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Anesthesiology, In the News, Technology

From “abstract” to “visceral”: Virtual reality systems could help address pain

From "abstract" to "visceral": Virtual reality systems could help address pain

Can you imagine a world wherein video games are good for your health? A piece on CNNMoney.com notes that advances in virtual reality (VR) have made headsets more affordable, and that applications for the technology, on the cusp of being available for home use, could extend beyond entertainment and into the realms of health sciences, finance and more.

From the piece:

“Virtual reality transforms relationships that tend to be abstract to become visceral,” says Jeremy Bailenson, [PhD,] director of Stanford University’s Virtual Human Interaction Lab. “Our research has shown that making this cause and effect relationship perceptual, as opposed to theoretical, changes consumer and other behaviors more than other interventions.”

VR can be an effective tool even where cause and effect are not obvious. In a collaboration with Stanford’s Department of Anesthesia, Bailenson used the technology to place children with chronic regional pain syndrome (CRPS) — a disease characterized by severe pain, swelling, and changes in the skin — in virtual simulations that divert their brains from unpleasant physical therapy and treatment. The children use computer-generated doubles known as avatars, a fixture in VR environments, to perform a simple exercise like popping balloons, distracting them from processing pain signals.

University of Washington researchers have developed a similar form of therapy known as SnowWorld, in which patients concentrate on throwing snowballs at penguins and mastodons to the music of Paul Simon, rather than focusing on painful wound and burn treatments. The technique is so effective, the researchers say, that it has reduced the need for strong narcotics and other addictive painkillers.

Previously: Can Joe Six-Pack compete with Sid Cyborg?Ask Stanford Med: Neuroscientist taking questions on pain and love’s analgesic effects and Can behavioral changes in virtual spaces affect material world habits?

Anesthesiology, Neuroscience, Pain, Stanford News

When touch turns into torture: Researchers identify new drug target for chronic, touch-evoked pain

When touch turns into torture: Researchers identify new drug target for chronic, touch-evoked pain

I admit it: I’m a baby when it comes to the smallest bruises. But I do feel guilty about fussing over papercuts when I hear about people with tactile allodynia, a chronic pain condition where the slightest touch can cause searing pain.

Allodynia, meaning “other pain,” refers to pain from things that shouldn’t normally hurt. For people with tactile allodynia, or touch-evoked pain, simple needs like a hug or a soothing breeze can turn into nightmares. Everyday activities such as brushing their hair or putting on a shirt can hurt. They can certainly kiss their NFL dreams goodbye.

Treating such chronic pain is tricky, because the root cause is not a wound that can be patched up with a Band-Aid. The culprit is often a damaged nerve or nerve circuit, leading to a mix-up of pain and touch signals, and fooling the brain into misreading touch as being painful.

Painkillers such as morphine haven’t been very effective at quelling this particular type of pain so far. That’s because they may have been targeting the wrong nerve cells all along, researchers here reveal.

Their recent article in the journal Neuron describing the finding points out that the nerve cells, or neurons, that control this type of pain are different from the usual pain neurons that morphine-based drugs target.

In my Inside Stanford Medicine story, I describe how the finding can help drug companies develop the right drugs to treat this type of chronic pain. Senior author of the Neuron article, assistant professor of anesthesiology and of molecular and cellular physiology Gregory Scherrer, PhD, and colleagues, zero in on specific binding sites on these neurons that drugs can target in order to cut off their signal and numb the pain.

Because the underlying nerves spread through the skin, topical creams or skin patches carrying the right drug would work quite well to reduce the pain, the authors say.

In the story, Scherrer also explains why drug companies gave up on such drugs before, and how his research could now help these companies successfully develop drugs to help patients with this type of pain.

Previously: Do athletes feel pain differently than the rest of us?Toxins in newts lead to new way of locating pain and On being a parent with chronic pain 

Anesthesiology, Pain, Research, Stanford News

Stanford researchers address the complexities of chronic pain

Stanford researchers address the complexities of chronic pain

If you’re in a reading kind of mood today, I highly recommend feeding it with a recent STANFORD Magazine feature on chronic pain and some of the research Stanford scientists are conducting to address it.

Chronic pain is usually defined as lasting longer than six months, the article notes, and may be present in 30 percent of adults in the United States. Owing to causes such as complex regional pain syndrome, arthritis, fibromyalgia, migraines or persistent lower back pain, many people turn to opioid medications, which can be addictive. The article notes some stunning statistics, such as this one – “More Americans are now dying as a result of prescription opioid overdose than from cocaine or heroin overdose.”

And this one: “In addition to the cost in human suffering, chronic pain costs the United States more than half a trillion dollars annually in direct medical expenses and lost productivity, according to a 2011 Institute of Medicine report (chaired by former School of Medicine dean Philip Pizzo, MD). This is more than the cost of heart disease and cancer combined.”

The article details research at Stanford working to understand the location and physiology of certain types of chronic pain, as well as to help patients overcome the lingering negative emotional effects it may produce.

Sean Mackey, MD, PhD, chief of the division of pain management at Stanford and a professor of anesthesia, said in the article, “When pain becomes persistent, it can become a disease in its own right.”

Previously: Retraining the brain to stop the painExploring the mystery of painMore progress in the quest for a “painometer and Ask Stanford Med: Neuroscientist responds to questions on pain and love’s analgesic effects

Anesthesiology, In the News, Technology

Advances in anesthesia make it possible for patients to remain awake and watch TV during surgery

579365935_5547cbdb96_zTired of hearing negative stories about the mind-numbing effects of television? Take heart, and read this BBC News story about the increasing number of patients that are given the option to remain alert and watch TV while they are being operated on.

As the story explains, it’s now possible for patients to receive a spinal anesthetic – so they feel no pain – and remain conscious during surgery. For patients that choose this form of anesthetic for their surgery, television offers a familiar and entertaining distraction from the medical procedure.

From the BBC News story:

“I feel fine, I can’t feel a thing and I’m watching Match of The Day.”

That was the perspective of 57-year-old patient Paul Eaton during his hip replacement operation at the orthopaedic hospital, one of the UK’s leading centres of excellence in its field.

While consultant surgeon Richard Spencer Jones cut, sawed and hammered during the hour-long hip replacement, Mr Eaton watched football highlights on iPlayer, via the hospital’s wi-fi network.

The benefits of using a spinal anesthetic (as described above) over a general anesthetic include: a faster recovery time, fewer instances of post-operative sickness and a shorter hospital stay.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: Researchers gain new insights into state of anesthesia
Photo by Kolya

Aging, Anesthesiology, Neuroscience, Orthopedics, Research

Researchers look at brain activity to study falling

Researchers look at brain activity to study falling

5089256378_bb06d1562dFalling down is an inevitable hazard of walking, even for a seasoned runway model. Basketball players practice taking a charge and modern dancers learn fall and recovery techniques, but what about those who are at greater risk of injury upon impact, such as older adults?

Researchers from the University of Michigan School of Kinesiology are working to understand why the elderly suffer more serious falls than younger people. In a recent study published in the Journal of Neurophysiology, scientists used an electroencephalogram to watch the electrical response in different regions of the brain before and during a fall to determine which parts first identify the fall.

The study used EEG on healthy young adults, who walked heel-to-toe on a balance beam attached to a treadmill, and who were able to continue walking without injury if they fell off the beam.

From a release:

[Lead researcher Daniel Ferris, PhD] and colleagues then used a method called independent components analysis to separate and visualize the electrical activity in different parts of the brain. They found that people sense the start of a fall much better with both feet on the ground.

The researchers were surprised that so many different parts of the brain activate during a fall, and they didn’t expect the brain to recognize a loss of balance as early as it does.

Future studies comparing the elderly with younger subjects could determine if the elderly sense falls too late, in which case, pharmaceuticals might help them regain their balance. If it’s a simple motor problem such as muscles not responding properly, strengthening exercises could help.

Photo by aurélien

Anesthesiology, In the News, Neuroscience, Pediatrics, Research

Study suggests early-childhood anesthesia exposure may affect the brain

Study suggests early-childhood anesthesia exposure may affect the brain

Research published this week in Pediatrics takes a newly rigorous approach to investigating whether anesthesia exposure harms young children’s developing brains. The results suggest that even a single anesthesia exposure before age 3 could hurt kids’ language skills and abstract reasoning abilities.

Earlier studies, including those in animals, had suggested that anesthesia drugs harm young brains, but none had taken such a direct approach to the question as the new paper. In the latest study, Columbia University’s Caleb Ing, MD, and colleagues studied a group of 2,608 Australian children, 321 of whom received anesthesia at least once before age 3. At age 10, the children’s cognitive function was rigorously tested. Scores for skill in expressive language (the ability to form words and sentences) and receptive language (understanding what others say) were both lower in children who had been exposed to anesthesia than those never exposed, as were abstract-reasoning scores. Motor skills, behavior, and visual tracking and attention were not different between the groups.

In a Healthland entry on the research, Ing cautioned that more work is needed to clarify the new findings:

While the exposed children showed deficits in language and reasoning, the researchers were not able to determine whether that effect was due to the anesthesia or to the underlying medical condition that required surgery in the first place. But Ing notes that anesthesia was the likely influence on brain development, since most of the infants who were exposed had had relatively minor procedures, including tonsillectomy, insertion of ear tubes to drain infections and circumcision; only a small percentage needed operations for more serious heart problems or neurological conditions.

Still, says Ing, “At this point there is not enough evidence to show a causal link between anesthesia and deficits. It’s concerning in the sense that we should continue to pursue research to answer this question. I don’t think we should change our practice; we still need to do a lot more research before causing too much alarm.”

Although many uses of anesthesia can’t be avoided, the research could help scientists and physicians figure out what cognitive problems to watch for in children who have had anesthesia, as well as how to remedy them, the Healthland post concludes.

Previously: Researchers gain new insights into state of anesthesia

Anesthesiology, Global Health

A brief look at the global anesthesia crisis in developing countries

In a recent KevinMD.com entry, Kelly McQueen, MD, discusses the critical shortage of anesthesiologists in developing nations. I know that anesthetics and equipment are in short supply in various parts of the world, but I had no idea how bad the situation could be in low-income nations:

Many are unaware of the global anesthesia crisis in low-income countries around the world. Some countries have less than one physician per 10,000 people and even less than one anesthesiologist per 100,000 people. The ability to provide safe anesthesia for surgery, labor and delivery, and other procedures, as well as for acute and chronic pain, is nearly absent in many countries.

She later writes:

According to a 2010 Lancet article, 2 billion people are without access to emergency and essential surgery worldwide, and 34 million anesthetics are delivered annually in low-income countries without the standard safety equipment needed or a trained provider.

Those are absolutely shocking numbers.

Anesthesiology, Cancer, History

A 60-year-old missionary recounts a mastectomy in 1855

Today Letters of Note is featuring a fascinating letter from Lucy Thurston, a 60-year-old missionary living in 1855 Hawaii, in which she recounts undergoing a mastectomy without anesthesia. Writing to her daughter, she describes how the procedure began:

Thus instructed, and everything in readiness. Dr. Ford looked me full in the face, and with great firmness asked: “Have you made up your mind to have it cut out?” “Yes, sir.” “Are you ready now?” “Yes, sir; but let me know when you begin, that I may be able to bear it. Have you your knife in that hand now?” He opened his hand that I might see it, saying, “I am going to begin now.”

The rest of the letter isn’t for squeamish readers, but it does provide a fascinating look at 19th-century medicine. Reading it will make you very thankful for modern anesthesiology.

Happily, Thurston lived for many years after her mastectomy: “And here is again your mother, engaged in life’s duties, and life’s warfare.”

Photo of Lucy Thurston is in the public domain

Anesthesiology, Applied Biotechnology, Research

Developing contact lenses to deliver anesthesia

In an effort to reduce the pain felt after eye surgery, scientists at multiple institutions are working to create contact lenses capable of supplying anesthetic medication at a consistent rate. As CNET reports, a team of researchers at University of Florida have made a notable advancement in the area and have identified a way to extend the time of release of anesthetics delivered by the lenses. Elizabeth Armstrong Moore writes:

The trick, chemist Anuj Chauhan and colleagues report in the journal Langmuir, is vitamin E.

By adding “highly hydrophobic” vitamin E aggregates to silicone hydrogel lenses for distribution of three commonly used anesthetics post-surgery, they found that the aggregates acted as barriers; by not interacting so readily with water on the surface of the eye, this barrier was able to extend the release time of the anesthetics from just a few hours to multiple days.

This isn’t the first time contact lenses have been used to distribute drugs, or even that vitamin E has been used to slow the release of drugs in lenses. But it is an early sign of success for the specific anesthetics used following laser eye surgery.

Photo by eyesogreen

Anesthesiology, Cardiovascular Medicine, Videos

Video offers an anesthesiologist’s view of the heart

Thanks to an entry over at Boing Boing, I’ve just finished watching this great video offering an anesthesiologist’s view of the heart. It was produced by The Guardian as part of its video series about heart health and cardiovascular medicine. The video centers on Bruce Martin, who talks about how he anesthetizes patients for heart surgery. (One other minor point: The video shows a Final Cut “media offline” message for a few seconds around 2:55, but the rest of the video is fine.)

Via Boing Boing

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