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What we know — and don’t know — about a new migraine drug

Leah Rosenbaum Migraines have plagued humans since time immemorial. Now a new migraine prevention treatment, recently approved by the U.S. Food and Drug Administration, promises long-awaited relief from the debilitating condition. But whether the drug will turn out to be a real solution for the 1 in 7 Americans who suffer from migraines, severe headaches that often come with nausea and visual auras, isn’t yet clear. Here’s what we know, and don’t know, about the new therapy. How does the drug work in the body? The new drug, Aimovig, generically called erenumab, is a type of monoclonal antibody treatment, a class of medications that resemble the antibodies that the body naturally produces to bind to infectious pathogens. These treatments work by using specially designed antibodies to target specific proteins and their receptors that contribute to disease. Aimovig, released by pharmaceutical companies Amgen Inc. and Novartis, targets the receptor for a protein called calcitonin gene-related peptide, or CGRP, that is increased in people suffering a migraine attack. The protein is released from nerve endings throughout the body, including in the meninges, the membranes that surround the brain. When it attaches to the receptor, CGRP widens blood vessels and can contribute to inflammation and pain transmission. Aimovig, delivered once a month with an EpiPen-like injector, works by blocking the receptor for CGRP, reducing pain. Blocking the protein’s receptor is kind of like putting gum in a lock, says Elizabeth Loder, a neurologist at Brigham and Women’s Hospital in Boston and at Harvard Medical School. The CGRP protein “key” is still floating around, but it can’t become activated. |© Society for Science & the Public 2000 - 2018

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain
Related chapters from MM:Chapter 5: The Sensorimotor System
Link ID: 25064 - Posted: 06.07.2018

Is It a Migraine? Many Patients Don’t Realize What Causes Their Suffering

By GINA KOLATA The first of a new class of drugs to prevent migraines was approved last week. The medication, called Aimovig, reduces the frequency of migraines among those severely afflicted, but the drug rarely prevents these episodes altogether. One expert called it “progress but not a panacea.” Migraine is the most disabling neurological disease in the world among people under age 50, beating epilepsy, strokes and chronic back pain. Yet many who have migraines don’t realize it or ever mention their symptoms to a doctor. Migraines are not just headaches. It is diagnosed in patients only if they have had a minimum of five attacks, each lasting four to 72 hours. Each attack has to include at least two of the following symptoms: throbbing headache with pain that is moderate to severe, that worsens with activity, and is only on only one side of the head. Also, a person suffering a migraine attack is nauseated or abhors sound or noise. What about auras? Are they part of a migraine? Sometimes, but not always. About 20 percent of migraine patients get an aura before the headache. Auras involve distortions of vision. People see jagged lights or have blind spots in their visual field. But auras can take other forms as well: a prickling pins-and-needles feeling on parts of the body, speech disturbances, distortions of sounds. Some get auras without a headache or only a mild headache. Auras actually involve different areas of the brain than migraines, and it is not clear why they are linked to migraine headaches. How common are migraines? They can start in childhood, although they usually begin in adolescence or young adulthood. They strike nearly one in five women worldwide, one in 16 men and one in 11 children. One out of four households has at least one member with migraine. The condition seems to spring from a combination of genetic and environmental factors. There is nothing a person can do to reduce the odds of developing migraine. © 2018 The New York Times Company

FDA just approved the first drug to prevent migraines. Here’s the story of its discovery

By Emily Underwood *Update, 18 May, 10 a.m.: Yesterday, the U.S. Food and Drug Administration approved the first in a new class of drugs designed to prevent migraines. This feature, originally published on 7 January 2016, describes the history of these drugs, the powerful relief they can bring some patients, and the limitations that still exist with them. As long as she can remember, 53-year-old Rosa Sundquist has tallied the number of days per month when her head explodes with pain. The migraines started in childhood and have gotten worse as she’s grown older. Since 2008, they have incapacitated her at least 15 days per month, year-round. Head-splitting pain isn’t the worst of Sundquist’s symptoms. Nausea, vomiting, and an intense sensitivity to light, sound, and smell make it impossible for her to work—she used to be an office manager—or often even to leave her light-proofed home in Dumfries, Virginia. On the rare occasions when she does go out to dinner or a movie with her husband and two college-aged children, she wears sunglasses and noise-canceling headphones. A short trip to the grocery store can turn into a full-blown attack “on a dime,” she says. Every 10 weeks, Sundquist gets 32 bee sting–like injections of the nerve-numbing botulism toxin into her face and neck. She also visits a neurologist in Philadelphia, Pennsylvania, who gives her a continuous intravenous infusion of the anesthetic lidocaine over 7 days. The lidocaine makes Sundquist hallucinate, but it can reduce her attacks, she says—she recently counted 20 migraine days per month instead of 30. Sundquist can also sometimes ward off an attack with triptans, the only drugs specifically designed to interrupt migraines after they start. © 2018 American Association for the Advancement of Science.

F.D.A. Approves First Drug Designed to Prevent Migraines

By Gina Kolata The first medicine designed to prevent migraines was approved by the Food and Drug Administration on Thursday, ushering in what many experts believe will be a new era in treatment for people who suffer the most severe form of these headaches. The drug, Aimovig, made by Amgen and Novartis, is a monthly injection with a device similar to an insulin pen. The list price will be $6,900 a year, and Amgen said the drug will be available to patients within a week. Aimovig blocks a protein fragment, CGRP, that instigates and perpetuates migraines. Three other companies — Lilly, Teva and Alder — have similar medicines in the final stages of study or awaiting F.D.A. approval. “The drugs will have a huge impact,” said Dr. Amaal Starling, a neurologist and migraine specialist at the Mayo Clinic in Phoenix. “This is really an amazing time for my patient population and for general neurologists treating patients with migraine.” Millions of people experience severe migraines so often that they are disabled and in despair. These drugs do not prevent all migraine attacks, but can make them less severe and can reduce their frequency by 50 percent or more. As a recent editorial in the journal JAMA put it, they are “progress, but not a panacea.” Until now, drugs used to prevent migraines were designed to treat other diseases, like high blood pressure. They are not very effective, may work only temporarily, and often are laden with intolerable side effects. In clinical trials, people taking the new drugs reported no more side effects than those taking a placebo. The side effects over the long term and among people with chronic diseases remain to be determined. © 2018 The New York Times Company

Study upends conventional view of opioid mechanism of action

A new discovery shows that opioids used to treat pain, such as morphine and oxycodone, produce their effects by binding to receptors inside neurons, contrary to conventional wisdom that they acted only on the same surface receptors as endogenous opioids, which are produced naturally in the brain. However, when researchers funded by the National Institute on Drug Abuse (NIDA) used a novel molecular probe to test that common assumption, they discovered that medically used opioids also bind to receptors that are not a target for the naturally occurring opioids. NIDA is part of the National Institutes of Health. This difference between how medically used and naturally made opioids interact with nerve cells may help guide the design of pain relievers that do not produce addiction or other adverse effects produced by morphine and other opioid medicines. “This ground-breaking study has uncovered important distinctions between the opioids that our brain makes naturally and therapeutic opioids that can be misused,” said NIDA Director Nora D. Volkow, M.D. “This information can be mined to better understand the potential adverse actions of medically prescribed opioids and how to manipulate the endogenous system to achieve optimal therapeutic results without the unhealthy side effects of tolerance, dependence, or addiction.” Naturally occurring opioids and medically used opioids alike bind to the mu-opioid receptor, a member of a widespread family of proteins known as G protein-coupled receptors (GPCRs). Recent advances in understanding the three-dimensional structure of GPCRs have enabled researchers to create a new type of antibody biosensor, called a nanobody, that generates a fluorescent signal when a GPCR is activated. This enables scientists to track chemicals as they move through cells and respond to stimuli.

Her perpetually runny nose was from a brain-fluid leak.

by Lindsey Bever For years, Kendra Jackson battled an incessantly runny nose — sniffling and sneezing, blowing and losing sleep each night. Jackson said she initially thought she was getting a cold, then, as her symptoms persisted, doctors suggested it was likely seasonal allergies, putting her among the more than 50 million Americans who struggle with them each year. But the symptoms never cleared up, and, as the years went by, Jackson started to worry that it might be something worse. She told ABC affiliate KETV this week her nose ran “like a waterfall, continuously, and then it would run to the back of my throat.” “Everywhere I went,” she added, “I always had a box of Puffs, always stuffed in my pocket.” She had frequent headaches. And she could rarely sleep. Doctors at Nebraska Medicine in Omaha recently diagnosed Jackson with a cerebrospinal fluid (CSF) leak, a condition in which the watery liquid surrounding the brain spills out through a hole or tear in the skull and then drains into the ears or the nose, according to Johns Hopkins Medicine. The doctors told Jackson that she was losing an estimated half-pint of the fluid per day through her nose, according to KETV. © 1996-2018 The Washington Post

Related chapters from BN: Chapter 19: Language and Lateralization; Chapter 2: Functional Neuroanatomy: The Cells and Structure of the Nervous System
Related chapters from MM:Chapter 15: Language and Lateralization; Chapter 1: Cells and Structures: The Anatomy of the Nervous System
Link ID: 24953 - Posted: 05.09.2018

Why getting old gives you itchy skin

By Emily Underwood Getting old can be a real itch. In addition to having memory and muscle loss, many elderly people develop supersensitive skin that gets itchy at the lightest touch. Scientists don’t know what causes this miserable condition, called alloknesis, or how to treat it. Now, however, a study in mice has revealed a counterintuitive mechanism for the disorder: a loss of pressure-sensing cells in the skin. Although the findings have yet to be replicated in humans, the study raises the possibility that boosting the function of these cells could treat chronic itch in people, both young and old. Chronic itch is different from chemical itch, which occurs when the immune system reacts to a foreign substance, such as oil from a poison oak leaf or saliva in a mosquito bite. Instead, chronic—or mechanical—itch is usually triggered by light pressure, such as the brush of fibers from a sweater. The condition is maddening, and when people repeatedly scratch their fragile, dry skin, it can lead to major health problems, including infections, says study author Hongzhen Hu, an anesthesiology researcher at the Washington University School of Medicine in St. Louis, Missouri. Like people, mice visibly itch more with age. To find out why, Hu and colleagues used a hair-thin nylon filament to apply a precise amount of pressure to a patch of shaved skin on young and old rodents’ necks. Young mice didn’t respond much to the gentle touch, but the older mice scratched furiously at the spot. Analyzing skin samples from mice of both ages, the team found that older mice had far fewer pressure-sensing Merkel cells than young mice did. The fewer Merkel cells a mouse had, the more their touch-related itch problems increased in response to the filament, the researchers report today in Science. © 2018 American Association for the Advancement of Science.

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 4: Development of the Brain
Link ID: 24941 - Posted: 05.05.2018

Genetic Adaptation to Cold Brought Migraines With It

By Viviane Callier A human genetic variant in a gene involved in sensing cold temperatures became more common when early humans migrated out of Africa into colder climates between 20,000 and 30,000 years ago, a study published today (May 3) in PLOS Genetics shows. The advantage conferred by this variant isn’t definitively known, but the researchers suspect that it influences the gene’s expression levels, which in turn affect the degree of cold sensation. The observed pattern of positive selection strongly indicates that the allele was beneficial, but that benefit had a tradeoff—bringing with it a higher risk of getting migraines. “This paper is the latest in a series of papers showing that humans really have adapted to different environments after some of our ancestors migrated out of Africa,” explains evolutionary geneticist Rasmus Nieslen of the University of California, Berkeley, who was not involved in the study. “There are a number of adaptations associated with moving into an artic climate, but none with as clear a connection to cold as this one,” he adds. Although studies have demonstrated some striking examples of recent human adaptation, for instance, warding off infectious diseases such as malaria or having the ability to digest milk, relatively little was known about the evolutionary responses to fundamental features of the environment, namely, temperature and climate. “Obviously, humans lived in Africa for a long time, and one of the main environmental factors that changed as humans migrated north was temperature,” explains population geneticist Aida Andres. So she and Felix Key the Max Planck Institute in Leipzig homed in on a gene, TRPM8, that encodes a cation channel in the neurons that innervate the skin. It is activated by cold temperatures and necessary for sensing cold and for thermoregulation. If there was a place to look for human adaptation, this gene looked like a good candidate. © 1986-2018 The Scientist

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 6: Evolution of the Brain and Behavior
Related chapters from MM:Chapter 5: The Sensorimotor System
Link ID: 24940 - Posted: 05.05.2018

To treat pain, study people in all their complexity

Beth Darnall Last month, the US National Institutes of Health (NIH) formally launched a multi-agency effort to combat the country’s opioid-addiction crisis. Funds for research into controlling opioid misuse and treating pain will nearly double in 2018, to US$1.1 billion. The forces behind this epidemic extend beyond overprescription: most of the tens of thousands of deaths caused by opioid overdose in the United States each year result from illicit use. Still, an inadequate understanding about how to treat pain has certainly contributed. We need to characterize patients better, and we need more studies that incorporate non-drug treatments alongside any form of medication. Consider this crucial question: what is the first treatment you should give a person for chronic pain, or even many acute injuries? Most clinicians now agree that the answer should not be opioids. Fewer recognize that the question is not which pill to use instead, but what system of interventions — including medication — and monitoring to implement. Too often, pain is treated as a purely biomedical problem. It is a biopsychosocial condition. Psychological treatment can be combined with medication to equip people with the tools to better control their pain experience. Psychological therapies can also lower risks such as addiction, because the emphasis is on engaging patients in managing their daily actions to help themselves to feel better in the long run, rather than relying solely on passive medications. Yet a common clinical practice is to recommend such psychosocial strategies for pain only after all medications have failed. © 2018 Macmillan Publishers Limited,

This engineered painkiller works like an opioid but isn’t addictive in animal tests

by Melissa Healy Sometimes forgotten in the spiraling crisis of opiate abuse is a clinical fact about narcotic pain medications: Addiction is basically an unwanted side effect of drugs that are highly effective at blunting pain. Addiction, of course, is a particularly dangerous and disruptive side effect, since it hijacks a patient’s brain and demands escalating doses of opioid drugs to hold withdrawal symptoms at bay. What if there were a drug that did the job opioids do best — relieve pain — without prompting many of their negative side effects, especially addiction? A researcher from the University of Michigan Medical School may have done just that. Tomas Joaquin Fernandez has described a process for designing opioid-like drugs that would act on pain receptors in the brain while blocking the receptors responsible for fostering dependence and building tolerance. Using pain-relieving peptides released by the brain as models, Fernandez and colleagues developed a library of “peptidomimetics.” These agents were small enough to get into the brain, and they worked on different opioid receptors in different ways. When they tested one such compound in mice, they found that it not only relieved pain, it also induced less buildup of tolerance and less physical dependence than morphine. In other words, it was less addictive. © 1996-2018 The Washington Post

Common Pain Relievers Beat Opioids for Dental Pain Relief

By NICHOLAS BAKALAR Over-the-counter pain pills are safer and more effective than prescription opioids for controlling the pain following dental procedures, a review of the evidence has found. Researchers analyzed five reviews of studies of medication and medication combinations for pain relief. They included only reviews of high or moderate methodological quality. The data included many randomized trials on the use of oral medication for the most severe kinds of postoperative dental pain — for example, the pain following the extraction of a molar. More than three dozen drugs and drug combinations were tested in various dosages. The study is in The Journal of the American Dental Association. The researchers conclude that the most effective pain relief with the fewest side effects comes from a combination of 400 milligrams of ibuprofen (Advil and other brands) with 1,000 milligrams of acetaminophen (Tylenol). No opioid or opioid-containing medicine or any other combination of drugs was more effective. A co-author, Anita Aminoshariae, an associate professor at Case Western University, said there may be some people who can get relief only with opioids. But for most patients, she said, opioids are not only less effective, they also have unpleasant side effects, including nausea, constipation and dizziness. They also carry a high risk of addiction. “You have to start with an NSAID,” she said, meaning a nonsteroidal anti-inflammatory drug. “If that doesn’t work, add Tylenol. No one should go home in pain, but opioids should not be the first choice.” © 2018 The New York Times Company

Why touch can be such a creepy sensation in VR

Maria Temming There’s a fine line between immersive and unnerving when it comes to touch sensation in virtual reality. More realistic tactile feedback in VR can ruin a user’s feeling of immersion, researchers report online April 18 in Science Robotics. The finding suggests that the “uncanny valley” — a term that describes how humanoid robots that look almost but not quite human are creepier than their more cartoonish counterparts — also applies to virtual touch (SN Online: 11/22/13). Experiment participants wearing VR headsets and gripping a controller in each hand embodied a virtual avatar holding the two ends of a stick. At first, users felt no touch sensation. Then, the hand controllers gave equally strong vibrations every half-second. Finally, the vibrations were finely tuned to create the illusion that the virtual stick was being touched in different spots. For instance, stronger vibrations in the right controller gave the impression that the stick was nudged on that side. Compared with scenarios in which users received either no touch or even buzzing sensations, participants reported feeling far less immersed in the virtual environment when they received the realistic, localized touch. This result demonstrates the existence of a tactile uncanny valley, says study coauthor Mar Gonzalez-Franco, a human-computer interaction researcher at Microsoft Research in Redmond, Washington. |© Society for Science & the Public 2000 - 2018.

Related chapters from BN: Chapter 15: Emotions, Aggression, and Stress; Chapter 8: General Principles of Sensory Processing, Touch, and Pain
Related chapters from MM:Chapter 11: Emotions, Aggression, and Stress; Chapter 5: The Sensorimotor System
Link ID: 24881 - Posted: 04.19.2018

The long search for the pain gene

Tor Wager Two soldiers receive similar injuries in battle. One recovers in months; the other endures excruciating pain for years. Why this difference? The question is pressing. One in five people suffers from chronic pain, affecting every aspect of their lives. Although significant gains have been made with anaesthetics and anti-inflammatory medications, the roots and relief of long-term pain are proving harder to find. Pain is also fuelling a global epidemic of opioid addiction and related deaths. In Chasing Men on Fire, neurologist Stephen Waxman provides a compelling portrait of scientific discovery in this area. Waxman, who works in basic research and clinical medicine, offers an insider’s account of the global search for a pain gene, beginning in 1966. He intertwines descriptions of cross-disciplinary neuroscience with portraits of scientists, and the struggles of people with conditions such as erythromelalgia, or ‘man-on-fire syndrome’, characterized by burning pain in hands and feet. Structurally, the book is innovative: 11 research papers are interlaced with the stories behind them. It is thus both a boon for researchers and an engrossing read for nonspecialists. Humans love simplicity. We want the intricate systems in our brains and bodies to ‘just work’. But Waxman shows that biology is complex, and genetic clues can be elusive. Detecting them relies on finding regularities across many people, which can make it seem impossible to pinpoint a key gene, and the rare mutations in it that lead to disease. As he reveals, it took considerable sifting and coordinated effort on three continents by scientists including pharmacologists, electrophysiologists, molecular biologists and geneticists before a ‘master gene’ for pain was isolated. © 2018 Macmillan Publishers Limited

Man eats world's hottest chilli pepper – and ends up in hospital

Nicola Davis A man who took part in a chilli pepper eating contest ended up with more than he bargained for when he took on the hottest pepper in the world. After eating a Carolina Reaper pepper, the 34-year-old started dry heaving before developing a pain in his neck that turned into a series of thunderclap headaches: sudden and severe episodes of excruciating pain that peak within a minute. Scoville scale: The hottest chillies in the world– in pictures The Carolina Reaper, which can top 2.2m on the Scoville heat scale, was the world’s hottest pepper at the time of the incident in 2016 – although new breeds called Pepper X and Dragon’s Breath have since reportedly surpassed it. The details, published in the journal BMJ Case Reports, reveal the pain was so terrible the man went to the emergency room at Bassett Medical Center in Cooperstown, a village in New York State. “[A thunderclap headache] lasts for a few minutes and it might be associated with dry-heaving, nausea, vomiting – and then it gets better on its own. But it keeps coming back,” said Dr Kulothungan Gunasekaran of the Henry Ford Health System in Detroit, a co-author of the report, adding that thunderclap headaches can be caused by a number of problems including bleeding inside the brain or blood clots. CT and MRI scans of the man’s brain were taken but showed nothing out of the ordinary. What’s more, the man did not report having any speech or vision problems. © 2018 Guardian News and Media Limited

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 19: Language and Lateralization
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 15: Language and Lateralization
Link ID: 24849 - Posted: 04.11.2018

Medical Marijuana's 'Catch-22': Limits On Research Hinder Patient Relief

Marisa Taylor, Melissa Bailey By the time Ann Marie Owen, 61, turned to marijuana to treat her pain, she was struggling to walk and talk. She was also hallucinating. For four years, her doctor prescribed a wide range of opioids for transverse myelitis, a debilitating disease that caused pain, muscle weakness and paralysis. The drugs not only failed to ease her symptoms, they hooked her. When her home state of New York legalized marijuana for the treatment of select medical ailments, Owens decided it was time to swap pills for pot. But her doctors refused to help. "Even though medical marijuana is legal, none of my doctors were willing to talk to me about it," she says. "They just kept telling me to take opioids." Cancer Patients Get Little Guidance From Doctors On Using Medical Marijuana Although 29 states have legalized marijuana to treat pain and other ailments, the growing number of Americans like Owen who use marijuana and the doctors who treat them are caught in the middle of a conflict in federal and state laws — a predicament that is only worsened by thin scientific data. Because the federal government considers marijuana a Schedule 1 drug, research on marijuana or its active ingredients is highly restricted and even discouraged in some cases. Underscoring the federal government's position, Health and Human Services Secretary Alex Azar recently pronounced that there was "no such thing as medical marijuana." © 2018 npr

Delusions of skin infestation may not be so rare

Aimee Cunningham A deep conviction that one’s skin is contaminated with insects or other objects despite a lack of medical evidence. She was certain her skin was infested: Insects were jumping off; fibers were poking out. Fearful her condition could spread to others, the 50-year-old patient told doctors at the Mayo Clinic in Rochester, Minn., that she was avoiding contact with her children and friends. The patient had delusional infestation, explains Mayo Clinic dermatologist Mark Davis. Sufferers have an unshaking belief that pathogens or inanimate objects pollute their skin despite no medical evidence. Davis and colleagues report online April 4 in JAMA Dermatology that the disorder is not as rare as previously assumed. In the first population-based study of the disorder’s prevalence, the researchers identified 35 cases from 1976 to 2010 reported in Minnesota’s Olmsted County. Based on the findings, the authors estimate 27 out of every 100,000 people in the United States have delusional infestation. Due to the county’s lack of diversity — the population of about 150,000 is predominantly white — the researchers used only the nationwide white population to estimate prevalence, so the result may not be representative of other populations. Delusional infestation has been recognized for decades, albeit under different names. Patients insist they’ve been overtaken with creatures, such as insects, worms or parasites, or inanimate materials like fibers — or both. © Society for Science & the Public 2000 - 2018.

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 24836 - Posted: 04.09.2018

Sheets of tiny bubbles could bring a sense of touch to virtual reality

Maria Temming PHOENIX — High-tech attire that would give users the sensation of being pushed, pinched or poked could someday make virtual realities feel as real as they look. Today’s VR systems rely heavily on goggle-generated visual displays to transport users to simulated worlds. But superthin, shape-shifting sheets worn as sleeves or built into other garments could provide gamers with tactile feedback that makes virtual realities more immersive. The new device, described April 5 at the Materials Research Society spring meeting, contains a grid of tiny, inflatable bubbles, sandwiched between two soft, stretchy silicone films. When one of these bubble wrap–like sheets is placed against a user’s skin, inflating different air pockets by different amounts at different speeds can make a gamer feel like she’s been grabbed around the wrist or patted on the back. Some previously developed hand- or finger-worn devices have allowed wearers to feel or manipulate virtual objects. But clothing embedded with smart silicone skins could make VR gaming more of a full-body experience. Each air pocket on the sheet is coated with a liquid metal sensor that tracks how much that bubble is distended, which helps regulate the device’s shape-shifting. Those sensors also detect indentations in the bubbles, so these sleeves could work as touch pad game controllers, too, says study coauthor Matthew Robertson, a roboticist at École Polytechnique Fédérale de Lausanne in Switzerland. |© Society for Science & the Public 2000 - 2018

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 11: Motor Control and Plasticity
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 5: The Sensorimotor System
Link ID: 24831 - Posted: 04.07.2018

Medicare Is Cracking Down on Opioids. Doctors Fear Pain Patients Will Suffer.

By JAN HOFFMAN Medicare officials thought they had finally figured out how to do their part to fix the troubling problem of opioids being overprescribed to the old and disabled: In 2016, a staggering one in three of 43.6 million beneficiaries of the federal health insurance program had been prescribed the painkillers. Medicare, they decided, would now refuse to pay for long-term, high-dose prescriptions; a rule to that effect is expected to be approved on April 2. Some medical experts have praised the regulation as a check on addiction. But the proposal has also drawn a broad and clamorous blowback from many people who would be directly affected by it, including patients with chronic pain, primary care doctors and experts in pain management and addiction medicine. Critics say the rule would inject the government into the doctor-patient relationship and could throw patients who lost access to the drugs into withdrawal or even provoke them to buy dangerous street drugs. Although the number of opioid prescriptions has been declining since 2011, they noted, the rate of overdoses attributed to the painkillers and, increasingly, illegal fentanyl and heroin, has escalated. “The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” said Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.” Underlying the debate is a fundamental dilemma: how to curb access to the addictive drugs while ensuring that patients who need them can continue treatment. © 2018 The New York Times Company

Zebrafish and Medaka Can Sense Magnetic Fields

By Shawna Williams | Humans like to fancy ourselves advanced, but there’s at least one area where cockroaches, and even nematodes, seem to have us beat: magnetoreception, the ability to sense variations in magnetic fields. To add insult to injury, our best human minds haven’t yet been able to answer basic questions about how the sense—also shared by some amphibians, fish, birds, and mammals—works. Joining the list now are zebrafish and medaka, as researchers reported in Nature Communications last month (February 23). Unlike in some animals, magnetoreception in the fish doesn’t require light to work. The study is “a promising beginning,” writes Roswitha Wiltschko, a researcher at Goethe University Frankfurt who has studied magnetoreception in birds, in an email to The Scientist. “[T]o demonstrate [sensitivity to magnetic direction] in two species whose genetics are known is novel, and this might form a basis for future investigations.” Animals as diverse as lobsters and pigeons are thought to use variations in Earth’s magnetic fields to orient themselves. One idea for how the sense might work is that magnetic fields could affect light-sensitive chemical reactions, possibly in structures in the retina known as cryptochromes. Another is that some animal cells contain magnetic field–sensitive metals that interact with mechanosensitive structures to produce a signal. © 1986-2018 The Scientist

Shingles Is Nasty, And The New Vaccine Works Well. Why Do Adults Avoid Shots?

Michelle Andrews Federal officials have recommended a vaccine against shingles that is more effective than an earlier version at protecting older adults from the painful rash. But persuading many adults to get this and other recommended shots continues to be an uphill battle, health providers say. " 'I'm healthy; I'll get that when I'm older,' " is what adult patients often tell Dr. Michael Munger when he brings up an annual flu shot or a tetanus-diphtheria booster or the new shingles vaccine. Sometimes, he says, they put him off by questioning a vaccine's effectiveness. Munger, a family physician in Overland Park, Kan., who is president of the American Academy of Family Physicians, says he gets more pushback from adults about getting their own vaccines than about immunizing their children. "As parents, we want to make sure our kids are protected. But as adults, we act as if we're invincible." The new schedule for adult vaccines for people age 19 and older has been updated in the last several months by the federal Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. The most significant change was to recommend Shingrix, the shingles vaccine that was approved by the Food and Drug Administration last fall, over an older version of the vaccine. Shingrix should be given in two doses between two and six months apart to adults who are at least 50 years old, the CDC says. The older vaccine, Zostavax, can still be given to adults who are 60 or older, but Shingrix is preferred, according to the agency. © 2018 npr

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