fire pretty much all the time. It spreads to different parts of your body," the 47-year-old Army veteran says.

Hubbard props up her leg, careful not to graze it against the kitchen table in her home east of Phoenix. It's red and swollen, still scarred from an ulcer that landed her in the hospital a few months ago.

"That started as a little blister and four days later it was like the size of a baseball," she says. "They had to cut it open and then it got infected and because I have blood flow issues, it doesn't heal."

She knows that soon it will happen again.

"Over the past three years, I've been prescribed over sixty different medications and combinations, none have even touched the pain," she says.

She holds up a plastic bag filled with discarded pill bottles — evidence of her elusive search for a solution to the pain.

More ...

https://www.npr.org/sections/health-shots/2018/07/08/622729300/patients-with-chronic-pain-feel-caught-in-an-opioid-prescribing-debate

Monday, June 25, 2018

The Neuroscience of Pain | The New Yorker

On a foggy February morning in Oxford, England, I arrived at the John Radcliffe Hospital, a shiplike nineteen-seventies complex moored on a hill east of the city center, for the express purpose of being hurt. I had an appointment with a scientist named Irene Tracey, a brisk woman in her early fifties who directs Oxford University's Nuffield Department of Clinical Neurosciences and has become known as the Queen of Pain. "We might have a problem with you being a ginger," she warned when we met. Redheads typically perceive pain differently from those with other hair colors; many also flinch at the use of the G-word. "I'm sorry, a lovely auburn," she quickly said, while a doctoral student used a ruler and a purple Sharpie to draw the outline of a one-inch square on my right shin.

Wearing thick rubber gloves, the student squeezed a dollop of pale-orange cream into the center of the square and delicately spread it to the edges, as if frosting a cake. The cream contained capsaicin, the chemical responsible for the burn of chili peppers. "We love capsaicin," Tracey said. "It does two really nice things: it ramps up gradually to become quite intense, and it activates receptors in your skin that we know a lot about." Thus anointed, I signed my disclaimer forms and was strapped into the scanning bed of a magnetic-resonance-imaging (MRI) machine.

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https://www.newyorker.com/magazine/2018/07/02/the-neuroscience-of-pain

Tuesday, June 12, 2018

HEAL Initiative | National Institutes of Health (NIH)

In April 2018, NIH launched the HEAL (Helping to End Addiction Long-term) Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis. This Initiative will build on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with Medication-Assisted Treatment (MAT) for opioid use disorder (OUD). Successes from this research include the development of the nasal form of naloxone, the most commonly used nasal spray for reversing opioid overdose, the development of buprenorphine for the treatment of OUD, and evidence for the use of nondrug and mind/body techniques such as yoga, tai chi, acupuncture, and mindfulness meditation to help patients control and manage pain.

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https://www.nih.gov/research-training/medical-research-initiatives/heal-initiative

Monday, June 04, 2018

How health insurers are making America’s opioid epidemic worse - Vox

Mandy has now been in recovery from her opioid addiction for more than two months — and she's ready to keep that going. But the 29-year-old in the Chicago area is now dealing with a big obstacle: her health insurer.

Mandy, who asked I use only her first name, said she struggled with addiction for six years. It started with back pain, which a doctor tried to treat with Vicodin. 

"I had tried [opioids] in high school," she said. "I had an older boyfriend, and I tried some of his wisdom teeth painkillers to get high off of. And I was like, 'Whoa, this is awesome.' When I got a Vicodin prescription for my back, I was like, 'Oh, I remember these being really great.'"

Mandy took the drugs as prescribed at first. But every once in a while, she would sneak in an extra pill or two to help deal with a bad day. Then she started taking extras on good days, and, finally, at work.

"It got to the point where I started using them recreationally," Mandy said. "But then I started using them to not get sick" — a typical experience for people addicted to opioids, who over time begin to use the drugs not to get high but to avert cravings and withdrawal.

In March, Mandy decided she had enough. She got into an intensive outpatient addiction treatment program for eight weeks and was prescribed buprenorphine, a medication for opioid addiction that staves off withdrawal and cravings without producing the kind of high that, say, heroin or painkillers might. She's remained on the medication as she's transitioned to less intensive treatment.

There's just one problem: Her insurer, Blue Cross and Blue Shield of Illinois, won't pay for the buprenorphine. That's left Mandy to foot the bill. Her latest bill — for a 28-day supply — was priced at $294 out of pocket, although she got it down to $222.69 with a discount. With the discount, similar bills throughout a full year would add up to nearly $2,900.

More ...

https://www.vox.com/science-and-health/2018/6/4/17388756/opioid-epidemic-health-insurance-buprenorphine

Thursday, May 31, 2018

BBC - Future - Pain bias: The health inequality rarely discussed

In 2009, my doctor told me that, like "a lot of women", I was paying too much attention to my body. Saying there wasn't an issue, he suggested I just relax and try to ignore the symptoms.

The decision seemed to run counter to what my records showed. A few weeks earlier, I had ended up in the emergency room with chest pains and a heart rate hitting 220 beats per minute. The ER crew told me it was a panic attack, gave me Xanax and told me to try to sleep.

I'd had panic attacks before. I knew this episode was not one. So I went to my doctor.

He put me on a heart monitor overnight. Bingo: I had another episode, this time recorded. It didn't matter. I still left his office thinking it was perhaps anxiety. And so, listening to the advice, I tried to ignore the pain.­­

Until it happened again. And again. First every month, then every week. Over the following nine years, I would complain about it and be told again that I was having panic attacks or anxiety, that women don't feel heart pain the way I was feeling it, and that maybe I was just confused.

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http://www.bbc.com/future/story/20180518-the-inequality-in-how-women-are-treated-for-pain

NIH Pain Consortium

The NIH Pain Consortium was established to enhance pain research and promote collaboration among researchers across the many NIH Institutes and Centers that have programs and activities addressing pain. To this end, the following goals have been identified for the Pain Consortium:

• To develop a comprehensive and forward-thinking pain research agenda for the NIH - one that builds on what we have learned from our past efforts.

• To identify key opportunities in pain research, particularly those that provide for multidisciplinary and trans-NIH participation.

• To increase visibility for pain research - both within the NIH intramural and extramural communities, as well as outside the NIH. The latter audiences include our various pain advocacy and patient groups who have expressed their interests through scientific and legislative channels.

• To pursue the pain research agenda through Public-Private partnerships, wherever applicable. This underscores a key dynamic that has been reinforced and encouraged through the Roadmap process.

https://painconsortium.nih.gov/

Saturday, May 19, 2018

Chronic pain treatment: Psychotherapy, not opioids, has been proven to work - Vox

When pain settled into Blair Golson's hands, it didn't let go.

What started off as light throbbing in one wrist 10 years ago quickly engulfed the other. The discomfort then spread, producing a pain much "like slapping your hands against a concrete wall," he says. He was constantly stretching them, constantly shaking them, while looking for hot or cold surfaces to lay them on for relief.

But worse was the deep sense of catastrophe that accompanied the pain. Working in tech-related startups, he depended on his hands to type. "Every time the pain got bad, I would think some variation of, 'Oh no, I'm never going to be able to use computers again; I'm not going to be able to hold down a job; I'm not going to be able to earn a living; and I'm going to be in excruciating pain the rest of my life,'" he says.

Like many patients with chronic pain, Golson never got a concrete diagnosis. For a decade, the 38-year-old Californian went from doctor to doctor, trying all the standard treatments: opioids, hand splints, cortisone injections, epidural injections, exercises, even elective surgery.

Golson's pain was not caused by anything physically wrong with him. But it wasn't imagined. It was real.

After weaning himself off the opioid Vicodin and feeling like he had exhausted every medical option, Golson turned to a book that described how pain could be purely psychological in origin. That ultimately took a pain psychologist, a therapist who specializes in pain — not a physician — to treat the true source: his fearful thoughts. Realizing that psychological therapy could help "was one of the most profoundly surprising experiences of my life," Golson says. No doctor he ever saw "even hinted my pain might be psychogenic," meaning pain that's psychological in origin.

More ...

https://www.vox.com/science-and-health/2018/5/17/17276452/chronic-pain-treatment-psychology-cbt-mindfulness-evidence

Friday, May 18, 2018

New Drug Offers Hope to Millions With Severe Migraines - The New York Times

The first medicine designed to prevent migraines was approved by the Food and Drug Administration on Thursday, ushering in what many experts believe will be a new era in treatment for people who suffer the most severe form of these headaches.

The drug, Aimovig, made by Amgen and Novartis, is a monthly injection with a device similar to an insulin pen. The list price will be $6,900 a year, and Amgen said the drug will be available to patients within a week.

Aimovig blocks a protein fragment, CGRP, that instigates and perpetuates migraines. Three other companies — Lilly, Teva and Alder — have similar medicines in the final stages of study or awaiting F.D.A. approval.

"The drugs will have a huge impact," said Dr. Amaal Starling, a neurologist and migraine specialist at the Mayo Clinic in Phoenix. "This is really an amazing time for my patient population and for general neurologists treating patients with migraine."

Millions of people experience severe migraines so often that they are disabled and in despair. These drugs do not prevent all migraine attacks, but can make them less severe and can reduce their frequency by 50 percent or more.

As a recent editorial in the journal JAMA put it, they are "progress, but not a panacea."

More ...

https://www.nytimes.com/2018/05/17/health/migraines-prevention-drug-aimovig.html?

Thursday, May 10, 2018

Treatments Prescribed For Lower Back Pain Are Often Ineffective, Report Says : NPR

Chances are, you — or someone you know — has suffered from lower back pain.

It can be debilitating. It's a leading cause of disability globally.

And the number of people with the often-chronic condition is likely to increase.

This warning comes via a series of articles published in the medical journal Lancet in March. They state that about 540 million people have lower back pain — and they predict that the number will jump as the world's population ages and as populations in lower- and middle-income countries move to urban centers and adopt more sedentary lives.

"We don't think about [back pain] the same way as cancer or heart attacks. But if you look at disability it causes, especially in middle- and low-income where there isn't a safety net, it impacts half a billion people," says Roger Chou, a physician who is a pain specialist at the Oregon Health and Science University and a co-author of the articles.

Disability from chronic back pain can hurt a person's ability to earn a living. One of the Lancet studies found that among rural Nigerian farmers, half reduced their workload because of back pain — an example of how the disability could contribute to the cycle of poverty in countries that lack benefits such as sick days or a social safety net.

Another study from Australia found that people who retired early because of back pain potentially lost out on hundreds of thousands of dollars of accumulated wealth when compared with healthy people who worked all the way to 65.

An overarching issue with back pain management is that the treatments doctors prescribe are often the wrong ones, the report concludes. Also, in many low-income countries, accessing health care is challenging — and getting appropriate care of back pain, specifically, is even harder. In some poor parts of Asia, pain medications are hard to come by and doctors may not have been trained on the most effective treatments.

More ...

https://www.npr.org/sections/goatsandsoda/2018/04/05/597505825/report-ineffective-treatment-often-prescribed-for-lower-back-pain

Tuesday, April 10, 2018

Lack Of Research On Medical Marijuana Leaves Patients In The Dark : Shots - Health News : NPR

By the time Ann Marie Owen, 61, turned to marijuana to treat her pain, she was struggling to walk and talk. She was also hallucinating.

For four years, her doctor prescribed a wide range of opioids for transverse myelitis, a debilitating disease that caused pain, muscle weakness and paralysis.

The drugs not only failed to ease her symptoms, they hooked her.

When her home state of New York legalized marijuana for the treatment of select medical ailments, Owens decided it was time to swap pills for pot. But her doctors refused to help.

"Even though medical marijuana is legal, none of my doctors were willing to talk to me about it," she says. "They just kept telling me to take opioids."

Although 29 states have legalized marijuana to treat pain and other ailments, the growing number of Americans like Owen who use marijuana and the doctors who treat them are caught in the middle of a conflict in federal and state laws — a predicament that is only worsened by thin scientific data.

Because the federal government considers marijuana a Schedule 1 drug, research on marijuana or its active ingredients is highly restricted and even discouraged in some cases.

Underscoring the federal government's position, Health and Human Services Secretary Alex Azar recently pronounced that there was "no such thing as medical marijuana."

Scientists say that stance prevents them from conducting the high-quality research required for FDA approval, even as some early research indicates marijuana might be a promising alternative to opioids or other medicines.

Patients and physicians, meanwhile, lack guidance when making decisions about medical treatment for an array of serious conditions.

More ...

https://www.npr.org/sections/health-shots/2018/04/07/600209754/medical-marijuanas-catch-22-limits-on-research-hinders-patient-relief

Saturday, April 07, 2018

Naloxone Stops Opioid Overdoses. How Do You Use It? - The New York Times

The United States surgeon general issued a rare national advisory on Thursday urging more Americans to carry naloxone, a drug used to revive people overdosing on opioids.

The last time a surgeon general issued such an urgent warning to the country was in 2005, when Richard H. Carmona advised women not to drink alcohol when pregnant.

More ...

https://www.nytimes.com/2018/04/06/us/naloxone-narcan-opioid-overdose.html

Wednesday, March 28, 2018

Medicare Is Cracking Down on Opioids. Doctors Fear Pain Patients Will Suffer. - The New York Times

Medicare officials thought they had finally figured out how to do their part to fix the troubling problem of opioids being overprescribed to the old and disabled: In 2016, a staggering one in three of 43.6 million beneficiaries of the federal health insurance program had been prescribed the painkillers.

Medicare, they decided, would now refuse to pay for long-term, high-dose prescriptions; a rule to that effect is expected to be approved on April 2. Some medical experts have praised the regulation as a check on addiction.

But the proposal has also drawn a broad and clamorous blowback from many people who would be directly affected by it, including patients with chronic pain, primary care doctors and experts in pain management and addiction medicine.

More ...

https://www.nytimes.com/2018/03/27/health/opioids-medicare-limits.html?

Friday, March 23, 2018

America's War on Pain Pills Is Killing Addicts and Leaving Patients in Agony - Reason.com

Craig, a middle-aged banking consultant who was on his school's lacrosse team in college and played professionally for half a dozen years after graduating, began developing back problems in his early 30s. "Degenerative disc disease runs in my family, and the constant pounding on AstroTurf probably did not help," he says. One day, he recalls, "I was lifting a railroad tie out of the ground with a pick ax, straddled it, and felt the pop. That was my first herniation."

After struggling with herniated discs and neuropathy, Craig consulted with "about 10 different surgeons" and decided to have his bottom three vertebrae fused. He continued to suffer from severe lower back pain, which he successfully treated for years with OxyContin, a timed-release version of the opioid analgesic oxycodone. He would take a 30-milligram OxyContin tablet twice a day, supplemented by immediate-release oxycodone for breakthrough pain when he needed it.

Then one day last May, Craig's pain clinic called him in for a pill count, a precaution designed to detect abuse of narcotics or diversion to nonpatients. The count was off by a week's worth of pills because Craig had just returned from a business trip and forgot that he had packed some medication in his briefcase. He tried to explain the discrepancy and offered to bring in the missing pills, to no avail. Because the pill count came up short, Craig's doctor would no longer prescribe opioids for him, and neither would any other pain specialist in town.

More ...

http://reason.com/archives/2018/03/08/americas-war-on-pain-pills-is

What's in a Name for Chronic Pain? | Pain Research Forum

For decades, pain researchers have set their sights on understanding pain mechanisms—the cellular and molecular machinery underlying chronic pain. In doing so, they became increasingly aware that the terms they used to describe the neurobiological workings of pain did not always match what they had learned.

But now, official adoption by the International Association for the Study of Pain (IASP) of an IASP terminology task force recommendation for a so-called "third mechanistic descriptor" of chronic pain could move the field forward in its efforts to more fully characterize the known pathophysiological mechanisms of pain. The new term, christened "nociplastic pain," joins "nociceptive pain" and "neuropathic pain" as terms officially adopted by the association to describe the underlying neurobiological basis of chronic pain.

More ...

https://www.painresearchforum.org/news/92059-whats-name-chronic-pain

Tuesday, March 13, 2018

Handing out naloxone doesn’t fix opioid crisis | Dalla Lana School of Public Health

In the midst of a national opioid crisis, take-home naloxone programs have expanded rapidly. Ontario's Minister of Health and Long Term Care Dr. Eric Hoskins recently announced that naloxone kits will be provided to fire and police departments across the province, but U of T researchers are questioning whether naloxone distribution might distance people from health-care services or worsen health inequities.

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Monday, February 26, 2018

“Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain - Pain Research and Management

Background. Despite the large body of research on sex differences in pain, there is a lack of knowledge about the influence of gender in the patient-provider encounter. The purpose of this study was to review literature on gendered norms about men and women with pain and gender bias in the treatment of pain. The second aim was to analyze the results guided by the theoretical concepts of hegemonic masculinity and andronormativity. Methods. A literature search of databases was conducted. A total of 77 articles met the inclusion criteria. The included articles were analyzed qualitatively, with an integrative approach. Results. The included studies demonstrated a variety of gendered norms about men's and women's experience and expression of pain, their identity, lifestyle, and coping style. Gender bias in pain treatment was identified, as part of the patient-provider encounter and the professional's treatment decisions. It was discussed how gendered norms are consolidated by hegemonic masculinity and andronormativity. Conclusions. Awareness about gendered norms is important, both in research and clinical practice, in order to counteract gender bias in health care and to support health-care professionals in providing more equitable care that is more capable to meet the need of all patients, men and women.

https://www.hindawi.com/journals/prm/2018/6358624/

Thursday, February 08, 2018

Migraine Relief May Be On The Way With New Therapies In Development : Shots - Health News : NPR

Humans have suffered from migraines for millennia. Yet, despite decades of research, there isn't a drug on the market today that prevents them by targeting the underlying cause. All of that could change in a few months when the FDA is expected to announce its decision about new therapies that have the potential to turn migraine treatment on its head.

The new therapies are based on research begun in the 1980s showing that people in the throes of a migraine attack have high levels of a protein called calcitonin gene–related peptide (CGRP) in their blood.

Step by step, researchers tracked and studied this neurochemical's effects. They found that injecting the peptide into the blood of people prone to migraines triggers migraine-like headaches, whereas people not prone to migraines experienced, at most, mild pain. Blocking transmission of CGRP in mice appeared to prevent migraine-like symptoms. And so a few companies started developing a pill that might do the same in humans.

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https://www.npr.org/sections/health-shots/2018/02/03/581092093/gone-with-a-shot-hopeful-new-signs-of-relief-for-migraine-sufferers?

Monday, February 05, 2018

PAS-18-624: Mechanistic investigations of psychosocial stress effects on opioid use patterns (R01- Clinical Trial Optional)

Psychosocial stress, defined here as socioenvironmental demands that tax the adaptive capacity of the individual (e.g., low socioeconomic status, childhood adversity, bullying), has repeatedly been linked to substance use disorders (SUDs). Neighborhood poverty and social support are shown to influence substance use patterns. Among smokers, multiple psychosocial stressors are associated with relapse, and acute psychosocial stress has been demonstrated to enhance cigarette craving and smoking behavior. Similarly, psychosocial stress has been associated with greater risk of relapse in individuals with alcohol and cocaine use disorders. Recent findings suggest that OUD might also be influenced by psychosocial stress, although the exact relationship and underlying mechanisms remain poorly understood.

In light of the current opioid epidemic in the United States, there is an urgent need to understand how psychosocial stress influences the risk for opioid misuse, abuse, and use disorder. According to the 2014 National Survey on Drug Use and Health (NSDUH), over 4 million Americans engaged in non-medical use of prescription opioids in the previous month, and approximately 1.9 million Americans met criteria for OUD. Further, according to the Center for Disease Control (CDC), deaths from drug overdose in the US exceeded 60,000 last year, surpassing the number of AIDS-related deaths at the height of the HIV/AIDS epidemic. Another recent CDC report indicates that areas with the largest number of filled prescriptions for pain medications also have higher rates of poverty and unemployment, implicating psychosocial stressors as factors that exacerbate opioid use patterns across the country. Notably, relatively few mechanistic studies have investigated the relationship between psychosocial stress and substance use disorders, of which only a fraction pertains to OUDs specifically.

This funding opportunity announcement seeks to address two specific mechanistic pathways via which psychosocial stress may modulate opioid use trajectories.The first pathway is through its effects on cognitive and affective systems that are also altered in OUDs. Stressful environments have been linked to impairments in reasoning, memory, inhibitory and cognitive control, and negative affect. Acute poverty, for example, has been shown to immediately impact performance on tasks measuring intelligence and cognitive control. Relatedly, there is substantial co-morbidity between OUD and stress-related affective disorders, including depression, anxiety and PTSD. Many neurobiological substrates and circuits that are thought to mediate cognitive and affective aspects of addiction are impacted by psychosocial stress. Taken together, these findings suggest that more research is warranted on the role of cognitive and affective systems mediating the effects of psychosocial stress on opioid use trajectories.

Psychosocial stress can also influence opioid use trajectories through its effects on pain processing. Of relevance here, adverse childhood experiences have been associated with an increased prevalence of pain-related medical conditions during adulthood and many individuals with stress-related psychiatric disorders have co-morbid chronic pain syndromes. This may be a consequence of overlapping neural circuits or substrates that are engaged by psychosocial stress and pain and that have been implicated in OUD. Recent estimates suggest that the rates of opioid misuse in patients with chronic pain range from 15-26%. Importantly, and germane to the discussion above, negative affect and the reduced ability to cope with negative emotions in pain appear to increase opioid misuse rates. Further research is needed to understand how the effects of psychosocial impacts on cognitive and affective components of pain may influence the opioid use trajectory. This knowledge may advance prevention and treatment strategies in chronic pain populations.

https://grants.nih.gov/grants/guide/pa-files/PAS-18-624.html

A Doctor’s Painful Struggle With an Opioid-Addicted Patient - Siddhartha Mukherjee - The New York Times

I once found myself entrapped by a patient as much as she felt trapped by me. It was the summer of 2001, and I was running a small internal-medicine clinic, supervised by a preceptor, on the fourth floor of a perpetually chilly Boston building. Most of the work involved routine primary care — the management of diabetes, blood pressure and heart disease. It was soft, gratifying labor; the night before a new patient's visit, I would usually sift through any notes that were sent ahead and jot my remarks in the margins. The patient's name was S., I learned. She had made four visits to the emergency room complaining of headaches. Three of those times she left with small stashes of opioids — Vicodin, Percocet, oxycodone. Finally, the E.R. doctors refused to give her pain medicines unless she had a primary-care physician. There was an open slot in my clinic the next morning, and the computer had randomly assigned her to see me.

We were living, then, in what might be called the opioid pre-epidemic; the barometer had begun to dip, but few suspected the ferocity of the coming storm. Pain, we had been told as medical residents, was being poorly treated (true) — and pharmaceutical companies were trying to convince us daily that a combination of long- and short-acting opioids could cure virtually any form of it with minimal side effects (not true). The cavalier overprescription of addictive drugs was bewildering: After a tooth extraction, I emerged from an oral surgeon's office with a two-week supply of Percocet.

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https://www.nytimes.com/2018/02/01/magazine/a-doctors-painful-struggle-with-an-opioid-addicted-patient.html

Saturday, February 03, 2018

Natural painkiller nasal spray could replace addictive opioids, trial indicates | The Guardian

A nasal spray that delivers a natural painkiller to the brain could transform the lives of patients by replacing the dangerous and addictive prescription opioids that have wreaked havoc in the US and claimed the lives of thousands of people.

Scientists at University College London found they could alleviate pain in animals with a nasal spray that delivered millions of soluble nanoparticles filled with a natural opioid directly into the brain. In lab tests, the animals showed no signs of becoming tolerant to the compound's pain-relieving effects, meaning the risk of overdose should be far lower.

The researchers are now raising funds for the first clinical trial in humans to assess the spray's safety. They will start with healthy volunteers who will receive the nasal spray to see if it helps them endure the pain of immersing one of their arms in ice-cold water.

"If people don't develop tolerance, you don't have them always having to up the dose. And if they don't have to up the dose, they won't get closer and closer to overdose," said Ijeoma Uchegbu, a professor of pharmaceutical nanoscience who is leading the research through Nanomerics, a UCL startup.

If the first human safety trial is successful, the scientists will move on to more trials to investigate whether the nasal spray can bring swift relief to patients with bone cancer who experience sudden and excruciating bouts of pain.

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https://www.theguardian.com/us-news/2018/feb/01/natural-painkiller-nasal-spray-could-replace-addictive-opioids-trial-indicates?

Tuesday, January 30, 2018

News Archive | Pain Research Forum

All of our news and discussion content, research resources and member services are provided free to researchers, clinicians and others interested in the problem of chronic pain.

https://www.painresearchforum.org/news/archive

Saturday, January 27, 2018

After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea - The New York Times

MUNICH — I recently had a hysterectomy here in Munich, where we moved from California four years ago for my husband's job. Even though his job ended a year ago, we decided to stay while he tries to start a business. Thanks to the German health care system, our insurance remained in force. This, however, is not a story about the benefits of universal health care.

Thanks to modern medicine, my hysterectomy was performed laparoscopically, without an overnight hospital stay. My only concern about this early release was pain management. The fibroids that necessitated the surgery were particularly large and painful, and the procedure would be more complicated.

I brought up the subject of painkillers with my gynecologist weeks before my surgery. She said that I would be given ibuprofen. "Is that it?" I asked. "That's what I take if I have a headache. The removal of an organ certainly deserves more."

"That's all you will need," she said, with the body confidence that comes from a lifetime of skiing in crisp, Alpine air.

I decided to pursue the topic with the surgeon.

He said the same thing. He was sure that the removal of my uterus would not require narcotics afterward. I didn't want him to think I was a drug addict, but I wanted a prescription for something that would knock me out for the first few nights, and maybe half the day.

With mounting panic, I decided to speak to the anesthesiologist, my last resort.

This time, I used a different tactic. I told him how appalled I had been when my teenager was given 30 Vicodin pills after she had her wisdom teeth removed in the United States. "I am not looking for that," I said, "but I am concerned about pain management. I won't be able to sleep. I know I can have ibuprofen, but can I have two or three pills with codeine for the first few nights? Let me remind you that I am getting an entire organ removed."

The anesthesiologist explained that during surgery and recovery I would be given strong painkillers, but once I got home the pain would not require narcotics. To paraphrase him, he said: "Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will know when to rest more; you will know when you are healing. If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals. All you need is rest. And please be careful with ibuprofen. It's not good for your kidneys. Only take it if you must. Your body will heal itself with rest."

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https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html?

Wednesday, January 24, 2018

Sourcing Painkillers from Scorpions’ Stings | The Scientist Magazine

Studying scorpions comes with its share of danger, as biologist Bryan Fry of the University of Queensland knows all too well. On a 2009 trip to the Brazilian Amazon, Fry was stung while trying to collect the lethal Brazilian yellow scorpion (Tityus serrulatus), and for eight hours he says it felt as though his finger was in a candle flame. Meanwhile, his heart flipped between racing and stopping for up to five seconds at a time. "At least the insane levels of pain helped keep my mind off my failing heart," Fry writes in an email to The Scientist.

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https://www.the-scientist.com/?articles.view/articleNo/51210/title/Sourcing-Painkillers-from-Scorpions--Stings/

Monday, January 22, 2018

Scientists Just Solved a Major Piece of the Opioid Puzzle | WIRED

When it comes to tackling the opioid crisis, public health workers start with the drugs: fentanyl, morphine, heroin. But biochemists have a different focus: Not the opioids, but opioid receptors—the proteins the drugs latch onto within the body.

These receptors embed themselves in the walls of cells throughout the brain and peripheral nervous system. There, they serve as cellular gatekeepers, unlocking not just the painkilling properties for which opioids are prized, but the severe, addictive, and often lethal side effects that, in 2016, contributed to the deaths of more than 50,000 people in the US.

But it doesn't have to be that way. "The idea in the field for many years has been to make an opioid that provides beneficial analgesic properties without the harmful side effects," says pharmacologist Bryan Roth, a physician researcher at University of North Carolina School of Medicine. Design a drug that kills pain, not people.

To build that drug, though, researchers need to know the shape of its receptor. This week in the journal Cell, Roth and nearly two dozen of his colleagues report for the first time the structure of the kappa opioid receptor while it's bound to a drug molecule, a discovery that could accelerate the discovery of less-addictive—and less deadly—opioids.

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https://www.wired.com/story/scientists-just-solved-a-major-piece-of-the-opioid-puzzle/

The Quest for Safer Opioid Drugs | The Scientist Magazine

Opioid drugs are well-established double-edged swords. Extremely effective at analgesia, they cause an array of harmful side effects throughout the body, including itching, constipation, and respiratory depression—the slowed breathing that ultimately causes death in overdose cases. What's more, the body's interaction with opioids is dynamic: our receptors for these compounds become desensitized to the drugs' activity over time, requiring ever larger doses to suppress pain and eventually provoking severe dependence and protracted withdrawal.

In the past few years, these side effects have plagued growing numbers of US citizens, plunging the country into the throes of a devastating opioid crisis in which nearly 100 people die from overdoses every day. Even so, opioids are still among the most effective pain-relief options available. "Over hundreds of years, [opioid receptors] have remained a target," says Laura Bohn, a biochemist at the Scripps Research Institute in Jupiter, Florida. "Therapeutically, it works."

Since the early 2000s, intriguing evidence has emerged suggesting that opioids' useful properties could be separated from their harmful attributes. (See "Pain and Progress," The Scientist, February 2014.) In 2005, Bohn, then at the Ohio State University College of Medicine, and colleagues showed that shutting down one of the signaling pathways downstream of the opioid receptor targeted by morphine not only amped up the drug's painkilling effects in mice, but also reduced constipation and respiratory depression (J Pharmacol Exp Ther, 314:1195-201).

That research opened the door to developing a new type of opioid: a "biased agonist" that could trigger analgesia without tripping the switches on other pathways that cause side effects. Now, more than a decade later, Trevena Inc.'s Olinvo (oliceridine)—a drug based on this principle and designated by the US Food and Drug Administration (FDA) as a breakthrough therapy—has completed Phase 3 clinical trials.

Olinvo is just one of many such drugs under development. From compounds that act only in specific regions of the body to those that engage multiple receptor types, researchers and pharmaceutical companies are trying many different tactics to produce less-dangerous opioids.

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https://www.the-scientist.com/?articles.view/articleNo/51159/title/The-Quest-for-Safer-Opioid-Drugs/