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Chronic Disease, Events, Pain, Stanford News

Stanford expert on back pain: “The important thing for people to know is that it’s treatable”

BackPainSeptember is Pain Awareness Month and later this month, Stanford will host a Free Back Pain Education Day. The event, sponsored by the Division of Pain Medicine, offers community members the opportunity to come to campus and hear about current back pain management strategies and the latest research. The event will also be live-streamed via YouTube for people unable to make it in person.

In anticipation of the Sept. 13 event, I sat down with Beth Darnall, PhD, a pain psychologist at Stanford’s Pain Management Center, and one of the day’s speakers. I was interested to understand why back pain is such a critical health problem worldwide and what people living with back pain can do to manage their pain.

Back pain is a leading cause of disability in the U.S. and other countries. Why is chronic back pain so common?

I think there are many different reasons why back pain is the number one pain condition. The back seems to be the place that’s really most related to the development of chronic pain and debility from chronic pain. Pregnancy can either trigger or flare back pain, but there are a multitude of reasons: aging (there is degeneration of the spine), obesity (when people gain weight, it puts additional load on the spine), activity levels, and influence of posture. Dr. Sean Mackey will be talking about some of the reasons why back pain is the most prevalent pain condition in the world at the event.

[Back pain] is something that almost everyone will experience at some point in their lifetimes, so it’s really relevant to all of us, whether we have pain now or not.

Why have a community event about back pain now?

There has been increasing global and national attention to chronic pain in terms of its impacts and costs to society. In the United States alone, 100 million suffer from pain on a regular basis, and that is associated with costs of $635 billion dollars annually. That includes treatment costs and loss of productivity.

What we also know is that the incidence and prevalence of chronic pain has been increasing, despite the fact that theoretically, we have better treatments. So then the question is why. While we have a multitude of treatments available, we haven’t been focusing on back pain as comprehensively as we really should. We need a broader approach to the treatment of pain. This was recently outlined in the National Institute of Health’s National Pain Strategy (Note: Mackey co-chaired the oversight committee).

Some people may be under the misconception that the best way to treat back pain is simply with a pill… While medication can be one helpful component, the best way to treat back pain is with a comprehensive approach that involves self-management strategies.

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Addiction, Aging, Chronic Disease, Pain

National survey reveals extent of Americans living with pain

National survey reveals extent of Americans living with pain

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Yesterday, the NIH announced a new analysis of data that examined how much pain people in America suffer. The findings, published in The Journal of Pain, were based on data from the 2012 National Health Interview Survey (NHIS), an annual survey that asks a random sample of U.S. residents a wide variety of questions about their health.

The survey results are staggering: More than half of the adults in the country (126 million) had some kind of pain, minor to severe, in the three months before the survey. About 25 million had pain every day for that time frame and about 40 million suffer from severe pain. Those with the worst pain were also most likely to have worse health in general, use more health services and have more disabilities.

The survey also looked at complementary medicine approaches people take to dealing with their pain. Natural dietary supplements topped the list, followed by deep breathing and physical exercise such as yoga, tai chi or qi gong.

Joseph Briggs, director of the National Center for Complementary and Integrative Health was quoted in an article about the new study in the Washington Post:

The number of people who suffer from severe and lasting pain is striking. . . This analysis adds valuable new scope to our understanding of pain … It may help shape future research, development and targeting of effective pain interventions, including complementary health approaches.

Another topic the WaPo article touched on, which we’ve written about here at Scope, is the link between chronic pain and prescription painkiller abuse:

The prevalence of chronic pain in America also lies at the root of an ongoing epidemic of prescription painkiller abuse. Since 1999, according to the Centers for Disease Control and Prevention, the amount of painkillers such as oxycodone and hydrocodone sold in the United States has nearly quadrupled.

Here at Stanford, the Division of Pain Medicine is sponsoring a free back pain education day on Saturday September 13. You can find out more details here.

Previously: Assessing the opioid overdose epidemicChronic pain: Getting your head around itFinding relief from lower back pain and Stanford researchers address the complexities of chronic pain
Photo by Steven Depolo

Behavioral Science, Genetics, Neuroscience

Wishing for a genetic zodiac sign: How much can genes really tell us about personality?

Wishing for a genetic zodiac sign: How much can genes really tell us about personality?

Brain MRIGiven all the recent news on how gene expression influences our brain, from Alzheimer’s to addiction and even our personalities, readers might come away thinking that we’re close to breaking the code and using genetics to understand why we behave the way we do. But, things aren’t that simple.

In a post on the science blog Last Word on Nothing, Eric Vance explores what getting your personal genetic sequence means for your personality – something he calls, tongue-in-cheek, “a genetic tarot card.”

Vance delves into an explanation of one specific mutation in the COMT gene. The gene creates an enzyme that neutralizes dopamine, a neurotransmitter. The gene comes in two forms, and the difference in these two forms is just one base-pair, the individual links in our DNA code. One version of the resulting enzyme is efficient at clearing away extra dopamine. But if the gene codes for the other version, “then the enzyme becomes a wastrel… Work piles up and the brain accumulates a bunch of extra dopamine.”

Because dopamine is such a powerful regulator of mood, and by extension personality, Vance then describes, in surprising detail, personality types he expects people with either version of the gene to have. But genetic information like this is meant to be used at the population, not personal, level. In fact, none of the people in his circle of friends who have had their genome sequenced turns out to be who he expects them to be (which begs the question, how many people does he know who’ve had their DNA sequenced?). Disappointed, he laments:

But that’s not how I want it work. While I don’t like the idea of boiling human emotions down to a couple squishy turning gears, I do like how tidy it is. I want to be able to look up my genome and make broad generalizations about myself. I want to have a genetic tarot card that I can inspect and say “ohhh, that’s why I always forget people’s names” or “that’s why I got in that fight in the third grade.”

Vance concludes, “But that’s not what nature gave us. Nature has given us messy, confusing and vastly complicated brains.” We are more, it turns out, than the sum of our base pairs.

Previously: New research sheds light on connection between dopamine and depression symptoms

Photo by deradrian

Aging, Ask Stanford Med, Chronic Disease, Neuroscience, Women's Health

Exploring Alzheimer’s toll on women

Exploring Alzheimer’s toll on women

Julianne Moore AlzheimersIn last year’s “Still Alice,” Julianne Moore’s portrays a woman beset by early-onset Alzheimer’s Disease. It’s fitting that the academy-award winning film (Moore garnered a Best Actress award for her role) about Alzheimer’s features a woman as the central character because the illness disproportionately affects women.

The BeWell@Stanford blog recently featured a Q&A with Stanford neurologist and Alzheimer’s researcher Michael Greicius, MD, MPH about Alzheimer’s and women. The piece covers the effects of the disease, but I was intrigued to read about the challenges for caregivers of people with the disease (who are also disproportionately women):

Most of the caregivers of people with Alzheimer’s Disease are women. Do you have any advice for them in terms of how they can take care of themselves while taking care of a loved one with the disease?

This gets to the damned-if-you-do, damned-if-you-don’t aspect of AD and women. On the one hand, women are more likely to develop AD; on the other hand, they are also more likely to find themselves as the primary caregiver for someone with AD. It is now well known that caring for someone with AD has a powerful, negative impact on physical and emotional well-being. Particularly as the disease progresses and patients require more care, there is a large physical toll taken when, for example, having to lift patients out of a chair or off the toilet or out of bed. Sleep becomes fractured for the patient. which means it becomes fractured for the caregiver.

Some of the questions also dealt with the fact that despite the recent advances in Alzheimer’s research, we still don’t completely understand how the disease works or how it can be prevented:

What can we do to reduce our risk for developing the disease?

We do not know of anything that definitely reduces a person’s risk of developing Alzheimer’s, although there is strong data to suggest that regular aerobic exercise and a heart-smart diet will reduce risk. Head trauma is an important risk factor for AD and another type of dementia, so minimizing exposure to head trauma can also reduce risk of AD. Numerous companies make explicit or implicit claims about their “nutraceutical” or vitamin or “brain-training” software being able to stave off AD. None of these claims are true and most, if not all, of these purveyors are modern-day snake-oil salesmen and saleswomen.

But Greicius is optimistic and pointed out that Stanford recently became an NIH-sponsored Alzheimer’s Disease Research Center, which means we can build upon Stanford’s past “ground-breaking Alzheimer’s research.”

Previously: Are iron, and the scavenger cells that eat it, critical links to Alzheimer’s?Alzheimer’s forum with Rep. Jackie Speier spurs conversation, activismScience Friday explores women’s heightened risk for Alzheimer’s and The toll of Alzheimer’s on caretakers
Photo by Maria Morri

Health Policy, Pediatrics, Research, Sleep

Rethinking middle and high-school success: strategies for creating healthier students

Rethinking middle and high-school success: strategies for creating healthier students

512px-Sleeping_while_studyingMy daughters are still years away from college or even high school, but I’m not looking forward to the high-pressure arena that they look to be from afar. The stress and lack of sleep has to take a toll on students’ health. I was curious, then, to hear about a program developed by researchers from Stanford’s Graduate School of Education called Challenge Success. The program helps parents and schools develop a more even-keeled approach to the high-pressure world that many college-bound middle- and high-schoolers find themselves in.

Last week, the program released Overloaded and Underprepared: Strategies for Stronger Schools and Healthy, Successful Kids, a book that gathers what researchers at Challenge Success have learned in the dozen years the program has been in place. The GSE’s website features a Q&A with two of the book’s authors: Denise Pope, PhD, EdM, a Stanford GSE lecturer and co-founder of Challenge Success, and Maureen Brown, Challenge Success Executive Director.

Below are some highlights of the interview, which is worth reading all the way through:

How are students overloaded today?

Pope: People assume with the new standards and requirements for college admission, that teachers need to cover more topics in class and that kids need to take more courses and do more activities in school and after school to meet expectations for success. This is a confusion between rigor and load. Rigor is real depth of understanding, mastery of the subject matter. That’s what we want. Load is how much work is assigned. Many educators and many parents assume that the more work you assign and the more work students do, the better they will understand it. That is not necessarily the case. For example, we have teachers who teach AP classes and cut their homework load in half, and the kids end up doing as well on the exam. You don’t have to do four hours of homework in order to learn something in depth or to retain it. But four hours of homework can be incredibly damaging physically and emotionally.

. . .

Who should read this book?

Pope: We started writing it for educators, to give a guide to those schools that couldn’t physically partner with us at Challenge Success. The goal was to compile our best practices. But after a little bit of writing, I handed it to my husband (who isn’t an educator) just to see if it made sense. He came back and said, ‘You know, I was really interested as a parent as to why a school would use a block schedule or why so many kids are cheating or what is the purpose of taking an Advanced Placement course.’ So we realized it was actually a book for a much broader audience of people who were interested in the research on some of these practices.

Brown: For example, if parents don’t understand the ‘why’ for certain policies or practices, they can’t help advocate for real systemic change. The book gives parents the ability to ask the right questions at their schools to understand why their school is going down a certain path.

Previously: Excessive homework for high-performing high schoolers could be harmful, study findsWith school bells ringing, parents should ensure their children are doing enough sleeping, Stanford expert: Students shouldn’t sacrifice sleep and Stanford researchers to study effectiveness of yoga-based wellness program at local schools
Photo by Psy3330 W10

Aging, Health Costs, Health Policy, Patient Care

A look back at Medicare’s 50 years

Hand in HandOn Friday, KQED’s Forum offered a look at Medicare and Medicaid to mark the programs’ 50-year anniversary. Stanford health policy researcher Laurence Baker, PhD, participated in the discussion, which covered issues such as how the programs drive the way prices for care are negotiated with medical providers, how the large population of Baby Boomers will affect the system, and how reimbursement rates affect the kind of care Medicare and Medicaid patients receive.

The panel also discussed the gaps in coverage — services like dental care are not covered by Medicare — and the challenges they create. Medicare coverage has grown from the narrow set of conditions it first covered, and Baker thinks the conditions are right to begin a new national conversation about expanding coverage:

One of the things that’s really ripe for discussion is how this country is going to handle the long-term care issues. Medicare’s got to be at the center of that. And it almost feels like the time is coming that we’re going to have to think about that much more seriously.

And when host Mina Kim asked Baker the question that’s on a lot of people’s mind — Is Medicare sustainable for the long term? — Baker noted:

The program is pretty important; it’s clearly something the country values across the political spectrum. Lots of people want to see it sustained. It may not be a pretty process. It might not be fun to watch the politics of how we work all this out, but there are lots of ways to keep the program solvent, so I’m optimistic.

Previously: Competition keeps health-care costs low, Stanford study findsWhat’s the going rate? Examining variations in private payments to physiciansCheck the map – medical procedure rates vary widely across CaliforniaMedicare payment reform shown to cut costs and improve patient care and KQED health program focuses on baby boomers and the future of Medicare
Photo by Garry Knight

Health Policy, Research, Stanford News

Exploring the link between patient-record fees and doctor switching

Exploring the link between patient-record fees and doctor switching

HCCH-medical_recordsWho owns your medical records – you or your doctor? If you answered that you do, you’re like most patients, according to a recent survey. But you would be wrong.

Legally, the doctors or hospitals who create medical records own them. Although federal law states they have to provide records to patients who request them at a reasonable cost, the definition of “reasonable” varies quite a bit. And that cost also has some surprising repercussions.

Three Stanford researchers – health economist Kate Bundorf, PhD, Laurence Baker, PhD, chief of health services research, and health and political economist Daniel Kessler, PhD, JD – examined the issue in a recent study in the American Journal of Health Economics. They compared rates of doctor-switching between states that have caps on medical-record copying fees and those that don’t.

The team found that patient record charges decreased the number of patients who switched doctors and that when there were caps on copying fees, more providers switched to electronic medical records. A Stanford GSB article described the findings in detail:

In states that imposed caps on fees for medical records, patients changed their primary doctors 11% more frequently and their specialty doctors 13% more frequently. In addition, the researchers found that health care providers were about 12% more likely to establish electronic medical records in states that imposed caps on copying fees.

The fact that more than 1 in 10 people would switch doctors if their records were easier to get means that copying fees matter. In addition, other research suggests that adoption of electronic medical records can significantly reduce mortality in complicated cases; to the extent this is correct, caps on copying fees not only enhance patient convenience but also save lives.

Kessler says the study suggests there is a good case for regulating the fees charged for medical records: “You can’t make it impossible for people to switch doctors. We know that can’t be the right direction.”

Baker agrees, telling me, “No one should have to feel like they’re stuck with a doctor when they’d like to switch. Policies that help people get reasonable access to their medical records look like they can help.”

Previously: Can sharing patient records among hospitals eliminate duplicate tests and cut costs?U.S. Olympic team switches to electronic health recordsA new view of patient data: Using electronic medical records to guide treatment and Do electronic health records improve health? It’s complicated
Image by Jackhsiao

Immunology, Nutrition, Stanford News, Videos

A Stanford dietician talks food sensitivities

A Stanford dietician talks food sensitivities

Ever wondered what the difference between a food allergy and a food sensitivity is? Neha Shah, MPH, RD, CNSC, a registered dietician at the Stanford Digestive Health Center, sheds some light in a new video.

In people with food allergies, she explains, the immune system responds to the presence of the food, which isn’t the case for food sensitivities. People with food allergies have to avoid the culprit foods entirely, whereas people with food sensitivities can sometimes have small amounts of the food – though they must figure out what their threshold is. (Too much and the offending food might set off other symptoms like gas, bloating or diarrhea.) Shah uses lactose intolerance as an example of a very common food sensitivity and describes how people can understand their threshold.

Previously: Peanut products and babies: Now okay?, Stanford dietitian explains how – not just what – you eat matters, Taking a bite out of food allergies: Stanford doctors exploring new way to help sufferers, Eating nuts during pregnancy may protect baby from nut allergies and Ask Stanford Med: Pediatric immunologist answers your questions about food allergy research

Behavioral Science, Neuroscience, Research, Stanford News

A not so fearful symmetry: Applying neuroscience findings to teaching math

A not so fearful symmetry: Applying neuroscience findings to teaching math

15415-symmetry_newsMany people grow up thinking of themselves as “not very good at math” after having struggled to learn abstract math concepts. Sometimes people hit their “math wall”— the point where math classes feel so complex that the subject becomes impossible to understand — in college, high school, or even earlier.

A team at the Stanford Graduate School of Education, led by Daniel Schwartz, PhD, might help young students avoid the math wall altogether. The researchers are using recent findings from neuroscience to explore how people learn core concepts in math and science. They recently published a study in the scientific journal Cognition and Instruction looking at how fourth-grade students learn about negative numbers and building on previous findings about our ability to process visual symmetry.

One of the new tools used in the study is described in a Stanford News article:

Students worked with a magnetic plastic strip that was numbered. To solve the problem 3 + -2, students attached three magnetized blocks to the right of zero and two blocks to the left of zero. The manipulative further included a hinge at zero, the point of integer symmetry. Students folded the two sides together, and the number of extra blocks on either side gave the answer, in this case +1. The hinge at zero helped students recruit their native abilities with symmetry, and the numbers on the little platform helped them coordinate the sense of symmetry with the symbolic digits.

The students taught with these new techniques were able to solve math problems involving negative numbers better than students taught using conventional teaching approaches; they built on the strategies they learned using the hands-on device. And:

As it turned out, students who learned to rely on symmetry didn’t simply do better than other students on the material they had just been taught. They also did better on topics that they hadn’t yet studied, such as making sense of negative fractions and solving pre-algebraic problems.

“The big difference was that the symmetry instruction enabled students to solve novel problems and to continue learning without explicit instruction,” said Schwartz.

Previously: Math and the brain: Memorization is overrated, says education expert, Building a bridge between education and neuroscience, Abstract gestures help children absorb math lessons, study finds, Peering into the brain to predict kids’ responses to math tutoring and New research tracks “math anxiety” in the brain
Photo courtesy of AAALab@Stanford

Addiction, Mental Health, Pain, Public Health, Technology

Student engineers unveil tamper-proof pill bottle

Student engineers unveil tamper-proof pill bottle

Pill-dispenserThe United States has been battling a prescription painkiller epidemic for years. The statistics from the Centers for Disease Control and Prevention are chilling: The number of painkillers prescribed has quadrupled since 1999; more than two million people abused painkillers in 2013; every day, 44 people die from a prescription opioid overdose.

In response, faculty at the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health issued a challenge to seniors in the university’s mechanical engineering program: build a pill bottle that would protect against theft and tampering.

One team of students came up with a design that worked so well that their team’s mentors Andrea Gielen, ScD, and Kavi Bhalla, PhD, submitted a proposal to the National Institutes of Health for further testing.

The device is about the size of a can of spray paint, much larger than the average pill bottle. It can only be opened with a special key, which pharmacists can use to refill with a month’s supply of OxyContin. A fingerprint sensor ensures only the prescribed patient can access the pills at prescribed intervals and doses. In a story on the Johns Hopkins website earlier this month, Megan Carney, one of the student engineers described how the pill dispenser works:

The device starts to work when the patient scans in his or her fingerprint. This rotates a disc, which picks up a pill from a loaded cartridge and empties it into the exit channel. The pill falls down the channel and lands on a platform where the patient can see that the pill has been dispensed. The patient then tilts the device and catches the pill in their hand.

A short video about the pill dispenser shows it in action, too. The dispenser still has to undergo additional testing, but the team hopes to bring it to market soon — and help prevent future opioid overdoses.

Previously: Unmet expectations: Testifying before Congress on the opioid abuse epidemic, The problem of prescription opioids: “An extraordinarily timely topic”, Assessing the opioid overdose epidemic, Why doctors prescribe opioids to patients they know are abusing them and Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse
Photo courtesy of Johns Hopkins University

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