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Pain

In the News, Pain, Patient Care, Research, Stanford News

More attention, funding needed for headache care

More attention, funding needed for headache care

In case you missed it, the San Francisco Chronicle ran a story over the weekend on migraines – and researchers’ ongoing search for a cause and universal treatment. Robert Cowan, MD, director of the Stanford Headache Clinic, was one of the people featured and told writer Stephanie M. Lee:

Headache care is 50 years behind things like diabetes and cancer… It just hasn’t had the attention, hasn’t had the funding, in order to get to the answers we need.

Previously: Director of Stanford Headache Clinic answers your questions on migraines and headache disorders and New Stanford headache clinic taking an interdisciplinary approach to brain pain

Pain, Pregnancy, Stanford News, Women's Health

Study shows women prefer less-intense pain at the cost of a prolonged labor

Study shows women prefer less-intense pain at the cost of a prolonged labor

child_birthAs a friend’s due date approached, she confided in me that the thought of going into labor was terrifying. It was her first pregnancy and we debated at length the pros and cons of having an epidural for pain management. Her main concern, like others, was that the common method of pain relief could prolong labor. Recent findings have shown that an epidural can lengthen the second-stage of labor for more than two hours.

In the end, she decided her birth plan needed to be flexible and include the option of an epidural, regardless of how it may impact the length of her labor. New research shows many would agree. Brendan Carvalho, MBBCh, chief of obstetric anesthesia at Stanford and lead author of the study, told Reuters that “Interestingly, intensity is the driver” behind women’s labor preferences.

More from the article:

For the study, Carvalho and his colleagues gave a seven-item questionnaire to expectant mothers who had arrived at the hospital to have labor induced but were not yet having painful contractions. The women took the survey a second time within 24 hours of giving birth.

The questionnaire pitted hypothetical pain level, on a scale of zero to 10, against hours of labor.

A sample question asked, “Would you rather have pain intensity at two out of 10 for nine hours or six out of 10 for three hours?”

Both pre- and post-labor, women on average preferred less intense pain over a longer duration, according to results published in the British Journal of Anaesthesia.

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a baby
Photo by Mamma Loves

Chronic Disease, Orthopedics, Pain

Finding relief from lower back pain

lower back painIf you thought a pain in the neck was inconvenient, try on chronic lower back pain for size. (Just kidding – both sound uncomfortable.) In a recent article, Prevention magazine suggests easily administered treatments for the latter kind of pain. Tips include paying attention to your body by noticing if you pronate your feet, taking action by attending yoga classes, and winding down with massage or acupuncture sessions.

Recognizing that back pain’s sometimes intractable nature can cause stress in other forms, the piece continues:

No, the pain isn’t in your head. But what is in your head could be making it worse. “Fear, anxiety, and catastrophizing can amplify pain,” says [Stanford anesthesiologist Sean Mackey, MD, PhD]. “People often get swept up in thoughts like This will never get better.” Because brain circuits that process pain overlap dramatically with circuits involved with emotions, panic can translate into actual pain. Cognitive-behavioral therapy helps you recognize and reframe negative thoughts. Deep breathing can help, too, as can simply shining a light on dark thoughts. “Start by accepting that you have pain,” Mackey says. “Then say to yourself, It will get better.”

Previously: Stanford researchers address the complexities of chronic painExploring the mystery of painExploring the use of yoga to improve the health and strength of bones and Ask Stanford Med: Pain expert responds to questions on integrative medicine
Via @StanfordHosp
Photo by U.S. Army

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 

Pain, Sports, Videos

Do athletes feel pain differently than the rest of us?

Do athletes feel pain differently than the rest of us?

With five days left in the 2014 Winter Olympics, here’s an interesting question to ponder: Do athletes feel pain differently than the average person? As this recently posted ASAPScience video explains, athletes seem to have a higher pain tolerance, and researchers are still trying to determine if this is because of genetics, training or environment.

Previously: Stanford researchers address the complexities of chronic pain, Retraining the brain to stop the painExploring the mystery of pain and More progress in the quest for a “painometer

Pain, Research, Stanford News

Toxins in newts lead to new way of locating pain

Toxins in newts lead to new way of locating pain

newtYou have to love a medical story that starts with newts. Newt eggs to be precise. Back in the 1960s, a Stanford chemist Harry Mosher (who died in 2001) collected eggs from newts on campus and isolated a toxin that turned out to be identical to the one in puffer fish. (Note to self: avoid eating newts or newt eggs found on campus.)

Many decades later, those toxins he studied and variants thereof are widely used in medical research. They latch on to tiny pores on nerve cells and prevent those nerves from firing—seen as a negative if you are eating a pufferfish, but a positive to researchers working in a lab trying to understand the inner workings of nerves.

Recently, Stanford chemist Justin Du Bois, PhD, teamed up with radiologist Sandip Biswal, MD, who studies the origins of pain, to see if this group of chemicals could be used to better understand (and maybe one day treat) pain. I wrote a story about the work and described Biswal’s frustration diagnosing the source of pain:

Biswal, an associate professor of radiology at the Stanford University Medical Center, spent a lot of time imaging parts of the body where people said they felt pain, trying to find the source. It was a frustrating task because often the source of pain isn’t obvious, and sometimes the source is far removed from where a person feels the sensation of pain. Other times, he’d see something that looked painful, surgeons would fix it, and the patient would still be in pain.

Along with some other collaborators, Du Bois and Biswal figured out a way to manipulate the toxins Du Bois had been studying so that they would latch onto nerves that send pain signals and be visible outside the body. When they tested the chemical in rats, they were able to see the location of pain in a living animal.

As with so much cool research, the team got its start with a seed grant from Stanford’s Bio-X. They recently started a company to see if they could develop their work into a useful drug or imaging technique.

Previously: Stanford researchers address the complexities of chronic pain, Exploring the mystery of pain, More progress in the quest for a “painometer”, Ask Stanford Med: Neuroscientist responds to questions on pain and love’s analgesic effects
Photo by Jason Mintzer Shutterstock

Orthopedics, Pain, Parenting, Pediatrics

On being a parent with chronic pain

Mom3The Atlantic posted a moving piece today written by a mother whose severe scoliosis has left her body in a near-constant state of pain. The author, Rachel Rabkin Peachman, points to a recent review of scientific literature documenting how children of parents with chronic pain are affected by their mothers’ and fathers’ condition:

The results, published in the Journal of Child and Adolescent Psychiatric Nursing, are, well, painful to read. It turns out that children whose parents experience chronic pain are at increased risk for adjustment problems and behavioral issues, and are more likely to complain of pain themselves. The whole family suffers.

Peachman details some of the studies’ findings. She also describes her own history with pain and parenting, and discusses the times she was unable to pick up and soothe her crying daughter. She writes:

Science may say the odds are against parents with chronic pain. And I know there are days I’m sidelined and short-tempered. But I’m determined to raise children who feel supported, secure, and loved. I don’t know what my future holds—surgery, therapies, or a lifetime of pain. But I have to believe that despite a deteriorating body, it’s possible to be a successful mother.

The entire piece is worth a read.

Previously: Image of the Week: The agony of painStanford researchers address the complexities of chronic painLetting go of control during chronic illness or pain and Chronic illness in childhood: One patient’s story
Photo by Miki Yoshihito

Autoimmune Disease, Pain, Research

Rheumatoid arthritis patients fare better than 20 years ago, study reports

Some encouraging news about rheumatoid arthritis (RA), a systemic autoimmune disease that causes painful, swollen joints: A new study out of The Netherlands has shown that people recently diagnosed with the disorder have an easier time with daily functioning than patients who were diagnosed 20 years ago, as measured by levels of depressed mood, anxiety and physical disability associated with the condition.

Earlier diagnosis, prescription of physical exercise, and more aggressive drug interventions are responsible for patient improvements, according to the study, which was published in the journal Arthritis Care & Research. From a press release:

For the present study, researchers recruited 1151 with newly diagnosed RA between 1990 and 2011. Participants were 17 to 86 years of age with 68% being female. Each participant was assessed at the time of diagnosis and monitored for the following three to five years.

Findings indicate that after the first four years of treatment 20 years ago, 23% of RA patients reported anxiety, 25% depressed mood, and 53% had physical disability compared to 12%, 14% and 31%, respectively, today. The decrease in physical disability remained significant even after adjusting for reduced disease activity. Results suggest that the downward trend in physical disability, anxiety, and depressed mood may be due in part to reduced disease activity.

“Our study determined that currently, 1 out of 4 newly diagnosed RA patients are disabled after the first four years of treatment; while 20 years ago, that figure was higher at 2 out of 4 patients,” concludes [Cécile L. Overman, a Ph.D. Candidate with the Department of Clinical and Health Psychology, Utrecht University]. “Today, RA patients have a better opportunity of living a valued life than patients diagnosed with this autoimmune disease two decades ago.”

Previously: Important metabolic defect identified in immune cells of rheumatoid arthritis patientsMany lupus patients on Medicaid fail to take medication as prescribed, study shows and Collaboration between Stanford and UCSF aims to advance arthritis research

Ask Stanford Med, Complementary Medicine, Nutrition, Pain

Ask Stanford Med: Pain expert responds to questions on integrative medicine

Ask Stanford Med: Pain expert responds to questions on integrative medicine

rolfing2Sometimes the best medicine is staying healthy. As more Americans look for ways to improve their health, prevent disease and manage pain, the subject of complementary practices may enter more conversations between patients and physicians. So for this installment of Ask Stanford Med, we asked Emily Ratner, MD, clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to questions on integrative medicine. Her answers appear below.

As a reminder, these answers are meant to offer medical information, not medical advice. They’re not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and provide appropriate care.

Mary says: Please speak about the efficacy of integrative medicine to alleviate multi-point pain from a variety of causes (ITP, OA, aging). A relative has doctor fatigue as well, and is not interested in anything else.

Integrative Medicine (IM) may be defined as the combination of conventional and nonconventional modalities chosen by a patient and physician in a patient-centered decision-making process in order to achieve the best outcome for an individual. Patients often seek nonconventional modalities when conventional medicine techniques are unable to achieve a particular goal, often pain relief or pain management. As a general rule, multi- and inter-disciplinary measures are often most helpful in relieving suffering from pain. These may include five general categories of nonconventional modalities, although there is overlap amongst the different types:

  • Mind-body medicine: meditation, hypnosis, biofeedback, guided imagery, yoga
  • Biologically based practices: uses substances found in nature – herbs, foods, vitamins, supplements
  • Manipulative/Body-based practices – massage, chiropractic/osteopathic manipulation
  • Whole medical systems: Traditional Chinese Medicine (includes acupuncture), Ayurveda, naturopathy
  • Energy Medicine – Reiki, Healing/Therapeutic touch, Qi Gong, acupuncture, yoga

Depending on patient preference, available resources in the community and other factors, a decision is made where to begin. I often recommend acupuncture as a place to start, closely followed by a mind-body medicine technique, as my experience is that stress plays a large role in either pain or the perception of pain. However, it largely depends on the individual’s needs and preferences.

Scope Editor asks: A recent study of herbal products found that most of those examined contained contaminants, substitutions and unlisted fillers among their ingredients. What are the implications of these findings, and how can consumers protect themselves when buying supplements?

This is a significant issue that highlights the need for increased supplement regulation, although the study to which you refer has been criticized for some of its conclusions. While FDA regulations for supplements are a bit stricter than for foods, the regulations are far less comprehensive than those for pharmaceutical agents.

That being said, product contamination with heavy metals, undisclosed pharmaceutical agents (especially in products from outside the U.S.), and inaccurate product ingredient amounts plague this field.

Until improved regulatory procedures are instituted, I suggest looking at a reputable database that independently tests these products, such as ConsumerLab.com. This and other independent organizations add their seal of approval to product labels that have tested either the products or the manufacturing practice involved in production of the substance. Look for the Consumer Lab seal or other seals: cGMP (current Good Manufacturing Practice), USP (United States Pharmacopeia), or NSF (another independent lab).

Some experts note that specific stores have strict quality control for their products – like Sam’s Club, Costco, Whole Foods – but I typically look up each individual product on a database (I use consumerlab.com) prior to recommending it.

Another option is to consult with a trained Integrative Medicine practitioner who has access to these databases and is knowledgeable about these products.

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Image of the Week, Pain

Image of the Week: The agony of pain

Image of the Week: The agony of pain

Pain Image

As my colleague wrote about last week, the current issue of Stanford magazine includes a feature, “Make It Stop,” on the pain research happening here. The image above - in my mind, the perfect representation of intense, all-encompassing pain – accompanies the article and makes Kristin Sainani’s piece that much more compelling.

Previously: Stanford researchers address the complexities of chronic pain
Photo by Lukasz Szyszka

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