Tag: chronic pain

Dependence on Pain Medication is on the Rise

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Dependence on pain medication is on the rise due to lack of vigilance by medical professionals, according to a new study from the University of Surrey. In the paper published in the journal Pain and Therapy, patients dependent on pain medication describe feelings of ‘living in a haze’ and being ignored and misunderstood by the medical profession.

In the first study of its kind in the UK, Louise Norton and Dr Bridget Dibb from the University of Surrey investigated the experiences of patients dependent on medication for chronic pain. Pharmacological treatment for chronic pain usually involves potentially addictive substances such as non-steroidal anti-inflammatory drugs, gabapentinoids, and opioids. Increased prescription levels of such pain relief medications have been associated with heightened levels of overdose and misuse.

Dr Bridget Dibb, Senior Lecturer in Health Psychology at the University of Surrey, said: “An increasing number of people are experiencing chronic pain, which can interfere with their daily life and lead to depression and anxiety. Medication can help alleviate pain and return a sense of normalcy to a person’s life; however, there is a risk of dependence, which can potentially cause damage to vital organs, including the liver and kidneys.

“The first step to tackle this problem is to learn more about a person’s experience, how they perceive their dependence and how they interact with others, including the medical profession.”

To learn more, interviews were carried out with nine participants who had become dependent on pain medication. Participants spoke about how their dependence on pain medication resulted in them feeling not fully present and removed from their lives due to the side effects of the treatment. Many also expressed frustration about the lack of alternative treatment options available on the NHS to manage their pain, with medications being too readily prescribed.

The majority of participants also spoke about their negative interactions with medical professionals, with some attributing the cause of their dependence on them. Many believed a lack of continuity between doctors led to missed opportunities in spotting their dependence, enabling it to continue.

Louise Norton added: “Relationships with medical professionals substantially affect the experiences of those with painkiller dependence. Doctors can often be seen as authority figures due to their expertise and so patients may be apprehensive to question their treatment options. However, through providing patients with thorough information, doctors can enable more shared-decision making in which patients feel better supported and equipped to manage their chronic pain.”

Researchers noted participants felt stigmatised when speaking with others about their dependence due to a lack of understanding about their reliance to prescribed pain medications. Such interactions left participants feeling ashamed and critical of themselves.

Dr Dibb added: “Those with a dependence on prescription painkillers not only have to navigate their reliance on the medication but the shame and guilt associated with such a need. Combining this with feelings of being misunderstood and ignored by medical professionals, they have a lot of emotional needs to be managed alongside their physical pain. To prevent this from happening medical professionals need to be more vigilant when prescribing medication and ensure that their patients are fully aware of the risk of dependence before they begin treatment.”

Source: University of Surrey

Chronic Back Pain may be Easier to Treat if it’s ‘in the Brain’

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One therapy for chronic back pain is to teach patients how to ‘reprocess’ it in the brain. Now, this therapy may become even more effective thanks a study published in JAMA Network Open. The study examined the critical connection between the brain and pain for treating chronic pain. Specifically, they looked at the importance of pain attributions, which are people’s beliefs about the underlying causes of their pain, to reduce chronic back pain severity. Understanding the source of the pain may help some to avoid surgery which may be ineffective or even worsen the pain.

“Millions of people are experiencing chronic pain and many haven’t found ways to help with the pain, making it clear that something is missing in the way we’re diagnosing and treating people,” said the study’s first author Yoni Ashar, PhD, assistant professor of internal medicine at the University of Colorado Anschutz Medical Campus.

Pain is often in the brain

Ashar and his team tested whether the reattribution of pain to mind or brain processes was associated with pain relief in pain reprocessing therapy (PRT), which teaches people to perceive pain signals sent to the brain as less threatening. Their goal was to better understand how people recovered from chronic back pain. The study revealed after PRT, patients reported reduced back pain intensity.

“Our study shows that discussing pain attributions with patients and helping them understand that pain is often ‘in the brain’ can help reduce it,” Ashar said.

To study the effects of pain attributions, they enrolled over 150 adults experiencing moderately severe chronic back pain in a randomised trial to receive PRT. They found that two-thirds of people treated with PRT reported being pain-free or nearly so after treatment, compared to only 20% of placebo controls.

“This study is critically important because patients’ pain attributions are often inaccurate. We found that very few people believed their brains had anything to do with their pain. This can be unhelpful and hurtful when it comes to planning for recovery since pain attributions guide major treatment decisions, such as whether to get surgery or psychological treatment,” said Ashar.

Before PRT treatment, only 10% of participants’ attributions of PRT treatment were mind- or brain-related. However, after PRT, this increased to 51%. The study revealed that the more participants shifted to viewing their pain as due to mind or brain processes, the greater the reduction in chronic back pain intensity they reported.

The role of discussing brain drivers of chronic pain 

“These results show that shifting perspectives about the brain’s role in chronic pain can allow patients to experience better results and outcomes,” Ashar adds.

Ashar says that one reason for this may be that when patients understand their pain as due to brain processes, they learn that there is nothing wrong with their body and that the pain is a ‘false alarm’ being generated by the brain that they don’t need to be afraid of.

The researchers hope this study will encourage providers to talk to their patients about the reasons behind their pain and discuss causes outside of biomedical ones.

“Often, discussions with patients focus on biomedical causes of pain. The role of the brain is rarely discussed,” said Ashar. “With this research, we want to provide patients as much relief as possible by exploring different treatments, including ones that address the brain drivers of chronic pain.”

Source: University of Colorado Anschutz Medical Campus

The Impacts of Persistent Pain in Older Adults

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In a study of 5589 US adults aged 65 years and older, persistent pain was common and was linked to meaningful declines in physical function and well-being over 7 years. Reporting in the Journal of the American Geriatrics Society, investigators found that 38.7% of participants reported persistent pain, and 27.8% reported intermittent pain. (“Persistent pain” was defined as being bothered by pain in the last month in two consecutive annual interviews and “intermittent” pain was defined as bothersome pain in one interview only.)  

More than one-third of participants described pain in five or more sites. Over the subsequent 7 years, participants with persistent pain were more likely to experience declines in physical function (64% persistent pain, 59% intermittent pain, 57% no bothersome pain) and well-being (48% persistent pain, 45% intermittent pain, 44% no bothersome pain), but were not more likely to experience cognitive decline (25% persistent pain, 24% intermittent pain, 23% no bothersome pain).

“The findings from this study point to the importance of access to effective treatment for persistent pain in older adults and the need for additional research in chronic pain to optimise quality of life,” said lead author Christine Ritchie, MD, MSPH, of Massachusetts General Hospital.

Source: Wiley

Scans of Brain Connectivity in Veterans Yield Objective Pain Measures

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A brain connectivity study of military veterans discovered three unique brain subtypes potentially indicating high, medium, and low susceptibility to pain and trauma symptoms. This could constitute an objective measurement of pain and trauma susceptibility, possibly leading to personalised treatments and new therapies based on neural connectivity patterns.  

Comorbidity Goes Unexplored

“Chronic pain is a major public health concern, especially among veterans,” said first author Prof Irina Strigo. “Moreover, chronic pain sufferers almost never present with a single disorder but often with multiple co-morbidities, such as trauma, posttraumatic stress, and depression.”

It is already understood that both pain and trauma can affect brain connections, but this had not been studied in the context of comorbid trauma and pain. Much pain and trauma research also relies on subjective measurements, such as questionnaires, rather than objective measurements like brain scans. This study, published in Frontiers in Pain Research, addresses these problems.

Theresearchers studied a group of 57 veterans with both chronic back pain and trauma, who had quite varied symptoms in terms of pain and trauma severity. Functional MRI scans of the veterans’ brains showed the strength of connections between brain regions involved in pain and trauma. The researchers then used a statistical technique to automatically group the veterans based on their brain connection signatures, regardless of their self-reported pain and trauma levels.

Based on the veterans’ brain activity, they were sorted into three groups. Strikingly, these divisions were comparable to the severity of the veterans’ symptoms, and they fell into a low, medium, or high symptom group.

The team hypothesised that the pattern of brain connections found in the low symptom group allowed veterans to avoid some of the emotional fallout from pain and trauma, and also included natural pain reduction capabilities. Conversely, the high symptom group demonstrated brain connection patterns that may have increased their chances of anxiety and catastrophising when experiencing pain.

Interestingly, based on self-reported pain and trauma symptoms, the medium symptom group was largely similar to the low symptom group. However, the medium symptom group showed differences in their brain connectivity signature, which suggested that they were better at focusing on other things when experiencing pain, reducing its impact.

Putting the findings into future practice

“Despite the fact that the majority of subjects within each subgroup had a co-morbid diagnosis of pain and trauma, their brain connections differed,” said Prof Strigo.

“In other words, despite demographic and diagnostic similarities, we found neurobiologically distinct groups with different mechanisms for managing pain and trauma. Neurobiological-based subgroups can provide insights into how these individuals will respond to brain stimulation and psychopharmacological treatments.”

Thus far, it’s not known whether these neural hallmarks represent a vulnerability to trauma and pain or a consequence of these conditions. The technique does however provide an objective and unbiased hallmark of pain and trauma susceptibility or resilience, not reliant on subjective measures such as the surveys. In fact, subjective measurements of pain in this study would not differentiate between the low and medium groups.

Techniques using objective measures like brain connectivity appear more sensitive and could provide a clearer overall picture of someone’s resilience or susceptibility to pain and trauma, thereby guiding personalised treatment and paving the way for new treatments.

Source: Frontiers

Body Mass Index Impacts Pain in People with Hand Osteoarthritis

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In a study published in Arthritis & Rheumatologypeople with hand osteoarthritis, higher body mass index was associated with greater pain severity in the hands, feet, knees, and hips.

Osteoarthritis is one of the most debilitating joint disorders worldwide, affecting up to 10% of men and 13% of women.  Osteoarthritis is characterised by a progressive onset of joint damage, commonly associated with pain. Joints commonly affected include the knee, hip and hand. Various stressors, risk factors and genetics may predispose an individual to developing osteoarthritis in a particular joint.

In a study of 281 patients, researchers noted that observed associations of body mass index with hand pain and total body joint pain seemed to involve certain inflammatory markers (leptin and high-sensitivity C-reactive protein, respectively).  

The researchers suggest that systemic effects of obesity, measured by leptin, could have a larger mediating role for pain in hands than in lower extremities. Low-grade inflammation, measured by hs-CRP, may contribute to generalised pain in overweight or obese individuals.

“Our results highlight the complexity of pain in hand osteoarthritis. Obesity is not only leading to pain through increased loading of joints in the lower extremities, but seems to have systemic effects leading to pain in the hands and overall body,” said lead author Marthe Gløersen, MD, of Diakonhjemmet Hospital, in Norway.

Source: Wiley

Chronic Pain in Spinal Cord Injury Increases Mental Health Risk

Having a spinal cord injury increases risk of developing mental health conditions such as depression and anxiety by nearly 80% compared to those without the traumatic injury, a new study shows. However, chronic pain may have an equally large, negative effect on mental health.

The study, published in Spinal Cord, compared private insurance claims from more than 9000 adults with a traumatic spinal cord injury with those of more than 1 million without. Researchers accounted for a range of psychological conditions, from anxiety and mood disorders to insomnia and dementia.

People living with a spinal cord injury had a diagnosis of a mental health condition more often than those without – 59.1% versus 30.9%. While depression and adverse mental health effects are not inevitable consequences of every traumatic spinal injury, previous studies have consistently echoed higher levels of psychological morbidity among this group than the general population without spinal cord injuries.

However, this study found that chronic centralised and neuropathic pain among adults living with a spinal cord injury were robustly associated with post-traumatic stress disorder, substance use disorders and other mental health conditions. In most cases, chronic pain was an even greater influence on these conditions than exposure to living with the injury itself.

The study authors said the findings should prompt physicians to identify mental health conditions when seeing patients with spinal cord injuries and refer them for treatment.

“Improved clinical efforts are needed to facilitate screening of, and early treatment for, both chronic pain and psychological health in this higher-risk population,” said lead author Dr Mark Peterson, associate professor of physical medicine and rehabilitation at Michigan Medicine.

However, researchers note a lack of insurance coverage and limited available services will likely cause the issue to remain largely unaddressed.

“Stakeholders need to work together to lobby for more federal research funding and special policy amendments to ensure adequate and long-term insurance coverage for both physical and mental health to meet the needs of folks living with spinal cord injuries,” Dr Peterson said.

Source: EurekAlert!

Depression Genes Result in More Physical Symptoms

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People who have a higher genetic risk of clinical depression are more likely to experience physical symptoms such as chronic pain, fatigue and migraine, researchers have found.

Depression is a serious disorder with lifetime risks of poor health, according to Dr Enda Byrne from UQ’s Institute for Molecular Bioscience.

“A large proportion of people with clinically-diagnosed depression present initially to doctors with physical symptoms that cause distress and can severely impact on people’s quality of life,” Dr Byrne said.

“Our research aimed to better understand the biological basis of depression and found that assessing a broad range of symptoms was important.

“Ultimately, our research aimed to better understand the genetic risks and generate more accurate risk scores for use in research and healthcare.”

Despite recent breakthroughs, Dr Byrne said it was difficult to find more genetic risk factors because of the range of patient ages, their symptoms, responses to treatment and additional mental and physical disorders.

“Previous genetic studies have included participants who report having seen a doctor for worries or tension – but who may not meet the ‘official’ criteria for a diagnosis of depression,” Dr Byrne said

Published in JAMA Psychiatry, the study analysed data from more than 15 000 volunteers who provided details of their mental health history, depression symptoms and a DNA sample using a saliva kit.

“We wanted to see how genetic risk factors based on clinical definitions of depression differed – from those based on a single question to those based on a doctor’s consultation about mental health problems,” Dr Byrne said.

The study found that participants with higher genetic risk for clinical depression are more likely to experience physical symptoms such as chronic pain, fatigue and migraine.

 “It is also linked to higher rates of somatic symptoms – that is, physical symptoms that cause distress and can severely impact on people’s quality of life,” Dr Byrne said.

“Our results highlight the need for larger studies investigating the broad range of symptoms experienced by people with depression.”

Source: University of Queensland

A Step Closer to Effective Electrical Pain Blocking

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New research from the University of Connecticut has brought the drug-free technology of electrical anaesthesia for all chronic pain sufferers a step closer. 

Pain stimuli, or ‘nociceptive stimuli’ is picked up by nociceptors which send signals to the spinal cord, which passes it on to the brain where the perception of pain is manifested.

Bin Feng, associate professor in the Biomedical Engineering Department, led research which discovered how electrical stimulation of the dorsal root ganglia (DRG), sensory neural cell body clusters, can block nociceptive signal transmission to the spinal cord and prevent the brain from perceiving chronic pain signals. The findings are reported in PAIN.

Electrical devices to treat pain typically deliver electrical signals to the peripheral nervous system and spinal cord to block nociceptive signals from reaching the brain.

A major obstacle with these devices is that while some patients find them beneficial in relieving their chronic pain, others have little or no pain reduction. Despite incremental developments of neurostimulator technologies, there has not been much improvement in getting the devices to work for these patients.

“The trouble with this technology is that it can benefit a portion of patients very well, but for a larger portion of patients it has little benefit,” Prof Feng said.

One of the reasons is that such devices lag behind research into neural stimulation.

“We’re sitting on a huge pile of clinical data,” Prof Feng says. “But the science of neuromodulation remains understudied.”

Neurostimulators relieve pain according to a ‘gate control’ theory. Our bodies can detect both innocuous stimuli, like something brushing against the skin, and painful stimuli, through low- and high-threshold sensory neurons, respectively.

The spinal cord ‘gate’ can be shut by activating low-threshold sensory neurons, preventing painful nociceptive signals from high-threshold sensory neurons from crossing the spinal cord to the brain.

Neurostimulators reduce pain in patients by activating low-threshold sensory neurons with electrical pulses. This usually causes a non-painful tingling sensation in certain areas of the skin, or paresthaesia, masking the perception of pain.

Many patients receiving DRG stimulation treatment reported pain relief without the expected paraesthesia.

Seeking to understand this, Prof Feng’s lab discovered that electrical stimulation to the DRG can block transmission to the spinal cord at frequencies as low as 20 hertz. This is in contrast to previous research indicating that blocking requires kilohertz electrical stimulation.

“The cell bodies of sensory neurons form a T-junction with the peripheral and central axons in the DRG,” Feng says. “This T-junction appears to be the region that causes transmission block when DRG is stimulated.”

More remarkably, sensory nerve fibres with different characteristics are blocked by different electrical stimulation frequency ranges at the DRG, allowing the development of new neural stimulation protocols to enhance selective transmission blocking with different sensory fibre types.

“A-fibre nociceptors with large axon diameters are generally responsible for causing acute and sharp pain,” Prof Feng explained. “It is the long-lasting and dull-type pain that bothers the chronic pain patients mostIn a chronic pain condition, C-fibre nociceptors with small axon diameter and no myelin sheath play central role in the persistence of pain. Selectively blocking C-fibres while leaving A-fibres intact can be a promising strategy to target the cause of chronic pain.”

This provides evidence to place more electrodes for devices that target the DRG and surrounding neuronal tissues, letting doctors provide more precise neuromodulation.

“The next-generation neurostimulators will be more selective with fewer off-target effects,” Prof Feng said. “They should also be more intelligent by incorporating chemical and electrical sensory capabilities and ability to communicate bidirectionally to a cloud-based server.”

Prof Feng hopes that more people will be eventually able to achieve chronic pain relief with this technology. He is now working toward conducting clinical studies with his collaborators at UConn Health to test the efficacy of this method in humans.

Source: University of Connecticut

Acupuncture Puts a Pin in Chronic Pelvic Pain

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A multicentre randomised trial showed that eight weeks of acupuncture sessions improved symptoms of moderate to severe chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) to a greater extent than sham therapy. Treatment effects endured over 24 weeks follow up. The findings are published in Annals of Internal Medicine.

CP/CPPS manifests as discomfort or pain in the pelvic region for at least three of the previous six months with no infection, with possible involvement of lower urinary tract symptoms, psychological issues, and sexual dysfunction. Men with CP/CPPS may have a poor quality of life associated with the disorder, such as inflammation in the prostate, anxiety and stress, and dyssynergic voiding. Standard care involves antibiotics, a-blockers, and anti-inflammatories, but their effectiveness is limited and long-term use is associated with adverse events. Though promising as an alternative treatment, acupuncture lacks high quality evidence.

A total of 440 male participants were randomised to either 8 weeks of acupuncture or sham therapy to assess the long-term efficacy of acupuncture for improving symptoms of CP/CPPS. The treatment was considered effective if participants achieved a clinically important reduction of at least 6 points from baseline on the National Institutes of Health Chronic Prostatitis Symptom Index at weeks 8 and 32. Between-group difference to be statistically significant at both time points for sustained efficacy. 

More participants in the acupuncture group reported marked or moderate improvements in symptoms at all assessment points compared to the sham control group. No significant difference was found in changes in International Index of Erectile Function 5 score at all assessment time points or in peak and average urinary flow rates at week 8. No serious adverse events were reported in either group.

According to the researchers, these findings show long-term efficacy of acupuncture and provide high-quality evidence for clinical practice and guideline recommendations.

Source: Medical Xpress

Transcranial Focused Ultrasound for Chronic Pain Relief

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A rodent study has demonstrated the potential for transcranial focused ultrasound (tFUS) to relieve chronic pain and other symptoms.

Neuromodulation, or therapeutic stimulation of neurons with electrical energy. chemicals or potentially with acoustic waves, can amplify or dampen neuronal impulses in the brain or body to relieve symptoms such as pain or tremor.

Ultrasound is a promising non-invasive, non-surgical type of neuromodulation. It offers a temporary modulation that can be tuned for a desired effect. In this study, researchers have shown that it can be targeted at neurons with specific functions.

A team led by Bin He, PhD, professor of biomedical engineering at Carnegie Mellon University, and funded in part by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), has demonstrated the potential of a neuromodulation approach that uses low-intensity ultrasound energy, called transcranial focused ultrasound-;or tFUS. In a paper published in Nature Communications, the authors describe the use of tFUS in rodent experiments, demonstrating the non-invasive neuromodulation alternative.

Moria Bittmann, PhD, Director of the Program in Biorobotic Systems, National Institute of Biomedical Imaging and Bioengineering, said: “Transcranial focused ultrasound is a promising approach that could be used to treat forms of chronic pain, among other applications. In conditions where symptoms include debilitating pain, externally generated impulses of ultrasound at controlled frequencies and intensity could inhibit pain signals.”

The researchers designed an assembly that included an ultrasound transducer and a multi-electrode array, which records neuronal data. During experiments with anaesthetised rodents, the researchers sent acoustic pulses into the brain cortex, targeting specific neurons, while recording change in electrophysiological signals from different neuron types.

When neurons transmit signals, whether engaging the senses or controlling movement, the firing of that signal across the synapse is termed a spike. The researchers observed two types of neurons: excitatory and inhibitory neurons.

When using tFUS to emit repeated bursts of ultrasound stimulation directly at excitatory neurons, the researchers saw an elevated impulse rate, or spike. Inhibitory neurons subjected to the same tFUS energy however did not display a significant spike rate disturbance. This showed that the ultrasound signal can be transmitted through the skull to selectively activate specific neuron sub-populations, in effect targeting neurons with different functions.

“Our research addresses an unmet need to develop non-toxic, non-addictive, non-pharmacologic therapies for human use,” said Prof He. “We hope to further develop the tFUS approach with variation in ultrasound frequencies and to pursue insights into neuronal activity so that this technology has the optimal chance for benefiting brain health.”

There are many broad applications for this research. Prof He believes non-invasive tFUS neuromodulation could be used to facilitate treatment for many people suffering from pain, depression and addiction. “If we can localise and target areas of the brain using acoustic, ultrasound energy, I believe we can potentially treat a myriad of neurological and psychiatric diseases and conditions,” Prof He said.

Source: National Institute of Biomedical Imaging and Bioengineering