ScienceDaily (Feb. 7, 2010) — Scientists at the University of Liverpool have discovered that treating the immune system of patients with Complex Regional Pain Syndrome (CPRS) leads to a significant reduction in pain.
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CRPS is an unexplained chronic pain condition that usually develops after an injury or trauma to a limb, and continues after the injury has healed. CPRS I -- formerly called Reflex Sympathetic Dystrophy -- can arise after any type of injury. CRPS II, previously called causalgia (a term coined in the American Civil War when it was first diagnosed), follows partial damage to a nerve. In some cases the pain can be so severe that patients request amputation, only to find that the pain returns in the stump.
CRPS pain can improve within one year after the injury, but if it is still unchanged after 12 months (longstanding CRPS), then it will often not improve at all. Longstanding CRPS affects about 1 in 5,000 people in the UK.
The team at the Pain Research Institute discovered that a single, low dose infusion of intravenous immunoglobin (IVIG) significantly reduced pain in just under 50 per cent of patients treated, with few adverse effects. The pain relief lasted on average 5 weeks. The results of this study may change the future treatment of patients with CRPS, and have an impact on research in other severe chronic pain areas. Intravenous immunoglobulin treatment for CRPS is currently not available on the NHS.
Although the cause of the syndrome is unknown, precipitating factors include injury or damage to the body's tissue. Changes in the way nerves send messages to the brain about pain may occur at the injury site. These changes may then lead to more changes in the nerves of the spinal chord and brain. All these changes are thought to play a role in causing and prolonging the condition. Conventional pain drugs either don't work, or have considerable side effects.
Dr Goebel, Senior Lecturer in Pain Medicine, explains: "In CRPS, the real effect of this treatment in clinic may turn out to be even greater than what we have already seen, because IVIG can be given in higher doses, and repeated treatment may have additional effects. IVIG is normally repeated every four weeks and we are working to develop ways which would allow patients to administer the treatment in their own home."
"The discovery is expected to have a real impact on the treatment of other unexplained chronic pain conditions; if one pain condition can be effectively treated with an immune drug, then it is possible that other types will also respond."
The research is published in the journal Annals of Internal Medicine.
Story Source:
Adapted from materials provided by University of Liverpool, via EurekAlert!, a service of AAAS.
Journal Reference:
- Andreas Goebel, Andrew Baranowski, Konrad Maurer, Artemis Ghiai, Candy Mccabe, and Gareth Ambler. Intravenous Immunoglobulin Treatment of the Complex Regional Pain Syndrome: A Randomized Trial. Annals of Internal Medicine, 2010; 152: 152-158 DOI: 10.1059/0003-4819-152-3-201002020-00006
Note: If no author is given, the source is cited instead.
Friday 30 April 2010
Scientists discover new treatment for chronic pain condition
Use of alternative therapy for pain treatment increases with age and wealth
ScienceDaily (Apr. 29, 2010) — In a University of Michigan Health System study, 1 out of 3 patients with chronic pain reported using complementary and alternative medicine therapies such as acupuncture and chiropractic visits for pain relief.
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Socioeconomic factors -- primarily race and age -- played a large role in the use of alternative therapy in chronic pain patients, the study showed. Whites used alternative modalities more frequently than blacks and elderly adults had a higher frequency of using alternative therapies than younger adults.
According to the lead author, Carmen R. Green, M.D., U-M professor of anesthesiology and obstetrics and gynecology and associate professor of health management and policy, this pattern may be due to alternative medicine therapies usually attracting individuals with higher education levels and income, or the pattern could be a result of differences in insurance coverage.
Also, as people age, there is a greater chance that they will deal with chronic pain, therefore as age increases, so does the likelihood that people will seek alternative therapies to deal with the pain.
The study which appears in the journal, Pain Medicine, highlights the importance of complementary and alternative medicine, its increasing usage, its economic impact, and concerns about safety and effectiveness.
To track the link between pain and alternative medicine, Green and S. Khady Ndao-Brumblay, PharmD, MSc, doctoral student in health management and policy at the U-M School of Public Health, looked at the ethnic and racial disparities in treating chronic pain in 5,750 adults over a six-year period.
Socioeconomic characteristics, medical history, physical and social health characteristics and pain-related symptoms in both black and white adults with chronic pain were collected with the Pain Assessment Inventory Narrative to assess the treatment methods.
The types of practitioner-based alternative therapy examined included manipulation therapy such as chiropractic or physical therapy procedures, biofeedback -- instruments that control the heart rate, blood pressure and brain waves for relaxation purposes -- and acupuncture.
These three alternative medicine therapy services were used most often by people with chronic pain, but who uses the therapy depends on the type of modality.
"This research may provide important new insights into the use of alternative therapies for people living with chronic pain. It helps us understand more about who is using CAM therapies, and also prompts a discussion on how these methods work and on whom they work best," Green says.
Of those observed, 35 percent reported using at least one form of complementary and alternative medicine therapy with 25 percent using manipulation techniques, 13 percent using biofeedback and 8 percent acupuncture.
Green, U-M pain medicine physician and anesthesiologist, says complementary and alternative medicine therapies can be beneficial in treating pain, but further studies are needed to determine just how effective they are and how great the risks and benefits are. Since alternative therapy is often used in combination with other methods, such as regular physician visits and traditional medications, she warns patients should inform their doctors when using these therapies.
"It's helpful for physicians to know that patients are using these therapies so that we can minimize any risks or side effects associated with them," Green says.
Because chronic pain has been found to double the odds of seeking alternative services, this along with decreased access to and negative perceptions about pain treatment, may be one of the primary reasons for seeking this type of therapy over conventional medicine. However, more research needs to be done to confirm this.
"Unfortunately patients are often reluctant to share information regarding alternative therapy usage with health care providers, but discussions and awareness of alternative therapy use in pain patients may improve the quality of pain care and patient safety," Green says###
Authors: Carmen R. Green, M.D., U-M professor, pain medicine physician and anesthesiologist and S. Khady Ndao-Brumblay, PharmD, MSc, doctoral student in health management and policy at the U-M School of Public Health.
Reference Pain Medicine, Vol. 11, No. 1, January 2010
Story Source:
Adapted from materials provided by University of Michigan Health System, via EurekAlert!, a service of AAAS.
Journal Reference:
- Ndao-Brumblay et al. Predictors of Complementary and Alternative Medicine Use in Chronic Pain Patients. Pain Medicine, 2010; 11 (1): 16 DOI: 10.1111/j.1526-4637.2009.00767.x
Note: If no author is given, the source is cited instead.
Fibromyalgia affects mental health of those diagnosed and their spouses, study finds
ScienceDaily (Apr. 28, 2010) — Fibromyalgia is a condition that causes chronic, widespread pain throughout the body. In a new study, University of Missouri researchers are examining how the diagnosis of Fibromyalgia can affect marriages. Initial findings reveal that diagnosed spouses have considerably higher levels of depressive symptoms and pain and report more marital instability and anger than their spouses. For both spouses, the symptoms can trigger increased emotional withdrawal and mental strain.
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"Preliminary research suggests that fibromyalgia is very hard on both spouses because their lives are changed dramatically," said Christine Proulx, assistant professor of human development and family studies in the College of Human Environmental Sciences. "There appears to be a strong link between fibromyalgia and feelings of depression and fatigue, which can be debilitating for those diagnosed and their marriages. The mental strain felt by both spouses can negatively affect marital quality."
Proulx found that individuals with fibromyalgia were almost three-times more depressed than their spouses. The diagnosed spouses reported higher levels of marital instability and more marital anger, indicating they were more likely to consider divorce than their spouses. The healthy spouses reported that it was difficult to watch their spouses experience pain.
"Both spouses are put in difficult positions when one partner is diagnosed with fibromyalgia," Proulx said. "Spouses must balance the presence of the disease, which can produce hostility or withdrawn behavior in the marriage, with the difficulty of being sick or being supportive to the spouse who is sick. These factors can create a cycle that can be very negative if it can't be broken."
In the study, Proulx is studying the interactions of married couples that include one spouse who has been diagnosed with fibromyalgia or chronic widespread pain. The spouses record diary entries about their marital interactions and personal feelings. Proulx is examining the associations between marital quality, daily interactions, social support and the spouses' personal well-being.
Fibromyalgia is controversial because there is no consensus on the cause of the chronic pain symptoms it causes, Proulx said. It has no cure, so many of the couples who participated in the study reported that they were constantly trying different treatments to manage the symptoms.
Findings from the pilot study, "Fibromyalgia, Chronic Pain, and Marriage: A Daily Diary Pilot Study," were presented last November at the National Council of Family Relations Conference.
Story Source:
Adapted from materials provided by University of Missouri-Columbia.
Note: If no author is given, the source is cited instead.
Uncanny Sight in the Blind
Snails and endangered gorillas: perfect together?
New Madrid quake analysis rewrites history books
Oil spill worsens, offshore drilling plans in dire straits?
Rare Mutation That Causes Mirror Movements Reflects Nervous System's Complexity
Reality Check: Just How Healthy are Packaged and Processed "Healthy" Snack Foods?
Why Does Light Make Headaches Worse?
Migraine sufferers have long complained about how their headaches worsen with bright light, and in case you ever doubted their complaints, Rami Burstein and other researchers from Harvard Medical School and the Moran Eye Center at the University of Utah recently made a giant step in understanding the light-to-headache mechanism in Nature Neuroscience. They found neurons in the rat thalamus sensitive to both light and to the dura (the membrane surrounding the brain).
More intriguing than the “how” of light and headaches is the “why”. Why should light be linked with pain mechanisms at all? Why should the retina be in the business of eliciting pain in your brain?
Upon reflection, however, we all know of occasions where looking hurts. The most obvious case is when we look at the sun. And another obvious case is when someone shines a flashlight in our eyes in the dark. In each case we are likely to respond, “Ouch!” From these real-world links between light and pain can we discern what the link may be for?
The example of the sun may coax us into suggesting that it is the retina-scorching amount of light that hurts. However, the fact that the same kind of discomfort occurs when someone shines a flashlight in our eyes shows it is not the intrinsic amount of light that is the source of the pain. A flashlight can be so dim that we can hardly see it in daytime, and yet hurt when shone in our eyes at night. The flashlight’s beam is not scorching anything, although the pain it elicits is every bit as real.
Instead, I suggest that these light/pain phenomena are similar to pain in other domains of our life. The general role of pain is not merely to tell us that something has been damaged, but to motivate us to modify our behavior toward safer or smarter action (and to so without our having to consciously think about it). For example, subtle pain signals are constantly causing me to shift my weight as I sit here and type this, leading to healthier blood flow in my lower extremities. Our eye fixations are like fingertips, reaching out and touching things in the world; just as fingertips need a pain sense to help optimally guide their behavior, so do our eye fixations.
In our normal viewing experiences there are very often wild fluctuations in brightness in our visual field, often due to the sun or to reflections of the sun. We are typically not interested in looking at objects having this full breadth of brightnesses, but, instead, at a range of “interesting objects” at a narrower range of brightnesses. To help us best see the objects of current interest, our visual system adapts to the brightness levels among them. If we were to fixate on a part of the scene that is much brighter than these interesting objects (perhaps a spot of glare), then our eyes would begin to adapt to the new brightness level, and when we look back at the objects of interest, we will be unable to see them well.
“Eye pain” of this kind may be the principal unconscious mechanism that keeps us fixating in a smart fashion within our visual field; it is what keeps our eyes performing at their best given our interests at the time. Although this kind of mechanism is unconscious, it by no means needs to be stupid. Instead, it may be able to infer where the brightest parts of the scene are on the basis of global cues in the scene.
For example, look at the earlier photograph of the glaring sun. It feels somewhat discomforting to look at this photograph, and our eyes want to steer clear from the sun. Yet the brightest spot at the center of the sun in the photograph is no brighter than the white elsewhere on this web page which causes us no discomfort to look at. Our brain seems to be able to recognize the sun-glare-like cues in the photograph, and elicits the glare-avoidance pain mechanisms for it but not for the white elsewhere on screen.
In light of these ideas for the role of light in pain, could it be that migraine-like headaches are the normal kind of pain elicited for these light/pain mechanisms, and that the trouble for migraine sufferers is the overactivation of these usually-functional mechanisms?
This first appeared on February 26, 2010, as a feature at ScientificBlogging.com.
Mark Changizi is a professor of cognitive science at Rensselaer Polytechnic Institute, and the author of The Vision Revolution (Benbella Books).
Wednesday 28 April 2010
Global Year Against Musculoskeletal Pain 2009-10
Tuesday 27 April 2010
Mindfulness website
IASP pain definitions
Monday 26 April 2010
Imaging CNS modulation of pain in humans
Pain is a highly complex and subjective experience that is not linearly related to the nociceptive input. What is clear from anecdotal reports over the centuries and more recently from animal and human experimentation is that nociceptive information processing and consequent pain perception is subject to significant pro- and anti-nociceptive modulations. These modulations can be initiated reflexively or by contextual manipulations of the pain experience including cognitive and emotional factors. This provides a necessary survival function since it allows the pain experience to be altered according to the situation rather than having pain always dominate. The so-called descending pain modulatory network involving predominantly medial and frontal cortical areas, in combination with specific subcortical and brain stem nuclei appears to be one key system for the endogenous modulation of pain. Furthermore, recent findings from functional and anatomical neuroimaging support the notion that an altered interaction of pro- and anti-nociceptive mechanisms may contribute to the development or maintenance of chronic pain states. Research on the involved circuitry and implemented mechanisms is a major focus of contemporary neuroscientific research in the field of pain and should provide new insights to prevent and treat chronic pain states.
Sunday 25 April 2010
Brain training software: is it worth it?
Influencing others
Friday 23 April 2010
A Love Story
Pain description
Stress, acute and chronic effects
Stress and disorders of the stress system. Chrousos G. (2009)
Nat Rev Endocrinol. 2009 Jul;5(7):374-81
All organisms must maintain a complex dynamic equilibrium, or homeostasis, which is constantly challenged by internal or external adverse forces termed stressors. Stress occurs when homeostasis is threatened or perceived to be so; homeostasis is re-established by various physiological and behavioral adaptive responses. Neuroendocrine hormones have major roles in the regulation of both basal homeostasis and responses to threats, and are involved in the pathogenesis of diseases characterized by dyshomeostasis or cacostasis. The stress response is mediated by the stress system, partly located in the central nervous system and partly in peripheral organs. The central, greatly interconnected effectors of this system include the hypothalamic hormones arginine vasopressin, corticotropin-releasing hormone and pro-opiomelanocortin-derived peptides, and the locus ceruleus and autonomic norepinephrine centers in the brainstem. Targets of these effectors include the executive and/or cognitive, reward and fear systems, the wake-sleep centers of the brain, the growth, reproductive and thyroid hormone axes, and the gastrointestinal, cardiorespiratory, metabolic, and immune systems. Optimal basal activity and responsiveness of the stress system is essential for a sense of well-being, successful performance of tasks, and appropriate social interactions. By contrast, excessive or inadequate basal activity and responsiveness of this system might impair development, growth and body composition, and lead to a host of behavioral and somatic pathological conditions.
Thursday 22 April 2010
Brain and aboriginal art
Cool stories
Look out for the first story!
Contributions welcome!
Wednesday 21 April 2010
Mirror Neurons
Single-Neuron Responses in Humans during Execution and Observation of Actions. Munkamel et al. (2010) Curr Biology Apr 7
Tuesday 20 April 2010
Ear wiggling
Monday 19 April 2010
Body in Mind
Who are we?
NOIgroup Conference
Wednesday 14 April 2010
Tuesday 13 April 2010
What is pain? A Modern Scientific Perspective: A recent piece on EzineArticles by Richmond Stace
Monday 12 April 2010
Pain scanning
Sunday 11 April 2010
Brain stuff
Noigroup conference in Nottingham
Thursday 8 April 2010
Chronic Pain is a disease
Back Pain Research Update
Comment
This does look very interesting however there is now a need to replicate these findings by other groups. What would be the effect of adding a rehabilitation programme?
Tuesday 6 April 2010
New Clinics
Clinics are also available at The New Victoria Hospital in Kingston, Surrey. Click here for information.
Both sites offer comfortable treatment rooms and on-site parking.