Pain
New study proves that pain is not a symptom of arthritis, pain causes arthritis
Pain is more than a symptom of osteoarthritis, it is an inherent and damaging part of the disease itself, according to a study published today in journal Arthritis and Rheumatism. More specifically, the study revealed that pain signals originating in arthritic joints, and the biochemical processing of those signals as they reach the spinal cord, worsen and expand arthritis. In addition, researchers found that nerve pathways carrying pain signals transfer inflammation from arthritic joints to the spine and back again, causing disease at both ends.
Technically, pain is a patient’s conscious realization of discomfort. Before that can happen, however, information must be carried along nerve cell pathways from say an injured knee to the pain processing centers in dorsal horns of the spinal cord, a process called nociception. The current study provides strong evidence that two-way, nociceptive “crosstalk” may first enable joint arthritis to transmit inflammation into the spinal cord and brain, and then to spread through the central nervous system (CNS) from one joint to another.
Furthermore, if joint arthritis can cause neuro-inflammation, it could have a role in conditions like Alzheimer’s disease, dementia and multiple sclerosis. Armed with the results, researchers have identified likely drug targets that could interfere with key inflammatory receptors on sensory nerve cells as a new way to treat osteoarthritis (OA), which destroys joint cartilage in 21 million Americans. The most common form of arthritis, OA eventually brings deformity and severe pain as patients loose the protective cushion between bones in weight-bearing joints like knees and hips.
Sex bias seen in control of cancer pain
How well pain is managed in people with cancer apparently differs between men and women, new research hints.
Dr. Kristine A. Donovan, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues examined pain severity and the adequacy of pain management in 131 cancer patients newly referred to a multidisciplinary cancer pain clinic.
Men and women did not differ significantly in terms of worst pain scores, least pain scores, or pain interference. However, average pain in the last week and pain right now were significantly higher in women.
Pain appears common among patients with Parkinson’s disease
Pain appears to be more common in individuals with Parkinson’s disease than in those without, suggesting that pain is associated with the condition, according to a report in the September issue of Archives of Neurology, one of the JAMA/Archives journals.
“Patients with Parkinson’s disease often complain of painful sensations that may involve body parts affected and unaffected by dystonia,” or involuntary muscle contractions, the authors write as background information in the article. This pain may resemble cramping or arthritis, or have features of pain caused by nerve damage. “The high frequency of these pain disorders in the general population makes it hard to establish whether pain is more frequent among people with Parkinson’s disease than among age-matched controls.”
Giovanni Defazio, M.D., Ph.D., of the University of Bari, Italy, and colleagues compared 402 patients with Parkinson’s disease to 317 healthy individuals who were the same age. Participants provided information about their current age, the age at which they developed Parkinson’s disease, scores on disease rating scales and details regarding any pain that was present at the time of the study and lasted for at least three months.
Surgery May Be Considered for Extreme Face Pain
A new guideline developed by the American Academy of Neurology finds surgery may be considered for people who suffer from extreme, electric shock-like pain in their face and do not respond well to drugs. The guideline on treating trigeminal neuralgia is published in the August 20, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“There are very few drugs with strong evidence of effectiveness in treating trigeminal neuralgia,” said guideline author Gary Gronseth, MD, with the University of Kansas in Kansas City and Fellow of the American Academy of Neurology. “If people fail to respond to these drugs, physicians should not be reluctant to consider referring the patient for surgery. Often surgery is considered a last resort and patients suffer while the well-intentioned physician tries other medications with limited effectiveness.”
Trigeminal neuralgia is a chronic pain condition that causes extreme, stabbing pain throughout the face. The pain normally doesn’t last more than a few seconds or a minute per episode, but the episodes can last for days, weeks, or months and then disappear for months or years. The intense pain can be triggered by shaving, applying makeup, brushing teeth, eating, drinking, talking, or being exposed to the wind. It is more common in women than in men.
Custom-made insoles may ease certain foot pain
Custom-fit insoles may help ease foot pain caused by high arches, rheumatoid arthritis and certain other conditions, a research review suggests.
Australian researchers found that in 11 clinical trials, custom-designed orthotic devices for the shoes helped ease certain forms of foot pain. One study, for instance, showed that within 3 months, the shoe inserts improved pain in adults with abnormally high arches.
Another study, of 209 adults younger than 60, found that custom orthoses eased pain from bunions—though they did not appear to be as effective as surgery in the long run.
Study Links Herpes with Widespread Neuropathic Pain
Reactivation of genital herpes is linked in some cases with the emergence of widespread neuropathic pain, according to a Finnish study reported in The Journal of Pain.
In the clinic at the University of Helsinki, 17 patients were examined who presented widespread chronic pain with no visible lesions in brain magnetic imaging. Because the majority had herpes simplex virus (HSV) infections, the researchers studied a possible association between herpes and neuropathic pain.
They hypothesized that in HSV-positive patients, the active virus may alter pain processing at different levels of the central nervous system (CNS).
“Emotional” writing may help ease cancer pain
Some cancer patients may find that putting their emotions down in writing helps improve their pain and general well-being, a study suggests.
Such writing, part of a concept called “narrative” medicine, has been seen as a way to aid communication between seriously ill patients and their doctors.
But the act of writing, itself, may also help patients better understand themselves and their needs, according to the study team, led by Dr. M. Soledad Cepeda of Tufts-New England Medical Center in Boston.
Limit sucrose as painkiller for newborns
Using sucrose to reduce pain in newborns undergoing painful procedures should be limited to babies having blood taken (venipuncture) for the newborn screening test but not for intramuscular injections, write Dr. Anna Taddio and co-authors.
In this double-blind, randomized controlled trial of 240 newborns at Toronto’s Mount Sinai Hospital, researchers found that “sucrose reduced overall pain in newborns when administered before painful medical procedures during the first 2 days after birth.”
Walking may relieve fatigue in leukemia patients
A walking exercise program can reduce fatigue levels in patients with acute myelogenous leukemia (AML) undergoing chemotherapy, according to the results of a new study.
Dr. Yeur-Hur Lai of National Taiwan University in Taipei and colleagues randomly assigned 22 hospitalized AML patients undergoing chemotherapy to a walking group or to a control group. The experimental group walked 12 minutes per day, 5 days per week for 3 weeks, and the control group received standard ward care.
All patients were evaluated before chemotherapy began and on days 7, 14, and 21 of chemotherapy. The complete study findings are published in the May issue of the Journal of Pain and Symptom Management.
How best to treat chronic pain? The jury is still out
How best to alleviate chronic pain, a leading cause of disability and employee absenteeism, continues to perplex both patients and their doctors.
A review of recent studies on pain medicine appearing in the June 2008 issue of the Journal of General Internal Medicine reports that while various approaches and combinations of therapies to treat pain have advantages and disadvantages, researchers don’t yet know how to determine which is best for individual patients.
Among the approaches to pain management studied were those relying on the prescription of opioids (drugs such as morphine, Percocet and Vicodin), surgery, and alternative medicine (acupuncture, herbal remedies).
Office initiative reduces headaches and neck and shoulder pain by more than 40 percent
Office staff who took part in an eight-month workplace initiative reported that headaches and neck and shoulder pain fell by more than 40 per cent and their use of painkillers halved, according to research published in the May issue of Cephalalgia.
They also reported that pain levels were less severe at the end of the study than at the start.
Italian researchers compared 169 staff in Turin’s registry and tax offices with 175 colleagues who hadn’t taken part in the educational and physical programme. Using daily diaries completed by both groups, they compared the baseline results for months one and two of the study with months seven and eight to see if there had been any changes. The study group started following the programme in month three.
Childhood Pain Trauma Unlikely Link to Adult Chronic Pain
Though some adults with chronic pain often say they experienced an adverse event in childhood (such as abuse), these events are no more common than amongst adults who are pain free, according to research presented today at the American Pain Society annual meeting.
In his plenary session address, Gary Macfarlane, MD, professor of epidemiology at University of Aberdeen (Scotland) School of Medicine, said that some pain patients hold perceptions that their pain stems from an adverse event in childhood and they more commonly remember such events.
Fibromyalgia Affects Women More Often than Men
Are you exhausted? Do you have pain all over but can’t figure out what’s wrong? If so, you may be suffering from fibromyalgia, a chronic condition that causes exhaustion, sleep disturbances and diffuse pain in your muscles, tendons, and ligaments.
Fibromyalgia patients experience a range of symptoms of varying intensities that increase and decrease over time and often resemble other conditions. For years, because of their complex nature and a lack of research on the condition, many doctors misdiagnosed fibromyalgia symptoms or dismissed them as being in the patient’s head. Even today, it is estimated to take an average of five years for a fibromyalgia patient to get an accurate diagnosis.
There is no laboratory test available to diagnose fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination.
Program helped doctors identify OxyContin abusers
Careful monitoring of patients taking powerful but addictive pain relievers like OxyContin helped doctors identify abusers and steer them toward treatment, U.S. researchers said on Wednesday.
The key was having a standardized program applied to all patients who were getting the drugs for conditions other than cancer.
“Physicians are not very good at predicting which patients will have problems. They want to trust the patient, and unfortunately, trust does not work well in this type of treatment,” said Dr. Jennifer Meddings of the University of Michigan, who presented her findings at a meeting of the Society for General Internal Medicine in Pittsburgh.
Strontium may relieve spinal osteoarthritis pain
A compound called strontium ranelate may reduce back pain in women with osteoporosis and osteoarthritis (OA) of the spine, according to new study. The compound may also delay progression of spinal OA.
Strontium ranelate has been shown to stimulate bone formation while inhibiting bone resorption.
Dr. Olivier Bruyere from University of Liege, Belgium and colleagues say their findings suggest that “strontium ranelate may have symptom- and structure-modifying effects in women with osteoporosis and OA.”
