Biological Psychology Links

By Jeremy Laurance, Health Editor If you want to tell whether your baby is in pain, looking at its face may not be enough, researchers have found. Generations of mothers have depended on their baby's facial expressions to tell them what they are feeling. But a study has found that giving a baby a spoonful of sugar before an injection or blood test may alter its expression without lessening its pain. The finding casts doubt on whether we can really know what a baby is feeling from observing its responses – and on the decade-old practice of using sugar as a pain reliever for infants. Until the 1950s, doctors thought babies did not suffer pain because their consciousness was not sufficiently developed. The normal pain responses – grimacing and crying – were dismissed as reflexes. Babies subjected to surgery were given anaesthetics to put them to sleep but not analgesic drugs for the pain, as children and adults were. In the 1970s, a definitive study showed babies did benefit from analgesia. But as it is difficult to test them on babies, few drugs are available. Giving a teaspoonful of sugar solution to babies was thought to relieve pain based on the way it reduced grimacing and crying after a painful procedure. It is believed to stimulate the production of "endogenous opiates" – the body's own natural pain-relieving drugs – and has become standard practice before blood tests and similar procedures. Some doctors maintain the evidence is now so strong that it may be unethical not to use it. ©independent.co.uk

By TARA PARKER-POPE For kids around the country it’s back-to-school time. But for many of them, it’s also the return of headache season. Doctors say frequent headaches and migraines are among the most common childhood health complaints, yet the problem gets surprisingly little attention from the medical community. Many pediatricians and parents view migraines as an adult condition. And because many children complain of headaches more often during the school year than the summer, parents often think a child is exaggerating symptoms to get out of schoolwork. Often the real issue, say doctors, is that changes in a child’s sleep schedule, including getting up early for school and staying up late to study, as well as skipping breakfast, not drinking enough water and weather changes can all trigger migraines when the school year starts. “In many areas people just don’t think kids can get migraines,” says Dr. Andrew Hershey, professor of pediatrics and neurology and director of the headache center at Cincinnati Children’s Hospital Medical Center. “But kids shouldn’t be missing activities and having trouble at school because they’re having headaches. If it happens, it shouldn’t be ignored.” Migraine is an inherited neurological condition characterized by severe, often disabling headache pain. During a migraine attack, a number of changes occur throughout the brain causing dilation of blood vessels; severe pain; increased sensitivity to lights, sounds and smells; nausea and vomiting; and other symptoms. It’s estimated that about 10 percent of young children and up to 28 percent of older teenagers suffer from migraines. (Hormonal changes during puberty can also be a trigger.) Copyright 2010 The New York Times Company

Smoking marijuana does help relieve a certain amount of pain, a small but well-designed Canadian study has found. People who suffer chronic neuropathic or nerve pain from damage or dysfunction of the nervous system have few treatment options with varying degrees of effectiveness and side-effects. Neuropathic pain is caused by damage to nerves that don't repair, which can make the skin sensitive to a light touch. Cannabis pills have been shown to help treat some types of pain but the effects and risks from smoked cannabis were unclear. To find out more, Dr. Mark Ware, an assistant professor in family medicine and anesthesia at Montreal's McGill University, and his colleagues conducted a randomized controlled trial — the gold standard of medical research — of inhaled cannabis in 21 adults with chronic neuropathic pain. Investigators used three different strengths of the active drug — THC levels of 2.5 per cent, six per cent and 9.4 per cent, as well as a zero per cent placebo. "We found that 25 mg herbal cannabis with 9.4 per cent THC, administered as a single smoked inhalation three times daily for five days, significantly reduces average pain intensity compared with a zero per cent THC cannabis placebo in adult subjects with chronic post traumatic/post surgical neuropathic pain," the study's authors concluded in Monday's online issue of the Canadian Medical Association Journal. Study participants inhaled the 25-milligram dose through a pipe for five days and then took no marijuana for nine days. Then they rotated through the other doses of THC. © CBC 2010

By Steve Connor, Science Editor A revolutionary way of screening the entire human genome for the genetic signposts of disease has produced its latest success – the first inherited link to common migraine and a possible reason for extreme headaches. The technique, which scans all 23 pairs of human chromosomes in a single sweep, has found the first genetic risk factor that predisposes someone to the common form of migraine, which affects one in six women and one in 12 men. The discovery has immediately led to a new possible cause of migraine by alerting scientists to DNA defects involved in the build-up of a substance in the nerves of sufferers that could be the trigger for their migraines. Scientists believe the findings could lead both to a better understanding as well as new treatments for the chronic and debilitating condition which is estimated to be one of the most costly brain-related disorders in society, causing countless lost working days. Scanning the entire blueprint of human DNA by genome-wide association studies (GWAS) has had a profound effect on the understanding of a range of other medical conditions over the past few years, from heart disease and obesity to bipolar disorder and testicular cancer. The study of migraine, published in the journal Nature Genetics, was an archetypal example of the new approach of medical genetics using the GWAS technique. Scientists analysed the genomes of some 5,000 people with migraine and compared their DNA to that of unaffected people to see if there were any significant differences that could be linked statistically to the condition. ©independent.co.uk

By HELEN EPSTEIN For the fortunate, pain is temporary and finite, with a clear beginning, middle and end. But for more than 70 million Americans, including Melanie Thernstrom, pain is chronic, and the primary reason that they seek medical care. The medical profession has been slow to recognize this development. There is currently one board-certified pain specialist in the United States for every 25,000 patients, she writes in her new book, “The Pain Chronicles.” That number, however, is likely to grow as pain is redefined not as a symptom but as a disease that “can eventually rewrite the central nervous system, causing pathological changes to the brain and spinal cord, and ... greater pain.” There have been hundreds of books published in the last decades on pain and its management, but none that combine memoir, scholarly research and journalistic reportage in the way Ms. Thernstrom, the author of two previous books, does. A stellar example of literary nonfiction (parts of which first appeared in The New York Times Magazine), the book recounts the author’s own years with chronic pain and the preconceptions she brought to it (including the idea of pain as the price for romantic love); summarizes its social, cultural and medical history; and gives us a reporter’s view of state-of-the-art treatment. The book has a patchwork quilt structure: more than one hundred small captioned patches (or dispatches), organized into five parts and threaded with personal narrative. This invites differently motivated readers to skip or skim. You can chuckle over the aperçus of poets and philosophers like Aristotle, Coleridge, Dickinson, Sontag, and Foucault in the section entitled “Pain as Metaphor.” You can become absorbed, as I was, in the fascinating struggle over the use of anesthesia (and, later, opiates) in “Pain as History,” or play voyeur during absorbing clinical vignettes of “Pain as Disease.” Copyright 2010 The New York Times Company

By Jenifer Goodwin (HealthDay News) -- Menstrual cramps are often dismissed as a mere nuisance, but new research suggests the monthly misery may be altering women's brains. Researchers in Taiwan used a type of brain scan known as optimized voxel-based morphometry to analyze the anatomy of the brains of 32 young women who reported experiencing moderate to severe menstrual cramps on a regular basis for several years, and 32 young women who did not experience much menstrual pain. Even when they weren't experiencing pain, women who had reported having bad cramps had abnormalities in their gray matter (a type of brain tissue), said study author Dr. Jen-Chuen Hsieh, a professor of neuroscience at the Institute of Brain Science at National Yang-Ming University in Taipei, Taiwan. Those differences included abnormal decreases in volume in regions of the brain believed to be involved in pain processing, higher-level sensory processing and emotional regulation, as well as increases in regions involved in pain modulation and regulation of endocrine function. Exactly how the changes in the brain could affect women's experience of pain is unknown, researchers said. But the brain abnormalities suggest that menstrual pain may have similarities with other chronic pain conditions in that over time, repeated bouts of excruciating aches make the brain unusually sensitive to pain -- in effect, making the experience of pain worse. ©2010 Bloomberg L.P.

Q. My husband gets disabling headaches from fluorescent lighting, even the new compact ones that look more like incandescent light. Also from looking directly at LCD monitors. Although he works at home and can avoid this lighting for the most part, it’s very disabling, prevents him from going many places that he’d like to, taking our daughter places, etc. Once he’s affected, the only thing that really helps is sleeping. He’s being treated by a neurologist (who has diagnosed them as migraine), but the one med that seemed to help (I think Topamax) left him with exhaustion as a side effect, so he had to stop taking it. Wearing a baseball cap and sunglasses helps him tolerate the lighting a little better, but not much. The effects are much, much worse earlier in the day; he can tolerate greater exposure if it’s later in the day. Is there anything in the research literature about light-induced migraine and treatment strategies? Ellen, New England Dr. David Dodick responds: Light-induced migraine is common, and light often amplifies the pain after the headache has begun. (Doctors refer to this occurrence as photophobia.) There is exciting new research on the anatomical pathways that account for how and why migraine is worsened by light, and ongoing research to explain how and why light may trigger a migraine attack. Copyright 2010 The New York Times Company

NEW YORK — Want to maximize the placebo effect? A good way to do this, according to a new study, is to tell someone they have a decent chance of getting the real treatment instead of a fake pill, but keep them guessing. In the study, Parkinson's disease patients given a placebo after being told they had a 75 percent chance of receiving an active drug produced significant amounts of dopamine, a chemical key to the brain's reward system that is scarce in the brains of patients with this disease. But no dopamine response occurred in patients given placebo after being told they had a 25 percent, 50 percent, or 100 percent chance of getting real treatment. The findings show that expectations directly regulate the power of the placebo effect by kicking the brain's reward system into gear, probably not just in Parkinson's patients but in a number of different illnesses, such as chronic pain and depression, according to Dr. A. Jon Stoessl of the Pacific Parkinson's Research Center in Vancouver, British Columbia, and his colleagues. "The greatest form of reward is really to get better, so expectation of improvement is akin to expectation of reward," Stoessl explained in an interview. Stoessl and his colleagues first demonstrated a relationship between the placebo effect and dopamine release in Parkinson's patients nine years ago. Given dopamine's role in the reward system, he explained, "perhaps it would be important for the placebo effect in other conditions." SOURCE: http://link.reuters.com/cab43n Archives of General Psychiatry, August 2010. Copyright 2010 Reuters.

Q. I had migraine diagnosed when I was 24 years old (I’m now 30), but I remember having them since my teens. I usually get them during times when my hormone levels change (e.g., during periods, ovulation). There are also other triggers like stress, too little sleep, etc. If the migraines start during the day, they are often preceded and/or followed by major mood swings, the kind that make me want to go jump off the bridge. The associated depression often recedes with pain and then comes back again after the pain recedes. Afterward, I can feel on top of the world — loving, caring and full of joy. Is this normal? Espoo, Finland A. Dr. Dodick responds: What you are experiencing before and after the headache of a migraine attack is not unusual. I am glad you asked, because it speaks to why I emphasize that migraine is more than just a bad headache. Migraine is too often “bookmarked” by the start and stop of the headache, but migraine is frequently associated with symptoms other than headache before, during and after the onset of head pain. About 75 percent of migraine sufferers will experience non-headache premonitory symptoms prior to the headache pain. Patients experience a range of cognitive, emotional and physical symptoms in this phase; the most common include feeling tired and weary, difficulty concentrating, stiff neck, dizziness, light and noise sensitivity, yawning, and depression or irritability. Copyright 2010 The New York Times Company

Janelle Weaver A Canadian research team that induced pain in mice to help develop a 'grimace scale' recently came under fire from a researcher-support organization, which posted an online commentary suggesting that the scientists may not have complied with Canada's animal welfare regulations. But Canadian officials have since determined that the study did follow national rules for the care of laboratory animals. The research team, led by pain geneticist Jeffrey Mogil of McGill University in Montreal, Quebec, videotaped the facial expressions of mice during 14 pain-inducing procedures, such as immersing the tail in hot water, putting a binder clip on tails, cutting the paw, injecting chemicals into the paw or stomach and constricting or damaging nerves during surgery. The researchers coded the intensity of facial expressions and reported their technique this May in the journal Nature Methods1. Two weeks ago, the Principal Investigators Association, a non-profit organization in Naples, Florida, that "communicates and promotes best practices and continuing professional education", posted a discussion-board topic about the study on Lab Animal eAlert, its online subscription newsletter for researchers. The commentary accused the McGill team of causing severe pain to mice that were not anaesthetized, and questioned whether Mogil and his collaborators followed regulations set by the Canadian Council on Animal Care, the national organization that oversees the use of animals in research. Canadian animal-research guidelines preclude or strongly discourage procedures that elicit severe pain "at or above the pain tolerance threshold". © 2010 Nature Publishing Group,

By THE NEW YORK TIMES Dr. Dodick — I have been getting non-aura migraines since childhood, around the time my menstrual cycle began. I cut out caffeine, chocolate and red wine in my mid-20s but continue to have migraines once a month in conjunction with my cycle. I am curious if taking a birth control pill that limits the number of periods will also lessen the frequency of migraines? Lauren, Austin Dr. David Dodick of the Mayo Clinic responds: Menstruation is a very common and powerful trigger in women who suffer from migraine. There is evidence — and it has certainly been my experience with patients — that in some women, these attacks are also more severe and last longer than those attacks that occur outside the menstrual period. By definition, attacks of migraine that are triggered by menstruation occur within two days prior and three days after the onset of menstrual flow. While the mechanism by which menstruation triggers migraine is not completely clear, experts believe that the precipitous drop in estrogen levels prior to menstruation leads to changes in the excitability of the central nervous system, including the regions of the brain that are involved in migraine. The answer to your question is yes, for some women, there is evidence that taking a combination oral contraceptive pill continuously does reduce the frequency of migraine attacks associated with menstrual periods. However, you should discuss the risks and benefits of this strategy with your primary care physician or gynecologist. Copyright 2010 The New York Times Company

by Andy Coghlan Fetuses aged 24 weeks or less do not have the brain connections to feel pain, according to a working party report published this week by the UK Royal College of Obstetricians and Gynaecologists (RCOG). Its conclusion is the latest to challenge the rationale for a law introduced in the US state of Nebraska in April. This law, which bans almost all abortions beyond 20 weeks of pregnancy, was introduced primarily on the grounds that the fetus feels pain. The report, which reviews recent scientific literature on the subject, also concludes that the fetus is sedated throughout pregnancy by chemicals such as adenosine contained in the amniotic fluid that surrounds it. Because the fetus is unable to feel pain before 24 weeks, no pain relief is needed for medical procedures up to that time, including abortion, the report concludes. This reverses the position the RCOG took in its previous report on fetal pain in 1997, which supported the use of analgesia. "We have now advised that analgesia is not indicated up to 24 weeks," says Allan Templeton, chairman of the working group that produced the report. He adds that administering painkillers carries risks of harming the fetus. © Copyright Reed Business Information Ltd.

By Bruce Bower Don’t be shocked if car sellers soon decide to seat prospective buyers in beanbag chairs, or maybe in La-Z-Boys. Soft seats subtly steer people away from driving hard bargains, a provocative new study suggests. Objects’ tactile qualities, such as a chair’s softness or hardness, automatically call to mind associated metaphors, such as flexibility or rigidity, say MIT psychologist Joshua Ackerman and his colleagues. In this way, sensations of weight, texture and hardness surreptitiously create mindsets that influence how people think about and deal with others, the researchers propose in the June 25 Science. The team conducted six experiments in which people, some passersby on streets and some volunteers in a lab, experienced different touch sensations while making several kinds of decisions. In one case, 43 people sitting in hard wooden chairs showed less willingness to compromise in price negotiations for a new car than 43 people who sat in cushioned chairs. After being told that their initial offer on a car with a $16,500 sticker price had been refused, wooden-chair sitters upped their offers by an average of $897, compared with $1,244 for the cushioned crowd. In other words, people in soft chairs increased their offers 38% more than people in hard chairs. “I suspect that the stresses of real-world decision-making environments will act as mental distracters, making people even more susceptible to the effects of tactile cues,” Ackerman says. © Society for Science & the Public 2000 - 2010

By Larry O'Hanlon It turns out that most parents are freaking kids out when children are about to undergo a painful medical procedure. A new study has started to crack the mystery behind why saying, "Don't worry," to kids causes them to be more anxious than ever, while children whose parents just talk about something else cope better. "It seems counterintuitive that reassurance can hurt," said Meghan McMurty of the Departments of Psychology, Pediatrics and Psychiatry at Dalhousie University in Halifax, Nova Scotia. But it's a well established fact that when parents try to soothe kids facing a needle, it nearly always backfires. To find out just what aspects of reassurance were heightening the fear in children, McMurty and her colleagues recruited 100 children between ages 5 and 10 and their parents. All the children were having blood drawn for tests in an outpatient blood lab. By videotaping the parents' behaviors and playing them back to children before they left the clinic, along with video vignettes by actors recreating the same behaviors, the researchers hoped to separate out the effects of whether the parents reassured them, their facial expressions as well as the tones of parents' voices. The children rated what they saw in the videos. © 2010 Discovery Communications, LLC.

As pain sufferers can attest, there’s room for improvement in painkilling medications. Many of the current ones can cause side effects, such as stomach ulcers, particularly in people who have to take them over long periods of time for conditions such as arthritis. Now, recent research points to what may be a good new target for analgesic drugs. It also sheds light on inflammatory pain sensitization, which causes patients to feel intense pain even in response to normally innocuous stimuli, such as a light touch. In the 7 May issue of Science, an international team led by Ulrike M�ller of the Max Planck Institute for Brain Research in Frankfurt, Germany, reports having identified the α3 form of the receptor for the neurotransmitter glycine as a key intermediate in transmitting pain signals from the spinal cord to the brain. The work shows that the receptor is needed for pain sensitization--the first time that a function has been identified for this particular receptor. Copyright © 2004 by the American Association for the Advancement of Science.

KINGSTON, Ont. - Anticipating our own touch - for example in tickling oneself - reduces its impact, says Queen's psychologist Dr. Randy Flanagan, a member of the university's Centre for Neuroscience Studies. This is evidence of an important human adaptation that helps us interact with objects in our environment. An expert in eye/hand movement, Dr. Flanagan is part of an international team exploring sensory attenuation - the way that we filter out or "cancel" unnecessary information from the world around us. Their study appears on-line today in the international journal Public Library of Science (PloS) - Biology. Led by Paul Bays of University College London, the team also includes Daniel Wolpert of Cambridge University. "It's well-known that you can't tickle yourself," says Dr. Flanagan. "One explanation is that since all the sensations are completely predictable, we do 'sensory attenuation' which reduces our touch perception." Because people continually receive a barrage of sensory information, it's necessary to distinguish between what is caused by our own movements and what is due to changes in the outside world. ©Queen's University, 2005

By JOHN TIERNEY ALEXANDRIA, Va., March 26 — The case of the United States v. William Eliot Hurwitz, which began in federal court here on Monday, is about much more than one physician. It’s a battle over who sets the rules for treating patients who are in pain: narcotics agents and prosecutors, or doctors and scientists. Dr. Hurwitz, depending on which side you listen to, is either the most infamous doctor-turned-drug-trafficker in America or a compassionate physician being persecuted because a few patients duped him. When Dr. Hurwitz, who is now 62, was sent to prison in 2004 for 25 years on drug trafficking and other charges, the United States attorney for Eastern Virginia, Paul J. McNulty, called the conviction “a major achievement in the government’s efforts to rid the pain management community of the tiny percentage of doctors who fail to follow the law and prescribe to known drug dealers and abusers.” Siobhan Reynold, the president of an advocacy group called the Pain Relief Network, hailed Dr. Hurwitz’s singular dedication and compared his plight to Galileo’s. Some of the country’s foremost researchers in pain treatment and addiction supported his appeal for a retrial, which was ordered because the jury in the first case was improperly instructed to ignore whether Dr. Hurwitz had acted in “good faith.” These scientists say they are upset by how their research has been distorted by prosecutors in this case, and suppressed by the Drug Enforcement Administration in its campaign against the misuse of OxyContin and other opioid painkillers. Copyright 2007 The New York Times Company

By GARDINER HARRIS GAITHERSBURG, Md., — A panel of federal drug advisers voted 20 to 1 Thursday to reject an application by Merck to sell its pain pill Arcoxia because of concerns that the drug could cause as many as 30,000 heart attacks annually if widely used. Food and Drug Administration officials were unusually harsh in their criticism of the medicine. “What you’re talking about is a potential public health disaster” if Arcoxia is approved for sale, Dr. David Graham, an F.D.A. safety officer, told the panel. Arcoxia is a sister to Vioxx, which Merck withdrew in 2004 after a study showed that it also increased the risks of heart attacks and strokes. Merck sells Arcoxia in 63 countries, and the company underwrote an extensive safety testing program that involved 34,000 arthritis patients. The studies showed that Arcoxia caused nearly three times as many heart attacks, strokes and deaths as naproxen, a popular pain pill sold as Aleve, but was no more effective in curing pain. Patients taking Arcoxia suffered worrisome increases in blood pressure. Dr. Peter Kim, Merck’s research chief, told the panel that the nation’s estimated 21 million arthritis patients needed new therapy options. Representatives of his company who followed him said Arcoxia was no more effective than 20 older pain pills already marketed — some for pennies a pill — and just as risky for the heart than all but one of them. Copyright 2007 The New York Times Company

By DONALD G. McNEIL Jr. WATERLOO, Sierra Leone — Although the rainy season was coming on fast, Zainabu Sesay was in no shape to help her husband. Ditches had to be dug to protect their cassava and peanuts, and their mud hut’s palm roof was sliding off. But Mrs. Sesay was sick. She had breast cancer in a form that Western doctors rarely see anymore — the tumor had burst through her skin, looking like a putrid head of cauliflower weeping small amounts of blood at its edges. “It bone! It booonnnne lie de fi-yuh!” she said of the pain — it burns like fire — in Krio, the blended language spoken in this country where British colonizers resettled freed slaves. No one had directly told her yet, but there was no hope — the cancer was also in her lymph glands and ribs. Like millions of others in the world’s poorest countries, she is destined to die in pain. She cannot get the drug she needs — one that is cheap, effective, perfectly legal for medical uses under treaties signed by virtually every country, made in large quantities, and has been around since Hippocrates praised its source, the opium poppy. She cannot get morphine. Copyright 2007 The New York Times Company

NEW YORK - Giving infants a small dose of a sugar solution just before they get injections seems to make the pain more tolerable, a study shows. Researchers gave babies ages 2 and 4 months the solution two minutes before getting routine immunizations and noted that it seemed to help them recover from the pain of the injection more quickly, the medical journal Pediatrics reported. Dr. Linda A. Hatfield, at the Pennsylvania State University School of Nursing in University Park, and her associates gave the sugar solution to 38 infants and plain water to 45 infants before they were to get a series of injections. The first, second and third injections were administered at 2 minutes, 5 minutes, and 7 minutes after the solutions were given. To assess the babies’ experience of pain, the investigators used a validated composite pain scale that measures crying, facial expression, behavior, body movement, and sleep. The scale goes from 0 to 5, with higher scores representing greater pain. Pain was assessed immediately after each injection, and at 9 minutes. Copyright 2008 Reuters.

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