Pain

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.

Popular Science reports:

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.

Previously: Researchers turn to mosquito to design painless needle
Photo by Indiana Public Media

In support of National Take Back Prescriptions Drugs Day on Saturday – April 28 – physicians and law-enforcement officials are asking patients to help prevent pill abuse and theft by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs. Old medications can be brought for disposal to designated “Take Back” collection sites around the country.

From a Stanford Hospital release:

“Storing unwanted prescription drugs at home or disposing of them in the trash or down the toilet may seem harmless, but the reality is that by doing so you could be putting the health of your family at risk and potentially releasing hazardous chemicals into our environment,” said Sean Mackey, MD, PhD, chief of the Pain Management Division at Stanford Hospital and associate professor of anesthesia at Stanford University School of Medicine. “I urge all patients to put safety first by taking their old drugs to their nearest collection site.”

Organized by the Drug Enforcement Agency in partnership with state and local law enforcement agencies, the service is free and anonymous – no questions asked. The public can find a nearby collection site by visiting www.dea.gov, clicking on the “Got Drugs?” icon and following the links to a database, where they enter their zip code.

This initiative addresses a vital public safety and public health issue. Medicines that languish in home cabinets are highly susceptible to diversion, misuse and abuse. Rates of prescription drug abuse in the United States are alarmingly high, as are the number of accidental poisonings and overdoses due to these drugs.

…

Last October, Americans turned in 377,080 pounds – 188.5 tons – of prescription drugs at over 5,300 sites operated by the DEA and nearly 4,000 state and local law enforcement partners. In its three previous Take Back events, the DEA and its partners took in almost 1 million pounds – nearly 500 tons – of pills.

Previously: Report shows over 60 percent of Americans don’t follow doctors’ orders in taking prescription meds
Photo by Thirteen of Clubs

Attention hikers, skiers, campers, mountain climbers and anyone aspiring to visit Denver or Tibet: A study published today in the Annals of Emergency Medicine finds that ibuprofen may help to prevent acute mountain sickness, also known as altitude illness or hypobaropathy.

The condition often occurs when people first find themselves at altitudes of roughly 8,000 feet or higher. Symptoms feel like a “really nasty hangover,” Grant Lipman, MD, told me. The Stanford Hospital & Clinics emergency medicine physician led the double-blind, placebo-controlled study of 86 men and women, who ascended 12,570 feet into an area of the White Mountains northeast of Bishop, Calif.

In my press release about the study, I discuss some of the findings:

Of the 44 participants who received ibuprofen, 19 (43 percent) suffered symptoms of altitude sickness, whereas 29 of the 42 participants (69 percent) receiving placebo had symptoms, according to the study. In other words, ibuprofen reduced the incidence of the illness by 26 percent.

Photo by bobwitlox

Stanford neuroscientist Sean Mackey, MD, PhD, recently took questions about pain research and the analgesic effects of love as part of our ongoing Ask Stanford Med feature. Mackey began his responses with a message for everyone who submitted questions: “I would like to first complement the participants for their interest and their insightful questions. There is clearly a strong interest out there in pain – a condition that affects us all without discrimination.”

Below he responds to a selection of questions submitted using the hashtag #AskSUMed, an @reply to the @SUMedicine feed or the comments section on Scope.

Nandini asks: Does romantic love actually work as a painkiller? Or, does it just distract the person from feeling pain?

Romantic love actually does work as an analgesic. We were concerned when performing our study about the very issue you raise – that passionate love was simply acting as a distraction. To control for this, we added in an additional task that involved distraction. This was a well-adopted mental word generation task that involved, for example, having the subject “think about every sport that doesn’t involve a ball.” It turns out that this is a very distracting task and fairly well established.

What we discovered is that both romantic love and distraction work very well to reduce pain. In fact, they reduced both moderate and severe pain equally well. And, this fact that they work equally well played to our favor during our analysis. What was particularly exciting was that while distraction and love worked to about the same magnitude they both involved much different brain systems. Distraction engaged higher-level outer cortical brain systems that have been well established in previous research. However, love engaged very deep-seated brain and brainstem systems that are involved with our basic hungers, drives and cravings. These brain systems (nucleus accumbens and ventral tegmentum) are rich in dopamine neurotransmitters. So, in conclusion, love does affect like a painkilling drug.

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Updated 4:15 pm: In his ongoing effort to push for a public health campaign to battle our country’s pain epidemic, Philip Pizzo, MD, dean of the School of Medicine, traveled to Washington D.C. to speak before the U.S. Senate Committee on Health, Education, Labor & Pensions today.

During the hearing, Pizzo highlighted the results of last June’s Institute of Medicine Committee report on pain, which concluded that the effective treatment of pain demands a “cultural transformation” on the part of patients, physicians and researchers. Pizzo chaired the committee that issued the report.

The total costs of treating pain are higher than the costs of cancer, cardiovascular diseases and diabetes put together, while the treatments still leave many patients suffering needlessly. In order to battle this epidemic, the government needs to support a public health campaign that includes improving education of providers, patients and communities, Pizzo and his co-authors concluded.

“The magnitude is simply astounding,” Pizzo told the committee. While the report focused on the public health implications of this epidemic and recommendations for change, the authors also understood that “it’s the individual human impact of pain that underscores why this is such an important issue…”

The effect on the individual was brought into stark focus by speaker Christen Veasley, an advocate for pain research who had a near-fatal accident 15 years ago and has suffered from residual back and neck pain ever since.

“For many of us, we wake up and the first thing we feel is pain,” she said. “It feels like you live with a veil over your face. As patients, we’ve been left completely disillusioned… This report has brought us renewed hope.”

Also testifying were John Sarno, MD, professor at New York University School of Medicine and William Maixner, PhD, director of the Center for Neurosensory Disorders at the University of North Carolina at Chapel Hill.

Previously: A call to fight chronic-pain epidemic and Relieving Pain in America: A new report from the Institute of Medicine

When you ask someone to describe the physical sensation of love, chances are you’ll get an answer like falling head-over-heels, having butterflies in the stomach or walking on sunshine. As it turns out, and as described in a recent Stanford study, those intense, consuming feelings of love can do more than make you happy: They appear to block pain in ways similar to painkillers or illicit drugs.

In honor of Valentine’s Day, we’ve asked Sean Mackey, MD, PhD, senior author of that study, to respond to your questions about the analgesic effects of love – and he’s happy to answer general questions about pain research, too.

Mackey’s research is focused on explaining the mechanisms of pain perception and control using neuroimaging techniques such as virtual reality and functional magnetic resonance imaging (fMRI). He has shown that chronic pain sufferers may be able to reduce pain levels by studying their own live brain images, and he is working with colleagues to develop a diagnostic tool that uses patterns of brain activity to give an objective assessment of whether someone is in pain. He also recently served on an Institute of Medicine committee that issued a report calling for coordinated, national efforts to tackle the chronic-pain epidemic.

To submit your questions to Mackey about the pain-relieving effects of love and the science of pain, send an @reply message to @SUMedicine and include the hashtag #AskSUMed in your tweet. (Not a Twitter user? Then please submit a comment below.) We’ll collect questions until Friday at 5 pm. In submitting questions, please abide by the following ground rules:

• Stay on topic
• Be respectful to the person answering your questions
• Be respectful to one another in submitting questions
• Do not monopolize the conversation or post the same question repeatedly
• Kindly ignore disrespectful or off topic comments
• Twitter handles and/or names may be used in the responses

Medical school experts taking questions on the @SUMedicine feed will answer a selection of the questions submitted, but not all of them.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: A call to fight chronic-pain epidemic, Stanford scientists work towards developing a “painometer”, Stanford’s Sean Mackey discusses recent advances in pain research and treatment, Relieving Pain in America: A new report from the Institute of Medicine, Long-term love may dull pain, study shows, Love blocks pain, Stanford study shows and Oh what a pain
Photo by Ryan Weisgerber

Findings recently published in the journal Obesity offer new insights into the link between obesity and chronic pain.

In the study (subscription required), researchers analyzed responses from 1,010,762 men and women who answered health survey questions during a telephone interview by the Gallop Organization between 2008 and 2010. Participants’ body mass index (BMI) was calculated based on questions regarding their height and weight. Respondents also answered questions about pain, such as if they “experienced pain yesterday.” Science Daily reports:

Sixty three percent of the 1,010,762 people who responded to the survey were classified as overweight (38 percent) or obese (25 percent). Obese respondents were further classified into one of three obesity levels as defined by the World Health Organization. In comparison to individuals with low to normal weight, the overweight group reported 20 percent higher rates of pain. The percent increase of reported pain in comparison to the normal weight group grew rapidly in the obese groups: 68 percent higher for Obese 1 group, 136 percent higher for Obese 2 group, and 254 percent higher for Obese 3 group.

Researchers suggested several explanations for the close relationship between obesity and pain including: the possibility that having excess body fat triggers complex physiological processes resulting in inflammation and pain; depression, often experienced by obese individuals, influences pain; and medical conditions that cause pain, such as arthritis, might result in reduced levels of exercise leading to weight gain.

Although more study is needed, the findings are notable and add to the evidence showing that overweight patients are at greater risk for chronic pain.

Previously: More than three-quarters of Americans projected to be overweight, obese by 2020, Behavioral therapy for weight loss may also benefit family members, Study finds family members of weight-loss-surgery patients also shed pounds, Stanford researchers, clinicians and academics gather for Obesity Summit 2, Study shows U.S. obesity rates will expand over next 40 years and Experts weigh in on the most effective approach to fighting obesity
Photo by Tony Alter

Working in media relations, I always get excited when one of our studies gets so much attention in the press. That was certainly the case this week, when oodles of reporters and bloggers wrote about a Stanford study of electronic medical records that found women reported more-intense pain than men may in virtually every disease category. (My only beef? The few headlines that implied that women “can’t handle pain.” That was not one of the findings – and if it were the case, babies would cease to be born!)

If you haven’t heard much about the study, or are interested in the topic of pain, this Forum show is one to listen to. Study co-author Martin Angst, MD, was one of the guests, and he and two other pain experts (including Stanford’s Sean Mackey, MD, PhD) discussed the findings and examined the causes and treatments for pain.

Previously: Women report feeling more pain than men, huge EMR analysis shows, A call to fight chronic-pain epidemic, No pain, no gain. Not!, Relieving Pain in America: A new report from the Institute of Medicine, Elliot Krane discusses the mystery of chronic pain, Researching ways to “heal the hurt”, Stanford’s Sean Mackey discusses recent advances in pain research and treatment and Oh what a pain

I’ve mentioned before that I rarely wear flat shoes. Even two pregnancies couldn’t get me to abandon my heels: I pulled on a pair of Skechers before heading to the hospital to deliver my daughters, but I can’t remember reaching for them before that. (I considered this a sort of badge of honor at the time; in retrospect it was probably pretty foolish.)

A few studies have shown that wearing high heels may lead to pain and knee and joint problems, but as Gretchen Reynolds writes on Well today, whether these shoes “affect the wearer’s biomechanics and injury risk has received scant scientific attention.” In her piece, she discusses a new Australian study that found wearing heels “may compromise muscle efficiency in walking” and may increase the likelihood of strain injuries. And she offers advice from Neil J. Cronin, PhD, the researcher who led the work, for readers who can’t kick (sorry, couldn’t resist) their heel habit:

So, if you do wear heels and are at all concerned about muscle and joint strains, his advice is simple. Try, if possible, to ease back a bit on the towering footwear, he says. Wear high heels maybe “once or twice a week,” he says. And if that’s not practical or desirable, “try to remove the heels whenever possible, such as when you’re sitting at your desk.” The shoes can remain alluring, even nestled beside your feet.

Previously: Do pretty shoes lead to ugly problems?, Study links high heels to osteoarthritis and joint problems and Ouch! How high heels can shrink leg muscle, cause pain
Photo by NessieNoodle

Although electronic medical records, or EMRs, are used only by about one percent of hospitals in the U.S. today, they are routinely produced and updated during patient visits to two Stanford-affiliated hospitals. Stanford’s nurses have been rigorously trained in the importance of reporting these patients’ pain - typically in the form of scores on a scale of 0 to 10 (where “0″ means “none at all” and “10″ means “the most imaginable”) – on those EMRs.

Henry Lowe, MD, director of Stanford’s Center for Clinical Informatics, and his colleagues have found a way to aggregate all of this clinical data into a searchable database that researchers can use, if they get approval.

Using de-identified patient data from EMRs, Stanford information-systems maven Atul Butte, MD, PhD, retrieved some 160,000 pain reports from over 72,000 patients, corrected for various confounders, crunched the numbers, and came up with an astonishing result: Across the board, for virtually any given disease men and women both get, women report higher pain scores than men do.

Not only is this difference statistically significant, it’s clinically significant: “In many cases, the reported difference approached a full point on the 1-to-10 scale,” Butte told me. “How big is that? A pain-score improvement of one point is what clinical researchers view as indicating that a pain medication is working.”

Butte, et al.’s results (described in this release) were just published in The Journal of Pain.

Okay, let’s get this out: Do women actually feel more pain than men, or do they just (to say it tactfully) report it more readily? That question, which husbands and wives have been arguing about for at least a few millennia, is unanswerable on the basis of this study.

Butte and his colleagues, however, are going to try to get to the bottom of it. They intend to rifle through those EMRs again to see if they can find any objectively measurable factor that correlates highly with reported pain.

Previously: A call to fight chronic-pain epidemic, How light exercise can help prevent arthritis from getting worse and Study shows poor sleep may increase risk of fibromyalgia among women
Photo by University of Salford