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Two-step treatment improved function and decreased pain severity in veterans

PainMar 09 15

Two-step treatment improved function and decreased pain severity in veterans

Although U.S. military veterans who have returned from Iraq or Afghanistan are more likely to suffer chronic pain than veterans of any other conflict in American history, little headway has been made in helping them manage the often debilitating effects of chronic pain. A new study by researchers from the Richard L. Roudebush VA Medical Center in Indianapolis, the Regenstrief Institute and the Indiana University School of Medicine reports that a stepped-care strategy improved function and decreased pain severity, producing at least a 30 percent improvement in pain-related disability.

“Pain is disabling and interferes with daily living as well as the ability to work,” said Matthew Bair, M.D., the VA and Regenstrief Institute investigator and IU associate professor of medicine who led the randomized controlled ESCAPE trial - short for Evaluation of Stepped Care for Chronic Pain. “It is a critical health issue among veterans, many of whom had multiple, often lengthy deployments.

“Many have significant long-term pain. We know that medications alone are only modestly successful in helping them; current pain treatments haven’t made much of a dent. The decrease in pain severity and 30 percent improvement in pain-related disability we achieved in the ESCAPE study are clinically significant, and we found that improvement lasted for at least nine months.”

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Father of Ga. woman with flesh-eating disease says she’s suffering worst pain of entire ordeal

Infections • • PainJun 17 12

The father of a Georgia woman battling a flesh-eating disease says his daughter has been suffering the worst pain of her entire ordeal.

Andy Copeland says his daughter, Aimee, sometimes cries from the pain but stops because crying hurts her stomach. She had resisted taking pain medications in recent days.

Andy Copeland said in a Father’s Day post on his blog that she’s now taking morphine and other medications, but they aren’t enough to block severe pain, which has now spread beyond painful amputation sites.

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In-Your-Face Fitness: Keeping your lower back pain-free

Backache • • PainFeb 28 12

On a recent ski trip, my best friend handed me a flask of cinnamon schnapps. He called it “courage in 100-proof form,” and I needed it. I was perched at the edge of a cliff, looking at a 20-foot drop into thigh-deep powder.

Nearly a decade ago, when I was laid up in an emergency room with two bulging disks in my lower lumbar spine, there’s no way I could have imagined myself attempting such foolish feats of middle-aged manliness.

I’m hardly alone in my lower lumbar woes. A 2009 study in Archives of Internal Medicine found that the prevalence of chronic, impairing low-back pain rose from 3.9% of adults in 1992 to 10.2% in 2006. And a 2006 study from the National Institute of Arthritis and Musculoskeletal and Skin Diseases says that lower-back pain is the No. 2 reason why Americans see a doctor, second only to the common cold.

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Researchers discover potential cause of chronic painful skin

Neurology • • PainJun 08 11

A new study may explain why only 50% of patients experiencing chronic nerve pain achieve even partial relief from existing therapeutics. The study, published in the June 6 online version of the international research journal PAIN, reveals that certain types of chronic pain may be caused by signals from the skin itself, rather than damage to nerves within the skin, as previously thought.

A Medical Mystery
For years, researchers have known that increased amounts of a molecule called Calcitonin Gene-Related Peptide (CGRP) is found in the skin of chronic pain patients. The source of the increased CGRP was thought to be certain types of sensory nerve fibers in the skin that normally make and release a type or “isoform” called CGRP-alpha. Curiously, however, the authors of the current study found that nerve fibers containing CGRP-alpha are actually reduced under painful conditions – leading them to investigate where the increased CGRP in the skin came from.

The answer, surprisingly, was that the skin cells themselves generate increased amounts of a lesser-known “beta” isoform of CGRP. This skin cell-derived CGRP-beta is increased in painful conditions and may be sending pain signals to remaining sensory nerve fibers in the skin. The discovery of CGRP-beta as a therapeutic target presents a potentially important new treatment approach.

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Tai Chi Relieves Arthritis Pain, Improves Reach, Balance, Well-Being

Arthritis • • Chinese Medicine • • Pain • • Rheumatic DiseasesNov 08 10

In the largest study to date of the Arthritis Foundation’s Tai Chi program, participants showed improvement in pain, fatigue, stiffness and sense of well-being.

Their ability to reach while maintaining balance also improved, said Leigh Callahan, PhD, the study’s lead author, associate professor in the University of North Carolina at Chapel Hill School of Medicine and a member of UNC’s Thurston Arthritis Research Center.

“Our study shows that there are significant benefits of the Tai Chi course for individuals with all types of arthritis, including fibromyalgia, rheumatoid arthritis and osteoarthritis,” Callahan said. “We found this in both rural and urban settings across a southeastern state and a northeastern state.”

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Little harm seen from painkiller shots for pro athletes

Pain • • TraumaJul 30 10

When professional athletes in sports like football and rugby are injured, they commonly get injections of pain-numbing anesthetics to help them stay in the game. Now a new study suggests that, while safety concerns remain, most athletes may not suffer any long-term harm from the practice.

Injections of local anesthetics, like bupivacaine and lidocaine, temporarily block sensation in a limited area around the injection site.

While the injections have long been used in some pro sports to keep athletes in the game, the practice has only been “presumed” to be generally safe—with few studies having actually looked at the question, according to the researchers on the new work.

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Fybromyalgia Symptoms Can Vary Widely By admin

Pain • • Rheumatic DiseasesJun 04 10

Sometimes you’ll hear someone grumble that it’s “just aches and pains” or something that one should just suffer through, but in reality 2% of the population suffers from this painful disorder. The American College of Rheumatology and the Food and Drug Administration have recognized this debilitating disorder and drug companies are actively seeking ways of treating Fibromyalgia.

The defining symptoms of this disorder include chronic, widespread pain and tenderness to the touch. Generally, Fibromyalgia and chronic fatigue go hand-in-hand. Allodynia, or skin sensitivity that feels like pins and needles, may accompany the pain. As a result of the Fibromyalgia pain, sufferers often encounter sleep deprivation or abnormal sleeping patterns and wake up feeling unrefreshed. Some people have irritable bowel syndrome, leg spasms in the night, headaches or Temporomandibular joint (TMJ) dysfunction that causes rigidity in the face.

For severe cases, depression, mood disorders, impaired memory, anxiety, dry skin and mouth, or chest pain may accompany the other symptoms, making it nearly impossible to get through the day. In fact, it’s estimated that 30% of people with Fibromyalgia Syndrome are incapable of working and require government assistance.

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Mayo Clinic Proceedings: Review of pain management practices for cirrhosis patients

Bowel Problems • • PainMay 26 10

In the May issue of Mayo Clinic Proceedings, physician experts review current practices for pain management in cirrhotic patients. The physician experts reviewed all current literature available on PubMed and MEDLINE with no limits in the search to recommend a uniform and practical guide to approaching analgesia in the cirrhotic patients.

Cirrhosis is a substantial public health problem, accounting for approximately 770,000 deaths annually and, according to autopsy studies, affecting 4.5 percent to 9.5 percent of the global population. “Pain management in patients with cirrhosis is a difficult clinical challenge for health care professionals, and few prospective studies have offered an evidence-based approach,” says Kymberly Watt, M.D., Department of Gastroenterology and Hepatology at Mayo Clinic.

No evidence-based guidelines exist on the use of analgesics in patients with liver disease and cirrhosis, says Dr. Watt. From her findings in the current literature, her recommendation for long-term acetaminophen use in cirrhotic patients (not actively drinking alcohol) is for reduced dosing at 2 to 3 grams per day. For short-term use or one-time dosing, patient should not exceed 4 grams total per day but the proposed new FDA guidelines (yet to be finalized) may recommend a maximum daily dosage of 2.6 grams per day for anyone.

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Personalized Genetic Pain Treatment May Not Be Far Away

Neurology • • PainMay 06 10

In the not too distant future, it may be possible to discern an individual’s genetic predisposition to chronic pain conditions and treat them proactively to prevent lifetime afflictions, according to research presented today at the American Pain Society’s (http://www.ampainsoc.org) annual scientific meeting.

In his keynote address to some 2,000 pain clinicians attending the APS conference, noted neuro- genetic researcher Clifford Woolf, MD, PhD, professor of neurology and neurobiology, Harvard Medical School and Children’s Hospital Boston, said that advances in genetic research will help identify individuals genetically at risk for developing pain and foster personalized pain medicine.

“We know there is a large genetic component for pain,” Woolf told the APS audience,” and this eventually will be the key that allows clinicians to learn the answers to basic questions, such as: ‘Why does one individual feel more pain than another?’, ‘Why do some transition to chronic pain and others do not?’, and ‘Why does one patient respond to one analgesic and not another patient?’”

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Physical and Psychological Functioning Important to Patient Coping and Appraisal of Disease-Related Pain

PainMay 06 10

Growing evidence suggests how individuals cope with and appraise disease-related pain, such as arthritis or cancer, is related not only to their experience with pain but also to their physical and psychological functioning, according to new research presented here today in a plenary session talk at the American Pain Society’s (http://www.ampainsoc.org) annual scientific meeting.

In his presentation titled “Pain Coping in Disease-Related Pain: Current State of the Science,” Francis J. Keefe, Ph.D., professor of psychiatry and behavioral sciences and associate director for research in the Duke Pain and Palliative Care Initiative at Duke University Medical Center, described the conceptual background for research on pain coping and appraisal, especially in disease-related pain, and provided an in-depth evaluation of key themes on pain coping that have emerged from important recent research studies.

“We are clearly observing that studies of coping do help us better understand variations in pain and disability,” explained Dr. Keefe. “It’s important to remember that any type of pain has both mental and physical components to it.

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American Pain Society Presents 2010 Achievement Awards

Pain • • Public HealthMay 06 10

The American Pain Society (APS), http://www.ampainsoc.org, today announced the winners of its prestigious annual achievement awards during the organization’s annual scientific meeting.

Every year, APS rewards excellence in the field of pain management by presenting six separate awards for career achievement, pain scholarship, education and public service, advocacy on behalf of children, outstanding service to APS, and early career achievements.

“Through its achievement awards, the American Pain Society recognizes excellence in improving the understanding of pain management among health care professionals and the general public,” said APS President Charles E. Inturrisi, PhD, professor of pharmacology, Weill Cornell Medical Center. “We congratulate these individuals and pay tribute to their dedication and service on behalf of those with chronic and acute pain.”

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Body’s own “heat messenger” offers new painkiller

PainApr 28 10

Researchers have discovered the body’s own “heat messenger,” which helps nerves feel pain, and said on Monday they hope to use it to design a new, safer class of painkillers.

They found heat activates basic fatty acids similar to capsaicin, the compound that gives chili peppers their kick, and found two potential ways to block the sensation.

“For the first time we have the opportunity to try to block pain at its source,” Dr. Kenneth Hargreaves of The University of Texas Health Science Center at San Antonio, who led the study, said in a telephone interview.

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Study Examines Costs of Neuropathic Pain

PainApr 27 10

Constantly rising U.S. health care costs could be reduced significantly by preventing and treating neuropathic pain conditions associated with diabetes and herpes zoster virus infections, according to research published in The Journal of Pain, the peer review publication of the American Pain Society, http://www.ampainsoc.org and jpain.org.

Researchers at the University of Rochester and the University of Arizona examined databases of medical and pharmacy claims at major national health plans covering some 75 million lives. The objective of the study was to estimate and compare health care costs of two peripheral neuropathic pain conditions, post herpetic neuralgia (PHN) and diabetic peripheral neuropathy (DPN). PHN causes pain following rash healing in herpes zoster, which infects 1 million people in the U.S. every year.

DPN is a painful neuropathy estimated to affect up to 47 percent of diabetes patients. According to one study, some 5 million Americans are afflicted with neuropathic pain conditions, of which PHN and DPN are the most common.

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Pain free treatment of children and adolescents

Children's Health • • PainApr 26 10

Properly performed analgesia protects children from pain and traumatization. In the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2010; 107(14): 241-7), Christoph Neuhäuser and his colleagues show how analgesia for children and adolescents should be carried out.

Medical interventions can be very unpleasant. However, we know that they are necessary and that they will help us, so we grit our teeth until the grueling procedure has been got through. On the other hand, children are often incapable of grasping the situation in which they find themselves and the possible consequences. They tend to regard painful treatment as a threat and suffer enormous psychological stress.

Children’s special needs are all too often neglected in pain therapy. This can have dire consequences and traumatize the child. If properly used, analgesia and analgesic sedation can prevent this.

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New Pain Management Approaches Reduce Pain, Speed Recovery for Knee or Hip Replacement

Pain • • TraumaFeb 12 10

Patients undergoing knee or hip replacements recover more quickly when treated with targeted pain-blocking medications that may eliminate the need for general anesthesia during surgery and intravenous narcotics drugs after surgery.

The February issue of Mayo Clinic Health Letter explains the newer pain management options and their benefits.

A decade ago, patients undergoing hip or knee replacements were almost exclusively given general anesthesia during surgery and intravenous narcotic pain medications afterward. This approach works for most people and still is commonly practiced. But both general anesthesia and intravenous narcotic drugs can cause nausea, vomiting, grogginess, decreased bowel function and other side effects.

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