Chapter 8. General Principles of Sensory Processing, Touch, and Pain

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Emiliano Rodríguez Mega On a cold Friday night in February 1995, addiction researcher Nora Volkow and her husband got into their car after a long day at Brookhaven National Laboratory in Upton, New York. Ice had covered the trees and the roads, making them sparkle. But as the couple drove down a slope, the tyres lost their grip. The vehicle spun out of control. Volkow curled up to shield herself as an oncoming car crashed into her door. Metal bit into her flesh. The pain was unrelenting. Finally, the fire service arrived to break her free and an ambulance rushed her to the nearest emergency department, where a doctor gave her Demerol, a powerful and highly addictive opioid painkiller also known as pethidine, which is similar to morphine. Volkow had spent countless hours talking to people with addiction and had read hundreds of papers on the mechanisms of drug abuse. Neither prepared her for what happened next. “It was extraordinary, those impressive sensations,” she says. A moment of ecstasy, one she describes as comparable only to long-lasting sexual pleasure, eclipsed all other feelings. She stayed on the medication for another few days and was sent home with more. But she decided not to take it. She was afraid — she knew many of her patients could not stop once they started. She would get through the pain without the help of drugs. © 2020 Springer Nature Limited

Keyword: Drug Abuse; Pain & Touch
Link ID: 27162 - Posted: 04.02.2020

by Laura Dattaro / Mice missing an autism gene called SHANK3 respond to much lighter touches than typical mice do, according to a new study1. And this hypersensitivity seems to result from the underactivity of neurons that normally dampen sensory responses. The study is the first to examine sensory sensitivity in mice missing SHANK3. Mice with mutations in other genes tied to autism, including MECP2 and GABRB3, have also been shown to be hypersensitive to puffs of air blown onto their backs. Up to 90 percent of autistic people have sensory problems, including hypersensitivity to sensations such as sound or touch. These disruptions may underlie many of the difficulties autistic people face in navigating the world, says lead investigator Guoping Feng, professor of neuroscience at the Massachusetts Institute of Technology. “Sensory overload is one of the reasons that autistic people cover their ears, [hide] in corners, want to be quiet,” Feng says. “It’s important to understand mechanisms.” Up to 2 percent of people with autism have a mutation in SHANK3, which encodes a protein needed for neurons to communicate with one another2. Autism is also common in people with Phelan-McDermid syndrome, a condition caused by deletions of the chromosomal region in which SHANK3 is located. Other experts also say the study underscores the importance of studying sensory problems in autistic people. “Hyperreactivity to sensory input might be connected with autism in a really deep way,” says Sam Wang, professor of neuroscience at Princeton University, who was not involved in the work. “If sensory experience in the first few years of life is necessary for setting up a model of the world, an understanding of the world, then sensory processing would be a gateway to all kinds of other difficulties.” © 2020 Simons Foundation

Keyword: Autism; Attention
Link ID: 27151 - Posted: 03.30.2020

Katarina Zimmer Long believed to be simple, pathogen-eating immune cells, macrophages have a far more extensive list of job duties. They appear to have specialized functions across body tissues, help repair damaged tissue, play a key role in regulating inflammation and pain, and participate in other roles scientists are just beginning to reveal. Now, a group of researchers in the Netherlands has identified a mechanism by which macrophages may help resolve inflammatory pain in mice. In a study recently posted as a preprint to bioRxiv, they report that the immune cells shuttle mitochondria to sensory neurons that innervate inflamed tissue, and that this helps resolve pain. The researchers speculate that the mechanism could replenish functional mitochondria in neurons during chronic inflammatory conditions, which is associated with dysfunctional mitochondria. “I think the transfer of mitochondria is quite convincing,” Jan Van den Bossche, an immunologist at Amsterdam University Medical Center who wasn’t involved in the research, writes to The Scientist in an email. If the findings can be replicated, “this could have [implications for] many diseases with chronic inflammation and pain,” he adds. The research is the result of a five-year project that began when Niels Eijkelkamp, a neuroimmunologist at the University Medical Center Utrecht, and his colleagues started investigating how inflammatory pain resolves, “so we could understand what causes chronic pain,” he says. © 1986–2020 The Scientist

Keyword: Glia; Pain & Touch
Link ID: 27097 - Posted: 03.06.2020

By Kelly Servick The dark side of opioids’ ability to deaden pain is the risk that they might kill their user. The same brain receptors that blunt pain when drugs such as morphine or oxycodone bind to them can also signal breathing to slow down. It’s this respiratory suppression that causes most overdose deaths. So scientists have hoped to design opioids that are “biased” toward activating painkilling signals while leaving respiratory signaling alone. Several companies have cropped up to develop and test biased opioids. But two new studies in mice contest a key hypothesis underlying these efforts—that a signaling protein called beta-arrestin2 is fundamental to opioids’ effect on breathing. “It seems like the premise was wrong,” says Gaspard Montandon, a neuroscientist and respiratory physiologist at the University of Toronto. He and others doubt that the good and bad effects of opioids can be disentangled. Hopes first arose in the late 1990s and early 2000s, as neuroscientist Laura Bohn, biochemist Robert Lefkowitz, and colleagues at Duke University explored the cascades of signals triggered when a drug binds to muopioid receptors on a neuron. This binding changes the receptor’s structure and its interactions with two types of proteins inside the cell—signaling molecules known as G-proteins, and beta-arrestins, which, among other effects, inhibit G-protein signaling. It’s still not clear how the resulting signal cascades influence cells or brain circuits. But the researchers reported in 1999 that mice engineered to lack the gene for beta-arrestin2 got stronger and longer lasting pain relief from morphine. And in 2005, Bohn and her colleagues at Ohio State University found that two morphine-induced side effects, constipation and slowed breathing, were dramatically reduced in these “knockout” mice. The findings suggested that a drug able to nudge the mu-opioid receptors toward G-protein signaling and away from beta-arrestin2 signaling would prompt more pain relief with fewer risks. © 2020 American Association for the Advancement of Science

Keyword: Pain & Touch; Drug Abuse
Link ID: 27083 - Posted: 02.28.2020

By Virginia Morell Dogs’ noses just got a bit more amazing. Not only are they up to 100 million times more sensitive than ours, they can sense weak thermal radiation—the body heat of mammalian prey, a new study reveals. The find helps explain how canines with impaired sight, hearing, or smell can still hunt successfully. “It’s a fascinating discovery,” says Marc Bekoff, an ethologist, expert on canine sniffing, and professor emeritus at the University of Colorado, Boulder, who was not involved in the study. “[It] provides yet another window into the sensory worlds of dogs' highly evolved cold noses.” The ability to sense weak, radiating heat is known in only a handful of animals: Black fire beetles, certain snakes, and one species of mammal, the common vampire bat, all of which use it to hunt prey. Most mammals have naked, smooth skin on the tip of their noses around the nostrils, an area called the rhinarium. But dogs’ rhinaria are moist, colder than the ambient temperature, and richly endowed with nerves—all of which suggests an ability to detect not just smell, but heat. To test the idea, researchers at Lund University in Sweden and Eotvos Lorand University in Hungary trained three pet dogs to choose between a warm (31 C degrees) and an ambient-temperature object, each placed 1.6 meters away. The dogs weren’t able to see or smell the difference between these objects. (Scientists could only detect the difference by touching the surfaces.) After training, the dogs were tested on their skill in double-blind experiments; all three successfully detected the objects emitting weak thermal radiation, the scientists reveal today in Scientific Reports. © 2020 American Association for the Advancement of Science

Keyword: Chemical Senses (Smell & Taste)
Link ID: 27081 - Posted: 02.28.2020

By Joshua Sokol As an astronomer at Chicago’s Adler Planetarium, Lucianne Walkowicz usually has to stretch to connect the peculiarities of space physics with things that people experience on Earth. Then came the email about whales. Sönke Johnsen, a biologist at Duke University, told Dr. Walkowicz that his team had stumbled upon a bizarre correlation: When the surface of the sun was pocked with dark sunspots, an indicator of solar storms, gray whales and other cetacean species seemed more likely to strand themselves on beaches. The team just needed an astronomer’s help wrangling the data. “This was like a dream request,” Dr. Walkowicz said. “And I finally got to do something in marine biology, even though I didn’t study it.” With that assistance, there is some evidence of this peculiar correlation, the researchers said in a paper published Monday in Current Biology. “The study convinced me there is a relationship between solar activity and whale strandings,” said Kenneth Lohmann, a biologist at the University of North Carolina who did not participate in the research. This coincidence across 93 million miles of space is more plausible than it might seem. Sunspots are a harbinger of heightened solar weather, marking times when the tangled plasma of the sun’s atmosphere coughs out more photons and charged particles than usual. These disturbances sail outward and smash into our planet’s magnetic field, creating colorful light shows like the aurora borealis and sometimes disrupting communications. Biologists have already demonstrated that many animals can navigate by somehow sensing Earth’s magnetic field lines. Gray whales, which migrate over 10,000 miles a year through a featureless expanse of blue, might be relying on a similar hidden sense. But unlike a migrating bird, a whale is not easily placed in a magnetized box for controlled experiments. Instead, Jesse Granger, a Duke graduate student, looked at whale strandings, which previous studies had suggested seemed to track with sunspot activity. She narrowed a list of gray whale strandings kept by the National Oceanic and Atmospheric Administration, to highlight the percentage of whales that were stranded alive, as well as whales that were released back to sea and seemed to recover. In theory, those cases were examples of healthy whales that had merely taken a wrong turn. © 2020 The New York Times Company

Keyword: Animal Migration
Link ID: 27076 - Posted: 02.27.2020

Elena Renken The sting of a paper cut or the throb of a dog bite is perceived through the skin, where cells react to mechanical forces and send an electrical message to the brain. These signals were believed to originate in the naked endings of neurons that extend into the skin. But a few months ago, scientists came to the surprising realization that some of the cells essential for sensing this type of pain aren’t neurons at all. It’s a previously overlooked type of specialized glial cell that intertwines with nerve endings to form a mesh in the outer layers of the skin. The information the glial cells send to neurons is what initiates the “ouch”: When researchers stimulated only the glial cells, mice pulled back their paws or guarded them while licking or shaking — responses specific to pain. This discovery is only one of many recent findings showing that glia, the motley collection of cells in the nervous system that aren’t neurons, are far more important than researchers expected. Glia were long presumed to be housekeepers that only nourished, protected and swept up after the neurons, whose more obvious role of channeling electric signals through the brain and body kept them in the spotlight for centuries. But over the last couple of decades, research into glia has increased dramatically. “In the human brain, glial cells are as abundant as neurons are. Yet we know orders of magnitude less about what they do than we know about the neurons,” said Shai Shaham, a professor of cell biology at the Rockefeller University who focuses on glia. As more scientists turn their attention to glia, findings have been piling up to reveal a family of diverse cells that are unexpectedly crucial to vital processes. All Rights Reserved © 2020

Keyword: Glia; Pain & Touch
Link ID: 27002 - Posted: 01.28.2020

By Benedict Carey Soldiers with deep wounds sometimes feel no pain at all for hours, while people without any detectable injury live in chronic physical anguish. How to explain that? Over drinks in a Boston-area bar, Ronald Melzack, a psychologist, and Dr. Patrick Wall, a physiologist, sketched out a diagram on a cocktail napkin that might help explain this and other puzzles of pain perception. The result, once their idea was fully formed, was an electrifying theory that would become the founding document for the field of modern pain studies and establish the career of Dr. Melzack, whose subsequent work deepened medicine’s understanding of pain and how it is best measured and treated. Dr. Melzack died on Dec. 22 in a hospital near his home in Montreal, where he lived, his daughter, Lauren Melzack, said. He was 90, and had spent most of his professional life as a professor of psychology at McGill University. When Dr. Melzack and Dr. Wall, then at the Massachusetts Institute of Technology, met that day in 1959 or 1960 (accounts of their encounter vary), pain perception was thought to work something like a voltmeter, in which nerves send signals up to the brain that reflect the severity of the injury. But that model failed to explain not only battlefield experience but also a host of clinical findings and everyday salves. Most notably, rubbing a wound lessens its sting — and accounting for just that common sensation proved central to the new theory. Doctors knew that massaging the skin activated so-called large nerve fibers, which are specialized to detect subtle variations of touch; and that deeper, small fibers sounded the alarm of tissue damage. The two researchers reasoned that all these sensations must pass through a “gate” in the spinal cord, which adds up their combined signals before sending a message to the brain. In effect, activating the large fibers blocks signals from the smaller ones, by closing the gate. © 2020 The New York Times Company

Keyword: Pain & Touch
Link ID: 26950 - Posted: 01.13.2020

Amber Dance The girl tried hard to hold her arms and hands steady, but her fingers wriggled and writhed. If she closed her eyes, the squirming got worse. It wasn’t that she lacked the strength to keep her limbs still — she just didn’t seem to have control over them. Carsten Bönnemann remembers examining the teenager at a hospital in Calgary, Canada, in 2013. As a paediatric neurologist with the US National Institute of Neurological Disorders and Stroke in Bethesda, Maryland, he often travelled to weigh in on puzzling cases. But he had never seen anything like this. If she wasn’t looking at her limbs, the girl didn’t seem to have any clue where they were. She lacked the sense of her body’s position in space, a crucial ability known as proprioception. “This is something that just doesn’t occur,” says Bönnemann. His team sequenced the girl’s genes, and those of another girl with similar symptoms1, and found mutations in a gene called PIEZO2. Their timing was fortunate: just a few years earlier, researchers looking for the mechanisms that cells use to sense touch had found that the gene encoded a pressure-sensitive protein2. The discovery of Piezo2 and a related protein, Piezo1, was a high point in a decades-long search for the mechanisms that control the sense of touch. The Piezos are ion channels — gates in the cell membrane that allow ions to pass through — that are sensitive to tension. “We’ve learned a lot about how cells communicate, and it’s almost always been about chemical signalling,” says Ardem Patapoutian, a molecular neurobiologist at Scripps Research in La Jolla, California, whose group identified the Piezos. “What we’re realizing now is that mechanical sensation, this physical force, is also a signalling mechanism, and very little is known about it.” © 2020 Springer Nature Limited

Keyword: Pain & Touch
Link ID: 26944 - Posted: 01.09.2020

By Jane E. Brody If you live with or work with someone who suffers from migraine, there’s something very important you should know: A migraine is not “just a headache,” as many seem to think. Nor is it something most sufferers can simply ignore and get on with their lives. And if you are a migraine sufferer, there’s something potentially life-changing that you should know: There are now a number of medications available that can either prevent or alleviate many attacks, as well as a newly marketed wearable nerve-stimulating device that can be activated by a smartphone to relieve the pain of migraine. Migraine is a neurological disorder characterized by recurrent attacks of severe, often incapacitating headache and dysfunction of the autonomic nervous system, which controls the body’s myriad automatic activities like digestion and breathing. The throbbing or pulsating pain of migraine is often accompanied by nausea and vomiting. Translation: Migraine is a headache, all right, but with body-wide effects because the brain converses with the rest of the body. It is often severe enough to exact a devastating toll on someone’s ability to work, interact with others, perform the tasks of daily life, or even be in a normal living environment. When in the throes of a migraine attack, sufferers may be unable to tolerate light, noise, smells or even touch. Dr. Stephen Silberstein, a neurologist at Thomas Jefferson University and director of the Jefferson Headache Center, told me “There are 47 million people in this country with migraine, and for six million, the condition is chronic, which means they have more than 15 headache days a month,” he said. “It’s time to destigmatize migraine and provide sufferers with effective treatment,” said Dr. David W. Dodick, neurologist at the Mayo Clinic in Scottsdale. “They’re not fakers, weak individuals who are trying to get out of work.” © 2020 The New York Times Company

Keyword: Pain & Touch
Link ID: 26936 - Posted: 01.07.2020

By Debbie Jackson BBC Scotland "Fluffing your son's hair, really hugging him, holding his hand." For someone who has been through what she has in the space of a year, Corinne Hutton doesn't need much to make her happy. Last January she got the double hand transplant she had been waiting more than five years for, and feared would never happen. This January, she will celebrate her "handiversary", a year since a surgeon handed her back her independence. Being able to do the simplest things for 11-year-old son Rory means the world to Finding Your Feet charity founder Cor. "From an emotional point of view to be able to do things for him - make the packed lunches or the washing, or do the ironing is great," she said. "But on top of that, being able to hold his hand, fluff his hair, little things that might not be hugely exciting to him - but they matter a lot to me. "People don't appreciate what it means to have lost them," she said. Cor became the first Scot to undergo a double hand transplant when, in a 12-hour procedure, Prof Simon Kay attached two donor hands to her arms at Leeds general Infirmary. The 48-year-old lost her hands and feet in 2013 after suffering acute pneumonia and sepsis, which almost killed her. After more than a dozen false alarms over the years, a match for her own blood group, skin tone and hand size had been found. Much celebration and wonder was made of the news that the transplant had finally happened, but the aftermath was far from easy. © 2019 BBC.

Keyword: Pain & Touch
Link ID: 26922 - Posted: 12.30.2019

By Eva Frederick One day in 2014, primatologist Yuko Hattori was trying to teach a mother chimpanzee in her lab to keep a beat. Hattori would play a repetitive piano note, and the chimp would attempt to tap out the rhythm on a small electronic keyboard in hopes of receiving a tasty piece of apple. Everything went as expected in the experiment room, but in the next room over, something strange was happening. Another chimpanzee, the mother’s son, heard the beat and began to sway his body back and forth, almost as if he were dancing. “I was shocked,” Hattori says. “I was not aware that without any training or reward, a chimpanzee would spontaneously engage with the sound.” Hattori has now published her research showing that chimps respond to sounds, both rhythmic and random, by “dancing.” “This study is very thought-provoking,” says Andrea Ravignani, a cognitive biologist at the Seal Rehabilitation and Research Centre who researches the evolution of rhythm, speech, and music. The work, she says, could shed light on the evolution of dancing in humans. For their the study, Hattori and her colleague Masaki Tomonaga at Kyoto University played 2-minute clips of evenly spaced, repetitive piano tones (heard in the video above) to seven chimpanzees (three males and four females). On hearing the sound, the chimps started to groove, swaying back and forth and sometimes tapping their fingers or their feet to the beat or making howling “singing” sounds, the researchers report today in the Proceedings of the National Academy of Sciences. All of the chimps showed at least a little bit of rhythmic movement, though the males spent much more time moving to the music than females. © 2019 American Association for the Advancement of Science.

Keyword: Evolution; Hearing
Link ID: 26916 - Posted: 12.26.2019

By Richard Sima Luke Miller, a cognitive neuroscientist, was toying with a curtain rod in his apartment when he was struck by a strange realization. When he hit an object with the rod, even without looking, he could tell where it was making contact like it was a sensory extension of his body. “That’s kind of weird,” Miller recalls thinking to himself. “So I went [to the lab], and we played around with it in the lab.” Sensing touch through tools is not a new concept, though it has not been extensively investigated. In the 17th century, philosopher René Descartes discussed the ability of blind people to sense their surroundings through their walking cane. While scientists have researched tool use extensively, they typically focused on how people move the tools. “They, for the most part, neglected the sensory aspect of tool use,” Miller says. In a 2018 Nature study, Miller and his colleagues at Claude Bernard Lyon 1 University in France reported that humans are actually quite good at pinpointing where an object comes into contact with a handheld tool using touch alone, as if the object were touching their own skin. A tool is not innervated like our skin, so how does our brain know when and where it is touched? Results in a follow-up study, published in December in Current Biology, reveal that the brain regions involved with sensing touch on the body similarly processes it on the tool. “The tool is being treated like a sensory extension of your body,” Miller says. In the initial experiment, the researchers asked 16 right-handed subjects to determine where they felt touches on a one-meter-long wooden rod. In a total of 400 trials, each subject compared the locations of two touches made on the rod: If they were felt in different locations, participants did not respond. If they were in the same location, the people in the study tapped a foot pedal to indicate whether the touches were close or far from their hand. Even without any experience with the rod or feedback on their performance, the participants were, on average, 96 percent accurate. © 2019 Scientific American,

Keyword: Pain & Touch
Link ID: 26914 - Posted: 12.26.2019

By Austin Frakt Some days I’m grumpy; other times, my head hurts or my feet or my arms do. Yet when I play the trumpet, my mood improves and the pain disappears. Why? Alternative medicine — including music therapy — is full of pain-relief claims. Although some are simply too good to be true, the oddities of pain can explain why others hold up, as well as why my trumpet playing helps. One thing we tend to believe about pain, but is wrong, is that it always stems from a single, fixable source. Another is that pain is communicated from that source to our brains by “pain nerves.” That’s so wrong it’s called “the naïve view” by neuroscientists. In truth, pain is in our brain. Or as the author and University of California, San Diego, neuroscientist V. S. Ramachandran put it, “Pain is an opinion.” We feel it because of how our brain interprets input transmitted to it from all our senses, not necessarily because of the inherent properties of the input itself. There are no nerves dedicated to sensing and transmitting pain. Anyone who has willed themselves to not feel a tickle as ticklish can appreciate the difference between stimulation and our perception of it. Pain can be experienced and relieved in phantom limbs. Discomfort and swelling increase when people believe a painful hand or knee is larger. They decrease when it seems smaller, for example in a distorted image or based on virtual reality technology. Injections are less painful when we don’t watch them. Using our brains, we can exert some control over it. © 2019 The New York Times Company

Keyword: Pain & Touch; Emotions
Link ID: 26865 - Posted: 12.02.2019

Ruth Williams Throughout the animal kingdom, there are numerous examples of neurons that respond to multiple stimuli and faithfully transmit information about those various inputs. In the mouse, for example, there are certain neurons that respond to both temperature and potentially damaging touch. In the fruit fly, there are neurons that sense light, temperature, pain, and proprioceptive stimuli—those arising as a result of body position and movement. And in C. elegans, two sensory neurons, known as PVD neurons, that run the length of the body on either side are thought to regulate proprioception as well as responses to harsh touch and cold temperature. Scientists have now figured out how a single PVD neuron can relay two different stimuli: while harsh touch results in typical firing of the neuron—an impulse that travels the length of the cell—proprioception causes a localized response in one part of the cell with no apparent involvement of the rest. The findings are reported today (November 14) in Developmental Cell. “[The] paper illustrates that different parts of the neuron do different things,” says neuroscientist Scott Emmons of Albert Einstein College of Medicine who did not participate in the research, “and that just makes the whole system much more complex to interpret,” he says. To examine how a single neuron interprets distinct inputs and drives corresponding behaviors, neuroscientist Kang Shen of Stanford University and colleagues focused on PVD neuron–regulated escape behavior when a worm is poked with a wire and the worm’s normal wiggling motion as it responds to proprioceptive stimuli. © 1986–2019 The Scientist

Keyword: Pain & Touch; Development of the Brain
Link ID: 26823 - Posted: 11.16.2019

Darian Woods Recently, Purdue Pharma filed for bankruptcy as part of a tentative multi-billion dollar settlement with state and local governments over lawsuits alleging that the company misled doctors and the public about the addictive nature of their well-known painkiller, Oxycontin. But Purdue Pharma's story is part of a pattern that has repeated itself throughout the history of the opium trade. It's a pattern documented by the book Opium: How An Ancient Flower Shaped And Poisoned Our World by Dr. John H. Halpern and David Blistein. The cycle begins when an opium product proves devastating to users. Innovators come along, promising a safer alternative, and virtually every time, they downplay the risks of addiction. Addiction ensues. Then come new innovators, promising something better and less addictive, and the cycle continues. This cycle, Halpern and Blistein recount, goes all the way back to Ancient Greece. Aulus Cornelius Celsus was a doctor famous for writing one of the world's first medical encyclopedias, which included a recipe for opium pills. He recommended it for insomnia, bad headaches, and joint pain. It didn't turn out so well. Opium addiction spread, and its victims included Roman emperor Marcus Aurelius. Around 1000 AD, Persian physician Avicenna developed standard opium doses the size of chickpeas. Dose standardization helped prevent overdoses but opium addiction rose in Persia over the following centuries. Avicenna himself died of an opium overdose. © 2019 npr

Keyword: Drug Abuse; Pain & Touch
Link ID: 26791 - Posted: 11.05.2019

Kas Roussy · CBC News · At the Toronto Rehabilitation Institute, Dr. Andrea Furlan, a pain specialist, is holding a regular meeting with some of her colleagues. Sitting around the table are physiotherapists, pharmacists, doctors and nurses. Other health-care professionals have joined in via teleconferencing. The discussion focuses on chronic pain and the role opioids have in treating the condition at a time when current prescribing guidelines in Canada advises doctors to put the prescription pad down. On a monitor, someone asks Furlan how she should start tapering her patient who is prescribed opioids. "Each patient is different," Furlan said. "I don't have a recipe for everyone. The patients are afraid of the pain getting worse. They are afraid of the withdrawal symptoms. You need to provide a lot of education." She also suggests exercise and physiotherapy — even diet and sleep can have an impact on chronic pain. One in five Canadians suffers from chronic pain (i.e., pain that is ongoing and lasts longer than six months like low back pain, nerve damage or arthritis). For these pain sufferers, opioids are a lifesaver. But access to the pain medication is getting harder because of doctors' concerns about addiction and abuse. More than 12,800 apparent opioid-related deaths occurred from January 2016 to March 2019, according to the Public Health Agency of Canada, the vast majority from illicit fentanyl use. "I have had patients referred to us because their doctors cut them from opioids," said Furlan. "That's ridiculous because they were not addicted. They were not having any complications. They were not on a high dose." ©2019 CBC/Radio-Canada

Keyword: Pain & Touch; Drug Abuse
Link ID: 26786 - Posted: 11.04.2019

By Aimee Cunningham At age 37, Hope Hartman developed a painful, burning rash in her right ear, in the part “you would clean with a Q-tip,” the Denver resident says. The pain got so bad she went to a local emergency room, where the staff was flummoxed. Hartman was admitted to the hospital, where she started to lose sensation on the right side of her face. During that 2013 health crisis, Hartman’s husband, Mike, sent a picture of the ear to his mom, a nurse. She said it looked like zoster, better known as shingles, which is caused by the varicella zoster virus. She “diagnosed it from an iPhone photo,” Hartman recalls. Antiviral treatment didn’t fully clear the infection. For about two weeks after her release from the hospital, Hartman coped with severe pain, hearing loss and difficulty eating. Her right eye wouldn’t fully open or close. Following an appointment with neurologist Maria Nagel of the University of Colorado School of Medicine in Aurora, Hartman was admitted to the university’s hospital to get another antiviral drug intravenously. The pain subsided, and Hartman regained her hearing and the feeling in her face. To spare others the same trauma of a delayed diagnosis, Hartman arranged for Nagel to give a talk on the virus at the local hospital where staff missed the signs of the illness, known as Ramsay Hunt syndrome. That’s the name for a shingles infection that strikes the facial nerve important to facial movement. As Hartman experienced, varicella zoster virus can cause a grab bag of symptoms that go beyond the typical torso rash. Hartman’s young age didn’t help with the diagnosis. Shingles is more common in people 50 and older. But no one is risk-free. Varicella zoster virus lives in about 95 percent of the U.S. adult population, thanks to the virus’s first line of attack: chicken pox. The body eventually clears the itchy, red pox from the skin, but the virus remains, dormant in nerve cells. The rash kept scores of U.S. children home from school until about 1995 (when a vaccine became available). © Society for Science & the Public 2000–2019.

Keyword: Pain & Touch
Link ID: 26773 - Posted: 10.31.2019

People with long-term health problems such as arthritis are more likely to feel pain on humid days, a study has suggested. Folklore suggests the cold makes pain worse - but there is actually little research into the weather's effects. And this University of Manchester study of 2,500 people, which collected data via smartphones, found symptoms were actually worse on warmer, damper days. Researchers hope the findings will steer future research into why that is. Hearing someone say their knee is playing up because of the weather is pretty common - usually because of the cold, Some say they can even predict the weather based on how their joints feel. But carrying out scientific research into how different types of weather affect pain has been difficult. Previous studies have been small, or short-term. In this research, called Cloudy with a Chance of Pain, scientists recruited 2,500 people with arthritis, fibromyalgia, migraine and neuropathic pain from across the UK. They recorded pain symptoms each day, for between one and 15 months, while their phones recorded the weather where they were. Damp and windy days with low pressure increased the chances of experiencing more pain than normal by about 20%. So if someone's chances of a painful day with average weather were five in 100, they would increase to six in 100 on a damp and windy day. Cold, damp days also made pain worse. But there was no association with temperature alone, or rainfall. 'Pain forecast' Prof Will Dixon, of the Centre for Epidemiology Versus Arthritis, at the University of Manchester, who led the study said: "Weather has been thought to affect symptoms in patients with arthritis since [ancient Greek physician] Hippocrates. © 2019 BBC

Keyword: Pain & Touch
Link ID: 26746 - Posted: 10.24.2019

Will Stone & Allison Aubrey There's no doubt that opioids have been massively overprescribed in U.S. In the haste to address the epidemic, there's been pressure on doctors to reduce prescriptions of these drugs — and in fact prescriptions are declining. But along the way, some chronic pain patients have been forced to rapidly taper or discontinue the drugs altogether. Now, the U.S. Department of Health and Human Services has a new message for doctors: Abrupt changes to a patient's opioid prescription could harm them. On Thursday, the agency issued new guidelines for physicians on how best to manage opioid prescriptions. They recommend a deliberate approach to lowering doses for chronic pain patients who have been on long-term opioid therapy. "It must be done slowly and carefully," says Adm. Brett P. Giroir, MD, assistant secretary for health for HHS. "If opioids are going to be reduced in a chronic patient it really needs to be done in a patient-centered, compassionate, guided way." This is a course correction of sorts. In 2016, the Centers for Disease Control and Prevention issued prescribing guidelines. Those highlighted the risks of addiction and overdose and encouraged providers to lower doses when possible. In response, many doctors began to limit their pain pill prescriptions, and in some cases cut patients off. These guidelines led to rigid rules in some cases. Giroir says it's concerning that some clinicians, policymakers, and health systems are "interpreting guidelines as mandates." © 2019 npr

Keyword: Pain & Touch; Drug Abuse
Link ID: 26691 - Posted: 10.11.2019