Chapter 8. General Principles of Sensory Processing, Touch, and Pain
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by Emiko Jozuka Touch, says David J. Linden, is something we take for granted. "It's very hard to imagine it gone," he tells WIRED.co.uk. "You can imagine what it's like to be blind or deaf, or have no sense of smell, but there's no way to turn off touch". Touch might not be an obvious starting point for Linden, who is a professor of neuroscience at the John Hopkins University, studying learning and memory. But according to the professor, "the story of the neuroscience underlying touch has yet to be told". Pointing to the advances made in touch research over the last 20 years, Linden tells us that his own interest in the topic was sparked over lunch by colleagues working in the School of Medicine. Making the complex links between the brain and our sense of touch accessible to a wider audience is no easy feat. Yet in his recent book entitled, Touch: The Science of Hand, Heart, and Mind, Linden offers anecdotal and factual ways in to exploring different aspects of touch, whether that be in the form of pain, itches, hot and cold sensations or caresses. "We think of touch as being a one sense modality, but it's many different sensors in the skin acting in parallel," says Linden. He explains how the information in the form of, for example, an itch, pain or caress relays to the brain, dividing them into either discriminative or emotional forms of touch. The discriminative touch allows a person to understand where the body is being touched, or to understand if an object is textured, smooth or 3D. While emotional touch is what makes pain feel emotionally negative, or an orgasm feel positive, says Linden.
Keyword: Pain & Touch
Link ID: 20708 - Posted: 03.21.2015
Loss of sensation in the eye that gradually leads to blindness has been prevented with an innovative technique, Canadian surgeons say. Abby Messner, 18, of Stouffville, Ont., lost feeling in her left eye after a brain tumour was removed, along with a nerve wrapped around it, when she was 11. Messner said she didn’t notice the loss of feeling until she scratched the eye. Messner wasn’t able to feel pain in the eye, a condition called corneal anaesthesia. Despite her meticulous care, the eye wouldn’t blink to protect itself when confronted by dust. A scar formed on her cornea, burrowed through, and formed a scar doctors feared would eventually obliterate her vision. "Everyone was like, 'Wow, she had a brain tumour and she’s fine," Messner recalled. "You don't really think that everything that is holding me back is my eye." Messner had to give up competitive swimming because of irritation from the chlorine, playing hockey, spending time outdoors where wind was a hazard or inside dry shopping malls. Over time, ophthalmology surgeon Dr. Asam Ali at SickKids introduced the idea of a nerve graft to restore feeling in the eye. "She started getting feeling back at about the two, three-month mark and that was a real surprise to her and we were very happy at that point because that was a lot faster than anything that had been reported before," Ali said. ©2015 CBC/Radio-Canada.
Sara Reardon Annie is lying down when she answers the phone; she is trying to recover from a rare trip out of the house. Moving around for an extended period leaves the 56-year-old exhausted and with excruciating pain shooting up her back to her shoulders. “It's really awful,” she says. “You never get comfortable.” In 2011, Annie, whose name has been changed at the request of her lawyer, slipped and fell on a wet floor in a restaurant, injuring her back and head. The pain has never eased, and forced her to leave her job in retail. Annie sued the restaurant, which has denied liability, for several hundred thousand dollars to cover medical bills and lost income. To bolster her case that she is in pain and not just malingering, Annie's lawyer suggested that she enlist the services of Millennium Magnetic Technologies (MMT), a Connecticut-based neuroimaging company that has a centre in Birmingham, Alabama, where Annie lives. MMT says that it can detect pain's signature using functional magnetic resonance imaging (fMRI), which measures and maps blood flow in the brain as a proxy for neural activity. The scan is not cheap — about US$4,500 — but Steven Levy, MMT's chief executive, says that it is a worthwhile investment: the company has had ten or so customers since it began offering the service in 2013, and all have settled out of court, he says. If the scans are admitted to Annie's trial, which is expected to take place early this year, it could establish a legal precedent in Alabama. Most personal-injury cases settle out of court, so it is impossible to document how often brain scans for pain are being used in civil law. But the practice seems to be getting more common, at least in the United States, where health care is not covered by the government and personal-injury cases are frequent. Several companies have cropped up, and at least one university has offered the service. © 2015 Nature Publishing Group
By Emily Underwood SAN JOSE, CALIFORNIA—If you've ever had a migraine, you know it's no ordinary headache: In addition to throbbing waves of excruciating pain, symptoms often include nausea, visual disturbances, and acute sensitivity to sounds, smells, and light. Although there's no cure for the debilitating headaches, which affect roughly 10% of people worldwide, researchers are starting to untangle their cause and find more effective treatments. Here today at the annual meeting of AAAS (which publishes Science), Science sat down with Teshamae Monteith, a clinical neurologist at the University of Miami Health System in Florida, today to discuss the latest advances in the field. Q: How is our understanding of migraine evolving? A: It's more complicated than we thought. In the past, researchers thought of migraine as a blood vessel disorder, in part because some patients can feel a temple pulsation during a migraine attack. Now, migraine is considered a sensory perceptual disorder, because so many of the sensory systems—light, sound, smell, hearing—are altered. During an attack, patients have concentration impairments, appetite changes, mood changes, and sleeping is off. What fascinates me is that patients are often bothered by manifestations of migraine, such as increased sensitivity to light, in between attacks, suggesting that they may be wired differently, or their neurobiology may be altered. About two-thirds of patients with acute migraine attacks have allodynia, a condition that makes people so sensitive to certain stimuli that even steam from a shower can be incredibly painful. One way to view it is that migraineurs at baseline are at a different threshold for sensory stimuli. © 2015 American Association for the Advancement of Science.
Keyword: Pain & Touch
Link ID: 20585 - Posted: 02.16.2015
By Siri Carpenter “I don’t look like I have a disability, do I?” Jonas Moore asks me. I shake my head. No, I say — he does not. Bundled up in a puffy green coat in a drafty Starbucks, Moore, 35 and sandy-haired, doesn’t stand out in the crowd seeking refuge from the Wisconsin cold. His handshake is firm and his blue eyes meet mine as we talk. He comes across as intelligent and thoughtful, if perhaps a bit reserved. His disability — autism — is invisible. That’s part of the problem, says Moore. Like most people with autism spectrum disorders, he finds relationships challenging. In the past, he has been quick to anger and has had what he calls “meltdowns.” Those who don’t know he has autism can easily misinterpret his actions. “People think that when I do misbehave I’m somehow intentionally trying to be a jerk,” Moore says. “That’s just not the case.” His difficulty managing emotions has gotten him into some trouble, and he’s had a hard time holding onto jobs — an outcome he might have avoided, he says, if his coworkers and bosses had better understood his intentions. Over time, things have gotten better. Moore has held the same job for five years, vacuuming commercial buildings on a night cleaning crew. He attributes his success to getting the right amount of medication and therapy, to time maturing him and to the fact that he now works mostly alone. Moore is fortunate. His parents help support him financially. He has access to good mental health care. And with the help of the state’s division of vocational rehabilitation, he has found a job that suits him. Many adults with autism are not so lucky. © Society for Science & the Public 2000 - 2015.
Link ID: 20574 - Posted: 02.13.2015
|By Stephani Sutherland More than half a billion people carry a genetic mutation that incapacitates the enzyme responsible for clearing alcohol from the body. The deficiency is responsible for an alcohol flush reaction, colloquially known as the “Asian glow” because the vast majority of carriers are descendants of the Han Chinese. Now research published last September in Science Translational Medicine suggests that the mutation might also compromise carriers' pain tolerance. The finding points to a new target for pharmaceutical pain relief and implies that drinking alcohol might exacerbate inflammatory conditions such as arthritis. When people consume alcohol, the body breaks it down into several by-products, including chemicals called aldehydes. These compounds are noxious if they remain in the system too long, causing flushing, nausea, dizziness and other symptoms of the alcohol flush reaction. In most people, aldehydes are immediately broken down by the enzyme aldehyde dehydrogenase (ALDH2), but in those with the genetic mutation, the enzyme is incapacitated. Researchers led by Daria Mochly-Rosen of Stanford University genetically modified some mice to carry the mutation seen in humans that disables ALDH2. When they injected those mice and normal mice in the paw with an inflammatory compound that turned it red and swollen, mice carrying the mutation showed increased sensitivity to a poke compared with those with functioning ALDH2. When the researchers treated all the rodents with a novel drug called Alda-1 that boosts ALDH2 activity, the pain symptoms were reduced regardless of whether they carried the gene mutation. © 2015 Scientific American
By Lenny Bernstein Parkinson's Disease patients secretly treated with a placebo instead of their regular medication performed better when told they were receiving a more expensive version of the "drug," researchers reported Wednesday in an unprecedented study that involved real patients. The research shows that the well-documented "placebo effect" -- actual symptom relief brought about by a sham treatment or medication -- can be enhanced by adding information about cost, according to the lead author of the study. It is the first time that concept has been demonstrated using people with a real illness, in this case Parkinson's, a progressive neurological disease that has no cure, according to an expert not involved in the study. "The potentially large benefit of placebo, with or without price manipulations, is waiting to be untapped for patients with [Parkinson's Disease], as well as those with other neurologic and medical diseases," the authors wrote in a study published online Wednesday in the journal Neurology. But deceiving actual patients in a research study raised ethical questions about violating the trust involved in a doctor-patient relationship. Most studies in which researchers conceal their true aims or other information from subjects are conducted with healthy volunteers. This one was subjected to a lengthy review before it was allowed to proceed, and, in an editorial that accompanied the article, two other physicians wrote that "the authors do not mention whether there was any possible effect (reduction) on trust in doctors or on willingness to engage in future clinical research."
The presence of a romantic partner during painful medical procedures could make women feel worse rather than better, researchers say. A small study found this increase in pain was most pronounced in women who tended to avoid closeness in their relationships. The authors say bringing a loved one along for support may not be the best strategy for every patient. The work appears in the journal Social Cognitive and Affective Neuroscience. Researchers from University College London, King's College London and the University of Hertfordshire say there has been very little scientific research into the effects of a partner's presence on someone's perception of pain, despite this being common medical advice. They recruited 39 heterosexual couples and asked them a series of questions to measure how much they sought or avoided closeness and emotional intimacy in relationships. Each female volunteer was then subjected to a series of painful laser pulses while her partner was in and then out of the room. The women were asked to score their level of pain. They also had their brain activity measured using a medical test called an EEG. The researchers found that certain women were more likely to score high levels of pain while their partner was in the room. These were women who said they preferred to avoid closeness, trusted themselves more than their partners and felt uncomfortable in their relationships. © 2015 BBC
Keyword: Pain & Touch
Link ID: 20502 - Posted: 01.21.2015
by Jessica Hamzelou YOU'RE not imagining the pain. But your brain might be behind it, nonetheless. For the first time, it is possible to distinguish between brain activity associated with pain from a physical cause, such as an injury, and that associated with pain linked to your state of mind. A fifth of the world's population is thought to experience some kind of chronic pain – that which has lasted longer than three months. If the pain has no clear cause, people can find themselves fobbed off by doctors who they feel don't believe them, or given ineffective or addictive painkillers. But a study led by Tor Wager at the University of Colorado, Boulder, now reveals that there are two patterns of brain activity related to pain. One day, brain scans could be used to work out your relative components of each, helping to guide treatment. "Pain has always been a bit of a puzzle," says Ben Seymour, a neuroscientist at the University of Cambridge. Hearing or vision, for example, can be traced from sensory organs to distinct brain regions, but pain is more complex, and incorporates thoughts and emotions. For example, studies have linked depression and anxiety to the development of pain conditions, and volunteers put in bad moods have a lower tolerance for pain. So does this mean we can think our way into or out of pain? To find out, Wager and his colleagues used fMRI to look at the brain activity of 33 healthy adults while they were feeling pain. First, the team watched the changing activity as they applied increasing heat to the volunteers' arms. As the heat became painful, a range of brain structures lit up. The pattern was common to all the volunteers, so Wager's team called it the neurologic pain signature. © Copyright Reed Business Information Ltd.
By Will Boggs MD NEW YORK (Reuters Health) - Patients with chronic pain show signs of glial activation in brain centers that modulate pain, according to results from a PET-MRI study. "Glia appears to be involved in the pathophysiology of chronic pain, and therefore we should consider developing therapeutic approaches targeting glia," Dr. Marco L. Loggia from Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, told Reuters Health by email. "Glial activation is accompanied by many cellular responses, which include the production and release of substances (such as so-called 'pro-inflammatory cytokines') that can sensitize the pain pathways in the central nervous system," he explained. "Thus, glial activation is not a mere reaction to a pain state but actively contributes to the establishment and/or maintenance of persistent pain." To test their hypothesis that patients with chronic pain demonstrate in vivo activation of brain glia, Dr. Loggia's team imaged the brains of 19 individuals diagnosed with chronic low back pain as well as 25 pain-free healthy volunteers using 11C-PBR28, a PET radioligand that binds to the translocator protein (TSPO), a protein upregulated in activated microglia and reactive astrocytes in animal models of pain. Each patient exhibited higher 11C-PBR28 uptakes than his/her age-, sex-, and TSPO genotype-matched control in the thalamus, and there were no brain regions for which the healthy controls showed statistically higher uptakes than the patients with chronic low back pain. © 2015 Scientific American
Rose Eveleth Ranking pain isn’t a simple thing. The standard scale that goes from one to 10, often accompanied by smiley faces that become increasingly distressed, has been lampooned by many as being difficult to use. What does it mean to be a five? Or a three? What is that mildly sad frowny face saying? Do you have to be crying for it to really be a 10? And for some people, it’s even harder to put a number to a subjective experience. Patients with autism, for example, often struggle to express the pain they’re feeling. “We do see many members of our community who either experience altered pain perception, or who have difficulties communicating about and reporting pain,” Julia Bascom, the director of programs at the Autistic Self Advocacy Network, told me in an email. “So someone might experience acid reflux not as burning pain, but as pressure in their throat, and then struggle to interpret a numerical pain scale, or not realize they should bring the issue to the attention of those around them—or what words to use to be taken seriously.” Autism can also mean a difficulty interpreting facial expressions, so the happy and sad faces wouldn't be the most helpful visual cues. And some autistic patients aren’t verbal at all. In fact, for a long time, people thought that kids with autism didn’t feel pain at all, because they often didn’t show reactions to it the same way other people do. “They might not understand the words other people use to describe pain, even if they are feeling the exact same sensation, and their outward reactions might seem to indicate much more pain than they are actually feeling,” Bascom said. © 2015 by The Atlantic Monthly Group.
By Abby Phillip Your smartphone addiction is doing more than giving your thumbs a workout, it is also changing your brain. A new study suggests that using a smartphone -- touching the fingertips against the smooth surface of a screen -- can make the brain more sensitive to the thumb, index and middle finger tips being touched. The study, which was published in the journal Current Biology this week, found that the differences between people when it comes to how the brain responds to thumb stimulation is partly explained by how often they use their smartphones. "I was really surprised by the scale of the changes introduced by the use of smartphones," said Arko Ghosh, of the Institute of Neuroinformatics of the University of Zurich and one of the study's authors, in a news release. Other research has shown that musicians and expert video gamers show the same type of brain adaptations. Smartphone use isn't something most people would consider an "expertise," but frequent use of the devices might similarly lead to brain adaptations. Researchers used an electroencephalography (EEG) device to record the activity that occurred in the brain when people touched their thumbs, index and middle fingers to a mechanical object. They compared the brain recordings of smartphone users and regular cellphone users.
Keyword: Pain & Touch
Link ID: 20446 - Posted: 01.01.2015
By Maria Konnikova Last year, Dimitris Xygalatas, the head of the experimental anthropology lab at the University of Connecticut, decided to conduct a curious experiment in Mauritius, during the annual Thaipusam festival, a celebration of the Hindu god Murugan. For the ten days prior to the festival, devotees abstain from meat and sex. As the festival begins, they can choose to show their devotion in the form of several communal rituals. One is fairly mild. It involves communal prayer and singing beside the temple devoted to Murugan, on the top of a mountain. The other, however—the Kavadi—is one of the more painful modern religious rituals still in practice. Participants must pierce multiple parts of their bodies with needles and skewers and attach hooks to their backs, with which they then drag a cart for more than four hours. After that, they climb the mountain where Murugan’s temple is located. Immediately after each ritual was complete, the worshippers were asked if they would be willing to spend a few minutes answering some questions in a room near the temple. Xygalatas had them rate their experience, their attitude toward others, and their religiosity. Then he asked them a simple question: They would be paid two hundred rupees for their participation (about two days’ wages for an unskilled worker); did they want to anonymously donate any of those earnings to the temple? His goal was to figure out if the pain of the Kavadi led to increased affinity for the temple. For centuries, societies have used pain as a way of creating deep bonds. There are religious rites, such as self-flagellation, solitary pilgrimages, and physical mutilation.
By Smitha Mundasad Health reporter, BBC News The precise part of the brain that gives people a sense of direction has been pinpointed by scientists. People with stronger nerve signals in their "internal compass" tended to be better navigators. The study, published in the journal Current Biology, suggested people get lost when their compass cannot keep up. The researchers in London hope the discovery will help explain why direction sense can deteriorate in conditions such as Alzheimer's disease. Scientists have long believed that such a signal existed within the brain, but until now it had been pure speculation. Volunteers were asked to navigate through a virtual environment Volunteers were asked to navigate towards certain objects placed in four corners of the virtual room They were then asked to navigate the area, from memory alone, while their brains were being scanned by an MRI machine. The scans revealed a part of the brain - known as the entorhinal region - fired up consistently during the tasks. The stronger the signal in the region, the better the volunteers were at finding their way around correctly. Dr Hugo Spiers, who led the study, said: "Studies on London cab drivers have shown that the first thing they do when they work out a route is calculate which direction they need to head in. "We now know the entorhinal cortex is responsible for such calculations and the quality of the signals from this region seem to determine how good someone's navigational skills will be." Dr Martin Chadwick, who was also involved in the study, explained: "Our results provide evidence to support the idea that your internal compass readjusts as you move through the environment. BBC © 2014
Keyword: Animal Migration
Link ID: 20431 - Posted: 12.20.2014
|By Claudia Wallis Touch a hot frying pan and the searing message of pain sprints up to your brain and back down to your hand so fast that the impulse to withdraw your fingers seems instantaneous. That rapid-fire signal begins in a heat-sensing molecule called a TRPV1 channel. This specialized protein is abundant on the surface of sensory nerve cells in our fingers and elsewhere and is a shape-shifter that can take an open or closed configuration. Heat opens a central pore in the molecule, so do certain spider toxins and capsaicin—the substance that gives chili peppers their burn. Once the pore is open, charged ions of sodium and calcium flow into the nerve cell, triggering the pain signal. Ouch! As neuroscientist-journalist Stephani Sutherland explains in “Pain that Won’t Quit,” in the December Scientific American, researchers have long been interested in finding ways to moderate the action of this channel—and other ion channels—in patients who suffer from chronic pain. Shutting down the TRPV1 channel completely, however, is not an option because it plays a vital role in regulating body temperature. In two papers published in Nature in December 2013 investigators at the University of California, San Francisco, gave pain researchers a big leg up in understanding TRPV1. They revealed, in exquisite atomic detail, the structure of the channel molecule (from a rat) using an electron cryomicroscope, an instrument designed to explore the 3-D structure of molecules at very low temperatures. One of those investigators, Yifan Cheng, also created this colorful animation, showing how the molecule looks when the channel is open. © 2014 Scientific American
Keyword: Pain & Touch
Link ID: 20411 - Posted: 12.13.2014
Carl Zimmer For thousands of years, fishermen knew that certain fish could deliver a painful shock, even though they had no idea how it happened. Only in the late 1700s did naturalists contemplate a bizarre possibility: These fish might release jolts of electricity — the same mysterious substance as in lightning. That possibility led an Italian physicist named Alessandro Volta in 1800 to build an artificial electric fish. He observed that electric stingrays had dense stacks of muscles, and he wondered if they allowed the animals to store electric charges. To mimic the muscles, he built a stack of metal disks, alternating between copper and zinc. Volta found that his model could store a huge amount of electricity, which he could unleash as shocks and sparks. Today, much of society runs on updated versions of Volta’s artificial electric fish. We call them batteries. Now a new study suggests that electric fish have anticipated other kinds of technology. The research, by Kenneth C. Catania, a biologist at Vanderbilt University, reveals a remarkable sophistication in the way electric eels deploy their shocks. Dr. Catania, who published the study on Thursday in the journal Science, found that the eels use short shocks like a remote control on their victims, flushing their prey out of hiding. And then they can deliver longer shocks that paralyze their prey at a distance, in precisely the same way that a Taser stops a person cold. “It shows how finely adapted eels are to attack prey,” said Harold H. Zakon, a biologist at the University of Texas at Austin, who was not involved in the study. He considered Dr. Catania’s findings especially impressive since scientists have studied electric eels for more than 200 years. © 2014 The New York Times Company
Link ID: 20400 - Posted: 12.06.2014
By Beth Winegarner When Beth Wankel’s son, Bowie, was a baby, he seemed pretty typical. But his “terrible twos” were more than terrible: In preschool, he would hit and push his classmates to a degree that worried his parents and teachers. As Bowie got a little older, he was able tell his mom why he was so combative. “He would say things like, 'I thought they were going to step on me or push me,’” Wankel said. “He was overly uncomfortable going into smaller spaces; it was just too much for him.” Among other things, he refused to enter the school bathroom if another student was inside. When Bowie was 3, he was formally evaluated by his preschool teachers. They said he appeared to be having trouble processing sensory input, especially when it came to figuring out where his body is in relation to other people and objects. He’s also very sensitive to touch and to the textures of certain foods, said Wankel, who lives with her family in San Francisco. Bowie has a form of what’s known as sensory processing disorder. As the name suggests, children and adults with the disorder have trouble filtering sights, smells, sounds and more from the world around them. While so-called neurotypicals can usually ignore background noise, clothing tags or cluttered visual environments, people with SPD notice all of those and more — and quickly become overwhelmed by the effort. Rachel Schneider, a mental-health expert and a blogger for adults with SPD, describes it as a “neurological traffic jam” or “a soundboard, except the sound technician is terrible at his job.”
Ewen Callaway Nerve cells that transmit pain, itch and other sensations to the brain have been made in the lab for the first time. Researchers say that the cells will be useful for developing new painkillers and anti-itch remedies, as well as understanding why some people experience unexplained extreme pain and itching. “The short take-home message would be ‘pain and itch in a dish’, and we think that’s very important,” says Kristin Baldwin, a stem-cell scientist at the Scripps Research Institute in La Jolla, California, whose team converted mouse and human cells called fibroblasts into neurons that detect sensations such as pain, itch or temperature1. In a second paper2, a separate team took a similar approach to making pain-sensing cells. Both efforts were published on 24 November in Nature Neuroscience. Peripheral sensory neurons, as these cells are called, produce specialized ‘receptor’ proteins that detect chemical and physical stimuli and convey them to the brain. The receptor that a cell makes determines its properties — some pain-sensing cells respond to chilli oil, for example, and others respond to different pain-causing chemicals. Mutations in the genes encoding these receptors can cause some people to experience chronic pain or, in rare cases, to become impervious to pain. To create these cells in the lab, independent teams led by Baldwin and by Clifford Woolf, a neuroscientist at Boston Children’s Hospital in Massachusetts, identified combinations of proteins that — when expressed in fibroblasts — transformed them into sensory neurons after several days. Baldwin's team identified neurons that make receptors that detect sensations including pain, itch, and temperature, whereas Woolf’s team looked only at pain-detecting cells. Both teams generated cells that resembled neurons in shape and fired in response to capsaicin, which gives chilli peppers their kick, and mustard oil. © 2014 Nature Publishing Group
Keyword: Pain & Touch
Link ID: 20362 - Posted: 11.26.2014
By RONI CARYN RABIN The Food and Drug Administration on Thursday approved a powerful long-acting opioid painkiller, alarming some addiction experts who fear that its widespread use may contribute to the rising tide of prescription drug overdoses. The new drug, Hysingla, and another drug approved earlier this year, Zohydro, contain pure hydrocodone, a narcotic, without the acetaminophen used in other opioids. But Hysingla is to be made available as an “abuse-deterrent” tablet that cannot easily be broken or crushed by addicts looking to snort or inject it. Nearly half of the nation’s overdose deaths involved painkillers like hydrocodone and oxycodone, according to a 2010 study by the Centers for Disease Control and Prevention. More than 12 million people used prescription painkillers for nonmedical reasons that year, according to the study. Prescription opioid abuse kills more adults annually than heroin and cocaine combined, and sends 420,000 Americans to emergency rooms every year, according to the C.D.C. Hysingla, however, will not be not abuse-proof, said officials at the F.D.A. and the drug’s manufacturer, Purdue Pharma. Its extended-release formulation, a pill to be taken once every 24 hours by patients requiring round-the-clock pain relief, will contain as much as 120 milligrams of hydrocodone. The F.D.A. warned that doses of 80 milligrams or more “should not be prescribed to people who have not previously taken an opioid medication,” but officials described the abuse-deterrent formulation as a step forward. © 2014 The New York Times Company
By Emily Underwood WASHINGTON, D.C.—Rapid changes unfold in the brain after a person's hand is amputated. Within days—and possibly even hours—neurons that once processed sensations from the palm and fingers start to shift their allegiances, beginning to fire in response to sensations in other body parts, such as the face. But a hand transplant can bring these neurons back into the fold, restoring the sense of touch nearly back to normal, according to a study presented here this week at the annual conference of the Society for Neuroscience. To date, roughly 85 people worldwide have undergone hand replant or transplant surgery, an 8- to 10-hour procedure in which surgeons reattach the bones, muscles, nerves, blood vessels, and soft tissue between the patient's severed wrist and their own hand or one from a donor, often using a needle finer than a human hair. After surgery, studies have shown that it takes about 2 years for the peripheral nerves to regenerate, with sensation slowly creeping through the palm and into the fingertips at a rate of roughly 2 mm per day, says Scott Frey, a cognitive neuroscientist at the University of Missouri, Columbia. Even once the nerves have regrown, the surgically attached hand remains far less sensitive to touch than the original hand once was. One potential explanation is that the brain's sensory "map" of the body—a series of cortical ridges and folds devoted to processing touch in different body parts—loses its ability to respond to the missing hand in the absence of sensory input, Frey says. If that's true, the brain may need to reorganize that sensory map once again in order to fully restore sensation. © 2014 American Association for the Advancement of Science