Pain

On Monday morning, Stanford pain expert Sean Mackey, MD, PhD, will deliver a lecture at the National Institutes of Health on the role of neuroimaging in understanding pain. The talk will begin at 6 a.m. Pacific time and be webcast live here.

This year’s featured speaker for the annual Stephen E. Straus Distinguished Lecture in the Science of Complementary and Alternative Medicine, Mackey will discuss how neuroimaging offers insight into the key mechanisms involved in how the brain processes and perceives pain as well as forms neural connections. Additionally, he’ll talk about the role of neural reward systems in regulating pain and the future potential for non-pharmacological strategies to reduce the experience of pain.

To find out more about how pain fundamentally alters the nervous system and about the latest advances in pain research and treatment, listen to this recent 1:2:1 podcast with Mackey.

Previously: Stanford’s Sean Mackey discusses recent advances in pain research and treatment, Love blocks pain, Stanford study shows, Image of the week: Your brain on love and Stanford research provides insight on pain, love

I’ve written before about a quandry facing many new parents: Should they put a bumper in their baby’s crib or not? Now comes from the definitive answer from American Academy of Pediatrics: No. In case you haven’t heard the news this morning, the organization is now saying bumpers should never be used. CNN.com reports:

This recommendation, issued as part of an updated and expanded set of guidelines on safe sleep and SIDS prevention for babies, is the first time the AAP has officially come out against the use of crib bumpers. According to the AAP, there is no evidence that crib bumpers protect against injury, but they do carry a potential risk of suffocation, strangulation, or entrapment because infants lack the motor skills or strength to turn their heads should they roll into something that obstructs their breathing.

Previously: Pediatric experts: Skip the bumper in Baby’s crib

The day I turned 60, I hiked up to a place in Yosemite called Cloud’s Rest. It’s nearly 10,000 feet tall, with some very big boulders to boot. I was grateful that all that time I spent in the gym and on local trails prepared me for the 15 miles I trod that day. My aging feet were safely supported in well-cushioned hiking boots.

Back in the real world, professional attire does not allow comfy hiking boots to substitute for the youthful fatty padding my vintage bones have lost through nature’s wear and tear. When I read recently about some new, biomechanically-engineered, arthritis-assuaging shoes designed by Tom Andriacchi, PhD, at Stanford’s BioMotion Lab – and available at retail stores – I stood up and cheered. Another option to maintain my mobility!

Andriacchi, a world-class expert on gait and osteoarthritis, was persuaded by Laura Carstensen, PhD, founding director of the Stanford Center on Longevity, to apply his knowledge and creativity to the challenge of therapeutic footwear. She saw the opportunity to break out of the classic thinktank syndrome with a breakthrough bench-to-bedside project. She explains:

This is the poster child for us. There are an awful lot of important ideas that academics generate and then sit back and hope someone adopts. Most researchers are not trained to move ideas past the conceptual stage. What we do at the center is to show how and where those ideas can be useful. We help to move practical ideas, based on science, forward to a place where they can positively affect peoples’ lives.

On behalf of my age group and up, I am grateful for that thought.

Previously: Exercise may alleviate symptoms of arthritis regardless of weight loss

When I’ve got a pounding headache, I often reach for Advil because Tylenol just doesn’t work for me. My brother, on the other hand, swears by Excedrin. Over at Shots today Patti Neighmond reports on what he and I already know: Not all pain relievers are created equal. And we can chalk it up to biology, says Perry Fine, MD, president of the American Academy of Pain Medicine and a specialist at the University of Utah Pain Management Center:

“Human beings, person to person to person, are very different in the way they respond to drugs, and one size does not fit all.” In large part, that results from genetic differences in our pain receptors – the cells in our nervous system that recognize pain and transmit that message to the brain. Just slight differences in the chemical nature of the drugs we use affect people differently, depending on their genetic makeup, says Fine.

The story also looked at a review by Oxford University scientists of 350 recent studies involving 45,000 patients and their individual responses to different pain medications, and found that what worked best for some hardly affected others. And, because genetic tests for efficacy remain in the future, Fine says the best thing for patients to do now is to work with their doctor to identify some kind of pain relief regimen that is effective.

Previously: Stanford scientists work towards developing a “painometer”, Using philosophy to create a vocabulary of pain, No pain, no gain. Not!, Relieving Pain in America: A new report from the Institute of Medicine, Stanford’s Sean Mackey discusses recent advances in pain research and treatment and Oh what a pain

According to the Centers for Disease Control and Prevention, nearly one in two Americans suffers from at least one chronic disease that affects their daily lives. Diseases such as fibromyalgia, arthritis, and diabetes are often referred to as invisible illnesses because the pain many patients feel is not visually apparent.

So what can a person do to get through the pain without feeling so defeated? Lisa Copen, founder of Rest Ministries and National Invisible Illness Week (which is happening now), shares some tips on Huffington Post on how to cope. My favorite? Number 3, where Copen says to “search for the joy in your blessings:”

Instead of dwelling on thinking about how badly you feel, find ways to bring more joy into your life, even if it’s just appreciating the small things. Explore what makes you happy and what you are doing when your natural adrenaline seems to take over some of the fatigue, and you have extra energy. That’s likely where your passions are!

Focus on bringing more of this into your life. And don’t let your limitations stop you. For example, maybe you once loved to garden. Now you could grow a few potted flowers or hire a neighborhood teenager to plant some vegetables and set up an automatic sprinkler system for them. You could even start a garden consulting business. Think beyond what you once did, but find ways to replicate the things you love in new ways.

I think this is something we can all apply in our often busy lives – whether we have an invisible illness or not.

Via @teaminspire
Previously: Rules for living with a chronic illness and Patients with rare diseases share their extraordinary stories
Photo by Caitlinator 

About two years ago, Stanford neurologist Sean Mackey, MD, PhD, was asked by defense lawyers in a workman’s compensation case to serve as an expert witness. A man, burned by chemicals at work, wanted compensation from his employer for chronic pain, and his attorney was attempting to use brain scanning evidence to prove that his client was in chronic pain. Functional magnetic resonance imaging scans of his brain showed heightened activity in a network of regions associated with pain. But the question was, did this prove he was in pain?

According to Mackey, definitely not. The case was settled out of court.

“I was very critical of the findings,” Mackey recently told me. “In fact, they had not proven that this person had chronic pain. He may well have been in chronic pain, but current technology could not determine this.”

That experience helped spark Mackey’s interest in working toward finding technology that could someday achieve such a goal. Now, a study based on work from Mackey’s lab has taken a first step toward the development of a diagnostic tool that would use patterns of brain activity to give an objective physiologic assessment of whether someone is in pain.

The press release I wrote about the study, which was published online in PLoS One today, specifies that this is preliminary research and that much more needs to be done before the creation of a usable “painometer.” But early results are promising:

Researchers took eight subjects, and put them in the brain-scanning machine. A heat probe was then applied to their forearms, causing moderate pain. The brain patterns both with and without pain were then recorded and interpreted by advanced computer algorithms to create a model of what pain looks like. The process was repeated with a second group of eight subjects.

The idea was to train a linear support vector machine — a computer algorithm invented in 1995 — on one set of individuals, and then use that computer model to accurately classify pain in a completely new set of individuals.

The computer was then asked to consider the brain scans of eight new subjects and determine whether they had thermal pain.

“We asked the computer to come up with what it thinks pain looks like,” co-author Neil Chatterjee said. “Then we could measure how well the computer did.” And it did amazingly well. The computer was successful 81 percent of the time.

Such a tool, which could possibly be useful someday in a court of law, has long been sought after by physicians, Mackey told me. The current method of “self-reporting” – when doctors ask patients to rank their pain on a scale of 1-to-10 – is limiting, he said. Too many patients, especially the very young and the very old, have difficulty communicating pain. “Wouldn’t it be great if we had a technique that could measure pain physiologically?” he asked.

Previously: Using philosophy to create a vocabulary of pain, No pain, no gain. Not!, Relieving Pain in America: A new report from the Institute of Medicine, Stanford’s Sean Mackey discusses recent advances in pain research and treatment and Oh what a pain
Photo by El Gran Dee

Today’s Portland Tribune has a feature on Beth Darnall, PhD, an Oregon Health & Science University pain researcher who uses mirror therapy and other unorthodox techniques to trick patients’ brains into rejecting pain. It’s fascinating stuff: Daily sessions involving staring at mirror images of two healthy limbs helped ease the pain of amputees with phantom limb pain in a study; ten out of 40 participants reported major pain reduction. It worked, Darnall explains in the piece, because the brain “had permanently reorganized itself to believe there was no reason to feel pain.” And the beauty of the therapy, she says, is that “it’s cheap, it has no side effects and no doctor’s prescription.”

Stanford’s Sean Mackey, MD, PhD, who uses imaging techniques to help people control the areas of the brain that manage pain, also weighs in:

Work of researchers such as Darnall will be critical, Mackey says. He notes that a recent Institute of Medicine report on the state of pain found that 160 million Americans suffer from chronic pain — but there are only a few thousand pain specialists nationwide.

“Clearly there are not enough specialists to practice this,” Mackey says. “We have to translate this knowledge into information more people can use to self-manage their pain. That’s the only way we’re going to be effective.”

Previously: Using philosophy to create a vocabulary of pain, No pain, no gain. Not!, Relieving Pain in America: A new report from the Institute of Medicine, Stanford’s Sean Mackey discusses recent advances in pain research and treatment and Oh what a pain

For people suffering from back pain, there’s about a 25 percent chance the culprit is a herniated disc, commonly known as a slipped disc, which occurs most often in the lower back. While the condition generally gets better within six months, it can be quite painful, resulting in soreness in the legs and rear end. Physicians often try to relieve this pain with a steroid injection in the spine, but according to Stanford orthopaedic surgeon Gaetano Scuderi, MD, there’s only about a 50 percent chance this approach will work.

“Most people figure, ‘Hey, I have nothing to lose,’” Scuderi recently told me. “However, there is a significant expense, not to mention the procedural risks and lost productivity.”

In a study appearing in the Aug. 15 edition of Spine, Scuderi and colleagues show how they identified a unique protein complex that may signal whether a patient will respond to an epidural steroid injection. As I write in a press release, testing for this biomarker could offer several advantages to patients:

If patients with lower-back pain could be screened to determine whether they would respond to the injections, they could be spared the discomfort and cost of a futile procedure, Scuderi said, as well as its potential complications, such as bleeding, infection and thinning and even death of bone tissue.

This research involved 26 patients, and the authors say larger trials are needed.

Photo by planetc1

I’m not much of a golfer. I played the back nine at the Palo Alto Golf Course about a decade ago – my first and last foray into the sport. What stands out from that experience, aside from the dull whistling sound of whiffing the ball with a borrowed 5-iron, is the unpleasant twang I would feel in my right elbow when I connected with it. Adding insult to injury, the ball would then either loft with more height than distance or skid mercilessly across the grass – a shot that I later discovered actually has a name: worm burner.

While I’m unlikely to pick up clubs again soon, a study published today in the Journal of Applied Biomechanics, which I’ve written about in a release, could help duffers on the two fronts I struggled with: injury prevention and distance.

Jessica Rose, PhD, and her fellow Stanford researchers analyzed the rotational biomechanics of 10 professional golfers and found that key parts of their swings were “highly consistent, highly correlated to [club speed at impact with the ball], and appear essential to golf swing power generation among professional golfers.”

The study’s authors also note that, among amateurs, golf injuries to the lower back, shoulders, elbows and wrists are largely caused by improper swing biomechanics. They go on to say that “a precise understanding of optimal rotational biomechanics during the golf swing may guide swing modifications to help prevent or aid in the treatment of injury.”

Photo of golfer Zack Miller by David Gonzales

Women suffering from fibromyalgia may find some welcome relief in yoga. A new study from York University in Toronto shows that practicing yoga boosts levels of the stress hormone cortisol, helping ease some of the symptoms, which include pain, fatigue, muscle stiffness and depression. Low cortisol has been tied to fibromyalgia, and this study is the first to look at the effect of yoga on levels of this hormone.

For the study, which appears in the Journal of Pain Research, the researchers followed a group of women who practiced 75 minutes of hatha yoga twice a week. After eight weeks, saliva samples revealed elevated levels of cortisol. Women also reported significant reductions in both physical and psychological symptoms. Kathryn Curtis, the study’s lead author, explains more in a release:

“We saw their levels of mindfulness increase – they were better able to detach from their psychological experience of pain,” Curtis says. Mindfulness is a form of active mental awareness rooted in Buddhist traditions; it is achieved by paying total attention to the present moment with a non-judgmental awareness of inner and outer experiences.

“Yoga promotes this concept – that we are not our bodies, our experiences, or our pain. This is extremely useful in the management of pain,” she says. “Moreover, our findings strongly suggest that psychological changes in turn affect our experience of physical pain.”

Previously: Study shows yoga may improve mood, reduce anxiety, Gentle yoga provides benefits for cancer patients and Book explores use of yoga to combat pain
Photo by lululemon atletica

Much like the people at the beginning of this video, I’ve often had difficulty describing my aches and pains to my doctor. And because pain is such a subjective experience, it can also be challenging for physicians to evaluate and prescribe effective treatments to help their patients.

Recognizing the need to develop a vocabulary of pain, University at Buffalo psychiatrist Werner Ceusters, MD, has turned to ontology – a branch of philosophy concerned with the nature of being or existence. He explains how in a release:

“The philosophical definition of ontology is the study of things that exist and how they relate to each other,” says Ceusters… “I am a person and you are a person so we share something. Suppose I drop dead. What lies on the floor? Is that still a person? If it is no longer a person, is it still the very same thing that was sitting here as a person but now is a corpse?”

Ceusters says that in much the same way, definitions of pain and especially of chronic pain need to be much more precise; ontology provides methods of distinguishing among categories and describing data in uniform and formal ways.

Werster, who said his goal is to create a software program that will allow pain doctors to “express themselves in crystal clear terms,” is discussing his research at this week’s International Conference on Biomedical Ontology.

Previously: No pain, no gain. Not!, Relieving Pain in America: A new report from the Institute of Medicine, Stanford’s Sean Mackey discusses recent advances in pain research and treatment and Oh what a pain

I’m a wimp when it comes to headaches, as anyone who’s witnessed my mad preemptive scramble through my trusty purse-full-o’-aspirin at the first glimmer of brain pain can confirm. For those who live with frequent or chronic headaches, the pain can be debilitating. Thanks to a new Stanford clinic, relief may be in sight.

Despite the occasional publicity and the fact that headaches cost America $30 billion per year in lost productivity, the complexity and many possible causes of headaches means they often go disregarded and misunderstood by physicians. Patients seeking help are sometimes passed off as drug seekers or treated with unhelpful narcotics. There’s a reason “headache” is synonymous with “hassle.”

Hoping to offer a more holistic, interdisciplinary approach to a complex problem, reknowned headache expert Robert Cowan, MD, will be joining Stanford Hospital & Clinics as director of its new headache clinic. The clinic will employ specialized nurses and physicians with a background in headache care, as well as a number of other specialists to help cover all the headache bases. According to a news release:

What is effective, Cowan said, and what Stanford will offer, are “physical therapists who understand that people with migraines are sensitive to touch, psychologists who understand that a migraine can be a physical manifestation of stress, nutritionists who understand that it’s not just what you eat, but when you eat it, and sleep experts who recognize more than sleep apnea.”

The program, which will open on July 28, aims to treat headache disorders like migraines as chronic conditions, offering long-term treatments and alleviation rather than temporary fixes and drugs. The headache clinic will join Stanford’s other pain-focused centers as part of an effort to take a holistic approach to a disabling problem.

Previously: A multidisciplinary approach to GI pain and No pain, no gain. Not!
Photo by Kingray

A new program at Stanford Hospital & Clinics is taking a multidisciplinary approach to help ease the pain of those suffering from a gastrointestinal disorder. The Gastrointestinal (GI) Pain Program brings together GI specialists and experts from the Stanford Pain Management Center, creating what pain expert Ravi Prasad, PhD, calls the best of both worlds:

Both sets of specialists, in pain management and in GI, can share and apply their intimate knowledge of their fields in a formal structure. We have a multidisciplinary conference about each patient; we all talk about the case together; we reach a consensus. It’s a much richer experience and result than just reading each other’s notes in the electronic medical record.

A recent report by the Institute of Medicine revealed that more than 100 million Americans suffer from chronic pain, and it called for a cultural transformation in how our society views and treats chronic pain. Prasad says the new program responds to the challenges detailed in that report:

Patients can feel lost in the system. People were getting helped, but that lack of communication was distressing. Now, when they know that their providers are talking with each other, they’re a lot more satisfied. You can feel like you’re getting the runaround when you’re shuttled back and forth.

You can read more about the program in this Stanford Hospital release.

Previously: No pain, no gain. Not! and Relieving Pain in America: A new report from the Institute of Medicine

I consider myself very lucky. I am not one of the more than 110 million Americans who experience chronic pain every year. In the past, when I have had neck pain from daily lap swimming, it consumed me. It was all I could think of 24/7.  I remember how generally bad I felt both physically and emotionally. I was completely drained and not easy to live with.    

So it is astounding to consider that more than a third of the nation’s population walks around feeling lousy all of the time from pain. I think one of the main obstacles that prohibits treating pain effectively is that we’ve been taught from an early age to just suck it up. From that perspective pain is  just the price of being alive. That’s just plain nonsense. 

A new report from the Institute of Medicine doesn’t quite see it that way either. The study concludes that pain costs the economy a boatload of money -$635 billion annually. The IOM reported back in record time – their work began after Thanksgiving in 2010 – and concluded that pain is a major public health problem in America.

I spoke to Philip Pizzo, MD, dean of Stanford’s medical school and chair of the IOM panel, about the work of the committee and why pain is undertreated in the United States. Pizzo has seen pain from two perspectives, professionally and personally.  He tells me in my latest 1:2:1 podcast:

Pain does takes a toll, and I’ve witnessed it in the patients I’ve cared for, in my own personal life, and particularly in the lives of members of my family who  every day have a new reckoning in terms of how to accommodate the insults of pain and make the best of one’s life accordingly.

Something this significant and far reaching won’t be easy to solve. Culture change may be the biggest obstacle to recognizing and effectively treating pain. The report calls on Medicare, Medicaid, worker’s compensation programs, and private health plans to find ways to cover interdisciplinary pain care.  Because of the size of the problem and the “significant toll on individuals and society,” the report concludes, “pain warrants a higher level of attention and resources within the National Institutes of Health.”

I know there’s a lot on the federal government’s table right now. Yet pain shouldn’t be dismissed as insignificant or peripheral to overhauling health care. It’s part of the puzzle. And it’s clear that it’s time to deal with this major public health problem.

Previously: Relieving Pain in America: A new report from the Institute of Medicine

A paper published today in Science Translational Medicine revealing the molecules that make sunburns hurt may provide insight into potential treatments for chronic pain.

In the study, researchers from King’s College London used UV light to sunburn small areas on some very brave volunteers’ bodies. They then measured levels of  CXCL5, a molecule belonging to a family of proteins that recruit inflammatory cells to injured tissue, in both sunburned and non-sunburned areas. The researchers tracked CXCL5 levels alongside the amount of pain that volunteers reported in the sunburned areas. The correlation between levels of pain and levels of CXCL5 suggested that the inflammation triggered by this molecule is responsible for most of the sunburn’s painfulness. Researchers noticed that an antibody that neutralizes CXCL5 reduced pain in sunburned areas.

Researchers hope that their discoveries will help generate an analgesic treatment not only for painful sunburns, but also for other disorders resulting in chronic pain or inflammation.

Previously: Relieving Pain in America: A new report from the Institute of Medicine, Elliot Krane discusses the mystery of chronic pain and Researching ways to “heal the hurt”
Via Futurity
Photo by re-ality