Back in 2011, a study (subscription required) showing how a group of lab rats repeatedly freed their trapped friends (often even choosing to do so before eating a coveted snack) garnered a fair amount of media buzz. Researchers involved in the study said the findings suggested that empathy, driven by another’s pain, was not limited to humans and animals of higher intelligence but rather was widespread in the animal kingdom.
In the latest NeuroTalk podcast, Forrest Collman, PhD, interviews study co-author Peggy Mason, PhD, a neuroscientist at the University of Chicago, about the experiment. During the talk they discuss what led Mason to investigate empathy and helping behaviors, and whether she would free a friend at the expense of having to share a tasty treat.
A new method of using brain scans to determine whether a patient has chronic lower back pain proved successful 76 percent of the time in a new study from Stanford researchers. The work appears online today in the journal Cerebral Cortex (subscription required), and the hope is this new tool could someday provide an objective measurement for chronic pain, something akin to a “painometer.”
The new method uses advanced computer algorithms to analyze magnetic resonance imaging scans of the brain to provide an objective measurement of chronic pain. While not yet ready for primetime, its success so far makes it appear promising, according to Sean Mackey, MD, PhD, chief of the Division of Pain Medicine and senior author of the study. As he told me for the press release I wrote:
People have been looking for an objective pain detector — a ‘pain scanner’ — for a long time. We’re still a long way from that, but this method may someday augment self-reporting as the primary way of determining whether a patient is in chronic pain.
The need for additional methods for measuring chronic pain beyond the gold standard of self-reporting has long been acknowledged, particularly for the very young and very old who may have difficulty communicating. In a past story I wrote about a similar study by Mackey and colleagues, Hank Greely, JD, a Stanford law professor, said such a tool has the potential to be a “godsend” to the legal system.
How often have you heard someone complain of back pain? According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, it’s one of the most common medical problems, with about one-fourth of U.S. adults experiencing at least one day of back pain in a three-month period. In a new BeWell Q&A Jean Couch, author of The Runner’s Yoga Book and producer of the Your Pain Free Life DVD, offers some suggestions on coping and overcoming back pain.
Couch, who is the founder and co-director of the Balance Center in Palo Alto, attributes the prevalence of back pain in industrialized nations to long-term poor usage of our bodies:
We have lost our natural alignment. Most people think it is because we sit so much, but really there are people in other cultures who sit at looms or other workbenches for hours a day without collapsing the way we do. It really isn’t the sitting that is the biggest problem; it’s the way we sit that is killing us. A hundred years ago most people sat up-right; now people sit curved over, and it is this collapse that is ruining the spine. I hear myself saying all the time that this fashion of collapse is a cultural phenomenon, but the suffering is individual.
The rest of the Q&A is worth reading, and it includes one small change people that people can do to save their backs.“You have to sit on the bottom of your butt,” Couch says.
In a recent New England Journal of Medicine Perspective piece (subscription required), Stanford psychiatrist Anna Lembke, MD, explored why physicians today experience intense professional pressure to prioritize pain treatment above other competing clinical issues.
Lembke discusses her work more in-depth in a podcast posted today on the blog Substance Abuse 411. During the conversation, she touched on reasons contributing to prioritizing pain treatment above other competing clinical issues and offered recommendations to address such problems.
As an addiction psychiatrist, I was recently asked to consult on whether a patient hospitalized for severe low back pain suffered from opioid addiction. The odd thing about the consult was that it was obvious to even the casual observer that the patient was addicted to opioids: Her personal narrative was marked by the classic downward spiral of a drug-ravaged life, including loss of jobs, friends, family, and a recent near-death narcotic overdose; a “CURES” search, which allows authorized health care providers practicing in California to track prescriptions for controlled substances, revealed that in the past 4-5 weeks alone she had obtained prescriptions for more than 1,200 opioid pills; and two psychiatrists on two prior hospital admissions had already documented “opioid dependence”, the formal “Diagnostic and Statistical Manual of Mental Disorders” term for opioid addiction.
So why the repeat-consult to tell the primary team what they already knew? Because the patient’s treating physicians, albeit fully aware that opioids were destroying her life, were uncomfortable denying her opioids for pain and wanted validation that withholding opioids was an acceptable course of action.
As I describe in a New England Journal of Medicine Perspective piece (subscription required), physicians today experience intense professional pressure to prioritize pain treatment above other competing clinical issues. And the reasons are as much cultural and financial as related to the healing arts:
Patients now evaluate their doctors on customer satisfaction surveys which can influence professional advancement and national reputation, and doctors who deny patients’ requests for pain pills are likely not to get very good survey ratings.
Today’s cultural ethos of ‘all suffering should be avoided’ encourages patients to believe that any level of subjective pain is unacceptable, and that doctors have a responsibility to remove the pain, lest the patient, in addition to being in pain, is psychologically traumatized by having to experience pain.
Writing a prescription for opioids is fast, easy, and readily reimbursed by third-party payers, whereas targeting addiction requires time, is complex, and is seldom financially rewarded.
My article goes on the make some recommendations about how these problems might be addressed. But until there’s a cultural paradigm shift in which addiction is acknowledged by patients, doctors, and third-party payers as a disease that inflicts its own kind of suffering and demands its own treatment, the current national epidemic of prescription opioid abuse will continue.
Anna Lembke, MD, is an assistant professor of psychiatry and behavioral sciences at Stanford.
New research shows that opioid drugs, such as morphine, may activate an immune response that boosts addictiveness and that blocking a specific receptor may eliminate this immune-addiction response. The New Scientistreports:
[Australian researcher Mark Hutchinson, PhD, and colleagues] previously observed that opioids bind to TLR-4 – immune system receptors in the cell membrane – which are responsible for identifying foreign bodies. However, the team did not know how this binding affected the body.
In their latest study, the team found that the receptor acts as an amplifier of reward when opioids are bound to it. The team did a series of experiments looking at addictive behaviour in rats and mice that had been given either morphine alone, or a drug called plus-naloxone – which blocks the TLR-4 receptor – followed by morphine.
Rats given plus-naloxone before receiving morphine did not exhibit behaviour linked to addiction. Their brains also showed a significantly lower release of dopamine than in rats that only received morphine. Using a heat sensitivity test, the team also showed that the rodents given plus-naloxone still experienced pain relief from the morphine, despite lacking signs of addiction.
The researchers say clinical trials could begin within the next 18 months.
In some households, including mine, the excitement over the upcoming release of The Dark Knight Rises has clearly eclipsed Olympics mania. That’s why a Huffington Post conversation with Michael Leong, MD, clinic chief at the Stanford Pain Medicine Center, and his colleagues speculating on the purpose of Bane’s mask caught my attention.
Colin Liotta writes:
They believe the mask may have two components to it.
The first has to do with the type of painkilling drug Bane could use, and how he could store it in his vest. They said that Bane’s mask could allow him to breathe in lyophylized drug (freeze-dried), which he stores in pouches on his vest (like the ones in the pictures above). Dr. Leong said the drug could be “sublimated via an apparatus at the back of the head piece and turned into gas which is directed above the head to the mask, covering his nose and mouth. The kinds of pain alleviating medications could be an opioid (morphine-like substance), steroid, Nitrous Oxide, ketamine or combination of any of these analgesics.”
The team also had an interesting theory about the tube on the back of Bane’s neck. They said that looking at the tube in relation to Bane’s surgical scars, the tube could have a chemical Venom “infused in the intraspinal fluid which would account for his extreme tolerance of pain and possibly increased neurological function with the side-effects of behavioral changes – extreme aggression, maybe even delusions and paranoia.”
New Stanford research shows that disturbing side effects of opiates, such as nausea, slowed breathing and potential for addiction, may be strongly influenced by a patient’s genetics.
The study, which was published online today in Anesthesiology, was prompted by past genetic studies in animals that have shown a strong genetic component in the response to opiates. My colleague Tracie White describes the work and the Stanford team’s findings in a release:
Researchers recruited 121 twin pairs for the randomized, double-blinded and placebo-controlled study. Pain sensitivity and analgesic response were measured by applying a heat probe and by immersing a hand in ice-cold water, both before and during an infusion of the opiate alfentanil, a short-acting painkiller prescribed by anesthesiologists. The team also compared individual variations in levels of sedation, mental acuity, respiratory depression, nausea, itch, and drug-liking/disliking — a surrogate measure of addiction potential — between identical twins, non-identical twins and non-related subjects. This provided an estimate of the extent to which variations in responses to opiates are inherited. For example, the finding that identical twins are more similar in their responses to opiates than non-identical twins suggested inheritance plays a significant role.
Heritability was found to account for 30 percent of the variability for respiratory depression, 59 percent of the variability for nausea and 36 percent for drug disliking. Additionally, up to 38 percent for itchiness, 32 percent for dizziness and 26 percent for drug-liking could be due to heritable factors. An earlier study published by the same researchers [in March online in] Pain reported that genetics accounted for 60 percent of the variability in the effectiveness of opiates in relieving pain.
Martin Angst, MD, professor of anesthesia and one of two principal investigators for the study, commented on the significance of the findings saying:
The study is a significant step forward in efforts to understand the basis of individual variability in response to opioids and to eventually personalize opioid treatment plans for patients… Our findings strongly encourage the use of downstream molecular genetics to identify patients who are more likely or less likely to benefit from these drugs—to help make decisions on how aggressive you want to be with treatment, how carefully you monitor patients and whether certain patients are suitable candidates for prolonged treatment.
Among my childhood phobias, a fear of needles is the only one that continues to haunt me in adulthood. So I was interested to read that researchers at the Massachusetts Institute of Technology have developed a new gadget capable of delivering a tiny, high-pressure jet of medicine through the skin without the use of a hypodermic needle.
It’s similar to a normal syringe, except instead of a needle plunger, it uses a Lorentz force actuator, made from a magnet surrounded by a conductive coil. When a current is turned on, the magnetic field interacts with the current to produce a force. That force kicks a piston, which ejects a drug that has been embedded inside the capsule. The speed of the ejection and the depth it will reach can be controlled by altering the current.
To penetrate the skin, the ejection happens at ultra high speeds, almost equivalent to the speed of sound through air. The drug flows through an opening that’s about as wide as a mosquito proboscis, according to MIT News.
Researchers led by Ian Hunter and Catherine Hogan tested a prototype device with two different velocities: One can breach the skin and reach deep into tissue, and another can deliver drugs more slowly, so they can be absorbed by the skin. Different people would need different piston velocities …
While the device won’t be ready for the upcoming flu season, I take some comfort in knowing that the research on making injections less painful is progressing.