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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

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

Aging, Health and Fitness, Orthopedics, Pain, Research

Exercise programs shown to decrease pain, improve health in group of older adults

Exercise programs shown to decrease pain, improve health in group of older adults

LASHER ILICEvery time I read about research on the benefits of exercise, I become eager to go outside and run. (Or, realistically, take a pleasant walk.) But before I do that today, I wanted to share a study showing that participating in an exercise program led to a decrease in pain from arthritis and other musculoskeletal conditions, as well as an improvement in mobility and overall health, among a group of older adults.

The research, which was presented today at the American Public Health Association Annual Meeting in Boston, involved 119 adults of Asian descent – most of them female and age 65 or older – living in New York City. Participants took part in multiple eight-week yoga exercise classes and sessions of the Arthritis Foundation Exercise Program between 2011 and 2013. The community-based classes were conducted by the Hospital for Special Surgery‘s Asian Community Bone Health Initiative using bilingual instructors at senior centers in the Chinatown, Flushing and Queens neighborhoods.

A release explained why the researchers focused on Asian adults:

The Asian older adult population in New York City grew by 64 percent from 2000 to 2010, and one in four seniors lived in poverty in 2010. “This population is at risk for osteoarthritis and osteoporosis,” said Laura Robbins, DSW, senior vice president of Education and Academic Affairs at HSS. “They are more than twice as likely to have no health insurance coverage compared to other major race and ethnic groups. Cultural and linguistic barriers limit access to healthcare services.”

And as for results:

In the survey, many participants reported that their pain intensity dropped and interfered less with their quality of life. The following statistically significant results are noteworthy:

  • 48% fewer participants had pain on a daily basis after completing the program
  • 69% more participants could climb several flights of stairs after the program
  • 83% more participants could bend, kneel, or stoop
  • 50% more participants could lift/carry groceries
  • 39% of participants felt the program reduced their fatigue
  • 30% participants felt that the program reduced their stiffness

Previously: Exercise is valuable in preventing sedentary deathModerate physical activity not a risk factor for knee osteoarthritis, study showsResearchers look at brain activity to study falling and Help from a virtual friend goes a long way in boosting older adults’ physical activity
Photo by ASSOCIATED PRESS

Chronic Disease, Pain

Letting go of control during chronic illness or pain

A friend who recently had inpatient surgery on her sinuses texted that she was on a 10-day yoga time-out. And no pranayama, either, of course, because the practice requires deep, deliberate breathing. This is a big deal for someone who’s yoga-obsessed! She put her furlough in perspective: “I can barely stand.”

When you’re feeling lousy, sometimes it’s extra hard to forgo your normal sources of pleasure and calm. In a recent post on KevinMD.com, patient Toni Bernhard, JD, writes about lessons she’s learned from her body and provides guidance for others dealing with chronic pain or illness.

Bernhard the patient has replaced her healthy law-professor self’s to-do list with a “not-to-do list” that includes willing her body to accomplish things it’s warning her to skip. Instead, she recommends to other patients, be kind to your present self and honor the body you have, exercise caution when considering a risky new treatment, and let go of what won’t serve you – such as a frozen image of your pre-illness self. (Sounds a lot like yoga, even on a time-out.)

Previously: Fibromyalgia – living with a controversial chronic disease“Live Because:” Living a fuller life with chronic illnessWhen you say nothing at all: Living with an invisible illness and Study shows poor sleep may increase risk of fibromyalgia among women
Via @dennisjboyle

In the News, Pain, Research, Science

Along came a spider: Spider venom could be the basis for a non-addictive pain blocker

Along came a spider: Spider venom could be the basis for a non-addictive pain blocker

spiderI like reading and writing so all of the spiders in my house are exceptionally well-read. I think. They’re all buried under a pile of books so it’s hard to tell.

But now I feel a sharp twinge of remorse for flattening so many of my eight-legged housemates after reading this story on the Eek Squad blog. Spider venom, as the blog explains, may provide humans and their companion animals with a non-addicitve way to block pain.

From the blog:

Pain usually means something is wrong, but for people suffering from chronic pain — like from arthritis, cancer or other illnesses — powerful pain blockers are the only thing that help.

While most pain relief drugs take a shotgun approach, venom-based molecules can zero in on a single channel or enzyme. Though this evolved for the more nefarious purpose of subduing and paralyzing prey, it could also stop pain in its tracks. Researchers are still trying to figure out how to tweak spider venoms to avoid affecting heart function and other muscles, however.

The benefits of spider venom extend beyond pain relief in people. Dr Maggie Hardy at the University of Queensland in Australia is working on spider venom-based treatments for your pets, too.

Researchers, such as Greg Holland, PhD, of Arizona State University, are also making headway by studying the molecular structure of spider venom. “Structure directly relates to how something functions, so in order to understand its function, you have to solve its structure,” Holland explained in this Inside Science TV story.

At this point, spider venom-based pain blockers are not yet available for humans or their pets.

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: Another big step toward building a better aspirin tabletRetraining the brain to stop the painA physician’s personal odyssey with chronic painFibromyalgia – living with a controversial chronic diseaseVexing venom delivered on the web, and Exploring the mystery of pain
Photo by cheetah 100

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